Second, and paradoxically, is the tendency of an overburdened system, for various reasons, to miss cases, sometimes with tragic results. Runyan, a pediatrician, noted that doctors are often hesitant to become involved with child protective services for a variety of reasons-fear of retribution from families and fear of legal consequences among them. He also stressed the limited training that medical students receive in handling and treating child abuse. Only a handful of training programs on abuse and neglect exist, and there are few resources for clinical research. During the four years of medical school, students receive approximately two hours of training.
Pediatric residents have roughly two days in a specialty clinic.
Further complicating matters is the dual mandate under which the child welfare system operates. The mandate to both protect children and support families can be incompatible at times. Families are diverse. Reforms, as Waldfogel reported, are emerging that attempt to address these and other inadequacies. One response has been to better tailor the services to families.