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"There was a glaring disparity of kids in the Porterville and Lind- say area and we only had a few advocates active here," Anthony said. "This is a whole new resource for a part of the county that has not been served properly." Maldonado said advocates spend two hours per week and make an 18-month commitment to a single child. They might take them to the library, to the movies or an event in an effort to provide a child with a constant in an otherwise chaotic or unsettled home. There are a number of ways to become involved in the organization. A CASA volunteer is a trained community volunteer who is appointed by a juvenile court judge to speak for an abused or neglected child's best interests. Volunteers are required to complete 30 hours of pre- service training, submit to screening and background checks and they must be 21 years of age or older. "We work hard to gain their trust and try to get them to share things they may not share with a counselor or judge," Maldanado said. "We try and identify their needs and their issues quickly to get them the help they need. Without that support, many of these kids get lost in the system." During his three years of advocacy, Maldanado said one case stands out where his observations and conversations with a young girl may have saved her a life of difficulty. After it was discovered that the girl was being sexually abused, Maldonado began meeting with the girl to find out which side of the family the girl should be placed with. The thought of going to either side seemed to be trau- matizing for the girl, but she eventually opened up about her aunt. Maldonado observed the girl with her aunt and made a recommen- dation to the court that the girl be placed with the woman, one of the few in the family who had a stable living condition and showed a genuine connection with the child. "That aunt is providing for her very well and, after nine weeks, she was hugging people again," he said. "Without an advocate, she may have been taken from a bad situation and put back into another bad situation. No one else was going to see that and be able to make that call." About 19% of all child abuse cases in Tulare County are for phys- ical abuse with 6.5% of cases for sexual abuse. Most cases in Tulare County (45%) are for neglect, but every type of abuse carries a lifelong toll for most children as they grow into adults. Adults who experienced abuse or neglect during childhood are more likely to suffer from cardiovascular disease, lung and liver disease, hypertension, diabetes, asthma, and obesity. According to a study conducted by the CDC in partnership with Kaiser Perma- nente, more than half (54 percent) of cases of depression and (58 percent) of suicide attempts in women were connected to adverse childhood experiences. Studies also found that victims of child sex- ual abuse are at a higher risk for rape in adulthood and that children who have experienced any type of abuse are nine times more likely to become involved in criminal activities. There is not only a cost to the child's physical, mental and emo- tional wellbeing, as child abuse and neglect also has a financial cost to society. According to the CDC, child maltreatment is more costly on an annual basis than the two leading health concerns, stroke and type 2 diabetes, totaling $124 billion per year. Indirectly, these children create costs associated with increased use of the health care system, juvenile and adult criminal activ- ity, mental illness, substance abuse, and domestic violence. Prevent Child Abuse America estimates that child abuse and neglect pre- vention strategies can save taxpayers $104 billion each year. Those interested in volunteering as a child advocate can contact CASA of Tulare County by calling 559-625-4007 or 559-786-2142. Above: Paul Moore, executive director for CASA of Tulare County, talks with a potention volunteer at the opening of the organiza- tion's second office in downtown Porterville on Sept. 5. Below: Ad- vocate Anthony Maldonado did the honors at the ribbon cutting. PEDIATRICS/CHILDREN'S HEALTH

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