DOCUMENT RESUME ED 393 570 PS 024 030 TITLE A Nation's Shame: Fatal Child Abuse and Neglect in the United States. A Report of the U.S. Advisory Board on Child Abuse and Neglect. Fifth Report. INSTITUTION United States Advisory Board on Child Abuse and Neglect, Washington, DC. SPONS AGENCY Administration for Children, Youth, and Families (DHHS), Washington, D.C. PUB DATE Apr 95 NOTE 294p.; The Executive Summary contained in this report has been separately published as a 41 page document, see PS 024 031. PUB TYPE Reports Research/Technical (143) Tests/Evaluation Instruments (160) EIIRS PRICE MF01/PC12 Plus Postage. DEZCRIPTORS Agency Cooperation; Change Strategies; Chi Abuse; Child Caregivers; Child Health; *Child Neglect; Child Welfare; Community Involvement; *Death; Family Programs; Homicide; Integrated Services; Investigations; Law Enforcement; Parents; *Prevention; Program Improvement; Social Problems; *Social Services; State Legislation; Training; *Young Children IDENTIFIERS Autopsies; Cause of Death; Child Abuse Prevention and Treatment Act; Child Safety; Family Preservation Services; Family Support ABSTRACT The U.S. Advisory Board on Child Abuse and Neglect was established under the Child AbusePrevention and Treatment Act (CAPTA). In its annual reports, the Board is charged withevaluating the nation's efforts to accomplish the purposeof CAPTA and to propose recommendations about waysthose efforts can be improved. Noting that every day, five young children die from abuse orneglect at the hands of their parents or caregivers,this report examines existing efforts and opportunities that aid inunderstanding and preventing child abuse and neglect fatalities. The reportalso provides a close look at system-wide weaknesses andobstacles, and lack of resources and commitment by policymakers totake action that could save children's lives. The first chapter of thereport explores the lack of knowledge over the scope and nature ofchild abuse and neglect fatalities, attempting to quantify theproblem. Chapter 2 examines the need for better investigation andprosecution and for major efforts to improve and train front-lineprofessionals. Chapter 3 discusses the encouraging emergence of Child DeathReview Teams. Chapter 4 examines the need for more aggressiveefforts to protect children and to facilitate community-based familyservices and primary prevention efforts to help families livesafe and healthy lives. The report offers 26 recommendations foraddressing deep-seated problems within the law enforcement,child protection, health agency, and court branches that constitutethe child-protection system. These recommendationsinclude: (1) establishing a national commitment to addressing theproblem of abuse and neglect fatalities;(2) increasing the number of professionals qualified to identify and investigate such fatalities;(3) enacting legislation establishing child autopsy protocols;(4) enacting model legislation to address confidentiality; (5) including the religious community in prevention efforts; (6) adopting child safety as the goal of family programs and policy; (7) using family support funding for prevention; and (8) adopting regulatory measures to reduce environmental dangers for children. The report's five appendices include, a list of participants in the board's previous congressional hearings and workshops, a roview of child fatalities research and literature, and a sample death certificate. (En!) *********************************************************************** * Reproductions supplied by EDRS are the best that can be made * * from the original document. * *********************************************************************** U.S. DEPARTMENT OF HEALTH AND HUMAN A Nation's Shame: SERVICES Administration for Children and Fatal Child Abuse and Families U S. DEPARTMENT OF EDUCATION Office of Educatonal Researce and Improvement Neglect in the EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) Kihis document has been reproduced as received from the person or organization originating it. 0 Minor changes have been made to improve reproduction quality United States . Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. A Report of the U.S. Advisory Board on Child Abuse and Neglect ',coy rNOV AVAII ARI The views expressed in this report are those of the members of the U.S. Advisory Board on Child Abuse and Neglect and do not necessarily reflect the views of any part of the U.S. Department of Health and Human Services. This document may be reproduced without permission. For information regarding this report, A Nation's Shame: Fatal Child Abuse and Neglect in the United States contact: THE NATIONAL CLEARINGHOUSE ON CHILD ABUSE AND NEGLECT IN,FORMATION: 1 (800) 394-3366 (703) 385-7565 THE FOLLOWING BOARD PUBLICATIONS ARE ALSO AVAILABLE FROM THE NATIONAL CLEARINGHOUSE ON CHILD ABUSE AND NEGLECT: Child Abuse and Neglect: Critical First Steps in Response to a National Emergency (August, 1990) Creating Caring Communities: Blueprint for an Effective Federal Policy on Child Abuse and Neglect (September, 1991) The Continuing Child Protection Emergency: A Challenge to the Nation (April, 1993) Neighbor:v Helping Neighbors: A New National Strategy for the Protection olChildren (September, 1993) U. S. ADVISORY BOARD ON CHILD ABUSE AND NEGLECT 200 Independence Avenue, S.W. Washington, DC 20201 (202) 690-8137 3 Department of Health and Human Services Administration for Children and Families A NATION'S SHAME: FATAL CHILD ABUSE AND NEGLECT IN THE UNITED STATES A Report of the U.S. Advisory Board on Child Abuse and Neglect Fifth Report U.S. Advisory Board on Child Abuse and Neglect April 1995 4 MEMBERS OF THE U.S. ADVISORY BOARD ON CHILD ABUSE AND NEGLECT Deanne Tilton Durfee, Chairperson California Yvonne M. Chase, Vice-Chairperson Alaska Randell C. Alexander Enid A. Borden Iowa Virginia Jane Nady Burnley Nancy Hoit Virginia Massachusetts Frances E. Jemmott Murray Levine California New York Elba Montalvo J. Tom Morgan New York Georgia Lawrence F. Potts Prince Preyer, Jr. Texas Alabama Michael S. Wald Michael W. Weber Washington, DC Minnesota John Wilson Washington, DC Preston Bruce, Executive Director Washington, DC "A simple child, That lightly draws its breath, And feels its life in every limb, What should it know of death?" William Wordsworth 6 Table of Contents Table of Contents DEDICATION vii FOREWORD xv MISSION AND COMPOSITION OF THE U.S. ADVISORY BOARD ON CHILD ABUSE AND NEGLECT xxi EXECUTIVE SUMMARY xxiii Background xxiii Chapter One: Quantifying the Problem xxviii Chapter Two: Government and Individual Responsibility xxix Chapter Three: The Need for Child Death Review Teams xxxi Chapter Four: Toward a Better Future xxxiii Part One: Family Services, Intervention, and Preservation x.xxiii Part Two: Fatality Prevention xxxiv Conclusion xxxvi Summarized Recommendations xxxvii References xliv BODY OF REPORT Preface 1 Introduction 5 1.. Chapter One: Defining the Scope and Nature of Fatal Abuseand Neglect 7 Understanding the Problem 7 What Do the Data Tell Us? 1 1 What Differentiates Abuse from Neglect Fatalities? 1 1 Who Is Committing These Acts? 1 3 What Are the Causes of Death? 1 5 Which Children Are Likely to Die? 1 6 What Happens to the Survivors? 1 6 Current Issues: Official Underreporting, Definitionsthat Obscure i U.S. Advisor) ooard on Child Abuse and Neglect 7 Table of Contents Abuse-Related Causes, and Poor Case-Level Data 18 Official Underreporting 18 The Annual Survey by the National Committee to Prevent Child Abuse 19 The Federal Bureau of Investigation's Uniform Crime Report 20 The National Center for Health Statistics, Vital Statistics 21 Unclear Definitions and Poor Case-Level Data 23 Insufficient Data Collection on Individual Cases 24 Highly Inadequate Research Efforts 24 Strategies for Improvement 26 Seeking Common Definitions and Data Elements 26 Use of Estimation Models by the Centers for Disease Control and Prevention 26 Sending a Clear Public Message 27 A New Effort by the National Child Abuse and Neglect Data System 28 Greatly Expanded Research Efforts 28 The Emergence of Child Death Review Teams 29 Chapter One Recommendations 30 Chapter One References 33 Chapter Two Addressing Shared Responsibility: Case Investigation and Prosecution 39 Case Investigation and Prosecution 39 The Child Protection System of Mandated Reporters and Agencies 40 The Role of Child Protective Services 42 The Role of Prosecution 43 A Struggle for States 43 Provision of Available and Necessary Medical Care to Children 45 Current Issues: Training Weaknesses 49 Physicians and Hospital Personnel are Unaware of Abuse Clues 50 Few Medical Examiners or Coroners Know How to Detect Child Abuse and Neglect 51 Police Often are Not Trained to Detect or Deal with Serious and Fatal Child Abuse 53 ii U.S. Advisory Board on Child Abuse and Neglect Table of Contents Child Protection Workers are Often Inexperienced,Undertrained, or Overextended 55 Multiple Problems Deter the Prosecution of Perpetrators 57 Strategies for Improvement: Expanding the Expertise 59 Broad New Training for All Front-line Workers 59 Increased Use of Immediate-Response Joint CriminalInvestigations 61 Hospital SCAN Teams and Other Hospital Ef torts 63 Mandated Autopsies 64 Enhanced Prosecution and Evidence Gathering 66 Chapter Two Recommendations 67 Chapter Two References 72 Chapter Three The Need for a Nationwide Systemof Child Death Review Teams 75 The History of Child Death Review Teams 77 A Rich Source for Understanding 78 How Teams