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Counting Child Maltreatment Deaths

(Originally published October 2015)

It is unusual, but not unknown, for measures of social phenomena to become the subject of political controversy. In recent years, high stakes testing in schools has been a contentious issue because of the (arguably) excessive weight given to students’ test scores in evaluations of educational achievement. Poverty scholars and a few policymakers have debated the federal government’s poverty standards and the extent to which benefits like food stamps should be factored into a poverty rate. Controversies over measures of child maltreatment deaths, and the resulting counts of child deaths due to child abuse or neglect, have pitted major newspapers or other media outlets against child welfare leaders or top managers of human services umbrella agencies in some states and large cities; or (amazing as it sounds) key legislative committees against politically appointed human services managers in a few jurisdictions. Several of these controversies have included explicit or implicit accusations of bad faith regarding how public agencies have counted and reported child maltreatment deaths. Some child welfare leaders have been forced to resign in the midst of these public debates, and in some jurisdictions, legislation has been passed to regulate the kind of information that must be released following a child’s death due to suspected child maltreatment and aggregate annual statistics regarding child maltreatment deaths. What accounts for such volatile political responses to seemingly technical questions of how to accurately measure child maltreatment deaths?

A Historical Perspective

Harry Ferguson is an English scholar who is the author of Protecting Children in Time (2004), a history of child protection in England and Ireland from the 1880s to the beginning of this century. Child protection trends in England and Ireland parallel those in the U.S. Ferguson offers an illuminating analysis of changes in how English and Irish child protection authorities have counted (or not counted) and reported child deaths for almost a hundred years. One of the surprising discoveries in Ferguson’s research is the National Society for the Prevention of Cruelty to Children (NSPCC) in England kept careful records of cases that ended in child death between 1915 and 1936:

Year Total cases No. of affected Child deaths/

children case closed

1915 49,046 143,025 951

1920 44,051 133,796 862

1925 38,559 95,512 442

1930 43,048 107,172 334

1935 44,886 109,471 264

Ferguson comments that “prior to 1914, in a context of extremely high infant mortality rates, child protection agencies came into contact with many children who were dying anyway.” And he adds, “By the 1920s and 1930s … the more involvement professionals had with reported cases, the fewer children died. This served to strengthen the faith of expert systems in their ability to assess risk and in the transformative capacity of social interventions to protect children …” (emphasis mine). In the early years of child protection, Ferguson maintains that “Child death was viewed with dismay, but high death rates in casework were a vital resource for child protection organizations. Information about the deaths of children was used as a sign that the practice was working well, not badly; that children were being reached and preventative work was succeeding, not failing,” a perspective made possible by large and rapid reductions in child death rates generally. According to Ferguson, “in 1907, an estimated one in seven infants died in the first year of life, as compared with one in 67 by 1977.”

The NSPCC in England stopped providing information on child deaths on open cases after 1936; and Ferguson maintains that child death was hardly discussed by child protection authorities during the 1940s, 50 and 60s “which meant that professionals had secrets that they kept even from themselves.” The discussion of child maltreatment deaths reemerged in England in the 1970s; by this time, Ferguson asserts the public expectation had become that all children can and should be protected, and that a child maltreatment death was an aberration for which professionals, not just parents, were blameworthy. By the 1970s, child deaths were not a common occurrence as was the case early in the twentieth century; they had come to be regarded as abnormal events which ought to have been prevented by competent social interventions.

Sequestering Child Deaths

Since the 1970s, Ferguson maintains that child protection authorities in England and Ireland have “sequestered” information regarding child maltreatment deaths. Ferguson quotes Giddens’ definition of sequestration: forms of structured concealment which separate from view a range of persons who in some way deviate from the normal run of activities in day-to-day life. According to Ferguson, some forms of sequestration are organizational, e.g., mental hospitals, while “others depend on the institutional repression of potentially troublesome information …”

After 1936 in England, the NSPCC “ceased to make data or statements about the subject available in the public domain.” The concealment or (more often) misrepresentation of data regarding child maltreatment deaths has occurred, according to Ferguson, during a period when “ …across the Western world the issue of the deaths of children in child protection cases has hung like a dark shadow over the professions who work with child abuse, and especially social work.” In England, there has been huge public interest and national outrage regarding a number of high profile deaths, including the death of Victoria Climbie, an 8-year-old child who suffered at least 128 bodily injuries prior to her death despite supervision of the child’s family by multiple agencies. The web site of the inquiry into this child’s death received about three million hits in a single 12 month period during 2001-02, Ferguson asserts.

Ferguson comments that the intensity of public outrage hollowing high profile child maltreatment deaths has increased the sense of risk and danger to practitioners who work in child welfare agencies based on the awareness that “Every case could be that case where serious harm or death occurs.”

Caseworkers, supervisors and managers have frequently been fired or demoted in response to demands for accountability; practitioners have occasionally been vilified in the news media or on talk radio; or even prosecuted in some instances when false information (or back dated information) has been entered in case records following a child death, or when children in open child welfare cases were not visited per agency policies. An experienced and highly acclaimed child welfare manager recently commented that every child welfare manager in the U.S., regardless of their achievements, is just one child death away from being fired. Child protection in both England and the U.S. has become a highly dangerous profession. It’s no wonder that a number of state child welfare systems are having difficulty recruiting and retaining caseworkers; and that once caseworkers have worked in child protection for a year or two, they often transfer to other positions in which there is less risk of public disgrace and punishment following what seem to be egregious failures of child protection.

Trends in the U.S. regarding the Counting of Child Maltreatment Deaths

At first glance, trends in the U.S. appear different than the “sequestration” of child death statistics in England and Ireland discussed by Ferguson. In the U.S., the federal government publishes annual Child Maltreatment reports that include data regarding child maltreatment deaths; and in a number of states child welfare agencies or other entities produce periodic reports on child deaths. In addition, newspapers and other media outlets sometimes go to great lengths to track the number of child maltreatment deaths in states or large cities over several years. Instead of a lack of data, there is a lot of statistical information regarding child maltreatment deaths in the U.S.. Nevertheless, there is widespread agreement among experts that the federal government’s NCANDS data is an undercount (probably a large undercount) of child maltreatment deaths. Furthermore, states use such a wide array of approaches and criteria for counting child maltreatment deaths that is difficult to figure out whether the number child maltreatment deaths is increasing, remaining the same or decreasing nationally or in specific states, and usually impossible to compare states’ performance in preventing child maltreatment deaths. Either intentionally or unintentionally, the way in which NCANDS data is collected and the differences among states in gathering information, classifying child deaths and organizing reports has served to conceal child maltreatment death trends, and made it next to impossible to evaluate by use of child maltreatment death rates to what extent child welfare agencies have protected children from serious injury or death.

Some of the practices that account for the uncertainty regarding child maltreatment death trends in the U.S. include:

Dependence on coroners’ or medical examiners’ determinations regarding cause of death, a practice which leads to a large undercount of neglect related deaths.
Some states do not include a category for “neglect related deaths” in their reports; instead they may count accidental deaths such as drownings, “roll-over” suffocation deaths, etc.
State child welfare systems may choose not to submit data regarding child maltreatment deaths to NCANDS; and states can utilize different criteria in categorizing child deaths as due or not due to maltreatment.
Child welfare agencies most likely to be damaged by child maltreatment data are usually responsible for its collection and for reports of this data to NCANDS.
States can change the criteria they use for determining child maltreatment deaths from year to year; for example, a child welfare agency can decide to eliminate entire categories of child deaths, for example ‘roll over’ deaths, and then assert that the state has had a decline in child maltreatment deaths.
Information regarding child maltreatment deaths can be included in reports as a sub category of ‘preventable deaths’; reports may not provide information regarding how many children who died due to maltreatment were open cases, or recently open cases, at the time of the fatal incident.
Some states provide information on deaths of children open to the agency at the time of death; other states may report of children with open cases in the past year, or 5 years, or at any time in the child’s life.
Some states require that any child death determined to be due to abuse or neglect by any investigative agency be counted in state totals; this practice almost always leads to an increase in official counts of child maltreatment deaths. However, most states do not have this requirement in law.

This list could be easily increased, but it should be enough to engender caution when interpreting child maltreatment death trends or comparing states’ or large cities’ alleged rates of child maltreatment deaths. If, by chance, child welfare agencies in this country were to adopt practices that lead to sizeable reductions in child maltreatment deaths, it would require years to be sure that the reduction in deaths had really occurred, and was not the result of changes in states’ criteria for classification or reporting of child deaths. Statistical tests of significance would not suffice for this purpose.

Why Bother to Achieve More Accurate Counts?

During recent years, I have been surprised to encounter resistance among some scholars and child welfare managers to the agenda of achieving more accurate counts of child maltreatment deaths. These experts understand the politically fraught nature of child death data and the distress of managers resulting from any new measurement practices that would likely increase official numbers of child maltreatment deaths. These reservations regarding the potential consequences of discovering many more child maltreatment deaths are often accompanied by the view that accidental child deaths can be greatly reduced by initiatives that seek to reduce deaths from drowning, unsafe sleep practices, house fires, car accidents, etc. without deciding whether specific deaths were due to neglect or abuse. This perspective assumes that the current undercount in child maltreatment deaths most likely concerns neglect related incidents; and that these fatal incidents can be reduced by the increased use of evidenced based practices developed to reduce accidents of specific sorts, rather than by labelling some of these deaths (but not others) as “due to neglect”.

Surely it’s true that some accidental child deaths can be reduced by public health interventions that promote certain parental behaviors and discourage others. The more important question, however, is whether CPS practices can be developed which reduce child maltreatment deaths and "near misses" without good measures of child maltreatment deaths during or immediately

following CPS interventions. Child welfare agencies have been so determined to avoid performance indicators that include counts of child deaths that most of these agencies do not measure injuries or serious injuries on open/recently opened cases. Agencies unwilling to measure accurately the harms to children they are attempting to prevent are unlikely to improve their performance in critical ways. The idea that child maltreatment deaths can be reduced without more accurate measures of whether abuse or neglect was a critical factor in a child’s death is almost certainly true, as about two thirds of children who die due to maltreatment do not come to the attention of CPS prior to death. However, for children who at some point in their lives are opened for service by CPS programs, it matters how child welfare agencies evaluate their performance and change their programs in response to accurate data; and whether policymakers provide resources and pass laws that will improve CPS effectiveness. For this reason, more accurate counts of child maltreatment deaths are crucially important.

Reference

Ferguson, Harry, Protecting Children in Time: Child Abuse, Child Protection and the Consequences of Modernity, Palgrave Macmillan, 2004.

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