Republished with permission from Governing, by Carl Smith

In Brief:

• More American children die from maltreatment than from cancer.

• Inconsistent approaches to tracking these deaths or documenting the circumstances that lead to them is a fundamental barrier to preventing harm.

• The American Enterprise Institute and the University of North Carolina have launched a project to bring attention to this public health problem and advocate for better data collection. Lives Cut Short is gathering publicly available data about every child death from mistreatment since 2022.

Just over 1,500 children, from newborns to age 14, were expected to die of cancer last year. Even more infants and children—an estimated 2,000—die each year as the result of maltreatment. A group of researchers and child services experts are working to bring attention to these deaths and the circumstances that can lead to them.

Lives Cut Short, a project from the American Enterprise Institute (AEI) and the University of North Carolina at Chapel Hill (UNC), was launched at the beginning of May. Among its early activities is gathering and publishing data from publicly available sources to tell the stories of children who have died as a result of abuse or neglect since 2022.

These are worst-case outcomes from a societal problem that affects a surprisingly large segment of the population. Somewhere between a quarter and a third of all American children are involved in investigations of alleged maltreatment at some point between their births and age 18.

This count encompasses incidents that are actually reported, not the full scale of mistreatment, says Dee Wilson, a member of the Lives Cut Short advisory board. Wilson worked in child services in two states for 32 years and directed child welfare services for Casey Family Programs.

If there are something like 7 million reports in a year, and only 2,000 children die, Wilson says, that’s a rate that’s too low to be much use in making predictions. It also makes it to harder to build agreement that this is a priority issue.

The rate may be low, but the absolute number of children who have died is not. Despite concerted efforts over 30 years, Wilson says, “There has been no success in bringing these numbers down.” Instead, the numbers have been going up.

It’s likely that fatalities are significantly undercounted. This is difficult to change, not least because data may emerge that reflects poorly on child welfare systems. But understanding more about the scale of the problem and the factors that contribute to it is the first step toward making progress in prevention.

Keeping Count

A report from AEI, A Jumble of Standards, looks at the inconsistencies in the ways that states count deaths from maltreatment, as well as the extent to which they share the data they do have. Deaths are likely undercounted by a factor of two or three in the annual report from the National Child Abuse and Neglect Data System, the AEI report concludes. (The data in these reports is provided by states.)

Under a 2011 federal law, states are asked to consult sources including law enforcement, medical examiners, coroners, vital statistics departments and child death review teams to compile information on deaths from child maltreatment. However, AEI observes, “The law is clearly not being enforced, as most states do not report using data from all these sources.”

In Indiana, for example, coroners are required to report “suspicious, unexpected or unexplained” deaths to Child Protective Services, but in Idaho this is only required for homicides. “Accidental” deaths resulting from egregious neglect may not be counted as deaths from abuse in some jurisdictions. A death that is the consequence of a young child ingesting fentanyl could be classified only as an accident.

The federal Protect Our Kids Act of 2012 established a Commission to Eliminate Child Abuse and Neglect Fatalities, with members appointed by Congress and the president. In its 2016 final report, the commission recommended that Congress expand the kinds of data that states are required to submit to include those outlined by the 2011 statute. It also called for the development of “uniform standards and guidelines” for case reviews of deaths from maltreatment.

An example of the data Lives Cut Short is collecting regarding fatalities from maltreatment. In this case, news reports and government documents were available. (AEI)

Who’s at Risk?

Children less than a year old have the greatest risk of dying from abuse and neglect—more than three times greater than those who are 1, and anywhere from 20 to nearly 40 times greater than children 6 or older. Six in ten fatalities are boys.

More than 80 percent of the perpetrators are parents, with mothers involved twice as often as fathers. The most recent report from the National Child Abuse and Neglect Data System shows that foster parents and legal guardians are involved in less than 0.5 percent of child fatalities, with child-care providers involved in about 1.3 percent.

Emily Putnam-Hornstein, a professor at the UNC School of Social Work, serves as principal investigator for Lives Cut Short and director of the Children’s Data Network. About half of the children who enter foster care have not entered kindergarten, she says. Large numbers have had significant prenatal exposures to drugs and alcohol.

Putnam-Hornstein was one of the investigators for a study published in 2021 that looked at how placing infants in foster care affected their survival. They matched records for all California births between 1999 and 2017 with child protective services data and death records. The fatality rate for infants placed in foster care after reports of abuse was half of that for those who were not.

Medically vulnerable children receive health insurance through Medicaid when they enter foster care, says Putnam-Hornstein. Infants who remained home after reports of alleged abuse or neglect had exceptionally heightened risk for death from medical causes alone.

“I don’t think you should take that number and say we just need to put more babies in foster care,” Putnam-Hornstein says. “I think it speaks to how preventable many of these deaths are with proper health care and support. I think there’s been far too little attention paid by legislators and others, in terms of how we prevent child deaths.”

Swimming Against the Current

Effective prevention of maltreatment deaths depends on more complete information regarding the circumstances and events that precede them. It’s more the exception than the norm for investigative reports to be available for the deaths Lives Cut Short is documenting.

There’s anecdotal evidence that deaths can be preceded by multiple reports of abuse that don’t receive the scrutiny or follow-up that they deserve. Much more data is needed to identify where systems are breaking down.

It’s the role of child services entities to act on behalf of children at risk, who aren’t in a position to be their own advocates. It’s a difficult moment for the field, however.

There are calls to abolish protective services altogether from both sides of the political spectrum. Some oppose it as government interference in the private lives of citizens, another form of “deep state” overreach, while others perceive CPS as a manifestation of systemic racism, an arm of the “carceral state.”

There’s a 40 percent turnover rate in some child welfare agencies, says Naomi Schaefer Riley, a senior fellow at AEI. There are problems with both the pipeline and the training for jobs within the sector. Putnam-Hornstein sees interest in child welfare waning among her students at UNC. “The people yelling on the sideline aren’t helping the situation,” Riley says.

Child welfare encompasses multiple state and local government systems attempting to deal with complex issues that encompass addiction, poverty, housing and more. There’s agreement across all of them that keeping families whole is the most desirable outcome, but children need some entity acting on their behalf.

It’s not surprising, or unreasonable, for the public to find fault when child welfare services fall short, Putnam-Hornstein says. “But if we don’t start creating more public accountability for the tracking of data,” she adds, “it’s probably not going to get any better.”