The Complexity of Child Abuse and Neglect: with Dr. Steve Berkowitz and Dr. Kathi Wells

In the past year, the Center faced scrutiny due to misconceptions surrounding the "Kempe Protocol." A narrative circulated about the Center, which did not reflect our perspective. In this discussion, Steve Berkowitz, MD, with CU’s Department of Psychiatry, and Kathi Wells, MD, Executive Director at the Kempe Center, share what they seek and gain from one another. They emphasize the significance of tackling challenges and impacts by delving deeply and adopting a big-picture perspective. Additionally, they explore the need to lean into the complexity of the issues and tackle the challenges of child maltreatment in a meaningful way.

Transcript

Welcome everyone and welcome back to Radio Kemp. I am Michelle Davis, the Director of Justice, Equity, Diversity and inclusion. At the Kim Center

at Radio Camp. We value the sense of community that unites people to support each other, share their experiences, offer encouragement and find a path forward.

Today we're excited to welcome back Dr. Kathy Wells, executive director of the Kim Center and Dr. Steve Berkowitz, to delve deeper into the complexities of child abuse and neglect.

Dr. Steve Berkowitz. Thank you for joining us. You are the chief psychiatric consultant for the Kempe Center.

Just want to give you an opportunity to say hello to our audience, and introduce yourself.

Steven Berkowitz

00:46

Hey? Everyone? Yes, I'm a child and a lesson psychiatrist at the University of Colorado School of Medicine.

And my area of expertise is over 30 years of work focusing on interventions and treatment and evaluation of children who are traumatized.

Michelle Davis

01:07

Thank you.

And I just also want to emphasize that in my role. And at the center we seek to integrate just as equity, diversity and inclusion into all aspects of our work through discovery, leadership.

action, accountability, evaluation and transformation.

This is a conversation about what we're learning and how we're transforming how we're continually

trying to grow and learn from ourselves and learn from others.

So as we approach this conversation,

to help strengthen families and communities and assistance that support them. Let's just talk about that. Use that as our anchor our desire to strengthen families, and communities to support them.

As we dive into this conversation.

Cause you know, as you've often said, Kathy, these are very complex issues. So let's dive in.

So over the last year. We've come under scrutiny. The center has for what has been erroneously termed the Kent Protocol.

There was a story being told about the center, but it wasn't the perspective from the perspective of the center.

What would you want to say about that? Now? Toss it to you, Dr. Wills.

Go with something.

Kathi Wells (she/her) @ Kempe

02:22

Yeah, it's thanks for having me here again, and for the opportunity to spend some time in this conversation.

Yeah. So we just given a little bit of background I first received information in September of 2022

that there was some concerns being raised regarding some Court testimony that was being offered in family court cases and custody cases in Colorado. That was citing something that was being called the Kemp protocol

and it was

related to a protocol that was reportedly developed some years ago at the camp center. And so I at that time, to be honest, I didn't. I did. I wasn't familiar with the term that we didn't have anything such as a camp protocol that we were utilizing at the center, and hadn't been for a long time well, before I started in my current role, I've been affiliated with the center since 2,001

so I did a little research and found that this was something that was being referenced as the Kemp interactional assessment.

And really the

original. That original term was cited in a book called Children speak for themselves.

using the camp interactional assessment to evaluate allegations of parent child sexual abuse, and that was a book written by a faculty member that was at the Kemp Center in the early in the late eighties and early nineties named Dr. Claire Haynes, seaman, and someone else by the name of Damon David Baumgarten, and that was published in 94.

but what I came to understand and doing a little bit of research is this tool that was published in that book which was really just a list of questions. And the word camp protocol were being sort of conflated. That there had been a protocol developed even prior to that

and again, it was really a

not really a tool or an assessment tool. It was a series of questions that was published in something called the New Child Protection Team Handbook in 1988. So these are, you know, quite some time ago.

and that was based on some work that was done by previous, even earlier faculty looking at infants. That were failure to thrive

and it was used in some clinical research

studies of hospitalized infants in the early eighties.

So what we have is a protocol that was developed in the early eighties. Actually, Dr. Ruth Kemp was one of the individuals that was looking at mom baby interactions, and infants that were not thriving and trying to understand that parent, child interaction and attachment.

Then, sometime later, Dr. Claire Hane, Seaman, applied some of those concepts to evaluating child sexual abuse, and published this book where she first coined the term Kemp interactional assessment?

and

A, and I think it was some of those sort of list of questions. And

that initial tool I guess one could describe that was then being used

in different settings by previous faculty. Members are a bit by previous faculty, but it was really news to me, because this is not something that we've used at the center. We've you know we have. We don't have a tool called the Kemp Protocol that we use. It was really, I think, related to this very, very early work and sort of drawing from some of those some of those

questions, and that series of questioning that was used back. Then.

Michelle Davis

06:08

Yeah.

Steven Berkowitz

06:08

Kathy, I think.

Important to mention.

that

the cam center

nor my center have ever done custody evaluations. I don't know when the last time Kemp actually did them, but it's been a fairly long time.

Kathi Wells (she/her) @ Kempe

06:28

Yeah, yeah, it has been. And we certainly don't do them right now, you know, we

sometimes we'll provide consultation on complex cases. But we don't do specific custody evaluations. And we don't use, you know, a tool like this. It's not part of our practice right?

Michelle Davis

06:49

So, Dr. Bercowitz, what has been your experience in utilizing interactional tools or assessments?

to support the work that needs to be done

between

kids or children and their families, or parents.

Steven Berkowitz

07:08

It's a, it's a really complex story and history. But

interactions are useful. Part of an evaluation

but need to be really put into context, and not the sole

this, the sole way or protocol of making decisions. There's so much more to it.

And you know.

you know, anybody who's doing evaluation comes into an interactional already with some biases. Right? They've read the reports. They've heard all these things. And so first step is to recognize that you have biases.

You're going to have them, but you need to really think carefully about them, and how

they inform some of the your opinions and decisions.

But you need collateral information, not only from you know the people directly involved, but extended family.

you know you need to understand who the child is, and all of this, and also recognize

that when we talk about attachment, which is a very complicated

you know. Idea? You know we often think of attachment as being well. It's up to the caregiver, but it attachments. It is really bi-directional

the child brings their peace and history into it, whether you know it or not, as does any of the caregivers.

So you know, really complex thing to try to try to really perform accurately, and that is why it cannot be thought of as being done in isolation.

The other piece is, you know, we know right particularly with young children. If you're talking about a a child who has been placed with another family.

That it's gonna be the family that they spent the most time with, that they're most attached to.

Assuming that the families, you know

at least good enough.

So keeping that in mind is also very important. You just can't take it as a you know.

a snapshot right? It has to be thought of in in over time over the child's development, the family's development. So there are multiple multiple aspects that need to inform any of your opinions and an interaction. It's just one of them.

Michelle Davis

09:52

Yeah.

thanks for that. What I'm hearing you say it's definitely complex. And

bias lives throughout. So being aware of that bias. And I hear you know you also said the family is good enough. And how do? What's the litmus test for the family? That's good enough. And how do we?

How do we sort of like

create some synergy around what that means, and what

what a family is doing? Well, if they're not doing well, and how all of that interferes with attachment.

So there seems to be a breakdown between.

You know what we talk about. You know what we've learned on paper what the evidence says and what happens in actual families. And I hear you saying that that's where the bias comes in. That's where perception comes in around. What's a family that we deem good enough that lives in that space, or a family that's challenged in those areas?

Can you talk a little bit about either one of you. Talk a little bit about where you see that breakdown

being between what we kind of know and what is experienced.

Steven Berkowitz

11:03

Okay. That's a that's a really complex question. But thank you. I'll do my best. And I I I think maybe an example. Can be useful.

So

we got

often, as we know, children involved in child welfare

come from challenged families with multiple issues, particularly financial and often living in poverty.

A child then gets placed into a solid middle class family who has more resources. And you know, is is capable of providing things that the child cannot receive. In their. You know. Biological family.

Well, you know. Certainly on paper.

family with more resources, is going to be a better, good enough family, right?

But that's not sufficient. You have to understand

the child's biological family where they are and what the context is of their lives, and because, you know, they don't have the resources that the quote Foster family may have.

Doesn't mean that they're not good enough.

You have to put in context of their community, their environment, their history, as well as where the child fits

a best

right? So just because you're, you know, have more resources doesn't mean that for that child. You're a better choice.

I hope. That's that answers your question, at least partially.

Michelle Davis

12:52

Yeah, partially, because, you know, we can, we can look at what evidence based research says about

what's needed in a family system for a child to thrive.

and it's not to say that that's not.

It's not to say that that's junk science. There's truth in that.

And there are also experiences of families. This is what I hear you saying. That don't have quote unquote those characteristics, those features, and the child can still be thriving.

A child.

Steven Berkowitz

13:26

Yeah, so.

Michelle Davis

13:27

Thriving their family system.

Steven Berkowitz

13:29

Yes, I think. Thank you. That's a great summary.

Michelle Davis

13:32

Yeah. Okay.

Dr. Wells, is there anything that you would add.

Kathi Wells (she/her) @ Kempe

13:36

Yeah, I think the one of the things that I'll add and part of what makes these situations complex right is.

I mean the stakes are high, right? This the stakes are high, you know. I think, as a you know, I think of this with my pediatrician hat on, and I say the stakes are high because we're we have a young child who, depending upon where they're at developmentally and their experiences. They're very dependent upon those that are around them.

And

you know, certainly in in the years of work that I've been do doing this work both as a pediatrician and someone who specializes in in kids that are vulnerable and families that are vulnerable. You know, I I've certainly seen times when children are in really dangerous situations, but

still have a really strong connection and attachment to their family, and sometimes those situations can be resolved.

And the child can be safe in that environment. And sometimes

they can't be and even the timeline is complicated. Right? Because, you know, children

grow and develop and are setting down really, really important.

you know, the foundation for who they are they are now and who they're becoming and who they're gonna be as the next generation. And so how do we put all that together? And you know, we ask really

complicated systems, and sometimes really contentious systems like course, to often make some of those decisions. And so you know, one of the things that we W. What we said early on in these conversations is that as Dr. Berkowitz so eloquently said, is, this is a part of a much broader. You know these sort of assessments, these sort of tools, these sort of evaluations are just one part of a much broader assessment.

And you know, in our role in this work at the center, you know, we're really committed to saying, how do we contribute the best knowledge, the best science, the best evidence of what we know to be true? Try to get that out into the world study it. So we we consistently know it is the right approach but then it has to be applied in individual cases. And that means individual people, individual families, children.

and that's where it gets really, really complex. And people get hurt in that process. And it is

this is not easy work, and I think we all feel at our center the weight

of the work that we do and the impact and the lifelong multigenerational impact that has because we know that kids that experience trauma that affects

generations to come, you know, and I think

we all would love to see a day when

when traumatic experiences are addressed as early on as possible, and

kids have the tools. Families have the tools to heal them in either avoid those experiences entirely, or when they're not avoidable, heal them so that they're the least impacted.

Michelle Davis

16:35

So I'm hearing bias. And I'm hearing

I'm hearing bias. I'm hearing the use of the tool should be

just a tool. There are so many more aspects to

evaluating and understanding a family and their structure and their system, and how they function and operate, especially when you have the complexity of

any type of chordal treatment that is occurring within a family system. So it is really complex.

I think. What's resonating for me is the what's coming back for me is the bias piece, because we have these tools. And there's they're designed

in such a way to try to evaluate what's happening within the system.

But, as you said, Dr. Berkeley's bias comes in with the designer of the tool

and I sit in my role as the Jedi justice, equity, diversity, inclusion, director, thinking about the families that commonly come into the child over system.

and those are often families of color.

So if we hold that sort of like as a

as a perspective of how we might

do better on behalf of those families, and thus, on behalf of all families.

What would we be looking to? To try to

lean into transformation across the field like what might? What might be some of the things that we could try to

become better at doing? Not that we're gonna achieve the pinnacle like we're gonna get it right all the time. But we're working to try to make something better.

So if you have any thoughts or ideas about what that might look like, you know, let's just kinda

dream a little bit.

Kathi Wells (she/her) @ Kempe

18:21

Well, you know, I thank you for that, Michelle. You know I think we've thought a lot about that at the center in terms of

How do we look at? You know what? What we believe to be true, based on the evidence based on the research

and really taking an honest look about at that, at that research, and say,

did. Was it done with an equity lens? Was it done with a lens of understanding bias. Right? How can we design what we do, moving forward

to better integrate those aspects into the research, into the into what we're putting out in the field so that we know you know, I think

you know, even your work at the center has helped remind us that you know, when research is done. If it's not done with. An awareness

of bias

then even the data that's produced is sometimes not accurate, right? Or it doesn't apply across all individuals, all families, and all systems. So how do we ensure that the data that we're relying upon

is informed in that way. And how do we really make sure that as we move forward

we embed that lens into everything

we do, moving forward? So we give the systems. We give these complex systems the tools that they need to make the best decisions and to best support kids and families.

Steve, I don't know what are your thoughts. You.

Steven Berkowitz

19:55

I completely agree.

you know. And to Michelle's point, you know, the system is biased.

Right?

you know, we know that, you know, if you're a minority, particularly African American you are more likely to be involved in in the child welfare system.

so

right out the gate. There's a bias there, right?

And I think

you know, the other thing that we know is, the majority of cases are around. Neglect

and neglect, you know, is very complex, and often due to certain circumstances beyond the family's control.

So you know.

you know. Again, one of my pipe dreams. But Michelle asked for them you know.

when you see a family who you're concerned about neglect, and you know that they have food, insecurity, or other such things. Maybe we should just give them money.

What? Why are we? You know. Maybe that would be an answer. You know this. Give them some money to take care of that with this, but with some support, and it may cost us far less than what we're doing now.

That you know, as an example of how we might really want to think about changing the system. So we don't get the place where we're doing these evaluations and placing kids disrupting their lives. Families, lives.

You know, one of the dilemmas is this.

this is, there's nothing really good about these situations. Right? Our job is to make them better than they are.

And

you know.

custody evaluations.

Are not really the way to make them better. Right? They're just they're reactive, and we're doing, you know, the best we can. But keeping those things in mind, I think, is really crucial back to you know. Where are you coming from? How do you think about these things? How do you evaluate your own perspectives?

I think that's the best we can do.

You know, all these tools can be useful if you have all these things in mind when you're doing the work, and there's no shortcuts. This is.

This is complex, difficult work.

With lots and lots of lion landmines.

Kathi Wells (she/her) @ Kempe

22:40

Well, and, Steve, I would point out that speaking of data, there's actually good data to suggest that giving families money, in a way that can reduce their involvement in the system for neglect.

And you know, I also want to acknowledge that you know

a as a healthcare professional, which is sort of the hat that I wear. In addition to my role as directing the center. You know, we're as complicit as all systems in terms of

over-identifying or over-reporting families of color. And so this is an issue that's embedded in all of our systems, right? Not just child welfare. And I think, while we're all trying hard to pay attention to those things and think about, how can we do better? Because

The sad truth is that there are, you know, still some children out there who do need that level of intervention. And so how do we walk? This balance of ensuring that families don't need involvement in those sort of systems. Get the resources that they need on that can help them flourish

and when there are circumstances where someone really does need that level of involvement?

how do we ensure that those systems are best equipped to support the families and the children in the way that they need to? Really. For as brief as we can. You know we all know that the Government doesn't do a great job in raising families right? And so, and I and I, honestly, I, you know, I have a lot of colleagues

over the years that are that work in those systems. And they would say the same thing right? So this is not a, you know, disparaging of our systems. I think we all know that kids do best in families, and they do best in 

their, you know, in their kin families, if at all possible. And so I think you know, those are all things that we strive to. How do we get closer to that?

Michelle Davis

24:40

Appreciating what both of you are saying, because it aligns with

my thinking in theory that if we don't

realize the biases within ourselves.

We don't sort of like source what's happening within ourselves and how we've been socialized, and whatever comes out of our out of us, even the development of a tool or the assessment of the information associated with that tool or any other assessments.

can become biased.

So it really. And we think about systems. And I've heard you both say systems a lot. But we're part of that system. I think there's sometimes a desire to separate ourselves from the system like. It's an embodied thing over there that we don't have a part of

what I'm hearing. You both say. It's like both of those pieces really working on

our own awareness of our biases, and how that influences the systems that we work in that impact children and families.

Kathi Wells (she/her) @ Kempe

25:36

Michaem. So glad you said that because, you know, there's legitimate differences and perspectives about how Kemp's con the Camps Center's contribution to modern child welfare. You know what that contribution has been, you know, historically, and where we are today. And again, another complex issue, right? You know when we look at how things occur many, many years ago. With our current lens. We uncover

things that we can and should see differently. And how do we reconcile that both? An acknowledgement of

the evolution of this field, and how complex this field is, as well as how do we move towards? It, you know. Not just, you know.

reforming or thinking about systems today? But in addition to preventing child maltreatment. To begin with, a. And also treating kids who have experienced sorts of abuse with the best interventions. And so that's the sort of space that that we're really committed to to staying in. And you know your leadership is really challenged us in

thinking about

you know where each and every one of us come from and our experiences, and how that you know impacts the work that we do, because I think it really is in that space for all of us, that work in these spaces, that awareness, that self awareness both of ourselves and systems that really is gonna help us best serve kids and families.

Steven Berkowitz

27:05

Think that's really important, Kathleen, I want to add

that

we you know this again, this is a really complex issue, right? And

context really matters. And in the seventies and eighties the context was quite different

than is now. We didn't know as much.

We had different perspectives.

The field

is still fairly new, that's you know. And

back then it was really new.

And a lot of mistakes were made. There's no question, and we have to acknowledge that the mistakes were made.

but also understand that they're made in a different context than what we have today.

And so how do we learn from them?

How do we recognize our current context

and evolve in a in a way that really does support children and families most effectively?

And I think

that's our job right? Our job is, you know, not so much to, you know, dwell in the past. But to really think about how the past can teach us how to do better, and how to do better in the future for everyone.

and including ourselves. By the way, I think we have to. We have to remember that these I mean again, you know. This is my work. But

these, these situations, these cases are really hard and difficult, and

they change us, too.

And so that's also something, I think, in you know, in the early days that wasn't even recognized.

Somehow we were, you know, these neutral, you know.

unaffected people. And that just isn't true. And so that's how that's important. And we think about the evolution, improvement, and understanding, the mistakes that were made.

Michelle Davis

29:06

I so love that I think it

dives into one of the initiatives that the center is taking on, which is

getting more engage with community because they have stories, and those stories help to shape

the lenses that we view them through, and that we view the practice through. And if we can really engage in their stories and their experiences and pair, that with the knowledge that's

known through the evidence, and

both of your experiences as practice professionals.

I started to say season, but sometimes that has a negative connotation.

Steven Berkowitz

29:49

I feel pretty gross. That's okay.

Kathi Wells (she/her) @ Kempe

29:52

Okay. We've

but.

Michelle Davis

29:57

But it allows us to be

shaped by them, whereas, you know, 20 years ago we weren't doing that. So it's just another way that we are working to transform ourselves and work to transform the systems, to be better in tune and aware

of what's needed, because it is all complex. But if we're able to utilize

the desire to grow and learn from experiences.

then I think we're on the right path, one. We're on the journey together.

So.

Kathi Wells (she/her) @ Kempe

30:31

Yeah, I I would agree, Michelle. I think that.

I feel like in doing this work.

there's sort of 2 paths right when you're when you're put in an uncomfortable situation, or you recognize that maybe

what you

how you saw the world wasn't as enlightened as it is today, right. And I think one is to sort of

put your head down and sort of say, you know it's too hard to recognize that the world is a little different than I thought it was.

but the other one and I am, you know, honored to work in a place and around

team members and colleagues that are willing to take the path of really challenging ourselves. And really, when we, as you voice, taught us, when we know different, we do different right? And so when we have those experiences that you know at the beginning of the last podcast. You know, I shared you know we all come with a lens, right? You know. I'm a white woman, right? And my lens

and my experiences and growing up are different than then, since someone else but when I become curious and when I do talk to people in community, and I do listen to stories, and I try to

put myself in someone else's shoes, or at least try to understand where they're coming from. It gives me a lens and a perspective that. I feel like once I experience that. Then I'm then we're kind of obligated to take that forward.

And that's you know, and it is maybe in some might describe a harder path, but for me, and I think certainly for the colleagues. I get to work with every day. It. It's really the only path. But it does have a cost, Steve, you're right. I mean, I think we wanna ensure that the professionals that work in all of these spaces

are able to be, be, continue to do the hard work right and move forward because, I think kids and families need us to be doing this in a lightened way, and in a way that is informed and

challenging ourselves and each other as we do this

rather than you know, burning out. Because I think that doesn't serve anyone. So it is complicated.

Michelle Davis

32:46

Yes.

Steven Berkowitz

32:49

So. You know, to the point about community. And I think

you know you raise that multiple times to show as you have Kathy.

there's also a training issue here.

That, I think, is, you know, needs to be

really

changed.

many of the experts quote experts. I think.

yeah, they've never spent any time in people's houses

who they may be serving

they haven't had a meal with them. They haven't, you know, they don't really know their lives. They only hear the stories and the stories are important, but I don't think they're sufficient.

And I have worried about that. My whole career, you know I I've been fortunate, and maybe one of the few child psychiatrists that have done home visits and worked in the streets, and

but that has to change too.

we, you know, if you don't know people you don't know who they are. You don't know how they live. Your biases and your experiences

become the forefront.

And I think that also relates to the compassion, fatigue, and burnout.

Right

the Delta. The difference between your idea and the reality can be very overwhelming and threatening.

And I'm gonna suggest that you know that it's a training paradigm. I think

all of our providers should have spent time in in in these communities and in these people's lives, and understand them

better, and get to know that. You know we're not that different.

Michelle Davis

34:43

Oh, I love that!

It's not an us in a them. It's a we.

Steven Berkowitz

34:49

Yes, absolutely.

Michelle Davis

34:52

We are all part of this, and just thinking back to our conversation, Kathy, and one of the things that pains you is divisiveness.

So I'd like to just close with thinking.

The anato antidote to divisiveness is generosity and grace on both sides.

both sides, or any side

of a issue or an argument. How can we lean in and

learn

with each other

and from one another?

I think that's a good path to really working to transform these challenging and complex issues. And it's journey. It's not a destination. Because we're human beings. And we come with tons of complexity

and tons and loads of experiences. So

I wanna thank you both for this conversation. It's been enlightening for me.

Our goal is to find the best ways to support children, youth, and families in need.

and we're driven by a passion for our work and an intentional approach that encourages us to connect, collaborate, and learn from each other as we work to prevent child abuse and neglect.

Again, want to thank our listeners for joining us today. Your dedication and involvement are invaluable as we continue to make a significant impact.

Join us next time on radio, Kim.