Karen Heller: It's the duty of us all to stop child abuse

Charleeni Ferreira, in the only photograph we have, is apple-cheeked, smiling, wearing a gold crown tinged with pink. She looks, to the camera, to the outside world, like a happy little girl with the future ahead of her.

But that wasn't Charleeni's true life. She was brutalized and tortured by her father and stepmother, police officials charge. She had a head gash so severe that her parents masked it with gauze and hid the wound under a hair weave. A hip was fractured, her ribs broken, her lungs collapsed. She was sexually abused.

Despite the efforts of school nurses, caseworkers, and doctors over the last three years, Charleeni fell through the cracks in the system, to her death. On Wednesday, her short, miserable life of 10 years came to a horrifying end, as she had suspected it might. "I'm going to have a birthday," she told a friend. "Well, maybe not." On Sunday, her father was found hanged with a torn bedsheet in his jail cell.

When a family tortures a child, who becomes responsible for her welfare? "Child abuse can't be investigated unless someone reports it. Unfortunately, we live in a no-snitch culture," says Debra Schilling Wolfe of the University of Pennsylvania's Field Center for Children's Policy, Practice and Research. "And children are afraid to tell. If they do, it's going to get worse."

Since Charleeni's death, friends and neighbors have come forward to allege abuse, all too late to change the outcome.

"This has been preoccupying my thoughts of what we could have done differently," says Anne Marie Ambrose, who became Department of Human Services commissioner in June 2008. "Children are powerless. Our job, as adults, is to make them safe."

"Everybody has to do the right thing, and they have to do it the right way. Sometimes the wrong thing done by two or more people can be catastrophic," says Penn's Richard Gelles, an authority on family violence. He advocates for strict scientific assessments, rather than accepted clinical judgments, and home health visits to document the welfare of children at risk.

"We're trying to raise the public's awareness that this happens," says Deputy Mayor Donald Schwarz, a pediatrician who oversees DHS. "We're encouraging people to report. It's really critical. We're doing everything to improve DHS."

Child advocates argue for more "consent and sharing information between agencies. Right now, we have data in all these separate silos," Wolfe says. Penn is working on a national pilot program in Montgomery County to get schools, government, social agencies, and health officials to ease access so full case studies can be created.

"Society has a responsibility to its children. Parents lie to us. They hide things," says Dr. Cindy Christian of Children's Hospital of Philadelphia. "The abuse and neglect of children in Philadelphia and the country is a public health problem. We give attention to rare diseases that don't affect nearly as many children as abuse and neglect."

Early medical care is akin to early education: It decreases the risks of social pathology. Child abuse correlates, Christian says, "to every bad thing in adulthood - obesity, cancer, heart disease, HIV drug use, depression."

Philadelphia public school students are obligated to see a physician every time they change schools, from elementary to middle to high school. Increased visits to health providers might help detect abuse, as well as prevent other medical issues.

Reporting abuse, instead of telling reporters tales of abuse posthumously, is paramount. Not to do so "is an ethical failure," says bioethicist Art Caplan. "People in the community need to be the eyes and ears to protect kids. When you err on the side of protecting kids, people will forgive you."

"Child welfare is a community response," DHS's Ambrose says. "Everyone can play a part." The next Charleeni should make it to her next birthday, not lie unloved in a morgue. People suspecting abuse are encouraged to contact the state child-abuse hotline; confidentiality is guaranteed: 800-932-0313.