II 

116TH CONGRESS 

1ST SESSION S. 1009 

To establish a demonstration program to explore effective practices to improve 

early detection and management of injuries indicative of potential abuse 

in infants under the age of 7 months, in order to prevent future cases 

of child abuse and related fatalities. 

IN THE SENATE OF THE UNITED STATES 

APRIL 3, 2019 

Ms. BALDWIN (for herself and Mr. CASSIDY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To establish a demonstration program to explore effective 

practices to improve early detection and management 

of injuries indicative of potential abuse in infants under 

the age of 7 months, in order to prevent future cases 

of child abuse and related fatalities. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Early Detection to 

5 Stop Infant Abuse and Prevent Fatalities Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 


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1 (1) According to the National Child Abuse and 

2 Neglect Data System, an estimated 1,720 children 

3 died from abuse or neglect in the United States in 

4 fiscal year 2017. Seventy-two percent of child fatali5 ties involved children younger than 3 years, and 50 

6 percent involved infants younger than 1 year. 

7 (2) According to the Commission to Eliminate 

8 Child Abuse and Neglect Fatalities, infants and tod9 dlers are at high risk of an abuse or neglect fatality 

10 compared to other age groups and require special at11 tention. Because these young children are seen by 

12 health care professionals, the Commission rec13 ommended coordinated, cross-system approaches to 

14 prevention. 

15 (3) Multiple studies have found that relatively 

16 minor, visible injuries in young infants, including 

17 bruising and intraoral injuries, are often indicators 

18 of abuse. Such injuries are commonly overlooked by 

19 medical providers, caregivers, and child welfare pro20 fessionals because they seem trivial. Without early 

21 intervention, physical abuse can escalate, resulting 

22 in severe injuries or even fatalities. Many child 

23 abuse professionals refer to such injuries as ‘‘sen24 tinel injuries’’ in young infants because of their im25 portance as early warning signs of abuse. 


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1 (4) Research conducted in Wisconsin showed 

2 that previous sentinel injuries were identified in 27.5 

3 percent of abused infants and 30 percent of infants 

4 who suffer abusive head trauma but were rare in in5 fants who had not been abused. Other studies have 

6 demonstrated similar rates of missed opportunities 

7 to identify abuse in young infants. 

8 (5) Proper identification of, and response to, 

9 such suspicious injuries provides an opportunity for 

10 early recognition and intervention to protect vulner11 able children and prevent many cases of abuse and 

12 related fatalities, as well as an opportunity to detect 

13 medical conditions that require urgent treatment. 

14 (6) Early detection of such injuries and effec15 tive evaluation and intervention requires education 

16 of caregivers of young infants, child protective work17 ers, and medical professionals about the significance 

18 of such injuries in young infants. 

19 (7) Best practices and protocols need to be de20 veloped to ensure an effective response by medical 

21 professionals, child protective services, and other 

22 professionals when sentinel injuries are detected. 

23 SEC. 3. DEMONSTRATION PROGRAM. 

24 (a) IN GENERAL.—The Secretary of Health and 

25 Human Services (referred to in this section as the ‘‘SecVerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009

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1 retary’’) shall establish a demonstration program to award 

2 grants to eligible entities in order to test effective practices 

3 to improve early detection and management of injuries in4 dicative of potential abuse in infants under the age of 7 

5 months to prevent future cases of child abuse and related 

6 fatalities. 

7 (b) ACTIVITIES.—Recipients of grants under this sec8 tion— 

9 (1) shall use such award to— 

10 (A) develop, implement, or expand training 

11 and best practices to assist medical profes12 sionals in identifying, assessing, and responding 

13 to injuries indicative of potential abuse in in14 fants under the age of 7 months, particularly 

15 bruising and oral injuries; 

16 (B) develop protocols and policies that im17 prove communication and coordination between 

18 mandatory reporters and child protective serv19 ices when such reporters identify such injuries; 

20 and 

21 (C) conduct the evaluation under sub22 section (e); and 

23 (2) may use such award— 

24 (A) to raise awareness regarding the sig25 nificance of such injuries by mandatory reportVerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009

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1 ers, health professionals, the public, profes2 sionals caring for children, home visitors, child 

3 care workers, and child protective services staff; 

4 and 

5 (B) for other purposes, as the Secretary 

6 determines appropriate, including using the ap7 proaches described in subparagraphs (A) 

8 through (C) of paragraph (1) to address inju9 ries indicative of potential abuse in children 

10 aged 7 months and older. 

11 (c) ELIGIBLE ENTITIES.— 

12 (1) IN GENERAL.—To be eligible to receive a 

13 grant under this section, an entity shall— 

14 (A) demonstrate knowledge and experience 

15 providing health services to children and identi16 fying and responding to child maltreatment; 

17 and 

18 (B) submit to the Secretary an application 

19 at such time, in such manner, and containing 

20 such information as the Secretary may require, 

21 including— 

22 (i) a description of the entity’s 

23 planned activities, including— 

24 (I) plans to reduce child re-vic25 timization and child fatalities; and 


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1 (II) plans to evaluate success, in2 cluding pertinent data sources that 

3 will be developed or utilized; and 

4 (ii) entities with whom the applicant 

5 will collaborate in carrying out the activi6 ties under the grant. 

7 (2) MULTIDISCLIPLINARY PARTNERSHIPS.—An 

8 eligible entity shall be a multidisciplinary partner9 ship of stakeholders with knowledge and experience 

10 providing health services to children and identifying 

11 and responding to child maltreatment, which may in12 clude nonprofit organizations, community-based or13 ganizations, administrators of any programs funded 

14 under the Child Abuse Prevention and Treatment 

15 Act (42 U.S.C. 5101 et seq.), children’s health care 

16 providers, board-certified child abuse pediatricians, 

17 child protective services, child advocates, State child 

18 death review boards, child advocacy centers, State 

19 department of justice officials, children’s hospitals, 

20 disability organizations, and mental health and so21 cial services providers. 

22 (d) GRANT PERIOD.—Grants awarded under this sec23 tion are for a 3-year period. 

24 (e) EVALUATIONS.—The Secretary shall require each 

25 recipient of a grant under this section to— 


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1 (1) evaluate and assess— 

2 (A) the efficacy of the projects carried out 

3 with grant funds; and 

4 (B) the extent to which such projects re5 duced re-victimization of children and child fa6 talities; and 

7 (2) submit a report on such evaluation and per8 tinent data to the Secretary. 

9 (f) REPORT TO CONGRESS.—Not later than 1 year 

10 after the conclusion of the demonstration program under 

11 this section and the submission of the report and data 

12 under subsection (e)(1), the Secretary shall submit to 

13 Congress a report that includes— 

14 (1) an analysis of the strengths and opportuni15 ties of the program; 

16 (2) barriers or challenges for implementing or 

17 replicating best practices under the program; 

18 (3) the feasibility of a national educational cam19 paign on injuries indicative of potential abuse in in20 fants under the age of 7 months; and 

21 (4) areas for further research or evaluation to 

22 improve early detection of such injuries. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $10,000,000 for the period of 2020 through 2022. 

Æ 


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