Current Trends in Child Abuse
Reporting and Fatalities:

The national increase in children reported between 1993 and 1994 is comparable to the increase observed between 1992 and 1993. Overall, 27 states reported increases in the number of reports received last year, down from 30 states which reported increased in the 1993 survey. Of these 27 states, six experienced increases of 10% or more In contrast,13 respondents noted actual or expected declines in their reports Two states, Nebraska and Rhode Island reported viralally no change. These declines were generally less dramatic than those observed in prior years, with no state reporting more than a 9% decline in the number of reports received in 1994 as compared to their 1993 statistics. Looking across the full five year reporting period summarized on Table 1, no state has experienced consistent declines each year and only 12 states have experienced regular annual increases in the number of reports. These patterns underscore the variability in reporting statistics over time and the sensitivity of this system to changes in social, political and administrative conditions or procedures.

As shown in the bottom half of Table 1,16 out of every 1,000 U.S. children were substantiated as victims of child maltreatment. This rate has remained fairly steady over the past four years. The 1994 rate is based on data from 40 states averaging a 33% substantiation rate. Last year, substantiation rates ranged from a low of 11% in Kansas to a high of 83% in Connecticut. Using this statistic, an estimated 1,036,000 children were substantiated as victims of child abuse and neglect in 1994, a 4.4% increase over the number accepted on to CPS caseloads in 1993. States which could not provide a substantiation rate for any of these years include California, Washington and West Virginia.

Factors Accounting for Reporting Changes

To help determine whether changes in reporting rates represent an actual increase in child abuse or merely reflect a more accurate assessment of the problem, we asked each liaison to name the two most sigmficant factors which accounted for the reporting trends in their state. While these answers are not based on quantitative data, they give a descriptive appraisal of those factors CPS administrators consider the most relevant. Twenty of the 27 states with an increase responded to this question. Ten, or half, of responding states attributed the rise in reports to increased public awareness with many states noting the influence of media attention on the issue. Poor economic conditions or fewer resources represented the next most common response, cited by six states. Finally, five states cited reporting system or procedural changes as a major contributor to growth in reports.

Only one of the thirteen states with an actual or predicted decrease in reports gave an explanation for their decline. The Indiana state liaison felt the decrease indicated that the state's reporting level had reached a plateau.

Like last year, most respondents stated that the 4.5% climb in the number of children reported between 1993 and 1994 was caused by an increase in public awareness. However, while last year many states felt that the system was reaching a saturation point and that child abuse reports might level off, the larger rate of increase for 1994 suggests that child abuse reports continue to increase at a steady pace.

Case Characteristics

Breakdown by Type of Abuse

To provide appropriate prevention and treatment services, it is necessary to determine the prevalence of different types of maltreatment as well as other characteristics of the CPS caseload. Each state liaison was asked to provide a breakdown of all reported and substantiated cases by type of maltreatment for 1993 and 1994. Five categories were provided: physical abuse, sexual abuse, neglect, emotional maltreatment and other. Twenty-six states provided reporting data for both years while 36 states gave a breakdown for substantiated cases for both years.

As Figure 1 indicates, neglect represents the most common type of reported and substantiated form of maltreatment. In 1994, 28 states provided the following breakdown for reported cases: 45% involved neglect, 26% physical abuse, 11% sexual abuse, 3% emotional maltreatment and 15% other. For substantiated cases, 36 states gave the following breakdowns: neglect 49%, physical abuse 21%, sexual abuse 11%, emotional maltreatment 3% and other 16%. For the first time in the history of this survey, these two patterns are essentially identical. T-ests conducted on the reported and substantiated distributions for each type of maltreatment found only one significant difference. As in the past, physical abuse constitutes a significantly greater percentage of reported cases (26%) than substantiated cases (21%) (t=-4.57, p=.00, df (24)), a pattern comparable to the one reported last year.

In prior years, the greatest difference between these two distributions involved sexual abuse and neglect cases. Overall, substantiated cases tended to include a larger percentage of sexual abuse and a lower percentage of child neglect than was observed in the larger pool of all reports. The similarity in the distribution of reported and substantiated cases in terms of primary type of abuse suggest that type of abuse, alone, may not be as critical a factor as in the past in determining whether a case will be substantiated. Neglect cases are now as likely to be substantiated as cases involving other forms of maltreatment.

The types of cases most frequently reported to child protective services have under gone some shift in the past eight years. Overall, the distribution for all reported cases noted in the most recent survey differs from the 1986 breakdown of reported cases. At that time, the American Association for the Protection of Children (AAPC) found that 26% of all reports involved charges of physical abuse, 16% involved charges of sexual abuse, 55% involved charges of child neglect, 8% involved charges of emotional maltreatment and 8% involved other or unspecified forms of maltreatment (AAPC, 1988). While some variation between the 1986 statistics and those reported in this document reflects different methodologies, (4) the shift also may reflect a change in the type of cases professionals and the public are willing to report to CPS and the classification systems used by child welfare systems in describing the reports they do receive. For exarnple, the percentage of cases falling into the "other" category has almost doubled over the past eight years, a pattern which may reflect a tendency on the part of workers to use this classification when multiple forms of maltreatment are present or if a family is involved in substance abuse.

One of the most interesting shifts suggested by these patterns is the decline in the proportion of reported cases involving child sexual abuse, as summarized in Figure 2. While such cases represented 16% of all reports in 1986, this percentage has gradually declined over the years. In the most recent survey, sexual abuse cases were only 11 % of all reports. To a certain extent, the rapid increase in the number of reported cases of child sexual abuse observed in the mid to late 1980's reflected the increased awareness and attention to a form of maltreatment which had been virtually ignored prior to this time. Child welfare agencies across the country were inundated with cases, many of which had involved several years of ongoing abuse. After almost ten years of attention to this problem, it is possible that the reservoir of cases involving years of abuse have been reduced such that child welfare is less burdened with such cases. Further, improvements in professional practice and the rapid expansion of child assault prevention services have produced an environment in which cases are identified closer to the onset of the abuse.

Whatever the reason, the decline in the percentage of reported cases involving child sexual abuse coupled with the changes in the pattern of substantiated cases noted above has resulted in a downward trend in the number of sexual abuse cases currently on CPS caseloads. The number of child sexual abuse cases currently being served by child welfare agencies dropped from a 1993 figure of 128,960 to 113,960 last year. This number, however, is far higher than the number of sexual abuse cases served in the 1970's and early 1980's and underscores the substantial threat to child well being represented by this form of maltreatment.

Day Care/Foster Care

Reports of child maltreatment involving day care centers and foster care homes attract a great deal of attention from the media and the general public. Such publicity has created the perception that abuse is common place in these out-of-home settings. However, this perception seems out of line with reality (Finkelhor, Williams & Burns, 1988). According to the 21 states that provided this statistic for 1994, less than l % of confirmed abuse cases occurred in day care centers or foster care settings. These figures have been consistent over the past eight years.

Primary Presenting Problems

Families reported for child maltreatment often display a number of problems which can contribute to their likelihood for engaging in abusive behavior. Identifying these problems is a first step toward prevention. To assess whether specific patterns are shared by families on CPS caseloads across the country, respondents were asked to describe the major problems presented by their caseloads. Thirty-eight state liaisons responded to this question with 76% (29 states) naming substance abuse as one of the top two problems. This is an increase over the 63% of the states that listed this response in 1993.

The next most frequent response involved the need for support services for families. Twenty-four percent of respondents (9 states) noted that the families on their caseloads lacked support from family and community sources. Several liaisons mentioned that the challenge of single parenthood was a problem for many of their families. Related to this issue was the belief that economic stress and poverty characterized a large percentage of families served by child protective services. Twenty-four percent (9 states) indicated that most families on their caseloads either lived in poverty or faced increased financial stress due to unemployment and the recession. These families, according to the liaisons, have insufficient resources to care for their children. Three other problems were noted by a significant number of states. Six states asserted that lack of knowledge regarding basic child care and child development, lack of parenting skills and inappropriate child management techniques represented primary problems for these families. Five states identified family or domestic violence as a major difficulty for their families. Finally, two other liaisons noted a heavy concentration of fragmented families on their caseloads.

Services to Abusive Families

A critical question concerns what happens to the child or family after a case has been substantiated. One study found that CPS social workers did not provide any service in almost 60% of the agency's confirmed cases (Meddin & Hansen, 1985) while a review of New York cases found that almost 56% of all indicated cases are closed the same day they are officially substantiated (Salovitz & Keys, 1988). In the current survey, only 19 states could provide an estimate as to the percentage of substantiated cases which received CPS services. Figures ranged from 29% to 100% with an average of 72% receiving some type of service. This figure is consistent with the 70% reported in 1993. While this level of service is notable given the increased number of reports, approximately 290,000 confirmed cases of child abuse received no services to remediate the negative consequences of maltreatment. Of those who did receive services, the most common intervention reportedly offered by the responding agencies were individual or family counseling, used by 68% (25 states).

One service common across all child protective service agencies is the removal of the child from the home either during the investigation or after allegations of maltreatment have been substantiated. When asked the total number of children removed from the home where abuse occurred, 22 states provided figures for 1994. Over 68,000 children from these states were placed in alternative care for some period of time in 1994. For the sixteen states who provided both the number of children removed and the total number of substantiated child victims, approximately 14% of child victims were removed from their homes in 1994 as compared to 17% removed in 1993 (based on data from 22 states). Further, only 5% of the children reported for maltreatment were removed from their homes. The small number of states providing data on these questions suggests caution is warranted in generalizing this finding. However, these data do contradict the prevailing notion on the part of the public and some policy makers that child welfare workers commonly remove children from their parents. Indeed, the vast majority of confirmed child abuse cases involve services being provided to abusive or neglectful parents who continue to have custody of their children.

Child Maltreatment Fatalities

One of the greatest tragedies is the death of a child from abuse or neglect. Although such deaths are relatively infrequent, the rate of child maltreatment fatalities confirmed by CPS agencies has risen steadily over the past eight years. As shown in Table 2, the rate of fatalities rose from 1.3 per 100,000 to 1.92 between 1985 and 1994, a 48% increase. In 1994, an estimated 1,271 children died from abuse or neglect. As noted in Table 2, this estimate is based on data from 34 states comprising 76.4% of the U.S. population under eighteen years of age. Estimates for earlier years are based on at least 80% of the child population. If data were available from all 50 states and the District of Columbia for all nine years, the actual rate of change and total scope of the problem could vary somewhat from these projections.

KEY:
P

Between 1991 and 1994, overall death rates remain unchanged. However, these data are not complete and as such should be viewed as estimated. Seventeen states did not provide the number of child maltreatment fatalities for 1994 and eight states still had some number of deaths under investigation at the time of the survey.

These figures confirm that over three children died each day last year as a result of parental maltreatment, a statistic this survey has supported for the past nine years. In addition, data from other studies and anecdotal information from liaisons strongly suggest thatzthese numbers under count the actual incidence of maltreatment fatalities in the United States. Research has consistently found that some percentage of accidental deaths, child homicides and sudden infant death syndrome (SIDS) cases might be more appropriately labeled a child maltreatment death if comprehensive investigations were routinely conducted (California Office of the Auditor General, 1988; Ewigman, Kivlahan & Land, 1993; McClain, Sacks, Froehlke & Ewigman, 1993; Mitchel. 1987). A recent study by McClain et al (1993) utilizing a mathematical model to estimate the total numbers of child abuse and neglect deaths found that child maltreatment fatalities remained relatively stable between 1979 and 1988 with between 949 to 2022 deaths each year. This study also concluded that 85% of deaths due to parental maltreatment were coded as due to some other cause on the child's death certificate.

To better understand how and why child abuse fatalities occur, we examined four characteristics of these deaths for the past three years: 1) involvement of the victim with CPS agencies, 2) type of maltreatment leading to death, 3) the ages of the child victims and 4) the involvement of parental substance abuse. Table 3 presents the results. According to information from at least 19 states, 45% of the children who died between 1992 and 1994 had prior or current contact with CPS agencies. This substantial percentage may reflect the fact that many states only investigate deaths of children with current or prior CPS contact, thereby ensuring that a high percentage of the reported deaths will involve such children. On the other hand, the inability of child welfare agencies to provide sufficient services to all victims or to conduct comprehensive investigations of all reports most likely contribute to this pattern. At least 19 states were able to report the type of maltreatment which caused the child's death. These percentages remained fairly stable over the years. Between 1992 and 1994, 42% died from neglect, 54% died from abuse while 5% died as a result of both forms of maltreatment. Young children remain at high risk for loss of life. Based on data from all three years, this study found that 88% of these children were under the age of five while an alarming 46% were under the age of one at the time of their death. In 1994, the rate of fatalities for children under five was 6.6 per 100,000 children. These numbers correspond with other studies (AAPC, 1988) and emphasize the vulnerability of young children to child abuse and neglect.

* Total does not equal 100 due to rounding.

Death Review Committees

Whether a state has a death review committee and that committee's function also influence the ability of CPS to provide an accurate count of fatalities. According to this survey, at least 35 states have some type of death review committee in place. (5) The number of deaths reviewed by these committees varied. For the 11 states which could provide this number, 1,365 child deaths were reviewed in 1994. Many of committees investigate not only the deaths of children with previous or current CPS involvement, but also the deaths that may not be due to abuse or neglect.

Substance Abuse

As noted earlier, the majority of states cited substance abuse as a major presenting problem of families on their caseloads. The increased use of drugs and alcohol by caregivers also was noted by several states as a primary factor in driving up reporting levels. In this survey, we sought to identify ways in which states and CPS agencies have responded to this epidernic. First, we asked for an estimate of the number of substantiated cases involving substance abuse. For the eleven states responding, an average of 35% of the substantiated cases in these states involved substance abuse though the percentage ranged from 4% to 65%. The fact that only eleven states could provide these data underscore the general lack of empirical data regarding the connection between these two problems.

One well-known result of increased substance abuse by women is the growing number of infants born exposed to illegal substances taken by their mother during pregnancy. Estimates on the scope ofthis problem vary substantially from 100,000 to 350,000 infants nationwide (Chicago Tribune, 1991; Chasnoff, 1988). In 1994, fourteen states reported a total of 7,469 drug-exposed infants. No state requires the uniform testing of infants for drug-exposure. Several states have responded to this problem by mandating that medical personnel and others report to CPS drugexposed infants or substance abusing pregnant women. As of 1994, at least 27 states require medical personnel to report drug-exposed babies. (6)

Child Protective Services

The ability of the child protection system to respond to the continued increase in reports and child abuse fatalities largely depends on the resources available. The amount of funding CPS agencies receive dictates whether reports get investigated, victims receive services or efforts are made to prevent maltreatment before a family enters the system. In this section, we investigate not only changes in child welfare budgets, but plans for spending future resources designed to prevent child abuse.

For the second consecutive year, state funding for child protective services improved. Seventeen out of 30 states (57%) reported an increase in resources between 1993 and 1994. Two states (Wyoming and Alaska) experienced budget cuts. While the remaining 11 states maintained stable funding, this funding level often prohibited needed staff or service enhancements, particularly in the area of child abuse prevention. Though 17 states reported an increase in funding, this did not necessarily translate into more staff. In 1994, twelve states (40%) hired new investigatory staff, 15 states (50%) increased the number of case managers and 12 (40%) were able to enlarge their supervisory staff.

When asked how the state planned to allocate these resources, the liaisons indicated that, on average, 54% of the funds would be allocated to family support services (with responses ranging from 25% to 100%), while 44% of the funds would be allocated to family preservation (responses ranged from 10% to 75%). Finally, an average of 2% would be allocated to other purposes such as technical assistance and planning.

As a part of the questions concerning funding for child protective services, twenty-five states responded to questions concerning the Child Protection Block Grant that was established in Title II of the Personal Responsibility Act, a component of the Republican's Contract with America. The Child Protection Block Grant, which passed the house in March, 1995, would replace 23 existing child and family service programs. Ninety-six percent of the states had serious concerns about this legislation and feared that it would have a negative impact on social service delivery. An anticipated decrease in funding was mentioned by 71% of the liaisons as an expected negative impact of the legislation. A variety of other issues were raised, including a concern that the legislation would decrease focus on child abuse prevention and that the relaxed state accountability to the Federal Department of Health and Human Services would remove important protective standards for children.

To assess the future availability of other prevention services, the survey asked respondents some questions regarding home visiting services. The National Committee to Prevent Child Abuse has launched a nationwide prevention initiative called Healthy Families America (HFA) to provide home visiting services to parents of newborns. The purpose of HFA is to ensure that all new parents, particularly those at high risk for child maltreatment, get off to a good start. At present, this initiative has resulted in the establishment of over 100 pilot programs in 22 states. Most other states have established task forces to explore the development of these efforts. Respondents were asked whether they had heard of this initiative and if their state CPS agency was involved in HFA. While the overwhelming majority (40 states) had heard of HFA, only 23 respondents stated that they were involved in this initiative.

The final set of survey questions sought to determine the effectiveness of a variety of child welfare reforms in improving child welfare services. The states were asked to assess six child welfare reforms on a 1 to 5 scale, ranging from not effective (1) to very effective (5). Table 4 summarizes the respondents ratings for each of these reforrns. According to the thirty-four states responding to these questions, the most effective reforms were family preservation services (79% of the respondents viewed this strategy as effective), the Children's Trust Funds and risk assessment protocols. These last two strategies were viewed helpful by almost half of all respondents. Moderately effective were computerized management information systems (approved by 41% of all respondents) and the Federal Family Preservation and Support Act passed last year (believed helpful by 38% of all respondents). Increased prosecution of child abuse was regarded as the least effective of the reforms listed with only 14% viewing this approach as effective. It should be noted, however, that many states noted that they had not seen any increase in prosecution levels over the past few years.

Note: Higher score indicates reform was perceived as more effective.

Conclusion

Child abuse reports continue to climb at a steady rate despite the absence of significant new funding to states for investigation or service provision. Last year, child abuse reports rose 4.5%, exceeding 3.1 million in 1994. A similar increase in the number of substantiated cases also occurred, with over one million new cases entering child protective service caseloads last year. Unlike past years, the proportion of cases involving various forms of maltreatment were essentially the same among the reported and substantiated cases, suggesting that a greater number of neglect cases and fewer child sexual abuse cases entered the system last year as compared to prior years. Of those cases that were substantiated, approxiInately 72% received some form of service and 14% of the cases involved the use of foster care.

Child abuse fatalities remain high. An estimated 1, 271 children were killed last year as a result of child abuse or neglect. Looking across the past three years, 45% of these fatalities involved children who had current or prior contact with local child protective service agencies. The vast majority of these cases (88%) involved children under the age of five and almost half were under the age of one (46%). Despite the increased implementation of child death review committees and administrative attention to the issue of child abuse fatalities, essentially no change in this statistic has been observed over the past nine years.

While 57% of the respondents indicated that their agency had experienced increased state funding between 1994 and 1993, these increases were relatively small and may well be offset by the decline in funding expected from Federal sources. Indeed, 96% of the respondents had serious concerns about the recent move in Congress to block grant child welfare and related services. These concerns reflect not only the potential loss of funding but also the loss of Federal leadership in this area, particularly with respect to supporting the increased emphasis on family support and other prevention services adopted by many child welfare administrators since passage of the Federal Family Support and Prevention Initiative passed by Congress in 1994.

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