Academic journal article Child Welfare

Advancing Public Health Surveillance to Estimate Child Maltreatment Fatalities: Review and Recommendations

Academic journal article Child Welfare

Advancing Public Health Surveillance to Estimate Child Maltreatment Fatalities: Review and Recommendations

Article excerpt

Fatal child maltreatment is a compelling problem in the United States. National estimates of fatal child maltreatment, based largely on child welfare data, have fluctuated around 1,500 deaths annually for the past ten years. However, the limitations of child welfare and other mortality data to accurately enumerate fatal child maltreatment are well documented. As a result of these limitations, the true magnitude of fatal child maltreatment remains unknown. Public health surveillance has been proposed as a mechanism to improve estimation of fatal child maltreatment, as well as to collect and analyze relevant risk factor data for the ultimate goal of developing prevention strategies. This paper describes public health surveillance efforts undertaken to improve estimation of fatal child maltreatment, and presents the unique challenges of identifying fatal child neglect. The strengths and limitations of existing sources of child maltreatment fatality data are reviewed and broad recommendations for strategies to advance public health surveillance of fatal child maltreatment are presented.

Fatal child maltreatment (CM) is a compelling problem in the United States. Compelling, not only for the obvious reason- that children are killed by their parent or assigned caregiver and most of these children are less than 5 years old-but also because the true magnitude of this problem remains unknown. The underascertainment of fatal child maltreatment has been consistently documented, not only in child welfare data, but in other mortality data as well (Paulozzi 6c Sells, 2002; Overpeck, Brenner,Trumble, Trifiletti, 6c Berendes, 1998; Ewigman, Kivlahan, 6c Land, 1993; Herman-Giddens et al., 1999; Crume, DiGuiseppi, Byers, Sirotnak, 6c Garrett, 2002; Schnitzer, Covington, Wirtz, Verhoek-Oftedahl, 6cPalusci, 2008).

The federal estimate of fatal CM in the United States (US), based largely on child welfare data, fluctuates around 1,500 annually, with estimates ranging between 1,420 and 1,740 for the period 2001-2011 (U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 2012). Although the actual number of CM deaths each year in the United States is not known, McClain and colleagues applied the findings of a Missouri study of fatal CM to death certificate data for the years 1979 through 1988 and reported an estimate of up to 2,022 CM deaths per year for the period (McClain, Sacks, Froehlke, 6c Ewigman, 1993). More recently, a special effort to identify neglect-related deaths among children less than 10 years old in Michigan documented a 75% increase in their estimate of fatal CM, from 110 to 192 over a two-year period (Schnitzer et al., 2008). Applying this 75% increase to reported national estimates would indicate that close to 3,000 children die as a result of maltreatment each year in the United States.

In 2011, the Government Accountability Office (GAO) released a report documenting the undercount of CM nationally (United States Government Accountability Office, 2011). This report calls for a national focus on understanding the magnitude of fatal CM by finding solutions for improving the count and analyzing additional information on the circumstances of CM deaths. Improving the ability to more accurately estimate and understand the circumstances of these deaths are necessary steps not only for monitoring trends, but for developing and evaluating prevention strategies.

The Centers for Disease Control and Prevention (CDC) is the federal agency focused on disease and injury prevention. Because of the broad scope of CM and the serious physical, mental and social consequences, a public health response to the prevention of CM has been a priority area for the CDC for over ten years (Hammond, 2003; Whitaker, Lutzker, & Shelley, 2005). In this paper, we describe public health surveillance efforts undertaken to improve estimation of fatal CM and the challenges unique to enumerating fatal child neglect. …

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