A Preventative Approach to Reducing Child Abuse and Neglect Fatalities

Opinion by Amy Templeman

(Originally published December 30, 2019, by The Hill)

Child abuse and neglect fatalities are preventable, not inevitable. This was the bold vision of the federal Commission to Eliminate Child Abuse and Neglect Fatalities in its report in March 2016, reimagining a 21st-century child welfare system.

Commissioners called for a public health approach to transforming child welfare systems guided by more significant leadership and accountability, decisions grounded in better data and research, and a multidisciplinary approach to ensuring child safety.

Based on the commission’s findings, the U.S. Department of Justice’s Office of Victims of Crime announced earlier this year a demonstration initiative to develop multidisciplinary strategies to address severe or near-death injuries as a result of child abuse or neglect.

Through a competitive grant process, they selected five sites that will receive federal technical assistance for three years.

The sites were selected based on their ability to support a collaborative, community-based approach to reducing child maltreatment fatalities and include St. Francis Hospital in Hartford, Connecticut; Cook County Health, Illinois; Indiana State Department of Health; Michigan Department of Health and Human Services; and Sacramento County’s Child Abuse Prevention Council.

This effort will provide what has been sorely lacking in previous attempts to reduce child fatalities — the identification and evaluation of evidence-based practices.

Prevention is increasingly taking a front seat in federal policy, as evidenced by the recent passage of the Family First Prevention Services Act.

However, given the lack of previous evidence-based practices, each site is applying a different lens on their data and how best to prevent fatalities in their jurisdiction.

The Michigan Department of Health and Human Services will use data and input from partners to create a fatality/injury risk identification tool, which will be used by Children’s Protective Services.

They are also focused on expanding the efforts of the Michigan Child Death State Advisory Team/Citizen Review Panel on Child Fatalities. Serving as a state advisory committee for the project, the panel will create a forum for sharing information and innovations related to preventing child maltreatment deaths and injuries.

The Child Abuse Prevention Council of Sacramento will develop a model for a coordinated response to effectively identify and address recurring child injuries and fatalities using collaborative partnerships.

Sacramento County will utilize a county-wide cross-disciplinary, public and private Prevention Cabinet to expand analysis of child fatality, near-fatality and injury data, gather social determinants of health data for neighborhoods most at-risk, review current screening and investigative policies, and use this information to inform and implement a strategic plan to eliminate child abuse and neglect fatalities in Sacramento County.

Cook County Health in Illinois, working in partnership with the Chicago Children’s Advocacy Center, CCH will bring together other critical stakeholders to form the Collaboration of Helpers Lowering Deaths of Children (Project CHILD).

Using a public health model, the Project CHILD collaborative will address the problem through parenting education, a home visiting nurse program, and family referrals.

Additional strategies include the use of a simulation laboratory, regional unit-based multidisciplinary teams, and telehealth technology to improve the assessment of information gathered during investigations.

The Greater Hartford, Family Advocacy Center in Connecticut, will utilize the funding to work with diverse stakeholders, including state agencies, policymakers, affected community members, first responders, educators, researchers, and providers, to develop a standardized, data-driven systemic approach to documenting and tracking child maltreatment.

The Family Advocacy Center will focus their work individually in cities and towns under the judicial district GA-14, including Avon, Bloomfield, Canton, Farmington, Hartford, and West Hartford.

The Indiana State Department of Health will conduct a two-phase project in three target counties (Clark, Delaware, and Grant counties) whose child fatality rate is higher than the state average.

The agencies will undergo a five-year retrospective review to identify risk factors for child injuries and deaths. All will work in partnership with the Community Partners for Child Safety program to develop prevention strategies for the different agencies and twelve-step programs will be created and implemented into the collaborative prevention network.

Technical assistance will support sites in improved data collection and analysis, and all sites will establish learning exchange teams and communications strategies to share findings, both regionally and nationally.

It is hoped that these actions will add up to a new knowledge base on best practices and what works to reduce and prevent these tragedies.

In the words of the commission’s final report: “In the Commission’s two years of hearings, deliberations, and meetings with stakeholder groups, we found little in the way of evidence-based programs to end child maltreatment deaths. But we found hope and urgency for building the steps to a 21st-century child welfare system that can prevent deaths of the 3,000 children who will die from abuse or neglect next year if the status quo remains in place.”

It is hoped that this innovative initiative will fulfill the mission of the commission by taking the first step to inform an ongoing nationwide effort to prevent child abuse and neglect tragedies before they occur.

Amy Templeman is a project coordinator for the demonstration project and director of the Within Our Reach office at the Alliance for Strong Families and Communities.