DEE WILSON CONSULTING
The Increase in Child Maltreatment Fatalities
(Originally published December 2024)
The federal Administration for Children and Families (ACF) publishes annual reports of National Child Abuse and Neglect Data Systems (NCANDS) submitted by states, the District of Columbia and Puerto Rico. The most recent report is Child Maltreatment 2022. These annual reports include child maltreatment (CM) fatality data submitted by states’ public child welfare agencies, and supplemented by data from child death review teams, coroners’ offices and medical examiners, law enforcement agencies and (in some states) other sources such as hospitals and public health departments.
NCANDS child fatality data has methodological limitations much discussed by scholars and advocates, e.g., the lack of a standard definition of “child maltreatment fatality” which state child welfare agencies must employ and the dependence on states’ variable substantiation practices. Maltreatment cases in which parental intent appears ambiguous, for example, child fatalities due to unsafe sleep practices in combination with substance abuse, might be classified as child maltreatment fatalities in some states, but not others. For this reason and others, NCANDS CM fatality data is likely to be an underestimate, possibly a large underestimate, depending on the definition of “neglect related fatality” states employ.
Nevertheless, annual Child Maltreatment reports are the only source of annual national maltreatment child fatality data. Furthermore, ACF has consistently used the same approach to collecting fatality data for many years, and therefore can be used to track trends, albeit subject to the limitations of its method-ology. In every annual report, the narrative in the chapter on child fatalities comments that year to year fluctuations in the number of fatalities may be due to changes in the way that a few states have collected and classified fatality cases. However, this standard caveat is unlikely to explain trends that have extended for a decade or more and largely move in the same direction.
Main NCANDS trends in child maltreatment fatalities, 2013-2022
The number of child maltreatment fatalities in annual NCANDS reports declined from 1,740 in 2009 to 1,550 in 2013. Since 2013 there has been a steady gradual increase in CM fatalities from 1,550 to 1,990 in 2022, a 28% increase. The number of CM fatalities increased in each year after 2013, with the exception of 2017, a year during which CM fatalities slightly declined from 1,750 in 2016 to 1,720. During this same ten-year period, the CM fatality rate increased from 2.14 to 2.73 per 100,000, almost a 28% increase.
During this same ten-year period, the NCANDS infant child maltreatment fatality rate (IFA) increased from 17.96 to 24.37 per 100,000, a 35.6% increase. In 2022, almost 45% of CM fatalities were infants, 0-1 years of age.
Infants have much higher CM fatality rates than other age groups:
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three to four times higher than one-year-olds
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almost 20 times higher than six-year-old children
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more than nine times higher than for all children, 0-17
For this reason, child welfare initiatives designed to prevent CM fatalities should view infants as a special case, even in comparison to other young children, in law, policy and practice, and in the development and funding of family support programs.
The other major trend in the past decade of NCANDS data has been the increase in CM fatalities of Black children, from 375 fatalities in 2013 to 549 fatalities in 2022; and an increase in the CM fatality rate for Black children from 4.52 to 6.37 per 100,000, a 41% increase. The numbers of CM fatalities for all racial/ethnic groups in annual Child Maltreatment reports is an underestimate. Information regarding the race/ethnicity of victims from states that have missing data for 30% or more of fatality cases is not included in these counts. Concretely, this means that in 2022 more than 400 child fatality victims were not included in the report’s race/ethnicity data. During most recent years, CM fatalities of Black children have been about one third of total CM fatalities; in 2022 the percentage was 34.9%.
The extent to which the increase in the rate of infant CM fatalities for all races/ethnicities is accounted for by the increase in fatalities of Black infants is not disclosed in recent annual Child Maltreatment reports; scholars with access to NCANDS data can make this determination. The increase in CM fatalities of Black children during recent years has occurred without much scholarly comment or analysis, possibly because such comment would invite personal attack from child welfare abolitionists and their supporters far less concerned with disproportional CM fatality rates for Black children than with other dimensions of
racial disproportionality in child welfare.
Why have child maltreatment fatalities increased?
The increase in CM fatalities began at about the same time that the number of children in foster care began to increase, after more than a dozen years of decline in the U.S. foster care population. These increases were associated with an opioid epidemic that led to an alarming rise in opioid overdose deaths and near deaths of youth and adults. However, this narrative leaves out something critical: worsening child welfare indicators such as CM deaths and entries into foster care followed a few years after the Great Recession of 2008-2009.
This pattern replicated events of the mid to late 1980’s during which period there was a huge increase in foster care entries, especially of infants, a few years after the Reagan recession of the early 1980’s. Deep recessions appear to have large effects on child welfare systems, but not immediately. Initially, recessions seem to have little, if any effect, on child welfare (arguably) because during deep recessions the federal government and state and local governments may initially strengthen support services. However, the effects of emergency measures prove to be temporary as governments at all levels phase out various types of economic assistance. Effects of economic crises on vulnerable populations and on human service systems are large, but delayed; and during the past forty years in the U.S. have been associated with large increases in substance misuse.
Discussions of why state child welfare systems during the past decade have been unable to reduce child maltreatment fatalities should consider social factors that lie outside the purview of child welfare, e.g., the slow response of governments to substance misuse and opioid overdose deaths, as well as child welfare responses to CM fatalities. Poverty rates, especially rates of severe poverty (i.e., annual incomes less than half the federal poverty standard), have large effects on substance abuse, mental health, homelessness and parenting. American Indian and Black families have rates of severe poverty three to four times higher than White families, which greatly exacerbates other adversities in these families. During the past decade, the only time the federal government made a concerted effort to greatly reduce severe poverty was during the pandemic, a temporary measure that did not survive the Biden Administration’s budget negotiations with Senator Joe Manchin.
The increase in infant child maltreatment fatalities
The most likely explanation of why infant CM fatalities has increased at a higher rate than CM fatalities as a whole is that:
(1) Parental substance misuse endangers infants totally dependent on parental care more than it does older children;
(2) Infants with child welfare involvement often have disabilities and/or chronic illness that add to the difficulty of caring for them. Public agencies have not developed, or sufficiently utilized, services designed to reduce child care burden in these families. As a rule, the greater the challenge of caring for a young child, the higher the risk of CM fatality or near fatality.
(3) Child protection programs have not been able to develop in -home safety plans that prevent or greatly reduce fatalities from unsafe sleep practices or accidental drug overdoses. The ill- tempered debate regarding why CPS programs have been unable to reduce CM fatalities during recent years despite thousands of child fatality reviews with their many recommendations boils down to this: CPS programs have no proven in-home strategies for preventing the types of fatalities involving infants and toddlers that became more common during the opioid epidemic. Foster care placement is not, and never has been, a viable legal option in most CPS cases, even in states – unlike Washington – that have not narrowed the legal grounds for involuntary child placement.
Foster care and infant child maltreatment fatalities
The debate over Washington State’s Keeping Families Together Act (KFTA) has tended to focus attention on the pros and cons of child removal from parents afflicted by substance misuse, chronic mental health problems, domestic violence, along with poverty, often severe poverty. This is an important emotionally fraught debate which, however, ignores the following:
(A) Many, probably most, infants who die due to child maltreatment are not reported to CPS prior to their death. In most studies, approximately one-third of CM fatality victims and half of their families were reported to CPS before the child’s death. For this reason, CPS contact should never be the first, or only, outreach to parents with a history of substance abuse or mental illness known to community professionals. There should always be personal outreach to the family by a public health nurse or other human service provider (not CPS) with an offer of a range of services, preferably during pregnancy or immediately following birth of a child. On-line referral services are not an effective substitute for personal contact in a Plan of Safe Care.
(B) Even when there is a CPS report of an endangered infant, CPS intervention is often too little, too late as CPS investigations/ assessments may require days or weeks to complete. In addition, when state law (as in Washington) mandates “risk of imminent harm” as the standard for child removal, CPS caseworkers must often wait until an infant is injured or seriously neglected before taking legal action, even when a parent (or parents) has a long history of addiction and/or child maltreatment. CPS caseworkers need access to safety-oriented services as they investigate a CPS report when there are plausible allegations of substance misuse, mental illness and/or domestic violence, and when there is a child with a disability or chronic illness.
Foster care entry rates for all children, 0-17, are not a proxy for child safety. CM fatality rates increased from 2013-2017 as the number of children in foster care increased; and continued to increase from 2018-22 as the U.S. foster care population began to decline (see AFCARS reports).
CM fatality is a low base rate phenomenon, i.e., 2 to 3 per 100,000 in NCANDS statistics. Even if CM fatality rates were six to ten times higher for children with CPS reports, a state child welfare system might increase the number of children entering foster care by several thousand following a high-profile child fatality while preventing few, if any, child fatalities. This is not to deny that foster care sometimes saves the lives of children, especially infants and toddlers. However, the critical factor is not the number of children entering foster care. Rather, foster care is most likely to save young children’s lives when there is a highly elevated risk of serious child maltreatment, and there is no other way to effectively protect an unusually vulnerable child.
To my knowledge, there is no recently published study that examines the effect of a state’s infant placement rate on CM fatalities. However, since the passage and implementation of KFTA (which began on July 1, 2023) Washington has engaged in a reckless experiment with the lives of infants in families with high risk factors, including substance abuse and chronic mental illness. KFTA led to a 26% decline in entries into care of infants during the first six months of the law’s implementation (see DCYF report on KFTA implementation) and continued the increase in CM fatalities and near fatalities, a trend that began prior to the law’s implementation. In the most recent Office of Family and Children’s Ombud’s (OFCO) annual report, two-thirds of CM victims were infants vs. about 45% during most recent years. Washington state’s experience in recent years has shown that a precipitous decline in placements of high-risk infants may lead to an increase in CM fatalities and near fatalities, especially when a decline in foster care entries is not accompanied by large new investments in substance abuse treatment and safety-oriented services.
Developing collaborations to protect infants’ lives
Washington State already has well developed elements of a model community collaboration needed to protect the lives of infants in troubled families: ‘Safe Baby’ courts in a number of counties; the Parent Child Assistance Program (PCAP) that serves mothers with substance misuse issues and their babies for three years; exemplary multiservice family support centers such as Spokane’s Vanessa Behan Center and the Tacoma Multicultural Center, a state child welfare agency responsible for publicly funded child care and a small number of residential treatment programs for mother and their babies. These programs can be expanded and replicated through both state funding and philanthropic support.
Other key elements need to be added to this strong foundation:
(1) A collaborative partnership between public health departments and CPS in which public health nurses are mandated by law to reach out to families with identified substance misuse and or mental health challenges prior to or immediately following a CPS report, with an offer of a range of services.
(2) An income support program designed to eliminate severe poverty, which is an essential part of programs developed to prevent homelessness. There is no prevention program that is an adequate substitute for income support in families with an annual income less than half the federal poverty standard.
(3) DCYF, with the support of policymakers in the legislature and Governor’s Office, must be committed to improving in-home safety plans by creating an infrastructure internally and with private agencies to support safety plans. One element of this infrastructure would be case aides who could visit families once or twice a week and assist parents in a variety of ways.
(4) In urban offices, DCYF should create specialized units for children, 0-3, staffed with experienced caseworkers and supported by paraprofessionals. The most vulnerable child population should be served by DCYF’s most experienced and knowledgeable staff.
(5)DCYF should expand its approach to child safety to provide intensive services, either voluntary or through legal mandate, to families with substance misuse, mental health or domestic violence concerns and a disabled or chronically ill child, before these children are endangered. Closing high risk cases involving young children without services is dangerous child protection practice which, according to the agency’s annual self-assessments and reports on KFTA implementation, has become more common in recent years. ©
References
The AFCARS Report #29 (2022), Administration for Children and Families, U.S. Department of Health and Human Services, Washington, D.C.
Child Maltreatment 2013, Child Maltreatment 2017 & Child Maltreatment 2022, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, D.C.
“Keeping Families Together Act, Quarterly Data Update,” April 2024, Washington State Department of Children, Youth and Family Services,
Olympia, Washington.
Report on Child Fatalities and Near Fatalities in Washington State (2024), Office of Family and Children’s Ombuds, Tukwila, Washington.
Sounding Board - 2024
January – Leadership and the Mismanagement of Child Welfare
February – Leadership vs. Management in Child Welfare
March – Substance Abuse and Child Welfare: Reflections on Child Welfare History, 1985-2024
April – Substance Abuse and Child Safety: Assessment and Decision Making
May- Plans of Safe Care
June – The Gender Difference in Child Maltreatment Fatalities
July – Child Protection in Northern Europe: Comparisons with the U.S.
August – The Unraveling of Child Protection in Washington State
September – What Is Child Safety?
October – Reflections on Safety Assessment
November – Effective Interventions in Child Neglect: Messages from English Research
December – The Increase in Infant Child Maltreatment Fatalities
See past Sounding Board commentaries
©Dee Wilson