The United States lacks coherent, effective strategies for reducing the stubbornly high number of children who die each year from abuse and neglect, a commission created by Congress reported Thursday after two years of sometimes divisive deliberations.
According to federal data, the number of such deaths has hovered at around 1,500 to 1,600 annually in recent years. But citing gaps in how this data is compiled, the report suggests the actual number may be as high as 3,000 a year.
Commission chairman David Sanders said a goal of zero maltreatment deaths was realistic.
"We looked at the airline industry — no one accepts a plane crash anymore. We can get that way with child fatalities," said Sanders, executive vice president of Casey Family Programs.
The report made dozens of recommendations, including expanding safe-haven programs for abandoned infants and enlisting a broader range of community organizations to help often-overburdened child protection service workers.
"We need a system that does not rely on CPS agencies alone to keep all children safe," the report said. "Other systems become key partners, including the courts, law enforcement, the medical community, mental health, public health, and education. Even neighbors who come into regular contact with young children and families are part of a public health approach."
Still, the commission, comprised of six members appointed by Congress and six by President Barack Obama, failed to reach consensus on some issues. Two members declined to approve the final report and wrote dissents criticizing one of the major proposals.
Under that proposal, states would be required to review all child abuse and neglect deaths from the previous five years, and then develop prevention plans. States would identify children at high risk, and conduct investigations and home visits to determine if their families needed support services or if the children should be removed. Some commissioners recommended that Congress immediately allocate at least $1 billion in new funding to implement the plan.
"The commission is claiming that spending $1 billion on an experiment reviewing previous deaths will immediately save lives. This claim is not supported by evidence," wrote dissenting commissioner Cassie Statuto Bevan, a child-welfare expert at the University of Pennsylvania's Field Center for Children's Policy.
The other dissenter was Patricia Martin, Chicago-based presiding judge of the Child Protection Division of Cook County Circuit Court. She expressed concern that the proposal would lead to more children being placed unnecessarily in foster care, and urged more support to keep families together. She also contended that the commission, by focusing on children under 5, had missed a chance to address fatalities among older children.
During two years of consultations and hearings, the commission uncovered little in the way of model programs at the state or local level that it could recommend on a national basis. One of the few initiatives to win praise was home visiting — visits to an at-risk mother's home by a nurse, social worker or early childhood educator during pregnancy and in the first years of a child's life.
The commission report called "stunningly high" the rate of maltreatment deaths among black children: 2 1/2 times greater than the rate for white children.
Maltreatment deaths represent a tiny fraction of the more than 3 million reports of child abuse and neglect received each year by hotlines and law enforcement agencies. According to federal data, about 40 percent of the reports are soon "screened out" — judged not to warrant further action.
The commission said states should be more rigorous, responding to all reports regarding children under 3 and children who were the subject of previous reports. It said reports about infants less than 1 year old should get responses within 24 hours.
The commission found shortcomings at virtually every sector of the child-welfare system, including at the federal level, which it said fails to provide guidance, monitoring and enforcement.
At the state level, the report decried high caseloads and stressful working conditions for child protection workers.
"Shortages of workers, funds and training may mean that inexperienced workers are tasked with making life-or-death decisions with insufficient preparation or support," said the report.
One commissioner, Jennifer Rodriguez, is a former foster child who spent six years in group homes. Now executive director of the San Francisco-based Youth Law Center, Rodriguez expressed hope that initiatives arising from the report would help provide substance abuse treatment, mental health care and other supports for parents in at-risk families, so that their children might be able to stay with them.
"Foster care is not always a safe place," she said.
Among the organizations following the commission's work was the American Academy of Pediatrics.
Dr. Andrew Sirotnak, a leader of the academy's Section on Child Abuse and Neglect and head of the Child Protection Team at Children's Hospital Colorado, said the report's legacy would depend on finding practical, politically feasible steps to reduce maltreatment fatalities.
His suggestions include strengthening child-abuse detection training for pediatricians and improving coordination between child-protection services and medical professionals who serve at-risk families.
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