How Child Fatality Findings Impact Healthcare
by Lisa DiFalco
Child abuse, neglect and child mortality continue to pose problems in every community. On April 18, CWLA members convened to discuss the commission on child fatalities findings. Key findings and recommendations were highlighted from the recent report with a presentation from Dr. David Sanders, Ph.D., chairman of the Commission, and executive vice president of Casey Family Programs. On issues ranging from the child fatality problem to new findings, suggested actions and potential outcomes for healthcare professionals, get more insight on child fatalities and what can be done about the crisis.
Why Are Child Fatalities a Continuing Problem?
Reports of child abuse on the media seem to be on the rise. Tanner Dowler, a 2-month-old infant, died from the physical abuse delivered from his young parents. Grandparents attempted to involve the authorities and intervene prior to his birth. And 14-month-old Demetri Robledo suffered starvation and torture from a male babysitter. A recent report shows that in 2015, 13 child fatalities in Hampton Roads, Virginia, were directly related to neglect or abuse from a caretaker. Three children were infants, and six others were under age 2. News reports continuously describe yet another disturbing story of a child abused or killed from the actions of a family member or caregiver. It is time to understand the scope of the problem of child fatalities.
Neglect and abuse appear to have a high correlation with child fatalities. In 2014, in 72.3 percent of cases of child maltreatment fatalities, neglect alone or in combination with another form of maltreatment were directly attributable to the fatality. If medical neglect were factored in, the total rises over 80 percent. And the populations most at risk are the youngest and most vulnerable of the nation’s children. Statistics show the inordinately high risk for children from infancy to under 3 years of age.
- 73.9 percent of children who died from neglect and child abuse were less than 3 years old.
- 46.5 percent were less than a year old.
- Within the population of infants under a year old, one fatal hospitalization was reported for every 10 cases of abuse-related nonfatal hospitalizations.
What can be done to protect the most fragile children from abuse and neglect? That a link exists in neglect, abuse and child fatalities cannot be denied. Families and healthcare professionals such as hospital staff, case managers, behavior analysts and professionals in various agencies throughout the community must act quickly to notify authorities and avert more child fatalities from occurring.
Communities are looking to identify ways to help families with young children to reduce the possibility of child maltreatment. Common factors that appear to contribute to child maltreatment and fatalities include:
- Substance abuse;
- Abuse of parents as a child;
- Social isolation;
- Unrealistic expectations demanded of a child;
- Economic stress related to unemployment; and
- A crisis within the home.
Additional community support and awareness of how to intervene and report suspicions to the local CPS agency can make a difference in the lives of affected children and their families.How many children have to die? Get more insight on child fatalities and what can be done about the crisis. Click To Tweet
What Is the Consensus?
The CWLA points to a number of key lessons learned through the Commission’s findings and opportunities for dialogue. The highlights include:
- Infants and toddlers require special attention because they are at higher risk of a fatality from abuse or neglect as compared to older children.
- Calls to child protection hotlines appear to be the best predictor of future child abuse or neglect incidents and fatalities. A new perspective on the previous decision to “screen out” certain calls may be necessary.
- Healthcare and public health professionals and agencies need to be involved to safeguard children at high risk. Coordinated inter-agency efforts are required.
- Child protection workers need access to real-time data on families.
- An accurate national count of all child protection fatalities is critical to efforts. Accuracy of data provides better understanding of which efforts work and which do not.
- The Nurse-Family Partnership program was demonstrated to have saved lives.
Coordinated care from agencies, case managers and hospital staff can have an impact on the outcomes of affected children. Furthermore, proportionally higher incidents of neglect and abuse are reported in black families than in white families, and black families receive less family and home support than their white counterparts. As Dr. Rita Cameron Wedding, California State University, shared in her testimony to the Commission:
“[T]he differential standards for neglect and abuse of black and white families can actually push families, black families, further outside the safety net. And that’s not what we want. One of the things that does that is a differential response of child welfare. We have oftentimes identical risk factors for black families and white families, but when the risk factors are identical, white families are more likely to get family and home support, and black families are more likely to have their children removed.”
This bias underlies one of the necessary actions that must be taken by all healthcare professionals and case managers. Prejudice in treatment must be addressed and removed from the equation of ongoing services and treatment, with more family and home support provided to black families whenever possible, along with fewer occurrences of children being removed from the home. The Commission recommends place-based or neighborhood strategies to address the areas that appear to have the highest rates of fatalities and work to correct any bias that may reduce the level of service provided. Pilot studies and additional concrete recommendations are laid out in detail in their report.
What Can Healthcare Professionals Do to Help?
The Commission’s findings on child fatalities and their extensive recommendations can work to reduce the number of child maltreatment fatalities with joint collaboration and follow-through from all healthcare agencies and professionals. Hospital staff, CPS case managers and behavior technicians are all able to document information and improve data collection as well as report on incidences of child abuse or neglect that they become aware of during their observations. Training that can identify and address bias in treatment may also help provide the necessary attention to all affected children, regardless of race. Additional call lines and a change in perspective can assist in identifying children at risk of future neglect and abuse. Not all recommendations will be implemented immediately, but some may find their way into new policy and improved outcomes for vulnerable children at high risk of a fatality from neglect or abuse from a family member or caregiver. Additional follow-up from the CWLA and the Commission may see improvement in the number of child fatalities in the future.