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78–759 2013

PROPOSAL TO REDUCE CHILD DEATHS 

DUE TO MALTREATMENT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

DECEMBER 12, 2012

Serial No. 112–HR16 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

DAVE CAMP, Michigan, Chairman 

WALLY HERGER, California 

SAM JOHNSON, Texas 

KEVIN BRADY, Texas 

PAUL RYAN, Wisconsin 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

JIM GERLACH, Pennsylvania 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

AARON SCHOCK, Illinois 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

RICK BERG, North Dakota 

DIANE BLACK, Tennessee 

TOM REED, New York 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

FORTNEY PETE STARK, California 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

SHELLEY BERKLEY, Nevada 

JOSEPH CROWLEY, New York 

JENNIFER SAFAVIAN, Staff Director 

JANICE MAYS, Minority Chief Cousel 

SUBCOMMITTEE ON HUMAN RESOURCES 

ERIK PAULSEN, Minnesota, Acting Chairman 

RICK BERG, North Dakota 

TOM REED, New York 

TOM PRICE, Georgia 

DIANE BLACK, Tennessee 

CHARLES W. BOUSTANY, JR., Louisiana 

LLOYD DOGGETT, Texas 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

JOSEPH CROWLEY, New York 


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C O N T E N T S 

Page 

Advisory of December 12, 2012 announcing the hearing ..................................... 2 

WITNESSES 

The Honorable Bill Frenzel 

Guest Scholar, Brookings Institution (former Member of Congress; former 

Chairman, Pew Commission on Children in Foster Care) 

Testimony .......................................................................................................... 9 

Teresa Huizar 

Executive Director, National Children’s Alliance (NCA) 

Testimony .......................................................................................................... 16 

Madeline McClure 

Executive Director, TexProtects (The Texas Association for the Protection 

of Children) 

Testimony .......................................................................................................... 23 

David Sanders, Ph.D. 

Executive Vice President of Systems Improvement, Casey Family Programs 

Testimony .......................................................................................................... 34 

SUBMISSIONS FOR THE RECORD 

Alliance for Children and Families ........................................................................ 49 

American Psychological Association ....................................................................... 52 

Children’s Advocacy Institute ................................................................................. 55 

First Focus ............................................................................................................... 59 

George Lithco ........................................................................................................... 63 

Michael Durfee ......................................................................................................... 69 

Michigan Department of Human Services ............................................................. 78 

National Association of Social Workers ................................................................. 81 

Stephanie Bingham Doss ........................................................................................ 89 

Sylvia Randolph ....................................................................................................... 92 


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PROPOSAL TO REDUCE CHILD DEATHS DUE 

TO MALTREATMENT 

WEDNESDAY, DECEMBER 12, 2012 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON WAYS AND MEANS, 

Washington, DC. 

The subcommittee met, pursuant to call, at 2:11 p.m., in Room 

1100, Longworth House Office Building, the Honorable Erik Paulsen [Acting Chairman of the Subcommittee] presiding. 

[The advisory of the hearing follows:] 


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HEARING ADVISORY 

Acting Chairman Paulsen Announces Hearing on 

Proposal to Reduce Child Deaths Due to Maltreatment 

Wednesday, December 05, 2012 

By (202) 225–3625 

Congressman Erik Paulsen (R–MN), Acting Chairman of the Subcommittee on 

Human Resources of the Committee on Ways and Means, today announced that the 

Subcommittee will hold a hearing to discuss a bipartisan proposal to establish a 

commission tasked with developing recommendations for reducing child deaths due 

to maltreatment. The hearing will take place at 2:00 pm on Wednesday, December 12, 2012, in Room 1100 of the Longworth House Office Building. 

In view of the limited time available to hear from witnesses, oral testimony at 

this hearing will be from invited witnesses only. Witnesses will include experts on 

child abuse and neglect and child fatalities due to maltreatment. However, any individual or organization not scheduled for an oral appearance may submit a written 

statement for consideration by the Committee and for inclusion in the printed 

record of the hearing. 

BACKGROUND: 

According to State reports, over 1,500 children in the U.S. died in FY 2010 due 

to maltreatment. However, research has shown that these reports substantially understate the number of children who die due to maltreatment each year. To gain 

a clearer understanding of this issue, Ways and Means Committee Chairman Dave 

Camp (R–MI) asked the Government Accountability Office (GAO) to review what is 

known about the circumstances of child deaths and near deaths due to maltreatment, State approaches to gathering and reporting this information, and what the 

Department of Health and Human Services (HHS) has done to support the collection 

and accurate reporting of this information. GAO testified about the findings of their 

review and released its report during an earlier Human Resources Subcommittee 

hearing held on Tuesday, July 12, 2011. 

Since the earlier hearing, Members have continued bipartisan discussions on ways 

to reduce fatalities due to maltreatment. Specifically, full Committee Chairman 

Dave Camp (R–MI) and Subcommittee Ranking Member Lloyd Doggett (D–TX) have 

developed a proposal, the Protect our Kids Act, to establish a commission that would 

examine the issue and recommend ways to improve current policy and practices. 

The purpose of this hearing is to review that proposal and solicit input from key 

stakeholders and other experts on how such a commission might best undertake this 

work. A draft of this proposal, on which witnesses will be asked to comment in their 

testimony, can be found at the following link: http://waysandmeans.house.gov/ 

UploadedFiles/Commission_Draft.pdf. 

In announcing the hearing, Acting Chairman Paulsen stated, ‘‘The death of any 

child is a tragedy, but there is nothing more heartbreaking than when a child dies 

at the hand of someone who should have cared for them most. Our hearing last year 

highlighted this issue and what can be done to collect better information on the 

problem. Now we have a bipartisan proposal to investigate this issue further and 

produce real reforms. I look forward to hearing our witnesses’ thoughts on this proposal so we can ensure that more kids are protected from abuse and neglect.’’ 

FOCUS OF THE HEARING: 

The hearing will focus on the bipartisan proposal, the Protect our Kids Act. The 

draft legislation establishes a commission to examine the issue of child fatalities 

from abuse and neglect, review the effectiveness of current programs and policies, 

and recommend ways to reduce child fatalities due to maltreatment. 


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DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit for the hearing record must follow the appropriate link on the hearing page of the Committee 

website and complete the informational forms. From the Committee homepage, 

http://waysandmeans.house.gov, select ‘‘Hearings.’’ Select the hearing for which you 

would like to submit, and click on the link entitled, ‘‘Click here to provide a submission for the record.’’ Once you have followed the online instructions, submit all requested information. Attach your submission as a Word document, in compliance 

with the formatting requirements listed below, by Wednesday, December 26, 

2012. Finally, please note that due to the change in House mail policy, the U.S. 

Capitol Police will refuse sealed-package deliveries to all House Office Buildings. 

For questions, or if you encounter technical problems, please call (202) 225–1721 or 

(202) 225–3625. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing 

record. As always, submissions will be included in the record according to the discretion of the Committee. The Committee will not alter the content of your submission, 

but we reserve the right to format it according to our guidelines. Any submission 

provided to the Committee by a witness, any supplementary materials submitted for 

the printed record, and any written comments in response to a request for written 

comments must conform to the guidelines listed below. Any submission or supplementary item not in compliance with these guidelines will not be printed, but will 

be maintained in the Committee files for review and use by the Committee. 

1. All submissions and supplementary materials must be provided in Word format and MUST 

NOT exceed a total of 10 pages, including attachments. Witnesses and submitters are advised 

that the Committee relies on electronic submissions for printing the official hearing record. 

2. Copies of whole documents submitted as exhibit material will not be accepted for printing. 

Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material 

not meeting these specifications will be maintained in the Committee files for review and use 

by the Committee. 

3. All submissions must include a list of all clients, persons, and/or organizations on whose 

behalf the witness appears. A supplemental sheet must accompany each submission listing the 

name, company, address, telephone, and fax numbers of each witness. 

The Committee seeks to make its facilities accessible to persons with disabilities. 

If you are in need of special accommodations, please call 202–225–1721 or 202–226– 

3411 TTD/TTY in advance of the event (four business days notice is requested). 

Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above. 

Note: All Committee advisories and news releases are available on the World 

Wide Web at http://www.waysandmeans.house.gov/

f 

. 

Mr. PAULSEN. Good afternoon. I call the subcommittee hearing 

to order. 

The purpose of today’s hearing is to discuss a proposal designed 

to reduce the number of children who die from abuse and neglect. 

I would like to thank our colleague, Mr. Doggett, as well as 

Chairman Camp, for their work on this very important proposal 

that we will consider today. There are tragically too many examples, like Devin Drake, of why this is an important issue. Threeyear old Devin Drake was brought to Mercy Hospital in Minneapolis, Minnesota, by his mother, Elizabeth Moorman, on August 

30, 2011. She said that Devin had been completely normal until he 

collapsed at home just a few minutes earlier. After questioning by 

medical staff, and later police, her boyfriend, Anthony Urban, admitted to punching Devin the day before. He said the boy then fell 


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off a stool and hit his head on the bathroom ceramic floor. Even 

though Devin had trouble standing up and was obviously seriously 

injured, neither his mother nor her boyfriend took time to bring 

him to the hospital. The next day, even after Devin’s condition 

worsened, they still did not get help for him. Finally, it was that 

evening that Devin’s mom took him to the hospital. 

Police reports revealed that this was not the first time that 

Devin had suffered abuse. Before his birth, Devin’s mother was 

convicted on drug charges. After Devin was born, social workers 

contacted his mother because of alleged drug abuse. At the time of 

Devin’s hospital visit, his mother had outstanding warrants for her 

arrest, which no doubt contributed to her reluctance to take her 

son to the hospital. 

Her boyfriend had two felony drug convictions. Neighbors said 

they noticed Devin recently had had a black eye. One neighbor said 

she had planned to go to authorities the very day that Devin was 

taken to the hospital. 

When Devin arrived at the hospital, medical staff realized his injuries were no accident. He was diagnosed with severe head trauma, punctured lungs, and a number of contusions. He was airlifted 

to Hennepin County Medical Center, where his injuries were found 

to be consistent with severe abuse. 

Four days later, 3-year old Devin Drake died. Nothing is more 

breathtaking, heartbreaking than when a child like Devin dies at 

the hands of someone who should have cared for him the most. 

And that is why we are here today, to review a proposal designed 

to reduce the number of these tragedies. Ultimately, the real solutions will come through the incredible work done by local child welfare agencies, education providers, police, healthcare providers and 

workers and many others. 

While it won’t be the Federal Government that solves this problem, we have a role to play. As the legislation before us suggests, 

we can bring together experts to review which of today’s practices 

work, and don’t work, to highlight what additional steps hold the 

most promise and ultimately help local officials incorporate that 

knowledge into their best practices. 

In July 2011, we heard about the magnitude of the problem, including the fact that hundreds of child abuse deaths go unreported 

each year. Today we will review a bipartisan proposal to establish 

a commission to consider these issues and develop recommendations to ultimately reduce the number of those deaths. 

This legislation would have a very small cost, which we would 

make sure is fully paid for by other savings. We believe it can move 

forward quickly through the House and then, hopefully, through 

the Senate. 

Most importantly, we think it will help prevent future child 

abuse deaths. While that will come too late for Devin, we do owe 

it to the many vulnerable children who might be saved in the years 

ahead to make any progress that we can. 

I look forward today to all of the testimony from our panel’s witnesses and advancing the bipartisan legislation offered by Chairman Camp and Representative Doggett. 


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Without objection, each Member will have the opportunity to 

submit a written statement and have it included in the record at 

this point. 

Mr. Doggett, would you care to make an opening statement? 

Mr. DOGGETT. I would, Mr. Chairman, and thank you so much, 

Mr. Chairman, for the work that you and your staff have shown 

on this measure. 

I am pleased that, with your personal leadership and that of 

Chairman Dave Camp, we are moving forward in a bipartisan 

manner to pass legislation to reduce the number of children who 

are exposed each year to abuse and neglect. 

It is my hope that we can use today’s hearing and the expert witnesses that we have together with us in the hearing to perfect this 

legislation before its bipartisan consideration here in the House. 

At the hearing that we had in July of 2011 in this subcommittee, 

I expressed hope that we would be able to work together, and I 

think these more recent developments suggest we are doing that. 

You know, as a grandfather myself of three little girls, who bring 

such tremendous joy to our family, it is just painful to even imagine a child being subjected to neglect and abuse, especially from a 

family member. 

Yet we recognize each year that there are thousands of children 

who face this cruel fate. As District Judge Darlene Byrne, a leader 

in establishing, really across the country, but beginning in Travis 

County in Texas, our child protection courts, has said, ‘‘Childhood 

should be a time of innocence and freedom, but it is a sad fact that 

many children are vulnerable to injury and abuse. Our Nation’s 

children need good leaders to stand up at a national level and find 

creative ways to protect them from harm. The creation of a national commission to end child fatalities is an important step in 

that direction.’’ 

We need thoughtful consideration of everything we can do to protect vulnerable children. And in some cases, we just need to share 

what is already working, what has been developed in some communities to try to avoid tragedy. And a lot of what we will hear today 

is that there are many areas of improvement in the fight against 

child abuse and neglect that we can, in fact, make. 

The draft legislation that we are reviewing today represents an 

improved version of the original H.R. 3653, that I introduced exactly 1 year from tomorrow, and that is pretty quick for Congress 

to act. 

It would establish a national commission to develop recommendations to reduce child fatalities stemming from abuse and 

neglect. In my home State of Texas, groups like TexProtects, Voices 

for Children San Antonio, CASA, children’s shelters in Austin and 

San Antonio serve as a voice for the voiceless, protecting and advocating for children, as their counterparts do in other States around 

the country. Local leaders, like Texas State Senator Carlos Uresti, 

was a driving force behind getting our Texas Blue Ribbon Task 

Force to combat child abuse and neglect set up, and getting Bexar 

County’s own task force to combat these problems. 

There are a number of similar organizations in Chairman 

Camp’s home State of Michigan, and I am sure in Minnesota as 

well, like Michigan’s Early Childhood Investment Corporation, 


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Michigan’s Council on Maternal and Child Health, and the Michigan office of Great Start. The important work that these folks are 

doing has been critical to improving the lives of at-risk children. 

Yet despite these developments, fatalities stemming from child 

abuse and neglect remain at epidemic proportions in Texas and in 

San Antonio, in particular. Last year there were almost 6,000 confirmed cases in Bexar County, that is San Antonio, the highest 

number in Texas, higher than even Houston and Harris County, 

which has a population that is about twice as large. 

In the decade from 2000 to 2010, Texas had over 2,000 reported 

deaths from child abuse and neglect. And last year, Texas had 

nearly 66,000 confirmed cases of child abuse and neglect, and over 

200 deaths during that one year alone. So there is much we need 

to focus on in my home State and around the country. 

Mr. Chairman, in so many cases, we may never fully understand 

what causes this abuse and neglect, but we can understand ways 

to reduce it. And I think, by creating this national commission, we 

will be taking a step, an important step in the right direction. 

Thank you. 

Mr. PAULSEN. Thank you, Mr. Doggett. 

I want to remind our witnesses to limit their oral statements to 

5 minutes. However, without objection, all of the written testimony 

will be made part of the permanent record. 

On a panel this afternoon, we will be hearing from Bill Frenzel, 

guest scholar at the Brookings Institution; Teresa Huizar, executive director, National Children’s Alliance; Madeline McClure, executive director, TexProtects; and David Sanders, Ph.D., executive 

vice president of Systems Improvement, the Casey Family Programs. 

I would like to now introduce our very first witness, Mr. Frenzel. 

Bill Frenzel is a former Member of the United States House of Representatives, representing my district, actually, in Minnesota’s 

Third Congressional District, where he had a very distinguished career for 20 years. He served as a member of this committee as well 

as a ranking member of the House Budget Committee and the 

House Administration Committee. 

Upon leaving the House, Mr. Frenzel continued his public service, serving as a special advisor to President Clinton on NAFTA, 

as well as chairman of the President’s Advisory Commissions on 

Trade Policy and Negotiations from 2002 to 2011. 

Mr. Frenzel also served as the chairman of the Pew Commission 

on Children in Foster Care from 2003 to 2008. 

It is an honor to have him testify here before the committee 

today. 

Mr. Frenzel, please proceed with your testimony. 

STATEMENT OF THE HONORABLE BILL FRENZEL, GUEST 

SCHOLAR, BROOKINGS INSTITUTION, FORMER MEMBER OF 

CONGRESS, AND FORMER CHAIRMAN, PEW COMMISSION ON 

CHILDREN IN FOSTER CARE 

Mr. FRENZEL. Mr. Chairman, thank you. 

Chairman and Members of the Committee, it may be bad form, 

but I want to say, first of all, what a great privilege and pleasure 


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it is for me to testify before a committee chaired by a Congressman 

From the Third District of Minnesota. My elation knows no bounds. 

Mr. Chairman, I want to testify on the structure of the committee and the remarks that I make are based on my own experience in a number of commissions and panels. And I hope that they 

will be helpful, and I realize that there are lots of other points of 

view that will be and can be made. 

First of all, the draft bill of Congressmen Doggett and Camp, 

provides for a Presidentially appointed commission. And that is a 

good idea if you are looking for prestige. However, Presidential 

commissions don’t have a glorious history of success. My guess is 

that this particular commission is going to succeed no matter who 

appoints it, but I believe you are likely to come to a better outcome 

if you appoint it through the Congress. 

The trouble with Presidential appointments is that you aren’t 

there to see that they get made. You may have trouble with what 

I call geographical distribution, which I think is important and I 

will talk about more later. And the President may want to reward 

other people, and his personnel department may have restrictions 

that make it difficult to put the kind of people you want on there. 

So I would say it would be a lot better to have the commission 

selected by Congress, and by your subcommittee and its Senate 

counterpart, I think they could work with the appointing authorities, all four of them in Congress, to get the right kind of commission. 

With respect to size, I think the draft bill has it about right. I 

would suggest a few more, but certainly no more than 20. So I 

think you are okay there. 

The qualifications are something that I am not myself qualified 

to speak about, but it looks like you have the bases pretty well covered. 

I think, however, I am going to suggest that you might try some 

former Members of Congress in leadership jobs, and they might not 

qualify under the qualifications listed in the draft bill. 

I talked about regionality before. You need to get a spread. The 

States are all different. The regions are all different. You can’t 

avoid California and New York, where certainly a lot of these problems exist, and you need a spread elsewhere. That is one of the 

reasons why I prefer a little larger commission than is outlined in 

the draft bill. 

With respect to congressional membership, it is up to you. I believe that Members have got a lot of things to do, and probably 

shouldn’t be on the commission and might not be reliable 

attendees. 

As to commission leadership, I have always thought that having 

a former Congressman to enforce management and leadership and 

look for consensus is a really great idea. I had a wonderful experience on the Pew Commission on Children in Foster Care working 

with Bill Gray, who had formerly been chairman of the Budget 

Committee when I was the ranking member. And I think neither 

of us knew very much about children in foster care, but I think we 

kept the commission going and aimed in the right direction. 

I have a note here on consensus. It is, I believe, very important 

to have the members come to a fairly unanimous agreement. SepaVerDate Mar 14 2013 14:40 Mar 20, 2013 Jkt 078759 PO 00000 Frm 00011 Fmt 6633 Sfmt 6602 I:\WAYS\IN\78759\78759.XXX 78759

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rate or minority remarks blunt the thrust of these kinds of commissions. I think that proper leadership will get you there. 

My time is expiring, but let me just say, with respect to congressional approval, I hope that this committee would see that there is 

some kind of action immediately following the report, because then, 

local agencies, private organizations, State, and other agencies will 

pay a lot more attention to it if they believe that the Congress 

thinks it is a good report. 

Congress may not be able to pass a bill to say this, but I think 

the committee could indicate approval somewhere along the line. 

Mr. Chairman, I have other thoughts, and I will leave them for 

the question period. Thank you very much. 

Mr. PAULSEN. Thank you, Mr. Frenzel, very much. 

[The prepared statement of Mr. Frenzel follows:] 


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Bill Frenzel 

Brookings Institution 

1775 Massachusetts Av. NW 

Washington, DC 20036 

WAYS AND MEANS CQMMmEE'S SUBCOMITTf ON HUMAN RESOURCES 

HEARING ON ESTABUSHING A COMMISSION TO DEVELOP RECOMMENDATIONS FOR 

REDUCING CHILD DEATHS DUE TO MALTTREATMENT; DECEMBER 12, 2012 

Mr. Chairman and Members of the Subcommittee: 

My name is Bill Frenzel. I am a Guest Scholar at the Brookings Institution, but my 

testimony tooay is mine only and has nothing to do with Bfookill9S. 

I have been advised by your fine staff to concentrate my remarks on the commission, 

its structure, its outlook, and possible results. I have served on several commissions: 

(1) the National Economic Commission in 1988, appointed by the President and 

Congressional leaders; (2) The President's Advisory Commission on Social Security in 

2001 and 2002; (3) The President's Advisory Commission on Tax Reform 2005; (4) the 

President's Advisory Commission on Trade Policy and Negotiations from 2001 to date; 

and (5) several private commissions, most notably the Pew Commission on Children in 

Foster care, from 2003 to 2007. 

The first three of the above were colossal failures. The Pew Commission was judged 

successful, even though some of its most important recommendations were enacted 

long after it had disbanded. I have some opinions on how best to structure and manage 

a government (or private) commission. Mostly they depend on what the commission is 

intended to do. Some of them follow. 

Appointing Authority Presidentially appointed commissions, and those appointed 

jointly by the President and Congressional leaders carry substantial prestige, and few 

potential appointees have nerve enough to decline them. They, however, are more 

appropriate for frontline issues, and they labor in the national spotlight. None have 

been successful in my memory except the Social Security Commission in 1982 and 

19B3, and a couple of base closing commissions. 

If you want it to be on the six o'clock news, have the President appoint the commission. 

If you want results, you may want to choose another appointing authority. 

Presidential problems abound. Presidents like to stack commissions with people to 

whom they owe something. You will get good people, but they may not exactly be the 
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qualified people you want. You may not get geographical distribution you want. You 

may not get other balances you seek. 

Worst of all, Presidents are too busy. If recommendations are not a slam dunk, or 

important enough, they lie there and die. I believe that is what happened to President 

George Bush's Tax Reform Commission in 2005, or more recently to President Obama's 

Fiscal (Bowles-Simpson) Commission. 

If the commission's sponsors can advise the legislative leaders on appointments (I 

presume they can), it will be much easier to get the skills and experience, the regional 

balance, and such other balances as are thought necessary, through Corn]ressional 

appointment. Here I assume that child mistreatment is not a subject that will 

engender partisan problems, and that House and Senate sponsors themselves can 

agree on commission member selection. 

Net, net, I believe that Congressional appointment is more likely to produce a better 

distribution, and better talent, and a better outcome, than if the President is involved. 

Size Less than a dozen members won't give you the geographical nor the experience 

spread you will need. More than 20 is likely to cause difficulties of less than orderly 

process. The draft bill of Congressmen Doggett and camp has it about right, although I 

believe 15 to 18 is optimal, particularly if you choose leaders as described below. 

You will also have to have a method for replacing members who are obliged, for 

reasons of health, family, etc., to leave the commission. 

Qualifications This subject is not my strong suit, but, in general, the draft bill covers 

the waterfront well. It also describes millions of people, and you want the very best. 

Your staff will have to call in the best advisors it can locate to identify the best of the 

best, both in talent and temperament. And don't eliminate all lobbyists. They can't taint 

this kind of commission. 

I hate to mention the phrase, but bi-partisan cooperation will produce the best 

commission. One of my Pew Commission's greatest strengths was that if anyone knew 

anybody else's party leanirn]s, they were never mentioned. Members could have been 

all Democrats, or all Republicans. What mattered was their experience and their 

unrelenting desire to help children. 

Because that also matters in this case, the House and Senate sponsors of this 

commission should be able to agree on a slate and to convince the leadership 

appointers to ratify it. 

Regionality The kind of people you choose for the commission will mostly be 

nationally known, and will know others of national renown in their fields. But America is 
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pretty big, and communities, states and regions are different, even when pursuing the 

same goals. You need wide geographical and cultural distribution on your commission. 

The locals will know all the other good locals, and they will be helped by the local peers 

who seek the same outcomes the commission seeks. You can never cover all the bases, 

nor get perlect representation, but you need to make a good try. 

However, I believe it would be unwise to write distribution requirements into the bill. 

They would be long and confining. I believe that the sponsors, aided by the 

Subcommittee staffs will understand their responsibility to take geography into careful 

account. 

Congressional membership This is for you to determine. My O·Nn feeling is that 

members of Congress ought to be committed to other duties, and are too busy to be 

dependable members of such a commission. If you put one member of Congress on the 

commission, with two houses and two parties you will have to have at least four 

members of Congress, and that may make it impossible to indude the other 

experiences and talents you want on the commission. I would not preclude members of 

Congress, but neither would I appoint any to this kind of commission. 

Commission leadership When you assemble an all-star line-up of commissioners, 

with experience and ability, you may find among them a natural leader who can 

manage the work plan, handle the schedules, instill a sense of practicality, keep the 

commissioners happy and engaged, and maintain regular communication with this 

Subcommittee and its staff. That is possible, but it's also highly un~kely. 

If my Pew experience is any guide, it is a good idea to go outside the fields of endeavor 

for leadership. r believe I was chosen as Chair precisely because I had no experience in 

foster care. The same maya little less true of the Co-Chair, former Congressman Bill 

Gray. Having multiple leaders, a Democrat and a Republican, was for optics. In practice, 

either of us could have done, and did, the same job. 

My highly subjective recommendation is that you pick a former mel1ber of Congress, or 

two, for the chair. 

She/he might, or might not, have experience in the field (from this subcommittee, for 

instance). More than keeping the program on the move in businesslike manner, the 

chair has to remind, constantly, the real enthUSiasts on the commission that perlection 

in recommendations is not always possible in a contentious and budget-restricted 

Congress, and that a consensus report multiplies its impact. 

Consensus Unanimity is contrary to human nature, but commission reports have far 

greater impact if they represent a consensus of the full commission. Minority or 
12 


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dissenting remarks may often be appropriate, and they may make the objectors fell 

better, but they really weaken the thrust of the report. In a child maltreatment 

commissiOll, every effort must be made to have a unanimous set of recommendations. 

Consensus seeking is a duty of leadership. It's one more reason in favor of appointing 

some kind of professional chair, or chairs, who can encourage commission members to 

hang together. 

Congressional Approval When the commission reports, its recommendations may 

indude requests for Congressional actiOOs of some sort. It is highly desirable that this 

subcommittee react to those recommendations as swiftly as possible. The Pew 

Commission on Children in Foster care referred to earlier, reported in 200S, had part of 

its recommendatioos enacted that year, but some not until 2008. 

The Report will also include recommendations for state and local government units in all 

branches, and fOf private organizations, too. Those units can move without federal 

approval, but the federal blessing will nurture far more enthusiasm. 

Honoraria First-class people will fight to get on this commission. You should pay their 

necessary expenses of travel, etc., but it is not necessary to award them honoraria. 

After you hire a first staff and pay commissioners' expenses, there won't be much 

money left anyway. 

Staff $2 million won't buy a large staff, but you won't need many people, because 

plenty of resources, private and governmental, national and local will be available to the 

commission. The staff should be competent, but lean, less than 10. It does not have to 

do the research. It just has to sort it out. Spare no expense on a first-rate staff director. 

She/he will save you a bundle in the long run. 

Your staff, and the Senate's, ought to help the commission and its staff director identify 

and recruit the staff, but the commission needs to maintain its independence. 

Operations, Hearings, etc. Other things being equal, the commission should do its 

business here in Washington. Its staff should be here, in close contact with your own 

staff and with other federal agencies. Hearings in other locations sound like wonderful 

ideas, and sometimes are, but field hearings usually turn out to be mostly for show. It 

is usually cheaper to bring commissioners to Washington than to New York, LA, or 

Chicago. It will be hard to find child mistreatment in the boondocks. I believe that you 

will find witnesses happy to come to Washington to testify about their local conditions. 

However, the commission may find it necessary and helpful to travel to national 

meetings of court personnel, and governmental or private organizations. There is a 

cost, but to learn and to inspire, such meetings may be needed. 
13 

f 

Mr. PAULSEN. Ms. Huizar, please proceed with your testimony, 

you are recognized. 

STATEMENT OF TERESA HUIZAR, EXECUTIVE DIRECTOR, 

NATIONAL CHILDREN’S ALLIANCE (NCA) 

Ms. HUIZAR. Thank you. 

Chairman Paulsen, Ranking Member Doggett, and Members of 

the Subcommittee, thank you for holding this important hearing on 

child abuse fatalities and the effort to establish a commission that 

would shed light on this issue, highlight evidence-supported interventions, and convene a national dialogue about the protection of 

the nation’s most vulnerable children. 

I represent National Children’s Alliance, which is the national 

association and accrediting body for the nation’s 750 Children’s Advocacy Centers. CACs coordinate a multidisciplinary team approach to the investigation, prosecution, and treatment of child 

abuse. In the case of child abuse fatalities, our CACs are often used 

for the interviews conducted with other siblings and child witnesses of these tragedies. So we know far too well the tragedy of 

children killed by their caretakers and the toll this takes on communities, the remaining family members, and the professionals 

who must investigate these sad cases. 

Because we believe these deaths are preventable, NCA has joined 

with other members of the National Coalition to End Child Abuse 

Deaths to raise awareness of the problem. 


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14 

Over the past decade significant gains have been made in child 

abuse prevention and intervention generally. The overall rates of 

sexual and physical abuse have declined, but what has not declined 

and in fact has either remained flat or increased, is the rate of 

child abuse fatalities or near fatalities. The horrifying persistence 

of fatal child abuse, despite the implementation of effective prevention and intervention measures for most other forms of abuse, calls 

for a deeper examination of its causes and scope. 

Official child welfare records indicate that at least 1,500 children 

are fatally abused annually. However, that number does not capture the scope of the problem, nor the scope of the suffering. Indeed, a recent GAO report indicates that the NCANDS data due to 

the voluntary nature of the data collection and the fact that in 

many States only one data source is used for the reporting, substantially undercounts fatal child abuse. And moreover, restrictive 

confidentiality laws and regulations make it difficult to thoroughly 

examine abuse fatalities when they occur so that we can learn how 

to prevent them and what risk factors are associated with them. 

What is sorely lacking in all of this is a comprehensive national 

strategy to combat the tragedy of child abuse fatalities. Rather 

than a piecemeal approach to preventing these deaths, children at 

risk of eminent harm need and require the government’s protection. And as a public health problem, child abuse fatalities can be 

approached as any other and successfully combatted. 

Key to this national strategy is the establishment of a bipartisan 

commission empowered by Congress to thoroughly examine the 

problem, particularly as it relates to children within or previously 

known to the child welfare system. States vary widely in their child 

abuse fatality rates. Guidance provided through the work of a commission can ensure that a child’s chance of surviving his or her 

childhood is not an accident of geography. 

By scrutinizing the effectiveness of Federal, State, and local data 

systems and identifying the most effective prevention and intervention practices, the commission can lift up successful examples for 

widespread dissemination. 

Reducing child abuse fatalities is a complex matter. It requires 

investigating and addressing many issues, including evidence-supported prevention and intervention efforts aimed at strengthening 

families and preventing maltreatment in the first place; workforce 

training; a risk-assessment practice within Child Protective Services; strengthening child death review teams; encouraging CAC’s to 

expand their services; strengthening the medical examiner and coroner systems within the U.S. to ensure accurate designations of the 

cause of death in these cases, which are often among the most 

medically complex; providing training to law enforcement and prosecutors to hold offenders accountable; and creating data-sharing 

systems that allow agency to cross share information so that children can be saved and research can inform our practice; and of 

course, educating the public so the communities can protect their 

own children. 

Because of the complexity of these issues, a coordinated and 

thoughtful approach is critical and can only be achieved through 

the work of a commission to end child abuse and neglect fatalities. 

Our efforts on behalf of these children must go beyond finger pointVerDate Mar 14 2013 14:40 Mar 20, 2013 Jkt 078759 PO 00000 Frm 00018 Fmt 6633 Sfmt 6602 I:\WAYS\IN\78759\78759.XXX 78759

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ing, the blaming and firing of individual caseworkers, and scattered 

prevention and intervention strategies if we are to prevent future 

deaths. Our best hope of reaching a comprehensive strategy is the 

establishment of a commission to end child abuse and neglect fatalities, empowered to investigate, make thoughtful recommendations, and lift up promising practices. The lives of more than 1,500 

children each year absolutely depend upon it. 

Thank you. 

Mr. PAULSEN. Thank you very much, Ms. Huizar. 

[The prepared statement of Ms. Huizar follows:] 


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joloto on DSK67XMDP1PROD with HEARING78759A.006

Testimony 

Before the Subcommittee on Human 

Resources, Committee on Ways and 

Means, House of RepresentativesTeresa Huizar, Executive Director, National Ch ildren's Alliance 

Chairman Paulsen: Ranking Member Doggcu. and Members of the Subcommiucc: 

Thank you for the opportunity \0 address Ihe important issue of child abuse fatalities in the US 

and what may be accomplished through Ihe Protect Our Kids Act and the establishment of a 

national Commission to End Child Abuse and Neglcct F3Ialili~'S . As the Executive Director of 

National Childrcn's Alliance, the national associ3lion and accrediting body for more Ihan 750 

Children's Advocacy Ccnlers in Ihe US serving morc Ihan 279.000 abused children laSI yearl, I 

know 100 wcHlhc tragedy of cllildren killed by their caretakers and Ihe 1011lhis takes on 

communities, thcif remaining siblings and extended family memb!-rs, and the multidisciplinary 

teams who must investigate these sad cases. 

Children's Advocacy Centers (CACs) are child-friendly facilities in which multidisciplinary 

teams of law enforcemcnt. child protective services. prosecutors. medical professionals. mental 

heahhcare providers. and victim advoca!es coordinate their efTons to investiga!e and treat child 

abuse while holding ofTenders accountabic.

2 In the case of child abuse fatalities. our CACs arc 

often used for the interviews conducted with other child witnesses and siblings. I have 

personally observed the interviews of small children who watched as thcir sister was purposely 

thrown out of a multi-story apanment window to her death. And. I have held the hand of the 

tearful. tough, and experienced detective who had left the side oftha! broken lillie 2 ycar-old 

body to come to the CAC to interview the siblings and was undone a! the prospeel. Child abusc 

fatalities are heanbreaking in cI'ery way: the loss and waste of a precious young life; the 

profound and traumatic grief of siblings. grandparents. and extended family memb!-rs; the loss of 

innocence of a community that thought children were proteck'd: and the Sl-.:ondary trauma 

sufTered by the child abuse professionals who intervene. 

Recognizing that these tragic deaths arc preventablc the National Coalition to End Child Abuse 

Deathsl. of which National Children's Alliance is a mcmb!-r. has been working since 2010 to 

' 2011 N.' ..... I ChHdm.·.A ll i""". 1'11"' ..... 1 S",i<li<$ 

, For """" inf"""",i.,.. 0""'" CAe. "i,i, " ·",.. .... K>nal,hild",nsalli"",, •. "'i 

' n.. N.,ion.ol Cool ilion 10 f.1Hl Child Abu", Dra"" i. <ompri«d of m....,bor orpniz.a' ion>: f."<1)' Child Mallon, "'" N",i.,...1 

" __ i","" ofSod>l "'''''' .... "'" 1'11 >1;""'1 [;l;<lrit' All1>11><)" Assoti"' ........ 1'11>1;""'1 Child","' , AlliAn«. and .... N.,ion.ol 

Cen,..-fo< ,he Re,·""'and P~n'ion of Child Dr"h<. 
17 


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raise awareness of the problem, to encourage bipartisan policy solutions. and to call for a 

national strategy to cnd child abuse deaths in America. For thc most vulnerable victims of 

abuS<.-~thosc at imminent risk of fatal hann-<mly the protection of the govemmem smnds 

between them and death. Ensuring that their lives are prOlL'Cted has been the ongoing work of 

this Suocommiuee through your hearing on Child Abuse Fatalities and the GAO report on the 

same in 2011. and nOW lhis one to directly address the establishment of a national Commission 

to End Child Abuse and Neglect Fatalities. Thank you for your ongoing oommitment to this 

important issue. 

Child Abuse Fatalities in the US 

Ol"er the past decade significant gains have been made in child abuse prel'ention and 

intervention: the overall rate of abuse has declined as evidenced by a series of National 

Incidence Studies; substantiated sexual abuse cases have declined by 47%: and while the data is 

more mixed about physical abuse, ovcrall substantiated physical abuse appears to have 

experienced some dcrline as well'. What has not dcrlined. and in fact has either remained flat or 

increased during this more general d~'Cline. is the rate of child abuse fatalities or ncar fatalities 

that warranted emergency dcpartmcnttreatment}. The horrifying pcrsistence of fatal child abuse 

despite the implementation of effective prevention and intervention measures for most other 

fonns of abuse calls for a deeper examination of its causes and scope. 

In 201 0 (the last year for which wc hal"e a full data set) US official child welfare records 

captured through NCANDS (National Child Abuse and Neglect Data System). indicate 1,537 

ehildrcn were fatall y abused6. Ofthcse. and consistent with prior periods ofrcporting, 

approximately 80"10 of children who died from maltreatmcnt were 3 years old Of younger. and 

Inorc than half were infantS.l However. that number docs not capture either the scope of the 

problem or the scope of the suffering. Indeed. a rcecnt GAO report indicates that the NCANDS 

data. due to the voluntary nature of the data collcrtion and the fact that in many states only one 

data souree is used for the reporting. substantially undercounts fatal child abuse and estimates 

that roughly 2.500 children arc fatally abused each year.1 Of those falall y abused, at least 14% 

were previously known to child welfare agencies or in their care.9 

MO ..... 'Ql"er, restrictivc confidentiality laws make it difficult to thoroughly examine abuse fatalities 

" 'hen they occur so that wc can Icarn how to prel'cnt thcm and what risk factors are most 

• Finkdhor. O. " k>n<s. L. "11 .. ·• Sa .. t Abus< an< Phy,ic.t Abux Ik<:tiO«l Sir>« ,ho I '19(1',"/". 2012. 

• 1.0>· .. 1111 1. l.M. an< l.R. Goi ....... I"""""". or.mo.. ioj..n.-s d .. '0 pIIl.ic.t . bux in !he Unitod Sta,,",, 19'11·2009.Pod i'1Ti<>. 

2012. 1l00S): p. 1-' 

• tkpartm.n, oflloot,h.nd l1um .. S<o-icc"s, Admini""""'" fu< ChHd"n . nd Fomiti«. "Chik! M. I',,"mrn' 20tO" , Ibid. 

• US Qov.mm<n, A<<OUIItabili'y Ollie<. ~hiM F ... Ii' .... From Mal"",,",<n,, N"ional 0. .. C",,1d II< S' ... n~''''ntd"'. Ju ly 

1011 . 

' Ibid. 

, 
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associated with them. Rcrent rules promulgated by HHS to darify the CAPT A confidentiality 

requirements were marginally helpful. While making clear that States may provide infonnation 

necessary so that child death review teams and policymakers can examine the panicular child 

welfare case in which the child died, it did not indicate that infom13tion on past child welfare 

reports or investigations involving the same child or siblings could likewise be provided. lens 

Justice 13111ndeis once said, "the best disinfcrtant is sunlight:' then the inability for policymakers 

to thoroughly examine all of the factors that lead to a child's death means that we continue to 

view these tragedies as though through a glass darkly and with linie hope of system refoml. 

And as imponant as delving into the spcrifics of a given case to learn from it. we also lack 

meaningful aggregate data. As the GAO concluded in their 2011 report "Child Fatalities From 

Maltreatment: National Data Could Be Strengthened," weaknesses in our current NCANDS data 

collcrtion effort include: 

Roughly half of all Stales reporting through NCANDS do not usc multiple data SOUI'<;CSsuch as death cenificales, Slale child welfare agency records, or law enforcement 

reports-in collating their repons for submission: 

Inconsistent State dclinitions of maltreatment. differing State legal standards for 

substa11liating maltreatment, and missing State data complicate reponing these deaths 

through NCANDS. and thus our understanding of the scope of the problem; 

And. that additional demographic, family composition. and risk factor infonnation has 

been collected by NCANDS but as yet is unreported to policymakers and the public in 

the annual HHS annual publication of Child Maltreatment. (Administration ofi1cials now 

plan to release this infonnation in the 201 3 report, which we welcome.) 

What is sorely lacking in all of this is a comprehensivc national strategy to combat the tragedy of 

child abuse fatalities. Rather than a pil'Ccmcal approach to prevcnting these deaths, children at 

risk of imminent hann need and require the government's protcrtion. Fatal child abuse is 

prevc11lable. And as a public health problem. can be approached in a thoughtful and analytical 

manner, much as the US has successFully combated other public health threats. States arc the 

great innovators: while the federal gOI'ernment has a unique role as a convener of States and 

policymakers to hold up examples of successes which may be emulated. 

Commission to Eliminate Child Abuse 

and Neglect Fatalities 

Key to this national strategy is the establishment ofa bipanisan commission, empowered by 

Congress to thoroughly examine the scope of the problem particularly as it relatcs to children 

within. or previously known to. the child welfare system. Statcs I'ary widely in their child abuse 

fatahty rates. Guidance provided through the work of a Commission can ensure that a child's 

3 
19 


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chance of surviving hislhcr childhood is not an accidcnt of geography. By serutinizing thc 

effectivencss of fedcral. State. and local data collection systems and identifying the most 

efficiem practices. the Commission can lift up examples from within the Slates of effect;"e child 

abuse falality pre"ention and intervention practices for widespread dissemination. 

In many ways. opening a national conversation on child abuse fatalities through a Commission to 

End Child Abuse and Neglect Fatalities mirrors and strengthens the process hy which States 

review child deaths 10 strengthen their own prevention efforts. In 1996. Congress authori7.cd 

CArTA and includcd issues relaK":! to fatal maltreatment through public disclosures of the 

existence of child ma ltreatment fatalitil"S and the esmblishl11em of Citizen Review Panels 10 

review and make n-eol11l11endmions for improvemem in child fmalities. foster care. and 

intervention.lo In some staleS these CRPs also serve as Child Death Review teams. Since that 

time. the Children's Bureau wilhin HHS has supported the development and cominuancc of 

Child Death Review and now all States conduct Child Death Rcview in some capacity. 'I For a 

decade the Maternal and Child Health Bureau has funded the National Center for the Review and 

Prevention of Child Dealhs. The resource center provides training and l~,<,hnical support to all 

states to help establish and improve Ihe review process. and manages a national Child Death 

Review Case Reporting System. While an invaluable resource to Child Death Review leams 

within States. the resources allocated 10 the National Center for Review and Prevention of Child 

Deaths are minimal and Stme participation in the Child Death Review Case Reporting system is 

voluntary. Undouhtedly. mOre rcsources are needed to improve child death review within Slates. 

with a special emphasis on child abuse fatalities. And. in a complementary way. the National 

Commission to End Child Ahuse and Negk-et Fatalities ~an take case studies within States and 

across States for examination of what has worked to reduce these pre\'entable deaths--and what 

strategies should be discarded as failing to produce desired olltcomes. 

Reducing child abuse fatalities. panicularly those in,"olving prior contact with the child welfare 

system. is a complex mauer. We. the National Coalition to End Child Abuse D<:aths. strongly 

support the cstablishment ofa Commission to End Child Abuse and Neglect Fatalities to 

investigalc and address issues such as: 

Building upon the best of eUTTent child protection systems and evidenee-5upponed 

prewntion and intcT"l'ention efforts. to de,"elop a national strategy to end maltreatment 

deaths. including public health and social services aimed at strengthening families and 

pre\"e111ing maltreatmc111 in the first place: 

Workforce training. easeload. and risk assessment practice within child protective 

services so that at-risk children may be identifi ed to preve111 fatal or ncar-fatal risk of 

hann: 

,. (:",·i"II'OII. T . .t. P .. i~ M. ""C!IapI<1 'O: ..,. p"" .. " ",,, ofCbiM f>taJil'''.- TIl< Cbil"""", OUf<au : sl\api"&' C""'ory of 

child "" If ... tk ... _am~ and poI ki .... Chi ld","', II ...... ". o.partm<nt of 1I .. lth and lI ... an s.,,,k«. Dnn lOll. 

" Ibid. 

• 
20 

f 

Mr. PAULSEN. Mr. Doggett, I understand you would like to introduce our next witness, Ms. McClure, who I understand is from 

your home State of Texas. 

Mr. DOGGETT. She is, indeed, Mr. Chairman. 

Thank you. I am pleased to formally introduce Madeline 

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tection of Children. She serves as the appointee of Lieutenant Governor David Dewhurst and Texas House Speaker Joe Straus on the 

Texas Blue Ribbon Task Force on Child Abuse, Prevention, and 

Child Welfare, and she is the chair of the Child Protection Roundtable, which she founded. 

She has a career of about a decade making money successfully 

on Wall Street before she turned to making lives better for children 

on Texas streets. She also works as a therapist now, has worked 

as a therapist with the Dallas Children’s Advocacy Center. I believe she has done much to help prevent abuse and neglect in 

Texas, more than anyone I know, and is a tireless advocate to have 

made this special trip from Dallas to be here today. 

Thank you, Madeline, for coming to join us. 

Mr. PAULSEN. Thank you, Mr. Doggett. 

Ms. McClure, you may proceed. 

STATEMENT OF MADELINE MCCLURE, EXECUTIVE DIRECTOR, 

TEXPROTECTS, THE TEXAS ASSOCIATION FOR THE PROTECTION OF CHILDREN 

Ms. McCLURE. Thank you for that lovely introduction, Ranking 

Member Doggett, and Chair Paulsen, and committee members, 

thank you so much for inviting me to testify today on this most 

critical issue of child maltreatment fatalities. I am honored to be 

here. 

Given that child maltreatment deaths stem primarily from child 

physical abuse and child neglect, I am going to focus my comments 

today on child maltreatment prevention, and given my background 

in economics and social work as you just outlined, I think it would 

be most helpful for the committee if I talk a bit more about monetizing the benefits and the costs, if that would be all right. 

So, first, let me put into perspective the incidence. We need to 

know what the size of the problem is before we attempt solutions. 

As you may know, the National Data Collection Systems and the 

National Incidence Studies, as well as national surveys, showed 

that 1 to 10 percent of our child population are abused annually. 

That is a big range. But whether it is 750,000 children or 7.5 million children, one abused child is one child too many. 

So just to put this in perspective on the screen, imagine an aerial 

view of the following stadiums filled to capacity. Hopefully, most of 

these are from your hometowns, the Hubert Humphrey Metrodome, 

Dallas Cowboys Stadium, the Cotton Bowl, Yankee Stadium, Sanford Stadium, Neyland Stadium, Tiger, Century Links Field, and 

the Rose Bowl. 

There wasn’t a stadium from North Dakota that was large 

enough that I could include in this, sorry, Congressman Berg. 

But imagine that instead of adult fans filling those seats, picture 

all of those seats now filled with children, abused children, almost 

50 percent that are less than 4 years old. So hold those nine stadiums, packed to the gills, brimming with just children. That is 

what 753,000 looks like. And that is the lowest incidence number, 

just to contextualize the problem. 

The consequences of child abuse and neglect, I think this committee has heard several times. But just because you mentioned 

Devin and his parents, Chairman Paulsen, I want to remind us 


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that children that are abused and neglected have impaired brain 

development, 85 percent more likely to have that and, in stepwise 

fashion, very often have cognitive difficulties, impaired learning 

disorders and then self-anesthetizing abusing substances which 

leads to doing poorly in school and also, teen pregnancy and school 

dropout, often leading to juvenile delinquency. 

We talk about the associations, but there is a lot of cause and 

effect here. Most importantly, children that are abused are six 

times more likely to abuse their own children. I can only imagine 

what Devin’s parents had gone through in their earlier lives. 

But child abuse also exacts a very high financial price. As you 

can see on this next slide, the Center for Disease Control’s recent 

study monetizing the outcomes of the consequences of child abuse 

and neglect found that for every child abused in their lifetime it 

will cost $210,000 per victim. That is for those who survive abuse. 

For those who die, for every child abuse fatality, we as taxpayers 

spend $1.3 million per victim. So, in 2012 inflation-adjusted dollars, that is $124 billion that we are throwing out the window just 

on the consequences of child abuse. 

But the monetary calculations cannot begin to place a value on 

the incalculable cost of lives lost, unseen scars of potentials 

quenched, spirits extinguished, and souls murdered. 

These human and financial costs are unacceptable and 

unsustainable, and they do represent an enormous financial burden 

on our taxpayers. 

The good news is that child abuse is largely preventable. We 

have found net cost savings of child abuse prevention programs 

that are of high quality that return on average $3.50 for every dollar invested, up to $14.50 for every dollar invested. Here is an example of a program that is entitled The Positive Parenting Program, and this particular program actually is cost neutral within 

a year. But it returns about $6 for every $1 invested, as you can 

see in terms of the costs of reducing out-of-home placements and 

also CPS cost, and other costs. 

So for a relatively modest investment up front, we will not only 

break the intergenerational cycle of violence, we can reduce an 

enormous economic tax burden on taxpayers immediately and the 

long term. 

And where we are today in preventing child abuse is akin to 

where Congress was 70 years ago in exploring the use of antibiotics 

to kill infections. So when you look back, or your children, or your 

grandchildren look back on this 10, 20, 50, 70 years from now, this 

is going to be that inflection point where we really go through this 

process of putting enough money up front to change that whole trajectory, not only for at-risk kids and their families, but our great 

country at large. 

This national commission is a right first step, and I really am excited about this commission helping all of the States have an accessible blueprint for implementing a meaningful child abuse prevention strategy. I thank you for your time. 

Mr. PAULSEN. Thank you, Ms. McClure. 

[The prepared statement of Ms. McClure follows:] 


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COMMITTEE ON WAYS AND MEANS SUBCOMMITTEE ON 

H UMAN RESOURCES 

US HOUSE OF REPRESENTATIVES 

HEARING O N " PROTECT O UR KIDS ACT" 

December 12, 2012 

MADELINE MCCLURE, LCSW 

FOUNDING EXECUTIVE DIRECTOR, TEXI'ROTECTS, THE TEXAS 

ASSOCIATION FOR THE PROTECTION OF CHILDREN 

Chairman I'auls~n, Ranking Member Doggett and Sulxommincc Members, iI's an honor 10 

be i""iled 10 IL'Slify loday on Child Maltrc.,menr in Ihe US and sp'-'<:ificall)", on .hill 

imponan. legislarion. 

! sc .... ·c as Ihe ED. ofTexProtcCls, Ihe Texas ]\ssocialion for the Protection of Children, 

whieh I founded in 200410 organi7.c stakeholders aCrOSS Texas 10 build COnsensus on thc 

beSt public poliC)' solutions for reducing child "bus~ and neglecl and 10 impro,·" Our child 

proacrive sc .... ·ices and healing SYSlelns based on solid, rigomus, OCg. pmclice research. (},'er 

a period of 4 T X kgisbli"c sessions, we h.,·e pro"ided ,he blueprin, and facili,"'cd passage 

of o"er 26 bills and pro"idcd inpul inlO 2 other omnibus refonn bills and raised o"er S45 

million in pri"ale and public in"cslmenls in e"idence-based child abuse pre"cntion programs, 

Prior to founding T""Protects, I worked as a clinician providing Iherap)" to child and adult 

"iClims of sc,'ere child abuse. 

Texas has !he dubious distinction of having Ihe highcst ra.c of child maltrea.mem farali,;cs 

;n !he narion, increasing fmm 103 10 281 deaths, a 124% increase O\'er a 15_)"""r period, 

while Ihc child population gTCw al only 19% o,·e. Ihis Same period. Gh'cn Ihat child 

ma\treatment dealhs Stem from child neglect and mostiy, child physical abuse, my lestimony 

will focus on Ihe rOOI causes of child abuse I ncgk'<:t (CAIN). Il .. ,nusc my background is in 

Finance and Economics as well as Social \Vork, I bcli~'ve I may oc helpful on this subject 

wilh a fOCUSL-d presem~liOIl on projccled COSIS o f C\!N and cost-benefits of child 

rna\trea.mcm prc"cmion, and how We can get in fronl of ,his problem_ 

To understand CO'StS, we need 10 unden;tand actual incidents and incidence rates. The 

National Su .... ·e)' of Children's Il.'posure 10 Violence (NatSCEV) from 2008 was Ihe firsl 

n.tional slud), .0 examine children'. exposure to ";olence in homes, schools, and 

communiries ~cmu all age groups (Finkdhor, Turner, Omlrod, & Hambr, 2(09). In tern,s 

of mairreaune"" NatSCEV found thaI more than I in 10 childrcn su .... ·cred (1O.2'''.) suffered 

some fonn of mairre.unelll during Ihe paSt rc~r and nearil' 1 in 5 (1 8.6%) did so during Iheir 

lifcum<'S (Finkelhor et aI., 20(9). 

Howe"cr, the incidents of child abuse/ neglectthat arc aClUall)' reponed, investigaled and 

subsequentl), substantiated by our ~tatc's CPS 'yslems, which are subsequently reponed to 

.11.J<lin< McChm-. U;:'W 

T"I'n>I«, .. 11>< '1'."""\,,,,,,,,,,,,,,, fo< II>< Proo«tion '" OUld>-<n 

.... ddiO<@;«,pro,"'''-'''lI I 214 .... 2· 1672 
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the NCANDS. tell a different story. which is thaI 1% of our child population is abused in a 

b~\'en year. US Depanmem of H HS ACF's Fourth National Incidence Studies concluded 

that CAIN arc und~rreporr~'d b)" 50% . That would indicate that ,he aClual incidence of 

child/ abuse and negleCl is 2% of our population. 

Whelher 1%.2% or \0% , ont .bused child is one tOO man)'.lct alone the 753K that ,encrt 

tht 1% figure. To put the low<,,, estimated incidence in comext. eonsid<,r the following: 

Imagine an aerial "iew of the ~ntirc: Hubert Humphre)' M~tro dome. DaUas Cowboy 

Stadium (80K-T A). The Cotton Bowl (IOOK-TA'), Yankee Stadium (S(D-NY. Sanford 

Stadium (92.7 - G A). Neyland Stadium (I02K-TN). Tiger Stadium (92.5K- L\). Centurr 

l..ink Ficld~ (67K_\,\IA). and the Rose Bowl (92.5) aU f,lled to capacit), crowds. Imagine in 

your mind an aerial "iew of aU <) of these l'normoUs stadiums. completely packed with fans. 

all al oncC. Now. picture each of all thos" seats fiUed with children-abused and ncgk'1:lcd 

children. 4D" ~ who arc und~r the age of 4. All those sems combincd arc still 11.000 scats 

short of the 753K children that are sC\'ercly ncglcrtl-.J. se~uall)' molested. or physically 

brutali>:ed l'wry rcar in the greatest nation On earth. This is a national epidemic. and thai is 

why Ihis task forcc is SO dc<perntdy nct.-.Jed. 

The conSl."<J"enccs of child abuse and neglcci ha"e been well documented from "asl "olumes 

o\'er multi-dcrades of rcscarch. In brief. abused and ncgkcted children. cornp~rcd 10 their 

non-abused counlerparts. arc significantl)' more likel)' to: 

....................... --- .....-. .... ~-_____ .............. -... 11 

.. _,..."..-

---. ...... _"'-

-....., . ....--""-

-....., ........ _- -....., _....., ... .. _ __ 

.. -

CIoIIIt 

-.......... _--.... 

-....., ... - -....., ... _ ... _-

-

50% 

50% 

..... 25% 

-

.... 

-

-

Impaired Brnin DC\'clopmenf; Cogniti\'C difficulties"; Lcanling difficulties requiring special 

Ed';; Poor mental heallh and emotional heallh. especian)' dcpressionR

; Abuse of alcohol and 

illicit dn'ss' ; School related problcmslll; TC(:n pregnanc)'''; School drop OUt Ill: JU"enilc 

delinquenc),"'; Under and unemployment'''; Adult incarceration";; HomclessntssU

; and 

Violent crimes·" (in about that order) . 

• \I.dcli"" ~I<£I . LCSW 

T<xPro<<< ... 'In. T"" .. . \ ,-,>",., ("" ,be PfOt«t. )O <of Child"," 

m • .J<Iin<@,<>pro<<<" ."'l\ I 2 14 ...... Z- 1672 
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SI40 

SI20 

"" 

SOO 

, • 

~ .ro 

.. , 

'" 

" 

Socie,y Pl)" a high price for child .buse, including but nO, limi,ed 10 ,he cos's from: Law 

enforccment, CPS/Child Welfare COltS, judici.l s)'stem,lwspi,~1 and heahh COre COstS, 

men,al heal,h ,rea,ment, direct CostS s,emming from substance abuse ou,ComeS and from 

,,..,ormenl, ju"cni!e delinquency .nd crimin.l iu"ice COS's, lost produe,i"it;,. ft,.1. 

n,e Ceme ... for Dise,se Comrol (CDC) ,..,ce", s,ud)' mone,izing ,hese consequences found 

,hor ,he life,ime fin.neial cos, for i"" one J'car of n~'W confinn~'(1 Case. of child 

maltre",me'" (750

' . of confirmed cases) is about 5124 billion: we spend about 51.3 million 

for "'cry child ,hor dies from abuse and o"c' S210 thousand for an abosed child ,,·ho li,·cs. 

U.s, lIfetime cOSI (rom one yea r of 

child maltreatment 

• Fatal victims 

medical costs 

• Fatal victims 

productlvi,y 

tosses 

• SurviVOr!; ,.-.' 

education costs 

• SurviVOr!; 

criminal jusTice 

costs 

• Survivor!;child welf~re costs 

.. Survivors longterm Iw!althcare 

00'" • Survivors short- term Iw!althcare 

00'" 

Average lifetime cost per 

s urvivor: $210,012 

Average lifetime cost per fatal 

victim: $ 1,272,900 

I"n .. io" .djusred, ,he life,in;c cos, per CA/N victim is 5222,785 and for Cl'cry child f."lity, 

,he cO'S. is S 1.350,.> 17 in 20 12 doU ... " 

This is "TWIll),' conse" ... ';,·c "",irn .. e hee."se ,he CDC only conside,..,d cos," of abuse for 

ages 6·64, and we know ,h., ,he mos. serious injuries - .nd cO'S" - occur to child,..,n under 

6, and hl ... hh rd.tl'd ",." continue '0 "ecrue past.ge 64, In addi,ion 10 ,he NI H findin!\, 

,hat aClllal occurrences of .buse are 50'''0 higher lhan confirmed, research shows ,h., 

hem'.,.,n 50·60"/0 of chadjululilinduc.o moJ,re.Ul">Cnt a", nO! record<..! .. such on d""th 

certifica'e<. Therefore. the CDC fatali.), vic,im COS" are undcr·cakulorcU b)' a (.c,orof2. 

M ......... ~Ica..... I'csW 

l<.i'ro<<<", 1M T ... , \,..""""" r", do: p"""""", oft;hildtto 

~""I"""<t.~ I Z,. ..... 2· 1672 

, 
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/\notha study published in I'Cr\:\ calculated the annual COStS per victim as S6},S71 by 

combining dir<-'<:t Coot5 (i.e., child welfare and law enforcement) with indir""t C05t. (i.e., 

special education, carll' intCl"vention. cmergenc)' housing. mental/physical hcalth care. 

juvenile delinquene)". adult criminal justice, lost worker productivity)." They did not usc a 

different COSt for children who die from abuse. which. as the CDC showed. means this COSt 

per child is likely higher if a child dies. NC>'crthdcss, w I' used this annual COSt per child to 

proj<-'<:t annual spending (adjusting for inflation and population gro\\1h and assuming a 

steady rntc of abuse in futurc ye ... s). 

! • 

$100 

$80 

160 

140 

$20 

$0 

Annual US Spending on Child Maltreatment 

_Total Annual Cost Using Calculations from Substantiated Reports 

-Total Annual Cost Using Calculations from NIH Abuse Estimates 

n'crcfore. we ha"c spent o,'cr S8} I\illion on thc calculablc financial consequenccs ofCA/N 

in 2012 alone. We eannO! continue to hoist this enormo us fi n ancial bu rd en On th e 

back o f ta"payers. These costs are not only unaccep table for a society, they are 

uns ustainablc. And yct, thcy are prevcn table. 

The social sciences has evoked to a lc"cl such that nperimental research trials, such as the 

double blind studies used by drug companies. arc able TO isolatc propos<-xI inte("\'entions 

(rom other variables", that we Can nOw itknlifj Imd nmmln h,mJ Dfll«mIt. btturin drmogruphi,d'l] 

mdltlxd in!m~ntion /!/'mplltnd rontroi.gronfS. 'n,is "cmerging" area of "'iJcnce;n social 

scienccs-while in uSC for sC"eral decades is still in iTS infancy-has allowed uS [0 test the 

c(ficac)" and cosl-cCf<-'<:tiveness of a m)'riad of social programs. including child abosc 

prevemion programs. 

In monetizing the benefits o f the u.,St prevention programs. we have found a net COSt 

sat'ings ranging from SI. 18 10 S1 4.6S for C\'cry doUar i"'·C5Ied. 

To illustratc more clcarly. one prcvcntion program (l'osi[i,'c Parenting Progrnrn. a.k.a .. Triple 

P) ;s cs[;ma.cd [0 reTurn o\"cr S6 for C"CT}' SI i""cslcd. and the cost of Ihc program can be 

reco\"CrcJ in a single year.- 11 is cstima[cd that the pilOT program in Houston. Tcxas will 

show almost a 2:1 rcturn in JUSt twO )"cars:-

M><I<Iin< .\!«:I"",. I.cSW 

T",P",.",,,.l"h< ,(""" .. .1._.".", foo-lOe I'n~ram ofChild",n 

nudtlin<€"<rror.m.o<g 1 214-442-t672 
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TOTAL IlF.N.:FITS FROM TRIPI,F. P 

IN TWO YI'.ARS, $26,216,746 

_S. .. ,..frnmlro. 

<hddm._~.tmetlt 

_S. .. ,., frnmfewec 

out-<>f·home 

pb<~menlS 

_S. .. ,..frnmfewec 

ho.piu li",tio ... 

H""..,,·cc, "'"co ,hc be" colcuLuion. annot begio '0 inalcul.bic ro." of no! 

only Ii,·", lost. but ,he unseen >CO ... of p<>ico.i.1s qucnche<J, spirito ,,",ingui.he<J .nd soul. 

murdered. Bu •• he", is a ""y 10 "ffse' the billion. "XO con q\\1n.ify .hot "XO'''' currently 

".,,,ing on CAIN consequcnces - " .. need 10 in"cS! .nd brinE: to >cole .hc COSt ""'ings of 

CAIN pre"cntion progt':'ms. !lu, "'C need a "..,U ,lc.igncd, "xoll ,hough, OUI implcmcn,ation 

""'tcgr "';th continual c"ol"ation for Qualit)" ' .. "",nc" and Q\\1lity Imprm·cmcnt •• , "",II 

as imp.c. oulcome •• ,,·hich \\;11 I"'",Kk a toolkit that.he .... cs ",10 .c""os . nd if dcoired. 

imple"""" depending "pon ,heir "niq"" popuia,ion oc .. ~I. , cuhu", .nd be .. fi" 

For a modest i""cstmcn" n01 only ",-ill "'XO b"",k .he in,ergcnCr.Jrion. 1 gxolc of.~ and.he 

mpi~ of n<gati,'C "",ul OUtcQffiC>. "XO an reducc on enormous ""onomic burdcn On 

,"xparers immedu,cly ."d ;n ,he long ,enll. 

N""d for a tosk fo1'<;~ 

Texa. Expericnc," UII1e Ribbon Task force 

Our ","""",h owr 3 ye ... h •• ,00"," ,hot if ".,"" h"'e child .busc/ncgicc, prc"cntion 

""'t<:gin. thg' lock c,·.luation. ,hou;ng o .. "come ,b,... NOflc of ,he exi,ting N .. ional 

org>o"'ation .... hou·n in the appendix. h"-e dc,-clop,;d 001' distribu.ed. child abuse 

pn"'emion ""''''g}" bh."'prim for usc .. ,he ... ,e or Iocalle,·c!. ThO! , •• glaring mi,,;og 

critical gop ,hat I belie,'c ,his task fore<: must .ddn»s. 

Ct.oclusion 

For a ",in'mal '",..,s.mcm in a National Ct.",,,,; •• ion, a. outlined in .hc Protect Ou, 

Ki d, Ac., " .. can cncourage s.atcs'O adopt p1'(l"en pr"""n'~';"e mcU""'S .ha. can 

ere .. ., a hig ;mpacl: Sa,;ng he. and S1\';ng Scarce ""6"urcU . As a ...,sult. we can 

.ignificanlly change .he traject"ry and ..., li~e posi.i,·c ",,'comu for o"r child...,n, "'" 

families, "ur communi.ics an d "ltima'ci)', o"r g..., .. countr)" . 

. ,............ ..a.....u:sw T" .... ....,~ 1btT .... \,..,.;" .... r""h<~oio.;l.l.'" 

....x1OK@; .. ~ .. -"'& I 21 ...... 2-t61Z 
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APPENDIX I 

Wof"lI. 

'" (;Dolo Summ. 

N.lIo .. 'O" .. A"".~ hnp-'i'/www,. To I.,m .. ,. _d.')' ,""Iy'" of~"'h ..... 

00 Child A",-.nd d""'n.<orn.lI,c ........ 0 •• 0 ,h. "udy of ,hlld .buse.nd M&I«1 N~«I{NDACAN) '"' 

H . ...... I Child Abu .. hnll'lI_www .• e Hc.o.NDS to."'" of...., <om....-u, (I) 

• nd N .. 1«t 0..1> o;<W<II.O<"&/II<. Summ.1)' D ... CompO",,"' (SOC) I •• 

SY'l<m (NCANDS) "'" com.,."'1on of k<y '11&"",11, ch ,Id .bu>< .nd 

M&I«1"""'ic> r""" .11 ....... ''''''''''" ...... <no "pO"" I.,,"!pllon •. v\c1jm".nd 

r>«P<"""'-" (2}1)o .. ,1«1 C ... 0.. .. Com_o. 

[OCOC) is . ",mp'lalloo of .... • ....... ' 

lnfQnn.allon .... m "' ... chlld """"", .... rile .. ",,,,,,,,""'0 prov1d. cl«tronic m,ld ....... .. , hll dW.II ~ hnp;II,.......,ch ~_"'pr1nl

- nd.........,.,ic 

Inloem •• lon IId"",If." .. _1 public."""., _1<~ ... , ......... nd on ll .. 

&",,,,,y 00' 1 .. ""," .001< lor Imp"",,'''' child w<ll ... 

p"-. W'udl ...... ""'''' ...... , .... bc ."-'red wUh f.mll ... 

On "". w<!KI1<.you "'. ",I'\t-w f<ftn, vublb ........ 0<1 oth<e "'PO"" on CAN, bu,lI is 

"'" ,h. ,,01>,'" 10 ", ... lIy '""'''''' d.,. .0<1/", 

,.-oct .p.<lRcout<om .. ofln'<e .. ~ ~ ,1>0 lin .. 

_" to oth<e c ... rinlh ..... lontion.;_ 

blip-oj Iwww,ch'ldw.,I .... ~/p~Jj .. d"IcJ/1!>' 

" • fo .... ... m 

Ch'Id "f.~ hnp;j/ ....... t< ChIld "f.~ o.,tome> .. . ~ ot.., I, 

o.".m .. Itoport 0.. .. _-,,",_hh,., publ' .......... u. lly by , .. U.s_ P<po"me.' of 

o_/d'''/'l:Rrt H •• llh ,n<! Hum,n s.rvi«> ,n<! """,,<1<0 

~ in"""'-"Ion on 1M p<rform,r>«t ,,(Sla ... ,. 

_ ... ,tom .... , ....... «4, redo"", 

""""UlTe .. " ofc.o.H, rod..-l.I CAN In fo>,," IIom ... lII<r< ... ......,.n,lI<)', <Ie.} 

n. ......... """"'.)'00 .loo<oo~,to. ..... _ .... full ... port is,,,,blt,hod 

ChIIdM.I ............ h"p'Jlwww.a< n. ... , ...... . ~.n<! •• _ .. _ld ... 

[h1ll. ... ""/p~ (""",en dow. by ...... ' well) o. c.o.N known '" 

c.m./'~/ ...... mild PfOOO<I'vc .. I'VI<ft.,....-Iet '" ,to. Unit'" «</$hlld· SUI<. duri".. ponl<ula, (<do,.., ft""'r<" m.II ..... m •• '· 1"' ....... '" UnO .... ,,,ted) 

N._I~"""'m> hltP-'i'/www.n, " NRC-CWOY I. COft'Ipr1...-J of. df ....... Jf<'UPof 

CC . .... foo-Cklld <cwd,."", too •• I"." wi"'. "'01< of " il" . nd e:<pcrlor>«t 

w. If ... 0.."" from S .... Child w.If . .. qc<><Ict.o<I ,..,h.In' 

'"" NRC· inf""" .. 1on t<ch "nos; t<chni<ol 

"""'"" .\I<O.w.,.cs., T .. _1hoT_' __ "' .. _~..­

~"f"""<"-'>1"''''' '''2 

(" "" H~' " Tb ............. vo .... y .. _ ......... 

'-"'''-' 

~"";/_...........v. .... /.I!I!M;.\ 

-.. ~1.!>''''''''''''' ......... _ ~\aII''''''-' .. _ ........ (.~ ......... ), 

~"";J/www~~"'JjO/«;A 

~ ......... """ ....... 'l'oINCANllS< 

II!U>;J/"'-""'·~JI'''''' • fIlo.....wJI ... '..u>o<:>J.m:.INI!U'.P<!.. 

-~, 

-_ Tb ...... _ ....... ,'" .... ~_. ....... _ ....,'" ,...- T._" ... ,-........ __ ...... _ .... ..m.-./ ................... ,_(.~U.s. __ ofl_. 

................ "" ...... -.. .... """ .......... , .................. , a.tId ........ _ .... ~""" • • _ 

...... "' .. _ .. _ .............. ..... ..-no<dy"""' ...... - ..... -'""' __ .... _'""1 __ .. 

...... _"" .......... _ .. ... "' ....... ,.to .................... ..... """"' ........ ,..-.. - , .................... ""-''''', ..... "'~""'''''''''''' .,"' ........ __ '''' y .. okoco. ........... ..... """ .. """"' ......... 01 ...11 .... '''''''''' ........ '''.001 •• ''''''" ... _ ............ ri~ .. _ .. "" 

... '"" ... , .............. ~ 

It!lJ>J/~~JIo 

n. ................... _"" .... ........ d ....... r.-- CP'S ........... 

""'"''1',"", "r.II .. "td .. """""", .. ..... (,_ .. ..ch ....... OFPS 

... "booIc"""ptW.tId""" .... """'.....,. .. CAN) 

............ _--........... ...... , .............................. _ ....... Hn"' .. _ • ..rvr _ .... tldd" ...... ( •• "CA"DS, 
29 


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~"" ... ,.tana is ... ila~." fI(> th .... to Stat«, 

Court< 'nd Tri.,...." imp""'" ,ho Q .. II'1 0( do ... 

... pOrtO<! '" ath., V""p< ('-<. A'·CARS. NCANOS, ~, .... NYTP 

AdQpt\<HI.O<l f .... ' h"':lIwww~ AFCARS <t>I'-"' .. ·Io .. I,nr.,r.....'.,. on.1I c..~A .. ,)'$I ..... [t!~J.~'lY/rrnIl "",Id, .. ,. ,,,._,.,...od 'hOSO who 1» •• 1>«" 

R.po"';"~ System roau/Sb' ....... odop". w~h ti,'.,V-E >g<DOJ' 'nvol .. m. n, 

(AFCARS) 1'<'11-<10'" 

'",h"""e/'" 

"",. 

,-"r<bl.r.ou 

011<l,...,',8u"." h"l!;lIwww.oc Th<CB """'It ....... ""hlkl _If .... ~ 

(CB) [hM~/p, .. to","'" • num ... '"h ..... m." ... od <niao$ 

"'lI>/.<bf_' (Child ,nd F. mIl1_ R<VIew>. T"I. IV_€ 

"'- Fo" .. ea ... AdopIIoo .r><! F"" .. , eare An.ly>is 

,1><1 R<pen'" Systt,",.nd <II_ SU"""" 

AU'Om.t«! Child W.lf .... '"r ..... ".,. S1"'''' 

.... .,w •.Th"""h ,hi .... "'it.)'W <>n pin 

0«< .. ",,11 •• 

KIDS COUNT hUP.·fLd • ...". KIDS COUNT d ... «nl<, I • • pmjod of'lI< Annlo 

.. f,kid~Ol .• t- Coooy Found_n 

~'oor .. l Stud'" hllPc'//wwwJp l.ONGSCAH if;. aa.><>rt'.m "' _ _ "" ,,00 .... 

oI'elIlklAO .... ",. f<_."c.<du/lml E.><h .i1, ""nd""" "1""" .0<1 uniqu, ...... r,h Ne&I«t (LO~GSCA.~) -", proje<" on tho etloO>lY.nd 1m.,... of ,h'i<! 

... It .. " .. , .. , Whll< .",11 proje<I <.n mnd 

• 'OM. th~ th •• " of rommon . ... "m' .. m ... u, .... 1.0110, 01.:1 .. colt<d ... ...-.hod, . nd 

"'h'Oul .... nd "",,1.0 . o.ly .... LONGSCA~ is • 

«>I .. bo ... ~,...rrort. 

The .... 1 oI'l.ONGSCAN "to 101 ..... """kI" •• nd thel, r,mUi<-> until ,h'i<!ro. mom. younl 

><lui ... Comprehen"v, ...... ",."" of ""'ldro .. ,h.i, p;lren ... . nd ,he'c' .. 'h ... . re .. h«luie<l 

to O«'\orot<hl'd og .... 6. 8, 12. 14, 16.,.d 18, ", • .,..., .... ,01.:1 .. if; ,ollo<tnl 1m... m.I"pl< 

""'«fl, Incr.drnS -.,rd rev ...... . , Ie." ~"1 two,.. ... , y .. oiy "I.ph""" In"rvlew, .I .. w 

,I", t. tro<k r.mill ... nd . ..... ,... oiy "rvk~ 

.,III .. ,Ion.nd lif< .wn". N!lACAN m.k ... 

... "tI<t«l do' .... . ,.II.bl< t .... mb< .. 

, ,.....,. .'k<lw<. u:,".' .,. .. ""*"'-llooT .... ' ... _foo ... -....oI'_ ~ .. _"' .. Il,......,·,." 

~YTD,C;'''' ,,~),_, 

",,,,,,~-.--

'" 1)0,., ............. _ ... "' ......... ........"" .... . _ ............ ... _ _-.. r..n...,.. 

-"", ...... 

N ... ...,.....NI_ ....... w_ 

Op«flkdlIOl ....... -.""' • ..t., K,... ... n"o __ ... ",MoI 

....... "' ............. 401 .... _.' 

pooI<I\« ... .-.... """'''''''' ... * , ... , .......... '1"<'". 

Qu .... _ • ..,w ...... N ...... 

r....., _'.......... ..... _ ..

' ... .. W _ ...... ...,k"'" 

• .. an ....... "",. ........... _ .. 

....... _k_ " .... "",,""','."' .. ~ .... ....... rdo .. 

""'" (po <on ...... ,.,... ..... CPS, 

'_ .... T_ .... )., ........ '2 • ".»Id ' 6; dw _11, --"'«' iok .. , .... d.> .. (. " ... ,,"'~k ....... "",' .. ....... rdi.<r, ........ ( ... I ....... _".ron...·'_ ..... dw 

_"''''-,h<I,.-.«< ~dw 

............... ...,~.II1 ............ _ . 

... ~ .. '".WJ«"' ............ _,,".~ Io<",""""', _..:, ... ,.". ........... ...,., .. ,""_" . ..... I>o<on..- publi<>< ... , . .... ~,rr-,_ ... " 
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APPENDIX II: Annual US Spending on Child Maltreatment 

Va'" Mr /1,,, C",/,bJ}Iki:Anka/ US5pgy/L"l M ChilJ Ma/Irt~I""nl 

TOhII Am!.ual Coal U.... don. £ram Total ........ uaI U."" Calcub.d 

• 

""" '"'' '"" ,em 

""" 

"'W "'" 

201! 

"''' '"" "''' 2015 

2016 

"''' 

u"-wuwfllRe 

546.473.544.2(.0 

HS.587,344,020 

SS<l.266.00'),710 

~~~~ ____ .JS45 '~~S,457~700 .894.805560 

5,198,380,36(1 

S45.376.896.797 

W.633.611,066 

S~9 . .w6.598.277 

S 727949679 

S52.237.077,850 

A.w,"" (V, !Jew, GJar/"'ioo, fiM S.bJl«wli~'" /VI""" 

Cos," Numbe, ufCunfinncJ Victim.' CoS! Per Vic,im 

NumocrofC'Mlfirmcd Vic.ims: 

Nl E.dnHl 

565,X04.475.657 

~763~732 

S70.234.862,8j4 

$72,431,G68.542 

575.313.730.193 

lli,(l.I5,m,066 

S76.276.390.219 

S7M7lP.!!!2,187 

S83.138.265.835 

__ ~$8.I~J61 7S ,5 23 

587.901.215.954 

__ ~"'~Z12!!1785 

593.329.272.7).1 

S96.!!H,.w6,521 

o For 2004 - 2010: d ... compile.J from 2008 - 2010 Child ~1.1,,".,mcn, Do,. R<'P'''' (f<um US 

Children', Bu",>o) 

o F"r 2011 _ 2017: ca!cul:otc-d .b~ "'~r1gt' ,,'c frum 2004 ·2010 (<<MlflHTled ,·jc.im,/ child 

popul •• ion); u>cd ,b •• ",=ogc .... c.nd .bc prujecrcJ ebilJ p<>pul:otion f01' ,",eh r"" until 

2011 {frum child ..... ·Sov).o pruj«r number of,;,;.im. c",h r= 

Coo, Per Vic,im: 

o Equob S63.871 in 2012 J"U." (from GeUt:> & I'crlmon 2012) 

o Thi. ,..lue w ••• dju"cd .nnu.1 for inlbtitMl/dc flo,ion 

lhrrr;l.6;",,,,··u.inflo,,oncr!cubm.I$ll:llll) 

For enml'le. 'hi' .mount "'Iu.'~. ,,, $52.159 in 2004 .nd 562.110 I"'r I'ic,;m in 2011 

• Inn .. iun for 2013·2017 1>'" ... umcJ.,. linca< ,..," ofinc«: ... fmm 200-1·2012 ... ,e> 

Au'"" U" UWrt 0,""/,,60., fio. ,'''/ll AI>NH [''-Iti",<III, 

Co .. - To .. l Number ofYicti""., Esrim".d br Nl$' Cos, Per \'ic,im 

T"tal Number ,,(Victim. os E .. inu'eJ br NlS, 

o NTS·4 ,hol>'ed. ,01.1 of 1.257.600 ,·k';m. nf chilJ .bu"" in 2005 romp .... -d '0 ,h" 901.000 

Sub".01i.,cd "'''''' of .bu", 'h""'''' by ,he Child M.ltrc."ncn, D.,. R .. 'P"" 

o \X '~ ca!cul:o,cJ ,he diffe"'rlCe in 'he .bu""",,, (,,,,.ll'ietim,/ch;]d popu",ion). be""..,.,n NI ll 

ond subst.nti.rcd cr>c> for .hi, )'e"" .nd .pp~ed .h.t difference .w», e.eh rOOf to 

determine ,he numh~r of children likely.o h.,·c been .bu",d each )'eo< 

All rnhe< proj .. ,<"ion, of CO". popula.ion S"",·,h .• nd inlb,ion ")jus""''''" "'ere completed.s 

prcl·iou.ly dc;crihcJ 

. 'bdd ... .\!<CJu...L('.'W 

T .. P""", ... Tho 1· .... ,\"", .. bon fo.- Ih< 1'wI«""" ofCIUIdn-n 

m><k1in<@""f"<>t«1.,,,,!!: I ZI~""2-1612 

• 
31 

f 


joloto on DSK67XMDP1PROD with HEARING78759A.019

I Oallam, S.J. (2001). The long·term medical consequences of childhood maltreatment In K. Franey, R. 

Geffner. & R. Falconer (Eds.). The cost of child ma ltreatment: Who pays? We all do. San ~iego. 

CA: Family Violence & Sexual Assault Institute. 

Perry, B. D. (2002). Childhood experience and the expression of genetic potential: What childhood 

neglect tells us about nature and nunure. 8roin ond Mind, 3, 19· 100, 

II Perry. B,D. (2002). Childhood experience and the expression of genetic potential: What childhood 

neglect tells us about nature and nunure. 8roin and Mind, 3. 19-100. 

" Barnen, W.s" & Masse, LN. (2002). A benefit·cost analyses of the Abecedarian Early Childhood 

Intervention. New Brunswick. NJ: National Institute for Early Education Research. Retrieved 

from www.ounceofpreventlon,org, 

.. Silverman. A. B .• Reinherz, H. Z. & Giaconia, R. M. (1996), The long-term sequelae of child and 

adolescent abuse: A longlludinal community study. Child Abase and Neglect 20(8). 109·723, 

• Swan, N. (1998). Exploring the role of child abuse on later drug abuse: Researchers face broad gaps 

in information. NJDA Note .. 13(2). Retrieved from 

www.nlda.nlh.gov!NI0I\...NoteS/NNVoI13N2/explorlng.html 

Wldom. C. Marmorsteln. N. R.. & While. 11. R. (2006). Childhood victlmb.:ttion and IlIlcll drug use In 

middle adulthood. journal 0/ Psychological Addictive Behavior. 20(4). 394-403. 

" Campbell. F. A., Ramey, C. T., Pungello, E. p. Sparling. J., & Miller·Johnson, S. (2002). Early childhood 

education: Young adults' outcomes from the Abecedarian project. Applied Developmenwl 

Science, 6, 42-51. 

U,S. Department of Health and Human Services. (2006). Long·term consequences of child abuse and 

neglect Child Welfare Information Gateway: Washington. O.c. Retrieved from 

http://www.childwelfare.gov !pubs!factsheets/long..term_consequences.cfm, 

'" Widom, C.,& Maxfield, M. (2001). An update on the -Cycle of Violence." Research in Brief, 

Washington. DC: U.S. Department of Justice, Office of justice Programs, National Institute of 

Justice. 

"" Child Welfare Information Gateway. (2006). Long·term consequences of child abuse and neglect. 

Retrieved from 

http://www.childwelfare.gov !pubs/factsheets/lon&..term_consequences.cfm. 

b Cook, R. (1991). A national evaluation of title IV-E foster care independent living programs for 

youth, RockVille. MO: Westat.lnc • 

• Fang. X" Brown, D. S" Florence, C. S., & Mercy, J. A. (2012). The economic burden of child 

maltreatment in the United Sates and implications for prevention. Child Abuse& Neglect 

36(2),156-165. 

~ GelleS. R.I .. & Perlman, S. (2012). Estimoli'dAnnuol Cost o{Chlld Abuse and Nf!9lec~ Chicago. IL: 

Prevent Child Abuse America . 

... Foster. M. E.. Prinz. R. J .. Sanders. M. R .. & Shapiro. C. J. (2006). The costs ofa public health 

infrastructure for delivering parenting and family support. Children and Youth Services 

Review, 30. 493·50 I. doi: 1 O. I 0 16/j.childyouth.2(}01. I 1.002 

~. Correa, N .. Quintal, t., Sanborn. R., Begley, c., Franzini, L, Giardino, A., .. Tortolero, S. (2012). The 

S/(lte o/parent educoflon In Houston. Texas: An opporlunlty tOSlrengtken/omily well-being. 

prevenl child mol/reolment and prepore children/oro briyhter {ulure. Houston. TX: Children 

at Risk. Retrieved from hup:! !childrenatrisk.orgfwp·content!uploads/20 12!0 1 /The-Stateof-Parent-Education-in-Houston-Reportpdf, 

.11 • .I<hn< ~lcCl"«. I£SW 

T<xPro<<<", Th< T"" .. ,1 .. 0<1>00n fo< d", p",,«OOn or Child«n 

mxl<lioc€,<xprot«".oflI I 214-142· 1(,72 
32 

Mr. PAULSEN. Mr. Sanders, you may proceed. 

STATEMENT OF DAVID SANDERS, PH.D., EXECUTIVE VICE 

PRESIDENT OF SYSTEMS IMPROVEMENT, CASEY FAMILY 

PROGRAMS 

Mr. SANDERS. Good afternoon, Chairman Paulsen, Ranking 

Member Doggett, and Members of the Subcommittee. I am David 

Sanders, executive vice president of Systems Improvement at 

Casey Family Programs, a national foundation committed to improving the lives of vulnerable children and families in America by 

building Communities of Hope. 

We thank the committee and, in particular, Chairman Camp, 

Subcommittee Chairman Paulsen, and Subcommittee Ranking 

Member Doggett, for their leadership and commitment to reducing 

child fatalities due to abuse and neglect. 

The discussion draft that has been shared would establish a commission to develop a national strategy and recommendations on 

this issue. We commend the vision and overall believe that such a 

commission would provide an incredible opportunity to better understand how we can prevent child fatalities. 

We offer two comments for your consideration. First, we agree it 

is important the 12 commission members represent a number of 

key expertise areas outlined in the draft. While the discussion draft 

states that each member should possess at least one area of expertise, it is important that the commission represent a broad range 

of issues. As currently drafted, it appears possible that all of the 

commission members could come from a single area of expertise. 

Second, the discussion draft limits the purview of the commission 

to programs funded under Titles IV and XX of the Social Security 

Act. There are a broad array of programs that provide upfront prevention and intervention services, such as Medicaid, maternal and 

child health programs, and substance abuse funding. We, therefore, 

urge the inclusion of a broader spectrum of programs. 

In an effort to influence and mobilize national efforts to prevent 

child maltreatment-related fatalities, Casey Family Programs 

launched a series of forums in the fall of 2011. The Administration 

on Children, Youth and Families, the Centers for Disease Control 

joined Casey Family Programs in hosting these events that were 

attended by experts, policymakers, advocates, researchers, practitioners, and child welfare leaders, as well as public health leaders. 

These forums provided us a tremendous opportunity to explore the 

issue of child fatalities from different perspectives. 

Findings explored in the Safety Forums that will guide our future work and recommendation center around four areas: Number 

one, risk factors for severe maltreatment and fatalities. Research 

in California linking birth records and CPS records has found that 

a report for child maltreatment before the age of 5, whether substantiated or not, is a risk factor for a later fatality from intentional or unintentional injuries. Other researchers found the rates 

of abusive head trauma identified among children under 5 years of 

age increased significantly at several major pediatric hospitals during the 2007 and 2009 period and were associated with increased 

economic hardship at the community level. 


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Number two, child maltreatment is a public health issue. A significant proportion of child maltreatment-related deaths occur in 

families who have no history of involvement in the child welfare 

system. Therefore, it would be prudent for us to look at the issue 

of child deaths, not just through the lens of child welfare but from 

a broader public health perspective. 

Number three, informing child protection policies and practices 

for reducing child maltreatment-related fatalities. There are several areas we need to consider to improve child protection policies 

and practices. The public’s perception of child welfare in this country is generally painted by media reports of isolated cases of tragedy. The gap between public perception and the realities of child 

welfare administration drives public policy in ways that are not always the best for keeping children safe. 

And finally, number four, measurement and classification of child 

fatalities. Experts agree that improving the measurement and classification of child fatalities is critical to understanding and preventing child maltreatment and fatalities. Building effective crosssector multi-agency collaborations is essential for obtaining accurate data on the incidence of preventable child deaths and serious 

injuries, and implementing successful prevention strategies. Multidisciplinary local and State child death reviews teams play a critical role in identifying patterns in child death and serious injuries, 

identifying common risk factors, and developing and implementing 

preventive efforts. 

The work of Casey Family Programs’ Safety Forums has led us 

to believe that we can succeed in this. Successful strategies are 

comprehensive. Strategies are not limited to one sector or agency. 

Successful strategies are focused. High quality data, as well as 

other kinds of research evidence, are essential to inform strategies 

and assess results, and finally, we currently have some important 

knowledge and experience in regards to data, but there are glaring 

gaps; gaps that we can close. 

Casey Family Programs has used its national platform and its 

resources to work with State child welfare administrators and 

other key voices to elevate this issue. We stand ready to work with 

this commission or any other group or organization focused on child 

fatality. 

Thank you and I am happy to address any questions you might 

have. 

Mr. PAULSEN. Thank you very much, Mr. Sanders. 

[The prepared statement of Mr. Sanders follows:] 


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joloto on DSK67XMDP1PROD with HEARING78759A.020

TestimOlly of 

I)a.-id San de rs. Ph. I). 

Executive Vice President of S)'stems Impro" emcnt 

Casey Family Progra ms 

U.s. House Commill ee Oil Ways an d Mea ns. Subcommillee on Huma ll Resources 

Hearin g on l'rol'O'Ia l to Redu ~ C hild I)ea th. I)ue to Maltreatment 

l)eccmlJ.t-r 12. 2012 

Good morning Chainnan Paulsen. Ranking Member DoggClt 8nd Members oflhe Subeommittee. 

Thank you for the invitation 10 join you today. 

I am David Sanders, ~xecutiyC "ice president of Systems Impr","ement at Casey Family I'rog",ms. a 

national foundation committed to improving the Ii,·cs of "ulnerable children and families in Amcrica by 

building communities of hope. 

Casey Family Programs has been sen'ing children in foster care for more than 45 years. We belic,'", that 

the goals of the nation around $Ccuring well_being for all children should be about both: I) keeping 

children who have been abused and ncgleetcd safe from further honn: and 2) prewnting abuse and 

neglect. the possibility of child deaths. and the ne<xI ror foster care in the first placc by strengthening 

vulnerable families and their communities. 

Extrapolating from fc-de",l gm'emment statistics, c,'ery 24 hours in America. on average: 

Approximately 2.000 children are confinned as victims of child abuse and neglect. 

Nearly 700 children are rell1o,""d from their fam ilies and plac<xI in foster care . 

About four children die as a result of child abuse and neglect. most of them before they reach 

their fifth birthday. 

That is C"cry day in America. 

And these child deaths. 1.537 in 20 10. are considered to be an under-co .. nt. ae<:ording to the 2011 U.S. 

Gm'emment Accoumability Offie<: (GAO) "'[IOn on child mahrcatmem and falalities. Indeed. 2010 was 

the first time in a de<:adc that the numbcrofchild deaths due to maltreatmenl declined instead of 

increased. But herein - in the data -lies the problem. Whether the numbers reponed go up or down. for 

a "ariety of reasonS there exists a common underlying concern among professionals in the field, seholars 

and many others about tl\c accuracy ofthe dala. 

When Casey Family Programs de"eloped its 2020: Building Communities of Hope strnlegy se,'en years 

ago. we were mOlivalc-rl to do so. in part. because of the number of child fatalil ies at that l;me. We had 

asked oursclws. whot would happen to America's moSt vulnerable children ifnOlhi ng changed. If"'e 

,,'ere 10 continue on the same trajcctory we were on in 200S. we estimated that by Ihe year 2020. alleas1 
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22.500 childrcn will ha"c died from abuse and neglce!. At least. because as I explained. that estimate is 

mQStlikely hased on an under-cc>uming of child fatalities_ 

Though wc have made significant strides toward kceping children safe - children who havc comc to the 

auent;on of child welfare - we cannot fully or adequately address the ;ssue of child fatalities ulllil we 

know the full scope of the problem. Not until we have aCcurate numbers to gi,'e uS a clearer picture of 

,,'hat's going on. 

How do we go 300m gening reliable data thm tell the whole story? Only afler we know what we're 

dealing with - what the problem looks like - only then can ,':e dcvelop eIT.:.:t;w strategies and solutions. 

We thank the Meml",rs of this Subeommil1.:.: for Iheir leadership and commitment 10 reducing child 

fatalities due to abuse and negl.:.:!. The proposal would establish a commission to de,'c1op a national 

stralegy and recommendations on this issue. We commend the vision and believe thaI such a 

commission would provide an opportunity 10 further infom' how we can pre"ent child fatalities. 

We oITer two commCnts for your consideration. First. We agree it is important the 12 commission 

members repreS\.'Tlt a number orthe key expertise areas outlinc-d in the proposal. While the proposal 

says each meml}(,,- should possess at least on area of expertise. ;t is important that the commission 

represent a broad range of issues. As curn:n(ly drafled. il appears possible that all oflhe commission 

members could come from a single area of expertise_ 

Second. the proposal appears 10 limit the purview oflhc commission 10 programs funded under titles IV 

and XX of the Social Sc<:u,-ily Ac\. There are a broad army of programs that provide upfront prevention 

and intcrycnlion serviC<."S such as Mc-dicaid. matemal and child health programs. substance abuse 

funding. etc. Wc. therefore, urge Ihat a broader spectrum of programs be explored for inclusion. 

Cast'y Fa mily Progra ms mpro\"ing Child Safet), and Prt"~nling Fatalilies" Forums 

In an eITort to influence and mobili~e national eITorts to pre"ent child maltreatment related fatalities. 

Casey Family Programs launched a seri ~"S of forums in the fall of2011. The Adminislr3lion on Children 

Youlh and Families, and the National Cemer for Injury Prevenlion and Control at the Cenlers for 

Oisease Comrol and Prevemion (CDC) joined Casey Family Programs in hosting these events thaI were 

~uended by experts. policy-makers. ad,·ocales. researchers. prllCtilioners and leaders in Ihe field of child 

welfare and public health. 

The fi rsl forum entitled ""Improving Child Saf~"\y and Reducing Child Maltreatment Fa1alilies"" was held 

at the Urban Inslitute in Washington D.C. on November 9-10. 2011 with a group of 35 experts. policy· 

makers. ad'·ocalcs. researehers. praclitioners and child welfare leaders. The second forum. which was 

aUendcd by O,'er 80 participants was held On Mareh 21 and 22. 2012 in Allanla, GA and focused On 

"Applying Public Health Approaches to Impro,'e Safety and I're,'cnt Child Falalities."' The Third forum 

look place on June 28-29. 2012 in Nashville. TN and was anended by o,'er .me hundred participants_ 

The e\'ent was co host~-d by the Tenn~'SSCc Department of Children's Se""ices and focused on 

"'Improving Safety and Prevenling Child Falalilies: Focusing on Child Protcelion. Most recently. on 

O<.."<:cmber 11.2012. Casey Family Programs hosled a "'Safety Action Planning Summil"' which was 

aUended by public child welfare and public health representali,-es from ten StaleS and the District of 
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Columbia. Thescjuri$dictions mct with exp<.'T1S to develop and refine specific action plans targctNi 

lOwards improving ehild safety and pr.:'·cnting fatalities. 

Thesc forums provided us with the tremcndOllS opportunity to explore this issue from different 

perspecti"es and focused on three major topics: 

Measurement: [)e"eloping more accurate "-ays to classify and cOunt maltreatment relak..:! 

fatalities as a meanS of informing policy and practice. as well as de,'eloping better child s'&'\y 

performance meaSUreS. 

Child Protection Policy and Practice: Infonning child protection policies and practices for 

reducing child maltreatment relatl..:! fatalities. 

Public II calih App r(lDc h: Exploring a new approach to child protection that emphasi,£s public 

health strategies for preventing child maltreatment fatalities_ 

The following si.~ lessons learned emerged from thesc discussions: 

We U n ucc~ . l'ublic health and safety engineering efforts hD "e reduced dc~lhs and injuries 

in the U.S. from many causes that initia lly seemed intractable. This has been true even when. at 

the beginning of the effort. those causes seemNi deeply ingrained in cultural and individual 

beliefs (drunk driving, smoking) and driven by interactions between human error (medical 

errors) and sheer. unpreventable bad luck (plane crashes). 

Successfu l strategies are comprehensive. This lesson emerges abow all from the public health 

successes which are comprehensive in multiple ways. First. they arc multi-le,·e]. potentially 

including components at the level of the indi,·idual. the family. the community. service sys ~ms 

and public policy. as well as broader public attitudes and beliefs. Serond. tlley target several 

different I",'e]s ofpre\'elltion - immediate prevention of death or injury. as well as more 

~upstream" prevention targ<"1c..:! at high-risk groups or individuals. They may also include 

unive"..1 pre"ention efforts. targeted towards an entire community or nation. 

Strat egies are not limited to Hny one sector or agency. The theme of multi-agency and multiseCtOr strategies. including health. law enforcement and education. as well as child welfare 

.y.t~m' and Krvicc pr"vide~. ,,<~i, eoJ I"'nicular all~n1ion. Ot h~r "",Ion or pan'>':r. identified 

inciudNi the media, elccted officials. the broader public and anti-po\"erty and affordable housing 

expcns and activisls. 

Successful strategi es are focu sed. Comprchcnsi,'e isn'tthe same as trying to do cverything. 

The key is a focused approach. based on data and e\'idenee. with high-impact opportunities that 

can make a difference. In the public health world. continuous attention is paid to what is 

working and to gaps that nct.":! to be filled. 

lIigh 'lu~l y data. u well as othe r killds (If earch c,·idenee. are s~ enti~ ll (I inform Ihe 

strategy a nd assess its resulls. This starts witll surveillance-being able to count and meaSure 

the problem. This strategy also includes data 10 identify families at the highest risk. which is 

necessary 10 target upstream prevention. And it includes data to place deaths. injuries and "ncarmisses" in a systemic context. 10 inform systcm improvements that have been crucial to safely 

engineering successes. In addilion. evidence synth~'Sized from past research should inform Ihe 

inilial choic~'S of programs and strategies. which thl." can be trach...! for effc'Ctivcness and finewnl...! ovcr time. 
37 


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00 the data side, we haw some imllort ant koowlwge and u llcrieoce right ~ow - yet there 

Drf also glaring ga ps. We dearly know more than we arc now pUlling into practice. but there 

are also substami,'c knowlc-dgc gaps. 

The following pr.".,nl. 50me oflhe major Ihemc, Ihal cmcrgw from Ihc Safel)' Forums con,'cned 

by C.,cy Family "...,gran,,': 

I) Risk hClors for Se"ere J\lallrealn'ent and Falaliti..., 

Large·sample research in California linking binh rc<:ords and child protCClion ser\'ices (CPS) mwds 

has found Ihal a rcpon for child m~hreatmc"t before the ~ge of 5. whether substantiak-d or no1. is a risk 

factor for a fatality from imentional or unintentional injury. The research using lin ked data found that 

factors at binh ineluding Mc-dicare health insurance. Black rnce. younger maternal agc. and lack of 

established paternity for the child arc associated with higher risk for report of child maltreatment. and 

espedally for repon ofncglect. during the first 5 years of life. Of interest was whether children reported 

for nonfaWI mai(reatment subsequently faced a heightened risk of unintentional and intentional injury 

mortality duringlhe first 5 years of life. Findings indicate that aller adjusting for risk factors at binh. 

children with a prior allegation of maltreatment died from intentional injuries at a rate thai was 5.9times 

greater than unrcponed children and died from unintentional injuries at twice the nile of un reponed 

children. A prior allegation to CPS provc-d to be the strongest independent risk factor for injury monality 

before Ihe age offi'·c.l 

Similarly other rescar<;h suggests that there arc risk factors that are predictive ofscwrc child 

maltrealmenl and fatalities. For c.<amplc. n.:scan.:hcrs found Ihal rnles of Abusive Hcad Trnuma (AHT) 

identified among children less than 5 years of age increased significantly at severnl major pediatric 

hospilals belween 2007 and 2009. and were associaled with increased c'Conomic hardship at the 

communily le,·el.l 

2) Child Maltrutmc," 3S a Public lI ealth Is e 

A significant proportion of child maltreatment·related dcaths occur in families who ha"c no history of 

involvement with the child welfare system, Since many ofth~'SC caseS are outside the oversight of child 

welfare. their numbers would not be rcnectcd in agency reports. Therefore. it would be prudent for uS to 

look allhis issue of child deaths. nOljuslthrough the lens of child welfare, but from a broader public 

' Chahine ct .1, (2012). Casey Family Programs Child Safety Forum Summories: The Road Ahcad: Policy and 

Practice Inno,'ations N""ded to hnprm'e Child Safety and Pre"ent Fataliti ••. (unpublished) 

, Pu'nom.HQ<n""in. Ii.. Web"e'. I)., N""dclt. B. & M"gn><l«. J. (~Ott) "A Pubti< Ik.lIh App«>o"h." Chitd 

Mal t",atment Surveillance: Evidence From a Data Linkage Proje<:t in the United States". Child Ab,/je Red"", 20. 

256-273, S •• also PUIMm.Homstein. E. (2011). "Report ofM.ltre.tmcnt u a Risk Factor for Injury rx.,h: A 

Prosptttivc Birth Cohort S,udy", Child MII/rret/rme'" 16(3). 163·1 74. 

) Berger. R.t' .. From' in. J.Il,. Stutl. H .• M. koroll". K .. Scribano. P,V .. Feldman. K .. Tu. L,C .. & Fabio. A. (2011). 

"Abusi,·. Head Trauma During I Time of I""reased Unemployment: A Multicenter Analys;s", P<'I1iarr/'" 128 (4). 

637-643. Soe also Wood. J.N .. Medina. S.P .• Fo"dlncr. C. Lu.n. X. Loc.lio. R,. Fieldston. E.S .. Rubin. D.M. 

(2012). Local Macroeconomic Trends and Hos~illl Admission. for Child Abuse, 20(1)...2009. P<'I1i"lr;". , 

Published online, 
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health perspective. A public health approach to the prevention of child maltrcaunent fatalities focuses on 

the health ofpopulalions rather than just the individuals. and aims to prc"ent critical c"cnts lxJi!rt· '''q Q££u~ __ This approach is more efficient. more effC'Cli'·c. and is associated with bellcroutcomC'S. compared 

to lrealmen! after harm occurs. Pre"cn!ion may take three basic forms: 

a) Primary prevention efTons are intended 10 reduce risk and enhance protecti"e faclors in the 

general population (all children and families), EXAMl't£S, Requiring usc of child safety sealS in 

ali cars with young child passengers; deli.'ery of safe slecping guidelines 10 ail parents of infants 

and toddlers. 

b) Secondary pre,-cntion efTons consist ofinte ... 'entions dC'SignC{) 10 reduce risk and enhance 

proleclive lactors among specific population sub-groups known to be at greater risk for child 

falalilies and serious injuries_ EXAMPLE: Uome visiting parent suppon and education programs 

targetC{) 10 low-income. first-time parents. 

c) Teniary prevention efTons. by com"'SI, are intended to reduce and prewnt subsequent harm 

among familiC'S "'here abuse or I1<'glecl has alrrodv occurI'M. EXAMPLES: In·home safely 

planning in families who are subjects of child maltreatmenl rcpons: protecti,·c custody and outof_home placcmem of child vtetims of abuse and neglect. 

While most child protection aClivitiC'S in the UnitC{) StatC'S have traditionally relied on teniary 

pre"ention, the value of broader public health approachC'S is lhallhey focus energy and resources on 

mor<: "upslrI:am" primary and s.,-.:ondary pr<:vention activities. and thus ha'-c the potenliallo keep more 

children safe " 'hilc n,ducing and prewming the trauma and disruption associated " 'ith removing 

children from their homes, 

As demonSlrated by the research, many high_risk family situations can be identified very early in lhe life 

ofa child. providing opponunilY for proaeti"c suppon and intervention which may help save livC'S and 

prevent serious injuries. Infonnation a"ailablc from binh records regarding a small set of risk faclors can 

be utilizC{)!O target high-risk children and familics for outreach and offers of voluntary se",ic~'S. 

Dr. Fred Ri"ara and Dr. Brian Johnston conducted a review o f successful public heallh elTons for Casey 

Family Programs_ Thcy found thai publk health research has demonstrated ceMain lypeS of interventions 

can help 10 reduce and prevent child falalitiC'S and serious injuries. and SOme clTecti,·c steps 10 

pre"ention are neither costly nor difficult to implement' Automobile child safelY seats. bicycle helmets. 

and safC1Y fences around swimming pools are c~amples of simple and effecti.'c steps lhal have save<! 

many li,-es. Thc promotion of safe slc'Cping pmcti""s ("Back to SIc'Cp") is an example of an initialivc 

thaI reduced preventable child deaths and injurics and could likely save addilionallivC'S if consistently 

promoted by organi~.nlions thaI corne into contact with familiC'S Ihat have infants and toddlers in the 

home. 

'Ri,·efl. F, p, and Johnston. B. (2012). Paper prepared for Casey Family Pr"l!flnl" "Effecti,-. Primary 

Pre"cntion Programs in Public Heahh and Thei. ApplicabililY to lh~ Prevenlion of Child Maltreatment'" 

(unpubli.hed), 
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Public information campaigns arc integral to efT~"C ive public heahh "ffons to ",due" and prevent deaths 

and injuries. They also playa critical rolc in informing the public about the work of CPS agencies and in 

framing child safety as a community responsibility. Comprchensive media relations ~trategie, are also 

r~'Commendc-d by child wdf",e leaders who haw successfully incorpornt~-d public heahh approaches 

into agency policy and practice. Using inf()1"Tl13!ion to help change culture within agencies and 

communitic~. and pcrsc"erancc over time in change "fTons. have been critical factors in the ~uccess of 

eOeeti,"e pre"cntion campaigns. Twenty years ago it would have been di01eult to find a bicycle helmet 

in a child's si:oc. and a"ailable helmels were often unaltracti"e 10 appearance_consciO\lS consumers. 

Today. helmets arc available in a wide rJngc of styles and sizes. and helmet uSC by bicycle riders has 

increased tremendously. Lessons from Ihis and other injury prevention campaigns can inf()1"Tl1 new and 

ongoing efTons to reduce and diminate child fatalities and serious injuries. 

It is encouraging that the COC's Division for Violence Prevention is exploring Ihe usc of experiential 

learning tools (simulation modc1ing) to more effccti"cly communicate Ihe imponancc of addressing 

Adverse Childhood Experiences (ACEs) as an imponant public heahh issue. These tools will be 

cmbcdd~-d in a larger facilitatc-d process Ihal " 'ill culminale in panicipants - indi"idwtl employers. 

community coalitions of employers. and/or the broader community - in de"eloping 3ction plnns to 

ensure safe, stable. nunuring childhoods by building community capacity and citizen r~"Siliency. 

Computerizl-d simulation modeling can be a valuable tool in engaging community sWkeholders in steps 

towards pre"enting child maltreatment injuries. and can be efTl"Cti .... in supponing group learning 

proccsses wilhin organizations. 

3) Informing child protection policies and I'ractices for reducing child maltrea tment related 

btalilies 

There are several areas thai need to be considered in order to impro'<c child pmll"Ction policies and 

practices. The public's p"rception of child " 'dfare in Ihis CO\lntry is gcnef1llly painl~-d by rn~-dia re!>Ons 

of isolated cases of tragedy. Not only is this an inaccurate picture orlhe child welfare sy,lem. but worse. 

dri~es public will againstlhat sys!em's leaders and leaves Ihem especially vulnerable to the falloUitha! 

occurs whcn caSl"S of severe abuse and child death hit thc fronl page. Thc gap between public pcrccl'tion 

and the realities of child welfare administration lea .... s the syslcms wanting for resourees and allies and 

drivcs public policy in ways Ihat are 1101 ah"ays the ocst for keeping children safe. Thus. a kcy challenge 

in child welfare is transfonning a culturc of public blame Icading to agency defensivcness and secrecy 

into a cuhure of learning. A key lesson from Ihe SucceSses in the safety engineering world is Ihe 

imponancc of looking at incidents from a systems perspectivc and dcveloping a ""safety CUIIUre:' Onc of 

Ihe components of such a cuhure is that staff fl..,l safc from unfair blame and as a r~"Sult op"nly share 

information Ihallhc agency can use 10 learn. Also critical is building the Child Proleclion's decisionmaking and workforce capacity, skills, and training as " 'cil as advancing and supponing promising 

community and cross-systcms approaches to pre"cnting maltreatment and fatalilies. 

Dr. Eileen Munro. a I'rofessor of Social Policy allhc London School of Economics and Political Scicncc 

recently completed a revicw of the ehild protection system at the requcst of the British go'·emment. Or. 

Munro was inviled by Casey Fantily Programs to present allhe Safety Forum held in Nashville in June 

2012. Dr. Munro commenled that the approach to child welfare management has not worked because it 

is based on a misunderstanding of the human factors in d~"Cision making as well as a mistaken 
40 


joloto on DSK67XMDP1PROD with HEARING78759A.026

undc:standi ng of me nature of the skills n.-quired for child prol<.'Ction " 'ork. Dr. Munro applied a 

system'S persp<Xtive to decision making in child protection. and she urged partitipants to be togni711nt 

that errors in ehild protection 3re inevitable; and th~ t agencies need to steadily work 3t minimizing errors 

without imagining that steadily increasing procedura l re<juin:ments is the only or best approach to 

achie"ing this goal. Dr. Munro asserted t ..... t agcncies need t(l create organi7.ational environments in 

"hich ongoing learning about how to improve pra~t cc can ocour and which value fccdb<lck from the 

recipients of agency servi.:es. She cmphasiled the need to ,,:duee the punitive response to child dcaths in 

"hich specif" persons are blamed and punished,! 

Dr. Tina L. Rzepnieki. a professor at the University of Chicago also presented at the Safety Forums. She 

similarly deseribed the adoption and implemcmation oCme ROO! Cause Analysis method of critical 

e"cnt n:"iew in lIIir.ois - the appli~ation o r a structured in"estigati"e and analytic Pl"Ol'ess originally 

designed 10 achic,'c in-<leplh understanding ofad"ersc oUlcoJres in other high -risk enterprises (e ,g .• 

chemical factory e .• plosions. airline crashes. failed military Oll"l1l1ions) 10 child protection. Dr. 

Rzepnicki ad"anced that syslem failures need to be re"icwed and understood acroSS systems (c.g .• 

mental heahh. medical, law enforcemenl). Defensive practite does not avoid risk but displaces it, A 

safetylleaming cnvironment embraces mistakes as opponunili.-s for adaptive learning to take place but 

for Ihis to happen. il is necessary to make c~plicitthe kinds ofcrrors that an: not acceptable (subject 10 

consequcnces) and ha,'c clear guidelines for reporting mistake. and ncar misses. Trnnsparent 

communication is essential. Such an environment also encou"'ges crilicalthinking and aeti"e problem 

sol"ing by peers in group context. · 

Dr. R7spnicki also addn:ssed approaches for Irnnsforming child proleclion agencies into "I ligh 

Reliability Organizutions'" during Ihe Safety Forums. High Reliability Organizations (HROs) are 

organizations with systems in place mat are exteptionally COn,iSlent in accomplishing Iheir goals and 

a"oiding potentially calastrophic errors M

• 1 Principles ofHRO were first embraced by industries in which 

past failures had led to catastrophic consequences: airplanc t""lhcs. nuclear reatlor meltdowns. and 

other such disasters. Thcse induslries found il essential to idenlify weak dangcr signals and to respond to 

Ihese signals strongly so that system functioning could be maintaincd and disasters could be a'·oided. 

These principles arC oow being applied in heahh care and thert is some emerging interest about potential 

applicability in child protl~tion . For example. Tennessee is cum:ntly engagl-.;i in an effort 10 implement 

High Reliabilily Organizing to reduce child fatulitks and serious injuries. 

Finally. preventing child maltrealmcnt injuries and dealhs requires ongoing collaboration among a range 

of agencies across ser .... ice sectors and the communily, This CannOt be accomplished by public child 

welfare agencies alone. There are e~amples from around lhe counlry of how cross system and 

community partnerships can impro"c child safcty and prevent maltreatment, 

, Munro. Eil«n. The Munro Rc,'icw or Child Protec,ion. ran 00<:; A Sys!<ms A ... h'su, 2(11(1 nail'ble .' 

v.-ww.edu<ation,g9".uk 

• R>.opnieki, T., Johnson. P .• Kane. D.; Monoh«, D .. Co<:ollOto. l.. Shulman. B. (2(112). "learning from d ... , The 

beginning oforror n."du<tion in Illinois ohild "'ollO",". In R""",,i<ki, T.L .. MoCllI<:kon. S., and Briggs. II.E .. 

00 .. Fro", T". k·Cemer<"J Sod,,/ W"..t 10 &1'ide"""·B<JJ<:Ii,,mllmcgrUli>-e Praclice: Rej/«liolU Oil 1Ii.1"')·(",d 

Imp/eme"''''ion. Cbic~go; Lyceum BOOks. Inc. 

'Rlopnicki, T. L., Johnson. P,R., Kar.c. D., Moncher. D., C«onalo. L. Shulman. B. (2010), Tran.fom,ing ohild 

pro!e<tion agonei .. inlo high ",liability organil3tion" A conceptual framewort. l'rotecli!]g.fhildrJ!!!, ]j (1 ). ~8· ". 
41 


joloto on DSK67XMDP1PROD with HEARING78759A.027

4) Measurcmcnt Bnd Cla" ificalion of Child fala lilies 

Expcns agree that improving the measurement and classification of child fatalities is critical to 

understanding and prevcnting child maltreatment and f,!alities. Improvc<l consisk'llcy in identifying and 

counting child maltreatment fatahties at the state and nationallcvel is secn as essential to detennining 

whether effons to reduce and prevent maltreatment fatalities are effective. A review of the child welfare. 

criminal justice. forensic. mcdical and public health literature highlights the lack of reliable and valid 

SOurces of local. state and national data On child maltreatment fatalities. The identification and 

in\"o:stigation of child maltreatment fatalities face seriolls challenges that together lead to the welldocumented undcrooulll of child abuse and neglect relatc..:l deaths. The rel,SOnS for this underasecnainmcnl and undem:poning of child maltreatment deaths have been described in detail in several 

studies. 

Building eITccti,'c cross-sector. multi·agency collaborations are l"SSential to obtaining aecurate data On 

the i""idence of preventable child deaths and serious injurics. and for the implementation of successful 

pre"ention eITons.. Multidisciplinary local and statc Child Death Re view Teams playa critical role in 

idcntifying pallerns in child deaths and serious injuries. in identifying common risk factors. and in 

de"eloping and implementing pre"cntive effons. Moving beyond blamc to focus on prevention is key to 

Icaming from critical e,'cms to a,'cn similar incidcnts in the future. 

For example. the child maltreatment fatality numbers in the National Child Abuse and Neglect 

Reponing System (NCANDS) - one of the primary sources of national child maltreatment data - are 

considered to be an undereoulll because most stato:s include only child deaths from families known to 

child protection agencies. Research has demonstrated that more than half of the children who die from 

maltreatment are from families that were not known to or were nner in"cstigated by child protection 

agencies. State child protection agencies vary widely in their definitions ofmaltrcatment adding to the 

concerns that the aggregate estimato:s an: likely to be incomplete. However, being ablc to count child 

maltreatment deaths reliably Bnd accurately O,'cr timc and across jurisdictions is essential for making 

sy.tem improvements and developing long_te"" comprehensive child maltreatment prevention 

strategies. 

Similar limitations exist for each of the other major data systems that arc uscrl to track child 

maltreatment fatalities. For example. law enforcement data sourc~"S tend to only track homicides (i.e .. 

death at the hands ohnother). 

Followins lh~ lin, S.fetl' Forum in NO"ember 201t. C .. ..,y Family Program. broughttosc,hcr "bout .. 

dozen nationally-rttognizcd expcns in sevlTaI diseiplines to fonn a Child Fatalities Measurement 

Wongroup. The objective of the Wongroup is to reeommcnd more accurate ways to count and classify 

child fatalities so that ultimately the nalion is 1"."ller positioned to funhcr impro\"c child safety and 

pre"ent fataliti~"S. The Workgroup " 'ill dcyelop oplions for national. state. and local policy makcrs to 

consider in dC"doping an ongoing strategy to improve measuremcnt of maltreatment falalilies by early 

2013 . Our work builds On the lindings of the GAO reporl and ,,'C arc working in partnership with the 

Administration 011 Childrcn. Youth and Families and the CDC. 
42 

f 

Mr. PAULSEN. Mr. Frenzel, in your testimony, you mentioned 

that you feel a number of commissions have been unable to achieve 

their objectives. What do you think contributes to that failure? Is 

it that the missions are too broad or the recommendations are too 

difficult to implement, or something else? 

Mr. FRENZEL. Well, I think those commissions, Mr. Chairman, 

and members, that we all know about, are the very high-profile, 

very difficult ones, such as the Simpson-Bowles Commission, usually dealing with economics or budget affairs. They only go to the 

commissions after the problems have become intractable and hard 

for the Congress and the President to deal with together. 


joloto on DSK67XMDP1PROD with HEARING78759A.028
43 

It is very hard to move a report of one of those commissions, especially when the President designates the commission and the 

Congress is not interested in following it up. I cite the Bush 43’s 

Commission on Social Security and one on tax reform. In that case, 

in the latter case, the part of Congress that didn’t want to deal 

with it was President Bush’s own party. And so it is just a long 

shot, I think. The problems are too tough. 

This would be quite different. I think this would be something 

on which everyone can get together, and the reason I suggest that 

you might not want a Presidential commission, is that I am afraid 

you might not get the right people or the right spread of people. 

And therefore, I suggest a congressionally appointed panel. But the 

failure of the Presidential commissions is that the subjects were too 

tough to begin with, and they weren’t going to be solved at that 

time. 

Mr. PAULSEN. Do you have any other thoughts about what we 

might do to make sure that the recommendations of the commission remain within budgetary and political reason and don’t become too expensive or too controversial for Congress to actually approve in the end? 

Mr. FRENZEL. The reason I suggested you get a former Member 

of Congress to chair that commission is exactly that. I had some 

experience on the Pew Commission for Children in Foster Care 

where we had a lot of wonderful advocates for children who knew 

lots about the subject, but my cochairman and I were able to bring 

them back to reality, to a position where most of their recommendations could be passed. 

You can have the best report in the world. If you can’t pass it, 

the whole thing sinks. And you can’t hold these people’s enthusiasm back, but you can give them, I hope, leadership that won’t 

let the enthusiasm run away with them. 

Mr. PAULSEN. Ms. McClure, you are currently serving on a 

commission in Texas that is focused on preventing child abuse, and 

this commission has had to develop recommendations for State policymakers to consider and approve. What mechanisms does your 

commission have in place to actually see that the recommendations 

are adopted? 

Ms. McCLURE. A reality check. I think, as the Congressman just 

mentioned, we have to be realistic. We can put out a report looking 

at the utopia or the ultimate solutions maybe for 20, 30 years, but 

we certainly have 2-, 4-, and 6-year goals that are realistic, given 

the resources, or scarce resources, I should say, and the political 

realities of our State. So I agree that what the Congressman is 

mentioning, you have to have the enthusiasts at the table, the experts, but we need some political and economic realists there as 

well. 

Mr. PAULSEN. Thank you. 

Mr. Doggett is recognized for 5 minutes. 

Mr. DOGGETT. Thank you very much, Mr. Chairman. 

And I think first I want to say to Ms. Huizar, I believe that it 

was your Coalition to End Deaths that really provided the impetus 

for the original legislation that I introduced and was introduced in 

the Senate last year, and I appreciate that and I think you helped 

to craft a good measure. 


joloto on DSK67XMDP1PROD with HEARING
44 

The changes that have been made in the bill since then, are to 

address some of the concerns that have been raised here today and 

also recognize the jurisdiction of the various committees and of this 

subcommittee. One of those changes really is designed to address 

precisely what Congressman Frenzel raised; we are not interested 

in just another report to sit on the shelf. We want some people who 

are actively involved, and so, since last year, changing it to have 

half of those appointees come from within the Congress in hoping 

that we will have people who work with the leadership here in the 

Congress, and the House, and the Senate to actually see something 

happen. 

With reference to your comments, and particularly Mr. Sander’s 

comments about Title IV and Title XX, that is the jurisdictional 

basis for this Committee. It is not my intention as an author to tie 

the hands of this commission. The commission may well consider 

matters that weren’t even mentioned in the bill last year in trying 

to decide how to fulfill its mission. But as it reports back, the focus 

of this Subcommittee is Title IV and Title XX of the Social Security 

Act. It may deal with, as it looks at these issues, some advice to 

the States that it found some practice in Minnesota, or New York, 

or Michigan that is particularly valuable for a State or a city to 

use. 

So I just wanted to make clear, while very sympathetic to the 

comments that you made, Mr. Sanders, that it was not my intention as we redrafted the bill to tie the hands of the commission or 

to deny it an opportunity to go wherever the evidence suggests. 

Even though its goal is to stick with a Title IV and Title XX, certainly our goal is to focus on prevention, and not just responses 

after this happens. 

And I think Ms. McClure has made it especially clear, the dollar 

savings we can have, which is also something all of us are very interested in; how can we see the most efficient use of our Federal 

and other resources to address this problem? 

Let me ask you, rather than use all of my time commenting on 

the excellent testimony that each of you gave, Ms. McClure, just to 

pick up with what the chairman was asking. From your work there 

on the Texas Blue Ribbon Task Force, which I understand is still 

a work in progress, and thinking about those experiences, if we 

have a State commission, and I am sure Texas is not the only State 

with a State commission, and there are a number of city commissions, what advantages do you believe we would gain from having 

a national commission to continue the review? 

Ms. McCLURE. Well, first off, Congressman Doggett, let me just 

point out that one of the reasons we do have a commission in Texas 

is, alluding to your earlier comments, is that our child fatality 

deaths grew by 124 percent over a 15-year period compared to our 

population growth of 19 percent. Over that same time frame, we 

went from 103 children dying from child abuse to 281 child deaths 

over a period of 15 years. 

So that was the impetus for the commission, but as we started 

getting deeper, we realized, what we really do need to do is address 

the root problem. But when we looked at national research, all of 

the national Web sites, and tried to study who has got a good blueprint or turnkey kit, if you will, on a child abuse prevention stratVerDate Mar 14 2013 14:40 Mar 20, 2013 Jkt 078759 PO 00000 Frm 00048 Fmt 6633 Sfmt 6602 I:\WAYS\IN\78759\78759.XXX 78759

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egy, there really wasn’t anything. So we ferreted out different 

States’ prevention plans and strategies, and we found about seven 

or eight States that had something in place, but what we couldn’t 

find was outcomes from the implementation, nor evaluation of performance outcomes from these plans. 

So what I see this commission doing is really putting the best of 

the best together and formulating something that is a flexible 

model that States can implement and access, of course, if they desire. It can be a kind of clearinghouse for a place to go that will 

be adaptable to each State’s unique needs, and population, and culture. So I really wish we had had something like this in place to 

go to to make our 4 years of work a bit easier. It will be a great 

resource. 

Mr. DOGGETT. My thanks to each of you. I think your testimony is really helpful and your ongoing participation. We still do 

have the possibility of action this year, and hopefully, with your 

input, not only to us, but to our colleagues in the Senate, we can 

get some movement and some action and get this underway none 

too soon. 

Thank you, Mr. Chairman. 

Ms. McCLURE. Thank you. 

Mr. PAULSEN. Thank you, Mr. Berg is recognized for 5 minutes. 

Mr. BERG. Thank you, Mr. Chairman. 

I want to thank you, Chairman Paulsen, for holding this hearing, 

and certainly Mr. Camp and Mr. Doggett for being cosponsors. I 

think one good way to determine whether or not something coming 

out of this commission will be heard is when you have the ranking 

member as the sponsor of the legislation. So, hopefully they will be 

able to work through those things. 

It is really unfortunate that child abuse is a challenge throughout our country. We just had a situation on one of our reservations 

in North Dakota that has really brought to light this very serious 

issue. It is unfortunate because it is out there all the time, and 

then you have one situation that comes up, and all of a sudden, it 

is on everyone’s mind in the State and all of the elected officials, 

and then it kind of goes away. So I think part of why this is important to me is it is obviously important to our State right now. It 

has been an alarm. 

So I am wondering if better communications from the different 

organizations involved could help move this along? And Ms. 

Huizar, I would like you to respond to whether or not there is a 

way to create a better communication process within the organizations. 

Ms. HUIZAR. Sure. Thank you very much, Congressman, for 

asking that question. I think there are several ways to approach 

this. One, is in terms of collecting information itself, one of the 

things that we should probably recognize is that NCANDS right 

now, the information that States turn over to the Federal Government in regards to these records, doesn’t even really require turning anything over in regard to near fatalities. There is no field for 

that. And so there is a lot of information that just gets missed in 

that way. 


joloto on DSK67XMDP1PROD with HEARING
46 

I think, at the local level, though, you see even misunderstandings about CAPTA confidentiality requirements and what information can be shared. 

There was some recent clarification that HHS put out to indicate 

that in child abuse fatalities, that information involving the child 

who had died, that that information could be shared as a part of 

policymaking, and the investigation to determine what could be 

done to prevent these deaths. However, it did not clarify whether, 

in fact, information on other cases involving that child, prior cases 

of abuse, or even cases involving other siblings in the family could 

be shared. And you can imagine that because, as Mr. Sanders 

pointed out, in many of these cases, there had been prior reports 

and that is a factor in future death, that would be a very important 

thing to know. So I think that there are some significant issues yet 

to be clarified that could be very helpful in that way. 

And finally, I would say that data systems can make that work 

easier. In our own Children’s Advocacy Centers and multidisciplinary teams, the reason there such open information sharing is 

because we have systems in place that make that possible, including the use of technology in doing that. And in the absence of that, 

it is tremendously difficult for all of the professionals who need to 

share that information to do so. So I think there are some very 

practical steps we can take along this line that would make that 

job easier. 

Mr. BERG. Well, maybe you can expand on that little bit. You 

have the data sharing between groups, getting on the same kind 

of platform, so same definitions maybe for abuse, or are some best 

practices that you can say, you know, here is how these groups can 

work better. 

Ms. HUIZAR. Absolutely. Well, I would like to think that certainly that Children’s Advocacy Centers are an excellent example 

of that multidisciplinary teamwork really coming together and 

sharing that sort of information. And what they have been able to 

demonstrate over 25 years in terms of their effectiveness in working in these cases, I think could be expanded to work in this arena 

as well. I think child death review teams are another excellent example, but their work has been somewhat limited. I mean, as you 

know, the resources that are actually going toward the work of 

those teams has have been very small. And so while there have 

been some good pilot projects in terms of cross sharing of information, there is a lot of work yet to be done, some of which will really 

require some additional resources. 

And then you also touched on a critical matter which is this lack 

of standardized definitions. I mean, this is really core in lots of 

areas where there are problems in child abuse reporting overall, in 

counting fatalities, and many other things. The lack of standardized definition makes it very difficult to get our arms around this 

problem, and I think if we can address that, it is a good first step 

to addressing some of the other matters. 

Mr. BERG. Thank you, and I yield back. 

Mr. PAULSEN. Thank you. The gentleman’s time is expired. 

Mr. Reed is recognized 5 minutes. 

Mr. REED. Thank you, Mr. Chairman. 


joloto on DSK67XMDP1PROD with HEARING
47 

And thank you, Mr. Doggett, for this important matter. I look 

forward to supporting it and working with you to get this to the 

finish line. 

And I appreciate the witnesses’ testimony today. And I wanted 

to continue on the issue of the standardization of definitions. This 

is one thing that, as I serve on this subcommittee, I am very interested in trying to pursue, making uniform, to make consistent the 

different terminology and language and data points that are being 

provided to the Federal Government, because I see a lot of just 

basic miscommunication and inefficiency associated with that. And 

so when we looked in particular at the definition of, for example, 

maltreatment, it varies State by State. And we have had a hearing 

on it back in July of 2011, and I am interested in hearing from the 

panel. Maybe Mr. Sanders to start with, why do the States do that? 

And what are the arguments for and against having those different 

definitional standards? 

Mr. SANDERS. Thank you for the question. 

I think there are a couple of perspectives on that. One is the Federal Government actually gives flexibility to States in the definition 

beyond the focus on physical abuse, sexual abuse and neglect. And 

States have taken that opportunity. And one example is educational, young children missing school. In some States, that is defined as maltreatment; in other States, it is not. And my guess is 

that it emerges as a concern from the local community or from the 

State as an issue that they want to address and feel that should 

be addressed under their child welfare agencies. So that would be 

an example of maltreatment being defined differently from State to 

State. 

I think that the other piece of that is it is important for this 

issue to come to some consensus to develop consistency in reporting, because I think that to address this issue, there is going to 

have to be accurate measurement of how many children are dying 

due to abuse or neglect. So I think it is quite possible to come to 

that and I think that the commission really offers an opportunity 

for that to happen. 

Mr. REED. Well, I appreciate that and I join in that sentiment. 

So if I am understanding your answer correctly, you think primarily the difference is the basic difference between communities 

coast to coast, north to south and the different community needs 

that they are identifying in the states where they have different 

definitions. 

Are there any practical effects? Is there any funding that is tied 

to these different numbers? I am trying to see if there is something 

else that is driving this distinction, other than just the uniqueness 

of the areas of the country upon which the terms are being defined 

differently? Does anyone have anything to offer on that side? Is 

there any policy reason why they would be making those distinctions? 

Ms. McClure. 

Ms. McCLURE. I would just say that almost every legislative 

session in Texas, there are proposals to change the definition of 

child abuse and neglect in some way. So those definitions are, I 

think they are more culturally defined. I don’t think that there is 

anything financial involved in making definition changes. 


joloto on DSK67XMDP1PROD with HEARING
48 

But back to your point on how to standardize measures, I think 

one of the ways of looking at child maltreatment fatalities is not 

so unlike looking at homicides versus manslaughter. So, in other 

words, an intentional death of a father, beating a child and putting 

him in the oven, versus the mom who is depressed, asleep, and her 

child runs out and gets hit by a car, are really different types of 

child deaths that we really need to consider. 

So I would say that there are quite a few deaths due to neglect, 

but mostly they are physical abuse. And I would look at those very 

differently. I don’t think it would cost the States much to stratify 

and come up with a consensus on a definition that would be acceptable to everyone, as long as they knew that the bottom line is that 

we are helping, trying to provide some tools to alleviate the problem. 

Mr. REED. That is a great point, and that leads to one last quick 

question. So do you see any barriers that we would have at the 

Federal level coming up with a common definition that we would 

have to overcome in order to implement it? Are there parameters 

that we should be focusing on in regards to defining that term, 

maltreatment? Anyone? Do you see any barriers? 

Ms. HUIZAR. Well, one thing that I would say is that your primary barrier may be people’s just innate sense of attachment to 

what they are already doing and reluctance to change. Exactly, reluctance to make change. I think it is important to know that the 

CDC did a tremendous amount of work on setting up standardized 

definitions in the area of child maltreatment, and I think encouraging their usage might be a first good place to start in that regard 

because they certainly did very fine work. And it, you know, reflected a consensus of experts and others. So—— 

Mr. REED. Good. All right. 

Well, thank you very much. 

With that, my time is expired. I yield back, Mr. Chairman. 

Mr. PAULSEN. Thank you. 

With that, I just want to thank all of the panelists and witnesses 

for taking the time to be here. 

I think, hopefully, we will be hearing from Chairman Camp and 

Mr. Doggett as they fine-tune some final changes that are consistent with today’s testimony. 

And with that, we are adjourned. 

[Whereupon, at 3:02 p.m., the subcommittee was adjourned.] 

[Submissions for the Record follow:] 


joloto on DSK67XMDP1PROD with HEARING
49 


joloto on DSK67XMDP1PROD with HEARING78759A.029

Comments on Hearing Before the Subcommittee on Human Resources, Committee on Ways and Means, 

House of Representatives 

Submitted on behalf of the 

Alliance for Children and Families by 

President and CEO Susan N. Dreyfus 

Thank you for the opportunity to submit comments On the Protect Our Kids Act, an important piece of 

legislation that will promote the sa fety of our nation's children. 

I represent the Alliance for Children and Families, a national organization dedicated to achieving a vision 

01 a healthy >o<iety and .trons communitie. lor all children, adult>, Bnd IBmilie •. The AlliBnce work> lor 

transformational change by representing and supporting hundreds of nonprofit human serving 

organi,ations located in North America to translate knowledge into best practices that improve their 

communities, Working with and through its member network, the Alliance strives to achieve high Impact 

by reducing the number of people living in poverty; increasing the number of people with opportunities 

to live safe and healthy lives; and increasing the number of people on pathways to educational and 

employment success, Our members have significant experience in child welfare with many of them 

providing the case management function In partnership with the public sector, We represent a 

significant force in the nonprofit human-serving sector. Colledively, our network contributes more 

than $14.g billion to local, state, and national economies, operate in 2,700 locations and serve more 

than 8,000 communities. 

I have had responsibility for the publiC child welfare systems In the States of Wisconsin and Washington, 

working for both Republican and Democratic Governors, in addition to my experience in the non profit 

sector. I have helped shape major reform efforts in systems under class action litigation and have 

helped shape public policy which aligns with our child and family centered values and goals to ensure 

that every child who comes to the attention of the publiC child welfare system is safe and able to live 

their lives with permanency and enhanced well -being. 

Most recently, I served as the secretary of the Washington State Department of Social and Health 

Services, where I had responsibility for child welfare, Medicaid, juvenile justice, aging and longlerm 

care, developmental disabilities. eligibilily and TANF, mental health, and substance abuse. At a time of 

Significant reductions in Our budget, we led Significant transformative change by fOCUSing On impact, 

partnerships and seizing the integration across our systems Ihat often silln wha t I respectfullv call, 

"cylinders of excellence". 

It was a true honor to serve Washington Governor Christine Gregoire from 2009-2012. DU'ing my 

tenure, we success/ully reduced child maltreatment rates by fOCUSing on safety. doing an in ·depth 

analvsis of our fatalities and bV using predictive analvtics to determine which children were at highest 

risk. Through intense collaboration we arrived at new ways to identify risk and implement many 

effective strategies. For example. we instituted a policV of always screening children under two years of 

age, looking more closely at repeat referrals within a household regardless of screening decisions. and 

screening in anv reports made bV medical professionals. 
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A national commission, such as that created by the Protect our Kids Act, would serve an important 

function in gathering the best, most Innovative solutions from ooth the public and non ·profit sectors 

and recommending strategies that improve child safetv and reduce the tragedv of child fatalities 

In considering innOlialive solutions, the commission should Include representation of the non profit child 

welfare agencies and their slgniffcant child welfare experience. States are increasinglv loo~ing to their 

prrvate partners to c"rrv out child welfare functions including, case management, and it is these private 

agencies that are leveraging both federal and private funds and "eative community partnerships to 

create innovative solutions. Without private agency input, a large piece of the knowledge and 

experience needed by the Commission would be missing, 

My experience has taught me that while Our first inclination is to alwaY' want to quickly focus On 

imprOliing results for children, we must first start with dear legislali~ policy on what we are to 

ultimatelv achieve and the principles through which we are to align and constantly improve the entire 

system beginning with intake, I would like to share 4 themes that I believe need to be included lithe 

Commission is to be successful in achieving its goals. 

Clear and Aligned Policy Creates Tme Reform 

Among states, the policy often is fractured bV numerous reform efforts over many vears thaI attempl to 

fix only par" of the system from the outside/in. This leads to great confusion and inconsistency in 

performance, I believe that the recent Information Memorandum issued by the Administration for 

Children and Famil ies is the first dear polky direction from the federal government in child welfare 

during mv 20 years of experience. II slates dearly what the system is to achieve, which is to promote the 

social. phY'ical, and emotional well· being for children receiving child welfare services and to impro~ 

the behavioral, physical, and social, emotional outcomes for children who have experienced abuse and 

Of neglect_ 

It is through thiS lens I suggest anv review of the country's vision and direction be undertaken. One of 

the key principles should be a strong policy statement on the system's mission: to mef!t the unique 

needs of everv child, every time, within the context of their emotional and phY'ical safety. This is not 

just an ultimate outcome, but must be experienced by a child everv dav thev are under the 

responsibility of the child welfare agency, 

A Focus on Impact 

I believe that a kev to successful child welfare systems Is the vision, transP<lrency and leadership of the 

public sector agency in inviting the community, famil ies, other state agencies, philanthropy, the courts 

and al l stakeholders to actively participate and share accountability for the success of the system, 

Reforms from the top down mav make for short term gains, but they do not bring long term and 

impacllul change, As lawmakers, you can enSure that the other public sector agencies responsible foreducation, mental health, substance abuse, developmental disabilities, TANF, Juvenile Justice, courts 

and law enforcement- are clear on their responsibil ities to carry out your clearly articulated child 

welfare policy, 
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Powerful use of Data Analytics 

To illustrate how private agencies are key to child safety, I would like to provide for you a vivid example 

of how Al liance members are using data and technology. 

Data analytics i~ Our next frontier in child welfare. If we use Our data not to ~imply find out too late 

what is not working but we use il to help uS with our daily work and decisions, to help uS understand 

what Is working and we use the data to continuously as the ·why· questions, we can not onty make 

better decisions for each child but constantty be improving Our policy, practice and results. 

Some of our member agencies in Florida have partnered with software company Mindshare to develop 

i s\'Stem using predictive analvlics to identify high risk children ind families in order to target 

interventions to keep children safe. The results have been promising. Caseworkers receive realtime 

updates that allow them to intervene before a situation becomes unsafe for the children. 

By harnessing the power of technology they are able to transform massive amounts of data Into useable 

information. The system inl egra!e' with the Statewide Automated Child Welfare Information System 

!SACWIS) and Incorporates Information from school districts. law enforcement. the health care agency 

and others. Using data from multiple sources has allowed agencies to identify children at risk even 

before they come to the attention of the child protection system. 

In designing the system, they studied every child death in the state, and Irom there were able to create 

models that detect behavioral panerns related to risk. The process takes a great deal of subjecl matler 

expertise and they are continually refining and updating their rules to make It more a(Culate. 

The use of data analytiC! in Florida points to a new direction in early detection and intervention. but 

barriers to full implementation remain. For example, confidentiality policies sometimes hinder the flow 

of information. And notall data is automated. For example. Information from court records must be 

extracted and entered manually. In addition, agencies cannot claim federal administrative dollars to 

operate Ihe system. These barriers represent the kind of issues that a national commission could 

addless in their recommendations to Congress. 

Sustainable Reforms Must be Aligned Across Systems 

The constant churn of child welfare reform efforts seems to be never ending. and that is because we 

keep trying to fi x the system from the outside in, one technical fix at a time. What is needed is to step 

back and ensure we have a clear and articulated policy and set 01 principles that are aligned acrosS 

multiple Systems and Shared by the wmmunity. Then, uslns the power 01 data analytics, scien(e, and 

creation of true partnerships that incorporate authentic voices of all involved. we will be able to 

implement sustainable solutions. I am convinced that child maltreatment is a major publiC health issue 

in America today, and that the Protect our Kid, Act is an important step to reaching a solution. 

In dosing. the public asency responsible lor child prOl eCl.ion is but one pan of the child welfare system. 

The safety and well-being of the nation's children are a shared and very serious responsibility, 'equlring 

a publiC child protection agency able to bring the many other parts of the system to the table in shared 

responsibility for our children. The national commission crealed by the Protect our Kids Act is an 

important step In that direction. 
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On behalf of the American Psychological Association (AI'A). thank you for holding hearings on 

r~'ducin g child deaths due to maltreatment and for the opportunity 10 submittcstimony for the 

l'C<:ord. APA. the largest scientific and professional organization of psychologists in the United 

States with more than 137.000 members and affiliates. works to advance psychology as a 

science. a profession. and a means of promoting health. education. and human welfare. APA 

promotes scientific inquiry. professional pmctice. tmining. and advocacy on the prcve11lion of 

child maltreatment. 

APA supports the ProtL'et our Kids Act. a bipartisan proposal developed by Commil1ce Chairman 

Camp and SuOcommil1ee Ranking Member Doggel1 to establish a commission tasked with 

developing recommendations for r\.>ducing child deaths due to maltreatment. This draft 

legislation is an imponant step toward a national commitment to ending child deaths from abuse 

and neglect. AI'A and the psychology community appreciate and suppon the inclusion of those 

with e!<per1ise in "child psychology and mental health" on the commission. 

Unfonunately. child maltreatment is a pervasive nmional problem. The congressionally 

mandated Founh National lncidencc Study of Child Abuse and Neglcct (NIS-4) found that one 

child in 25 in the U.S .• or 2.9 million children. e.~per;enC1::d some kind of abuse or neglect in 

2005--06. For fiscal year 2011. states reponed 1.545 child deaths due 10 maltreatment to the 

National Child Abuse and Neglect Data SyStem. This number is likely an underestimate. 

according to the Government Accountability Office repon Child Mal'rea,men': SlrellglllCning 

Natiollal Dalll 011 Child FOlillilies CO/lid Aid ill Pnmmlioll. The NIS-4. which relics 011 multiple 

sources ofinfonnation on child deaths, estimated that 2,400 children died from maltreatment in a 

single year. The Centers for Disease Control and Prevention has estimated the total lifetime 

costs associated with a single year of confimled cases of child maltreatment at $124 billion. The 

value ofa child's life lost to maltreatment is incaleulable. 

Fonunatcly. child maltreatment can be pre,·ented. Psychological research has produced 

programs that have been shown, through rigorous scientific evaluation. to be cff~'eti\'C in 

preventing child maltreatment. Approaches used by effecti,'e programs include multilc"el public 

health imen'emions. home visitation. and coordinated. family-(:emcT<.-d services. Despite 

advances in thc development of cvidence-based prevemion progmms, however, more work is 

nceded. Documented evidence of effcctiveness through rigorous researeh is still the e!<ception. 

mther than the norm. among child maltreatment prevention effons. Effective prevention 

programs face challenges in large-scale implementation and in adapting to local conditions and 

cultures while maintaining fidelity to the clements of the intervention that make it clrcet;,·e. 

AI'A and the psychology community stand ready to suppon the commission in meeting these 

challenges_ 

Prevention of child maltreatment is also hampered by lack of coordination across systems and 

jurisdictions. Multiple public and private systems are involved in preventing and responding to 

child maltreatment. Service delivery systems related to health care. menIal health. substance 

abuse. housing. child care. and income suppon often are not imegrat~'d with each other. 

Mandated reponing laws vary from state to state with respect to how child abuse is defined and 

the minimal criteria that need to be reached in order for a mandated repon to be made. States 

2 
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--- ...... e.,_ 

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-"'""~"-I .... ) 1-.... , ...... _A"_ 

--- .... _.M,1l -...... ..... tin ....... , Ol .. .-_ .... W • ..,..o. ....... - ~.­ -- Childre n's Advocacy In stiHIIC 

_ ..... ,...._ .. "" -_ ...... '-, ... ." .. mK __ 

(0" '_ ""I __ "'~'" ,.. ,""-C,.,,,. ,,, •. ,,,-j,,,. ' .. " ...... 11 Ct • ., 

'''','_,,,,s,,,_,.. ~_"" __ """"J,,, _"'_' __ 0.'_"" """@<~- ........ ~--

Testimony to the Subcommittee on Human Resources, 

Committee on Ways and Means, House of Representatives 

in support of the proposed Protect Our Kids Act 

ACling Chaim,an Pa ulsen. ellainnan Camp. Ranking Member Doggcn •• nd Members Oflhc 

Subcommillcc: 

We.1 (he Child",,,', Advocacy Ins!itulc are graldul for the opportunily 10 addrtss tl>e importanl issue of 

child abuse f.talities and ncar f.I.lilies in lh. U.S. and the )XlI""li.1 Oflhc Prol..,! Our Kids ACI to help 

remedy Ihis lragie epidemic. We suppoon the adoption of this importantlegi.lation and hoI'" that you will 

consider our recommendations as to how it m.y ful fi ll its potential Once enacted. 

Our Credentials 

We haw I><:en ,,"o";';ing On issueSl"'naining to child abuse Of neglect fatalities and ncar fatalities for a 

number ofye.rs and.rr teCO!Inized .. one ofthc leading ad,'oc.ey organiC(ations in this space. ~ focus 

of our ;nterest on this issue is on enhancing the public di""losure and transparcncy of these tragic 

incidents and using impro"cd reponing and discl ... ure as a means to pre,'ent future fatalities and tICar 

fat.lities, CAl I><:li.,-.s th.t StateS mUSt I><: held accountable 10 the public regarding what led up to each 

child abuse Of neglect deaths and n.ar-death so that thc public can idcntif)' and remedy systemic 

shortcomings_ 

In order 10 be eligible to n:cei,'e federal Child Abuse Pre,'emion and Treatment Act (CAPTA) funds. 

states must "3\'C provisions that "a llow for public disclosure of the findings or infonnation .bou!. .. c.sels) 

of child .buse or neglect [thaI h"'eJ resulted in a child fatality or near fatality." ' Together with First Star. 

CAl has gathered .nd a""I)"l.ed the pro";sions th.t ha"e been adopted by st.les in funherance of this 

mandatc and published two repons on th. sUbjttt. entitled "Stale SeCl",,<"Y und Child [)e",I" in ,Iw U S,-

All E,'U/uution oiCA PT A·M,,,,dlll"'} Publi~ Disdusure Poli~ies ubout C/,Ud Abuse ""d Neglect FlJIu/;ties 

'" Nell' F"'''{;tjes, "'il" StUIe R,mkings.'" The repons gi"e each state. grade (A to F) based OIl the 

quality of the Stale 's CA PTA·mand.ted public disclosure policy. 

Our first rcpOl1 . published in 2008. found Ihat a majorily ofU,S, states h.d adopted policies that did nol 

plm';de adequate public access 10 infonnation about fatal .nd life-Ihre.lening child abuse c ..... The 

findings of our ;nili.1 repon generaled substantial public .ltention and " 'ere key in prompting posit;"e 

ch.nge with regard to child maltreatmentl.w, and policies in $everal st.tes. 

'.2 U.S.C. SI06o(b)(l)(A)(x). 

'Th< ,~-"rt-po<I~ fMJbti_ i.lOOl! >t>ollOU ...... "ilMolt oo]i .. at ~:---".<li<hi dt'''of'!g.~rO<lS~ '~'""l Final Rtf!!:>'!.. 

&o'~ ODd "",. ... i<hHo,It.w-<MIIMiO<lS~<S«...,12ndFc.fI<lr. 
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The Second Edilion. released in 2012. provided an updalcd analysis oFslatcs' public disclosure laws and 

policies. Since thc 2008 report. we Found Ihal II SlalCS improved Iheir laws signilicanlly. while a Few 

olhers had aClUally reduced lransparency- and several SlaleS kcpllhe same low grades Ihey had n-cei'·ed 

in 2008. 

CAPTA aekno""'edges the importance of public disclosure in order 10 ident;fy and f,x system;c problems 

Ihat may unnecessarily lead to child dealhs or nearoodealhs. Unfortuna lely. CA l and First Slar have found 

Ihal polic;es al the slale le'·el ,·ary widely. and many stales slill have polic;es Ihat fail 10 fullill CAPTA·s 

inlent. E,·en in states where disclosure has ~n decmed an importanl goal. Ihc requirement is onen nol 

adequalely re fluled in SlalC laws or wriuen polici.s and Ihus is nOI.n fore.able. or can be quickly undOll. 

by a change in administralions. 

Because enforeeability is Ihc key concepl 10 address in evalualing a Slale·s policy regarding public 

disclosure oflhis infonnalion. a major goal of our S,ate Sec",,"), "'port has ~n 10 encourage more Slales 

10 fonnal iu Ihcir policies in Sialuies or to iss ue binding regulations. 

Sta les must be he ld a ccountable and comply with ex isting law. Oul we lu,·e lea rned tha llhey will 

not do SO ,·oluntoril,.. Unm Ih e fede .... ' go,·ernmenl enfa ..:.ces its o,,·n 1""·5 n, anda lin g Ih al ea eh . Iate 

re luses a ccurate nd th orough informa tion in a timely manner. we ,,·iII be hind ered in ou r ability 

10 ide ntify a nd rep. ir Ih e faull line. in Ou r child pra teeti'·. '5 tcm or redue. the ha rrif)" ing .... Ie or 

child fat . litie-s in this coun try. 

Recolllmendation th at the COlli mission Work to Strengthen Current Federal 

law Governing Disclosure and Reporting or Child Abuse and Neglect 

Fatalities and Ncar Fatalities 

We would rttommend Ihal one primary focus oflhc Commission 10 End Child Abuse Fatalities and Near 

Falalities be to follow-up wilh the unfullilled mandale from the 2010 reauthorizalion ofCAPTA . 

The primary federal law go"eming the public disclosure of information pertaining to child abuse fa lalilit'5 

and ncar faral ilies is Ihe Child Abuse Pre'·emion and Trealment ACI. In 2008. afler Ihc release oflhe 

2008 edilion of our .. pon. we. along with ad,'ocacy groups including the entire Nalional Child Abuse 

Coalition petitioned Congress to clarify and strengthen Ihe reporting requirements imposed on Ihe sia ies 

by CAPTA. 

Undercurrent law. many Slates curremly rail to re-shin Ihc balance belween confidentiality and public 

discl","re when a child dies or nearly dies from maltreatmenl. Many Slates' narrow re.ding of CAPT A 

frustrales Ihe statute's purpose. And 10 be fair, in irs currenl fonn, CAPTA·s public disclosu"" mandate is 

und uly vague. We would be happy 10 work closely wilh Ihe Commission loward idenlifying CAPTA 

","cndmenIS Ihat would help bring Stale policics in linc and I"<:sull in more p,..,diclable. consislenl. and 

enforceable discl",ure of Ihis crilical infomlalion, 
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Recommendation that the Commission Hold DIIIIS Accountable for 

Implementing Regulations to Strengthen and Clarify Disclosure 

Requirements of CA PTA as Instructed in HELP Committee Report 

Due primarily to procedural and not ,ubstanti"e hurdles. "ariou, proposed amendment' to CAI'TA were 

not adopted in 2010. Howe,·er. the Senate HELl' commiuee repon did take an unequivocal po,ition 

directing HHS to implement existing CAI'TA law requiring child protective service, "to provide for the 

mandatory public disclosure ofinfom,ation ahoul a case of child abuse or negleCI which has resulted in a 

child fatality or ncar faLality" in order to enSUre "improved accountability of protective services and dri,·c 

appropriate and eITecli"e syslcmic refoon."" Recogni,-ing lhat nOt all states arc in compliance with the 

CA rTA requirements. lhe commil1ee adopted report language calling upon HHS 10 de"clop clcar 

guidelines in the forn' of ,egu l~ti £ clarifying for and inmucting States of their responsibililies under 

CA rTA. 

The text of the relc"ant section reads: 

DISCLOSURE Of INFORMATION ONCHILD FATALITIES ANDNEAR FATALITIES 

The comminee belie"es that the duty of child protecti,'" services. required in CArTA S"". I06(b)(2)(xl. 

to provide for lhe mandatory public diselosure of information about a case of child abuse or negl""t which 

h •• ",.uhN! in a child fal.lily or near fat.lily en<ur". improved accounl8bilily of pro'"",,,ive <eNice •• nd 

can dri,·c appropriale and eITe<:ti,'c systemic reform. However. the comminee is aware Ihal nOi all StaleS 

arC in compliance wilh Ihe"",, CA rTA requirements. The comminee calls upon Ihe Secretary of Heahh and 

Human Services In develop clear guidelines in Ihe form ofr.gulalions insmlcling Ihe States ofthe 

re'ponsibilities under CAI'TA to release public infoonation in cases of child mallreatrnenl fatalities .nd 

ncar falalilies. and to provide lechnical assisLance In Stales in de"eloping the appropriate procedures for 

full disclosure of infomwion and findings in these cases. 

In September 2012. ACF did. in fact. fioally re, pond to) the Senate HELl' Connniu •• ·s directions. bUI it 

did not do what waS r«luested of it. First. il issued program instructions ro.her than regulati!)" s. The 

dislinction between the twO is meaningful. Regulati!)ns arc binding. An)'lhing less is nOl. The imem of 

Ihe Commiuce was also not respected. The HELP Commiuee called for regulations Ihal would provide 

grouter lranspareoey. beller information. and more effect;'", public disclosure. What was released 

accomplishes Ihc opposite. The cause of ensuring faithful compliance with CArTA and. more 

importantly. accomplishes the desired g().11 of preventing further fatalities. requires rules that have the 

dignity and binding impact of regulations. 

We respectfully request Ihal Ihc Commission put pressure on ACf to adhere to Congressional direClion 

with re'pecl to issuing lhese regulations 

Furthermore. we call upon Ihe Commission In consider mool carefully how In strengthen federall"w as it 

pertains In diselosure. confidentiality. and reporting on this issue. 
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FIRST FOCUS 

CAMPAIGN fOR CHILDREN 

COMl\IENTS FOR T HE RECORD 

l">«<moo 12. 2012 

S/uJ, !I, .... h, .. ,. \ '>« 1"",Iok", r.,. (holJ \\;'df.", 1~>Ioq' 

1'""I'''cu, 1110 \'."""", h",,,",,,.N\~· Sm," '!OO 

1I' .. h"W"". IX: 20005 

""""'" (202) GS7.{lG78 

:m.~ .tudih@;flN,foruo.n<1 
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Fir;, !'<>cu, C:unp>.ign For Chilill<n ComtrI<m. f", ,he Reconl 

Cha!nnm l'a"l",n. R.n.ing ~kmbn D'-'m!<u uW members of ,I\c Subrummiu«. thank l"" for Ihi' 

opponuni'l' '" ... bmiT • ""e"",n[ for [It.; "-'Coni ~~ ,h~ Dec~mbo.·r 12 h<"ring on • ." p'"f»UI ~ "J"" 

t1Ji/J obI< d<albs ""'~",al"'a/"".I " W~ .ppreci.I' 'ho ""ntion that lOur Subcommiucr i. bringing '0 ,he 

""igh,)' .,,"" of child f.[.ti[;" ",.wring from 000,., .nJ ncgk<' .nJ Ufg<' you '0 .u ... ,h., in thc co ...... 

of your work, [h .... i. con.iJer. [ion of . b,ood . ...... y of.rr«[i,·. p"" 'omion PfQgt"am. r~e'in~ child 

obu.~ . nd neglee,. Follo..-inK OIl the 11«1. of 'ho Julr lOll release of. Go"ernmcn' Accountobility Ofii", 

(G,\O) "'1"'" .n,i,led ~S"'.§JJ.';"l NaiNmal /lola"" Chi/J l'a/a!i';'fWU ,-j;Ji. p,.,..n.....~ .nd a .ub""!"" ,,, 

hearing hdJ by l-our Suixummiu", ,ha' .. mc month '0 rcvK ... · 'hr da .. OIl "h~d <ka,h, ""ul'in~ frum 

nul""'Tm<m. [h .. h<arin~;, bnnging rnoch ne",deJ a" • ."ion '" a <k, .. " .. ;"g "",,,,,a! problem, 

The F"" Focu, Campaign fo,ChilJr<n;'. biparti$>n """n;,,,;on .d""<1rin~ for \q:i>lori,'c ch.nge in 

Cong«>. '0 emun: "hildren 000 f>milia are a priori,y in fe<k ... 1 policy and budg<I dcri,ion" Our 

o'l\>ni .. ri<>n i, deJico"d tv 'hr lung-«ml guol of o"b".nt;'lI)' reductng ,It.; numlx" of "hilJrrn "'«nng 

f""or carc. and "''''kin)( [0 en ... re th" 0.,. ex;'ring 0J'"cm of .. r< P""oc" cbilJn:n .nd ~Ll':llcl)' m.,." ,hI 

nero, of familia. in the chilJ ",,,I&rc 'r"cm. WI arc ,,[><c;'Ur C()[KC=«.! ",;th inCfca.in)( ollr f<..Ie .. 1 

in,-o<tmcnlS in prevent;"n cllono aOO p •• )\'iJing ,uppon' ~nd .<",.;.,« for .,·risk f.mihe> to en'Il'" ,h .. Ihry 

ne'·C1'en, .. Ihe child ~"If.r< ,)~,"m in ,he fttS! pla«_ 

M )'0Il know. each r'or. chdJ p""crli,'c sell';'" .)«nc;", ""ei,'" ,We, llTUllion "1""''' of obu",. clo>c '0 I 

million of "'hich .r< .ul»,.",ia"d - m •• ing chilJ abu"" • n"~,,,"1 cpiJc:mic. /\Jmitt«II)'. ,he «"1$':'1"'''= of 

chihl .bus< and ncgk<I .r< ",,,Il·J.>Ctlmcn[ed E.po,u« [() child .bu,< •• [><dflC.II), «-'Currin;: «[><ricnceo of 

.bust anJ nlglee[ can hOI'" ,ignif"an[. curnwan," and k"'g' [Cfm im[>"CI on a child', d,,·elopm.:m. oftc'll 

k,ding 10 <krlCi" in in"<I'<", ..... 1 rel.,k,,,,h'!,,, . .rfce, .-cgul"ion •• nd ,,,,If-dc,·.Iop,,,.n, ....... 011 .. incre.""d 

.. 1<$,-,f mul,iple !"'j"h .. ,ric: di>.gl>O«:'_ 

Whik "'" aU.buocJ dlikl.-cn Jc:,'elop difficulties. man)'J.Hx[><DenCC a ch",ruc «><I"" ofp,)d><,p"hology. 

,,,,h P<>'"r."m.tlC .If.," Ji",,,,I<. (I'TSD). <kpn:"';"n. and behO\;"'",1 J,sotclc .. commonty r<'f"J<'ed in 

,ic,;,ni""d chiIJ"," ond .dull .. Sodel)' . 1"" [>")'. a h<>,)· prk< for child '00"". In .. lJi,ion '" 'he " .... " 

incurred by law cnfon:~""'nt. chilJ p",,«n,·c >ell';""'. judicial. bcohh .nJ ",hr, 'j"I<"'" ""cording [0 the 

un"" fOf Di"""" Con,rol (CDC). the ~fetim< fin.n,,;'1 """ for a 'in~1< j"" of new ",,,,fumed "''''' of 

ch[IJ .00"" ""'01, roughl)' SI24 billion. 

The grim «..Ii.), i, ,h .. not all "ietim, of chilJ .1,11"" .nJ neglect >Un'lVO. In lOll, :lCcorJing.o the National 

Ch[tJ i\l",,,,, aOO N<W<c' D ... Sr>trm' (NCANI>S). there were 1,570ch[ld cleath, .. . ","Illt of.bu"" '00 

n<glee, · ,,;[h 61 [><=n, nf'ho .. d."h, ac")lI"t<oJ fM 1,)' childr"" )""[1,1\<' [han f,>u, ).., ..... ~J. While 

signif.cm,. [hi, numbe.;" likd)' an undclCOlln, gi"en [hOI mosr <t.t", rcpon onl)'child cle.,h, from fami~"" 

knov.'f\ to "hild pro<cction agencie •. We Irnow from .. -.ilabk <=orrh that more .hm holf of children who die 

f""" abu"" "" f",m fomil;", "'h" "'~ .... ne'·" ."' ... ·n '" "r in"."igoroJ br chi~1 r",,,'C';on agond«. 

R"""",h h .. <kmon.",neJ th., no 'inj(k fac,,, •• but ""hr, a combin";",, ofindi,;du. L fomili.:oL and 

communi.y n,k fac",,, in" .... "" dt. ri,k for m.II< .. ,m<II'. F.milr leI'ol risk fac' ..... include "ar<"gl'-« "u.s. 
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Firs, 1'<"'0' Um(»ign For Ch,W,.,;n Comm ... "" for ,t..: Roe .. rJ 

Jcp"",ion. GlITgivcr'. ",,-n hi,,"'l' of "",lorcalmcf1', limi,eJ w<ia1 ,uppons, .nJ 'he c'p<ric"", "f "",,,ful 

lif< o,'em., 1'0«-,,,,.1 ",,1»..,,« .!>u,.,;. osw .. "eJ 10 be, romribmin,'t flK~" in on.· ,hi,.! '0 , .. ,,·,hirJ. of.1I 

nuJr,..,.,,,,,,n, c,''''. Illld bo:.>1h n"ij;hborh<~><1 ond familial i""'<")' .", "'" of ,h • .,runge" preJic,,," of .t.u", 

.".1 "<gkc,, I" flKt, <.,,,gk ... i" 1"''''''11)''IT ""'IT likdl' '" ""')!glo .. ith sub, .. ,," a!>usc .".1 mc",21 t..:.lth 

problem., CXI"'''''tIC<' gn"I'<' cum"I>,;,'O "<8"h'< life <"."", .nJ 1;"< ;" ,,,I,, .. ,,,b,J h<>u";ng, fae'.".. aU 

""",iated ,.-ith in<"",,,,d ri,k for '!>uK and nc;tlc<t, 

MojO< challenge' rem:oin, The con,inwng high h'd of chik! oc.,h. i, ,1M: cle....,,, imlico,ion of continued 

tIC<'d k>t impr",'.m,,,,;,, oor <hilJ pro,o."h' •• J .... m. In .Jill ... ",. ,,'hile .,idcn<e on 'h< effoe,. "f ,he 

n'c<"~>n i. nIDal, ,,:ant .10 .. pain" to noticcable . piku in child abuo< folJo..;ng ,he <c«"ion, One ,tu<I)'. 

"r-I.lr"""",,_k 1."".{, "NI fl.?"" Ad.,iniolt, fo,ChiJJ A/wlt, }Q(j() ,. 1009 ~ bnk, • rio< ;" ph) .. iciI chikl 

'!>uk in the 10" Joc1<k '0 1oc.1 mortgage' fu"",k"ur",. Th" ,n.oJy, pobli.hW in ,he juum.II',di.,rkt, i. the 

10'1,'<-'" "'L"niru,~", 1<, .10« of ,he irnp><' ,ho ".'"""io" ho< h:oJ on chilJ .bu.." The .rudy. found ,h" ""ery I 

percen' inCfO'" ,n 90-.10)' m<.><1g>£<: Jd;"'!U<n<k. ''''« 0 ''''''-)'''''' penod ,,'" .. "",i",-.I ,,';,h •. 1 percen, 

inc«-.. ", in chikl=', hosp;1211<1mi"OO. for phr.in.l child . bu .. , onJ a 5 pe''''''' inc""" in chilJr",,', 

..... ]>ital • .lmi" ........ rn< '",,,nu,ic hr;>.in injorio •• ".pte,,,J tn "" <."S«! by chilJ abu,." 

Th< .. .I ..... in oddirion '" ,t..: ,,"'obi), ..... · "urn"'" ,,( familie, "'h<, «c';,'e on)" •• "',""" .,'en "'hen 

"",it""'"",n' i. oub."nn.,al _ ,ulQIC" ,h .. we ncrd to "",,,gthen dfon. '0 iden,;f), .nJ pro,-iJe ",,,,icc< '0 fomili'" ,h .. HO .. high risk fo, child .bus< onJ nogk"'t. CUrTCml),. ,h. fru. .. 1 gm'crnm,:", 'pend. 

'I'I'ro.,im:>tcir 10 time. ""n. on f"stCT .U. ,n." on p'c..-cmh-e "",«" This is due '" limited fcJcr.ol .".1 "ote {und;ng .nd <"""n' fcJ< ",1 re"ric"'",. in ,he _Ih.-_ble ,,'" "f f"nd .. and •• a "'''01,. the ""go' portion 

of fede,,1 Jolla ... going '0 fO,le< corc. One i"'tenri:rl ,,""tion migh' be fo, ,,.te, to directl}" 1<CC", f,-.Ienl 

fond. ,ueh .. ""J«Ti,k IV·'" of, he Sod.1 Seco";t)" Act (1'.1 .. 74-271) f.j\' i",'«""."" in. bro.J ron,in"om 

of ""·K,"" for chikJren onJ farrulics ",duJing pre"en,;,,,,, c:orl)' in'er""n';',.,, .nd I""" ' p<rmonencr ..,rvK<>, 

Ab><m ouch. bro.d ",form ,,(,he f«kr21 fWlJing "rue,,,,,,, "'0 n«-d :roIuti<M" now. 

The l'rot<ct Ou, Children ,\c' of 2011(I!.R. 3651) nl1bli;he> 'he Commi,,;"" ". E~min .. c Chikl ,\bu", ond 

Ncgloct F. "I;,ic" .. ,ked "ith COflJucting I ,hor-ough "00), on redue;ng f."oliri<, from chikl .bu", onJ 

negi""" The ,,-ork of ,he Commission con k1<l ",.n ine",oS«! un.krs .. ndirr~ of de .. h. ,,-",ulring from child 

.b"", ond can leld '0 in'l',,)\'c .... nl> in ').""""r ,)~ ,erru ",.I pNCoc"" '" pro<ce, ehiklr<n.nd p"''''''' ehlkl 

abu,., 0,,,1 nogl«t, We u'ge ),ou '" en . .. ,. ,h. , in ,he CO" ..... of'he " 'Q,k of ,h. C"rnm; •• i"n. ,hc", i, 

con.;de""ion of. bro.d . .... y .. ferre.,ive prog ... m •• including child h •• hh. men .. 1 heol'h, jU\'enile 

jo"; ••• nd .due.,;on .. ,,-ice. th.,.", d •• igned '0 I'","<:n' child . hose . nd negle" '. In 'he 1''''''.'', i, 

; •• 10" ;"'1"''''''' '" ."nl;". b .. , 1''''''';'''' in """Io. ,;ng p",,'ention p.-og.an,. f" •• ffe"';v.n .. ~. 

Fu<!hem",,,,. W~ u'g~ )'OU '0 .n,u,. 'hat ,h • .ole off.mi~ol f..,'ors .. including po",n'oI . ubo .. nc. 

obu ••• 1'".n,.1 mcn,.1 he.lth ond "",s', dom ... ic ,';olene., and child co,..,;n pr«ip;'''ing child 

m21,,,,. ,,,,on, and fat.U'i .... and effec';"e .. ",icc. J e,igned '0 . dd .... ,h ... i,.oe,.rc con. id ..... d. 

P",,-en p""'ention prugr.om, <on lick! eoo,ide ... bk .. ,;ngo "'nging from Sl.I ~ '0 $14,('5 for ""C<}' doll., 

in"dted, Ikyond ,he cOnlpelling r",'nciol'rgum<n'. dfecti"" pre""nrion me." .. ",,, COn ',,-e li,'co. W. ""'"<;, 

... 
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George Lithco. Esq. 

Co-founder. Policy Advocate 

SKIPPER (Sha ing Kills: Instead. Parents Please Educate and Remember) Initiative 

1011 Dutchess Turnpike 

Poughkeepsie. NY 12603 

December 24. 2012 

Han. Lloyd Doggen 

United States House of Representatives 

201 Cannon House Office Building. 

District of Columbia 205 15-4325 

Han. Erik Paulsen 

United States House of Representatives 

127 Cannon House Office Building. 

District of Columbia 20515·2303 

Han. Dave Camp 

United States House of Representatives 

341 Cannon House Office Building. 

District of Columbia 20515-2204 

Thank you for the opportun~y to comment on HR 6655. the Protect Our Kids Act. 

I wish to express my support for the bill. but also to offer suggestions for improvement. 

The goal of protecting children from abuse is vitally important. and I hope HR 6655 moves forward 

quickly towards enactment in the Senate. 

My statement of support is intensely personal. 

Our forst son. Skipper. was born at dawn on Christmas Eve. 1999. 

A week later. on New Year's Eve. my wife and I recorded wishes for the New Year. and the new 

MHienium. We wished Skipper health and well being. and the hope that he would see the tum of 

the next century. 

We did not know rt then. but he would flOt live to see his first birthday. 

A week atter Thanksgiving Day. 2000, Skipper was shaken by his childcare provider - a fitty-one 

year old grandmother. with four children of her own. 

He never regained consciousness. 

Although his date of death is officially recorded as December 3. 2000. the bright, intelligent child we 

knew lett us late on the last evening in November. as he was being taken by helicopter from our 

local hosprtal to the regional trauma center. 

With other family members, my wife and I spent the next three days at the pediatric ICU at 

Westchester Medical Center. in Valhalla. New Yorl<.. That time started in hope. and ended in 

darl<. ness. 

At Skipper's bedside. we received an education in the causes of traumatic brain injury. and its 

progression in very young children. 
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Since that time, we have worl<ed w~h family and friendS, other advocates, hospitals and childcare 

organizaHons, schools and parenting educators, and eKlcted officials at local, state and federal 

levels to help Increase awareness about the vulnerabil ity of young children to inflicted head injury, 

and educate parents and caregivers about how they can help keep children in their care safe from 

such preventable injuries . 

... We joined the efforts of Sen. Paul Wellstone, Rep. 8uck McKeon, and a diverse coalition of 

advocacy organizations to recognize the third week of April as Shaken 8aby Syndrome Awareness 

Week. which culminated in a Joint Resolution of COrlQreSS recognizing National Shaken 8aby 

Syndrome Awareness Week (H. Cons. Res 59, 2001). We have since worl<ed with the NatiOflal 

Coal ition Against Child Abuse and other advocates to have the Week recognized by Senate 

resolution, and state action in New Yorl<, California, Texas and numerous other states_ 

... We have worked in New Yorl< and other states to enact legislation requiring hospitals to offer 

new parents the opportunity to learn how to keep their child safe, and to educate child care 

providers about the causes and consequences of infiicted head injuries . 

... We have submitted testimony in support of prevention educa~on to legislative commillees and 

sponsors in New Yorl<, Massachusetts. Illinois, Kentucky, California, ArI<ansas, Nebraska. 

Minnesota, Oklahoma, New Jersey, Virginia, South CarOlina, Hawaii and Wyoming . 

... We have shared our at the 2005 Surgeon General's Worl<shop on Child Maltreatment. the 2004 

Prevention Institute of the National Center on Shaken 8aby Syndrome, and the 2005 Leadership 

Conference of the American Academy of Pediatrics. 

My wife and I brought different skills and backgrounds to these efforts. t have an educational 

background in psychotogy, at the graduate and undergraduate Klvels. a legal education and twenty 

years of experience as a legal advocate for municipal clients. My wife has a master's degree In 

education and fifteen years experience as an educator. 

We have ten years of experience in working wrth hosprtals, chi ld care providers and parents on 

awareness and prevention education. 

The Klssons we've learned about prevention education inform our recommendations and 

suggestions regarding the Protect Our Kids Act. 

(Page numbermne number references are to the discussion draft dated December 5. 2012] 

1. The Act should expedite review and recommendations lor imptementing evidence-based, peer 

review practices exist that have been shown to be effective in reducing the incidence of innicted 

head Injuries. 

1\ the ul~mate goal of Congress. as Representative Camp appropriately said in his statement, is to 

do what it can to reduce child fatal ities, the Act should include a directive to the Commission that 

prioritizes evaluation of existing evidence-based prac~ces and Identifies actions that can be taken 

to remove barriers to their implemen a~on. 

As an example, Califomia maintains an inventory of such practices. with linkS to the professional 

literature demonstrating effectiveness_ 

As another example, in 2005, Pediatrics. the Journal of the American Academy of Pediatrics, 

reported on worl< by the Upstate New Vorl< Shaken Baby to educate new parents that resulted in a 

reduction of the incidence of abusive head trauma by 50%. 

As the Act notes (p.2, lines 9·11), nearly half the children who die from abuse are under the age of 

1. A 2004 study by Keenan et. al in the Journal of the American Medical Association estimated 
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that approximately 300 children die every year as the result of abusive head Irauma. most of whom 

are children under age 2. 

AClion can be laken now 10 reduce Ihalloll, 

2. The obje<;tives Of the Act should include reporting of injuries and survivors of abuse. 

Understandably. the findings set oul in Ihe Act focus on the failure of Ihe report system to 

accuratelY track child fatalities due to abuse (pgs. t-2. lines 1-19). 

While we know too well that the death of a child is an enormous Iragedy. we know that children 

may survive abusive head trauma with injuries thai vary from traumatic brain injuries Ihat results in 

coma that last for years, to "mild" brain trauma that leaves a growing child with behavioral issues 

and learning disabilities that impair their ability to function as adults in many differenl ways. Such 

inflicted disabil ilies consume the efforts of their families and caregivers and divert the resources of 

schools. social service agencies and the health care system. 

At a time when healthcare and social service budgets are slretched beyond capacity. Congress 

should take into accounl the SOCial and economic costs of preventable injuries. 

3. If the goal of the Act is to prola<:t children. not merely improve the accuracy of child abuse 

fatamies. Ihe ACI should ensure thai members of the CommisSion have experience and expertise in 

sustainable prevention education. 

Child abuse is a consequence. Most immediately. il is the consequence of physical violence by a 

parent or other caregiver. Bullhere is growing evidence that education and awareness about the 

vulnerability of young children to inflicted injury can make a difference in a significant percentage of 

cases, especially with very young children, 

In many cases, child abuse educalion has been left 10 the medical profession. In other cases, it 

involves the child protective services of state and local agencies. All of the professionals we have 

encountered who work in this area make extraordinary efforts to keep children safe and deserve 

the thanks of the naLon. 

However. tile resources are not suffIcient for the need. and too often the resu~ is thai efforts are 

focused on deta<:ling abuse after it has taken place and preventing further abuse. 

The cost in lives, emotions and resources 10 undo the consequences of abuse is simply nOI 

sustainabte. 

Primary prevention that provides parents and caregivers with the understanding and ski lls 

necessary to copy with the daily frustration of raising children is etilicalto changing the 

circumstances children now encounler. 

Efforts such as the Education Begins at Home Act. which allows states to Pfovide parenting 

education for new families. do much to help. but the Commission requires skills and expertise Ihal 

have not traditionally been taught al medical schoots and other institutions of h;gher educaLon. 

Our understanding of social psychology and cognitive behavior shows the importance of 

understanding Ihe cogn~ive biases that parents and caregivers bring 10 Iheir roles as guardians of 

young children in their care. That behavior is also influenced by stress and other social and 

psychological faclors. 

TO understand Ihe opportunities for behavioral interventions Ihat promote prevention. Ihe Act 

should require that one or more members of the Commission have experience in des;gning and 

implementing primary prevention programs with proven effectiveness, experience in social 
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mar1<.eting of primary prevention programs, Of experience in implementing universal parenting 

education programs_ 

4, The Act should emphasi~e the need for universal prevention and awareness education, 

The message of the "traditional" form of child abuse preven~OIl is typically directed at a "high risk" 

population and takes the form that that the recipient - a parent or caregiver - should not abuse a 

child. The very act of doing so stigmatizes the recipient, and makes the effort harder for the 

educator and the educatee. 

As a practical matter, the "chitd abuse" label also essen~a ly eliminates the abWty of most parents 

to informally educate the caregivefS of their chitd about coping behaviofS. the causes and 

consequences of inflicted injury and ways to protect children in their care. 

Instead of just directing the Commission 10 sludy methods of "prioritizing child abuse and neglect 

prevention within [child protectionj services for families with the highest need", we encourage an 

amendment to direct the Commission to study "methods of effective prevention education, 

Including universal education of all parents and caregivers about what they can do to help keep 

children in their care safe and the promotion of informal behaviors by parents and caregivefS to 

extend and support prevention education." 

5. Child abuse is a consequen<:e of behavior that crosses sociat-economic lines. 

There is a growing body of evidence that the incider>ce of abusive behavior is not so different 

between social classes. For example, wor1<. by Runyan et al in 2005 shows that reports of abusive 

practices is not statistically significant between social-economic classes. 

At the same time, the literature svggests that the diagnosis of abuse may vary inversely w~h socialeconomic class of Ihe perpetrators. so as to make ij less likely to be diagnosed and reported when 

the perpetrator is of higher social-economic background. 

The resu~ is that in.cidents of abuse are mOle likely to be missed or diagnosed as simply injuries 

when the family is of higher economic status. The difficu~y in evaluating the nature and cause of 

head injuries, particularly when the child suIVives the injury, further impairs the accuracy of child 

abuse statistics and masks the eKient of abusive behavior. 

To improve the reporting of child abuse, the Commission shoold be directed to evaluate the effect 

of diagnostic bias on reporting, and estimate the extent to which ~ influences under-reporting, 

particularly among children who survive an incident of physical abuse. 

ThiS is particularly imjXIrtant because the prevalence of inflicted brain injury may be much higher 

than diagnosed. Limited research has foond that between 2% and 5% of mothefS report behaviors 

such as incidents of shaking children in their care. The military experience with blast trauma in Iraq 

and Afghanistan shows the peIVasive impact that "mild" traumatic brain injuries inflicted by blast 

have on brain function over time. As we've leamed from that experience. the cost of treating the 

sUIVivors of brain injury will be enormoos. 

Likewise, the Commission ShOl.lId be directed to assess whether inflicted head injuries result in 

inflicted learning disabilities. 

6. Other comments: 

Page 2, lines 9 - 10, notes that 700 children under age t die of abuse. The importance 01 

preventing inflicted head injuries is highlighted that estimates svggest more that 200 children under 

age 1 die because of inflicted head injuries. 
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Page 2, lines 16 - 20, improvemenl in understanding lhe causes of behavior thai contribute to 

abuse can contribule to the improvenwnt of primary prevention efforts direded allhe general 

population, not just child protective services. That is especial ly important because the limited data 

available suggests that the majority of families of children who suffer inflk:ted head injuries have not 

been involved with child protective services, 

Page 2, lines 21 - 23, given lhatthe goal 01 the Commission is to "eliminate" child abuse, the name 

of tile Commission should include "Injuries", not just "Fatalities." 

Page 3, lines 16 - 16, qualifications of one or more members should include "eKperience in 

implementing effective primary prevention programs, cognitive psychology and parenting 

education. and ... •. 

Consideration should also be given to including at least one parent-advocate and a foster-parent 

advocate as memoors of the Commission. 

Page 4, Iines 17 -19. should include 'eKperience in implenwnting parenting education at an 

elementary or secondary school. " 

Page 6, lines 11 - 16, should include "the numoor of injuries and the cost incurred by federal an<! 

state agencies for the care and treatment of children injured by physical and other forms of abuse, 

including foster care placement." 

Page 6, lines 21 - 25, should include "as well as forms of abuse that are nOI well.(;(lrrelaled with 

those risk factors associated with intentional forms of child abuse." 

Page 8, lines 1 -4, should include direction to ' include recommendations for edtM:ating parents and 

caregivers on effective actions they can take to keep young children in their care safe from inmded 

injury as part of a truly comprehensive national strategy to reduce fatalities and injuries." 

Page 8. lines 9 -16. should include "The wor!< of the Commillee in developin9 such report shall 

accord the highest priority to evaluating and disseminating recommendations for action on eKisting. 

evidence-based prac1iws that have been shown to be effective al reducing fatalities and inmcted 

injuries in young children, including the preparation and dissemination of white papers or other 

interim statements on the evidence-base for such practices and reoJmmendations for their 

dissemination and implementation. prior to the final report of the Commission." 

Page 9. lines 12 -13. should include "The Commission shall develop comprehensive methods of 

publicizing the work of the Commission. including opportunities for public comment and 

partk:ipation at hearings. that illCludes the use of common Social media networks. websites that 

provide background Information. agendas and ways to access the work of the Commission for 

individuals and organizations unable to attend hearings, at least equal to the efforts undertaken by 

the Interagency Autism Coordinating Council of the Department of Health and Human Services.' 

See !!ill:!:lrlllcchhsgovi 

I respectfully subm~ these comments. suggestions and recommendations for consideration. I 

would be pleased to discuss them with Committee staff or provide more detailed supplemental 

references on any of the points discussed above. f can reached at (845) 778-2121 

I thank the members of the Commitlee for their important worle on this issue. 

Hon. Chris Gibson 

United States House of Representatives 

1708 Longworth House Office Building. 

District 01 Columbia 20515-3220 

George Lithco, EsC!. 
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Proposal to Reduce Child Deaths Due to Maltreatment 

Michael Durfee MD Chief Consultant 

los Angeles County Interagency Council on Child Abuse and Neglect, ICAN 

michaeldSS@aol.(om 

INTRODUCTIONS· I began with fatal child abuse in 1975, planning and building a structure for 

the world's first Child Death Review team. Deanne Tilton Durfee ran the largest Interagency 

Council on Child Abuse/Neglect housed this team in 1978. That gives us 71 years experience 

that continues today. I will present some of our experience and note people we admire. 

OUR BACKGROUND Both of us had earlier experience. Deanne began as a line welfare worker 

and was asked to join a new profeSSion, child protective services. 5he can still find the memory 

and image of a baby who later died. 5he helped create the LA County Dependency Court 

5ystem and became a manager. She was asked to manage a small multiagency forum that she 

grew to 32 agencies, 20 committees, 12 community based child abuse councils, five 

cooferences, multiple reports and a private charity. I helped create our annual report on child 

death and a report on multiagency data systems. Deanoe became chair of the US AdviSOry 

Board on Child Abuse/Neglect that used our experieoce and contacts to create A National 

Shame, a report Fa tal Child Abuse/Neglect in the US. Randy Alexander MD now in Florida 

helped with that report aod later was the editor of the primary text on Child Fatality Review. 

San Diego County formed the secood Child Death Team Review in 1982. Their work suggested 

that such deaths peaked at age three. Our experieoce allowed me to suggest changes in their 

program that helped them find irlfaots that they had been missiog. Other counties and then 

other states fOllowed. Canada aod Australia had team reports in 1994. ICAN became the 

National Ceoter on Child Fatality Review, the major source of support to others formiog teams. 

We shared our work nationally and then internationally. The last state was added in 2001. 

ICAN was the primary program aod I was the primary advocate for teams from 1978 into this 

century and I had few people to back me up. I met with team members from half of the states 

and talked with most of the rest by phone. I ioitiated, chaired and managed the California state 

team with no money or legal mandate. The Coalition of teams in SOu theastern States gave me 

the title of MFather of Child Death Review". I earned that title and value those words. 

EARLY DAYS The early days were anchored in peer support. Teams called each other to ask for 

help. Regiooal groups formed that continue today. The Southeastern states have the largest 

group of teams with states from Virginia to Florida to Texas. 

MEDIA - Much of the growth came in the 19905 with early press coverage with stories 00 

individual cases. A series of articles in the Atlanta Constitution were nominated for a Pulitzer 
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Prize. A Washington Post reporter was gi~en that award and a series in the Chicago Tribune 

recei~ed a Pulitzer. Media become part of this process. The deatll of lisa Steinberg in 1987 was 

major print and TV news. Other famous cases followed with Susan Smith and Eli Creekmore. 

My computer news review noted most reporters were female as if tllis was a female issue. 

Most stories with pictures were wllite male toddlers. Tile years 2000 to 2010 brought 

complaints of agency failure and occasional Child Death Review team reports noting success 

with pre~ention programs. These stories are now larger with Governors or senior manager and 

media and arguments on confidentiality. Congress and federal officials have joined us. 

TEAM REPORTS ICAN shared team reports in the 1990s with an annual press release. 

Newspapers TV and radiO reporters were given different stories to cover w ith homicide, suicide 

or accident pre~ention. The lA Times Magazine had a cover picture of the lA County Team 

titled "The Worlds Worst Job". The public learned ways to protect children. Media contacts 

ha~e been used for prevention programs including pool safety, Silfe Surrender and Safe 

Sleeping. 

FORMAL LITERATURE My formal medical literature includes Origins and Clinlcol Relevance 0/ 

Child Death Re~iew 1992, lAMA, Fatal Child Abuse Chapter Henry Kempe A SO Year legacy 2012, 

Springer. Most of my work has been published in local reports and protocols with topics that 

needed to be addressed. Richard Bullock wrote a document for the creation of Child Death 

Review in the UK, NFor the Scottish Executive, 2005 He noted conflicts and stated that, ·once 

again it falls to Durfee to resolve this issue". Our experience had value in the UK. Many teams 

were formed, after a notoriOUS child abuse death, by ad~oca es on or near the line who were 

officially not important but knew how to protect children and to share resources. 

INTERNATIONAL EFFORTS We have traveled to other countries with presentations at 

International meetings in Ireland, Australia and England and Canada. We met with Canadian 

offiCials in Ottawa. I was asked to present to new teams forming in London. We presented in 

Porto Portugal and met with experts in f rance afld had contacts for Japan, lebanon, Israel, 

England, Australia, New Zealand, China, Singapore, Russia, Sweden, Brazil, Argentina and 

Netherlands. I was asked to create an international curriculum for the Helfer Society for 

physicians and the International Society for Child Abuse and Neglect to use internationally. 

, 
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ISSUES TO CONSIDER 

1) TECHNOLOGY VS PEOPLE T&hnology and science are needed, but this is also a personal 

issue. The death of a child changes us. Line staff may be casualties. We need to temper 

the damage but keep the motivation that pain generates. 

2) CITIZENS The major resource for children facing fa tal and severe damage is the people 

around them. We encourage people to report but not to act. They can offer a parent 

help with child care or shopping. Friends, family and neighbors can temper isolation and 

secrecy that is a major part of the problem. 

3) OTHER DEATH REVIEW Child Death Review, AKA, Child Fatality Review has been 

followed by: [)omestic Violence Fatality Review DVFR, Elder Abuse Fatality Review and 

Dependent Adult Abuse Fatality Review. Domestic Violence Fatality Review exists in 

multiple nations and includes deaths of children. They serve some of the same families. 

4) CHILD AND FAMILY GRIEF Neil Websdale trains DVFR teams, works with ICAN NCFR and 

shares the concern about childrePl who survive fatal family violence. ICAN has a PliPle 

year old aPlnual conference on child grief and trauma. We shared speakers OPl fatal 

family violence that is visible at !ill!:!:ljwww.youtube.com/watch?v:eYWxSmOWKIl Neil has 

a video on a case with multiple child victims. hltp:ljvimeo.com/15147441 . 

5) TEAM CONfLICT A commoPl split in multiagePlCV Child Death Review Teams causes a 

separation of criminal justice and human services. Major systems for "fatal child abuse" 

miss the word homicide that is common with some variation to Coror'ler, Law 

EPlforcemer'lt, Vital Statistics and Prosecutors. CrimiPlal justice data is part of this work. 

6) TERMINOLOGY CorOPlers, law ePlforcement, and prosecutors use the word Homicide. 

Social services and media use fatal child abuse I r'leglect. We store data in handwritter'l 

documents and lump data tied as if Homicide, Abuse, Neglect, are the same. 

7) PREVENTION VS INTERVENTION Some child fatality review teams believe that 

investigation and prevention must be separate. My 35 years with multiagency teams 

finds these activities more than compatible. They can support each other. 

8) A SINGLE AGENCY- Various studies note 25-50% of fatal child abuse have previous CPS 

records. That means that 50- 7S % don't. CPS agencies may not be the local leader or 

investigator. These cases require multiple agencies working together mixing skills 

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9) fUNDING funds and official status can create and destroy. If several people apply for 

the same grant, the grant score could include points for describing how the applicants 

will work with others applying for the funds. Grant fund5 5hould not separate programs. 

10) CORONERS VARY California Coroners may be in Sheriff5 Department. Other 5tates may 

elect or appoint them. SOme are morticians. Coroner Investigators may have a police 

background, but in recent years include Public Health Nurses that work well with infant 

toddler cases. Medical examiners may not be trained on infant toddler autopsy. The 

National Association of Medical Examiners, NAME is a resource working on this. 

11) MIXED JURISDICTIONS. A chi ld from Maryland injured in Virginia could be sent to 

Washington National Children's Hospital in Washington DC. If the chi ld dies there could 

be a case with Maryland Child Protective Services for home of residence, Virginia law 

Enforcement for the crime, and DC for medical care and coroner autopsy. 

DATA IS A MAJOR ISSUE THAT IS MORE THAN NUMBERS 

DATA The large scale national attempts to col lect national data will only succeed when local 

data is improved. The issue of data is expanding with the growth of computer systems. Some 

simple models are possible using infants and the designation of homicide. I presented the ICAN 

study of infant homicide data that is lost in transfer from Coroner to Vital Statistics at the 

national conference for the National Center for Health Statistics and the National Association 

for Public Health Statistics and Information Systems. There was interest but no data repair. 

Issues for local case managers need to mix data from different professions and different 

jurisdictions. Criminal justice data would include the FBI UCR SHR and criminal court outcome. 

DCFS and Ciyil court outcome may display previOus contact and show intervention with 

surviving siblings. Different jurisdictions will appear in criminal, social service and health data 

sets with access to cross lines between counties, states and international boundaries. We 

gather data on family risk factors whi le we miss other agency data and fail to gather data on 

our own action and inaction. When Children die we need to measure ourselves. 

COLO DATA AND HOT PAIN Case Reyiew should be one case at a time. Done well the case 

presentation can capture the child and family as people and help others, for a moment create a 

personal sense of loss. Pictures of th e child can make the child real. The words for the story and 

the picture are important. There is a balance between cold data and personal images. The team 

review can help professional staff feel less alone. The cold data may be easier to work with. 

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HOSPITALS ARE A MAJOR MISSING RESOURCE 

HOSPITALS - Fatal child maltreatment lends itself to multiagency investigation, but the child 

needs to die before the review. The ICAN hospital program provides a program with liaison 

today in 126 hospitals including 32 PICU, 12 child burn programs, the majority of inpatient 

services for injuries under age three, about half of such children in Emergency Departments and 

about half of all births. Some hospitals and ICAN are working on software to automate systems. 

Hospitals probably have contact with the majority of children before their death. Hospitals are 

also the major private sector program in a field that is primarily government. 

This system of hospitals includes peer support as a resource for quality control and program 

management. This system wil l first connect hospitals to themselves using computer data 

systems. Multiple models exist w ith growing connections from a national working group. 

ICAN software is designed to fit the needs of hospitals that do not spend time on this issue and 

also meet the needs of staff who want to pursue details of child abuse. The digitized report can 

be sent to the investigating agency and digitized medical records can be added . There are also 

data elements to allow tracking and monitoring of case management. Guidelines for Ad Hoc 

team formation will allow joint case management with the hospital. Fatal cases can be tied to 

local chi ld death review. Children who require intensive care can be designated nonfatal severe 

abuse for that special review. 

This system is designed in part by previous experience in public health 1981-1986. We began 

with six hospitals with Suspected Child Abuse and Neglect, SCAN teams. By year five that had 

grown from 6 to 30 hospitals with SCAN teams and the number or reports had grown from SO a 

month to S()() a month. 

HOMLCIDE SOFTWARE AND SYSTEMATIC CASE MANAGEMENT 

This custom software is designed to define and automate multiagency records of value w ith 

child homicide cases w ith caretaker suspects. This system will begin with homicide but spread 

to other cause and manner of child death. This model began with a list 0120 records that were 

collected by an attorney in the LA County Dependency Court. Additional records were added 

and the software is approaching a beta version that can be tested by Child Death Review 

Teams. 80th software programs should be available in 2013. 

The homicide software will be managed on the Internet. Security measures roughly match or 

exceed the basic systems used to protect financial activity on the Internet. The access to 

medical records will make multiagency interaction easier. The review team can access records 

during review. The computer system can create reports and a system can be devised to monitor 

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PROTOCOLS MAY BE CREATED AND IMPLEMENTED 

HISTORY The data collection instrument in the ICAN Hospital Software will help record 

collection. Previous well child medical records can increase the understanding of the child's 

health. However, many teams avoid investigation. LA County has seen 1,000 cases of homicide 

by caretaker since the team began in 1975. The experience of reviewing those cases leaves us 

impressed that multiagency review is useful for the investigation and should begin ASAP 

There are special issues with investigation of the death of young children. DNA or other 

evidence can put a suspect at the scene of a crime. That may help with a suspect who should 

not have been at the scene but have no value if the child and perpetrator are supposed to be 

together. Young victims, particularly infants, are easier to kill and may have no visible lesions. If 

suffocated, there may be no findings and what happened may only come with confession. 

Witness Interviews are a special issue. Child witnesses mayor may not quality for court, but 

may be able to provide critical evidence. The best person to perform these interviews may not 

be law enforcement. People who work with infants and toddlers witl need help to address 

violent themes and law enforcement may need help with infants and toddlers. 

There are some protocols for investigation. Bill Walsh, Dallas PO, created one for USDOJ in 200S 

Steve Clark from Occupational Research Assessment In Michigan helped create the protocols 

and training material for Sudden Unexpected Infant Death Inve5tigation, SUiDl. Victor Vieth DA 

now in Wisconsin provided us material from the National District Attorneys Association. 

NONFATAL SEVERE CHILO ABUSE REVIEW 

A growing number of states have some defined process for review of nonfatal severe child 

abuse. There are federal and state legal issues for these cases. Some child death review teams 

review such cases. Maine began some years ago buause they had time with small numbers of 

deaths. Oklahoma built a separate team for review of cases reported from two hospitals 

Pediatric IntenSive Care Units, PICU. California DSS asks counties social services for numbers for 

a state report. In 2013 the California network will begin connecting staff from PICU and buildinS 

a system to Identify PICU reports. 

JOINT REVIEW OF CHILD AND DOMESTIC VIOLENCE 

La County teams for child and domestic violence fatali ty review met to share two cases where 

fathers killed multiple children because their wife was going to leave. The reviews were useful 

for both teams and that review helped build bridges for future similar cases. That theme has 

been repeated at the ICAN conference on traumatic grief. 

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PROPOSED LEGISLATION AND RECOMMENDATIONS 

The central focus of the legislation as presented for this hearing is child protective service and 

child welfare systems. These are important services but some would disagree with the 

emphasis on CPS The suggested focus. could create a commitment that would be hard to 

change. The first task I would suggest would also feature a mi~ of: 

1 prevention and intervention. Both are necessary and they can support each other 

2 Addition of nonfatal severe cases to e~pan d prevention and early intervention 

3 Multiple professions working together as it is with child death review 

The first assessment would gather advice from multiple bodies. 

HEALTH 1) The American Academy of Pediatrics has a strong history of work w ith child abuse 

including two Presidents and committees. 2) The Ray Helfer SOCiety includes physicians who 

work w ith child abuse. They have created pediatric boards in child abuse and training 

fellowships 3) The National Association of Children's Hospitals and Related Institutions. NACHRI 

has a national study of child abuse programs in Children's Hospitals. 4) ICAN California Hospital 

Network and informal national working group have systems for peer support and for computer 

automation of child abuse reports. 

PUBLIC HEALTH -1) The American Public Health Association has a Forum on Family Violence 

and a Section on Health Informatics Information Technology, 2) Programs at CDC address 

violence and programs e~ist at NIH and HRSA. 

JUSTICE 1) US Department of Justice has multiple programs. 2) There may be resources in 

national law enforcement associations. 3) The National Association for Medical Examiners, 

NAME, has roles with justice and health, 4) The National District Attorneys Association's 

National Center for Prosecution of Child Abuse S) The National Association of Juvenile and 

Family Court Judges 6) Steve Clark with Sudden Unexpected Infant Death Investigation 

Protocols 6) Dallas Police Dallas Annual Training Conference 

TEAMS 1) The network of teams and multistate clusters 2) ICAN National Center on Child 

Fatality Review 3) Michigan National Center for Child Death Review 

CHILD PROTECTIVE SERVICES 1) National Association of Child Welfare Director, 2) National 

Association of Social Workers, NASW 

OTHERS - 1) US Department of Defense, child death review teams 2) Children's Alliance has 

child advocacy centers that supply specialized evaluations of children for court. 

DOMESTIC VIOLENCE -1) Domestic Violence Fatality Review Training· Neil Websdale 2) 

Futures w ithout violence San Francisco 3) Or Jacqueline Campbell at Johns Hopkins 

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RESOURCES AND POTENTIAL RESOURCES 

1) MUlllAGENCY TEAMS - There is no single central agency to do this work. The teams are the 

closest wilh a mulliagency model. For Child Death Review, core Membership includes Coroner, 

law Enforcement, Child Welfare, Health, Public Health, Schools, Civil law, Criminal law, Central 

focus for local multi agency teams could use a national counterpart team, perhaps USDHHS, 

USDD] and USOOD with counterparts from other federal and national organizations. 

2) HEALTH SYSTEMS Almost all babies are born in hospitals. One eKception would be babies 

killed on the day they are born and those mothers might enter a hospital afterwards for 

medical care. Hospitals also see injuries and provide special care for trauma and burns. Most 

hospitals are private and offer a resource separate from the maze of government agencies 

3) DEATH REVIEW There may be 1,000 multiagency child fatality review teams in the US and a 

growing number of Domestic Violence fatality Review Teams that may serve the same families. 

4) PREVENTION PROGRAMS: Prevention Programs include Safe Sleeping, safe Surrender, Don't 

Shake Your Baby and programs to prevent death from drowning and motor vehicle injury 

S) RISK PROGRAMS - Home ViSitors, Substance Abuse and Pregnancy and Program for 

underserved high risk pregnancy from child sex abuse and developmentally disabled mothers, 

6) GRIEF PROGRAMS and child trauma programs for child survivors of fatal family violence 

7) CONNECTIONS BETWEEN AGENCIES and professions with a focus on creating resources for 

line case managers. That is different from major funds for new staff and different from creating 

complex central data for data experts to analyze. 

8) Nonfatal severe child abuse review should be reachable with hospitals and software. That 

software can address all reported cases as a population. Data study can provide direction to 

future screen evaluation and case management. 

9) The fCAN CUSTOM SOFTWARE for hospitals and software for multi agency Child Fatality 

Review. Both of these programs should be available soon. The ICAN informal national working 

group on hospital and Child Fatality Review software has other models. 

10) MEDIA NEWS coverage continues and a wrnputer alert can scan variOUS news. The news 

educates the public and prevents history. 

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A Submission for the Record 

By Maura D. Corrigan, Director 

Michigan Department of Human Services 

to the Subcommittee on Human Resources. 

Committee on Ways and Means, House of Representatives 

Re: The Protect Our Kids Act 

Chairman Paulsen, Ranking Member Doggett. and Members of the Subcommittee: 

Thank you for the opportunity to comment about the tragedy of child abuse fatatities in 

the U.S. and what may be accomptished through the Protect Our Kids Act and the 

National Commission to End Child Abuse and Neglect Fatalities. The Michigan 

Department of Human Services received more than 150,000 complaints of abuse and 

neglect last year. We also considered reports on the fatal abuse and neglect deaths of 

127 Michigan children from 2009-2010. We are thus acquainted with the costs of these 

deaths to children, their families, our communities, and the professionals who must 

respond to these deaths. 

We know that Chairman Dave Camp commissioned the GAO study to investigate the 

problem of child maltreatment fatalities after learning about the tragic deaths of several 

young children from Michigan. Our state learned many lessons from those deaths. We 

have implemented numerous improvements within law enforcement, forensic 

investigations, health care, child welfare and criminal justice. We are still learning and 

taking actions to keep children safe. Michigan's efforts to learn from these deaths 

could provide valuable assistance to the proposed national commission. 

Our state has a very well established and sophisticated multi-agency process, managed 

by the Department but in collaboration with other agencies, to identify, count, study, and 

respond to child abuse fatalities. We won< to identify the risk factors and failures in our 

child welfare system so we can better protect our children. For over a decade, our 

Department has funded the Michigan Child Death Review Program and Citizen Review 

Panel on Child Fatalities. We support the Michigan Public Health Institute's 

management of multi-disciplinary teams covering all 83 counties in the state. These 

teams are charged with discussing the circumstances of all child deaths to improve 

investigations. services, and agency policies and practices. They submit comprehensive 

case reports to the State. We participate in the National Child Death Review Case 

Reporting System, which has been essential in helping us to record the number and 

circumstances of child deaths. This system was highlighted in the GAO Report as an 

important means to improve national counting and reporting on child maltreatment 

deaths. 

Michigan has a state level advisory panel that meets several times a year to identify 

systemic problems and to make recommendations to our governor and legislature on 

opportunities 10 prevent these deaths. The Child Death State Advisory Team also 
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functions as Michigan's federally mandated Citizen Review Panel (CRP) on Child 

Fatalities. The CRP meets quarterly to examine deaths of children who were involved in 

the child prolection system. This examination is a specialized, multi-step process that 

involves the identification of cases with the assistance of DHS, the collection of relevant 

materials and a thorough case review. 

Because 01 our focused, multidisciplinary approach, we now know a good deal about 

the profiles of children who die from maltreatment in our slate. 

In 2009 and 2010, local Child Death Review teams reviewed 127 maltreatment deaths 

(38 abuse-related and 89 neglect-related fatalities). When local teams review a child's 

death. they are asked whether they believe that someone caused or contributed to the 

child's death by any action or inaction on their part. These numbers represent those 

cases where the team concluded that abuse or neglect either caused or contributed to 

the child's death. These reviews showed thai infanls under age 1 and children ages 1-4 

are at an increased risk of fatality over all other age groups. For 2009 and 2010 reviews, 

a larger percentage of the deaths attributed to neglect were 10 infants than in the 

previous two years. This finding is due in large part to local review teams increasingly 

identifying sleep-related infant deaths as neglect. \ 

The CRP on Child Fatalities looks specifically at deaths of children who had previous 

interaction with the child protection system. In 2011, the CRP reviewed 93 such cases41 % of those cases were found as child maltreatment related fatalities (14 abuserelaled and 25 neglect-related). In both review processes, neglect-related fatalities 

greatly outnumber abuse-related fatal ities. indicating the importance of accurately 

identifying and preventing child neglect. 

We don't stop at understanding the circumstances in the lives of children who have 

died- we work to develop and act on recommendations to prevent other deaths and to 

improve our system. A study of six years of our reviews, published in the Joumal, Child 

Abuse & Neglect, found that we were able to significantly decrease child abuse deaths 

correlated with improvements in practice. 

As outlined in the article by V.J. Palusci, many system changes were implemented as a 

result of Michigan's Child Fatalities CRP. These include statewide training for 

physicians, a new statewide protocol to determine cause and manner of sudden child 

deaths, a new protocol for joint investigation, a birth match system linking birth 

certificates with CPS records, as weil as new training for CPS workers and supervisors. 

The study identified decreases in child fatalities associated with findings from the 

reviews among children known within the child protection system. The system changes 

implemented could also be associated with those findings and potentially linked to the 

fewer child maltreatment deaths shown in the study.2 

While we have been hard at work in our state to protect children, we applaud the efforts 

of this Subcommittee through your hearing on Child Abuse Fatalities in July 2011 , the 

GAO report, and now the Protect Our Kids Act that will establish a national Commission 
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Reducing Child Deaths Due to Maltreatment 

Written testimony submitted by 

Elizabeth]. Clark, PhD, ACSW, MPH 

Executive Director 

National Association of Socia l Workers 

to 

Subcommittee on Human Resources 

Committee on Ways and Means 

December 12, 201 2 

Hearing on "Proposal to Reduce Child Deaths Due to Maltreatment" 

Contact Information: 

Eli,~be~~ J. Clart., P~D, A(SW, MPH 

E,,,,uli,,,,, Director 

Nal i",,~1 Associ.li"" 01 Social Worke" 

750 ~irsl Street. NE. Su~e 700 

Wa.hinBton. DC 20002-4241 

b<:~rk@na.wdt.OlJ 

f'hone 202 336 8200 fa. 202 3363313 

Nalional Association of Soda I Workers Page 1 
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On behall olthe 145,000 members 01 the National A'so<iation 01 Social Workers (NASW), the world'. 

la rge" prolessional association 01 social work rs, I am pleased to ,ubmit written testimony lor the 

hearing on the "Propo,al to Reduce Child Death, Due to Maltreatment" that was held by the 

Subcommittee on Human Re,ourc s 01 the House Wavs and Me.ns Committee on December 12, 2012. 

NASW advocate, lor ,ound ,ocial policie, that support children, lamilies and communitie, and thanks 

ihe subcommittee lor taking the issue 01 preventing child abuse latalitie, so seriously. The 

committee', previous hearing on Child Abu,e Fatalities and your committee', request lor the 

Government A((ounlabillty Ollke (GAO) report on the 'ame in 2011 are c,;tkallirst step, towa rds 

resolving Ihi, issue. 

Comments on the Discussion Draft of Protect Our Kids Act 

NASW is pleased Ie eller testimeny en the prepesed biparti.an draft el the legislatien, the "Prete<:t 

Our Kids Act. " Thi, act weuld establish a cemmissien to deve lep a na tional ,trategy and 

re<:emmendatiens lor reducing I"talities resulting lrom child abuse and negle<:t. NASW and the .ocial 

work prolession work lirelesslv to saleguard children lrom child abu.e and neglect. A commission to 

study the extreme outcome ollatalitie. i.long overdue. In July 201 1, the GAO lound that children 

who have died lrom maltreatment are li kely undercounted in the National Child Abu.e and Neglect 

Oata SYSlem (NCANDS) (GAO, 2011j. A commission could leek al this undercount and suggest changes 

to nOI enly better counl the data, but te also impreve practices and policies to prevent such fatalities. 

The composition of Ihe cemmission is imperlanl. NASW urges Cengress te lecus on experts in child 

wellare Including so<iai workers. Since the leunding et the seclal werk prolesslen ever 100 years age, 

enhancing the safety and well·being ef children and fam ilies has been at its hearl. Social werkers can 

be lound in a broad array 01 settings ,erving children and lamilies including child wella re, mental 

hea lth, health care, and schools, and in early childhood, juvenile justice and lamily support programs. 

All of these settings Can playa critical role in children's salety and well·being. There 15 a long history 

of social work leadership In child welfare practice, resurch, training and policy. SOCial workers are 

Invelled In prOmOting policies and practices that will prevent child abuse and neglect and reduce the 

number of child abuse latalities. Today more children may be at risk. There are concerns that the 

current economic climate is Increasing fam ily stress and causing cutbaCkS In education. menial health. 

and lamlly support services (ECM, 2011; Sedlak. et al. . 2010; Zagorsky, Schlesinger & Sege. 2010). 

Recent research by Putnam·Horn5tein (2011) found that children who have previously been reported 

to a child prOteCtiOn agency due to physical abuse may be at the highest risk of fatality. 

The dulies of the commission as outlined In the discussion draft will help to reduce child abuse and 

neg lect fatalities. The study on Ihe use of child protective services and child welfare services will help 

Congress learn about the prevalence of the problem and potential solutions. Examining how multiple 

federal and Slate funding Streams are woven together With Title IV and Title xx of the SOCial $&urity 

Act will be essential to more fuliV understand how child abuse prevention and Intervention funding 

Can be more fully actualited to keep children safe. 

Providing the opportunity for graduate and doctoral students' research to be coordinated with the 

commission will help advance ou r knowledge and recognlte the Important contributions that early 

Career researchers. including SOCial workers. are making to thiS field . SOCial work students often 

research child protective services and child welfare services. Their research Can he lp the commission 

better understand the service delivery systems' strengths and gaps. 

National Association of Soda I Workers P~ge2 
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The recommendations from the commission will help federal. state and local agencies better meet the 

needs of children and help reduce fatalities from child abuse and neglect. 

The hearings set forth in the draft legislation will be imperative to gather information about the 

prevalence of child abuse and neglect fatahtles as well as the Innovative methods to prevent such 

fatalities that are occurring in the states and localities. 

High Rat es of Child Abuse Fat alities are a Great Concern t o the Social Work Profession 

While many valuable programs focus on child abuse prevention and Intervention, our societal response 

is insufficient to prevent the estimated 2500 children's deaths due to abuse and neglect that occur each 

year (Every Child Matters Education Fund [ECM]. 2010), Although federal reports indicate that overall 

child abuse and neglect rates are decreaSing. child abuse deaths remain high, and children under age 4 

are m~t at risk (U,S. HHS, 20U). The Government Accountability Office (GAO, 2011) found that the 

current data and lr"cking we have on deaths from child abuse "nd neglect Is woefully inadequate and 

cOnCurs with the National Coalition to End Child Abuse Deaths (NCECADj that the number of deaths 

from child abuse and neglect are undercounted. The GAO recommends that there be greater federal 

investments in strengthening the qu"lity of data as well as the infOl'mation available on child abuse 

fatalities so that this increased knowledge can help prevent future deaths. 

Identifying and Reporting Child Abuse and Neglect 

Many of the deaths due to child abuse and neglect that we,e profiled in W", Can Da B",tter (ECM. 2012). 

the third edition 01 a report about deaths from child abuse and neglect across the United States, 

prepared by the Every Child Matters Education Fund, were Children wha were not previously known to 

the child protective system. These deaths signalth3t as a society we need to do more to nurture and 

support bath children and their caregivers and ensure that children are safe, Doctors, teachers. nurses, 

social workers, clelgy, familv members and neighbors al l are stakehOlders in plotectlng children. Sl ightly 

mOle than one half of child abuse and neglect reports are from professionals who came in contact with 

children suspected of being abused and neglected. The remaining reports are from friends, caregivers, 

coaches, neighbors and relatives (US flHS. 2012). We do know, also, that many Children at rls~ are never 

,eported to the child protection system (Sedla~, et aI., 2010). 

Professionals who are legally mandated to report children who are suspected of being maltreated 

should have confidence that the child protection agency has the necessary resources to make an 

adequate and appropriate response. and that suth reports will be assessed and heeded In a timely 

fashion. However, high workloads. Inadequate staffing and lack of resources and training often result in 

systems that do not respond adequately to maltreatment reports. 

AddreSSing Child Neglect 

It Is Imporunt to note that child neglect Is the most prevalent type of maltreatment (over 7S percent of 

maltreatment victims and 35 percent of child fatalities [US HHS, 2012)), yet we continue to have 

inadequate responses to what is frequently a chronic problem. The services offered to those who are 

National Association of Social Workers Page 3 
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maltreated and Ihelr families a re usually episodic .lnd crisls-oriented rather than focused on long term 

concerns (Blome & Sieib, 2(09). To approprialely address chronic neglecllhere is a need for largeted 

on·golng service. and ,uppons a, well a. early Intervention services for new parents. The provi,ion for 

the early childhood evidence·based home visiting program Included In Ihe Patient PrOlection and 

Affordable Care AClls one attempt 10 address thiS need for parents most at risk. 

The Need fo r Skilled Soci.1 Worken; in Child Pro tection Work 

Each day, child welfare professionals work diligently 10 support famil ies in creating healthy and 

nurturing environments for children; bul. 100 often. there are barriers to successful outcomes for 

children, youth and families. Whelher II i. social workers. nurse., physicians or lawyer, involved in the 

child welfare system, a skilled and stable child welfare workforce Is critical 10 providing eff...:tive 

services. 

Of partkular COnCern to NASW, Is the Involvement of professional social workers in child we lfa re 

agencies. Research by NASW and others sllows that personal factors. like commitment to child welfare 

and education, e'pe<:ia lly a ,ocial work degree paired wilh specialized education in child welfare, are 

Important 'actors for successful child welfare outcomes. vel. nationally. less than 40 percent of child 

welfare workers have SOCial work degrees and in many states it Is less Ihan 20 percent (Zlotnik. 

DePan filis. Daining & Lane, 2005; Social Work Policy Institute. 2011). Agencies mu.t also ensure that a 

supportive organizational culture and climate Is in place to effectively support their child welfare 

workers. High quality supeNision and peer support strengthen competent practice and prevenl worker 

burn-out. Cross-agency collaboration and communication. on-gOing training and available resources for 

the children and families Can help ensure that workers can do their lobs. 

As one of sociely's First Responders. fronl ·line child protective seNice workers are challenged by low 

salaries. limited access to necessary lechnology. safety risks. and high caseloads and workloads, Too 

often, large <aseloads and unsupportive work environments lead 10 high turnover, hindering agencies' 

altainment of key safety and permaneocy outcomes lor children. Ensuring a supportive work 

environment helps our child welfare workers do their lob well and demonstrates that ultimately we ca re 

aboulth" well·being of children and famili ... , Not only do we have 100 many child abuse fatalities, bUI 

there are also safety risks for workers, and too many child wellare or~efS have died doing their jobs. 

Addressing Racia l and Ethnic Dispari ties In Child Abuse and Neglect 

Across the country. child welfare workers 'lre working with chiklren from diverse racial and ethnic 

background •. Social workers playa critical role in ensuring that children and familie. of color receive 

qua lity services and Ihat ~pp oprlale culturallv responsive decisions a re m~de to ensure their s~fety. 

well·belng, and permanency. Nationally, and In most stales, children of color. especiallv African 

American Ch ildren, are overrepresented in the system, esp...:ially in foster ca re. We also see differential 

attenlion bv the media and the public to child abuse deaths (Alennder, 2011). This disproportlonality 

continues despite research Indicating that there are no differences in the incidence of child abuse and 

National Assocl~tion olSoclal Workers Page 4 
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neglect bV racial or ethnic group. In addition, a large number of children in~olved with the child we lfare 

s~tem are Immigrants from all torners of the world. 

II is largely caseworkers and supervisor1 who make decisions regarding keeping children with their 

families, placement of children in foster care, reunification and other permanency outcomes for 

children. AI each dedsion point, culturally appropriate action can profoundly Influence the trajeclory of 

a child·s life. Making Sure the child welfare workforce is culturally competent. and has the prerequisite 

knowledge and skills, is essential to maintaining the community"s trust that the system is truly about the 

welfare of children and families ralher than aboul enforcing discriminalOry and unnecessary 

interventions. 

Recommendations 

To pre~ent deaths from child abuse and neglect and to pre~ent and treat child abuse and neglect. NASW 

makes the following recommendations: 

1. Standards and Bener Data Collection are Needed on Child Abuse Fatalities 

NASW recommends Ihatlhe Oepartment of Health and Human Services standardile definitions and 

methodologies used to collect data related 10 ma ltreatmenl dealhs and require states 10 provide 

such data. As hlghlighled In Ihe recent report, Child Mallreo/menf: Sireng/hening Notional 0<1/0 on 

Child F%lities Could Aid in Prevention (GAO, 2011~ Ihere is a need for consistent dala tolle<:tion 

and Slandards for defining child abuse and neglect falali'ies. In addition. state child dealh review 

teams should be adequately funded . Such data and rellOrting will assist the federal government and 

states to identify mOre effective strategies to prevent future deaths from maltreatment and to 

address racial disparities that might be occurring. 

2. Iducatlon, Tr .. 1nlnl I nd Workfo rce Standards Are Needed to Incourage Highly Skliled 

Professionals to Work In Prog"ms that Promot e the S .. fety and Well·Beln. of Children ;o nd 

Promote family Self·Sufficiency and family Stability 

NASW recommend, Ihat federal funding be "nhanced to ,uppon the education and training of 

profe"ional social worker< to work in public and pr;"ate child welfare agencies, induding SUPllOrt 

for the education and training of superviSOrs. In addition, child protection agencies should increase 

their staffing standards, bV requiring a minimum of a bachelor's degree in social work (BSW) for 

front-line workers and a master's degree in social work (MSW) and experience for supervisor< in 

child protection programs. Resources should also be available to ensure that other professionals, 

including physicians, lawyers, and nurses, have the necessary Iraining 10 recognize and assess child 

abuse and neslect and to ensure thaI there are hiSh qua lity multi-disciplinary ,ervices a~ abl e. In 

addition, all health and behavioral health. lega l, and social service professional should have training 

relaled 10 child abuse and neglect assessmenl and prevention. 

3. The Research Evidente to End Child Abuse Fata)ities Should be Strengthened 

National Association of Social Workers PageS 
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Additional research re~iews and research st\ldies are needed on topics such as' 

Reasons for undeHeporting of child abuse and neglect 

E.ploring and addressing the reasons that mandated reporters do not always report 

suspected abuse or neglect. 

InCfeasing understanding of the specific service and information eochange issues that niSI 

wilhin ~g"ndp, .nrl .un" .g"nri." IhM mighl r","1t in 1.1.lit,." .nrl Ih .. , lr.I"g'''' In 

ameliorate them. 

A comparative re~iew of state policies (regarding reporting responsibilities and abuse and 

neglect definitions); funding methods (which federal, state and private funds support the 

programs lor pre~ention and child protection services); and the variations in child abuse 

and neglect fatalitv data and how they are define.:l, gathered and reported. The outcome of 

this review will offer evidence on the potential linkages among these variables, and can 

identify factors that address the disparities In the number of reported child abuse deaths 

across states and potential prevention options. 

4. A National Commission to End Child Abuse and Neglect Deaths Should be Created 

A national commission to end child abuse and neglect fatalities should be created by Congress to 

uamlne the best of current child protection strategies. to address the comple.itles of gathering 

accurate and complete data regarding child abuse and neglect deaths and to make 

recommendations regarding a multi.faceted national strategy for stopping ma ltreatment deaths. 

The National Association of Social Wo rkers stands ready to wor. with Congress to address this epidemic 

of child abuse and neglect deaths and to address the critica l workforce issues facing child welfare 

agencies. The safety of our children and the well· being of the workers who every day work with our 

most aHisk children and families deserve no less. 

National Association of Social Workers Page 6 
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References 

Ale.ander, K. (2011, Ju ly 10). II C~y ee Anthony h~d been bl~ck, would you know her n~me? Washington 

posr. Retrieved from hlll!.lI ww.w~~hlng~o~t.com/Ol!inionl!jl ca~e.:.anthony had be · 

black.:.w o~ou.:know·her·name/201l/07l06l&lfJ.6nW23H prlnt.html. 

Blome, W., & Steib, S. (2009). How Can neglected organ ,ation~ serve neglected children? ProtecUng 

Children,24,1:9·19. 

Every Child Maller~ Educalion ~und. (2012). We Can Do 8eller. Retrieved from 

httpj /www.everychi dmatte~ org/s orag~l oc ment;lpAflreportsLcan rel!ort~gust2012 Ii 

~..!!f. 

Every Child MMte~ Education ~und . (201 1). The Growing Crisis In Child Protection. Retrieved Irom 

http://www.everychi dmatters org/storagMdocumentsjpdjjreports[crisis nchil~p otection.pdf. 

GAO. (2011). Child Maltreotment: Strengthening Nationol Data on Child Fatalities Could Aid in 

Prevention. Retrieved from httP..J/..,."ww.&;!o.g~new.i(emsjd 11599.p..!!f. 

Putnam·Hornstein, E. (2011). Report of maltreatment as a risk factor for Injury death: a prospective birth 

cohort study. Child Moltreatment, 16(3), 163·174. 

Sedlak, A.J .. Mettenburg.. J., Basena, M., Petta. I.. McPherson. K .• Greene, A .• and Li. S. (2010). Fourth 

Notionollncidence 5tudy o/Chlld Abuse and N"9lec! (NIS-4): Report to Congress. Washington. 

DC: U.S. Oepartment of Health and Human Services, Adm ni~tration for Child ren and Families. 

!!!!I!:Uwww ... cf.hhs.~~rams/owe/abuse neBlect/nall incid/nis4 report congress full p 

df j_n2010.pdf. 

Social Work Policy Institute. (2011). Supervision: The Safety Net for FronHine Child Welfare Practice. 

Retrieved from Ilttp://www.socialworkpolicy.org/wp-content/ul!loads/20lJj03/SWPIChildWe lfare-Supervision-Flnal-Report.pdf. 

U.S. Department of Health and Human Service,. Admini,tration lor Ch ildren and Familie~, 

Administration on Children. Youth and Families. Children's Bureau. (2012). Child Ma ltreatment 

201 1. Retrieved from http://www.aci.hhs.BOv/programs/cb/resource/chlld-maltrealment-2011 

Whitaker. T., Wei~miller. T., & Clark, £. (2006). ""suring the .ufficiency of. fro ntline workforce, A 

national study of licensed socia l workers. Exetutive summary. Washington. DC- National 

Association of Social Workers. Retrieved from 

httl!:ljworkforce.socialworkers.org,istudies/nasw 06 ecsummary ~. 

2aBorsky, J •• S<:hlesinBer. M. & Sege, R. (2010). What Happen, to Child Maltreatment When 

Unemployment Goes up? Presentation at the American Academy of Pediatrics Annual 

Conference, San Francisco. CA, Octo~r 3. 2010. 

National Associ~tion of Soda I Workers Page 7 
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Name: Rev. Stephanie Bingham Doss 

Date: Oeeembl-r 10,201 2 

Organi7.<ltion: Student at University of Southern California School of Social Work & 

Pastor at First Congregational Church ofTul~rc. United Church of Christ 

Please st .... the editorial that we submined to media sourc"'$ on December 5"" We would 

like this to be considered for the record regarding the hearing on the Protect o ur Kids Act 

scheduled for Decembu 12, 2012. 

Docs Every Child Malter? 

America. Ie!"s be honcs!. In our politieallandscape of elections. budgets, deadlines and 

compcting interests, children arc not the priority. Children can't make campaign contributions or 

VOIC but they are simply put, thc future. We havc an cthical and economic imperati,'c to protect 

them. When the day comes that the youngest in our society need to take up the reigns, will they 

be ready? Or will wc sec in our nation. legions of young peoplc damaged by years of abuse th31 

newr have much of a chance for the American Dream. Or even more tragically will some of the 

visionaries of our futnre never li\"e pasl the agc of 4 and die at the hands of a caretaker? Just 

imagine for a moment thc effeclthe tmgic death of a child has on a family. a community and the 

nation. 

According to a report put out by E,"cry Child Mallcrs Educ3lion Fund in Washington. 

DC, an cstimated 2 thousand children arc killed nationally each year by child abuse and neglect. 

Thcse dC3lhs arc sensclcss. tragic, and can be prevC11ted. Oc3lhs by child abuse are a mere 

fmction of the 3 million reported child abuse and neglect allegations each year in the Unitcd 

St3les. With early intcl"\'ention and education, many of these child abuse and ncglect rel3led 

deaths can be prevented. Additionally, with proper changes to regulations combined with 

coordination across states. impro"cmcnls can be made. [t is time to take a stand and support the 

future of our Nation by supporting The Protect our Kids Act (H.R. 3653 and S. 1984). Evl'ry 
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Child Mallers Edueation Fund. along with the Coalition to End Child Abuse Deaths. worked 

with Congress to author this bill. which calls for a national commission to study child abuse 

fatalities and to make rtx:ommcndations for our Nation'S child welfare system. 

The National Coalition to End Child Abuse Deaths (NCECAD) was formed out of 

ooncern about the increasing numocr of child abuse deaths across thc Nation. NCECAD is 

composed of representatives from the National Association of Social Workers. National District 

Anomeys Association. and National Children's Alliance. National Center for the Review and 

Prevcntion of Child Dcalhs. and Every Child Malters Education Fund. 

Last Dcccmber. The Protect our Kids Act of2011. also known as S. 1984 and H.R. 3653, 

was introduced to Congress. [t is supported by Senators Kerry (D-MA) and Collins (R-ME). 

along with Ranking Memocr Congressman Lloyd DoggC1t (D-TX) and Representative Joseph 

Crowley (D-NY). With the lack of funding and attention. grassroots action is critical in order for 

this bill to succeed. 

Child abuse and negkx:t ha\'c long-Ierm physical and emOlional consequences on the 

individual child, their tamilics, and the communities in which they li\'e. Studies of child abuse 

and neglcct show that abuse leads to problems in society such as poverty. crime. gang 

affiliations. low self-cst~-eIH. alcohol and drug usc. dropout rates. and teen pregnancics. 

Preventing child abuse before it starts through education and inlervention programs could reduce 

the amount of money spent by our government each year. Current statistics show that ehild 

abuse and neglect cost the nation appro.~imately 109. I billion dollars each year. Unfortunatcly. 

we also hold the highest ",te of death from child abuse in an industriali7.cd nation. 

As g",du8le students 8tthc University of Southern California. School of Social Work, in 

cooperalion with Every Child Mailers Education Fund. we ask for your action on this important 
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Dcar Ways and Means Con"nin~e 

My name is Sylvia Randolph I ha,'. a aachelor's degm: in Liberal studies (psychology, 

sociology, urban development). I am currently in school for my MA in Public Policy. I also have 

professional de"eiopmem credits from "" 'eral higher educational in,titutions. I h.ve a long professional 

wor~ history with experience in man.ging diffe ... nt components of the daily operating programs. 

My mOSI ... cent wor~ consisled of ... .., .... hing and analy~ ing women and child ... n issues in public 

policy with the National Organi:auion for Women. Areas such as social securily and weahh disparilies 

amongst women. additionally, health ea ... and educahon. as ..... ell as dOing some proj«1 managemen! lor 

the Nalional Women', Conference. I ha"e also be<:n inn""ntial in thc passing ofsevcrallegislative law, 

in the ,tate of Maryland around issue, of women children and familie, the past 2 years I have volunteered 

my lime with congressional legislators. Ihe GO"emor', Offic~ and community programs addressing issues 

in Maryland's foster care. reunification and adoption program 

I am currenlly working in the field ofGovemment Relations Public Policy On a sp«ial imerest 

projecl around women and children', familie,; family I ....... education. finance and health care. The 

currenl projecl addresses Ihe need of neW legi,lalion and policy Ihat ,uppons women and children in our 

coun systems specifically foster care and adoplion. At thi, time my research finds thaI although the 

federal g(wemment has legislation Ihal suppons Ihe family environment legal. sociologiul and financial 

stand point. many StateS ha"e failed to up hold and Or successfully implement them into their own State 

legislation. for example the education la ..... where the states are to assist children who are in foster care 

with some from higher educ.tion or carcerde"elopment .nd or training. Vet we find statistically thaI 

children are aging out of the system unskilled and unemployed where homeless""s, becom~s Iheir factor 

oflik 

My question atlhe onset of my rcscareh looked at the dichotomy between federal and sta1e 

legislation. I purpOsed my posilion on tnc maner tnat federal law Should be and take precedence in the 

devdopment or writing of,lale la ...... and that Ihere is no room for subjection or juxlaposing the federal 

legislation in order for Ihe SlalCS purpOse and goals via il's courts and judicial setting. Second I ha"e 

found the relationship betwecn Ihe legal judicial and departments are lading in the inclusive and cOncrete 

practices. Although the language and the meaning provided by the federal government substantiate the 

practices in Ihe couns we find thaI the lawyers and the dopanmenl, are far reached in the area. 

I looked over the pasl }'cars academic syllabus Ihe Children Ad"ocacy Program (CAP) is perfect 

the courn:. as well as Ihe guest speakcrs addressed the areaS ofm)' projC\:t m()s1 specifically how do we 

begin to address thc needed changcs in the legislati"e "enue of the child advocacy and what that should 

look like for purpose of the won;ing in the field. 

I would like 10 ofTer Hal"\'ard's CAP program the chance 10 know face to face what law looks like 

in ",Ialion 10 ,,·omen. chBd",n and families. In doing so, knowing the importance and relevance in 

eonsideralion oflegislal;>'e la ..... and how thaI not onl), afTecls the families butlhe system as a whole. 

Under.llanding the difTerencc between the family law procedural mandates '"s. the Depanments agenda 

and how the judicial system is the so 10 speak moderator of the combined. I would like 10 ofTer the 

program a case study Ihat will give examples of how often times many i .. ues that arrive through the 

syS1ematk daily operalions are often lell out or ignored. Ihat families are lell in Ihe system for the 

modcnuors 10 Ihen sel d~cisions o,'er. We will find thaI in Ihe WOTSI case of all scenarios childrc:n are 

dying atlhe hands oflhc syslem. The day Oflhe O''CI'''·on.:ed case won.:ers are gone amended legislalion 

and new reponing systems ha"e addressed Ihat yet we slill today find this as a major issue. More children 

than e,'cr are suffering as I result ofa failed systcm. Lawyers are al the \\'ill of stated depanmcnts; Ihere 

only justification for rep ... sentation i. to follow what in lhe best interest of the system ralherthan thc 

child or family. 
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