Why Doesn’t the U.S. Have an Accurate Count of Child-Abuse Deaths?

Tanner Bivins was declared dead on January 5, 2018, at a hospital in Paducah, Kentucky, the week before his sixth birthday. As the Louisville Courier-Journal reported, Tanner was emaciated and dehydrated, and his scalp was covered with sores. Authorities later found his home strewn with garbage and vermin. The house had no utilities and no heat; the temperature had dropped to eleven degrees the night that Tanner died.

According to the National Child Abuse and Neglect Data System (N.C.A.N.D.S.), an arm of the Administration for Children and Families, an estimated 1,720 children in the United States died due to abuse and neglect in the fiscal year 2017, the most recent year for which national statistics are available. But a death like that of Tanner Bivins would not have been included among them, because the medical examiner’s autopsy lists Tanner’s cause of death as “undetermined.” (As a state review panel noted in 2017, “Neither child maltreatment nor homicide is typically entered as the cause of death on the death certificate . . . because investigations necessary to make those determinations have not been completed at the time the death certificate is filed.”) The “undetermined” finding means that Kentucky’s social-service agencies will not report Tanner’s death as being the result of maltreatment.

In part because of such cases, it is virtually impossible to find anyone who is both well versed in national child-abuse statistics and has faith in their accuracy. “The numbers could easily be three times or four times higher than what’s reported,” Emily Putnam-Hornstein, the director of the Children’s Data Network in California, said. “Whatever’s being reported to [N.C.A.N.D.S.] is an undercount.” In 2016, Kentucky reported that fifteen children died of abuse or neglect, for a rate of 1.48 per hundred thousand. (The national average is 2.32 per hundred thousand, while two states next door to Kentucky, Indiana and West Virginia, report death rates of 4.96 and 4.87, respectively.)

Standards for accounting for child-abuse deaths vary wildly from state to state. In some Ohio counties, a death is not counted if there are no surviving siblings in the home. In Michigan, in some cases, a death may not be counted if the assailant is not a parent or legal guardian—for example, if a mother’s boyfriend kills her child. Alaska has no set definition for what constitutes a maltreatment death, according to Jared Parrish, the senior maternal and child-health epidemiologist in Alaska’s Division of Public Health. “Our child-welfare agency does not investigate all child deaths,” he said. “They usually just default to what the medical examiner reports. We know our numbers are grossly underestimated.”

In 2016, a congressional commission on eliminating fatalities due to child abuse and neglect recommended that a nationwide “uniform definition” for counting such deaths and life-threatening injuries be rapidly designed and implemented. “Unless you have good data, you can’t tell if anything you actually do works to lower the rate of these fatalities,” Rachel Berger, a Pittsburgh pediatrician who led the commission’s research team, said. “The idea that every state has a different definition of child maltreatment is crazy. We focussed on fatalities because it seemed like the most straightforward place to start, but, if being counted as a maltreatment death depends on where you live, we’ll never get anywhere.”

Putnam-Hornstein said that child-abuse deaths, while relatively uncommon, offer important clues to a bleak bigger picture. “The death itself may be a rare occurrence, but the circumstances around it are usually far from rare,” she said. “We can look at those circumstances to see what went wrong, and learn how child-protection agencies can conduct better investigations and make better decisions.”

On May 20th, the U.S. House of Representatives passed a bill that would finally set a standard national definition of maltreatment deaths, as part of its reauthorization of the Child Abuse and Prevention Treatment Act. The bill passed by unanimous consent, and was co-sponsored by nineteen Republicans, including two from Kentucky. Yet, in the Senate version of the bill approved on Thursday by the Committee on Health, Education, Labor, and Pensions, the requirement for a standard definition has been omitted. Before the vote, Taylor Haulsee, a spokesman for the committee’s Republican chair, Lamar Alexander, of Tennessee, said that Alexander “is generally not supportive of a single federal definition.”

Senator Patty Murray, of Washington, the committee’s ranking Democrat, tried to convince her colleagues to reinsert the requirement. “Senator Murray’s office has spent hours and hours trying to make it work,” Theresa Covington, another member of the commission, said. Senate Republicans “don’t want a national standard. They believe it should be up to the states.” Another Democrat, Senator Sherrod Brown, of Ohio, introduced a separate bill that would require the Department of Health and Human Services to work with local state agencies to develop a uniform definition of maltreatment death. But the odds of such a bill coming up for a vote are slim.

“Things move in Washington because of advocates,” Covington said. “But there is no natural cheerleader for these children. The parents certainly aren’t advocating, and neither are the children.” She added that “the voice of an affected individual is always going to be stronger” than that of an expert witness.

Meanwhile, Sarah Morrow, the mother of Tanner Bivins, and her boyfriend’s parents, Larry and Patricia Duvall, have been indicted on charges of criminal abuse in the first degree. The Duvalls, with whom Tanner was living when he died, have requested a trial; Morrow pleaded guilty to the charges on October 2nd. She is scheduled to be sentenced on January 6th, two years and a day after her son’s death, the cause of which remains, officially, “undetermined.”

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