Severe Child Maltreatment Injuries & Fatalities: A Serious Public Health and Child Welfare Concern

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This article is abstracted from the foreword to an upcoming special issue of CWLA's Child Welfare journal.

In FY 2011, 51 U.S. states reported a total of 1,545 child fatalities. Based on these data, a nationally estimated 1,570 children died from abuse and neglect (USDHHS, 2012, p. x). This number is considered to be an under-count, according to the 2011 U.S. Government Accountability Office (GAO) report on child maltreatment and fatalities (GAO, 2011). Though we have made significant strides toward keeping children safe in this country, we cannot fully or adequately address the issue of child fatalities until we know the full scope of the problem.

Casey Family Programs' "Improving Child Safety and Preventing Fatalities" Forums

In an effort to influence and mobilize national efforts to prevent child maltreatment-related fatalities, Casey Family Programs, a national foundation dedicated to improving child welfare outcomes in this country through its 2020 strategy, launched a series of forums in 2011 and 2012. The Administration on Children Youth and Families and the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention joined Casey in hosting these events. The forums were attended by national organizations, experts, policymakers, advocates, researchers, practitioners, and state leaders in the field of child welfare and public health. At the forum in the fall of 2012, leaders from 12 state and local jurisdictions met with national experts to develop specific action plans targeted toward improving child safety and preventing fatalities.

These forums provided child welfare and public health with an opportunity to explore this issue from different perspectives, and the forums focused on three major topics:

  1. Measurement: Developing more accurate ways to classify and count maltreatment-related fatalities as a means of informing policy and practice, as well as developing better child safety performance measures.
  2. Child Protection Policy and Practice: Informing child protection policies and practices for reducing child maltreatment related fatalities.
  3. Public Health Approach: Exploring public health strategies for preventing child maltreatment fatalities.

The following lessons learned emerged from these discussions:1

Child maltreatment fatalities are a public health issue: The prevalence of maltreatment overall in the population and the numbers of children who die due to maltreatment is substantial. A significant number of child maltreatment- related deaths involve young children, and occur in families who have no history of involvement with the child welfare system. Therefore, it would be prudent to look at the issue of child deaths, not just through the lens of child welfare, but from a broader public health perspective.

High-quality data, as well as other kinds of research evidence, are essential to inform the strategy and assess its results. This starts with surveillance: being able to count and measure the problem. This strategy also includes data to identify families at the highest risk, which is necessary to target upstream prevention. And it includes data to place deaths, injuries and "near-misses" in a systemic context, to inform system improvements that have been crucial to safety engineering successes. In addition, evidence synthesized from past research should inform the initial choices of programs and strategies, which then can be tracked for effectiveness and fine-tuned over time

Successful strategies are comprehensive. This lesson emerges above all from the public health successes that are comprehensive in multiple ways. First, they are multi-level, potentially including components at the level of the individual, the family, the community, service systems and public policy, as well as broader public attitudes and beliefs. Second, they target several different levels of including universal prevention efforts, targeted towards an entire community or nation.

Strategies are not limited to any one sector or agency. Multi-agency and multi-sector strategies involvement, including health, law enforcement and education, as well as child welfare systems and service providers is necessary to address this issue. Other sectors or partners identified included the media, elected officials, the broader public and anti-poverty and affordable housing experts and activists.

Successful strategies are focused. Comprehensive isn't the same as trying to do everything. The key is a focused approach, based on data and evidence, with high-impact opportunities that can make a difference.

We can succeed. Public health and safety engineering efforts have reduced deaths and injuries in the U.S. from many causes that initially seemed intractable. This has been true even when, at the beginning of the effort, those causes seemed deeply ingrained in cultural and individual beliefs (drunk driving, smoking, bike riding without helmets, low use of infant car seats), or driven by errors caused by interactions between humans (medical errors), or hampered by a belief that the injury or fatality was the result of unpreventable bad luck (plane crashes).

The contents of the upcoming special issue of Child Welfare journal reflect the presentations and discussions that took place at the Casey Forums. The special issue will include the latest research on risk factors related to severe child maltreatment as well as showcase innovative safety assessment, safety engineering, and replicable efforts by public health, child welfare and other systems. In addition, it will discuss other strategies for creating learning environment for improving child protection and strengthening the efforts of child welfare, public health and other systems to identify and respond to children at risk.

Zeinab Chahine is a Managing Director for Strategic Consulting at Casey Family Programs, responsible for leading the Foundation's strategic engagements in 14 states and multiple local jurisdictions that are working toward improving child welfare outcomes. Peter J. Pecora has a joint appointment as the Managing Director of Research Services for Casey Family Programs and as a professor at the University of Washington's School of Social Work.


Chahine, Z. & Pecora, P.J. (2013). Preventing severe child maltreatment injuries and fatalities: Applying public health and other approaches. Child Welfare, 92(2), in press.

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2012). Child Maltreatment 2011. Retrieved from child-maltreatment-2011

U.S. Government Accountability Office. (2011). Child Maltreatment: Strengthening National Data on Child Fatalities Could Aid in Prevention. (GAO 11-599). Retrieved from new.items/d11599.pdf

1 Special thanks to Olivia Golden and the Urban Institute staff for the issues paper that informed the design of the first forum and the lessons learned.

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