Challenges in Determining Child Maltreatment Fatalities: What Do We Really Know?

Abstract

The challenges associated with determining causes of fatal child maltreatment have been documented by multiple professional fields and by the US government. This study explored these challenges, as well as the relative lethality of determinations of general neglect, medical neglect and physical abuse. Existing sources of information were used for this study: (1) data from the US National Child Abuse and Neglect Data System (NCANDS) data set extracted from annual Child Maltreatment reports published by the US Department of Health and Human Services; and (2) information published in recent state‐level child death review team (CDRT) reports. Results from the NCANDS data set indicated that more children died from general neglect (x̅ = 70.9%) than abuse (x̅ = 44.8%) or medical neglect (x̅ = 8.2%). Children who experienced medical neglect died at the highest rate (6.82 per 1000 medical neglect victims), making it the most lethal, followed by physical abuse and general neglect. The findings from CDRT reports were inconsistent, with some states indicating that more children died from abuse than neglect, which is in direct contrast to national statistics. The inconsistent and confusing use of language and constructs from CDRTs has important implications for multiple child‐serving fields.Key Practitioner Messages Professional child‐serving fields struggle with making accurate determinations of abuse or neglect‐related fatalities. Most child maltreatment fatalities are related to neglect. In terms of lethality, medical neglect appears to be most lethal, followed by physical abuse, and then general neglect. US‐state CDRT reports are not consistent in their use of terms and confuse constructs such as ‘neglect’ and ‘accident’. This makes it challenging to use their reviews as reliable sources of information. We recommend the adoption of consistency in the use and understanding of terms related to child maltreatment deaths, at a minimum across all jurisdictions in the USA, if not across all nations.

Child Protection Work: ‘How Can We Make It a Better Experience?’

“…Nevertheless, as a contributory or background factor, neglect is found in a majority of cases of fatal child maltreatment: in the most recent triennial review, there was evidence of neglect in 68 per cent of all fatal cases (Brandon et al ., 2020). These findings are in keeping with those of Douglas and Lee (2020) and once more confirm the need for consistency with regards to definitions of cause of death among children in the areas of abuse and neglect.…”

“…Our first paper in this issue by Emily Douglas and Kerry Lee (2020) from the USA addresses the challenges associated with determining fatal child maltreatment and revisits a topic that we have previously covered in Child Abuse Review (Brandon et al ., 2014; Brown and Tyson, 2014; Sidebotham, 2013). Douglas and Lee (2020) begin their paper by making the case that child maltreatment fatalities in the literature are generally treated as a single construct, when actually the research shows ‘that abuse and neglect emerge from different child and family risk factors’ (p. 507). They also highlight the literature and anecdotal evidence from frontline staff showing discrepancies in the reporting of how children die and what happens in practice.…”

“…The two sources included: (1) the US National Child Abuse and Neglect Data System, which is presented in annual child maltreatment reports published by the US Department of Health and Human Services; and (2) information published in state‐level child death review team reports. One aspect that came out of the analysis ‘was the inconsistent use of language, terms and definitions’ (Douglas and Lee, 2020, p. 512) and the need for uniformity in definitions. Douglas and Lee (2020) identified inconsistency in how professionals use terms such as ‘abuse’, ‘neglect’, ‘negligence’ and ‘accident’; they comment that:

‘These terms are used interchangeably, which makes it difficult to determine the best service plans for families and also in determining whether surviving children might be at risk.’ (Douglas and Lee, 2020, p. 515)

The triennial analyses of serious case reviews (SCRs) in England have previously identified that severe neglect is rarely the primary cause of death in cases of fatal child maltreatment, accounting for no more than three per cent of all fatal SCR cases (Brandon et al ., 2020; Sidebotham et al ., 2016).…”

“…One aspect that came out of the analysis ‘was the inconsistent use of language, terms and definitions’ (Douglas and Lee, 2020, p. 512) and the need for uniformity in definitions. Douglas and Lee (2020) identified inconsistency in how professionals use terms such as ‘abuse’, ‘neglect’, ‘negligence’ and ‘accident’; they comment that:

‘These terms are used interchangeably, which makes it difficult to determine the best service plans for families and also in determining whether surviving children might be at risk.’ (Douglas and Lee, 2020, p. 515)

The triennial analyses of serious case reviews (SCRs) in England have previously identified that severe neglect is rarely the primary cause of death in cases of fatal child maltreatment, accounting for no more than three per cent of all fatal SCR cases (Brandon et al ., 2020; Sidebotham et al ., 2016). Nevertheless, as a contributory or background factor, neglect is found in a majority of cases of fatal child maltreatment: in the most recent triennial review, there was evidence of neglect in 68 per cent of all fatal cases (Brandon et al ., 2020).…”

“…‘These terms are used interchangeably, which makes it difficult to determine the best service plans for families and also in determining whether surviving children might be at risk.’ (Douglas and Lee, 2020, p. 515)…”