Ending Child Abuse and Neglect Fatalities, A National Strategy

Last week, the United States Commission to Eliminate Child Abuse and Neglect Fatalities released its final report, “Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities.” This report represents a culmination of a two-year effort to study, review, and address an issue that has frustrated and confounded generations of policy makers, child protection officials and government leaders.

We – the 12 commissioners appointed by Congress and the president – realized that our current system is designed to intervene with an investigation after harm has been reported when we believe a better system would focus on prevention.

Each of those of us who served on the Commission cares deeply about the work we were undertaking. Over the two years, we heard testimony from more than 120 individuals and organizations at public hearings held in 12 communities. We received and reviewed testimony from more than 90 additional organizations. We reviewed existing research, data, state and federal legislation impacting this issue.

When we were nominated to this commission, we knew that our goal was not just to consolidate existing research. That is why each of the commissioners brought our unique perspective and expertise as child welfare professionals and former foster care youth, as pediatricians and child advocates, as judges and policymakers. Our combined experience contributed to the deliberations and recommendations that are included in the final report.

With so many different points of view represented, I was struck by the level of consensus we were able to reach around both the full report and each of the recommendations. Nine of eleven commissioners supported the full report and even the two dissenting Commissioners were able to find common ground.

For example, Commissioner Patricia Martin’s dissent lists 19 recommendations, all of which were also included in our majority report. And, while Commissioner Cassie Statuto Bevan did not agree with the Commission’s recommendations on funding she did agree that it is essential to focus on infants and children under age 5 who are most at risk.

As the Chairman of this Commission, I respect the diverse views of my fellow Commissioners and believe our points of agreement are a good place to start. The Commission was unanimous in agreeing that there was a lack of research and data available to inform both policy and practice regarding child fatalities caused by abuse or neglect. We heard about other safety-focused industries like the airline industry and thought about ways to change the dialogue around child protection from crisis management mode to proactive prevention and up-stream services. We all agreed that child protection has been woefully underfunded and while we did not reach agreement on what it will cost to bring child welfare into the 21st century we all know that an investment will be needed in services and supports that work to keep children safe.

We agreed that there was no one-size-fits-all solution and that state and local agencies and tribes need flexible funding and the ability to make decisions based on their own needs and the risk and protective factors of children in their communities.

While risk factors may vary some across communities, there were some remarkable similarities. Infants and toddlers were the most vulnerable. Approximately half of all fatalities are infants younger than one year old and approximately three quarters are under three years of age. A report to child protection for a child under five, regardless of disposition, is the strongest predictor of a later child abuse or neglect fatality. Information like this would have been vital to me when I served as a child welfare director ten years ago.

All of these elements led us to one of our key recommendations: The administration and Congress should support states in improving current child protection agency practice through a two-year multidisciplinary action to protect children most at risk of fatality and begin to better evaluate what works.

The process would begin with each state conducting a review of all child abuse and neglect fatalities from the previous five years, including those known and not known to the child protective agency. The characteristics of, and services received by, those children would be compared to those who were successfully served to determine family, child or service characteristics that distinguish children who have died from those who did not.

Why is this important? First, it will provide a body of knowledge and data, unique to each state, that doesn’t currently exist. Based on that data, states can then identify children currently being served who are at highest risk and develop prevention plans designed to protect children from future risk. This was perhaps the most effective strategy to reduce child abuse and neglect fatalities that we heard during more than two years of testimony.

The goal of this process is for states to develop the capacity to get the right supports to the right families as early as possible to prevent a tragedy.

As an example, the one evidence-based practice demonstrated to reduce fatalities, the Nurse Family Partnership, a home visiting program, did not appear to be reaching many of the families that needed it the most based on testimony we heard.  By assuring the right services reach the right families, the commission is certain lives can be saved immediately.

As much as we know about who is at risk for a later fatality, we don’t know nearly enough about what works to reduce fatalities. It is clear that there are no magic bullets here. Saving lives will require both immediate action and long-term system reform. It will require a federal commitment to providing the resources and flexibility for state, local and tribal agencies to be more effective. It will require a greater body of knowledge and data sharing across multiple agencies to ensure children aren’t killed while bureaucracies protect their turf.

The commission conducted perhaps the most comprehensive review of this subject to date and achieved remarkable consensus on next steps. We can save children’s lives by following those steps.

David Sanders, Ph.D., Chairman, is Chairman of the Commission to Eliminate Child Abuse and Neglect Fatalities. He also serves as executive vice president for Casey Family Programs, a position he has held since 2006. Sanders previously served as the director of the Los Angeles County Department of Children and Family Services from 2003 to 2006. He is also a member of the The Imprint’s Advisory Council.  

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