Policy and Practice Changes Form Around National Strategy to Reduce Fatalities and Improve Child Safety

When the President and Congress asked the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) to develop a national strategy to eliminate child maltreatment fatalities in 2014, we knew the task would not be easy. There was little in the way of evidence-based programs from which to learn. The myriad of policies at the federal, state and local level for defining, counting and addressing fatalities made the task all the more complicated.

However, as we concluded our two years of public hearings, study and deliberations on this issue, we felt that we identified some clear and attainable steps that, if taken, will provide both short term and long term solutions for protecting vulnerable children. As more states and the federal government begin to implement these recommendations, there is good reason to believe that more children’s lives can be saved.

Our strategy called for a new vision of a 21st century child welfare system. This reform requires a multidisciplinary, public health approach with shared accountability and a safety culture that draws from knowledge gained by other industries. And, we identified steps that CPS agencies can take today to save lives, including prioritizing children who are at increased risk of fatality, such as those with past CPS reports and those under the age of three.

Most importantly, the Commission agreed that as a nation we should not view child abuse and neglect fatalities as inevitable. Working collaboratively, we have the tools to save lives.

On the heels of the release of our March 2016 report: “Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities,” we established an office at the Alliance for Strong Families and Communities, funded by Casey Family Programs, to advance recommendations and track practice and policy changes around the country.

Our findings over the past ten months are encouraging. We see significant policy changes in at least 30 states and jurisdictions that are consistent with strategies the Commission put forth. While some of these changes were underway prior to the release of our report, they represent a significant shift in child welfare practice that both validates and, in some cases, is bolstered by our findings. We are eager to learn how jurisdictions that have not yet begun this work plan to implement change and how the Within Our Reach office can be of assistance.

At the federal level, the U.S. Department of Health and Human Services (HHS) announced its intention to advance 60 percent of the Commission’s recommendations impacting HHS, noting: “Overall, HHS heartily embraces the Commission’s vision for a robust response to families in crisis: one that intervenes early to prevent maltreatment and strengthen families whenever possible, but also protects children aggressively as needed. This is a vision that, as the Commission suggests, combines leadership and accountability with multidisciplinary support for families and decision making that is grounded in data and research.”

We look forward to meeting with the Trump Administration’s domestic policy team to brief them on the report and work collaboratively toward meeting joint goals with regard to child safety.

Additional federal activities include new guidance on maternal depression screening and treatment from the Centers for Medicare and Medicaid Services (CMS), a Department of Justice-funded grant of $6 million approved for fiscal year 2017 to develop partnerships in support of a data-driven approach to prevent fatalities (which is currently frozen), and a White House-hosted “Foster Care and Technology Hackathon” which identified strategies for breaking down barriers around information-sharing and real-time data sharing.

Congress has also introduced, and in some cases, passed groundbreaking legislation on issues related to CECANF recommendations. The Comprehensive Addiction and Recovery Act (S.524) was passed by Congress this summer and signed into law by the President. The bill requires that states that receive federal funds for child protective services comply with federal law and enact certain guidelines for the welfare of children exposed to opioids. Talia’s Law (H.R. 3894) was signed into law last December. It requires greater collaboration and communication between military children and state child protective services in cases of alleged neglect or abuse. The Family First Prevention Services Act (H.R. 5456 and S. 3065) was reintroduced this year and calls for the delivery of more upstream prevention services and the development of state fatality prevention plans. This bill would accomplish a number of recommendations from the Commission, including finance reform as described in former Commissioner Wade Horn’s recent commentary. Additionally, reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) presents an opportunity to examine strategies articulated by the Commission.

At the state and local level, more than 30 jurisdictions are currently implementing or considering implementation of CECANF recommendations including:

  • Eight states (Alabama, Oregon, Wisconsin, Tennessee, West Virginia, Virginia, Maryland, and Kentucky) are developing state fatality prevention plans with the support of technical assistance from the Three Branch Institute on Improving Child Safety and Preventing Child Fatalities.
  • Seven states (Alaska, Connecticut, Florida, Illinois, Indiana, Maine and Oklahoma) are working to implement Eckerd Rapid Safety Feedback, a unique process highlighted in the Commission report that relies on real-time data analytics to flag high-risk child protection cases for intensive monitoring and caseworker coaching.

Additional activity by states and local jurisdictions includes:

  • California committed to predictive analytics statewide to prevent child abuse and created a Multidisciplinary Review Team (MDRT) to review all fatality and near fatality reports to collect and record data to identify risk factors and prevent future deaths.
  • Monterey County, California is using the Commission report to develop a county-wide plan for child well-being.
  • San Diego County, California is working with the MITRE Corporation to apply safety science in the field of child welfare.
  • Los Angeles County, California announced a review of the last five years of child death and critical incident reports within the Department of Child and Family Services to determine risk factors for child fatality.
  • Connecticut adopted the Strengthening Families practice model which establishes a working partnership with families to provide vital preventive services and supports like mental health and substance abuse treatment.
  • SAS, a predictive analytics firm, delivered a report to Florida’s Department of Children and Families featuring a child abuse prediction algorithm focused on adult abusers rather than children at risk.
  • Indiana’s Department of Child Services (DCS) changed its assessment policies statewide to assess all children for any report of child abuse or neglect who had not yet reached their third birthday, with support from home-visiting programs.
  • In Michigan, in response to an increase in drug-addicted newborns, state Sen. Rick Jones drafted a bill to compel Child Protective Services (CPS) to automatically open a case for services for at least 90 days when a baby is born with an illegal drug in its system. He plans to introduce the bill in early 2017.
  • Prince George’s County, Maryland launched a child safety awareness campaign focusing on caretakers that provides information about child care resources in the county and what to keep in mind when screening adults potentially caring for children.
  • Massachusetts Department of Children and Families (DCF) announced a series of reforms following an uptick in child deaths. Those reforms included increased staffing and new supervisory policies. Since implementation, child maltreatment fatalities have declined.
  • Hennepin County, Minnesota is launching a $26 million prevention program that will provide resources for additional staff to reduce child protection caseloads, more staff for a parent support outreach program that helps connect parents with the right services, a new child well-being director to head up the initiative and a new “transformation team”.
  • Montana created a Child Fatality Review Team that has called for changes in policy, including the creation of a standard format for reports of fatalities, determining the criminal and child protection history of everyone in a home within 24 hours of an initial report, and working on ways to intervene early in families with multiple risk factors.
  • Nebraska’s University of Nebraska-Lincoln research center was awarded a $15 million grant to study ways to address the workforce problems facing child welfare agencies.
  • Republican lawmakers in New Hampshire announced the establishment of a joint legislative committee to review a report calling for the overhaul of the Division for Children, Youth, and Families (DCYF), citing concerns that the agency was failing to protect endangered children due to a lack of manpower to handle workload.
  • New Jersey is partnering with The Baby Box Company to improve new parent education, encourage newborn health awareness and reduce Sudden Unexpected Infant Death Syndrome.
  • New York introduced State Bill S.137 that would require hair follicle testing for opioids of an infant or toddler under the age of three who is in the vicinity of parent or guardian who is arrested on a drug charge. Another piece of legislation, State Bill S.3146, establishes a statewide standard of no more than 15 cases per month per full-time child protection caseworker.
  • New Hanover County in Wilmington, North Carolina announced a new child fatality protocol which requires law enforcement to contact the DA’s office and Dept. of Social Services immediately after responding to a child’s death.
  • Doctors and nurses at 19 Ohio hospitals will soon receive training on how to screen for signs of child abuse in the most vulnerable residents — infants six months and younger. Governor Kasich recently signed into law a provision to provide a safe haven for parents who want to surrender unwanted newborns through newborn safety incubators. They are also opening the first non-hospital setting for the recovery of substance-exposed infants and their caregivers in Kettering, Ohio.
  • Allegheny County, Pennsylvania pioneered a predictive analytics tool utilizing a “data warehouse” to help screen high-risk child abuse reports for further investigation.
  • Two new bills signed by Rhode Island Governor Gina Raimondo require the state Department of Children, Youth and Families (DCYF) to disclose deaths and injuries of children in state care within 48 hours. Schools must also now contact DCYF if they think a child is being sexually abused by someone at the school, as well as send reports of sexual abuse to state police and local law enforcement.
  • Texas released a five-year strategic plan to prevent child maltreatment fatalities, the first statewide plan that we know about in the country.
  • Virginia passed legislation focusing on enhancing care for the 73,000 children of Virginia’s military families by improving collaboration among civilian and military agencies. The legislation would require child welfare agencies to share a child’s military affiliation with military authorities.

A broad number of policy and advocacy organizations nationwide are also working collaboratively to support and implement recommendations. The National Coalition to End Child Abuse Deaths, which was instrumental in passage of the Protect our Kids Act of 2012 and the establishment of the Commission, is executing an action plan to advance CECANF recommendations.

Collectively, these actions represent an essential shift at the federal, state and local level to adopt a public health approach to child safety predicated on prevention and community-level support that aligns and leverages existing resources to prevent crises before they occur.

The timeliness and urgency of these steps were underscored by the most recent child maltreatment report, which was released January 19, 2017 by HHS’s Administration for Children and Families. The report, which draws data from the National Child Abuse and Neglect Data System (NCANDS), a voluntary national data collection and analysis program of state child abuse and neglect information, shows that 1,670 children died of abuse and neglect in 2015, an increase of 5.7 percent since 2011.

We urge all local, state and federal jurisdictions to join our efforts and to work collaboratively toward realizing our nation’s goal of protecting vulnerable children from abuse and neglect. Our children’s lives depend on it.

David Sanders, Ph.D.,
is former Chairman of the Commission to Eliminate Child Abuse and Neglect Fatalities. He currently serves as executive vice president of systems improvement for Casey Family Programs, a position he has held since 2006. Sanders previously served as the director of the Los Angeles County Department of Children and Family Services from 2003 to 2006. He is also a member of The Chronicle of Social Change Advisory Council.

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