Joining Forces

Joining Families

Volume 14, Issue 1 • Winter 2014

R e a l W o r l d R e s e a r c h f o r F a m i l y  A d v o c a c y P r o g r a m s

F e at u r e d I n t e r v i e w

Child Maltreatment Fatalities: U.S. Army Responses
An Interview with Rene Robichaux, PhD
Rene Robichaux, PhD
Dr. Robichaux is the U. S. Army’s Family
Advocacy Program Manager and Social Work
Programs Manager at the Army Medical
Command in San Antonio, Texas. He received
his doctorate at the National Catholic School ofSocial Service, Catholic University, Washington,
DC. He is certified by the American Board ofSocial Workers by the National Association ofSocial Workers as a Diplomate in Clinical Social
Work. He maintains a wide variety of teaching
appointments and has numerous presentations
and publications to his credit. He served a full

In This Issue

Child maltreatment deaths are among the most tragic events in our society. In July 2013, the Army Times published an article entitled, “The Army’s
Hidden Child Abuse Epidemic.” This article reported the numbers and rates
per 100,000 of children who suffered abuse or neglect and also child death
rates as the result of maltreatment. In this issue of Joining Forces Joining
Families, we expand on the topic of child maltreatment deaths: in the Army,in the U.S. population, and the worldwide problem of child mortality. Ourinterview is with Dr. Rene Robichaux, the Family Advocacy Program Manager
at the U.S. Army Medical Command, who was also interviewed by the Army
Times. Here, we present his comments and analyses of child maltreatment
fatalities including the Army responses to child maltreatment deaths. As apart of our reports on child maltreatment fatalities, we provide a list of majorrisk factors identified by child death reviews. Other features include a briefreport on children’s concerns reported to helplines and a sample of scientificarticles on child maltreatment fatalities. As always, we appreciate the work or
our readership, and wish you a productive and healthy 2014.
Contents
Featured Interview: Rene Robichaux, PhD………… ......................................1
Child Fatalities Worldwide and in the U.S.………… ......................................3
Forensic and Medical Research on Child Maltreatment Death........................4
Major Risk Factors for Child Maltreatment Fatalities......................................5
Children Seeking Help through the use of Child Helplines.............................5
Websites of Interest.......................................................................................8

career in the U.S. Army as a social worker andretired as a colonel.

Dr. McCarroll: As the Family Advocacy
Program Manager at the Army Medical
Command (MEDCOM), responsible for theclinical aspects of FAP intervention, you havea major role in helping the Army prevent childmaltreatment fatalities. What is the recent
history of these fatalities?
Dr. Robichaux: In 2009, there were 11 childfatalities and the rate was 2.14/100,000. In
2010, there were 13 and rate was 2.45/100,000.
In 2011, there were 17 and the rate was
3.17/100,000. In 2012, there were 19 for a rateof 3.62/100,000. As you can see, an increase ofjust one or two deaths can cause a big jump in
rates per hundred thousand. By comparison,
several states in 2011 had similar or higher
child fatality rates per 100,000. Among themwere Florida (133 fatalities; 3.33/100,000),Louisiana (45; 4.02/100,000), Michigan (75;3.27/100,000), Oklahoma (38; 4.06/100,000),
Texas (246; 3.53/100,000), and West Virginia(16; 4.16/100,000). I believe that there is somedanger in comparing Army rates and civilian
rates in that the Army includes fatalities where
the manner of death is undetermined, or accidental and perhaps suspicious, and I am notsure that such fatalities would be counted as
child abuse related fatalities in the civilian community. Fatalities attributed to inflicted trauma
are classified as homicides and those of course
are counted the same way in either system.
Continued on page 2

Army fatality review
boards found somevery troubling
percentages
associated with
the impairment of
parents throughbehavioral healthdiagnoses, inparticular alcohol orsubstance abuse.

Dr. McCarroll: The Army conducts annual
review boards to better understand thecircumstances of child maltreatment
fatalities as well as for quality and process
improvement. How is the Army fatality review
board conducted?
Dr. Robichaux: We are always by, design,
two years behind. The delay is designed toallow all investigative and prosecutorial efforts
to be completed. The process begins with thelocal fatality review board at each installationthat has had fatalities. The review is conducted
as a garrison-level review process. The Family
Advocacy Program Manager (FAPM) is responsible for notifying, training, and bringing
all members together for the board. There is anestablished protocol for review.
We completed the 9th annual Departmentof the Army fatality review in June 2013. That
report has not yet been released, but an article
in the Army Times published in July 2013
reported the aggregate statistics. It focused onchild deaths for FY2011 (Sandza, 2013).
Dr. McCarroll: What have been the findings
from these boards?
Dr. Robichaux: I can give you general results. Looking at the results of boards 7 (2009),
8 (2010), and 9 (2011), 28% were deployment-

Joining Forces
Joining Families
Editor-in-Chief
James E. McCarroll, PhD
Email:
James.McCarroll.ctr@usuhs.edu
Joining Forces Joining Families
is a publication of the U. S.
Army Installation Management Command and theFamily Violence and Trauma
Project of the Center for the
Study of Traumatic Stress(CSTS), Bethesda, Maryland
20814-4799, tel. 301-2952470. CSTS is part of the
Department of Psychiatry of
Uniformed Services University of the Health Sciences,which is our nation’s federal
medical school.

2 • Joining Forces/Joining Families

Editorial Advisor
COL Anthony L. Cox, LCSW, DCSW,
MSC, USA
Family Advocacy Program Manager
Headquarters, Department of the Army
Editorial Consultants
David M. Benedek, MD, COL, MC, USA
Professor and Scientist
Center for the Study of Traumatic Stress
Uniformed Services University of the
Health Sciences
dbenedek@usuhs.edu
Nancy T. Vineburgh, MA
Director, Office of Public Education
and Preparedness
Center for the Study of Traumatic Stress
Email: nancy.vineburgh@usuhs.edu

related in that they occurred while the Soldier
was deployed, 85% were children under the ageof four and 54% were children under the ageof one. The boards identified risk factors, thosewhich might have appeared in one or more
reports. In addition to children under the ageof four, there were histories of marital problems
or domestic violence, substance abuse, special
needs children, behavioral health concerns suchas depression, suicidal ideation, prior incidents
of child abuse, and, as previously noted, thespouse was deployed at the time of the incident.
There were some very troubling percentages associated with impairment of the parents
through behavioral health diagnosis, in particular alcohol or substance abuse. The incidents
that occurred while the spouse was deployed
were largely due to lack of supervision. Typically, the mother, a single parent now due to the
spouse soldier being deployed, was depressedand self-medicating with alcohol or prescribeddrugs. No one in the house was sleeping. About
80% of the at-home parents endorsed the factthat during the deployment their sleep was significantly disturbed as was that of the children,
not surprisingly. Then, of course, we have datathat during deployment there is an uptick in
psychotropic drugs, primarily antidepressantsand probably other sleep medications. That has
been identified and supported by looking at
the pharmacy and the medical data in termsof bigger mental health bills for the health caresystem during the war, related to family member care.
Dr. McCarroll: What have been the Army’s
actions based on these reviews?
Dr. Robichaux: There are mandatory briefings on shaken baby syndrome and infant
safety. In addition, there has been training forcommanders on risk factors for child abuse andneglect and making more counselors and home
visiting available. It’s part of the shaken baby
avoidance campaign. One of the known correlates with child injuries is inconsolable crying.
However, the number of shaken baby
deaths was never really very high. It is difficult
to use the medical data system to ferret out
injuries to children that are a result of inflictedtrauma. For instance, you might have someneurological impairment or a bleed that goes
untreated. It is very difficult to tie all of thattogether. What we do know has been extrapolated from the civilian literature. Our shaken
baby avoidance campaign primarily relies on
Continued on p. 6
Winter 2014

Child Fatalities Worldwide and in the U.S.
By James E. McCarroll, PhD, David M. Benedek, MD, and Robert J. Ursano, MDChild maltreatment
deaths are among
the most tragic
events for families
and for societies.
The prevention of all
family maltreatment,
including fatalities,
is a major goal of
the Army Family
Advocacy Program(FAP).

Child maltreatment deaths are among themost tragic events for families and for societies. The prevention of all family maltreatment,
including fatalities, is a major goal of the Army
Family Advocacy Program (FAP). Fortunately,
child maltreatment fatalities in Army families
are rare events. Before specifically addressing
child fatalities in the U.S. Army, a review ofchild fatalities in general may be helpful.

Worldwide Deaths of Children

The death of children is a worldwide
problem. In 2012, 6.6 million children under
the age of 5 died. The leading causes of deathsof under-five children are pneumonia, preterm
birth complications, birth asphyxia, diarrhea
and malaria. As of June, 2013, the worldwide
mortality rate for children less than 5 years ofage is 59/1,000 children (range from 202 in
Sierra Leone to 3 in Hong Kong, Singapore,
Finland, Iceland, Sweden and Luxembourg).
The U.S. rate was 8.0/1,000 live births. Worldwide, malnutrition is the contributing factor
in over one third of all child deaths. Malnutrition makes children more vulnerable to severe
diseases. A child’s risk of dying is highest in
the neonatal period, the first 28 days of life.
Each year, nearly 3 million babies die in theirfirst month of life and 43% of child deaths areto those under the age of five. Child mortality
rates vary widely from continent to continent.
Over 70% of all child deaths occur in Africa
and South-East Asia.
The death rate has always been higher formales than for females. This is thought to be
due to more vigorous immune response andgreater resistance to infection by females.
Worldwide, for the ages 0–4, there were 144,930
deaths of males in 2005–2010; for females, thenumber was 127,563.

Child Deaths in the United States

Infant mortality. Infant mortality in the
U.S. was 6.39/1,000 live births in 2009. In thissame year, the rate ranged from 4.4/1,000 for
Asian/Pacific Islander mothers to 12.40 for
non-Hispanic black mothers. Infant mortality
for males was 7.01/1,000, 22% higher than forfemale infants, 5.75/1,000.
Injuries. Unintentional injuries are theleading cause of death of children ages 1–19 in
the U.S. For the time period 2000–2006, unin-

http://www.CSTSonline.org

tentional injuries accounted for 44% (n=67,169)
of child deaths. Non-injury deaths were 38%(57,373) and intentional injury deaths were 18%(27,222). Among children less than one year
old, most children died from non-injury deaths:
4% were unintentional injuries and 1% were intentional injuries. Males had higher death rates
than females. Transportation accidents (motor vehicles, pedestrians, and cyclists) were theleading causes of accidental deaths. For children
under age 1, suffocation was the leading causeof death; for children 1–4, it was drowning.
Child Maltreatment Fatalities. The following data are taken from the latest annual
report of child maltreatment in the UnitedStates (Child Maltreatment, 2011). The numberof reported child fatalities due to maltreatment
during the past 5 years has varied between
from 1,608 in 2007 to a high of 1,685 in 2009,
and to a low of 1,545 in 2011. The rates of U.S.
child fatalities have been remarkably stable overthe period at between 2.10–2.30/100,000. Boys
had a higher child fatality rate (2.47/100,000)
than girls (1.77/100,000). White child victims
were 40.5% of all victims, followed by AfricanAmerican (28.2%) and Hispanics (17.8%).
African-American children had the highest rateof child fatalities at 3.92 per 100,000. Childrenof multiple races (two or more races) had thesecond highest fatality rate at 2.90/100,000.
Relationship of child to perpetrator. The
child’s mother acting alone perpetrated 26.4%
of child fatalities, fathers acting alone were
responsible for 15.3% and both parents were
responsible for 22.0%. Perpetrators without aparental relationship to the child accounted for
13.4%. Child fatalities with unknown perpetrator relation-ship data accounted for 8.3%.
Childhood Deaths and Maltreatment
Types. Children who died from abuse orneglect could have suffered from more than
one type of maltreatment. Neglect and physicalabuse were the major types of maltreatment forchild deaths: neglect, 78.4%, and physical abuse,
47.9%.
Risk Factors for Child Maltreatment
Deaths. The most commonly reported risk
factors for child fatalities are: domestic violencein the home, 16.7%; drug abuse, 12.8%; andalcohol abuse, 5.7%.
Continued on page 7
Joining Forces/Joining Families • 3

Forensic and Medical Research onChild Maltreatment Death
By James E. McCarroll, PhD, David M. Benedek, MD, and Robert J. Ursano, MD

It is widely believedthat child mortality
figures in the U. S.
underestimate theincidence of childmaltreatment.

Child maltreatment death research is
published in forensic, medical, and childmaltreatment journals, and a wide variety of
informational and advocacy sites on the internet. Investigation of child death is a complex
process and, as a result, guidance for practitioners such as emergency room physicians andpediatricians is complex. Child deaths frominjury and neglect present with many different
characteristics of perpetrator, type of injury or
neglect, prior contact with child protective services (CPS) authorities, and family risk factors.
It is widely believed that child mortality
figures in the U. S. underestimate the incidenceof child maltreatment (Herman-Giddens,
Brown, Verbiest, Carlson, Hooted, Howell, &Buatts, 1999). This conclusion was reachedbased on a retrospective study of 11 years ofchild abuse homicides from medical examinerrecords in the State of North Carolina. Records
from 1985–1994 were reviewed and classified using the International Causes of Disease,
Ninth Revision, codes E960 to E969 as theunderlying cause of death and homicide as themanner of death. Of 259 homicides, 220 wererelated to child abuse. State vital records underrecorded deaths due to battering or abuse by
58.7%. Black children were killed at three times
the rate of white children (4.3/100,000 versus
1.3/100,000). Males were 65.5% of the known
probably assailants. Under-recording prevents
improved strategies for prevention of childhomicides. Other causes of undercounting areinconsistencies in investigations, reporting, legal standards and definitions, medical diagnosis and death certificate coding (Palusci, Yager& Covington, 2010.)
Neglect can also be a cause of child maltreatment mortality. A retrospective review
of pediatric deaths in South Carolina over a
25-year period found 16 cases due to pediatricneglect (Knight & Collins, 2005). Cases wereanalyzed for age, sex, race, cause and mannerof death, autopsy findings, ancillary studies,
past medical history, social/family history andcaregiver. Six deaths were due to malnutrition/
starvation and/ or dehydration. Others were
electrocution, drowning/ aspiration, delayed orabsent medical therapy, toxic ingestions, andhyper- or hypothermia. Researchers noted that

4 • Joining Forces/Joining Families

typically investigators encounter cases where
the child under the age of one year has been
deprived of food or drink, or the independently
mobile child has been inadequately supervised.
As a prior history of maltreatment or nonfatal
neglect may be missing, medical records should
be included as part of the investigation.
A study of 4.3 million children in California
during the time period 1999–2006 found thatchildren who had been reported for nonfatal
maltreatment subsequently faced a heightenedrisk of unintentional and intentional injury
death during their first 5 years of life (PutnamHornstein, 2011). These children died from
intentional injuries at a rate that was 5.9 times
that of children who had not been reported,and died at twice the rate from unintentional
injuries. A prior allegation to CPS was thestrongest independent risk factor for injury
mortality before the age of 5 years. Because
the study demonstrated that children who arereported for maltreatment can die at a higher
than normal rate from unintentional injuries,
a focus solely on intentional injuries may missa significant opportunity for child protection
from unintentional injuries.
Determination of death as a result ofmaltreatment depends on good investigation,
documentation and recording of events. Deathreview boards are very helpful in providing forunderstanding these deaths. Such reviews are
conducted by the military services as well as bycitizens review panels (Palusci, Yager & Covington, 2010.) The National Death Reporting System is also a significant source of information
for research on all child fatalities (Klevens &Leeb, 2010). Study of the results of such review
can provide service workers and practitioners
with significant information to prevent childdeaths and improve the lives of children andfamilies.

References

Herman-Giddens ME, Brown G, Verbiest S,
Carlson PJ, Hooten EG, Howell E, & Butts JD.
(1999). Underascertainment of child abusemortality in the United States. Journal of theAmerican Medical Association; 281(5):463–467.

Continued on page 8
Winter 2014

Major Risk Factors for Child Maltreatment Fatalities
By James E. McCarroll, PhD

Most childmaltreatment deaths
result from physicalabuse, in particularfrom injuries to thehead.

The National Center for Child Death
Review is a resource center for state and local
child death review program and is funded by
the Maternal and Child Health Bureau. The
Center, (http://www.childdeathreview.org/aboutus.htm), promotes, supports and enhanceschild death review methodology and activities
at the state, community and national levels.
Most child maltreatment deaths result fromphysical abuse, in particular from injuries tothe head. These injuries are likely to occur
when a child’s head is hit against a surface
such as a wall or is severely struck or violently shaken. Another common cause of childphysical abuse deaths is injury to the abdomen
often through kicks or punches, which lead tointernal bleeding. The most common reason
for these injuries is that caretakers lose patience
when the child does not stop crying. [Editor’snote: See interview with Dr. Robichaux and thecard for Soldiers “Tips on Soothing a Crying
Baby”.]
Fatalities from neglect can occur whencaregivers fail to adequately provide for orsupervise their children. Examples are failure toprovide food leading to malnutrition, starvation or dehydration. Other caregiver omissions
include the failure to nurture or to provide
medical care for children or failure to supervise. These omissions may result in bathtub

drownings, suffocations, poisonings and otherfatal incidents. Fatal abuse is often interrelatedwith poverty, domestic violence and substanceabuse.
It is difficult to predict child maltreatment
deaths, but major risk factors have been identified by the CHD.
■■ Younger children, especially under the ageof five■■ Parents or caregivers who are under the ageof 30■■ Low income, single-parent families experiencing major stresses■■ Children left with male caregivers who lackemotional attachment to the child■■ Children with emotional and health problems■■ Lack of suitable childcare■■ Substance abuse among caregivers■■ Parents and caregivers with unrealistic
expectations of child development andbehavior
These risk factors are helpful tips for all
providers who are in contact with families in
distress.

Children Seeking Help through the Use of 			
Child Helplines
By James E. McCarroll, PhD
A recent United
Nations study ofchildren seeking help
through helplines
found that they arewilling to share theirconcerns and fears
once they trust asystem.

http://www.CSTSonline.org

Children’s problems occur worldwide. A
recent United Nations report (http://srsg.violenceagainstchildren.org/story/2013-11-20_929)
provided data from a ten-year project, theChild Helpline International (http://www.
childhelplineinternational.org), showing thatchildren around the world contact helplines forsupport with violence and abuse, peer relationships, psychosocial and mental health andfamily conflicts. This report provides insight
into the nature of challenges that children facefrom their own point of view. Adults on the responder end of these helplines attempt to help
children take control of their own lives andresolve their problems as best they can.

The study found that children are willing toshare their concerns and fears once they trust asystem. There were over 4 million reports, themost from Europe (46%) followed by AsiaPacific (31%), Africa (14%), Americas andthe Caribbean (7%) and the Middle East andNorth Africa (2%). The number of contacts has
increased by 5% per year. Child helplines also
received calls for help dealing with problems
at school including academics, performanceanxiety, violence and abuse committed byteachers and peers. Bullying was found to bea worldwide concern. Immediate or extended
family members were reported to have comContinued on page 8
Joining Forces/Joining Families • 5

Rene Robichaux Interview,
From page 2

It is Army Medical
Command policy toscreen aggressively
for depression in
spouses of deployedsoldiers

a mandatory briefing of parents about inconsolable crying, and techniques for soothing acrying baby. The briefing is given after the birthof their child, but prior to their release fromthe hospital. [Editor’s note: See for Soldier Tip
Card for a Baby’s Inconsolable Crying.]
There was one other initiative that might
not be referenced in the results of the reviews.
It was an outcome of the research findings
related to increased risk of child neglect during deployment — a MEDCOM policy urging
more aggressive screening for depression in
spouses of deployed soldiers. The screening is averbal inquiry from the medical provider. The
inquiries have to come from the provider. If it
is done by the person doing the blood pressurecheck, you often will get a negative response.
We tried to get the word out to all primarycare physicians, primary care managers, andpediatricians who might see the parent inconjunction with seeing the child, and ob-gyn
providers who see the spouse.
Dr. McCarroll: Are cases that were notpreviously known to FAP reviewed?
Dr. Robichaux: They are. We review any
fatality that is related to child abuse or domestic violence. If a case was not entered into the
Army Central Registry (ACR) as a FAP-related
fatality, but on closer observation the board
finds that it should have been, it is presented to
the local hospital Case Review Committee. If

6 • Joining Forces/Joining Families

they find that it should have been a FAP case, it
is put into the ACR.
The child cases that are reviewed are theones where there was inflicted trauma or accidental death due to parental negligence. In casesof domestic abuse, of course, any homicide andany suicide. Sometimes the suicides are notconnected to a homicide. Sometimes, the suicides are in close proximity to or in an ongoingdomestic violence dispute. An example might
be a situation in which the couple argued;
they had been arguing and fighting all day. She
was able to flee to a neighbor for help. He had
beaten her and abused her. Anticipating that hewould go to jail and that he had contributed tothe end of the marriage, he took his own life.
Dr. McCarroll: Is there any mandatory
requirement for abusive families to have home
visiting?
Dr. Robichaux: It is not mandatory. You
can make soldiers do things, but you cannot
force spouses. That is one of the themes in thelast two fatality reviews. Quite a few cases were
known to helping agencies and had received
referrals to the New Parent Support Program(NPSP). NPSP contacted the families and thefamilies declined the services. To many people
on the Fatality Review Board, this was just so
sad because we had an opportunity; we might
have been able to make a difference, but wewere turned away.

Winter 2014

Rene Robichaux Interview,
From page 6

We could up theacceptance rate offamilies who decline
home visiting services
if we had the ability tobetter train the home
visitors in delivering
services to resistantclients.

To some degree, we believe that there is a
training issue involved in getting the families
to accept the service. We have not been able
to train the people who are in the positions.
They are both social workers and nurses andin either case they appear to be insufficiently
trained on how to deliver services to resistantclients. It is just not that difficult. We know that
we could up the acceptance rate if we simply
had the ability to train these people. Social
workers have been doing this for a 100 years
or more: delivering services to people who do
not want their help. You do it by approachingthem in a helpful fashion, by providing support. One means is by providing somethingtangible. It could be a used washer or dryer thatyou could get a helping agency or a church to
donate. That something tangible creates a senseof trust and obligation on their part to invite
you back. In addition, the connection between
labor and delivery, maternal and infant healthin the hospital, and NPSP staff at ACS needs tobe very strong.
Dr. McCarroll: So much of the success ofthese programs is personality-driven anddependent on the abilities and desiresof the leaders on the installation to work
cooperatively.
Dr. Robichaux: Exactly. That is a potential
vulnerability for our programs.

Dr. McCarroll: What other concepts or topics
are important that I have not asked you about?
Dr. Robichaux: You have hit on the concernsthat we have about the frequency of impairment of the parents and the importance of thepeople who interface with those parents. Sometimes, they do not have the perspective that
there could be children impacted and negatively
affected by the parents’ incapacity.
For example, often when providers or counselors see soldiers or civilian parents seeking
alcohol or substance abuse counseling or any
other behavioral health counseling that had to
do with mood disorder, they do not address
whether there are children that could be affected by the parents’ incapacity. Sometimes, welook at soldiers in isolation from their families
and support groups. We limit ourselves to assessing risk of harm to self. What is missing
is the risk of harm to others, in particular, theharm to the family.
Dr. McCarroll: Thank you for your insights
into the difficulties in understanding andpreventing child maltreatment fatalities.
Dr. Robichaux: You are welcome.

References

Child Maltreatment, 2011. http://www.acf.hhs.
gov/programs/cb/research-data-technology/
statistics-research/child-maltreatment
Sandza R. (2013). An Epidemic of Abuse. Army
Times, July 28, 2013.

Child Fatalities Worldwide
and in the U.S. 		
From page 3

In summary, theyoungest children
are the most at-riskfor child deaths.

In summary, the youngest children are themost at-risk for child deaths. Death rates mayvary geographically around the world. Childhood deaths are due to disease, injury, lack of
medical care, and maltreatment. Child protection workers and health care providers who areaware of as many aspects of child vulnerability
as possible can prevent many child deaths.

■■ CDC Childhood injury reports can befound at:			
http://www.cdc.gov/safechild/images/CDCchildhoodinjury.pdf■■ The latest U.S. child maltreatment data canbe found at:				
http://www.acf.hhs.gov/sites/default/files/cb/
cm11.pdf■■ Mortality data can be found at:
http://esa.un.org/unpd/wpp/Excel-Data/
mortality.htm			
http://www.who.int/mediacentre/factsheets/
fs178/en/■■ Information on death rates for males andfemales can be found at:		
http://www.pnas.org/content/105/13/5016.
full

http://www.CSTSonline.org

Joining Forces/Joining Families • 7

Neglect can also
be a cause of childmaltreatment
mortality.

Forensic and Medical Research,		From page 4Children Seeking Help,				
From page 5

Klevens J & Leeb RT. (2010). Child maltreatment fatalities in children under 5: Findings from the National Violence Death
Reporting System. Child Abuse & Neglect;
34: 262–266.

mitted 58 percent of the physical abuse. The
majority (60%) of abuse and violence wasreported by girls. Family matter concerns
were parent-child relationships, parents inconflict, divorce, and separation and new or
blended families.
Many times, children’s concerns may be
expressed both within and outside of thefamily and are recognized by children as
challenge to themselves, their parents andother caregivers, peers, and support providers. Thus, specific inquiry to children,
themselves, into the many topics of potential
concerns can open new avenues of support tohelp them.
The National Child Abuse Hotline can bereached at 800-422-4253 and at http://www.
childhelp.org/pages/hotline-homeThis service began in 1982 and hasreceived over 2 million calls from children
at risk for abuse, distressed parents seeking
crisis intervention and concerned individuals
who suspect that child abuse may be occurring.

Knight & Collins, 2005). A 25-year retrospective review of deaths due to pediatricneglect. American Journal of Forensic
Medicine and Pathology; 26(3):221–228.
Palusci VJ, Yager S & Covington TM.
(2010.) Effect of a citizen’s review panel in
preventing child maltreatment fatalities.
Child Abuse & Neglect; 34:324–331.
Putnam-Hornstein E. (2011). Report ofmaltreatment as a risk factor for injury
death: A prospective birth cohort. Child
Maltreatment; 16(3):163–174.

Websites of Interest
The National Center for Child Death Review Policy and Practice at
the Michigan Public Health Institute, Okemos, MI 48864 lists resources
for the prevention of child maltreatment as well as information on
prevention programs.
The following are but a few of the long list of resources that may be
helpful in understanding and preventing child maltreatment. Most of
the resources listed on this site link to further resources.
■■ National Center for Child Death Review Policy and Practice
http://www.childdeathreview.org/■■ American Humane Association— http://www.americanhumane.
org/children/stop-child-abuse/fact-sheets/shaken-baby-syndrome.
html■■ Child Welfare League of America — https://www.cwla.org/■■ Prevent Child Abuse Americ — http://www.preventchildabuse.org/
index.php■■ Healthy Families America
http://www.healthyfamiliesamerica.org/home/index.shtml■■ Understanding Child Maltreatment, CDC Fact Sheet 2010
http://www.cdc.gov/violenceprevention/pdf/CM-factsheet-a.pdf

8 • Joining Forces/Joining Families

www.childdeathreview.org/causesCAN.htm(The National Center for Child Death Review
Policy and Practice at the Michigan Public
Health Institute)

Winter 2014