Child Maltreatment:
Strengthening National Data on Child Fatalities Could Aid in Prevention
GAO-11-599, Jul 7, 2011
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Children's deaths from maltreatment are especially distressing because they involve a failure on the part of adults who were responsible for protecting them. Questions have been raised as to whether the federal National Child Abuse and Neglect Data System (NCANDS), which is based on voluntary state reports to the Department of Health and Human Services (HHS), fully captures the number or circumstances of child fatalities from maltreatment. GAO was asked to examine (1) the extent to which HHS collects and reports comprehensive information on child fatalities from maltreatment, (2) the challenges states face in collecting and reporting this information to HHS, and (3) the assistance HHS provides to states in collecting and reporting data on child maltreatment fatalities. GAO analyzed 2009 NCANDS data--the latest data available--conducted a nationwide Web-based survey of state child welfare administrators, visited three states, interviewed HHS and other officials, and reviewed research and relevant federal laws and regulations.
More children have likely died from maltreatment than are counted in NCANDS, and HHS does not take full advantage of available information on the circumstances surrounding child maltreatment deaths. NCANDS estimated that 1,770 children in the United States died from maltreatment in fiscal year 2009. According to GAO's survey, nearly half of states included data only from child welfare agencies in reporting child maltreatment fatalities to NCANDS, yet not all children who die from maltreatment have had contact with these agencies, possibly leading to incomplete counts. HHS also collects but does not report some information on the circumstances surrounding child maltreatment fatalities that could be useful for prevention, such as perpetrators' previous maltreatment of children. The National Center for Child Death Review (NCCDR), a nongovernmental organization funded by HHS, collects more detailed data on circumstances from 39 states, but these data on child maltreatment deaths have not yet been synthesized or published. States face numerous challenges in collecting child maltreatment fatality data and reporting to NCANDS. At the local level, lack of evidence and inconsistent interpretations of maltreatment challenge investigators--such as law enforcement, medical examiners, and child welfare officials--in determining whether a child's death was caused by maltreatment. Without medical evidence, it can be difficult to determine that a child's death was caused by abuse or neglect, such as in cases of shaken baby syndrome, when external injuries may not be readily visible. At the state level, limited coordination among jurisdictions and state agencies, in part due to confidentiality or privacy constraints, poses challenges for reporting data to NCANDS. HHS provides assistance to help states report child maltreatment fatalities, although states would like additional help. For example, HHS hosts an annual NCANDS technical assistance conference, provides individual state assistance, and, through NCCDR, has developed resources to help states collect information on child deaths. However, there has been limited collaboration between HHS and NCCDR on child maltreatment fatality information or prevention strategies to date. State officials indicated a need for additional information on how to coordinate across state agencies to collect more complete information on child maltreatment fatalities. States are also increasingly interested in collecting and using information on near fatalities from maltreatment. GAO recommends that the Secretary of HHS take steps to further strengthen data quality, expand available information on child fatalities, improve information sharing, and estimate the costs and benefits of collecting national data on near fatalities. In its comments, HHS agreed with GAO's findings and recommendations and provided technical comments, which GAO incorporated as appropriate.
Status Legend:
- Review Pending
- Open
- Closed - implemented
- Closed - not implemented
Recommendations for Executive Action
Recommendation: To improve the comprehensiveness, quality, and use of national data on child fatalities from maltreatment, the Secretary of HHS should use stronger mechanisms to routinely share analyses and expertise with its partners on the circumstances of child maltreatment deaths, including insights that could be used for developing prevention strategies.
Agency Affected: Department of Health and Human Services
Status: Open
Comments: In September 2011, HHS stated that it had several mechanisms in place for sharing information on child fatalities from maltreatment, including the Federal Interagency Work Group on Child Abuse and Neglect, the National Child Abuse and Neglect Data System (NCANDS) annual meeting for state liaisons and members of the data team, and the annual National Conference on Child Abuse and Neglect. GAO acknowledged these and other mechanisms in its report, but noted that child maltreatment fatalities was not often discussed at interagency meetings and there was little routine information sharing between NCANDS officials and national child death review data analysts on child maltreatment fatalities. In FY12, HHS reported that they have no additional update to offer, as they have already noted their activities in response to this recommendation.
Recommendation: To improve the comprehensiveness, quality, and use of national data on child fatalities from maltreatment, the Secretary of HHS should expand, as appropriate, the type and amount of information HHS makes public on the circumstances surrounding child fatalities from maltreatment.
Agency Affected: Department of Health and Human Services
Status: Open
Comments: For 2010, HHS's annual Child Maltreatment report made public two additional tables of information about child fatalities from maltreatment than in its 2009 report, one of which provides information on the circumstances surrounding child deaths. The tables included information on child fatalities among caregivers with selected risk factors, such as alcohol abuse, and on child maltreatment fatalities by state from 2006-2010. HHS noted that NCANDS data is intended to be nationally representative and that some information is not provided in the report when there is insufficient data from the states. In FY12, HHS reported that they have no additional update to offer, as they have already noted their activities in response to this recommendation. GAO, however, believes that additional information on the circumstances surrounding child maltreatment deaths--such as data on perpetrators, risk factors associated with the child, or method of death--can provide a more comprehensive understanding of the issue and help reveal patterns that could aid prevention efforts.
Recommendation: To improve the comprehensiveness, quality, and use of national data on child fatalities from maltreatment, the Secretary of HHS should identify ways to help states strengthen the completeness and reliability of data they report to NCANDS. These efforts could include identifying and sharing states' best practices, particularly those that foster cross-agency coordination and help address differences in state definitions and interpretation of maltreatment and/or privacy and confidentiality concerns.
Agency Affected: Department of Health and Human Services
Status: Closed - Implemented
Comments: On September 30, 2011, the Child and Family Services Improvement and Innovation Act (42 USC 1305) was passed into law. The Act requires states to describe the various sources of data on child fatalities and, if applicable, why information is not included from other relevant agencies, such as state vital statistics, child death review teams, law enforcement agencies, and offices of medical examiners or coroners. The additional information required of states by the Act will assist in improving the comprehensiveness and quality of national data on child fatalities from maltreatment. HHS did not provide updates in FY 2012 on activities that could help strengthen national data, such as sharing best practices with regard to fostering cross-agency coordination or addressing privacy/ confidentiality concerns or differences in interpretation of maltreatment.
Recommendation: To improve the comprehensiveness, quality, and use of national data on child fatalities from maltreatment, the Secretary of HHS should estimate the costs and benefits of collecting national data on near fatalities and take appropriate follow-up actions.
Agency Affected: Department of Health and Human Services
Status: Open
Comments: In September 2011, HHS noted that it had initiated conversations with the states to improve the identification of cases that involve children's near-fatalities. The agency anticipated that, with states' support, the key data file on child maltreatment will be modified to include an additional data element identifying near-fatalities. In FY12, HHS reported that they have no additional update to offer, as they have already noted their activities in response to this recommendation.