When it comes to child abuse, a Congress-spurred commission found that the United States didn't have coherent, effective strategies for reducing the high number of children who die each year from abuse and neglect.
The official federal data states these deaths fall between 1,500 to 1,600 annually in recent years, but with the gaps in how the data is complied, the true number may be as much as 3,000 a year.
Commission chairman David Sanders, who is the executive vice president of Casey Family Programs, believes that number can be reduced to zero.
"We looked at the airline industry — no one accepts a plane crash anymore. We can get that way with child fatalities," he said.
The report's recommendations for addressing the issue include expanding safe-haven programs for abandoned infants and enlisting a broader range of community organizations to help often-overburdened child protection service workers.
Still, the commission, comprised of six members appointed by Congress and six by President Barack Obama, failed to reach consensus on some issues. Two members declined to approve the final report and wrote dissents criticizing one of the major proposals.
Under that proposal, states would be required to review all child abuse and neglect deaths from the previous five years, and then develop prevention plans. States would identify children at high risk, and conduct investigations and home visits to determine if their families needed support services or if the children should be removed. Some commissioners recommended that Congress immediately allocate at least $1 billion in new funding to implement the plan.
The other dissenter was Patricia Martin, Chicago-based presiding judge of the Child Protection Division of Cook County Circuit Court. She expressed concern that the proposal would lead to more children being placed unnecessarily in foster care, and urged more support to keep families together. She also contended that the commission, by focusing on children under 5, had missed a chance to address fatalities among older children.
During two years of consultations and hearings, the commission uncovered little in the way of model programs at the state or local level that it could recommend on a national basis. One of the few initiatives to win praise was home visiting — visits to an at-risk mother's home by a nurse, social worker or early childhood educator during pregnancy and in the first years of a child's life.
The commission report called "stunningly high" the rate of maltreatment deaths among black children: 2 1/2 times greater than the rate for white children.
Maltreatment deaths represent a tiny fraction of the more than 3 million reports of child abuse and neglect received each year by hotlines and law enforcement agencies. According to federal data, about 40 percent of the reports are soon "screened out" — judged not to warrant further action.
The commission said states should be more rigorous, responding to all reports regarding children under 3 and children who were the subject of previous reports. It said reports about infants less than 1 year old should get responses within 24 hours.
The commission found shortcomings at virtually every sector of the child-welfare system, including at the federal level, which it said fails to provide guidance, monitoring and enforcement.
At the state level, the report decried high caseloads and stressful working conditions for child protection workers.
"Shortages of workers, funds and training may mean that inexperienced workers are tasked with making life-or-death decisions with insufficient preparation or support," said the report.
Among the organizations following the commission's work was the American Academy of Pediatrics.
Dr. Andrew Sirotnak, a leader of the academy's Section on Child Abuse and Neglect and head of the Child Protection Team at Children's Hospital Colorado, said the report's legacy would depend on finding practical, politically feasible steps to reduce maltreatment fatalities.
His suggestions include strengthening child-abuse detection training for pediatricians and improving coordination between child-protection services and medical professionals who serve at-risk families.