!,

U.S. DEPARTMENT OF HEALTH AND HUmAN SERVICES

Office Of Human Development Sewices ..=y3hds

Administration for Children, Youth and Families

Children’s Bureau

uman

development

National Center on Child Abuse and Neglect services

STUDY FINDINGS

National Study of the Incidence

and Severity of Child Abuse and Neglect

. . .. .

.:
Acknowledgments

The National Incidence Study was designed and implemented by Westat, Inc, and Development Associates, Inc.,

under the s~nsorship and direction of the National Center on Child Abuse and Neglect (NCCAN). At NCCAN,

David Sears, Joseph Wecbsler and Douglas Besharov guided the development of the study design and provided

administrative oversight and technical assistance to the contractors. Contractor sta~ and consultants who contributed

to the study are listed below.

This study would not have been possible without the s“p~rt of a great many organizations and i“divid”als. The study

team is particularly indebted to the staff of the National Study of Child Neglect and Abuse Reporting at the Children’s

Division of tbe American Humane Association, whose assistance and advice were helpful in many ways. We also wish

to acknowledge the following groups, whose endorsements oWned many doors for the study: the Council of Chief State

School Officers, tbe National Education Association, tbe Education Commission of the States, tbe American Association Of School Administrators, the America” Nurses AsswiatiOn, the American p“b]i~ Welfare A~~~iatiOn, the

American Association of Psychiatric Services for Children, the American Bar Association, and the American Hospital

Association.

Finally, and most importantly, we wish to thank the hundreds of individual caseworkers, teachers, police officers, and

other professionals in tbe study counties who contributed so much of their time in the eKort to bring greater attention

and awareness to the serious problems of child abuse and neglect.

Key Project Stafl and Consultants

Westat Development Associates

Corporate Oficer-in-Charge Corporate O@cer-in-Charge

D. Krug P. Davis

Project Directors Project Direc[ors

C. Eldred (Phase I); T. Walsh (Phase I);

K. Burgdorf (Phase 2) E. Taylor, R. Cardenas,

T. Romasbko (Phase 2)

Assistant Project Directors

C. Sosdian, S. Dickey-Darby, Assistanf Projecz Directors

S. Rogers, G. Rush J. Willette, L. Johnston

Data Preparation, Assessment

M. Usher, J. Southard-Buryk,

C. Prusinowski, M. Weinstein

Advisors: Methodology

J. Waksberg, J. Edmonds,

T. McKenna, E. Bryant

Computer Processing

J. Escatell, R. Craig

Manuscript Preparation

A. Mayn, J. SorrelIs,

S. Hadley

Consultants

T. Wmlsey, D. Broadburst,

R. Devine, M. D., L, King

Sfafe Directors

R, Anderson, J. Faulkner,

L. Johnston, L, Mancini,

M. Muzzio, L. Radigan,

P. Sanz, M, Scott,

B. Wardlaw, P. Vasquez

CPS Coordinators

M. Keal, V. Keeton,

D. Krings, C. Malone,

A. Nees, L. Plowden,

L, Radigan, P. Ross,

C. Seltzer, B. Wunderlicb

CPS Research Assisfanfs

B. Nobles, S. Rusbton,

E. Drew, H. Mordy,

M, Edgerton, M. Miller,

W, Foster, P, Kennedy,

K. Render, A, Barrett,

J. Sowers
U.S. DmP.m,wB., o, “nAL,” .“. ““MAN SERVICE=

Off,,. 0, ““”.” ..vel.,me”, Sew,.,,

Adm!.i,,,,,io. ,., cm’,,,.”, ,.”,,.., F..’,’.,

CM,,,.., B“,...

h&

~~:ome”,

Na!’o”al Ce.,.r o“chlldAb.,ea”d ..,,,., SOW*,

STUDY FINDINGS

National Study of the Incidence

and Severity of Child Abuse and Neglect

This report was made possible by Contract No. HEW-105-76-1137 from the National Center on Child Abuse

and Neglect, Children’s Bureau, Administration for Children, Youth and Families, Office of Human Development

Services, U.S. Department of Health and Human Services.

DHHS Publication No. (OHDS) 81-30325

Issued September 198I
Table of Contents

Chapter

1

2

3

4

5

6

7

Appendix

A

B

Table

2-1

2-2

3-1

3-2

Reported and Total Incidence of Recognized Maltreatment.

CPSReporting and Substant~tion . . . . . . . . . . . . . . . . . . . . .

Non-CPS and Combined Findings.. . . . . . . . . . . . . . . . .

Subpopulation Incidence Estimates..

Characteristics of Maltreat4 Children and Their Famines.. . . . . . . . . . . . . . . .

Demographics of Recognition and Reporting. . . . . . . . . . . . . . . . . . .

Who Sees What? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Much is Reported? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wbat is Reported? .,, , . ...,,..., . . . . . . . . . . . . . . . .

Wbois Re~rted?, , . .,, ...,,.... . . . . . . . . . . . . . . . . .

Data Forms for Child Protective %rvice Agencies . . . . . . . . . . . . . . . . . . . . . . . .

Guideline and Data Form for Non-CPS Respondents . . . . . . . . . . . . . . . . . . . . . . .

Ust of Tables

Results of CPS data collection in sampled counties, by type of county. . . . . . .

Participation data for non.CPS agencies encompassed by study design . . . . . . . . . . . . . . . . . . . .

Reports of suspected child abuse and neglect received by Child Protective Service agencies from

May 1, 1979 to April 30, 1980: National estimates bytyW of county . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of family reprts to CPS and ~rcent substantiated, by source of reprt:

National estimates of reports to CPS agencies, May 1, 1979 to April 30, 1980 . . . . . . . . . . .

Page

1

1

1

2

3

6

7

7

9

11

11

14

18

22

33

33

34

35

37

39

39

41

42

43

45

51

Page

6

8

11

13

111
Table of Contents (Continued)

fist of Tables (Continued)

Table

3-3

3-4

3-5

3-6

4-1

4-2

4-3

5-1

5-2

5-3

5-4

5-5

6-1

6-2

6-3

6-4

Primary reason report not substantiated by CPS, by source of reprt: National estimate of number

and ~rcent of family-level re~rts not substantiated by CPS agencies. .,

National estimates of annual number of suspected maltreatment victims identifiable from non-CPS

agencies, bytype of agency, ,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results of study assessment of children substantiated by CPS and of addition;d suspected children

identifiable from other study agencies Percentage distribution . . . . . . . . . . .

Computation of national incidence estimates, by level of recognition . . . . . . . ., . . . . . . . . .,

National incidence estimates by major form of maltreatment and by severity of maltreatment-related injury or impairment: Estimated number of recognized in-scope children per 1,000 Wr

year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National incidence estimates by selected child characteristics: Estimated number of recognized

in-scope chiidrenpr1,000psr year. ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National incidence estimates by selected household geographic characteristics: Estimated number

ofrecognized in-sco~cbildrenpcr 1,000 ~r year....,,,,,,...,,,, . . . . . . . . . . . . . . . . . . . . . . . .

Estimated number of recognized in-scow children and severity percentage distribution by major

form andsubcategory of maltreatment .,....., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Severity of maltreatment related injury or impairment by form of maltreatnlent and age of child:

Estimated ~rcentage distribution by severity category. . . . . . ., . . . . . . . . . . .

Form of maltreatment by child demographic characteristics: Percent of estimated total number of

in-sco~maltreatedcbddren, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of maltreatment by selected household demographic characteristics: Percent of estimated total

number ofln-scope maltreated chddren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of maltreatment by involved adult characteristics: Percent of estimated total number of

ur.scope maltreated chddren. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of maltreatment by source of information to CPS and/or study Percent of estimated number

ofrecognized in-scops children, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rate of reporting to CPS by source: Estimated annual number of recognized in-scope children and

proportion reported to CPS, by source of information to CPS and/or study. ., ., . . . . . . . . . . . .

Level of recognition by form and severity of maltreatment: Percent of estimated number of recognized

in-scop children, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Selected cbaractersitics of all U.S. children, all alleged CA/N victims reprted to CPS, and all recognized in-scope children by level of recognition: Estimated percentage distribution . . . . . . .

Page

14

15

16

16

18

20

21

23

25

27

30

31

33

34

36

37

iv
Table of Contents (Continued)

List of figures

Eeure Page

:

2

3

4

5

6

7

8

Level ofrecognition ofchild abuse and neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Re~rted and substantiated incidence rates hy sample county Unduplicated numbers of alleged and

substantiated victims reprted to CPS pcr 1,000 children in wunty . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Composition of the iceberg Estimated number of in-scow children ~r year at recognition Levels

1-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National estimates of the incidence of recognized maltreatment by selected child and household

characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age by sex incidence rates for major forms of in-sco~ child abuse and neglect. . . . . . . . . . . . . . . . . .

National incidence estimates for White and Nonwhite children by annual family income and form of

maltreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

In-scope children reported to and substantiated by CPS agencies. . . . . . . . . . . . . . . . . . . .

Sources ofreports ofin-scope childrento study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i

12

17

19

26

28

40

41
1. Introduction

Overview of Report

This reprt presents an analysis of data from the National Study of the Incidence and Severity of Child Abuse

and Neglect. The report is written for professionals in the

field, and the emphasis is upon findings, rather than methods or policy implications,

This introductory chapter presents a brief historical

pers~ctive and overview of the study objectives and definitions. Chapter 2 summarizes the study’s data collection and data analysis methodology.’ Chapter 3

presents estimates of the numbers and kinds of cases reported to Child Protective Sewices (CPS) agencies, of the

numbers of additional children identifiable from other

community agencies, and of the overall measured incidence of abuse/neglect. In Chapter 4, incidence estimates

are computed for the major categories of child maltreatment and for various demographic sub~pulations.

Chapter 5 summarizes tbe study’s definitional requirements for tbe specific forms and subcategories of maltreatment and describes the children identified as meeting

these requirements. Chapter 6 examines demographic

factors assmiated with tbe recognition and reporting of

child maltreatment. Finally, Chapter 7 presents a brief

summary of the findings,

This report highlights major study findings with res~ct

to the above topics. A series of more detailed reprts

fwusing on specific policy and research issues is planned.

Historical Background

Widespread public concern about tbe problems of child

abuse and neglect is largely a phenomenon of the 197WS.

Organizations such as the Smiety for the Prevention of

Cruelty to Children, the Children’s Division of tbe American Humane Ass~iation, tbe Child Welfare League of

America, and others have been active in the field for many

years, and Federal involvement dates from 1935, when

the Smial Security Act first provided funding of public

welfare services “for tbe protection and care of homeless,

dependent and neglected children and children in danger

of becoming delinquents.”2 It was not until the mid196WS, however, that the first state laws were enacted

Additional information about data collection prmedures. definitions,

sample design, and statistical estimation prmed”res is contained in a

xparatc Nalionol IncidenceS1udy Methodology rewrl, which is

available .Pn request from the National Center on Child Abuse and

Neglect (NCCAN Cleatingbous., P.0, Box 1182. Washington, D.C.

20013).

‘ Child Welfare Slraf.gy in !he Coming Yeors, U.S. Children’s Bu197S, DHEW Publication No, (DHDS) 78-30158, p. 5.

mandating reprting to public agencies of suspected cases

of child abuse and neglect and offering re~rters protection from retaliatory litigation (e.g., slander suits, suits

alleging breach of confidentiality). Between 1963 and

1966, 49 states enacted such reporting laws.]

In large measure, tbe impetus for Ibis initial surge of

legislation was provided by the work of Kemp and his

associates at the Colorado General Hospital, who coined

the term “battered child syndrome” in the early 196~s

and effectively called public attention to tbe problem of

severe physical abuse of children.’ The reporting statutes

enacted during the 196WSvaried from state to state, but

generally focused on removal of legal obstacles to reFrting of “battered children” by medical professionals. In

most states, the statutes were not highly publicized at first

and did not stimulate high levels of reporting.

In 1970, the Florida Department of Social Services

compiled 17 repurts of suspected child abuse or neglect.

Tbe following year, the department instituted and widely

publicized a statewide toll-free “hot line” for reprting of

suspected cases. In its first year of operation, the hot line

received 19,120 reports, far more than the Department

expected or was prepared to handles This dramatic experience did much to awaken public concern and to raise

questions botb about the “true” magnitude of the problems of child abuse and neglect in the United States and

about the adequacy of existing mechanisms for the identification and protection of abused and neglected children.

A series of hearings on these subjects, held by the Senate Subcommittee on Children and Youth in 1973, resulted in the passage of P.L. 93-247, the Child Abuse

Prevention and Treatment Act, which was signed into law

in early 1914.’ The Act created a National Center on

Child Abuse and Neglect (NCCAN ) to suppDrt state and

Imal efforts for the prevention and treatment of child

abuse and neglect. The Act also instructed NCCAN to

“make a full and complete study and investigation of the

national incidence of child abuse and neglect .“ (Section 2(b)(6)).

Immediately upon its creation, NCCAN began work

on the formulation of a model state Child Protection Act

to define child abuse and child neglect, specify how, when,

from whom and to whom reports of suspcted abuse or

neglect should be made, and detail the actions to be taken

‘ S.ssman, A. and Cohen, S.. Reporting Child Abuse .nd Neglect:

Guidelines for L.gisl.(ion, Ballin g.. Cambridge, Mass., 1975.

“ Kemw, C, H., Silverman, F.N., Steele, B.F,. Drwgcm.eller, W. and

Silver, H. K.. Tbc baltercd-child syndrome. J.A.M.A., 181, 1.1962.

17-24.

‘Sussman.A. and Cohen, S., Op. cir., 1975.

“ Child Abuse Pre.enrion ..d T,e.rmenr ACI, /973, S, / !9/, P.,ls I

.nd 2. U.S. Consress, Senate Committee on Labor and Public Welfare, Subcommittee o“ Children and Youth, 93rd Congress, March

26, 21, 31, April 24, Washington, D.C.: U.S. Governmc”t Printing

Office. 1973. The Act was subsequently amended in 1978.

1
upon receipt of such reports. An initial draft of the

NCCAN “Model Act” was completed in 1976 and—

based opon inputs from the field-it was updated in

1977,7 Key features of the Model Act are that it authorizes reporting of suspected child abuse or child neglect

by “any person” and requires such reporting by a wide

range of law enforcement, medical, mental health, educational and child care professional it specifies that reprts are to be made to the state Department of Social

Services (DSS) and/or the Child Protective Services division of the Ioual DSS (Welfare Department).

In 1976, when the initial draft of the Model Child

Protection Act was completed, NCCAN awarded a contract for the design and implementation of a national

study of the incidence and severity of child abuse and

neglect,’ After two years of design a“d pretest work, the

Natinnal Incidence Study was conducted in 1979-1980.

The study results are the subject of this report.

As work on the formulation of tbe National Incidence

Study went forward, NCCAN continued its efTorts to

support modernization and standardization of state child

protective service programs and reporting statutes. Since

1976, most states have updated their reporting laws to

incorporate some or all of the provisions of the Model

Act. All SOstates now have laws mandating the reporting

of suspected child abuse or neglect. In most states, reports

are to be made to the Child Protective Service division of

tbe state and/or local Department of Social Services, In

some states, reports may also be made to other designated

agencies such as the juvenile court, the local police de-

‘M“dtl Child P,”!ectio” AtI with C“”tme”t.,y, draft, U.S. Dcpdrtment of Health, Education and Welfare. Childrcn,s B“rea.,

NCCAN. 1911.

xThis had been preceded by the conduct of a feasibility sl”dy in 1975,

partment or the public health department,9

Another major development since 1976 was the establishment of an ongoing National Study on Child Neglect

and Abuse Reporting. Oprated by the Children’s Division of the American Humane Association, this project

collects and analyzes statistical information from all 50

states about reports of suspected child abuse and neglect

received by Child Protective Services agencies. Findings

from the national reporting study indicate that, with

growing public awareness of the problems of abuse and

neglect and trends toward broadening and publicizing of

report laws, reporting has increased substantially in recent years, In 1976, the first year for which data from all

50 states were available, 416,033 reports were documented; by 1979, the number had jumped to 711,142, an

aPParent increase 0f71 perc~:nt over a three year period. ]o

Objectives of National [ncidence Study

The design of the Natior]al Incidence Study was derived from a simple conceptl]al model, shown in Figure 1.

The premise is that, although substantial numbers of

abused and neglected children are recognized as such and

are reported to the state and/or local Child Protective

Services (CPS) agency, reported children (Level I in the

model) revresent onlv “the top of the iceberg, ”

—’

‘ Child Ab”.ve o“d Neglec(: Slot, Rcpo,,inE Lawx, National Cemer .“

Child Abuse and Neglect, 1980, DH HS Publication No, (OH DS)

80-30265.

‘“ Nario”ol A“olysi~ of Oficiol Cbi/d Neglect .“d Abuse ReWrti.g

(/978), N.tio”al Center.. Child Abux and NeElect. 1980, DHHS

Publication No. (OH DS) SO-3027 1: se. also Na,ionol A“./ysi$ “f

Ofici.1 Child NeglecI ond Abuse Reporling (1979), National Center

o“ Child Abuse and Neslcc(. 1981, i“ press,

figure 1. Level of recognition of child abuae and neglect. “

Level l—Known to CPS

Level 2—Known to other

Level 3—Known to professionals

In schools, hospitals and other

i

t

b Level 4—Known to other

\ —-—— _— —__ ___ ___

Level 5—Known to no one

2
The model assumes that additional children are known

to other “investigatory” agencies such as ~lice and public health departments, courts and corrections agencies,

and the like (Level 2). The mandate of Child Protective

Services to deal with abused and neglected children is

comparatively new and may overlap or even conflict with

these other agencies’ mandates to deal with related problems, such as felonious assault, homicide, delinquency,

dependency, domestic disputes, “children in need of control,” or nutrition and hygiene problems. Unresolved or

disputed questions of definition and responsibility could

be among the major reasons additional abused and neglected children would be found at this second level, Such

children would be “officially known,” in a sense, but they

would not necessarily be viewed as abused/neglected and

they would not necessarily he receiving assistance for

their abuse fneglect problems.

At the next level (Level 3) are abused and neglected

children who are not known to CPS or to any Level 2

agencies but who are known to professionals in other

major community institutions schwls, hospitals, and social service and mental health agencies. Such children

could remain “hidden” at this level for many reasons.

Definitional ambiguities could be involved in some cases,

as at the previous level. Even when a problem is clearly

recognized as abuse or neglect, it might not be reported to

CPS for any number of reasons: the professional who

knows about the situation may feel that be or sbe is in the

best psition to help, may not trust CPS to handle the

problem appropriately, may have apprehensions about

becoming involved in an .’official” investigation, etc.

At Level 4 are abused and neglected children who have

not come to the attention of any of the above agencies but

whose problems are recognized by someone: the child, the

perpetrator, another member of the family, i neighbor, or

someone else.

Finally, no doubt there are some children who are

abused or neglected but are not recognized as such by

anyone (Level 5). The parent may not realize the abusive

or negligent nature of his or her behavioc the child may

not either (e.g., an infant), and no one else may have

observed the situation.

This level of recognition mtiel points up some of the

difficulties in attempting to measure the “true” incidence

of child abuse and neglect. Level 5 is esWciaOy elusive.

Obviously, it would be very difficult to document occurrences which are not known to anyone. Identification of

Level 4 children would be only slightly less difficult. In

principle, one could identify such children through surveys of parents, children, and/or neighbors, Several sur.

veys of this kind have been conducted, but usually on a

small scale and only with reference to physical abuse. 1’11

,,Gi1, D,, violence.E.ins, Children: Physical Child Ab.5. i. (h.

Unired Sr.I.s, Harvard University Press Cambridge. Mass.. 1970.

“ Gclles, R.J., The Violenl Home: A Study of Physical Aggression

bcrween Husband., and Wivc$, Sage Beverley Hills, Calif., 1974.

Telephone and in-person self-report surveys of parents

were given serious consideration during early stages of

the National Incidence Study and, in fact, were pretested,

Ultimately, such approaches were abandoned because of

concerns about the reliability and validity of self-reprt

data, particularly in the areas of sexual and emotional

abuse and in all areas of neglect,

After concluding that it was not feasible to collect reliable information about Level 4 or Level 5 children, the

National Incidence Study fmused on Levels 1, 2, and 3.

In a probability sample of 26 counties across the nation,

the study assembled information about the numbers and

characteristics of abused and neglected children who

were known to CPS, to other investigatory agencies or to

professionals in other major community institutions

which come into contact with children, The primary study

objectives were to obtain a more comprehensive picture of

the extent and character of recognized child abuse and

neglect than is achievable from official report statistics

alone and to examine how and how well the official re~rting system is working.

A secondary objective was to obtain a more precise

understanding of officially reported cases than is pssible

from aggregation of data collected by the 50 individual

states. Although great strides have been made in improving the standardization and quality of state-o~rated

information systems in recent years, significant questions

and problems remain when state-reported data are aggregated. For example, interpreting national statistics about

number of reports to CPS is complicated by the fact that,

in counting “reports,” some states count families while

others count individual children. Usually, the extent or

duplication is unknown (e.g., Do 20 reports represent 20

ditTerent children, or are some individuals being refmtied

and counted more than once? ) as is the completeness of

the data (e.g., Are all reprts included, or are some being

lost along the way?). Definitional and procedural

differences among the states further complicate interpretation of state-collected CPS statistics. Thus, collection of standardized data about official (CPS) reports

was a secondary, but important, objective of the National

Incidence Study.

Study Definitions

a. Definition of Child Maltreatment

The terms child abuse and child neglect cover a lot of

territory. Abuse/neglect is not one problem, or even two;

rather, it is a multitude of problems which can recur in

the day-to-day interactions between a child and the adults

responsible for his or her care. These problems shade

imperceptibly into one another (for example, sexual

abuse usually has elements of physical and emotional

abuse as well) and into other kinds of s~ial and family

problems—poverty, alcoholism, teenaged parenthd,

spuuse abuse, drug abuse, etc. Moreover, there is no clear

line of demarcation between “normaP’ or “acceptable”

3
child rearing practices and those which are “abusive” or

“neglectful.” “Spare the rod and spoil the child is a

time-honored precept in our swiety, and corpral punishment is accepted as a “normal” practice. Physical

abuse is not. Yet, where dms the one leave ofl and the

other begin? Such “threshold” questions can be asked in

every area of child abuse and neglect,

As noted earlier, widespread concern about child abuse

and child neglect problems is a comparatively recent development, and consensus has yet to be reached as to the

specific meanings of these terms. ]3To a very considerable

extent, state legislatures have left it up to professionals in

the field to interpret specifically what constitutes “abuse”

or “neglect.” For example, the reporting statutes in several states define “neglected child” as “a child who is

without proper parental care because of the faults or

habits of his parent, guardian, or other custodian. ,“

“Pro~r” care and parental “faults” are not defined in the

statutes.

In designing the National Incidence Study, it was considered imWrative that opratimral definitions be established to specify as clearly and objectively as pssible the

kinds of problem situations which wO”ld or would “Ot be

encompassed. The definitions ultimately developed for

the study are in some ways similar to those in tbe

NCCAN Mtiel Child Protection Act. Like those in the

Model Act, the study definitions focus on the acts or

omissions of tbe child’s parents or other adult caretakers

and on the harmful effects of those acts/omissions on the

child’s health or development. The general study definition was:

A child maltreatment situation is one where, through

purpasive acts or marked inattention to the child’s

basic needs, behavibr of a parent/s”bstit”te or Other

adult caretaker caused foreseeable and avoidable injury or impairment to a child or materially contributed to unreasonable prolongation or worsening

of an existing injury or impairment,

In implementing the general study definition, seven

more specific criteria were established, all of which would

have to be met in order for a child to be considered within

the scope of this study:

a. Age of chi/d: child was live-born 14and under 18

years of age at the time of the harm-causing acts or

omissions.

b. Residence ofchi/d: child lived in one of the 26 study

counties at some time during the ~rid May 1, 1979

“ This is not to imply thal consensus is in the offing. Recent research

indicates that diflere”t professional groups maintain widely varying

Frceptions concerning the ti”ds and degrees of pcohlcms which co.-

stit”te ,$child abuse>,and ..child neglect., >%e. for example, Gtova”-

noni, J.M. a“d kcerra, R.. Defi”i”E Child Abu.e, Free Press N. Y.,

1979,

‘“ Co”ge”italdrug dewndencc and other problems resulting from

actsfomissio”s d.ring preg”a”cy or delivery were exl.ded,

to April 30, 1980.

c. Custody status of cfri/d; child was a noninstitutionalized de~ndent of parent(s) /substitute(s) at the time of the harm-causing acts or

missions.

d. Time of occurrence: h:lrm-causing acts or omissions

occurred during the (four or twelve month) study

period which applied for the respondent agency.

e. Person responsible for maltreatment: a parent, parent substitute or other adult caretaker was

responsible for the harm-causing acts/omission$

maltreatment by other persons (e.g., a sibling, a

neighbor) or developmentally maladaptive behavior

by the child (e.g., habitual truancy, delinquency,

prostitution ) was in-scow only if knowingly permitted by a parent/substitute.

f. Nalure of maltreatment acls ar omissions: the occurrence or prolongation of injury/impairment was

a foreseeable consequence of purposive (nonaccidental ) acts or of marked inattention to the

chil~s basic needs.

g. Efleci of maltreatment: there must be reasonable

cause to believe that maltreatment acts/omissimrs

during the study period caused or materially cmrtributed to the occurrence or unreasonable prolongation of some actual injury or impairment

depending upon the form of maltreatment, the

injury/impairment must be of “mtierate” or “seriious” severity, at minimum.

The last two criteria were further elaborated to detail

the particular kinds of acts/omissions and the particular

harm “thresholds” required for 2 I sWcific forms of maltreatment. These category by-category requirements are

summarized on pages one and two of the guidelines to

study respondents, shown in Appendix B. The study’s

definitional requirements {ire discussed further in Chapter 5 of this report.

The study definitions encompass a wide range of maltreatment situations, inchlding some areas which have

only recently become incorporated in state reparting laws.

Thus, in addition to the traditional areas of physical and

sexual abuse and physical neglect, the study definitions

encompass problems in the areas of educational neglect

and emotional abuse/neglect. In this respect, the study

definitions are consistent with the NCCAN Model Act

and with many of the ne\ver state reporting statutes. In

many other respects, however, the study definitions are

extremely narrow and conservative, excluding many

kinds of problem situations for which protective or other

services might be appropriate. Among them:

. Institutional abuse or institutional neglect,

● Any physical or sexual assault (e.g., by pers, siblings, strangers) in which an in-home parent or other

adult caretaker was not directly implicated.

4
● Parent or other caretaker behavior which, however

inappropriate, inadequate, or dangerous, did not apWar to have caused or prolonged any particular injury or impairment during the study pried. The

study did not deal with situations where a childs

health or safety was endangered through abusive or

neglectful treatment, only ones where injuries had

actually occurred from such treatment.

. Any problem, hazard, or injury which the parent/

substitute lacked the financial means to prevent m

alleviate and for which appropriate assistance was

not available through public agencies.

. Lack of care resulting from parent/substitute death,

hospitalization, incarceration or other circumstances making it physically impossible to provide—

or arrange for—adequate care.

b. Definition and Measurement of Incidence

Tbe study defined incidence of maltreatment as the

annual number of children (per 1,000 children in the

U.S. ) who exwrience in-scow maltreatment. The key

elements of this definition are:

● The incidence estimate was based on an estimate of

the number of children who met tbe study requirements in one or more maltreatment categories. The

study did not attempt to “count” families, incidents,

or reports. The ultimate “count” was of childrew

how many diflerent children met the study requirements in at least one category of maltreatment?

● The time parameter was a 12-month period,

specifically, May 1, 1979 to April 30, 1980. During

that time, many diflerent incidents of several

ditTerent forms of maltreatment may have occurred,

hut any particular child would be “counted” only

once in any particular incidence estimate.

. Incidence was expressed as a rate, the denominator

of which was an estimate of the number of children

under 18 in the nation, in thousands. For example,

the denominator in the estimated incidence of maltreatment for the 15-17 age group was an estimate

of the total number of 15–17 year olds (in thousands) in the United States.’s

“Unless stated otherwise, denominator estimates were derived from

Census Bureau Wp.lation estimates contained in Sfafi$lical Abst,ocl

“f {he United Sr.Its: /979 (U.S. Bureau of the Census, Washington,

1979) a“d are tstimate$ for or projections to 1979.
2. Methodology

Selection of County Sample

The National Incidence Study was conducted in a stratified random sample of 26 counties clustered within 10

states: Arizona, California, Georgia, Illinois, Kansas,

Missouri, New Hampshire, New YOrk, Ohio, a“d SO”th

Carolina:

Overall, the sample contained:

. Ten “urban” counties—located in one of (he 277

Standard Metropolitan Statistical Areas (SMSA’S)

in the nation and containing the central city of the

SMSA. These 10counties ranged ic population from

90,000 to 1,600,000 and averaged 426,000.

● SiX “suburban” counties—l~ated in ~ SMSA b“t

not containing tbe central city (example: DuPage,

IL, a suburb of Chiuago), These counties ranged

from 90,000 to 550,000 in population, averaging

280,000.

● Ten “rural” counties—not located in SMSA’S, with

populations ranging from 7,000 to 85,000 and averaging 33,000.

Each sample county had a known probability of selection, which provided the basis for comp”ti”g national

estimates.

Data Collection Procedures

Data collection procedures in CPS agencies were quite

diflerent from those i“ other (“o”.cps) ~gencie~,~Sde.

scribed below,

a. CPS Data Collection

The study design called for completion of a “familyIevel” data form’ for each reWrt nf sus~cted child abuse

nr child neglect received by the county Child Protective

Services (CPS) agency between May 1, 1979 and April

30, 1980, excluding reports immediately referred to nther

agencies or otherwise scref:ned nut with no attempt at

investigation. As a quality control device, reperts were

recorded on a s~cial study Ing as they came into each

local CPS office, and completed data forms were checked

off against tbe log as they were received,z

Two CPS data forms were used, a “long form” containing all information needed for statistical analysis and a

“short form” containing only enough information to prmit identification of “duplicates,” situations where a particular child was reported more than once during the

study. [n counties where the expected total number of

repnrts over the 12-month data collection prind was less

than 200, long forms were used for all reports. In the 16

larger counties, long forms were used for all reports involving fatalities or sus~cted sexual abuse and for a random sample of the remaining reports.] Short forms were

used to describe all other re~rts,

To assure maximum quality control and minimize what

otherwise would have been an enormous res~nse burden

for agency personnel, the researchers prnvided each state

with a CPS Coordinator to assist the local CPS nffices.

‘ The CPS forms requested information abut the familyandak”t all

childrenin the rainilywhoweres“s~cted (.,ailc~e~) bylhe so”r~

.f the rcprl 10halvehten ab),sedor neglected—seeApwndixA.

‘Thestudylogwasmaintainedbystudystafl,frominformationco”.

Pdinedinasencyintakelogsorrecords.Iftheascncydidnotnormally

mainvainsucha 1.s,.ne wasestablishedforthed.rati.” ofthestudy.

‘S*mplingprxed.rcs in large counties were desisncd to obtain

sufficient iorormatio” for sed[in ical analysis whilered”ci”sthe CC.

swnseburdena“d prmessins..s1slhal wouldhavewc”rrcd ifIons

formshad bee”obtainedfor allreprts.

Table 2-1. Results of CPS data collection in sampled counties, by type of county

Statistic

Type of county

Urban Suburban Rural Totel

1. No. counties In sample 10 6 10

2. No. reports of suspected abu%lnegl~t received

26

by CPe agencies May 1, 1979 to April 30, 1960,

from report log 13,711 2,833 1,356

No. completed data forms obtained:

17,900

3. Long forms 3,307 1,235 1,030 5,572

4. ehon forms 10,161 1,596 316 12,073

5. Total 13,46e 2,631 1,346

6. Completion rate (line 5- line 2)

17,645

96,2% 99,98A 99.3% 98.6Y.

7. Average effective sampling rate (line 3 + line 2) 24.l% 43.6% 76.00h 31.lY.

6
The level of assistance and the s~cific res~nsibilities of

the CPS Cmrdinator varied, depnding on the needs and

circumstances of the individual CPS offices. Typically,

the Cmrdinator maintained the study report log, identified reWrts for which a long form was needed, assisted in

the preparation and transmittal of data forms, and

followed-up on home office inquiries concerning data

forms with incomplete or inconsistent information.

Table 2- I summarizes the results of the CPS data

collection. A total of 17,900 reports of susWcted

abuse/neglect were Iogged during the study year by the

26 CPS agencies, and completed data forms were obtained for 17,6450 ftbem(98.6 Wrcent). For23 counties,

the completion rate was over 99 Wrcent; completion rates

for the remaining three counties were 87 ~rcent, 89 prcent, and 97 ~rcent.

The sampling prmedures used in tbe various counties

produced a total of 5,572 long forms for statistical analysis, These forms represent anoverall average of31 percent of the reports received by the CPS agencies in the

study counties.

b. Non-CPS Data Collection

In addition to CPS caseworkers, professional stafl in an

average of 20 other agencies per county were asked to

participate in the study.4 These non-CPS agencies were of

two general types other agencies which may have statutory authority for investigation or treatment of

situations involving child abuse or neglect, and other institutions and agencies whose staff may encounter abused

or neglected children. Agencies in the former category

(“other investigatory agencies” ) included:

. The county juvenile probation department, juvenile

court, or equivalent agency (one percountyk

. The county sberi~s department or county police department (one per county);

. Local police departments serving cities/towns of

5,000 or more population (all such departments, except in three large counties where samples of 4-5

departments were drawnk

. The office of the county coroner or medical examiner

(one per countyk and

● The county public health department (one per

county, if thought likely to encounter ~rtincnt

cases).

“ The number of “0”.CPS agcncics was derived from budgetary consid.

crations, The kinds ofnon-CPSagencics incl”dcdinth. study was

determi”cd Iurgely on the basis of findin~s from the study’s pretest,

which encompassed a m“cb wider range of professionals and agencies.

Agcncieswhicb con~ributcd relatively largenumbersofunre~rtcd

cases in the pretest (e.g., public schwls, hmpitals, mental health

agencies )wercselectcd inprefercnce tooncswhicb contributed few.,

cases (e.g., private schwls, dayc.re and preschml programs). Some

agencies which could b. accommtiated at relatively slight incremental cost (such as coroner’s “nd sheri~s departments, since

tberc is only one of each in anygivcn county) were included. even

though they had not contributed many casesin thepr.test.

Agencies in the latter category (“other study agen.

ties”) included:

.Public schools (a random sample of 10 schools in

most countieq 24 in each of the two largest

counties);

● Short-stay general hospitals located within the

county (all such hsopitals, except in one large county

where a sample of 13 was drawn~ and

. Asmallnumber ofmental health facilities and other

social service agencies thought capable of identifying cases, such as runaway or women’s shelters,

rape crisis counseling centers, family service agen.

ties, and the like (one to five per county, depending

on the county population).

At non-CPS agencies which agreed to participate in the

study, the professional staff were given concrete guideIines describing the kinds of ’’child maltreatment” situations which were of interest tothe study and were asked

to provide certain narrative and demographic information

about any children they suspected to have ex~rienced

one or more of these situations during a s~cified four

month Wriod.? As the individual reswndent preferred,

information could be provided either by filling in a “childIevel’’ data form6 or by anonymously calling a toll-free

WATS line number and giving the data form information

to a study telephone interviewer. Participants were assured that information would be treated as confidential

and used only for research pur~ses. They were also explicitly advised that the study team would take no action

to identify or protect children described to the study and

that providing information to the study did not constitute

an official report as may be required under state law,?

As with CPS agencies, non-CPS data collection was

prospective in nature. Agency staff were oriented to the

study during the first month of the four-month period and

were asked to provide information, voluntarily and at

their own initiative, if and when cases came to their attention.’ The non-CPS guidelines and data form are

‘The swcific four month Frid varied. Generally. one county i. a

given slate bad September-Decem~r. 1979. another had October

1979-January 19g0, and the Ibird bad Novemkr 1979-Fcbr”nry

1980.

‘ Unlike the CPS forms. this form described a sin~l. child. If more than

one child in a family was s.spcted to meet the study req. ircments,

more than one form was needed.

‘At the request of the slate DSS, tbesc provisions were mdified

s!ightly inonestalethcre, non-CPS,cswndenls were notified that, ii

$Pcifically rcq”cstcd by the resp”dent. the rcsearcher$ would file a

reprt with CPS on the rcspnde”t’s behalf. However, no such r..

~UCStS were mad..

“ Often, rcswndents provided information on tbcir own time as well as

at their own i.itbative. For example, msny teachers wbo idc”tified

cascs did so from their bomes, astbey did “m have access to a phone

during scbml bo”rs or sufficient time or privacy for filling in

confidential datu formsat schml.
Table 2-2. Participation data fornon-CPS agencies encompaaaed by study design.

Type of agency,

excluding CPS

Investigatory agenciaa

Juvenile probation department,

or equivalent

Local pollcelaherlffs departments

Office of county coronerlmedical

examiner

County public health department

Total

Othar study agencias

Short stay general hoapltala

Public schools

Mental health agenciea

Other social sewice agencies

Total

Total, all non-CPS aoenclea

Uumber o!

eligible

agenciee<

(1)

26

167

26

(19)

2S6

100

2,067

(21)

(32)

2,240

2,47e

do. sampledl

designated

agencies

(2)

26

102

26

19

173

92

262

24

36

434

607

dumber 01

participating

egenciee

(3)

24

66

24

19

153

70

252

21

32

375

52e

?artici.

pation

rate

(4) ‘

920/0

64°h

920A

1Oov,

66Y.

760h

a90h

67°h

e9*h

e6v0

—-

S7%

Total

tie. caaea

Iubmitted

(s) 2

606

604

7

121

1,338

4oa

929

152

297

l,7e6

3,124

Mean

No. aaaea

(6) “

25.2

7.0

0.3

6.4

6.7

5.6

3.7

7,2

9.s

4.s

5.9

‘ Entries Indicate the “umber of agenclas In the 26 study Cou”tles to which Countv.level flndln~s were aenerallzed throuah statistical

welghtlng 01 caaas oblalned from partlclpatlng age”cles. Sp~tflc publlc health departments, ;e”t$d he;lth agencies and-other social

Setica agencies were asked to participate only If there was reason to believe they could contribute Suspected cases the Combl”ed total

number of such aga”cles In a given county ranged from two to SIXde~ndlng on the population of the county. aecause of this non-random

method of selmtlo”, findings for partlclpatl”g agencies In theaa cat~orles are “01 weighted to represent any larger number of ,,eflglbf e<<

agenclas.

‘Entries exclude cases which clearly fa[led to meet minimal raqulrement% child under 18 and resided In a study count~ Suswted avents

occurred d“rl”g the four-month study period; etc.

3 Entries - Ilne 3 + ll”e 2.

. Entries = line 5- line 3.

presented in Appendix B,

Results of the non-CPS data collection e~ort are summarized in Table 2–2. Overall, 528 non-CPS agencies

participated in the study, representing 87 psrcent of the

607 agencies asked to participate. Tbe participation rate

was 88 percent for investigatory agencies and 86 prcent

for all other agencies sampled or designated in tbe design,

The participation rate for public schwls would have been

higher (i.e., 93 ~rcent rather than 89 percent) but for the

unfortunate occurrence of a schwl strike in tbe largest

city of the largest county in the sample, which caused a

loss of 10 of the 24 sampled schools in that county. The

lowest rate of participation was that for hospitals (76

psrcent ).

These high participation rates are doubly impressive

when one considers the intrusive nature of the study, its

unusual duration (four months of continuous data COI.

Iection), and tbe possible risks asswiated with participation,9 The fact that so many agency administrators

agreed to authorize participation by their staff says much

about the importance these administrators attached to

the goal of dwumenting the extent of child abuse and

neglect in the United States,

It should be noted, however, that nonparticipation was

a problem in the non-CPS component of the study, Ironically, participation negotiations were most difficult and

were most often unsuccessful at agencies which, by virtue of size or clientele, believed they would encounter

substantial numbers of children meeting the study re-

‘The staf of most study .Sencies (i”cl”ding courts and ~lice) are

required hy law to re~rt all s“s~cted cases of child abuse and

neglect m CPS. and the obvious p.r~se of the .on-CPS dala collection was to identify u“re~>rted cases.Thus, parlicipatio” by ascncy

s1.K could amount to dxumenvatio” of noncompliance with law a“d

could Ftentially create “.n>ero”s legal and other problems (e.g., in

co””ec! ion with medical malpractice suits) for the ascncy and its

Stafi.

8
quirements. Logistical difficulties and concerns about response burden for agency stafl were significant problems

for such agencies and were not always overcome, Thus,

although nonparticipating agencies were few in number,

they included the largest police department in tbe sample,

the largest hospital (which had a spcial child abuse

team), and several other agencies which would have been

expected to contribute large numbers of cases. The loss of

all central city schmls in the largest county in the study

was also significant.

Among participating non.CPS agencies, quality of

participation varied considerably from one agency to

another, High levels of interest and supprt wcurred at

some agencies but not at others. For example, probation

officers at one juvenile probation department identified

165 sus~cted cases to the study, while those at two other

departments of similar size and function identified zero

and three case$ respectively. One high school guidance

counselor spent six hours on the telephone dictating information about suspected cases in his schwl; many other

guidance counselors did not. As a result of these two

factors—underrepresentation of large agencies and incomplete participation by the staffs of many participating

agencies— findings from the non-CPS data collection undoubtedly underestimate the numbers of in-sco~ cases

known to the stafls of agencies encompassed by the study

design.

Returning to Table 2-2, it may be seen that participating juvenile probation departments bad tbe highest

per agency res~nse, submitting an average of 25.2 sus-

~cted cases apiece. The lowest average respnse was

obtained for coroners and medical examiners: the 24 such

agencies submitted atotalof only seven cases, orO.3 pr

agency. Public schools had tbe next lowest pr-agency

response (3.7 cases ~rschml) but, because of the large

number ofschwls in thestudy, schools accounted for the

largest total number of susWcted cases (929),

Of the 3,124 non-CPS data forms obtained, 23 ~rcent

were called-in on the study’s WATS line; the rest were

received by mail,

Data Processing

Three major steps were involved in the processing of

data forms: assessment, unduplication, and estimation.

Briefly, these steps were as follows

a. Assessment

CPS long form reports were assessed in two stages. The

first assessment was made by the CPS caseworker who

investigated the report. Tbe caseworker was asked to classify the report as “unfounded:’ based on agency standards and criteria. Data forms were to be submitted to tbe

study within three weeks of the date of the report to CPS.

If the investigation had not been completed by that time,

a provisional assessment of “indicated” (meaning there

were strong indications of abuse or neglect, as defined by

theagency) or’’unfounded” was requested, [fthereprt

was’’substantiatefl by CPS (i.e., founded orindicatd)

for any child in the family or if any child was believed to

have experienced a situation meeting the study requirements, details of the situation were to be given for each

applicable child. Otherwise (i. e., if the child was nor assessedas fmmdedorindicated and wasnof identified by

the CPScaseworker asmeetingtbestudy criteria), itwas

assumed that he/she did not meet therequirements, and

no further assessment was made.

Based on the caseworker’s narrative information and

using detailed s~cifications, a semnd assessment was

made for each child who was substantiated by CPS or was

thought to meet the study requirements the researchers

assessed the likelihood that a situation meeting the

SIudy’s definitional requirements hadmcurred, After assessing each applicable form of substantiated or suspected maltreatment for a particular child, an overall

assessment wasmade of thelikelihd that the child had

ex~rienced any “in-sco~” form of maltreatment. Similar assessments were made for all non-CPS data forms.

The study assessment twk into account both tbe substance of tbe suspscted situation (who was thought to

have done what to whom, when, and with what effect) and

the nature and credibility of the information upon which

the suspicion was based. The major assessment categories

were in-stop, insufficient information, and out-of-stop.

An “in-scow” assessment means that, in the judgment of

the researchers, there was reasonable cause to believe that

the child actually ex~rienced a maltreatment situation

meeting all of the study requirements. The study’s

definitional requirements are discussed further in Chap

ter 5,

The assessment procedure was complex; it was also

reliable. In inde~ndent assessment of a random sample

of 300 children, inter-rater agreement in the classification

of tbe suspected form or forms of maltreatment was 99

percent, and was 97 psrcent for the bottom-line assessment of whether or not the child had ex~rienced problems falling within the scope of the study “definitions.

b. Undupbcation

A particular child may have been reprted to CPS

more than once during the study year and/or may have

been described to the study by any number or combination of non-CPS sources, Identification of such duplicates

was complicated somewhat by the fact that, in the interest

of protecting confidentiality, the data forms did not request fully identifying information—last name, address,

or the like. However, enough close-t~ identifying information was collected (childs first name, last initial,

birthdate, place of residence, etc. ) to ~rmit reliable de.

termination of whether or not any two data forms were

describing the same child.

Once duplicates were identified from various sorted

listings of the computerized data file, one rewrd was

retained and all duplicate records describing tbe same

.9
child were, in effect, discarded. Whenever a child

identified to the study by a nnn-CPS respondent also

appeared in the CpS file, the CPS record was retained. In

etTect, nnn-CPS respondents were “given credit” only for

children who had nof been reported to CPS—by tbe respondent or by anyone else. Whenever a child was identified by more than one non-CPS source, the source to

whom the child was “creditefl was based on a “level nf

recognition” classification system. This is discussed further in Chapter 3.

c. Estimation

National estimates were produced by attaching various

sampling “weights” to individual data forms. In counties

where CPS reports were not sampld, only one weight was

involved for CPS cases, the “county selection weight:” the

inverse of the county’s probability of selection. In counties

where CPS cases were sampled, the CPS estimation

weight was the product of the “county selection weight”

and the “case selection weight:” the number of children

reported to CPS as possible victims of abuse or neglect

divided by the number for whom at least one long form

was obtained. The estimation weight for non.CPS cases

consisted of the product of three components: the “county

selection weight;” tbe “agency selection weight,” adjusted for non-participation by designated agencie$ and

an “annualization weight, ” This annualization weight

converted non-CPS data, collected over only a four month

period, totbe same 12montb period used for CPS, For

any particular ty~ nf non-CPS agency, the annualization

weight was the total number of children that agency type

reported to CPSduring theentire study year divided by

the number it reported to CPS during tbe four month

period when non-CPS data were collected. Annualization

weights ranged from 1.9 (for schools) tn 3.0 (for pnlice

and probation departments).

10
3. Re~orted and Total

In&dence of Recognized

Maltreatment

This chapter gives an overview of findings concerning

levels and patterns of reporting to and substantiation by

CPS agencies. It then presents estimates of the numbers

of additional maltreated children identifiable from the

non-CPS agencies included in the study. Finally, the two

sets of findings (CPS and non-CPS) are combined to

derive national estimates of the incidence of recognized

child maltreatment.

CPS Reporting and Substantiation

Table 3-l presents national estimates of reports to

CPS, by ty~ of county. An estimated 718,200 familyIevel reports of suspected abuse or neglect were received

by CPS agencies across the nation during tbe study year,

May 1. 1979 to April 30, 1980. As noted earlier, the

National Study on Child Neglect and Abuse Re~rting

compiled a total of 711,142 CPS reprts in calendar 1979.

The correspondence between tbe Incidence Study estimate and the Reporting Study “census” count reflects

favorably upon botb data basex it suggests that the Incidence Study sample of counties is reasonably representative of the nation as a whole and also that the

state-provided counts compiled by the Reporting Study

are reasonably complete. 1

Table 3-I indicates that the 718,200 family level re-

~rts to CPS listed an estimated total of 1,254,500 children as possible (“allege&’) victims of abuse/neglect, or

a mean of 1.75 alleged victims per report. Tbe estimated

number of different children involved in reports to CPS is

1,101,500. (This means that 13 percent of tbe alleged

victims reprted to CPS during tbe study year were reported more than once during the year.)

Expressed as an incidence rate, tbe 1,101,500 children

reported to CPS represent 17.8 children pr 1,000 Pr

year. In other words, nearly two percent of all children in

tbe nation are estimated to have been reported to CPS

agencies as possible victims of child abuse and/or neglect

during the study year. As may be seen, the estimated

report rate is about half as high in suburban counties

( 10.9 per 1,000) as in either urban (19.5 psr 1,000) or

rural (20.9 per 1,000) counties.

Tbe lower portion of Table 3-1 shows the estimated

The two studies are also convergent i“ findings concerning recent time

trends in repr!ing 10CPS. Dale compiled over the past three years by

the Reprting Study indtcalc an apparent average increase of 24

~rccn~ wr y~~r in re~rts tO CpS. At lhe conclusion Of Cps dal@

collection, CPS offickals in the 26 Incidence Study sample counties

were asked !. compare the level of rewrling to their agencies during

the study year to that during the prior year. The mean estimat. was

that reprting in the sample counties was 27 wrccnt htgber in the

study yvar than i“ the prior one.

Table >1. Reports of suspected child abuse and naglect received by Ctild Protective Sewice agencies from

May 1, 1979 to April 30, 1980: National estimates by type of county.

Netional Eetimate

(No. counties In sample)

No. children under 18 years of age’

Reporla to CPS

No. family reports to CPS, including duplicates

No. alleged victims listed in repofls, including

duplicates

No. children reported as alleged victims, undupllcated

Reported incidence no. alleged victims per 1,000 children

Substantiated Reports*

No. elleged vlctlms substantiated by CPS, unduplicated

Substantlatlon rate

Substantiated incidence no. substantiated victims per

1,000 children

Urban

(lo)

27,300,000

351,400

615,000

532,200

19.5

213,000

40Y.

7.8

pe of COul

Suburban

(6)

15,300,000

114,200

17e,400

166,100

10.9

69,600

42Y.

4.5

Rural

(10]

19,300,000

252,600

461,100

403,100

20.9

166,000

47Y.

9.7

Tolel

(26)

61,900,000

71S,200

1,254,500

1,101,500

17.6

470,600

42.7°1.

7.6

‘ Population estimates by type of county ba%d on Census estimates of child populations of Indlvldual study counties, Weightd by the

Inverse of the County,s sel=tlon probability. Estimated total based on census estimate of total child population.

‘ aubstantlated means classified by CPS as ..foundti’ or ‘Slndlcatti’ folloting prellmlnaw Investlgatlon.

11
number and prcent of alleged victims who were “substantiated by CPS. Substantiated means that the investigating caseworker assessed the re~rt as “founded’

or “indicated for the particular child following preliminary investigation,2 The estimated substantiation rate

is 42.7 ~rcent overall and is somewhat lower in urban

and suburban counties (40 ~rcent and 42 prcent, respcctively) than in rural countics (47 ~rcent).

Expressed as an incidence rate, this means that, overall,

unestimated 7.6childrenpcr 1,000 peryearare substantiated by CPS agencies as victims of child abuse and/or

neglect. Rural cmmtiesareestimatedto havethehighest

incidence of substantiated abuse/neglect (9.7 children

per 1,000) and suburban counties the lowest (4.5 children

~r 1,000).

Of course, levels of reporting to and substantiation by

CPS vary from one county to another. This is illustrated

in Figure 3,which shows reWrted andsubstantiated incidence rates for the 26 study counties, ordered from largest to smallest total population within urban/suburban/

rural categories. As shown, the greatest variability Wcurred among the 10 relatively small rural counties.

There was much less variability among the larger urban

and suburban counties of the sample, particularly in

terms of substantiated incidence (the lower prtions of

the bar graphs), Excluding the urban county with the

very high rate, the nine remaining urban counties (IG

catcd in eight different states) had substantiated incidence rates ranging between 4,3 and 8,3 children par

1,000: Excluding the suburban county with the extremely

Iow rate, substantiated incidence rates among the other

five suburban counties in the study (Iwatd in four

diflerent states) varied within an even narrower range,

from 3,8 to 5.7 children per 1,000.

It appears from Rgure 3 that, within urban/suburban/

rural categories, counties with relatively high rates of

reporting tend to substantiate lower proportions of their

reports than counties with relatively low rates of reporting, with theresult that substantiated incidenw rates are

about the same in counties with high report rates as in

ones with Iower report rates. This patterrr is particularly

clear among the suburban counties in the study sample.

In isolation, this finding might be interpreted assuggesting that there may be a “point of diminishing returns” in reporting level, such that rep fiing above a

certain level tends to be relatively ineffective in uncovering additional “rear’ (i.e., substantiated) cases of

child abuse and neglect. ~Arl alternative hypothesis might

be that agency resources and aewice capabilities establish

‘This assessmentreflects agency definitions a“d criteria, “ot those u~d

in thcstudy defi”itions oi..i.-scop,, maltreatment.

‘findings simikar to those in Figure 3 have ke”soi”terpretcd pre.

vio.sly. See, [or example, Nagi, S.2., Child M.lt,e.lment i“ ihe

U“ired Sr.t.s: ACha//c”ge to Sotiai Imtitu(iom, Col”mbta U”iversity Press, N. Y., 1971.

Figure2. Reported and substantiated incidence rates by sample county: Unduplicated

numbers of alleged andaubatantiated vlctlma reported to CPS per 1,000 chlldrertin county,

Legend

9 Unsubstantiated

❑ Substantiated m 1

I

I

12 Urban Suburban Rural
Table&2. Number and percent of femily reports to CPS end Percent substantiated, by source of rePo~:

Nationel estimates ofreports to CPSagenclea, Mayl, 1979 to Apri130, 1980.

Source ol reports to CPS

DSSIWelfare Department

Law enforcement (police, sheriff, cOurtsJcOrr~tiOns.

coroners, etc.)

Medical (hospltala, cllnica, physicians, publlc health

depatiments, etc.)

Schools (public and private)

All other agencies (preeshool, daycare, marital

health, aoclal sewlces, ate.)

Other (non-agency) sources (child, parents,

neighbors, armnymoua, etc.)

the upper bound on the number of cases which can be

handled by individual agencies and that substantiation

numbers are more reflective of such constraints than of

the actual extent of child abuse or neglect in the community, These hy~theses will reconsidered further in later

sections of this report.

Table 3-2 presents additional information about CPS

reporting and substantiation, showing the estimated number and prcent of family reports to CPS and the prccnt

substantiated by source of the reWrt. Non-agency

sources (e.g., neighbors, relatives, self-referrals) account

for nearly half of all reports toCPS (49 percent), but

u~n investigation, only about one-third of reports from

such sources are substantiated (35 percent). Scbeels, law

enforcement agencies, and medical sources arc the major

professional/institutional sources of reports to CPS and

arc roughly comparable to one another, both in amount of

re~rting (these three sources account for 14, 12, and 10

percent of reports, respectively) and in proprtion substantiated (57 percent, 56 percent, and 53 prcent,

rcpcctively. )

Table 3=2 indicates that substantial proportions of reports from all sources are not substantiated. Overall, 65

Wrcent of reprts from non-agency sources are nOnsubstantiated, as are nearly half of those from peliw,

courts and other agency sources.’ Table 3-3 examines the

primary reasons for nonsubstantiation of repetis from

various sources, The data were obtained by classification

of the investigating caseworker’s narrative explanation.

“Allegation invalid” refers to cases where the in-

‘The s.bsvantkdt ion findings i“ Table 3-2 arc not new or ..”s”.1. The

America” H.ma” .Na(io”al Re~rli”s Study,’ has found overall

CPS substantiation rates of 40-50 Frccnt for {h. past several yearn.

Netional estimate

No. reporte

to CPS,

including

dupficstea

43,000

88,200

74,500

100,300

57,800

354,500

718,200

Percent 01

all reports

to CPS

6

12

10

14

8

49

100

For tMa source,

percent of

reports aubstarttiated by CPS

45

56

53

57

49

35

44

vesti~atinc -- caseworker was satisfied that the re~rtcd

child(ren) bad not been abused or neglected. For examplti a neighbor heard an infant crying rcwatedly over a

two or three day period and reperted a concern about

pssible abuse or neglect after investigation, the CPS

caseworker was satisfied that tbe crying was due to illness,

for which the infant was receiving appropriate care.

“Insufficient evidence! means that. althOugb the caseworker was not entirely satisfied that the allegation was

invalid, there was not sufficient evidence of maltreatment

to warrant intervention. Perhaps a child described a sexual abuse incident to his or her teacher, but Iatcr refused

to acknowledge the problem to the CPS caseworker. “Unable to investigate” includes situations where the household could not be Iwated from the information given in

the report, the family “skipped town” before the caseworker got there, etc. Finally, “nOt seriOus enOugW refers

to situations where the allegation was found to bc valid

but where the problem was assessed as inappropriate for

CPS or as not serious enough to justify intervention beyond the initial investigation.

Overall, invalid allegation was the most common reason for nonsubstantiation, this being tbe primary reason

given for 53 percent of all nonsubstantiated rcperts. Unable to investigate was the most infrequent reason (11

prcent). However, this I I pcr=nt is not an inwnsequential figurq it means that there are about 44,000

uninvestigated reports pcr year.

In comparing findings for ditTerent sources, the “not

serious enoug~’ column is particularly interesting. One

might anticipate that this would be a much more common

reason for nonsubstantiation of reprts from non-agency

sources than for reports from agencies agency reprts

13
come from professionals, whose training and experience

would presumably make them better able than untrained

individuals to assess whether a problem is serious enough

to warrant intervention. Apparently, this is not how it

works, “NOI serious enough” was a minor reason for nonsubstantiation of reports from non-agency sources (accounting for only 16 percent of such reports), but was the

single most common reason for nonsubstaniiation of reports from law enforcement agencies (39 percent ) and

from schools (also 39 percent). Clearly, CPS agencies are

turning away significant numbers of cases which other

professionals in the community consider serious enough

to require attention. This may indicate that CPS resources (staff, service programs, budget) have not kept

pace with the dramatic increases in reporting which have

occurred in recent years and that substantiation has become not so much a question of whether the child and

family need help as of how badly or how urgently help is

needed.

The substantiation findings may also reflect definitional

ambiguities of the sort discussed in Chapter 1, They su~

gest a less than complete understanding on the part of

schools, courts, police, and other major referral sources of

how CPS agencies define child abuse and neglect (i.e., of

the standards and criteria used by CPS in determining

whether or not CPS intervention is appropriate, given

available resources). Reporting of inappropriate cases is

one side of this problem, TO some extent, findings from

the non-CPS component of the National Incidence Study

are indicative of the other side of the problem: non.

reporting of appropriate cases. Findings concerning un.

reported cases are summarized in.the following sections

of this chapter and are discussed further in Chapter 6,

Non-CPS and Combined Rndings

Results of the non-CPS data collection e~ort are summarized in Table 3–4. The first column of this table shows

that cases submitted to the study by participating nonCPS agencies in the 26 sample counties over a four month

periti “weight up” to an :innual national estimate of

928,900 suspected cases identifiable from agencies encompassed by the study desi,gn, After unduplication (i.e.,

after subtracting out all dati] forms for children who had

been reported to CPS and all but one data form in situations where the same child ~wasidentified more than once

by non-CPS sources), the titimated number of different

children identifiable from non-CPS agencies, over and

above those known to CPS, is 674,900.

Children identified to tile study by more than one

agency were “credited” to one agency or the other based

on a somewhat arbitrary level of recognition classi.

fication.’ CPS was consider,;d the highest level; Table 3-4

lists non-CPS agencies in priority order, from highest to

lowest “level,” Thus, the unduplicated estimate of 50,200

suspected children credited to police and sherifls departments is the estimated number of additional children

identifiable from this source, over and above children

identifiable from CPS or from juvenile probation departments. TO cite a second example, data forms sent in

by coroners and medical examiners “weight up” to an

estimate that 300 cases would have been obtained if data

‘The classificati”” reflects the studys 1...1 of recognition model (fig.

g.r. I-I ). HOWCV.r. the ordering or sources within a particular level

(e.g., ~licc vs. probation vs. public health) is essentially artitrary

from a substantive point of vie.x it is based o“ slutistical r.thcr than

theoretical considerations.

Table 3-3. Primary reason report not substantiated by CPS, by source of report: National estimate of number

and percent of family-level reports not aubatantiated by CPS agencies.

Source of report to CPS

Source of Report

DSSIWelfare Depsrtmsnt

Law enforcement agencies

Medical sources

Schools

All other agencies

Other (non agency) sources

Total

Reason report not substantiated by CPS

No. nonAIIega- Not lnaufiUnabla All noneubatantion

to inserioua cient

subetanfiated vesti- tiated

reports

invalid enough evidence

gate reports

23,600

36,600

34,800

43,400

29,500

228,800

398.700

4s

3s

52

34

49

60

53

I

I

20

39

29

39

28

16

23

14

13

9

16

13

13

13

18

10

11

11

10

11

11

100

100

100

100

100

100
had been collected over a 12-month period from all coroners and medical examiners in the nation. However, all

cases sent in by coroners and medical examiners contributed no additional cases over and above those credited to higher “level” sources, and tbe unduplicated

estimate for coroners is zero.

As indicated in Table 3-1, an estimated 1,101,500 different children were re~rted to CPS agencies as suspected victims of child abuse or neglect during tbe study

year. Of these, an estimated 470,500 children (43 percent) were substantiated by CPS. An additional 6,200

children who had been reperted to CPS were not substantiated by CPS but were identified-by tbe CPS caseworker or by a non-CPS respondent—as possibly meeting

the study requirements. The results of the study assessment of these 476,700 reported children and also of the

estimated 674,900 additional suspected children identifiable from non-CPS agencies are summarized in Table

3-5.

As may be seen, 44.5 ~rcent of the children substantiated by CPS were accepted as meeting all study requirements (i.e., as “in-sco~”), and almost all of the rest were

assessed as not meeting the study’s harm requirements.

Only 2.6 percent of substantiated CPS cases were

screened out for other reasons.

The finding that many substantiated CPS cases (53

~rcent) do not meet the study’s harm requirements reflects the narrowness of tbe study definitions and is not

surprising. In most categories of physical neglect, for example, the study definitions require evidence of serious

injury or impairment, such as diagnosed malnutrition.

One would certainly hope that CPS agencies would not

wait until a problem had gone that far before intervening.

It may be seen from Table 3-5 that the study assessment of non-CPS cases was almost identical to that for

CPS cases, except that 20.5 prcent fewer cases were

screened out because of no indication of required injury or

impairment (20.5 percent for non-CPS vs. 40.5 psrcent

for CPS), and a correspondingly larger percentage was

accepted as in-scope (65. 1 prcent vs. 44.5 psrcent). No

doubt this reflects the fact that non-CPS respondents

were given the study’s harm and other requirements

ahead of time and were asked to send in only cases they

believed to meet these requirements.

Table W. National estimates of annual number of suspected maltreatment victims identifiable from non-CPS

agenciea, by type of agency.

Susp=t+ victims identifiable to etudy

Type of non-CPS agency Total number, Undupbcated

includ}ng duplicate’ numbers

INVESTIGATORYAGENCIES

Juvenile Probation Department 76,800 55,100

PollcelSherlWs Department 83,900 50,200

CoronerslMedlcal examiners 300 0

Public Health Department’ 19,900 11,900

Total 180,900 117,200

ITHERSTUDYAGENCIES

Hospitals 48,000 25,900

Public schools, elementav 375,800 282,400

Public schools, smondaw 258,300 200,700

Mental health agencies’ 37,100 26,900

Other social sewlce agencies’ 26,800 21,800

Total 748,000 557,700

otal, all nOn-CPS agencies

encompassed by study 928,900 674,900

‘ Total number of child-level data forms r%elved from pa fllclpatlng agencies over fOUr month study period in sampled counties, Wef9ht0d:

(a) to adjust for sampling andlor nonpatilclpatlon of agencies In study counties, (b) to conveti frOm 4-month to t2-month period, and

(c) to represent all U.S. counties.

‘For each row, children also known to CPS or to agencies In previous ro~ are subtracted from the total number of Susp= ted victims

Identlfled to the study by agencies In the row. Thus, each enty represents additional children over and above the= known to CPS or

to previously listed agencies.

3SeCause of non-random selwtlon prwedure used with these agencies, estimates for public health, mental health, and other social Sewlce

agencies are based Only on partlclpatlng agoncles, with no adjustment for agency sampling or nonpartlclpatlon.

15
Table ~. Results of study assessment of children substantiated by CPS and of additional ausoected children

identifiable from other study agencies Percentage distribution.

Children

Study aseeeement eubstentiated

by CPS

10,substantiated fsuspacted maltreatment vlctlms,

ndupllcatad (National estimate) 476,700’

l-aco~ (meets study raquirementa) 44,5

lsufficient Information or out-of-scope, total I

(55.5)

Perwtratorfacta fevents out-o f.scopa I 1.1

No indlcatlmt of raquired Injuryllmpalrment 40.5

Insufficient Indlcatlon of Injurylimpalrmant 12.4

Insufficient indication of required caretaker

responaibllicy for child’s Injurylimpalrment 0.8

Other reason (child’s age, time of occurrence, etc.) 0.7

Total 100,0

674,900

65.1

(34,9)

1.2

20,0

11.6

1,151,600

56.6

(43.4)

1.1

26.5

11.9

7Data base Includaa 470,500 children substantiated by CPS PI”S a“ additional 6,200 chlldran who were not substantlatti according to

agenv crltarla but wera Identlf lad as maatlnn the studv r~uhements. Since the Iattar rapresent only ona percent of the total, the CPe

data ba~ consists almost anthely of Substa;tlated chlidran.

In Table 3-6, findings from tbe CPS and non-CPS

components of the study are mmbioed to produce national incidence estimates. As noted earlier, an estimated

470,500 different children were re~rted to and substantiated by CPS agencies during tbe study year. Of these,

an estimated 212,400 children (3.4 children per 1,000 per

year) meet all study definitional requirements. This is the

swcalled tip of tbe iceberg,

The study estimate is that an additional 71,400 children meeting all study requirements are identifiable from

other investigatory agencies. Adding those children to the

ones known to CPS increases tbe estimate to 4,6 in-scope

children ~r 1,000 pcr year who arc known to some public

agency with investigatory responsibilities-CPS, the 10-

cal ~lice or sheriff, the juvenile probation department, or

the public health department.

An estimated additional 368,100 children meeting all

study requirements are identifiable from other study

agencies—public schools, hospitals, and major mental

health and sucial sewice. agencies. Adding these to the

previous total increases the estimate to 652.000 children.

or 10.5 children Wr 1,00(1~r year. Since this is as far into

“the iceberg” as the study went, this is the bottom-line

study estimate of the national incidence of recognized

child maltreatment. The mmpenents of this estimate are

shown pictorially in Figure 3-2,

Teble M. Computation of national incidence estimates, by level of recognition.

I

Level of raoqnition

A. Children reported to CPS

B. Additional suapaoted children Identifiable from “other

lnveatlgato~ agencies”: juvenile probation, pollcel

sheriff, and publlc health department

C. Addltlonal auapscted children Identifiable from “other

study agencies”: public schools, hoapltals, and participating mental health and social semice agencies

Netionel Eetimal

No. in-eoope

children

212,400

71.400

366,100

‘ All aatlmates baaad on 12 month Derlod May 1, 197910 A~rll 30. 19S0

Cumulative

No. in-scope

children

212,400

263,600

652.000’

Cumulative

Incidence rate

(per 1,~)

3,4

4.6

10.5

‘ The prmlm total Is 651,900, For convenience, throughout this raport, the number has bwn roundad off to 652,000.

16
The total shown in Figure 3-2 (652,000 children) provides the basis for the analyses in Chapters 4 through 6.

It is an estimate of the total number of “maltreated

children in the nation who met the study’s definitional

requirements during the study year and who (a) were

reprted to CPS agencies as suspected victims of child

abuse or neglect, or (b) were not re~rted to CPS agencies

but were identifiable from other agencies represented in

the study design through the kind of voluntary, confidential data collection pr~edures used in the study.

As hopd, the estimate provides a considerably more

comprehensive basis for analysis than one based solely on

reported cases: children reported to CPS represent

slightly less than one-third of the total (212,400 of the

652,000), It should be stressed, however, that the estimate was not intended, and is not, an estimate of the full

extent of the problems of child abuse and neglect in the

United States. The estimate is incomplete in four major

res~cts:

1) The estimate is based u~n narrow definitions,

which encompass less than half of tbe high risk

situations already being substantiated by Child

Protective Services agencies.

2) Thenon-CPS comWnent of theestimate is derived

from a Iimited-rangeof information sources. If a

wider range of information sources had been included in the study, tbe incidence estimate undoubtedly would have been higher!

Figure 3.

3) Asnoted in Chapter 2,1arge andcentral city agenties were underrepresented in the non-CPS data

collection, and tbe extent of participation at some

“participating” agencies was questionable. These

problems intrtiuce biases in the direction of underestimating the number of recognized-but-notreported children known to agencies encompassed

by the design.

4) The study estimate excludes nearly all non+

substantiated CPScases, some of which mayactu~

ally have met tbe study criteria (es~cially those

wbicb were nonsubstantiated because of insufficient

evidence or inability to investigate). Similarly, cases

which were screened out by the researchers for reasons of incomplete or questionable information

undoubtedly included some children who had experienced vroblems meeting tbe study criteria.

For’ alloftheie reasons, thes~udy’s overall incidence

estimate is obviously incomplete. This is discussed further

in Chapter 7.

‘ 1( will be shown i“ Chapter 6 that agencies includd in the non-CPS

dava collection are es!ima ted to have reprtd 10CPS only 11 wrccnt

(at most) .f tbe recognized in-stop children they cnmuntcred. If that

isthere~rting rate forallsourc.s, including those not reprcsentedin

the non-CPS davd collection (private schmls, day care wntcm, medic.l clinics. private individuals, etc.). theincidcne estimate would k

16.3 children Wr l,~~ryear, or about 1.000,~ recognized in.

scow children wr year.

Composition of the iceberg: Estimated number of in-scow children per year et r=ognition Levels 1-3.

A

Investigator agencies 283,800

\

t.

t

\

Known to none of above

—-——— ———— ———- —

17
4. Subpopulation Incidence

Est~mates

Table 4- I presents a breakdown of the estimated

652,000 in-scope children by major form of abuse or ne.

glect and by severity of maltreatment-related injury or

impairment. Findings are presented both in terms of estimated numbers of children and in terms of incidence rates

pcr 1,000 children. Incidence rat= were obtained simply

by dividing the estimated number of maltreated children

in a particular category by 61,900 (the Census-based estimate of the total number of children in tbe United States

in 1979, in thousands). All estimates in Table 4-1 are

“unduplicate~’ in that a particular child is not counted

more lhan once in any given category or total. However,

children who experienced two or more different forms of

in-scope maltreatment are included in each applicable

category. (As a result, subtotals are generally lower than

the sum of their component parts, )

As shown, physical assault was the most frequent form

of abuse identified in the study. Among tbe major categories of neglect, educational neglect was the most frequent.

Overall, abuse-related problems were slightly more common than ones in tbe neglect areas of the 652,000 inscope children, 351,000 (54 percent) had experienced one

or more in.stops forms of abuw, and 329,000 (50 psrcent) had experienced one or more in-scow forms of

neglect. (The fact that these percentages sum to only

slightly more than 100 indicates that few children experienced both in-scope abuse and in-scope neglect problems.) These relationships reflect tbe study’s definitional

requirements, particularly the emphasis upon demonstrable injury, No doubt, if diKerent definitions bad been

used, the relative frequencies of the various forms of maltreatment would have been different. ] The study’s definitional requirements are discussed further in Chapter 5.

Severity was assessed based on the respondent’s narrative dexription of the childs maltreatment-related injuries or other problems. In the event of multiple injuries

and/m multiple forms of maltreatment, the most serious

problems was the one used in this classification. “Fatal”

is self-explanatory, “Serious” means serious enough to

require professional care aimed at retieving acute present

‘ It isnoteworthy. for example, that the leg.1-clinical dcfi”itions i“ “X

by CPS agencies result in a grealcr emphasis .Wn ncglecl than

mc.rred in this study. The CPS findings from the national Rcprtina

St .dy show a tw+[o.o”e neglal/ab”~ ratio among su~la”tiated

children, in contrast to this study,, onc.t~one ratio (see Notional

A“oly,is o~ “ficiol Child NeglecI ond Abuse RePrrinE, /978, op.

cit.. p. I 8),

Table &l. National incidence estimates by major form of maltreatment and by severity of maltreatment-related

inju~ or impairment: Estimated number of recognized In-scope children” per 1,000 per year.

Form of maltreatment and eeverity No. in-scope Incidence rate’

of injurylimpairment children (par l,W)

Form of maltreatment’

rotal, all maltreated children 652,000 10.5

rotal, all abused children 351,100 5.7

Physical assault 207,600 3.4

sexual exploitation 44,700 0.7

Emotional abuae 13e,400 2.2

rotel, all neglected children 329,000 5.3

Physicel nsgl~t loe,ooo 1.7

Educational neglect 161,500 2.9

Emotional neglffit 59,400 1.0

Severity of child’s inju~limpairment

Falal 1,000 0.02

eerlous 137,400 2.2

Moderate 411,600 6.6

Probable 102,000 1.6

‘ Totals may be lower than sum of categories, sl”ce a child may have experienced more than o“e I“-scope catego~ of maltreatment,

2Numerator = estimated ““mber of r~ognized 1“.scope children; denominator = 61,900, the estimated total number (In thoum”ds) of

children ““der 18 In the U“lted States in DWember, 1979.

18
Figure 4. National estimates

All r=ognlzti In-scow children

Sex of child (99QAknown)

Boys

Girls

Age of child (99.A known)

o-2

3-5

w

9-11

12-14

15-17

of the incidence of r%ognlzed maltrmtment by

Child,8 race (99°A known)

White

Black

Other

Annual family Inwme (81°A known)

Under S7,000

S7,000-$ 14,999

$15.00G$24 .999

$25,000 or more

No. of children in family

(898A known)

1

24

4 or more

TYW of Cone (100 ‘h known)

Urban

Suburban

Rural

sel=ted child and household characteristics.

14.2

-’37

0 5 10 15 20 25 30

suflering or at preventing significant long term impairment. Generally, this encompasses injuries and other

health conditions for which the child received, or should

have received, professional medical care (e.g., fractures,

severe burns). The category also includes severe emotional, behavioral, or even educational impairments if the

problem was significantly debilitating and if a competent

professional had recommended psychiatric or other remedial treatment. “Moderate” means injuries or impairments serious enough to remain evident in observable

form for at least 48 hours. “Probable” was used in situations where, although the respondent or caseworker had

observed no specific symptoms of injury or impairment, it

was considered highly likely (by the respondent and by

the study statT) that the child’s physical, mental, or emotional health or capabilities had been significantly impaired as a result of the extreme or traumatic nature of

the maltreatment events. Some forms of maltreatment

(e.g., abandonment, some forms of sexual exploitation)

automatically qualified for this category even if there

were no observed injuries (see Chapter 5 for discussion of

definitional requirements).

Cding was conservative in that, if there was any question about which category applied, the less severe choice

was used. All probable injury classifications were reviewed by the project director and were retained only if he

agreed that in-sco~ injury was highly likely to have occurred in view of the circumstantial evidence. As may be

determined from Table 4-1, 2I percent of in-stop children (an estimated 137,900 children) had ex~rienced

serious injuries or worse, and 84 percent had evidenced

symptoms of at least mtierate severitfi the remaining 16

percent were judged to qualify as probable injury cases.

The study estimate is that child abuse or neglect was

recognized as the primary cause of death of approximately 1,000 children during the study year. This number

19
Table -2. National incidence estimates bv selected child characteristics Estimated number of recognized

In-scope children per 1,000 per-year.

National Estimate

Characteristic No. children No. in-scope

Incidence

in U.S. children’

rate

(per 1,000)

Total 61,900,000 652,000 10.5

Sex of child (Y. known = 99)

Male 31,600,000 336,100 10,6

Female 30,300,000 314,200 10.4

Age of cMld (Y. known = 99)

&2 6,270,000 51,900 6.3

%5 9,500,000 59,500 6.3

*6 9,770,000 110,800 11.3

9-11 10,630,000 120,900 11.4

12-14 11,600,000 136,000 11.5

15-17 11,930,000 169,600 14.2

CMld’s ethnic group’ (Y. know” - gg)

White 51,400,000 537,600 10.5

Black 9,200,000 106,300 11.6

Other 1,200,000 6,400 7.0

‘ For comparison with Census data, study classification of ,Whlte,, combines data form categories white, not of Hlspanlc orlgln,, and

‘sHlspanlc,,,

Whenever more than 1.0 percent of Study cases have missing data, estimates are adjustti to 100 ~rcent a%umlng mlslng data cass

have -me Prcentage dlstrlbutlon m ‘,k”own,, cases.

is lower than most prior estimates and may indicate that

deaths caused by child abuse or neglect are not as common as has been thought. However, this finding should be

interpreted cautiously, For such a rare event phenomenon, the reliability of a national estimate based on a

sample of only 26 counties is susWct,

Incidence estimates for major population subgroups

are shown in Figure 4 and are described in greater detail

in Table 4–2. Denominators for these incidence rates (i. e.,

the estimated number of children in the U.S. belonging to

tbe ppulation subgroup) were derived from Census Bureau estimates for 1977– 1978, projected to 1919,

The estimated overall incidence of in-stops maltreatment is essentially tbe same for boys as for girls. By

age group, measured incidence rates increase with age

and are roughly twice as great for children over five as for

children five or under. The relatively low rates of mea.

sured incidence among young children could be due, in

part, to the fact that some of the study’s non-CPS agencies (particularly schools) deal primarily with older

children,

In terms of ethnic group, incidence estimates are essentially the same for Black and White children.2 Tbe estimate is somewhat lower for other groups, but the

numbers involved are very small and are therefore of

questionable reliability.

Incidence estimates by family income level, shown in

Table 4-3, should also be interpreted somewhat cautiously. The numerators (estimated number of in-sw~

children in each income category) were derived from the

respondent’s estimate of the family’s annual income, not

from any “hard’ income information. There was a substantial amount of missing data on this item (19 ~rcent ).

Also, the denominators were derived from 1917 Census

estimates, which may be inaccurate when projected to the

1979-1980 study periti. [t seems unlikely, however, that

‘ In the classification used, ..White, comb!ncs da~a form categories

,.White not of Hispanic Origin,, a“d ,,Hispa. it,,. ..alacr is derived

from da~a rorm category ..alack, ..1 of Hispanic OriSin.,, ..Othcr,,

includes .,America” Indian or Alaskan Native,.. ..Asian or Pacific

Islander: and “Other? The reason for comhinins Hispanic and

White, not of Hispanic origin is that available Census aurea. statistics do not make this distinction. The assumption is lhat most children

identified to the study as Hispanic would have been classified as

.,Whit.,.. according to Census aurea. race definitions.

20
these data problems are capable of “explaining away” the

very strong measured relatimrsbip between family income

and recognized maltreatment: the estimated overall incidence for children in families of under $7,000 income

(27.3 children Wr 1,000) is ten times higher than the

estimated incidence for children in families with annual

incomes of $25,000 or more. This relationship will be

examined further in Chapters 5 and 6.

Incidence estimates are somewhat higher for one-child

families and for families containing four or more children

than for families with two to three children.

Finally, the incidence estimate for suburban counties

(8.8 children per 1,000) is somewhat lower than for urban

( 10.9 children ~r 1,000) m rural (11.4 children PSI

1,000) counties. The difference is not nearly as large,

however, as that noted earlier in describing urban/

suburban/rural levels of reporting to CPS agencies

(Table 3-l).

Table M. National incidence eatlmatea by selected household geographic characteristics Estimated number

of recognized in-scope children per 1,000 per year.

E

u

$

$

$:

N

1

2

4

T

u

s

R

National Eetimate

Characteristic

Study estimete Incidence

No. cfdldren of no. meltreatad rete

in U.S. children’ (~r 1,~)

Total 61,900,000 652,000 10.5

ctimatad annual femily income’

(O/.known - 81)

rider $7,000 10,200,000 278,200 27.3

7,00G$14,999 17,500,000 255,700 14.6

15,000-$24,999 20,900,000 81,500 3.9

25,000 or more 13,300,000 35,800 2.7

0. children in family

(OAkno”wn - 89)

11,600,000 158,400 13,7

-3 36,800,000 340,000 9.2

or more 13,500,000 153,500 11,4

ypa of County’ (“Aknown = 100)

rban 27,300,000 297,600 10.9

uburban 15,300,000 134,600 8.6

,ural 19,300,000 219,600 11.4

‘ Whenever mora than 1.0 percent 01 study cases have Ml=lng data. estimates are adjust~ to 100 Prcent a~uming Ml=lng data=%

have same percentage dlstrlbutlon as known”” Ca=s.

‘Census estimate ba%d on 1977 data, the MOst r=ent available information about number of children by annual ramlly Income -tWow.

Study estimate Is based on respondents estimate or family’s annual tnwme. and Is of unknown Valldlw.

sEstimates for all U.S. children are baw on eStlMatti child populations for individual study counties, weighted by the Inverw 0? the

counws MlStIon probability.

21
5. Characteristics of

Maltreated Children

and Their Families

This chapter describes the particular ki”d~ of ~al.

treatment situations encompassed by the study and summarizes relationships between major forms of in-sco~

maltreatment and various child, family and perpetrator

characteristics,

a. Form and Severity of Maltreatment

Table 5- I shows the estimated number of i“.scope chil.

dren and the severity of injury distribution for the major

forms and subcategories of maltreatment. Children who

experienced more than one form of maltreatment are

included in each applicable subcategory. However, all

subtotals are unduplicated in that individual children are

counted only once in any particular subtotal or total.

The general definitional requirement in the abuse areas

was that the child must have experienced nonaccidental

physical, mental or emotional injury or impairment of

moderate or greater severity as a foreseeable result of

purposive acts committed by a parent, parent substitute

(e.g., foster parent), or other adult “caretaker” (e.g., a

grandparent living in the home, a mother’s live-in boy

friend) or as a result of similar acts by other perso”~ if

knowingly permitted by a parent or parent substitute

(e.g., the father was present but did not attempt to stop

tbe sibling abuse),

Physical assault is largely self-explanatory. The only

distinction was whether or “Ot the as~au]t ~a~ know” to

have entailed use of an implement (e.g., lamp cord, stick,

cigarette, flat iron ) or foreign substance (e.g., nonaccidental drowning, poisoning, scalding). As shown in

Table 5-1, awaults not involving known use of any implement or foreign substance (e.g., hitting with hand or fist,

kicking, biting, throwing or unknown means of assault)

were the most common. Although there were some injuries at all severity levels (including death), mderate

injuries were by far the most common in both subcategories. In both, about 15 ~rcent of in-sco~ children

were judged to be in-scope on the basis of probable

harm—that is, there was no direct evidence of injury but,

from tbe nature of the acts and events, it was judged

highly likely that observable injury had ~curred.

In the area of sexual exploitation, subcategories reflect

different kinds of acts. Evidence] of actual ~ni]e

~netration—whether oral, anal or genital, homosexual

Evidcncc means credible information (e.g., lb. ~rwlrator ack”owi.

.ds.d bis/hcr actions), The lcrm is not used here i“ any technical

sen~, legally or medically.

or heterosexual—was required in the intrusion subcategory. Except for promoting or Wrmitting of

prostitution, allegations that a parent had knowingly

permitted a child to engage in voluntary sexual activity

with someone other than an adult caretaker were not

accepted, Molestation with genital contact involved acts

where some form of actual genital contact had occurred

but where there was no specific indication of intrusion.

“Other and uns~cified” was just that, unspecified

“molestation” or “sexual abuse” or sexually exploitative

acts not known to have involved actual genital contact

(e.g., fondling of breasts or buttocks, exposure), Threatened or attempted sexual assault not involving actual

physical contact were not included (see emotional abuse),

NO evidence of injury was required in the first two

subcategories; circumstantial or direct evidence of moderate or greater injury was required in the third, In eKect,

it was accepted as a matter of definition that sexual exploitation involving intrusion or molestation with genital

contact is inherently traumatic and injurious, For other

kinds of acts, the burden of proof was o“ the respOnde”t

to show that the child had in fact been significantly traumatized or injured.

Table 5- I shows that intrusion was the most common

form of sexual exploitation; “other and uns~cified” acts

represent the smallest component of the total. The sever.

ity distributions are somewhat surprising. Thus, although

no evidence of actual injury was required in tbe first two

categories (i.e., in-scope acts were sufficient to justify a

probable injury classification), demonstrable injury was

not at all uncommon; proportionately, there were more

serious injuries associated with sexual exploitation than

with physical assault.

Emotional abuse includes three diverse subcategories

. Verbal or emotional assault: habitual patterns of

scapegoating, belittling, denigrating or other overtly

hostile, rejecting treatment, including threats of

physical or sexual assaulq

. Close confinement: tortuous restrictions of mOvement, as by tying a childs arms or legs together,

binding a child to a chair or bed, or confi”i”g a child

to a closet or similar enclosure for prolonged period~

and

● Other/uns~cified abusive treatment, which could

include attempted physical or sexual assault (e.g.,

tbmwing something at a child, but missing), “overworking” or economic exploitation, withholding of

fti, sleep, or shelter as a form of punishment, or

similar purposive acts not encompassed elsewhere,

In this category, acts of a“ u“”s”al a“d extreme nature

were required, as were: (a) direct or strong circumstantial

evidence of injury of moderate or greater severity and (b)

compelling indications that the caretaker’s acts had in

. .
Table %1. Estimated number of recognized In-scope children and severity percentage distribution by major

form and subcatego~ of maltreatment.

No.

in-scope

children

652.000

Severitv of child’e iniuryfil airment 2

Probable

Form end subcategory

of maltreatment’ Fatal’ SeriOua Moderata “otal

100

100

100

100

100

100

100

100

100

100

100

t 00

100

All forms, total

Abuse. total

0.16 20

12

9

8

6

15

16

6

7

63

69

16

19

12

16

15

54

67

76

50

17

22

73

8

351,100 0.20

Physical assault

Assault with Implemantl

foreign substance

Other and unspecified

Sexual exploitation

Intrusion

Molestation with genital

contact

Other and unspecified

Emotional abuae

Verbal/emotional assault

Close confinement

Other (e.g., threatened or

attempted physical or

sexual assault)

Neglect, total

Physical neglect

Abandonment

Other refusal of custody

Refusal to allow/provide care

for diagnosed health

condition

Failure to seek medical care

for serious haalth condition

Inadequate physical supervision

Disregard of avoidabla hazards

In home

Inadequate nutrition, clotting,

hygiene

Other

207,600

79,400

131.500

0.34

0.30

0.3s

0.02

0

0

0

76

76

7e

30

17

16

43

44,700

21,400

16,000

e,400

138,400

120,200

3,300

19,100

329,000

108,000

6,700

le,900

40,600

16,300

6,600

2,800

t7,800

3!400

181,500

120,300

61,400

59,400

26,000

14,000

20,000

0

0

0

0

0.06

0.25

0

0

0

1.06

1.22

0.43

0

0

16

15

4

2

32

46

1

4

25

e6

66

99

65

65

66

63

23

90

55

35

7

31

75

0

0

0

0

0

13

19

91

65

0

12

13

0

15

16

9

4

le

10

12

5

17

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

0

0

0

14

6

10

74

e5

93

47

77

66

72

12

0

0

30

Educational neef=t

“Permitted” chronic truancy

Other (e.g., kept child home,

rafused to enroll)

Emotional neglect

Inadequate nurturance (e.g.,

fallura-to-thrive)

“Permitted” chronic maladaptlve behavior

Other

o

0

0

0

‘ More than One subcategory may apply to an Indlvldual child.

‘ The severity measure for maltreatment subcategories Is the severity of the lnJuwllmpairment resulting from acts!omissions in the

particular subcategory. Severity measure for major cat~orles Is the most mrlous Injuwllmpalrment resulting from all In-scope maltreatment events during the study period.

‘ Percentages expressed to two d%lmals.

23
fact caused or materially contributed to the chil~s injury

or impairment.

Verbal/emotional assault was by far tbe most common

form of maltreatment in the emotional abuae category

and, for most in-stop cases (78 ~rcent), there was direct

evidence of injury or impairment, Only 22 percent of the

children in this subcategory were judged to be in-sco~ on

the basis of circumstantial indications of injury. For close

confinement, it was the other way around: most in-scope

cases (73 prcent) involved an assessment that the caretaker acts were inherently traumatic and emotionally injurious (e.g., locking a tweyear old in a clothes dryer as

a form of punishment).

Tbe general definitional requirement in the neglect

area was that, aa a result of extreme parent/caretaker

inattention to the childs basic needs for care, protection

or control, the child experienced foreseeable injury or

impairment of serious or greater severity. Key tests in

assessing individual cases were (a) bad the caretaker

been specifically informed of the chil~a need or problem

by a com~tent professional or, under tbe circumstances

of the situation, would the child’s need have been apparent to most reasonably caring and attentive adults, and

(b) was the parent/caretaker physically and financially

able to obtain or provide the needed care, protection, or

supemision? Cases were not accepted as in-scow unless

botb the respondent and the study ~taff felt there was

reasonable cause to believe the answers to botb questions

were yes,

Physical neglect encompassed a variety of situations:

● Abandonment: deserting an infant or child, without

making any provision for tbe chil&s care or shelter,

and not returning to reclaim custody within two days

(desertion by only one of tbe child’s parents was not

included, and there was no harm requirement—

abandonment was assumed inherently injurious~

. Other refusal of custtiy (a) expelling a child from

home without arranging for care by others, (b) refusing to accept custody of a returned runaway,

without having initiated any action to relinquish CUS.

tody or (c) repatedly shunting a child from one

household to another due to guardian unwillingness

to maintain custdy (there was no harm requirement

for (a) or (b~ evidence of mderate m greater physical, mental or emotional injury was required for

(c)k

. Refusal to allow or provide recommended care for a

professionally diagnosed injury, illness or other

health condition, resulting in foreseeable exacerbation or significant prolongation of the

condition;

. Failure to seek competent medical attention for a

serious injury, illness or other health condition, resulting in foreseeable ,exaccrbation or significant

prolongation of the condition;

● Inadequate physical su~wision, such as leaving a

young child physically unsu~mised for long ~riuds

(dots not include inadequate supcmision or control

of chil~s bebavioq etidence of serious injury foreseeable resulting from extreme inattention was

requiredl

● Disregard of avoidable hazards in the home, foreseeable resulting in serious injury;

● Inadequate nutrition, clothing or hygiene, foreaeeably resulting in serious injury impairment or

health condition; and

. Other or unsWcified physical neglect foreseeable resulting in serious injury, illness or health condition.

As may be seen from Table 5-1, cases accepted as

in-scow in tbe area of physical neglect had serious injuries, and worse, proportionally more often than did

physical abuse cases (46 percent vs. 9 percent). This, of

course, reflects the rigorous severity requirements in most

subcategories of physical neglect.

In the area of educational neglect, the most often identified problem was “permitted chronic truancy.” Key requirements in this subcategory were that the cbilds

truancy must have been habitual, at a level of at least five

days a month on an average, and evidence was requird

that the parent/guardian bad been informed of the problem and had not alrempted toalter tbe child’s behavior,

If there was any indication that the parent/guardian had

made a real effort to change the child’s behavior but had

been unsuccessful, tbe case was not in-sco~, Truancy at

the required frequency was considered to qualify as evidence of mental impairment of at least mtierate severity,

on the assumption that the childs educational development was surely being impaired if he or she was regularly missing upwards of 25 percent of schml days. The

eight percent of cases classified as serious were ones

where a diagnosed need for remedial educational sewices

had already been made.

“Other” educational neglect included:

● A parent/guardian was regularly keeping a child of

mandatory school age at home (e.g., to work for pay,

to care for siblings) with a frequency of at least three

days a month on the average

● A parent/guardian had neglected to enroll a child of

mandatory school age in school, causing the child to

miss at least one month of classe$ or

● A parent/guardian refused to allow r~ommended

(and available) remedial educational sewices, for

reasons other than concern for the childs well-being

(for example, if the parent’s concern was that the

services would do more harm than gd, the case was

not mnsidered in-scow, if inconvenience or possible

embarrassment to the parent was tbe reason, the

case was accepted as in-scope).

24
As shown in Table 5-1, these “’other” problems were by

no means uncommon; they constitute about one-third of

all in-sw~ educational neglect problems.

Emotional neglect included three subcategories

● Inadequate nurturance (extreme parent/guardian

inattention to a childs needs for aflection, attention,

or emotional supprt) causing or materially con.

tributing to the occurrence or unreasonable prolongation of a serious physical, mental or emotional

problem, including but not limited to nonorganic

failure-to-thrivq

. Encouragement or permitting of seriously maladaptive behavior (such as severe assaultiveness,

chronic delinquency or debilitating drug/alcohol

abuse) under circumstances where tbe parentf

guardian bad cause to be aware of tbe existence and

seriousness of the problem (e.g., the child had been

picked up by the plice on previous occasions) and

bad not aftempfed to correct i~ and

. “’Other,” which included refusal to permit recommended treatment for a child’s diagnosed emotional

condition, failure to seek professional assistance for

a severely debilitating emotional condition, and extreme overprotectiveness (if implicated in the causation of prolongation of a severely debilitating

emotional condition).

As shown in Table 5-1, inadequate nurturance was the

most common form of emotional neglect. NO fatalities

were attributed to emotional neglect, but of the six major

categories of maltreatment, this one had the highest proportion (74 percent) of demonstrably serious injuries/

impairments, such as attempted suicides, severe failureto-thrive, and drug overdoses.

Table 5-1 shows the severity distribution for each form

of maltreatment. In Table 5–2, the relationship is

presented in the other direction, showing the form of

maltreatment distribution for each severity category. Fatalities were very uncommon in all major categories,

never exceeding 0.34 ~rcent of in-sco~ children (from

Table 5- I). Table 5-2 shows that the fatalities which did

occur were clustered in two categories, physical assault

(72 percent of fatalities) and physical neglect (28 prcent). Serious injuries/impairments were most often associated with physical and emotional neglect.

In terms of the age of the child, Table 5-2 shows that

extreme injuries tended to occur at tbe extremes of the

age range. Nearly three-quarters of the fatalities Wcurred to children under six years of age (74 percent), and

Table ~2. Severity of maltreatment related injury or Impairment by form of maltreatment and age of child:

Eatlmated percentage distrlbutiona by severity catego~,

Form of maltreatment

and age of child

Estimated no. of children

‘orm of maltreatment

‘hysical asaault

iexual exploitation

lmotlonal abuse

‘hyslcal negl~t

!ducatiemal negl%t

:motional neglect

Total ‘

Aga of child

o-2

3-5

*8

9-11

12-14

15-17

Total

L

Sevel

T

72

1

0

28

0

0

101

14

5

16

36

19

34

124

49 I 16

1

25 7

2 17

0 19

1 14

23 27

100 100

of injury or impairment

T

40 24

3 24

22 24

9 20

34 15

1 6

113 113

5 10

9 13

la 15

18 20

23 20

27 22

100 100

Total

652,000

32

1

21

17

26

9

114

e

9

17

19

21

26

100

1Percentages sum to more than total slnca a child with a glvsn savarity of inj”~ may have experlencti more than one form of

maltreatment,

‘ ‘<Probable<, should not be Intorprated as le~ serious than ,,Moderate.,s Incsst, abandonment, axtmma CIOS confinement and other

,,probabls,, lnju~ situations are considered to beat least as serious as many situations where there are known injuries of mtierata or

evan 8erlou8 dimension (e.g., a black aye or laceration resulting from a slap).

25
26

Figure 5. Age by sex incidence rates for major forma of In-scope child abuse and neglect.

Abuse Boys Nwlect

_ _ Girls

6.o

I “’’-’-” ‘-’””- PHYSICAL ABUSE

2.0 I

----------

.=--

6.0

I

EMOTIONAL/OTHERABUSE

4.0 l!

‘~

o-2 3-5 6-8 9-11 12-14 15-17

CHILD,S AGE GROUP

PHYSICAL NEGLECT

I

I

EDUCATIONAL NEGLECT

/

/

ALL FORMS OF NEGLECT

/

) I I I I I

&2 3-5 66 9-11 12-14 15-17

CHILD’S AGE GROUP
Table W. Form of maltreatment by child demographic characteriatlcs Percent of estimated total number of

in-scope maltreated children.

Form of maltreatment

Child characteriafic

Abuse Negleot

PhyaSexual ::a; Total p~- y;;:- ;:a; Total ‘eta’ iml

Estimated no. children (1,000) 207.6 44.7 136.4 351.1 108.0 181.5 59.4 329.0 652.0

tge of child (OAknown) (99) (99) (loo) (99) (loo) (99) (loo) (99) (99)

)-2 11 2 3 7 23 0 6 9 8

j-5 17 6 9 12 9 3 5 5 9

j-8 17 11 17 17 20 16 13 18 17

I-11 16 21 19 18 18 19 16 16 19

12-14 19 26 20 21 14 29 20 22 21

j5-17 20 32 32 25 16 31 40 28 26

Total 100 100 100 100 100 100 100 100 100

3ex of c~ld (OAknown) (99) (99) (loo) (99) (loo) (99) (loo) (loo) (loo)

30ys 47 17 43 43 53 63 72 61 52

;Irls 53 83 57 57 47 37 28 39 48

Total 100 100 100 100 100 100 100 100 100

Shjjd’s ethnic groupl (O/.known) (99) (99) (99) (99) (99) (99) (99) (99) (99)

Nhlte 86 66 92 69 64 72 69 77 62

3jack 13 11 7 10 15 27 11 22 16

3ther 1 1 1 1 2 1 1 1 1

Total 100 100 100 100 100 100 100 100 100

‘For comparison with Census data, ,<White” Includes ..White, not of Hispanic origin,, and “Hlspanlc.”

most of the rest (23 percent) to children in the 15-17

range. Serious injuries also wcurred relatively often in

the extreme age groups.

b. Age and Ssx of Child

Age by sex relationships for the major forms of inscow abuse and neglect are presented in Figure 5 and, in

a somewhat different format, in Table 5-3. In Figure 5,

data are presented in the form of incidence rates, to adjust

for the fact that the number of children in the nation

increases as a function of age group. As may he seen, age

by sex relationships are very diKerent for the different

forms of maltreatment. There are some conspicuous similarities, however. First, in the O-2 age group, there are

essentially no sex ditTerences in incidence. In that age

group, incidence rates for boys are nearly identical to

those for girls, for all forms of maltreatment. Second,

there is a consistent pattern of sex ditTerences increasing

with increasing age, the largest sex differences occurring

..- . . . . . .. . . .

In the I>–II group, 1nlra, tne alrectton 01 me sex

ditTerence in the up~r age range is different for abuse

than for neglect. For all three forms of abuse, incidence

rates are substantially higher for girls than for boys in the

upper age range, and the reverse is true for two of the

three major neglect categoric% the one exception is physical neglect, where incidence rates are slightly higher for

girls than for boys in the 12-17 age range.

Among girls, the incidence of physical abuse gradually

increases with increasing age, For boys, 3–5 seems to be

the pak age, and incidence rates gradually decline thereafter. It is curious that the incidence rate is so much

higher for boys than girls in the 3-5 age group, but nw

where else along the age spectrum. It is also interesting

that the measured incidence of physical abuse of boys

declines during the teenage years: one wonders whether

physical abuse of boys occurs less often then, or isjust less

often recognized.

1n the area of sexual abuse, girls are victimized more

27
-m

,,.,,

/ ,

,’

,’

,’

,,

/

,’ g!

,/ gg

/’”~

-
often than boys at all age levels. The problem is not

unique to girls, however. Overall, 17 ~rcent of sex abuse

victims are boys (Table 5-3). The striking thing about the

incidence curve for boys is that it is very close to horizontal: the incidence of sexual abuse of boys dws not inappreciably with increasing age. It is no higher (or lower)

at age 16 than at age 6. For girls, the incidence rate dws

increase with age, but not as much as one might exwct.

As many female sex abuse victims are under age 12 (50

percent of the total) as are in the 12-17 age range (from

Table 5-3). It appars that the age-at-risk for sexual

abuse has a wide range. The risk in the years before

puberty is only somewhat lower than it is after puberty,

for girls as well as boys.

In the area of emotional abuse, incidence rates increase

gradually with increasing age for both sexes. There is no

appreciable sex difference in incidence until the 15-17

age groups, at which pint the incidence rate for girls

suddenly jumps to almost three times the rate for boys. It

is intriguing that such a pronounced increase ~curs in the

15-17 group and that it occurs only for girls. The reasons

for the increase, however, are not readily apparent.

Physical neglect is the only form of maltreatment for

which the incidence curve has a generally downward S1OF

for both boys and girls. For both sexes, the age group at

greatest risk is 0-2. NO doubt, this curve reflects the

extreme physical dependency of infants and the decline in

physical de~ndence which occurs as children get older.

Since educational neglect involves school-related problems, it is essentially nonexistent until age 6. Then and

thereafter, the incidence rate is higher for boys than for

girls, For boys, incidence rates increase sharply and

evenly over the 6-17 age range. One might s~culate that,

in families where educational neglect wcurs at all, the

problem tends to be chronic and cumulative in its manifestations. Such an interpretation may work for boys, hut

doesn’t seem to apply to girls. For girls, the jagged age

curve is not suggestive of long term cumulative problems.

Finally, tbe incidence of serious emotional neglect is

substantially higher for boys than for girls from age six

onward, For both sexes, the incidence rates are constant

from ages 6-14 and then increase significantly during the

years I 5-17.

c. Ethnic Group of Child

Relationships between cbilts ethnic group and major

form of maltreatment are presented in the bottom prtion

of Table 5-3. Compared to their representation in the

national ppulation (15 Prcent), Black children are underrepresented in all abuse categories and in all neglect

categories except educational neglect. Educational neglect is a large category, however, and the overrepresentation of Blacks is substantial (27 percent of

children in-scope for educational neglect vs. the 15

~rcent of U.S. children). Because of this, tbe overall

representation of Blacks among in-scow children is about

the same as in tbe general population (16 percent).

White children constitute 83 percent of the child PpuIation. It may be seen that this group is proportionately

overrepresented in all maltreatment categories except educational neglect.

d. Family Income

Table 5-4 presents relationships between form of maltreatment and estimated annual family income. An estimated 55 percent of all U.S. children live in families with

annual income of $15,000 or more, and only 17 ~rcent

live in families with incomes under $7,000. In comparison

to the income distribution for all U.S. children, children

from low income families are overrepresented in all maltreatment categories. Not to the same extent, howevec

tbe strongest relationships between poverty and maltreatment occur in the areas of physical and educational

neglect, where over half of all in-scope children were

reprted to live in families with income under $7,000.

Overall, the relationship is substantially less pronounced

for abuse than neglect: 34 percent of all in-scow abused

children have family incomes under $7,000, as compared

to 53 pcr=nt of in-sco~ neglected children. The forms of

maltreatment recognized proportionately more often in

families of $15,000 or more than in lower income families

are emotional neglect and emotional abuse.

e. Ethnicity and Family Income

In the previous chapter, it was shown that tbe overall

incidence of in-scow maltreatment is unrelated to ethnicity, but it is strongly related to income (Figure 4). In

the general population, income and ethnicity are related

to one anothe~ the proportion of Nonwhite children who

live in families with annual incomes under $7,000 is three

times higher than the percent of White children whose

families are in that income group ( 38 percent vs. 12 Prcent).l This implies that, at least for some income levels

and/or for some forms of maltreatment, the incidence

rates for minority group children must be lower than

those for White children.

Interrelationships among ethnicity, family income and

form of maltreatment are examined in Figure 6.3 It may

be seen that, for families with annual incomes of $15,000

or more, there are essentially no differences at all between

White and Nonwhite children in measured incidence,

Among lower income groups, the incidence rates are consistently higher for White children than for Nonwhite

children. This is particularly true for abuse: in the lowest

income groups (under $7,000), the overall incidence of

in-sco~ abuse is four times higher for White than for

Nonwhites (16. I children pcr 1000 vs. 4.4 children pcr

1000k it is two times higher in the $7,000-$14,999 group

‘From 1911 income estimates conlaind in Srafisdcal Abslrocl of Ihe

UniledSt.fc$ (/979), U.S. Bureau of {h. Census, Washington. DC.,

I 979.

‘For simplicity, .’BI.cW and ‘“Other” sro.ps arc mmbind t. rorm a

sinale .,Nonwhite” catcsory in these graphs. As in earlier tabulations.

..Wbite. includies .~White, not .f Hispanic .rigin” and .<Hispanic.”

29
Teh,m z “ r--- -’ -”, --------- L., -_, __.. >L... -- L-a2 . . . . ---- ... . . . . . . - . ..-.+-A ●-,-, -, .-h---- :- “------ ,. .--.-4 -L: ,4---

Household characteristic

Estimated no. children (1,000)

Estimated annual family income (.A know”)

Under $7,000

$7,000-$14,999

$15!000-$24,999

$25,000 or more

Total

No. children in household (“Aknown)

1

2-3

4 or more

Total

Type of county (OAknown)

Urban

Suburban

Rural

Total

For I of maltreatment

Physical

207.6

(8S)

35

44

16

6

100

(95)

25

54

21

100

(loo)

47

21

32

100

Abuse

Sexual

44.7

(89)

38

42

18

2

100

(95)

23

51

26

100

(100)

36

16

46

100

Emotional

138.4

(62)

31

46

15

8

100

(92)

21

52

27

100

(loo)

42

27

31

100 ;

Total

351.1

(63)

34

44

15

7

100

(94)

24

53

23

100

(loo)

44

22

34

100

Physical

106.0

(66)

57

34

7

3

100

(90)

27

45

26

100

(loo)

46

21

33

100

Nqle

Edu=tional

161.5

(75)

53

35

10

2

100

(79)

20

56

24

100

(loo)

52

14

34

100

Emotional

59.4

(87)

45

31

15

9

100

(87)

38

37

25

100

(loo)

30

35

35

100

Total

329.0

(60)

53

34

10

4

100

(63)

24

51

25

100

(loo)

47

19

34

100

Total

652.0

(61)

43

39

13

6

100

(89)

24

52

24

100

(loo)

45

21

34

100
(9.8 pr 1000 vs. 4,7 pr 1000} and the rates are essentially identical in the $15,000 and above group (2,2 ~r

1000 vs. 2.3 pcr 1000).

To a lesser extent, the same relationships exist in the

neglect areas. The one exception is educational neglect,

where incidence rates for White and Nonwhite children

are essentially identical at each income level. This indicates that the overall overrepresentation of minorities in

this area (noted in Table 5-3) is nof due to an unusually

high incidence of educational neglect in Nonwhite famiIiey rather, it is due to two other factors (a) the strong

assmiation between educational neglect and pverty for

all ethnic groups, and (b) the assmiation between ethnicity and pverty in the total U.S. ppulation.

f. Numkr of Children in Family

As noted earlier (Table 4-3), overall incidence rates

are somewhat higher for one-child families and for families with four or more children than for families with two

or three children. In the total U.S. ppulation, 22 percent

of children live in families with four or more children; 19

percent are only children. It maybe seen from Table 5-4

that “only” children are overrepresented in all maltreatment categories, but particularly in the area of emotional

neglect (where 38 percent of in-scope children are “only”

children, exactly twice the ~pulation percentage). Children in families of four or more children were somewhat

overrepresented in tbe areas of physical neglect, emotional abuse, and sexual abuse.

g. Type of County

Table 5-4 also presents relationships between form of

in-scope maltreatment and type of county. The strongest

association is for sexual abuse, which appears substantially more common in rural areas than elsewhere. Thus,

46 percent of sexual abuse cases were identified in rural

counties, though only 31 prcent of the nation’s children

live in such counties (from Table 4-3).

By contrast, educational neglect is more common in

urban areas than elsewhere 44 ~rcent of U.S. children

live in urban counties (from Table 4-3), but 52 percent of

in-sco~ educational neglect cases came from such

counties.

Emotional neglect is disproportionately common in

suburban areas, which contain 25 ~rcent of the nation’s

children but 35 percent of children with in-stop emotional neglect.

The urban-suburban-rural distribution for the other

three major forms of maltreatment (physical abuse, emotional abuse and physical neglect) is roughly the same as

the population distribution.

b. Involved Adults

Table 5-5 presents findings concerning the adult(s)

involved in the di~erent forms of maltreatment. In-home

parents and parent substitutes could be involved either as

perpetrators of the harm-causing acts/omissions or as

having knowingly permitted maltreatment by others.

Other adult caretakers were considered involved only if

Twbb W Form d maltreatment by lnvo~ adult cha,acterlstlw Perw”t of -timat~ total n.m~r of In-Sow maltre.t~ children

*yshl

ml,e

(9s)

24

22

41

5

8

lW

w

3

2

1

72

45

15

3

1

as

e

1

5

?

13

Al

bxuml

U.7

(08)

10

36

21

1a

17S

100

43

1

1

46

28

30

1

3

62

11

2

5

14

32 —

For

e

:motloml

1s,4

(99)

27

8

m

2

10

lW

71

13

2

3

89

m

21

3

2

u

4

2

3

3

13

,Oml — I

,51,1

(99)

23

19

42

6

10

lW

w

e

2

2

74

40

18

3

2

S3

7

2

3

3

&

fl maltreatment

NWIH

~hyslal

108,0

(09)

38

8

43

?

12

100

83

5

1

89

48

6

~

1

54

6

1

4

1

A

+

:duwtionat

181,5

(99)

52

6

a

0

4

lW

88

4

1

93

36

7

1

44

1

2

1

1

.

7

:motbnal Tohl

59.4 329,0

(99) (99

33 45

5 0

47 41

3 1

12 7

lW

84

4

2

1

91

42

10

2

%

5

8

3

A

100

88

4

1

1

92

40

7

1

1

49

3

2

3

8 —

,Otal

;52.0 I

(99)

u

13

41

4

8

100

75

4

1

1

82

41

12

2

1

58

5

2

4

1

12 —

, 70 -! 0! [- w. @mblnatlon 01 mot*/,ub.tlt”t. -d otm adul! -M*-. 31
they had committed harm-causing acts/omissions.

The top section of Table 5-5 shows the mmbinations of

adults involved in tbe various forms of maltreatment. It

indicates that, overall, tbe mother/substitute was the only

involved adolt for 34 percent of in-sco~ children, the

father/substitute was tbe only adult involved in 13 percent of the cases, and botb parents/substitutes were involved for 41 percent of the cases. This last prcentage

includes situations where both parents/substitutes were

directly involved as “perpetrators” and situations where

one parent/substitute was tbe “prpctrator” and tbe

other a passive “accomplice,” who was aware of the other

parent/substitute’s behavior but did not intewene to help

or protect the child. An additional four percent of cases

were ones where an adult caretaker other than an in-home

parent/substitute was tbe sole perpetrator. The remain.

ing eight percent involved an “other adult” perpetrator

and one or both parents/substitutes, who may have been

actively or passively involved.

The lower section of Table 5-5 indicates, for each

major category (mother/substitute, father/substitute,

and other), the prcent of in-stop children for whom an

adult in that category was involved in the maltreatment

and the adult’s relationship to the child. It may be seen

that mother/substitutes were involved in 46 percent of

sexual abuse cases, in 72 ~rcent of physical abuse cases,

and in approximately 90 percent of all other forms of

maltreatment, Particularly in the abuse categories,

mother/substitutes were seldom the only involved adults,

however, Across all forms of abuse, mother/substitutes

were the sole perpetrators only 23 percent of the time.

In-home father/substitutes were involved (singly or with

other adults) in 63 percent of abuse cases, and other adult

caretakers were involved as perpetrators in 15 percent of

abuse cases.

[n the area of sexual abuse, the patterns of adult involvement are diflerent than for other forms of maltreatment. In this area, mothers and mother substitutes

were seldom the primary prpctrators. Even for the 10

~rcent of sexual abuse victims for whom mother/

substitutes were listed as the only involved adults, tbe

mother/substitute’s involvement may often have been one

of allowing someone else (e.g., a sibling, a neighbor) to

abuse the child, It is noteworthy, however, that

mother/substitutes were at least passively involved (if

only in allowing a known problem to continue, without

attempting to help the child) in nearly half of all in-stop

sexual abuse cases (46 prcent).

Biological fathers were also involved in sexual abuse

less often than in other forms of maltreatment. At most,

only 28 percent of in-scope sexual abuse cases involved

father-daughter (or father-son) incest or molestation.’

More often than for other forms of maltreatment, step- ,

fathers and other adult caretakers (such as a single.

parent’s paramour) played relatively major roles as

pcrptrators of sexual abuse).

“ %me of the scx”al abuse cases in which biological falhers were involved were . ..s where the fathers involvement was i“direci,

32
6. Demographics of

Recognition and

Reporting

Thus far in this re~rt, the emphasis has been on a

description of the numbers and characteristics of in-scope

children identified to the study, without regard to whether

or not they bad been repnrted to the local CPS agency: In

this chapter, it is the reporting system which is tbe primary fmus of attention. Analyses in this chapter center

around four system-related questions: who sees what?,

how much is repnrted?, what is refmrted?, and who is

reported? The premise of the analyses is that most of the

problem situations encompassed by the study definitions

also fall within most states’ abuse/neglect re~rting statutes and, arguably, should be reported to CPS.

Who Sees What?

It would be useful (e.g., in targeting of in-semice training and other community education and case finding

eflorts) to know what kinds of abuse/neglect problems

are most often encountered by ditTerent pntential referral

sources.

Table 6- I shows, for each major form of maltreatment,

thepercent ofin-scope children who were identified-to

CPS and/or directly to tbe study—by each major source

of information. The findings in this table are disappointing in that they do not reveal a great deal of

differentiation among sources in the kinds of i“.sm~

maltreatment encouritered. Basically, everyone seems~o

see a little of eve~thing. Courts and corrections agencies,

for example, account for (i.e., were the source of information to CPS and/or to the study for) seven ~rcent of all

in-scope children, and they account for roughly seven

percent of in-scope cases in most categories of maltreatment: the excsption is sexual abuse, where courts/

corrections agencies contributed a larger share of the

in.sco~ cases (17 ~rcent), Other law enforcement agencies (police, sheritTs’ and cnroners’ offices) also encoun.

tered a relatively large proportion of sexual abuse cases,

accounting for 15 percent of in-scope sexual abuse cases,

as compared to an overall contribution of eight ~rcent,

Although sources were not strongly differentiated in

terms of the kinds of cases encountered, they were

markedly difierent from one another in the numbers of

cases they identified to CPS and/or to the study, In this

respect, public schools stand out as the most impnrtant

source of information about all forms of maltreatment.

Public schnnls account for 81 ~rcent of educational neglect cases and for about half of the cases in all but one

of the other maltreatment categories. The exception is

sexual abuse, but even there, schnnls identified 20 percent

nf all in-sco~ cases, which was more than any other

single source,

Tbe prominence of schnnls is not surprising. Nearly all

children in the 5-17 age range are enrolled in schnnl, and

scbnnl personnel have a daily contact with children of a

nature which places them in a uniquely advantageous

position to observe iniuries. behavior chanzes. and other -.

indications of pnssible child abuse or neglect,

r

&urm d lntim*tbn

10CPS sndlar study

Estlma!ti no. children (l,OW)

Swm. d Intirm.th” t. CPS

.“dlor mt”ds, (.A known)

OSS/Welfere hpt.

co”,t8/co,,wtlon, age”cl~

Polloalsnerlfllcoro”w

Public health dewtime”ts

Mtilcat w“,..,, .Xwt Publlc

hmlth

P“bllc ~hmls

Other ,t”dy ew”cl~

Other CPS murc~

rota!

Phy.lal

207,6

(00]

2

5

11

1

10

4s

13

12

?nn

m

kxul

U,7

(lW)

2

17

15

2

Q

20

19

15

lW

8

EMt~l

lW.4

(tin)

1

7

8

1

3

55

10

14

lW

Ttil

351.1

(00)

2

7

10

1

8

a

!2

14

lW

[lW) (lW)

3 2

e 8

10 5

4 0

12 1

M 81

6 2

13 3

Em-l

59,4

{lW)

1

12

11

1

8

52

8

10

lW

(lW)

2

7

7

2

5

w

5

7

lW

2

7

8

1

7

m

9

11

lW —

33
Table -2. Rate of reporting to CPS by source Estimated annual number of recognized in-scope children and

proportion reported to CPS, by source of information to CPS and for study.

Source of information to CPS

andl or etudy

Investigatory agencies’

Courfslcorr=tions agancies

Pollcelsherlfflcoroner

Public health departments’

Subtotal

Other etudy egarmiee’

Hospitals

Public schools

Mental health agencies’

Other social sewlce egancies’

Subtotal

Total, all study sources

Other sourcee (CPS only)’

DSSIWelfare Department

Other professlonallagency sources’

All othar sources (child, femily,

neighbors, anonymous, etc.)

Subtotal

Total, all sources

Eetimatt no. in-ecopa children

I

Reported

to CPS

(A)

10,300

22,400

2,400

35,100

20,600

46,800

9,200

7,000

63,600

118,700

12,300

12,300

69,100

93,700

212,400

Not

reported

to CPS

(B)

33,100

31,500

6,800

71,400

16,200

316,600

19,900

15,400

368,100

439,500

7

7

?

7

439.500+

Total

(c)

43,400

53,900

9,200

106,500

36,800

363,400

29,100

22,400

451,700

558,200

12,300+

12,300+

69,100+

93,700+

652,000+

Proportion

reported

to CPS

(AIC)

.24

.42

,26

.33

.56

.13

.32

.31

.19

.21

?

7

7

7

7

‘ Priority Classlflcatlom each row represents children over and above those In previous row% children who were identified to study by

Dartlclpatlng nOn-CPS OgenClOS and who were afso reported to CPS by any source are in the ,,Reported to CPS” column. Thus not

reported’ means nOt reported by this agency type or by anv other source.

2 ,, Reported” column Includes ch!ldren reported to CPS by all such agencies. In the county or elsewhere. “Not reported” column reflats

response from partlctpatlng agencies only, with no statistical adjustment for agency sampllng or non-partlclpatlon.

‘ Categow Includes State pOllCO. m&lCal CllnlCS. private phvslclans, smlal educatlOn schools, prlvatelparochlal =hools. preschools and

day care facilities.

‘ The qUOStlOn marks In this SOCtlOn Indicate that, fOr sources nOt represented In the nOn-CPS data collection, the study has no dtr%t

estimate of the numbers of In-xOpe children who were rmognlzed but not reported to CPS or of the repofilng rates for such sourc-.

How Much is Reported?

As noted in Chapter 3, children reported to CPS represent only one-third of the in-scow children identified to

the study. The other two-thirds were identified to the

study by non-CPS agencies hut were not reported to CPS.

In this section, CPS reperting by individual sources is

examined.

Table 6-2 gives national estimates, by source, of the

number of in-sco~ children reported to CPS, the number

of additional in-sco~ children (not reported to CPS)

identified to the study, and the proportion of the total

(reported Plus unreported) which was reprted to CPS. It

may be seen that agencies encompassed by the non.CPS

com~nent of tbe study are estimated to have reprted a

total of I I8,700 in-stop children to CPS during (be

study year, The estimate is that, in addition to tbe inSCOP children who are rewrted to CPS each year (by

these and all other sources of information to CPS),

439,500 other in-scoW children are recognized and identifiable from these non-CPS agencies. Thus, tbe 118,700

in-sco~ children reported to CPS by study agencies rep

resent an estimated 21 ~rcent of all recognized in-scope

children identifiable from such agencies.

The estimate that, overall, only 21 percent of recognized in-scope children are reported to CPS by agencies

encompassed in this study is regarded as an uppr limit

estimate, for two major reasons

( 1) In several categories, tbe number of agencies

34
represented in the reported-to-CPS column is considerably larger than the number of agencies

encompassed in the study estimate of unreprted

children, Examples:

● The study estimate of unre~rted children identifiable from cOurts/corrections agencies

(33,100) is based on findings from a single

courts/corrections agency in each study county

(usually, the Juvenile Probation Department),

while the estimate for reported cases ( 10,300)

includes reports to CPS from the study agency

and also those from all other courts/corrections

agencies in the county (or elsewhere) which

may have made reprts to CPS—the adult

probation department, adult and juvenile parole

departments, family and criminal courts, the

offices of the county prosecutor or district attorney, etc. Thus, the estimated reprt rate in this

category (24 percent) overstates the amount of

reprting by agencies encompassed in the study

design.]

. The estimates of unreprted cases for mental

health and social service agencies are based on

findings from one or two such agencies per

county, while the reported column includes reprts to CPS from all such agencies which exist

in the study counties and surrounding areas.

Particularly in the larger counties, tbe number

of mental health and social service agencies participating in thestudy represented only afraction of the agencies which exist in these

counties.

(2) Theestimated numbers ofunreprted children understate tbe actual numbers of in-scope children

who were known to, but not reported toCPS by,

the professional statTs of tbe study’s non-CPS

agencies. As noted earlier (Chapter 2), Iarge and

central city agencies (which provided relatively

large numbers of cases per agency) are underrepresented in the study estimates. In addition, the

voluntary nature of the non-CPS data collection,

together with the limited support the study received at some non-CPS agencies, undoubtedly led

to further underestimation of the numbers of rec.

ognized but unreported cases.

The reporting proportions shown in Table 6-2 are

rather striking, particularly since they are overestimates.

The table shows that, for the relatively clear-cut and

serious kinds of abuse/neglect problems encompassed by

the study definitions, courts/corrections agencies and

public health departments report to CPS at most only

about one-quarter of the cases they encounter and recognize. Public schwls, altbough they arethemajor institutional source of referrals to CPS of in-scow cases, reprt

an even lower 13 percent. In fact, the estimated number

of unreported in-scope children identifiable from public

schools alone (316,600) is substantially larger than the

total number of in-scope children reprted to CPS by all

sources combined (212,400).

The highest rates of reporting toCPS were found for

hospitals (56 percent) and for police/sheriff/coroners (42

percent). These findings could indicate: (a) that these

sources reported to CPS relatively high proportions of the

in-scop children they encountered, and/or (b) that the

study data collection prwedures were relatively unsuccessful in documenting unreported cases from these

sources, The latter is a distinct possibility, The study

prmedures to enlist participation by individual professional staff members may have been Iessefiectivein hos.

pitals and police/sheri~s departments than for other

agencies, due to their particular structural chracteristics—the use of work shifts, outstationing of personnel (e.g., in precinct stations, as opposed to the

headquarters offices), socialization of personnel (e.g.,

emergency room physicians vs. attending pediatricians vs.

outpatient department nurses, etc., each of which had to

reenlisted separately ), and soon. Incontrast to schools,

where it was often possible to achieve face-to-face contact

with all professional sta~ in a single faculty meeting,

there was relatively little direct contact between study

~rsonnel and the statTs of hospitals and plice/sheritTs

department the quality of the data collection may well

have suflered as a result.

Thus, it is not clear whether public schools reported a

smaller proportion of recognized abuse/neglect cases to

CPS than other agencies or wbetber tbe study simply did

a better job with schools than with other agencies of

documenting unreported cascs. Asnoted earlier, thereporting rates shown in Table 6-2are overestimates and,

forsome kinds of agencies, they mayoverestimate bya

substantial degree the actual level of reporting to CPS of

recognized child abuse and neglect.

It is unfortunate that tbe study is unable to provide

more precise information about tbe extent of reprting to

CPS of recognized cases of child abuse and neglect. From

even the most optimistic reading of Table b-2, however,

one thing d~s seem clear: the vast majority of child abuse

and neglect cases recognized by professionals in the community are not being reported toCPS agencies.

‘Touv.id s"ch,..verc."ntina,, .frewrts t. CPSbyaaencies rcpre. What is Reported?

se.tcd i. the n.n.CPS data c.llecti.n, it would have b... necessary

Iousccrtai” lhcs~cific ”amcs(rathcr than thcac”cral ty~s)o[ the As may be seen from Table b-3, level of recognition

agenciesinvolved in rcprts m CPS.This was “01 done. since it w.”ld

have been a breach of confidentiality [or CPS agencies t. have pr+

distributions varied substantially from one form of real.

vialed such idc”tify ina information. treatment to another, Overall, an estimated 33 percent of

35
all in-stop children (those reported to CPS or identifiable from other agencies encompassed by this study)

were reported to CPS. Forthree of thesixmajor categories of maltreatment, less than one-fourth of all in-stop

children had been reported to CPS: educational neglect

(13 prcent), emotional neglect (20 psrcent), and emotional abuse (24 percent). Even for the form of maltreatment proportionately most often repurtd to CPS,

sexual abuse, the prcentage was only 54 percent.

Overall, “other investigatory agencies” identified to the

study an additional II percent of all in-scow children,

The percentages were about twice that for sexual abuse

(23 percent of the total) and emotional neglect (20 per.

cent). The percent of in-scow children who were not

known to CPS or to other investigatory agencies but were

identified by other study agencies (schools, hospitals, etc. )

was 56 Wrcent overall; it ranged from a low of 23 percent

(sexual abuse) to a high of 78 percent (educational

neglect ),

The lower section of Table 6-3 shows the level of recognition distributions by severity of maltreatment-relatd

injury or impairment, As shown, 87 ~rcent of all

maltreatment-related fatalities identified by the study

had been reported to CPS, andtbe remaining 13pcrcent

were known toother investigatory agencies, Schools, hospitals, and other study agencies identified no in-stop

fatalities over and above those already known to CPS or

other investigatory agencies, This is an unexpected, interesting, and ironic finding. The irony stems from the fact

that the 87 percent report rate for fatalities represents tbe

single highest report rate found in the entire study: of all

the reportable phenomena (problems, situations, subpupulations) covered in this study, the only one which

seems to be reported to CPS agencies with a high degree

of regularity is the one about which CPS can do abs~

Iutely nothing to help tbe victim: fatalities.

The finding is also unexpected, tie of the byputheses

upon which the study design was based was that

abuse/neglect-related fatalities (i.e., homicide or manslaughter) might seldom be re~rted to CPS. It was

thought that such cases might often be handled by law

enforcement agencies and that, partly because CPS could

do nothing for a child wbo had died, it might seldom wcur

to anyone to report such a situation to CPS (unless there

was concern for other children in the family, in which case

they—rather than the homicide victim—would be the

“reprte~ or “client” children). An interest in identifying such cases was one of the major reasons for including coroners, police departments, and public health

departments in the study design. The hypothesis, it seems,

was incorrect. Very few unreported fatalities were picked

up through the non-CPS data collection.

In marked contrast to fatalities, only 23 ~rcent of

recognized in-scow children wbo had suffered serious

Table ~. Level of recognition by form and severity of maltreatment Percent of estimated number of r%ogrrlzad In-scopi children.

Level of rwognition

Form and severity Eotimatad Other Othar

of maltreatment no. children CPS

invesfi- Total

gatory

study

agencies agancies

Form ot maltreatment

Physical assault 207,600 46 9 45 100

eexual exploitation 44,700 54 2s 23 100

Emotional abuse 138,400 24 14 63 100

Abuse Total 351,100 41 12 47 100

Physical neglmt 108,000 41 12 48 100

Educational neglwt 181,500 ‘13 9 78 100

Emotional neglect 59,400 20 20 59 100

Neglect Total 329,000 23 11 66 100

Total 652,000 33 11 56 100

Severity of inju~ or impairment

Fatal 1,000 87 13 0 100

SerlOua 137,400 23 17 59 100

Moderate 411,600 32 9 59 100

Probable 102,000 48 11 41 100

Total 652,000 33 11 56 100

36
Table ~. Selected characteristics of all U.S. children, all alleged CAIN victims reported to CPS, and all

recognized in-scope children by level of recognition: Estimated percentage distributions.

In-scope children

Allqad Level of rwegnifion

Characteriafic All U.S. victims Other

children’ reported investiOther Total

to CPS CPS

gatory

study

agenciea agenciea

;stimated No, children 61,900,000 1,101,000 212,400 71,400 368,100 652,000

Shlld’# ethnic group’

(% known) (96) (99) (96) (99) (99)

Nhlta 63 82 84 83 81 82

31ack 15 16 14 15 18 16

Other 2 2 2 2 1 2

Total 100 100 100 100 100 100

Estimated annual family

Income (“Aknown) (86) (95) (60) (72) (61)

under $7,000 17 52 46 50 36 4s

$7,000-$14,999 26 36 40 26 41 39

$15!000-$24,999 34 6 10 17 14 13

$25,000 or more 21 2 3 6 7 6

Total 100 100 100 100 100 100

Income by ethnicity ’

Under $7,000 ‘A White 63 73 79 68 80 76

$7,000-$14,999: “AWhite 80 e9 8e 94 87 68

$15,000 or more “h White 92 92 64 96 95 92

All income levels Y. Whit e 83 82 64 63 81 82

Age of child (“A known) (99) (99) (99) (99) (99)

o-5 29 41 32 19 8 17

6-11 33 34 33 12 42 36

12-17 38 25 35 69 50 47

Total 100 100 100 100 100 100

'Estimates derived frOm Statlstlcal Abstract of the Unit&States: 1979, U.S. Bureau olthe~nsus. Washington, D.C.. 1979

‘For comparison with Census data. first categow includes ,,whlte, not 01 Hlspanlc Orlgln,, and ‘sHlspanlc. ” Data for 197S.

‘Data for 1977.

injuries or impairments as a result of child abuse or neglect were re~rted to CPS. This is lower than the overall

reported ~rcentage (33 ~rcent). Thus, with tbe conspicuous exception of fatalities (which represent only

l,OOOOf the652,000 in-scopc children), it appsars that

the most seriously injured children are least Iikely to be

reported to CPS.

Who is Reported?

The conventional wisdom is that, although child abuse

and neglect occur in all racial/ethnic groups and in all

socio-economic strata, one’s chances of being reported to

CPS agencies and officially labeled as a victim or pcr-

~trator of child abuse or neglect are greatly enhanced if

one is ~r, fmwerless, or a member of an ethnic minority.

Among the factors often cited in supprt of this notion

are:

. CPS agencies are Iwated in county welfare departments, which may be seen as “appropriate” only

for minorities and the PC

. Professionals working in arnuent communities may

often be particularly reluctant to reprt suspected

cases to CPS, due to fear of retaliation by an

influential parent, reluctance to “make waves” in the

community, availability of alternative service resources for the family, etc.; and

37
. Cultural, economic, and ethnic stereotypes may

aflect perceptions and reporting practices (e.g., what

a White middle class professional may see as an

unfortunate family stress problem if it occurs in another White middle class family may be perceived as

a reportable child abuse problem if it wcurs in a

pmr or minority family).

Several features of the National 1ncidence Study methodology were intended to minimize the influence of such

reporting “biases:”

. Collection of data from schmls, hospitals, mental

health facilities, and other agencies serving a wide

demographic spectrum, as well as from CPS, plice,

courts, etc.;

. Use of safeguards to ensure respondent anonymity

and confidentiality, to avoid possible reprt-related

concerns about retaliation, embarrassment, inappropriate intervention, etc.;

. Avoidance of pejorative terminology as much as Pssible in study definitions and other materials, as by

referring to assault rather than abuse, inattention

rather than neglect, etc.; and

. Use of rigorous harm and other screening criteria to

minimize further the influence of sociocultural value

judgment: for example, not accepting allegations of

“inadequate” care or “pigsty” living conditions unless the respondent could demonstrate that the child

had actually suffered serious injury or impairment as

a result of the inattention or disarray.

This section examines factors associated with the reporting (or non-reporting) to CPS of suspected child maltreatment and assesses the demographic effects of the

study data collection and screening procedures. As a basis

for discussion, Table 6-4 presents demographic profiles

for in-scope children—by level of recognition—and for

two comparison populations, all alleged victims reported

to CPS and all U.S. children.

In terms of ethnicity, the various study provisions to

adjust for the expected “overreprting” of minorities to

CPS appear not to have been needed. The ethnic distribution for all children re~rted to CPS as alleged victims of

abuse/neglect mirrors the ppulation distribution almost

exactly. The subset of reprted children who were accepted as meeting all study requirements and the additional in-scope children wbo were identified from other

study sources also mirror the ethnic distribution of the

general ppulation. These findings do not support the

conventional wisdom that minorities are being overre~rted to CPS agencies.

The situation is different with respct to annual family

income. As shown in Table 6-4, the income distribution

for children reprted to CPSismarkedly different from

the general population distribution. In 1977,55 percent of

all U.S.cbildren livedin families with annual incomes of

$15,000 or more. With inflation, the percentage was

probably higher than that during the 1979-1980 study

period. Yet, only 10percent ofchildren re~rtedto CPS

were described as having family incomes of S15,000 or

more, and the percent of re~rted children with estimated

family incomes under $7,000 was three times higher than

in tbe general population (52 percent vs. 17 percent). As

may be seen, screening CPS cases against the study

definitions altered the income distribution somewhat insco~ CPS cases had a somewhat lower ~rcentage under

$7,000 (46 percent) and a correspondingly higher ~rcentage inthe$15,000 andabove category (13 prcent).

The unreported children identified from .’other study

agencies” (schools, hospitals, etc. ) had a still lower Prcentage under $7,000 (38 percent) and a correspondingly

Iarger percentage inthe$15,000 andovercategory (21

percent ).

These differences are all in the expected direction, and

they lend some support to the notion that stereotyping

and selective reporting may have something to do with the

association between poverty and reported abuse or neglect. Inparticular, thcyseem to support the contention

that there may he some underreporting to CPS by

schools, hospitals and the like of suspected abuse/neglect

situations among relatively affluent families, families of

$15,0000r more income account for 21 percent of unreported cases from these sources, as compared to 10-13

percent of reported cases,

These trends notwithstanding, tbe major income

finding is that the strong relationship between poverty

and reported abuse/neglect is not entirely, or even

largely, explainable as a result of selective reporting. The

relationship persists after CPS cases are screened against

thestudy’s definitional requirements, and it is almost as

strong for unreported cases as for those which are re.

ported to CPS

It was shown in Chapter 5 that, within income categories (and particularly for the lowest income groups), measured incidence rates are higher for White children than

for Nonwhite children, Theincome byethnicity section

Table 6.4 indicates that the earlier incidence findings are

nof attributable to the particular definitions or data

sources used in this study proportionate overrepresentation of Whites within income categories (and

particularly in the lowest income categories) occurs at all

three levels of recognition and for all alleged victims reported to CPS as well as for those meeting the study

requirements,

The above findings concerning income and ethn~city

lend little support to the notion that CPS report statistics

reflect selective overreprting of minorities and the pmr.

By the same token, these findings are of little help in

explaining why some in-scow children are reported to

CPS while many others are not.

In this context, findings concerning child age distribu38
lions are interesting. The bottom section of Table 6-4

shows that young children are reported tn CPS as alleged

victims of abuse/neglect much more often than one wnuld

expect from the population age distribution: children

aged O-5 represent 41 percent of all alleged victims reported to CPS, while they constitute only 29 percent of

the child population of the U.S. The age distributions for

in-scope children who were recognized by non-CPS respondents as victims of maltreatment but were not reported to CPS are even more “skewed,” in the opposite direction: children under 6 years of age constitute only 19

percent of the unreported in-sco~ children identified

from “other investigatory agencies” (~lice, courts, etc. )

7. SUMMARY

This report summarizes major findings from the National Study of the [ncidcnce and Severity of Child Abuse

and Neglect, The “National Incidence Study” was conducted by the National Center on Child Abuse and Neg

Iect (NCCAN) of tbe Children’s Bureau, U.S.

Department of Health and Human Services. It is tbe first

large scale effort to assemble information, based on standardized definitions, about the scope and character of

recognized child abuse and neglect in the United States.

From findings obtained in a probability sample of 26

counties in 10 states, this report presents national estimates of the numbers and characteristics of abused and

neglected children who (a) are referred to Child Protective Service (CPS) agencies for treatment, (b) are not

referred to CPS but are known to other investigatory

agencies which may handle abuse/neglect situations—

local police, court-corrections agencies, public health departments, etc., m (c) are not known to either of the above

but are identifiable frnm nther community institutions,

particularly schools and hospitals. Study findings in

major subject areas are summarized below.

Level and Rate of Reporting to CPS

In his opening remarks at the 1973 Senate hearings

which culminated in the passage of the Child Abuse Prevention and Treatment Act, then-Senator Mondale

quoted an alarming statistic “Each year, snme 60,000

children in this country are reported to have been abused

and they constitute only 8 prcent of those identified by

“other study agencies” (schools, hospitals, mental health

agencies, etc.). Stated another way, 67 percent of all

in-scope children under age 6 had been reprted to CPS,

while 78 percent of all in-scope children aged 12-17 had

no~ been reported to CPS.

In summary,” it appears that the chil{s ethnic group

and family income are not major factors in accounting for

repnrting or non-reporting of sus~cted maltreatment but

that the childs age may be a major determinant of

whether or not a recognized maltreatment problem is

reported to CPS for investigation and treatment.

“ ‘Since that time, repnrting of sus~cted child abuse

and neglect has increased dramatically. The study estimate is that over 1,100,000 children were repnrted to

Child Protective Service agencies as sus~cted victims of

child abuse or neglect during the last half of 1979 and the

first half of 1980.2 Following investigation of the reprt,

nearly half of these children (an estimated 470,500 children) were substantiated by CPS as victims of child abuse

or neglect. Of these children substantiated by CPS,

212,400 met the study definitions of maltreatment (see

Figure 7).

Unfortunately, the study findings do not indicate that,

with the unprecedentedly high current levels of reporting,

most abused and neglected children are now being identified and helped (see Figure 8). On the contrary, of the

total “in-scope” children reported to the study, only 33%

(i.e. 212,400 children) were reported from CPS agencies.

In contrast, 86% (i.e., 558,200 children) were reprted

from the participating non-CPS agencies, These percentages sum to more than 1007. because 187. (i.e.,

I I7,200 children) of the “in-stop” children were reported to the study by both CPS and non-CPS agencies.’

‘ Citati.n fr.m Sussman, A., and Cohen, S.J., Rcprri”z Child Abuse

ond Net/eel: Guide/ines for Le~is/olio”. aallinger Cambridge,

Mass,, 1975. p. 118.

‘ This is an estimate 01 the number Of diKere.t children far whom

rcwrts were received and accepted far investi8ati.n. It dms .0! inVOIV.double-co.nting .f children who were reprtd more than an..,

nor dms it include children involved in rcprts which were screened

o.! or referred elsewhere by CPS prior 10an attempt at investigation.

‘ As noted in Chapter 6, theseare .p~r limit estimates .f extent of

revrting 1. CPS .r recognized in.sc.~ children. T. varying dcgr-s

f.r diKercnt ty~s Of agencies, the estimates involve overcounting Of

reprts t. CPS and/r .nderc.unting of “nrewrtd cases.

39
Figure 7. In-scope children reported to and substantiated by CPS agencies.1

Children Reported to CPS Agencies as

Suspected Victims of Child Maltreatment

Children Substantiated by CPS Agencies as Victims (43Y. of those

“In-scope” Ctildren Who Were Reported TO and Substantiated By

CPS Agencies ss Victims (45V0 of

those substantiated 19°A of those

‘All numbsrs are estlmatd annual national totals

The key findings presented in figure 8 are

● 68% (i.e., 441,000/652,000) of the “in-scope” children reported to the study were not reported to the

local CPS agency.

. Of those “in-stops” children recognized by non.

CPS agencies and reported to the study, only 21%

(i.e., 117,200/558,200) were reprted to CPS.

Thus, the study learned about a huge number of maltreated children recognized by ~rsons in a variety of

community agencies but not known to Iwal CPS

agencies.

No doubt, many of the “’unreported children identified to the study were receiving needed assistants from

agencies other t~n CPS. That would seem a distinct

possibility for children Identified to tbe study by probation or public bealtb departments or by mental health or

swial semices agencies. Unfortunately, such agencies accounted for only 17 Frcent of all unreportd in-scoW

children identified to the study (see Table 6–2). The great

majority of unre~rted children (83 psr~nt) were identified by agencies with very limited sesial semice capabilities public sch~ls, hospitals, and police/sheritTs

departments.

The proPrtiOn Of in-sco~ children who had been reprted to CPS was 33 percent overall, but was not

wnstant across subcategories or subpopulations. Nonreprting was es~cially pronounced for problems in the

area of educational neglect, where 87 ~rcent of in-scope

children identified to the study had nor been reported to

CPS (Table 6-3). The reporting percentages were only

slightly higher in the areas of emotional neglect and emotional abuse where, respectively, 20 ~rcent and 24 percent of in-sco~ children had been reported to CPS. Even

in the areas of traditional CPS emphasis—physical and

sexual abuse and physical neglect—the percentages of

in-scow cases known to CPS were only 46 psrcent, 54

~rcent, and41 percent, respctively,

An unexpectedly bigb 87 percent of all in-stop fatalities had been reported to CPS. Of prhaps greater pr~

grammatic significance-since need for protective

semices is somewhat academic in fatality cases—the prcentage of children with “serious” maltreatment-related

injuries and impairments who bad been reported to CPS

wasonly23 Wrcent (Table 6-3).

Somewhat surprisingly, in view of s~culation in the

literature concerning “overreprting’, of minorities and

the~r, ethnicity and family income were not found to

be major factors in the re~rting or non-reporting to CPS

of recognized in-scope cases (Table 6-4), Age, on the

40
other hand, appears to have been a major factor in reprt.

ing three-fifths of in-stop children under age six had

been reported toCPS while over three-quarters of those

aged 12-17 had not been reported.

Total Incidence

Of the approximately 470,000 children who were reported to and substantiated by CPS agencies, an estimated 212,400 were identified as meeting the study’s

definitional requirements, This translates i“tO an ann”aI

incidence estimate that 3.4chil~ren psr 1,000 children in

the nation were re~rted to and accepted for treatment by

CPS agencies for abuse/neglect problems falling within

the scope of this study.

The study estimate is that an additional 71,400 insco~ children were known to’’other investigatory agenties” during the study year: juvenile probation

departments, Iwal police and sheri~s departments,

public health departments, and coroners or medical examiners. Combined with tbe CPS findings, this means

that an estimated 4.6 in-sco~ children pcr 1,000 were

known to CPS and/or other investigatory agencies.

An estimated 368,100 additional in-sco~ children

Figure8. Sources of reports of “ln-scope’’c hildrentot hestudy.

Number ofln-%ope Children Reported

tothe Studv bvNon.CPS Agencies B“t

Number ofln-%ope Children Reported

Not Reported TO CPS

from Non.CPS Agencies to either CPS

andlor the Studv

(439,500 + 118,700= 558,200)

Number of In-%opa Children

Reported to the Studv by

CPS Agencies Onlv

Number of In.%ope Children

Reported to CPS bv Studv

Non.CPS Agencies

Number of in-&opeChildren Reported

to the Studv from CPS Agencies

(1 18,700+ 93,700= 212,400)

Grant Total in the TWO Circl= is the Unduplicated Number of Children Reported to the StudV bv All Sourcesl

(439,500+ 118,700+ 93,700 =652,~0)

‘117,200 Is an eatlmateof the number of ,,ln-=opa,, childrenrepmfad to the study by both non-CPSand CPS agenciaa. The actual

number may besmaller, butlsnot larger than 117,200 .95,200 isan~tlmate of thenumber0f ,sln.Wop,, children repotiAto thestudy

on fyby CPSagencles, Theactual number may besllghtly larger, but Is not smaller than 95.200.

'The total lnthelarge clrclemay besllghtly toolarge, alnce one of ltacompOnents (117,2 OO)maybe sllghtly twlarge(sWfwtnote 1).

‘The total In the small circle IS accu,ate.

‘As noted previously lnthle report, fmconvenlonce we have rounded off-652,000 -the esomated number of ,,ln-scope,,children.

41
were known to and identifiable from other agencies encompassed by the study design: public sch~ls, short-stay

general hospitals, and certain mental health and social

service agencies. Adding in these children increases the

estimated total of 652,000 in-sco~ children (or 10.5 children per 1,000)knownto CPS, other investigatory agenties, and/or other agencies encompassed by the study.

As noted at several earlier puints in this repurt, findings

obtained from the study sources do not constitute a completeeslimate of the total incidence of child abuse and

neglect in the United States, even for recognized cases of

the 2I specific kinds of abuse/neglect problems addressed

in the study definitions. One way of extraplating findings beyond the study sources would be to assume that the

response rate findings for agencies represented in tbe

study provide a best-guess estimate of the rate of reporting for other sources as well: private schmls, physicians in

private practice, preschool and day care facilities, private

individuals (parents, children, neighbors), etc. If the measured average CPS reprt rate for study agencies (2 I

percent, from Table 6-2) is applied to all sources of reports to CPS, a first-cut estimate might be that there were

approximately one million recognized in-sco~ children in

the nation during the study year (=212,400 repurted

in-scow children - .~l, tbe estimated repurting fraction).

This estimate may ’be unreasonably conservative. For

one thing, it seems unlikely that the level of re~rting by

neighbors, spuuses, private schouls, etc. isasbigh as that

for police and probation officers, public health nurses,

public schml teachers, and other mandated professionals

encompassed by the study design. Secondly, the 21 percent repurt rate figure for study agencies is an upwr

bound estimate (see discussion in Chapter 6). Perhaps the

13 percent report rate obtained for public schwls would

be a more realistic estimate of the overall level of reporting to CPS agencies. If that rate is used, the estimated

total annual number of recognized in-scope children

would increase to over a million and a half.

(=21 2,400/0. 13)

Another factor to consider is that tbe definitions used in

this research were considerably narrower than those used

in clinical settings somewhat Iess than half of thechildren who were reported to and substantiated by CPS

agencies were accepted as being clearly within the scow

of the study definitions (see Table 3-5). Thus, if one were

to guess the incidence of the full range of problems being

handled by Child Protective Service agencies, it might be

appropriate to double the above estimates.

Of course, such extrapolation beyond the data sources

and definitions actually used in tbe research is an exercise

in s~culation. Tbe intent of tbe exercise is not to propuse

any particular estimate of tbe “true” incidence of child

abuse and neglect. Rather, it is to emphasize tbe point

that the study estimate of 652,000 children is not intended and should not be interpreted as an estimate of the

full extent of the problems of child abuse and neglect.

Extrapolation of study findings using the most conservative of assumptions suggests that the number of recognized cases of the kinds of problems studid is at least

1,000,000 children Wr year, and it may well be substantially large rthan that. ?

Relative Incidence

For the kinds of maltreatment problems encompassed

by the research, the National Incidence Study findings

provide the most comprehensive information presently

available about the characteristics of maltreated children

and their families. Some of the main findings were

a. *verity

● Eighty-four percent oftbe’’in-sco~’’ cbildren rep

resented in the study evidenced known symptoms of

physical or other injuries or impairments as a result

of abuse and/or neglecc the remaining 16 permnt

had experienced forms of maltreatment for which

evidence of injury was not required (e.g., sexual exploitation, abandonment) or were assessed, based on

circumstantial evidence, as “probably” having ex-

~rienced demonstrable injury or impairment.

● The pro~rtion of children who expcriend serious

injuries or impairments as a result of maltreatment

was lowest in the area of physical abuse (9 pcrwnt),

was highest in the area of emotional neglect (74

percent), and was 20 percent overall.

● Deaths resulting from maltreatment were unmmmon, constituting less than one prcent of the cases

(an estimated 1,000 children Wr year).

.Nearly all maltreatment-caused fatalities resulted

from physical assault (72 ~rcent) or physical neglect (28 percent), and most (74 ~rcent) recurred to

children under 6 years of age.

b. Age and %x of Child

. For most forms of maltreatment, incidence rates increased astheage oftbe child increased.

.In the area of sexual abuse, the age-incidence relationship was not as strong as one might ex~ct:

among male victims, incidence rates were essentially

constant across age groups, and 50 ~rcent of female

sexual abuse victims were 11 years of age or

younger.

● At the lower end of the age range, incidence rates for

all forms of maltreatment were essentially the same

for boys as for girls.

. In the older age groups, abuse incidenw rates were

substantially higher for girls than for boys, while

neglect incidence rates were bigber for boys than for

girls.

c. Family Income and Etbnicity

● In the higher income groups (i.e., families with annual incomes of $15,000 or more), incidence rates

for all forms of maltreatment were essentially the

42
same for White and Nonwhite children.

.For White children, incidence rates were much

higher inthelow income groups than in the higher

income groups, for all forms of maltreatment.

● For Nonwhite children, a similarly strong association between pverty and incidence of maltreatment was found, butmrlyin the neglect arew abuse

incidence rates were essentially constant (at low

level) across income levels for Nonwhite children. ,

d. Type of County

. Overall incidence rates were somewhat lower in suburban counties than in urban or rural counties.

. Sexual abuse was proportionately more common in

rural counties than elsewhere.

● Educational neglect was pro~rtimrately more common in urban counties than elsewhere.

● Emotional abuse and emotional neglect were proportionately somewhat more common in suburban

counties than elsewhere.

e. Other Variables

. Incidence rates were somewhat higher in families

with a single child or with four or more children than

for families with two to three children.

. The only form of maltreatment where a substantial

proportion of the involved adults were prsons other

than biological parents was sexual abuse. In that

area, father substitutes (primarily stepfathers) were

involvedin 34pcrcent oftbe cases and non-parental

per~trators were involved in 32 percent of the cases.

Even in this area, however, biological mothers were

involved—at least to the extent of having known

about the problem and having allowed it to

continue—in a significant fraction of the cases (43

percent ).

Implications

The National Incidence Study findings have a bearing

upona wide range ofissues. Although a thorough assessment of the study’s implications for policy, programs, and

legislation is beyond the scow of this report, implications

in selected topic areas are briefly discussed in this coneluding section. Byraising questions and suggesting interpretatimrs, the intent is to stimulate further thought

about the findings and tbe issues. The views expressed are

those of the researchers and do not necessarily represent

the policy or position of the National Center on Child

Abuse and Neglect or any other government agency.

a. Awareness of Caws

Until quite recently, lack of “community awareness” of

the problems of child abuse and neglect has been ~rceived as a major im~diment to identification and treatment, and extensive eflorts have been made to increase

such awareness. From all indications, these efforts have

been highly successful. Reprting to CPS agencies has

increased enormously in recent years, and the study

findings indicate that professionals in the community are

aware of a great many more cases than they report.

Clearly, awareness, per se, is not nearly as much of a

problem now asit may have been five orten years ago.

b. Awareness of Reporting Guidelines

Public schwls are reporting about 100,000 cases ~r

year toCPS agencies. However, nearly half of these reports are not substantiated, frequently because the reported problem is—by CPS standards—inappropriate or

not serious enough. Yet, public schmls identified to this

study nearly seven times more in-scope cases than they

reported to CPS. Most of tbese cases, presumably, were

serious enough to be reported.

These findings (together with similar findings for other

agencies) suggest that, although much has been accomplished in heightening public awareness of the general

problem of child abuse and neglect, much remains to be

done to educate the public (and particularly the major

professional groups in the community) about the spcific

circumstances and situations for which re~rting to CPS

is or is not appropriate. It apWars that reporting of inappropriate cases (resulting in a wasteful ex~nditure of

CPS resources in investigation and prwessing of cases

which ultimately receive no services) and nonreporting of

appropriate cases (resulting in a lack of needed semices)

are both occurring on a large scale and that both are

major problems in the current child protection system.

Perhaps if school ~rsonnel (and other major groups)

had a better understanding of the s~cific kinds of maltreatment situations CPS officials do want to know about

and also ofthose theagency feelsit cannot handle, more

of the former and fewer of the latter would be forthcoming. In this connection, several questions need to be

raised.

. Do state abuse/neglect reporting statutes contain

sufficiently detailed definitions and guidelines concerning the kinds of situations mandated professionals are required to reprt?4

● Has the state and/or Imal Department of Social

Services established sufficiently detailed regulations

and guidelines (both for dissemination to the general public and for use by CPS personnel) corrcerning the specific kinds of situations in each

“Many states presently distinguish between ..mandated,, rcvrters

(Occupational gro.ps specifically listed inthestat.te asreq.iredta

rcp.rt suspected cases) and ,,permissive,, reprters (e.g., .,any other

p,rs.n:” wrmi,,ive r.~rl.rs are nOt r.q.ired 10 r.wrt b.1 are

afl.rded cervain legal pr.tecti.”s if they chmse t. d. so in gd

faith). Perhaps one way Of achicvi.s src.ter swcificity in rewrting

statutes would be !. make analogous distinction between mandated

and wrmissivc sit”ati.ns, where mandated situations (i.e., ones for

which reprting isreq. ired)are s~cifically listed ineachmaj.rcategory of abusclneglect, and Frmissive situations (i.e., ones where the

rcwrIer is allowed t. usc his.r her.wn j“dsment) arc described in

more generic terms, e.g., ,..oY other sit”ati.n where a child’s physical,

menval .r em.ti.nal health .r development is seri.. sly endangered as

a result .f the acts .r omissions .f Fcs.”s res~nsible f.r the .hil&s

care and pr.tect i.”.,,

43
general area of abuse/neglect which should be: (1)

reported to CPS? (2) accepted for investigation?

and (3) substantiated?

● Is there a need for better communication between

the local CPS office and other agencies in the corn.

munity, aimed at achieving a common understanding of what shmddorshouldn't be reprted?

c. Unmet Service Needs

Any death resulting from child abuse or neglect represents a tragic, and highly conspicuous, failure ~f the child

protection system, Intervention aimed at protecting the

child from (further) physical injury or death is a major

programmatic objective for CPS agencies. In this context,

it may be significant that tbe estimated annual number of

deaths attributed tochild abuse andneglect (i.e., 1,000

children per year) is so small. Prevention of fatalities may

well be an area where CPS agencies are having a

significant impact. At least, it appears that CPS programs

are focused on the groups at highest risk. Nearly all fatalities identified in the study occurred from physical abuse

or physical neglect, the areas of greatest CPS emphasis

(64 percent of all substantiated re~rts to CPS had physical abuse or physical neglect as the primary allegation).

Also, nearly three-quarters of all in-stop fatalities Wcurred among preschmlers, an age group for which the

reporting system apWars to be working relatively well: 67

percent of recognized in-stop children in the O-5 age

range had been reported to CPS, a much higher rate than

was found for most other groups.

On the other hand, an emphasis on situations involving

risk of physical injury or death may be resulting in

insufficient attention to other situations. Adolescents and

children with in-scow problems in the areas of educational neglect, emotional neglect and emotional abuse

were’ reported to CPS pro~rtionately much less often

than younger children or children with other kinds of

abuse/neglect problems. One must askwby these groups

are not being reported. Is there a perception inthecommunity that CPS agencies are not able to handle such

cases effectively? Is there a need to strengthen service

capabilities in these areas?

d. Poverty and Maltreatment

A very strong statistical relationship was found be.

twecn family income and reported abuse/neglect (where

87 percent of in-scope children substantiated by CPS

agencies were found to live in families with annual incomes under $15,000). By itself, this finding is not new,

anditssignificance is not clear: itcould’’merely ’’indicate

that low income families are particularly susceptible to

re~rting, What is new in this study is the finding that,

while low income families predominate among those receiving protective services, they also predominate among

the much larger numbers of maltreated children who are

nor receiving such assistance: 79 percent of recognized

but unreprted children also lived in families with annual

incomes under $15,000.

At one level, this finding may suggest that, in allocating

available Protective service resources among jurisdictions

(or among neighborhoods within a county or city), particular attention should be given to low income areas. At

another level, the finding raises larger questions about the

causes and prevention of child abuse and neglect. If the

strong statistical association between family income and

child maltreatment is not merely an artifact of tbe reporting system, does it indicate that tbe condition of pverty,

witb its attendant psychological stresses and problemsin

daily living, is an imporPant r~t cause of child abuse and

neglect? If so, will it be pssible to achieve a substantial

reduction in the national incidence of child abuae and

neglect as long as widespread pverty exists in this

country?

e. CPS Resources

Over the past three years, many states have broadened

their re~rting statutes, enlarging the range of child

abuse and neglect problems for which CPS agencies are

mandated to provide assessment and treatment services.

Reporting has nearly doubled over this perid, and has

now reached a level where over one million children are

being reported (some more tbanonce) annually. At the

same time, increased concerns about “accountability”

and “case management” have resulted in the impsition

of additional rcprting requirements upon CPS agencies

(i.e., increased paperwork),

In most states, CPS resources (staff, programs, budget)

have not kept pace with the enormously increased workload and, in some jurisdictions, funding levels have actually been cut back.

Perhaps tbe most significant and distressing finding

from this study is that, even with the dramatically increased levels of reprting, many (indeed, most) cases of

demonstrably serious child abuse and neglect arc still not

being reported. It is not difficult to see ways in which the

re~rting system should be improved. Given current funding levels, however, it is very difficult toseehow substan.

tial improvements could actually be implemented. If CPS

agencies do not have enough resources to handle existing

cases, they can hardly be expected to go out and .’beat the

bushes” for more.

44
APPENDIX A

Data Forms for

Child Protective Service Agencies
Form No. 2

SUMMARY OF REPORT TO PROTECTIVE SERVICES

OF ALLEGED CHILD ABUSE OR NEGLECT

NATIONAL STUDY OF THE INCIDENCE AND SEVERITY OF CHILD MALTREATMENT

WeStat, Inc. with Development Associates, Inc.

11600Nebel Street, Rockville, Mawland 20652

1. Study Report No.

2. PS Case or Repoti No.

3. Date of Repon ~

Mo. Day Yr.

4. Source of Repofl:

l. LWal Protmtivesewlces 12. Public School (K-12)

2. Other Local Welfare Dept. 13. Private School (K-12)

3. Mental Health 14. SpWlal Ed. School

4. CoronerlMedlcal Examiner 15. Preschool/Day Care Agency

5, Hoapltal 16. Other Mandated/Agency Source

e, Medical Cllnlc(not in hospital)

7. Private MD (not in hospital)

S. State Police 17. Family Membar

9. Other Pollee/Sheriff 18. Other Non-Mandatad Source

10, Coufl 19, Anonymous/Unknown

11, Other Law Enforcement

5, Allegation

6. Name Of investigating CPS Worker

(orreason, lfnotaSigned for

Inveatlgatlon)

7. Number of children in household: (list below, beglnnlng with alleged victims)

Child’s First Name and Initial Age Sex

Letter of Last Name in Blmhdate

1 1

(M

I Years Mo. I Day I Yr. or F)

First Name t Initial 1 I

a. ( I I

, I I

b. 1 I 1

I , ,

(

c. , ( I

( I I

d. 1 I 1

I I I

e. , I

, I ,

f, , I

I ( ,

, I (

9. 1 I ,

h.

I I I

I I I

1.

I I I

I I I

1.

I , ,

1 , ,

6. Location OfHOuWhOld:

CltylTown: COuny State _

Chwk

(.) if

alleged

victim

Check (J)

if fatal

or critical

inju~

47
PROTECTIVE SERVICES DATA FORM

Da@ Form W

03070 NATIONAL SURVEY OF THE INCIDENCE AND SEVERITY OF CHILO MALTR~TMENT

WB W: 8WW

PLEASEuSE BALL POINTPEN Wti b. m mm — lm.

PRE= FIRMLV

Wti k. Iw

llW bw *m Mlla, w = Ww M, w

A, B.—/—/_ c. D.—1—i—

PS ,PROTECT!VE S,,”,,,S, CASE NO, DATE W REP~T ~ ?S NAME W lNVESTiGAnNG ?S WRKER DATE F~M COMPLETED

E.

F,

G.

H.

1,

L.

M

N,

o

P

o

~

PARENT(s) lSUS6TlTms) IN HOMEANO AGE SEX

OTHERINVOLVEOAOUL~, IF ANY. SPeclVrelatlnnshlp(0.P.,~M’s ~yVNend, bbysiner)

3,

4.

NUMBEROF CHILORENUNOER18 IN HOUSEHOLD_ (L13tbelow.wnnlng with allwti Vltilms.)

CHILDSFIRSTNAMEANO RELAmONSNIPTO SNILOROLE

INITIALLETTEROF AGE BIRTNOAT5 SEX Q @

LAST NWE IN 1 (M ~ w ~ NDlNAME INITIAL YEARS MO.10A.1VR. or n SUB. SUB, ALLEGEOCAED

a. ( II

b, I ,1

c, ( (1

d. I II

8. , II

1. I ,!

LOCATIONOF HOUSEHOLDCOYITOWn m“w

@ ETHNICGROUPWOE

1. Amwlmnlndlanl

Almkm Native

2. tilmlbdflclslmdn

3. Blati, MOf HlsWnlc

orlgln

4. HNWic

5. Whtia,ntinf Hlswnlc

Wlgln

6, ~w(SPECIFY)

T. unkn~

@ EDUCATIONCODE

1, GradSH

2. %me HighMml

3. Hlgh~ml Gmd

4. %metillwewm.

HSTtininQ

5. @NegroGrad

6. UnknM

Wte

@ EMPLOYMENTSGOE

1. Employtihll.nme

2. Employti M.~me

S. UnemplOV&,Lwklng

br work

4. mtlnhbr~rw

5. Unknw

@ RELA~ON6HlPTO

PARENTISUSSTITUTE

WOE

1. ~tirti ChNd

2. %epchild

3. b*r ChNd

4 Adoptti Child

5. GrandChGd

6. ma (6PECIFY)

@ CHILOROLECOOE

1. Vialm

2. Nma Vltilm

S. U“kwn

SETTINGOF HOUSEHOLD(Clrclnone) 1. Ruralx= 2, vluage/Mlti 3. UnlnmlWmtti tiburb 4. Cuy 5. Unknown

ESTIMATEOANNU& 1. L= than 2. $7,W 3.~}~ 4. S25,~ 3. FMILY RECEIVINGtiOC?

FWILV INCOME $7,W

K. FMILV mVEREOBY MEWCA107

S14,W M~lB 1.VW 2.m 3. UnknM 1.Yu 2.No 3.Unm

WURCE(S)OFTHISREWRT 9. ~w NNwlSherlfl 14.Shl Ed.~w! 17.FmNy memb, relatlvo

1. LocalPr0tmlv8 %wices 5, HosPltil 10,Coufl 15.PreschwNOaySsreAgency 18.WW nonmndatti source

2. me, Loal Welf%eUnit 6. M8dlwl Cfinic(nOtlnhosplWl) 11.~mhw Enfommmt 16.~ar MandattilAgmcy

3. MenwlHmlth

19.AnOnymousiUnknOW

7. PNvtio MO(not In hospltil) 12.Wbllc *hml (K-12) tirce @PECl~

4.tiranwlMtilml Eminm 8. SUte NbW 13.~ltin *hml (K-12)

FS STATUSAT TIMEOFfiLEGEO INCIDEW. 1. Atiw PS= 2. Nti atim M Prtimly r~fiti 3. Ml prwiwb lwflti

WCIOENCESTUOYSTATUS 1. Firstmdy fum @rallwti titilm 2. NOIflrti tom (Rlw fwm no.:— )

PARENTISUETITUTERESWNSETO P3 ~E~ENT(Emer timnumbw lnspams lndlmtti, answwa. mdb. fwWPaentslti&t!WOs)

a. Motherltibtilme _ 1.m~auve b, Mtiai%b3UWe _ 1. AcknMltig& All@atlon

2. Unmwratlw 2. OmltifllmatiOn

FatierlQbstlltie _ 3, Notmtiti Fatii&MWO _ 3. NntmntititilNm wPN@LAO

STATUSOFP3 ASSESSMENT 1.bundti 2. Indlatti 3. Unbundti

GIVE A BRIEF EXPMNATION OF BASIS FOR ASSE~ENT AND, IF UNFOUNDED, WMMARIZE ALLEGATWN.

IF FDUNDEOOR INOICATEO, OR BELIEVED TO MEET STUOY DEFINITIONS, REMOVE CARBONS

ANO CONTINUE ON REVERSE SIOfi OTHERWISE, 00 NOT COMPLETE REST OF FORM.

49
R, SUMMARV OF SUSPECTEO MU~EA~E~ (USE ANSWR WOES FROM SO~M OF PAGE.)

1. FORMS) OF MALTREATMENT @

2. OATE OF (MW RECEN~ OCCURRENCE

S. SRIEFLV OE%RIBE WE SUSPECTEO HARM CAUSING OR ENDANGERING ACTSIOMISIONS. Includepenlnem Intirmtion akti tiqu8nw, dumtlon,prwlplmlw weti, If

wpllwble. Indlate Suspetied involvementof Prentslsubstlttis or mer adultaretiers. Use Item V if mre Spaconetiti.

V. AOOITIONAL WMMENTS 08 EXWATION5

— —

IEM R A#8WR CODE8

‘“?+& 7, mN- F-””””””--’”””””~”~

50
APPENDIX B

Guidelines and Data Form for

Non-CPS Respondents
Daft Form No. NATIONAL INCIDENCE STUDY DATA FORM OMBNO.: es~o~s

Expires Dec. 1980

WESTAT INC., WITH DEVELOPMENT AMOCIATES, INC. Study No.: 0086

11600 Nebel Sheet, Rockville, Maryland 20S52

FOR A%ISTANCE IN COMPLETING THE FORM OR TO PROVIDE OATA ANONYMOUSLY BV TELEPHONE, CALL TOLL-FREE (600~~696, 9 A.M. TO 6 P.M.

(PREVAILING EASTERN TIME) MONDAV.FRIOAV OR NOON TO 5 P.M. ON SATURDAVS,

IMPORTANT Information provided on this form is confldenfial and will be used tirmm.ti PUPSB on~.Retirn of this form dws not mntittio an official

repod of suspetied child abuse or negleti as may be requhed of you under Sfcte law, and the study guidelines (below) are not intended to Indimte

chcumsfcnces where an oticial repofl would-or would not—be required,

GUIDELINES FOR USE OF OATA FORM

GENERALINSTRUCTIONS

Plcc$eprovidethe information requested on this form—either by completing the form itself or by Mlling Westa~s toll-free number (above) and

giving th8 information to a study staff member–for any chNd under f8

living in a study county whom you suspect to have been “maltiwtedr<

defined below, Note that, although data collection begins October 1,

1979, thn study encompasses maltrmtment situations occurring at any

time timeen September f, f979 and Owember 3 f, f979. I“formatio”

must be received by January 15, 1980 to be included in the tidy

flndlngs.

SITUATIONS ENCOMPASSED BY STUOY

The three major aspects of the study definitions are as follows

1. Parton8 rmponslblo Ior malfmafmonk Child malteated by a

“parent/substitute” or ‘<other adult aretcker,,, or a ,,~enti

substittie” ‘,permltfed” maltreatment by other persons. Key terms (in

quotation) are defined at bonom of page 2.

2. Msflmatmant eventt Through purposive ads or mxked inattention to

chllds needs, behavior of a parent /substitti8 or other adult umtaker

caused foresemble and avoidable inju~ or impairment to a child or

matedally contributed to unreasonable prolongation or worsening of

an existing Iniury or impairment. Any of the following occurrences

during the study period would meet this definition.

. Phy:lcll as$iulf (including excessing corporal punishment) resulting

In bodily injury with observable symptoms lasti”D at least 46 hours

(stight bruising or reddening of skin co”slste”t with mild wrporal

punishment is excluded~

. SIxud axploltallow acts such as sexual intercourse (forcible or

COnSenSual), deviate intercourse, molestation with genitcl contcti

or promoting of prostitution (study assumes probable emotional

injuvh

. Clo:o confinnmonk Mnding of arms or legs, l~king in closti, etc.

(study assumes probable emotional inju~)

. Any other piltnrn al ?waulfivo. oxploititivo or abo$lto troatmont such

as threatened or anempted physiml or sexual w~ult, eflreme

verbal abuse or other Ovenly hostile or punitive timtment If b+

Ileved to have Mused significant physical, mental or emotional

injury or impairment serious enough to persist at Imst 48 hours

(transito~ emotional upset is excluded~

. Comp18t#abandonmentor other rofusll to ❑alntaln custody expulsion

tiom home, refuccl to accept custody of a runaway, etc. (study

assumes probable emotional iniu~~

. Encooragomont or “p@rmlltlog” of chronic ❑?ladtpllve btiavitr vuancy (at least five days per month on an average), dellnquen~,

prostitution, serious druglalcohol abuse, etc.:

. Rofo:sl to allow nmdad treatmentfor a prolwionally diagnosti

physical, educational, emotional or behavioral problem, or failure to

obtcln or provide treatment in accord with professional recommendation, if physi~lly and financially able to do so and if the retisl

or fcilure has resulted in signiflmnt prolongation or worsening of

the conditio~

. Failuro 10 mgistar or onmll cblld in whool as required by State law,

if resulting in slgnifi~nt loss of schoollng (three weeks or more)

. FINorofod orOnwanlnf@ddtliy Insaekln~cornpafanf ❑edicalcam

for a ,,seflous”inju~, illnessw impairment,N kilure or delay

r=ulted in signlfimntprolongationor worseningofthecondition

andiftheneed for professional are should have been apparent to

a responsible adult without special medical training;

. Consllflnt or axtmma Inattgntlon to tbm cbllts pb;;lc81 or emotional

naads, Including needs for food, clothing, supewision, affection,

and reasonable Ccfe and hygienic tiving conditions, N such i“anen.

tiOn has resultedin the occurrence of a serious” and foreseccble

accidental injury, health problem, or other impairment and if the

p%entsisubstltutes were physi~lly and financially able to provldn

the netied me or

. Otbor maltreatment occurrences of similar seriousness,

3. Ewldcncoof Inluq or Impalrmank In addition to situations where there

is visible evidence of physiml, mental or emotional Injury or impairment, the study includes situations where–in your iudgment–

there Is reacon to believe that significant inju~ or impairment has

probably occurred, due to the extreme or traumatic nature of the

maltreatment. As noted above, ce~n forms of maltr~tment (sexual

exploifction, etc.) have been designated as falling in this ‘probable

Impairment atego~ and should be included oven if you are not

aware of ny pafllcular signs of iniu~ or impairment.

. Lack of preventive health care such as inoculations or routine

examination%

. Behavior problems that had not been brought to the parent/

substitute’s anention or that persisted despite conscie”tlo”s effofis to

motify the childs behavloc

. Problems the parenlisubsthute lacked the financial mmns to prevent

or alleviate and for which appropriate assictcnce was not awilablo

through public agencies.

SUPPLEMENTAL FORMS FOR SIBLINSS

If you suspect mom than one child In a family to have been ‘amaltreatet,

during the study period, plme fill In a form completely for one child. For

each additional maltreated child in the family, enter the first child’s data

form number (kom top of page 1) In item 32 of a new daft form and

answer items l-lk items lMI may beleffblank lfthelnformatlonls

the same as for the first child. Aner checking to be sum the form numbers

have been cross-referenced (In item 31 of the ffrst childs form) stcple or

pcper clip the forms together for return to Westct.

BEFORE COMPLETING THIS FORM, PLEASE PROVIDE WE INFORMATION REOUESED BELOW 30 WE CAN REACH YOU IN C~E ANY CLARIFICATION IS NEEDED

(does not apply if date provided by telephone), This setion will be deleted and destroyed within 10 days of receipt at Wes@t.

Vour

a

Home

Phone

Name

Best time of

No. &ce day to Mll

53
● NOTE REMEMBERTO PROVIDEINFORWTIONREaUES7E0aN PREVlaUSPAGEVOUR NME, ETC.)

1. OATEFOW WMPLETED

T’T’T

4. CHILDSRRST NAME

2. YaURPLACEOFEMPLOYMENT(ClrCleanO)

5. INITIALLE~ER OF CHILDSMT NAME

1. ,Elcmenw%bl 6, bun 6. CHILDSSW (CircleOne) 1 Male 2 mm

2. %conday,,Schwl 7, ~roneror Me#ml

3. Spwial Ed.%hml Emmlnor~ce

4. HOSQIMI

7’ CH’LDS “RmDATE ~’~’~

8. ~w(SPECl~

5. Pollc81SherNfOMc8 8, CHILDSAGE —Yws(OR]— MOnthS

3. YOUR0CCUPA710N(CircleOne) 9. CHIWS ETHNICGROUP(ClrCleb8)

1. %clal Worker 8. Princlpl

2. Nurs

1. ~8rlmnlndlm nrNas~n Mve

9. Cl=swmtmtiw

3. MDlntmn 10. WllwafNcw

2. khnar Padflcklmdm

4, MD HO$Q.eMQIOyeO 11. Judg8 3. Black,mtHlsmlcotioln

5. MD Prlvtieprati. 12. ath@muti ONica 4. Hls@nic

6. MD mhw e.g., 13. Gther(SPECl~ 5. Whk8,nOtOfHlwlcmlaln

Medial Examiner 6. Gthor(SPECIW)

7. PsychOIWlst GGT04? 7. Unk”mn

SOX A–FORWS) OF SUSPECTED MTREA7MEN7(~R USE IN IWM 13)

Physiml Aw”lt wlm Btiily lnju~

1. kSultwlth lmplemont(knife,strW, clawti8, tic.)

2. tiuktitioti implement(hit mm fiti, bit, tic. w msns of a=uh

.nknawn)

%XWI Eqldmfion

3. lnmslon (atisinwlnng penilepenemtlOn-wd, aml0rgenbke.0.,

rape,Incest)

4. Moles@tionwllhaenlm!conmti

5. Omuwunknom

mhw Atidw Trmtmmt

6. VerW w emotmti WUt (tirmtening, Mllnllna, tic.)

7. Closownflnement (Wng, Imking In closa, tic.)

8. mher or unknown(e.g.,aftemptedQhysimlor MXUl 8WUU)

ReW 0/ C“sw

9. Abndonmenl

10. mher (expulslon,reti=l to accept custiy 01 rumwy, tic.)

Imflenthn m Remtikl Hwm We N&s

11. Retisti to allow w provide netiti are br dlagnoti condition or

Immlrment

12. un~titi delay or hllure to =k ntid we

lnanmtlon m EMtiwl/&mlwMBl MS

19. Imdmmm nummmiaflmlon (e.g.,hllur+twtirh)

20. Knotinaly prmti~ mlampNw bktiw (definquenv, wlws dwgi

alcoholabuse, etc.)

21. Omer

WX B–SEVERITYOF IwURY OR IMPAIRMENT(FORUSEIN 17EM14 ENTERLOWESTNUMBERTHATAPPLIES)

1. FaGlin]w w mnditlm: ~!k~an! smmti = mjm mntdbw wuw ti Chllts dti.

2. lib fhrmtinlng injuv w With: Ryulrti omergenw me almti at presrnlng till~s tile.

3, Wlous Injuv w mndit)on:ProfSslOnalkwment needndM rellive atie presentsufferlnaor p~mt SIgnlflmntIongtwm lmwlrment.

4. Mtimm hjw M wdltim: Betitior Qmblomor phwlul, menul or motlwl Injuw w lm@rment Mm o-1o SPQMW wng * Iti 46 hws.

5. htibm Immiment: NoObdousInjuriesor problem bti, Intiw oftie ememeOrtiuwtic retire ofme~ati, n is wobble mti tio tillds m, mtinti

or physlml hmlth or Mwbllnles haw been slonlflmnUy lmwlred.

6. Ww (Pi@ explain In Item 10)

DEFINITION OF KEY WRMS

menqs)ltibtitittis): the parents, SteQWrenS, foster parents or mm Ima gudlans with whom me child w Nvlng, or If not Ilvlng wnh such Wwns, tho adu~s) tim prlw

rm~nslblllw br ma chllds me, If one ~entl%bzt~o dw nti hvo a spse nomlly Ilting In m8 hmShOM (e.g,, SWti, dlmti, n~ Mdl th8 tiw Is wtidd

mlsslng.

~w AduN &eWw: Any adult 18 or oldor who NW at orlqul%ly vlsh4 th8 tillfs homn (grandwenb, adun Slbllnns, a mtiher’s boplmd, m.) u w In Wme tiw WY

r=wnslblo W the chllds me (m adufi ~yz~, a dlmm WeM not lMng titb me tilld, tic.) md Is lnw~ Inme WSW Wmmmt—k wWM M &w ~

th8 tilld,

mmim: Knowingly allowd wlthoti auemptlng to Inteweno–m Qrment during the ma~mment and dld nti tiempt m sop Hu hd rm m ~ titi me voblem w &gm

(e.g., bvlng kn Intimti of Qrotiou Incldm) bti dld not anem~ to Ptiti the tilld or Wwent ranena.

,Elem8nmw, ~wl: tintins noq of gradns%12 ,tidaw %hwl: bnmlns any d gmdes+12.

54
WW 7/9/81 SLW MS 10S

NOTE

● REMEMBER TO PROVIOE INFORMATION REOUESTEO ON PREVIOUS PAGE (QUESTIONS 1-9)

● uSE ITEM 32 OR A SEPARATE SHEET OF PAPER IF YOU NEEO MORE SPACE FOR VOUR ANSWERS.

10. INDICATIONSOF lMURV/lMPAIRME~ Oewlbe a“y injuries, hmlth M“~Oons, physiwl Impalrmenls, emtional problems, or schml or hhatior problms flu suspmt m havo

been mused or Worsnnodby maltr~tment. Be specific (e.g., Childoflen Vmnt during last 2 months–missed 18 of last 30 %hwl days). Indlmte Wproxlmato dats of key ave”ts.

If YO” %8 not aw~e of any mlcula symptoms w problems, m indlmm

11, SUSPECTEO MALTREATMENT SEHAVIOR: Oescrl& the s“spetiti mal~mtment ads or omi%lo”s of the chilfls wrenws)lsubstltti~s) or othw adut memkms. I“cludo my

available Informtlo” akti tie pr~lpititing 8v8”B md *M 00 ~rlo”sn- 01 the Foblm (e.g., twuenw, dumtlon, prior lnctdenB]. Refw to indidd~ls by rtitiotip to

child {e.g., mother, grandhther), Ml by mme.

12. BASIS FOR3USPICION ktib hw uds $Immlo” mme to wr attentlo”; i“dlmto tie inti~tion w r-”in~ tilch lads wu to su$m tit tie abtiwlw mrior

by the susp~ti ad”t has atially Wcurrti and Of Wpllmble) auti or wntibtiti !0 chll$s iniurls m problems.

Indlml# t“ Item 13 tit 10cM3) 01 m!v~ment you WSM the tild to hava ewlo”cti during tie tidy pwlti

and the” answw 14-18 (for mch brm, If more tin one appfi~), If you SUSQ~ mre Ihan ono fwm 01MmtmoM,

begin In the Iofimost column wlti tho one ati”t which you are most cetin.

1S. FORwS) OF SUSPECTEOMALTREAWE~ (EntwWe %om%x A, tietiWS %oe)

14. SEVERITVOF IwURV OR IMPAIRMENT(Entw Me FromBOXB, PreviousPage)

15, NPE OFlWUFfVOR IMPAIRMENTOEWRISEOIN l~M 14 (Ci,c18OnONo,)

l. Aphyslml lnju~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.~Uhmfih wndlUOnOrph~lal lmWirmtnt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3, Amen@lOrOmtilOnalnjuwOr impairmentOrabehav10rproblem..,.., . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Mher(Explalnl"ttemlO.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. NMaQpllmb18(8.g.,nOknownsymptOmsOrpOblem,)..,

16, (APPROXIMAn)OATEOFINCIOEW (Etiw blhlVr.)

MMOR FOW

OF ~-

TREATMENT

IF APPLICABLE

2nd FORM I 3rd WRM

1

2

s

4

5

1

2

3

18, CERTAINW Takl”g Into awnt the wmpltionoss and rellablll~ of the Infwwtlon avamble to ~, how wuld

w wss the tikelihti that this bm of tiament [MM in Ioem1S) stilly mmti ati, if tim w

notti, that It m“s~ or Conrntiti to tho chtlds lnj”~ or problem? (Circle One No.)

1. Vewllk81y ~malmmt ctiln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2, Llkelyl wuld~mltien, ~ldon,tml”kw

3, Un5ur8(Qlm9 explaln lnltem 32].,,.,,.,,,.,.,

1

2

3

I

T

1 1

2 2

3 3

4 4

5 5

1 1

2 2

3 3

55
De%rlbe In 1%25 the PXen~s)l%bstiWtis) in me ChllCs h0m8 wd my other aduN

mtiker Involved in the suspati mameatment. It a Wlumn does nti 3PPIY(e.g., if mere

IS no fatherlsuhstltute in the home). Ieavn blank.

19. RELATIONSHIPTOCHILD(CircleOn%If n~, spmity, e.g.,grandmutber,mm.

KS Mmond, adult baby31ner)

20. WSPECTEO ROLE IN MALTREATMENT (CircleOn%anwm shwld b Wnslstent with

Item 17)

1. Maltimtti thochNd . . . . . . . . . . . . . . .

2. PermiUWma WmlmeMby others .. . . . . .

3. NOtinwlvti lnmaltimtment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4, Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21. SEX (Circle One)

22. AGE (Est(mat8 If uncetialm if no b-is for =fimato, enter unknown”)

23. EMPLOYMENT STANS (Clrclo One)

1. Employed till.time (30h1s. orm0r81wk) . . . . . . . . . . . . .

2. Employed pati.time (less than 30hrs/wk) . . . . . . . .

3. Unemployed, lmMng fOrti . . . . . . . . . . . . . . . . . .

4. rnher (SPUIN e.g., housotife, diwblw)

5. Unknown . . . . . . . . . . . . . . . . . . . . . . . . . .

24. HIGHEST EDUCATION LEVEL OSTAINED (urclz One)

1, Grades &8 . . . . . . . . . . . . . . . . . . . . . . .

2.%mebgh schwl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Hloh%hml gmdMte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.%mecollme orpost.hlgh schmlb31nlno . . . .

5. College graduate or beyond. . . . . . . . . . . . . . . .

6, Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

25, LOCATION OF CHILDS HOUSEHOLD

CNy 01town

bunw

Stme

26. SETTING OF THE HOUSEHOLD (Clrc18One)

1. Rural arm

2. tillage or hamlet

4. Unincorporated suburb

4. CNV

5. Unknown

27. ESTIMTEO ANNUW INCOME OF HOUSEHOLD (Cbcle One If no hsis for etiI

mate, Mite ,Unknown,,)

1. Les thn $7,~0

2, S 7,0G0-$14,~

3. $15,000–$24,W9

4$25,000 or more

26, DOES THE HOUSEHOLORECEIVE AIO TO FAMILIES Wl~ OEPENOENT CHILORE!

(AFOC)?(Chcle One)

1, Yes

2. No

3. Unknown

29. IS THE FAMILY COVEREO BY MEOICAID? (Clrc18One)

1, Y*

2. No

3. Unknown GO 1030 t

32. AOOITIONAL WMMENTS OR EXPLANATIONS

MOTHERI

SU63TITUTE

1. Natiml m~w

2. *epmothw

3. Mher (SPEClm

1

2

3

4

F

2. hle

I I

1

2

3

4

5 I

1

2

3

1

2

3

I

1 11

~

30. SESIOES THE CHILO OISCUSSEO ON THIS FORM, HAVE THERE SEEN OTHER

CHILOREN UNOER 1S LIVING IN THE HOUSEHOLDOURING THE STUDY PERIOO?

(Circ18Onc 11Yes, spwi@)

1. Ys —> HowMy otherMldren? _

2, No

3. Unknown

IF YOU -REO NO OR UNKNOWN TO ITEM 30, SKIP TO IEM

32, IF YOU NSWERED YEW CONTINUE TO ITEM 31.

31. IF YOU HAVE RUWN TO SUSPECT OTHER CHILOREN IN mls HOSEHOLO To

HAVE BEEN HARMEO OURING THE STUOV PERIOOTHROUGH MALTREATMENT,

PLEASEPROVlOETHE INWRMATION REOUESTEDBELOWMO FILL IN A %PPLE.

MEHTU FORMFOREACHSUCHCHILO.(W Bgo 1 GuidefinS fm Iwtilons)

I I I I nATA . 1

CHILDS FIRST NAME MO LAST INITIAL AGE SEX FORM NO.

r I

I

1

THANKVOUFORTAKINGTHE TIME TO WMPLETETHIS FORM.

*“.5. GOVERNMENT PRINTING OFFICE, , ,8,-720.0,9/69,9

56
U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

Wshington, D.C. 20201

OFFICIAL BUSI NESS

PENALW FOR PRIVATE USE, S3W

DHHS Publication No. (OHDS) 8 I -30325

Issuad September 198 I

U. S.

Postage

DEPAfl~&~9~OF

and Fees Paid

H.H.S. o

*=

Special Foutih+lass Rate