Academic journal article Child Welfare

Preventing Severe and Fatal Child Maltreatment: Making the Case for the Expanded Use and Integration of Data

Academic journal article Child Welfare

Preventing Severe and Fatal Child Maltreatment: Making the Case for the Expanded Use and Integration of Data

Article excerpt

In this article we examine risk factors for severe and fatal child maltreatment. These factors emerge from studies based on different data sources, including official child maltreatment data, emergency department and hospitalization data, death certificates, and data from child death review teams. The empirical literature reflects a growing effort to overcome the measurement uncertainties of any one individual data system. After review and reflection upon what is known, we consider how integrating this information can advance efforts to protect children, providing examples where the use and linkage of multiple sources of data may enhance surveillance, improve front-end decisionmaking, and support cost-effective research and evaluation.

In 2011, an estimated 1,570 children in the United States died as a result of abuse or neglect (U.S. Department of Health and Human Services [DHHS],2012). An additional 6.2 million children were referred to child protective services (CPS) as alleged victims of abuse or neglect. Among referred children, 3 million were included in a CPS investigation and roughly 681,000 were determined to have been maltreated. More than three quarters of maltreated children were neglected, 17.6% were physically abused, and 9.1% were sexually abused. Many children experienced multiple forms of maltreatment (DHHS, 2012).

These estimates were derived from the National Child Abuse and Neglect Data System (NCANDS), the official U.S. source of child maltreatment data. The annual NCANDS report provides information about cases of child maltreatment reported to and investigated by CPS; yet estimates from this data system almost certainly understate the public health burden and number of children affected by abuse and neglect (Gilbert, et al., 2009; Sedlak et al., 2010). For example, NCANDS data indicated 2.1 maltreatment deaths occurred per 100,000 children (DHHS, 2012), yet half of states only reported data on maltreatment fatalities for children who were already known to CPS agencies prior to their death (U.S. Government Accountability Office, 2011). In Pennsylvania, one of 51 states and territories that contribute data to NCANDS, a maltreatment fatality (or any other abuse) can only be substantiated if there is a clearly identified perpetrator. Therefore, in Pennsylvania a child can be fatally maltreated or seriously injured from abuse, but if the perpetrator is unknown, the case is not substantiated or reported to NCANDS (Joint State Government Commission, 2012).

The under-ascertainment of nonfatal and fatal child maltreatment is not unique to NCANDS; emergency department and hospitalization records have also been shown to capture only a fraction of all medical encounters arising from maltreatment. Even among children who receive medical attention as a result of maltreatment-a small subset of all abused children-failure of medical professionals to recognize and diagnose abuse, as well as failure of coders to assign appropriate diagnosis codes have contributed to the undercounting of abuse in medical data (Hooft, Ronda, Schaeffer, Asnes, & Leventhal, 2013; Jenny, Hymel, Ritzen, Reinert, & Hay, 1999; Schnitzer, Slusher, Kruse, ScTarleton, 2011; Scott, Tonmyr, Fraser, Walker & McKenzie, 2009; Somji, Plint, McGahern, Al-Saleh, & Boutis, 2011).

Death certificates, the official record of death in the United States, have also been shown to dramatically underestimate fatalities from maltreatment, as more than 50% of deaths from abuse and neglect may be miscoded on death records (Crume, DiGuiseppi, Byers, Sirotnak, & Garrett, 2002; Ewigman, Kivlahan, & Land, 1993; Herman-Giddens et al., 1999; McClain, Sacks, Froehlke, & Ewigman, 1993). Even child death review teams (CDRTs)-multiagency entities charged with systematically compiling data about child deaths-have been found to underestimate the number of deaths attributable to maltreatment (Palusci, Wirtz, & Covington, 2010; Schnitzer et al. …

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