COEUR d'ALENE - Dr. Ronda Westcott hopes the public outcry about the twin 2-year-old girls taken from a home here recently because of severe neglect and possibly abuse might trigger needed changes.

Westcott, of Lakeside Pediatric and Adolescent Medicine in Coeur d'Alene, said that as a professional working in the community for more than eight years, she's seen multiple demonstrations of weakness in the system that's supposed to protect kids. The case of these girls is the latest.

"When concerns about a child arise," she said, "there should be a detailed system in place that will address that concern at the time of the incident."

Just as important, there needs to be appropriate follow-up, ensuring that kids don't "fall through the cracks" after a report has been made.

Dr. Mary Jo Shaw, of Coeur d'Alene Pediatrics, said those are common frustrations among pediatricians.

Shaw would like to see child protection authorities, such as this state's Child Welfare Program (which is what other states call Child Protective Services), give more weight to reports of suspected cases of abuse or neglect submitted by health care professionals than those made by casual observers.

With limited resources to investigate reports, those tasked with looking into them need to prioritize, she said.

"We don't call casually," Shaw said. "We're calling because we have something serious to report. We're putting a little bit of our reputation on the line when we're calling."

Elisabeth C. Crossley, 26, and her mother, Ruth K. Cassidy, 55, were both arrested earlier this month for two felony counts of injury to a child for the condition police found Crossley's daughters at their apartment at 1201 N. Lincoln Way in Coeur d'Alene. A passer-by notified police of the conditions in the apartment on Dec. 5.

Police responded and found the girls confined to a filthy bedroom with no clothes, blankets or furniture, with multiple bruises and infected wounds. Police had gone to the apartment seven times in the past year to check on the girls after people complained about children screaming and crying.

A woman who often took care of the girls to help Crossley said she'd called child protection authorities multiple times.

Beth Barclay, director of the nonprofit child abuse prevention agency ICARE that serves Kootenai County, said, "It is a teachable moment in our community. It shows us that the whole system is broken."

Tom Shanahan, spokesman for Idaho Department of Health and Welfare, said, "I think we can learn something from every case."

He said conditions at home can change quickly for a child, and authorities must find evidence that proves that a child is in imminent danger before removing them. He said police make the call on whether that level of danger has been reached, not the department. There's usually agreement on imminent danger, he said.

Also, he said, it's a very emotional system.

"We're talking about children," Shanahan said. "And we're talking about parental rights. It can be hard to navigate."

Westcott said she has voiced concerns to child protection authorities, "though often the response I get is that they don't have the power to investigate certain concerns about child abuse."

Then she'd be asked to call law enforcement if she wants her concerns to be investigated further.

"I have a tremendous amount of respect for our law enforcement officers," Westcott said. "But to charge them with making the decision as to whether or not to shelter children based on concerns for abuse or neglect is not right."

She questions the training law enforcement personnel get to be able to recognize signs and symptoms of child abuse or neglect.

On the other hand, if child protection authorities do investigate a claim further, she just gets a generic letter in response, thanking her for the report and assuring her it will be looked into.

"That is the last that we hear of the situation, which often leads me to wonder if any action was taken," Westcott said. "More importantly, what kind of diligence should I be taking in my practice to help ensure that the child is safe?"

Westcott said one change to the current child protection system would be more open communication between the state's authorities and those caring for children, such as pediatricians, day care providers and teachers.

She said that would expand the safety net and ensure that children are making it to school and to medical appointments, gaining appropriate weight, meeting milestones and not showing signs of abuse or neglect.

Shanahan, of Health and Welfare, said the department can't communicate with health care providers or educators beyond what's already being done.

"We looked into it," Shanahan said.

Shaw also has some ideas that might improve the system.

Like Westcott, Shaw said sharing information is crucial. She'd like to be told what actions are being taken when she reports suspected abuse or neglect.

She would like it to be more clear what specific steps follow a report being made, so she could be certain about what happens from one point to another.

Barclay said one sure way to help kids is to help parents.

Research shows that parents with financial stress, dealing with unemployment and poverty, can react by mistreating their children.

"Reach out in your neighborhood and in your families," Barclay said. "Be a friend to parents. Ask how the kids are doing. Share experiences. Offer to help out. Show you understand they're stressed."

She said it's important that the state's Child Welfare Program refer families to ICARE earlier for help in cases where the state might not be able to.

"They don't refer to us early enough," Barclay said.

If ICARE gets the referrals earlier in the process, it can offer home visits, parenting classes and support groups.

The home visits are in-home parent coaching that's individualized to a family to "strengthen their parenting skills through education, information, modeling and support. We provide new 'tools' for their parenting tool belt."

The earlier ICARE can intervene with a family, the more influence it can have, she said.

ICARE is a program of St. Vincent de Paul North Idaho.

"We get many families that self-refer, or are referred by friends," Barclay said.

Shanahan said if it has been determined a child is not in imminent danger, the state can still offer the family services and point them to organizations like ICARE. The state can't, however, point ICARE to the family, he said.

With the current economic conditions, more people are living near poverty. The stress of that on families sometimes is taken out on the children, he said.

Following the arrests of Crossley and Cassidy, Coeur d'Alene Police Chief Wayne Longo called for a meeting between his department and officials from the Idaho Department of Health and Welfare to discuss ways to work more cooperatively, improve communication and tackle crimes against children more proactively.

"We wanted to create awareness about how we can work better together," said Sgt. Christie Wood. "You're better when you share resources."

She said state Health and Welfare officials pointed out resources police can use in these types of cases.

The state also will do some police officer training to help them in child abuse and neglect cases, and it agreed to better share information, she said.

"We want to keep a close-knit relationship," Wood said.

Shanahan said the meeting gave the two agencies an opportunity to revisit their roles, and it helped them strengthen their relationship.