While brutal child deaths caused by physical abuse may grab newspaper headlines, a new study shows that the majority of injury fatalities of children five or younger in California stemmed from neglect.
Between 1999 and 2006, 4.3 million babies were born in California, according to a report published in the October edition of the American Journal of Public Health. By age five, more than 500,000 were reported to Child Protective Services for maltreatment. Of those children, 392 died for reasons ranging from severe physical abuse to a parent unintentionally smothering his or her baby while sharing a bed.
The report, conducted by researchers Emily Putnam-Hornstein, Mario Cleves, Robyn Licht, and Barbara Needell, builds on existing research that has shown allegations of maltreatment as a strong indicator of subsequent maltreatment, including injury deaths.
This latest study goes a step further, linking certain types of allegations – physical abuse, neglect and other – with birth and death records.
“Stratification by manner of injury showed that children with an allegation of physical abuse died at a rate five times as high as that for children with an allegation of neglect, yet faced a significantly lower risk of unintentional fatal injury,” the report reads.
Conversely, children reported for neglect were more likely to die of unintentional reasons, begging the question of what strategies should be employed to protect them.
Putnam-Hornstein et al.’s research highlights factors that contribute to heightened rates of child maltreatment and subsequent child death – whether intentional or not. Birth order, maternal education and whether or not a mother was receiving public health insurance during birth factored greatly in all fatal injury deaths to children in the sample. More than 70 percent of fatal injuries to children with a prior referral were born second or later; or to mothers on public insurance at birth. Eighty percent were born to mothers who had not completed high school.
While the link between and allegation of physical abuse and subsequent acts of intentional harm is clearer, the causes and effects of neglect are more diffuse and harder to address, according to social workers who see these cases day in and day out. Michelle Selinger, a child and family services supervisor with Carver County Community Social Services in Minnesota, pointed out that dealing with cases of neglect are often more complicated – and more often fatal – than cases of clear cut physical abuse.
“I do believe that in most situations where parents are found to be neglecting their children, it is not purposeful but more a lack of understanding, mental illness or child development issues that get in the way of their ability to care for their children,” she wrote in an e-mail to The Imprint after reading the California report. “I think they almost always believe, and likely are, parenting better than their parents cared for them, but may still be short of society’s expectations of what good parenting looks like.”
“Being able to wrap a safety plan around physical abuse is almost easier than wrapping a plan around chronic neglect.”
In a phone interview, Selinger said that over the past few years, the rare cases of injury deaths to children with CPS contact were almost entirely attributable to families with prior allegations of neglect, not physical abuse. Despite this, Minnesota’s state screening guidelines disallow considering prior allegations of abuse or neglect when making the decision about whether or not to send a social worker out to assess a child’s safety.
“When screening an allegation of child maltreatment, a history of previous involvement with child protection, or of a prior child maltreatment allegation, are not factors to be considered,” reads a 2012 revision to the state guidelines.
Such measures are in direct contradiction with evidence that prior allegations are one of the strongest indicators of a child’s risk for subsequent abuse.
In the recent paper, Putnam-Hornstein et al., concluded that “attempts to reduce the absolute number of child injury deaths must focus on the broader population of neglected children and incorporate strategies to prevent unintentional injuries.”
Daniel Heimpel is the founder of Fostering Media Connections and the publisher of The Imprint.