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Hearing on Proposal to Reduce Child Deaths Due to Maltreatment

December 12, 2012

Hearing on Proposal to Reduce Child Deaths Due to Maltreatment










December 12, 2012


Printed for the use of the Committee on Ways and Means


DAVE CAMP, Michigan, Chairman

WALLY HERGER, California                         
PAUL RYAN, Wisconsin
DEVIN NUNES, California
JIM GERLACH, Pennsylvania
TOM PRICE, Georgia
RICK BERG, North Dakota
DIANE BLACK, Tennessee
TOM REED, New York

RICHARD E. NEAL, Massachusetts
JOHN B. LARSON, Connecticut
RON KIND, Wisconsin

JENNIFER M. SAFAVIAN, Staff Director and General Counsel
JANICE MAYS, Minority Chief Counsel

ERIK PAULSEN, Minnesota, Acting Chairman

RICK BERG, North Dakota
TOM REED, New York
TOM PRICE, Georgia
DIANE BLACK, Tennessee






The Honorable Bill Frenzel
Guest Scholar, Brookings Institution (former Member of Congress; former Chairman, Pew Commission on Children in Foster Care)

Teresa Huizar
Executive Director, National Children’s Alliance (NCA)

Madeline McClure
Executive Director, TexProtects (The Texas Association for the Protection of Children)

David Sanders, Ph.D.
Executive Vice President of Systems Improvement, Casey Family Programs


Hearing on Proposal to Reduce Child Deaths Due to Maltreatment

Wednesday, December 12, 2012
U.S. House of Representatives,
Committee on Ways and Means,
Washington, D.C.


The subcommittee met, pursuant to call, at 2:11 p.m., in Room 1100, Longworth House Office Building, Hon. Erik Paulsen [acting chairman of the subcommittee] presiding.

[The  advisory of the hearing follows:]


Mr. Paulsen.  Good afternoon.  I call the subcommittee hearing to order. 

The purpose of today’s hearing is to discuss a proposal designed to reduce the number of children who die from abuse and neglect. 

I would like to thank our colleague, Mr. Doggett, as well as Chairman Camp, for their work on this very important proposal that we will consider today.  There are tragically too many examples, like Devin Drake, of why this is an important issue.  Three‑year old Devin Drake was brought to Mercy Hospital in Minneapolis, Minnesota, by his mother, Elizabeth Moorman, on August 30, 2011.  She said that Devin had been completely normal until he collapsed at home just a few minutes earlier.  After questioning by medical staff, and later police, her boyfriend, Anthony Urban, admitted to punching Devin the day before.  He said the boy then fell off a stool and hit his head on the bathroom ceramic floor.  Even though Devin had trouble standing up and was obviously seriously injured, neither his mother nor her boyfriend took time to bring him to the hospital.  The next day, even after Devin’s condition worsened, they still did not get help for him.  Finally, it was that evening that Devin’s mom took him to the hospital. 

Police reports revealed that this was not the first time that Devin had suffered abuse.  Before his birth, Devin’s mother was convicted on drug charges.  After Devin was born, social workers contacted his mother because of alleged drug abuse.  At the time of Devin’s hospital visit, his mother had outstanding warrants for her arrest, which no doubt contributed to her reluctance to take her son to the hospital. 

Her boyfriend had two felony drug convictions.  Neighbors said they noticed Devin recently had had a black eye.  One neighbor said she had planned to go to authorities the very day that Devin was taken to the hospital. 

When Devin arrived at the hospital, medical staff realized his injuries were no accident.  He was diagnosed with severe head trauma, punctured lungs, and a number of contusions.  He was airlifted to Hennepin County Medical Center, where his injuries were found to be consistent with severe abuse. 

Four days later, 3‑year old Devin Drake died.  Nothing is more breathtaking, heartbreaking than when a child like Devin dies at the hands of someone who should have cared for him the most. 

And that is why we are here today, to review a proposal designed to reduce the number of these tragedies.  Ultimately, the real solutions will come through the incredible work done by local child welfare agencies, education providers, police, healthcare providers and workers and many others. 

While it won’t be the Federal government that solves this problem, we have a role to play.  As the legislation before us suggests, we can bring together experts to review which of today’s practices work, and don’t work, to highlight what additional steps hold the most promise and ultimately help local officials incorporate that knowledge into their best practices. 

In July 2011, we heard about the magnitude of the problem, including the fact that hundreds of child abuse deaths go unreported each year.  Today we will review a bipartisan proposal to establish a commission to consider these issues and develop recommendations to ultimately reduce the number of those deaths. 

Mr. Paulsen.  This legislation would have a very small cost, which we would make sure is fully paid for by other savings.  We believe it can move forward quickly through the House and then, hopefully, through the Senate. 

Most importantly, we think it will help prevent future child abuse deaths.  While that will come too late for Devin, we do owe it to the many vulnerable children who might be saved in the years ahead to make any progress that we can. 

I look forward today to all of the testimony from our panel’s witnesses and advancing the bipartisan legislation offered by Chairman Camp and Representative Doggett. 

Without objection, each Member will have the opportunity to submit a written statement and have it included in the record at this point. 

Mr. Doggett, would you care to make an opening statement? 

Mr. Doggett.  I would, Mr. Chairman, and thank you so much, Mr. Chairman, for the work that you and your staff have shown on this measure. 

I am pleased that, with your personal leadership and that of Chairman Dave Camp, we are moving forward in a bipartisan manner to pass legislation to reduce the number of children who are exposed each year to abuse and neglect. 

It is my hope that we can use today’s hearing and the expert witnesses that we have together with us in the hearing to perfect this legislation before its bipartisan consideration here in the House. 

At the hearing that we had in July of 2011 in this subcommittee, I expressed hope that we would be able to work together, and I think these more recent developments suggest we are doing that. 

You know, as a grandfather myself of three little girls, who bring such tremendous joy to our family, it is just painful to even imagine a child being subjected to neglect and abuse, especially from a family member. 

Yet we recognize each year that there are thousands of children who face this cruel fate.  As District Judge Darlene Byrne, a leader in establishing, really across the country, but beginning in Travis County in Texas, our child protection courts, has said, “Childhood should be a time of innocence and freedom, but it is a sad fact that many children are vulnerable to injury and abuse.  Our Nation’s children need good leaders to stand up at a national level and find creative ways to protect them from harm.  The creation of a national commission to end child fatalities is an important step in that direction.” 

We need thoughtful consideration of everything we can do to protect vulnerable children.  And in some cases, we just need to share what is already working, what has been developed in some communities to try to avoid tragedy.  And a lot of what we will hear today is that there are many areas of improvement in the fight against child abuse and neglect that we can, in fact, make. 

The draft legislation that we are reviewing today represents an improved version of the original H.R. 3653, that I introduced exactly 1 year from tomorrow, and that is pretty quick for Congress to act. 

It would establish a national commission to develop recommendations to reduce child fatalities stemming from abuse and neglect.  In my home State of Texas, groups like TexProtects, Voices for Children San Antonio, CASA, children’s shelters in Austin and San Antonio serve as a voice for the voiceless, protecting and advocating for children, as their counterparts do in other States around the country.  Local leaders, like Texas State Senator Carlos Uresti, was a driving force behind getting our Texas Blue Ribbon Task Force to combat child abuse and neglect set up, and getting Bexar County’s own task force to combat these problems. 

There are a number of similar organizations in Chairman Camp’s home State of Michigan, and I am sure in Minnesota as well, like Michigan’s Early Childhood Investment Corporation, Michigan’s Council on Maternal and Child Health, and the Michigan office of Great Start. The important work that these folks are doing has been critical to improving the lives of at‑risk children.  Yet despite these developments, fatalities stemming from child abuse and neglect remain at epidemic proportions in Texas and in San Antonio, in particular.  Last year there were almost 6,000 confirmed cases in Bexar County, that is San Antonio, the highest number in Texas, higher than even Houston and Harris County, which has a population that is about twice as large. 

In the decade from 2000 to 2010, Texas had over 2,000 reported deaths from child abuse and neglect.  And last year, Texas had nearly 66,000 confirmed cases of child abuse and neglect, and over 200 deaths during that one year alone.  So there is much we need to focus on in my home State and around the country. 

Mr. Chairman, in so many cases, we may never fully understand what causes this abuse and neglect, but we can understand ways to reduce it.  And I think, by creating this national commission, we will be taking a step, an important step in the right direction.  Thank you. 

Mr. Paulsen.  Thank you, Mr. Doggett. 

Mr. Paulsen.  I want to remind our witnesses to limit their oral statements to 5 minutes.  However, without objection, all of the written testimony will be made part of the permanent record. 

On a panel this afternoon, we will be hearing from Bill Frenzel, guest scholar at the Brookings Institution; Teresa Huizar, executive director, National Children’s Alliance; Madeline McClure, executive director, TexProtects; and David Sanders, Ph.D., executive vice president of Systems Improvement, the Casey Family Programs.  

I would like to now introduce our very first witness, Mr. Frenzel.  Bill Frenzel is a former Member of the United States House of Representatives, representing my district, actually, in Minnesota’s Third Congressional District, where he had a very distinguished career for 20 years.  He served as a member of this committee as well as a ranking member of the House Budget Committee and the House Administration Committee. 

Upon leaving the House, Mr. Frenzel continued his public service, serving as a special advisor to President Clinton on NAFTA, as well as chairman of the President’s Advisory Commissions on Trade Policy and Negotiations from 2002 to 2011. 

Mr. Frenzel also served as the chairman of the Pew Commission on Children in Foster Care from 2003 to 2008. 

It is an honor to have him testify here before the committee today. 

Mr. Frenzel, please proceed with your testimony.


Mr. Frenzel.  Mr. Chairman, thank you. 

Chairman and members of the committee, it may be bad form, but I want to say, first of all, what a great privilege and pleasure it is for me to testify before a committee chaired by a Congressman From the Third District of Minnesota.  My elation knows no bounds. 

Mr. Chairman, I want to testify on the structure of the committee and the remarks that I make are based on my own experience in a number of commissions and panels.  And I hope that they will be helpful, and I realize that there are lots of other points of view that will be and can be made. 

First of all, the draft bill of Congressmen Doggett and Camp, provides for a Presidentially appointed commission.  And that is a good idea if you are looking for prestige.  However, Presidential commissions don’t have a glorious history of success.  My guess is that this particular commission is going to succeed no matter who appoints it, but I believe you are likely to come to a better outcome if you appoint it through the Congress. 

The trouble with Presidential appointments is that you aren’t there to see that they get made.  You may have trouble with what I call geographical distribution, which I think is important and I will talk about more later.  And the President may want to reward other people, and his personnel department may have restrictions that make it difficult to put the kind of people you want on there. 

So I would say it would be a lot better to have the commission selected by Congress, and by your subcommittee and its Senate counterpart, I think they could work with the appointing authorities, all four of them in Congress, to get the right kind of commission. 

With respect to size, I think the draft bill has it about right.  I would suggest a few more, but certainly no more than 20.  So I think you are okay there. 

The qualifications are something that I am not myself qualified to speak about, but it looks like you have the bases pretty well covered. 

I think, however, I am going to suggest that you might try some former Members of Congress in leadership jobs, and they might not qualify under the qualifications listed in the draft bill. 

I talked about regionality before.  You need to get a spread.  The States are all different.  The regions are all different.  You can’t avoid California and New York, where certainly a lot of these problems exist, and you need a spread elsewhere.  That is one of the reasons why I prefer a little larger commission than is outlined in the draft bill. 

With respect to congressional membership, it is up to you.  I believe that Members have got a lot of things to do, and probably shouldn’t be on the commission and might not be reliable attendees. 

As to commission leadership, I have always thought that having a former Congressman to enforce management and leadership and look for consensus is a really great idea.  I had a wonderful experience on the Pew Commission on Children in Foster Care working with Bill Gray, who had formerly been chairman of the Budget Committee when I was the ranking member.  And I think neither of us knew very much about children in foster care, but I think we kept the commission going and aimed in the right direction. 

I have a note here on consensus.  It is, I believe, very important to have the members come to a fairly unanimous agreement.  Separate or minority remarks blunt the thrust of these kinds of commissions.  I think that proper leadership will get you there. 

My time is expiring, but let me just say, with respect to congressional approval, I hope that this committee would see that there is some kind of action immediately following the report, because then, local agencies, private organizations, State, and other agencies will pay a lot more attention to it if they believe that the Congress thinks it is a good report. 

Congress may not be able to pass a bill to say this, but I think the committee could indicate approval somewhere along the line. 

Mr. Chairman, I have other thoughts, and I will leave them for the question period.  Thank you very much. 

Mr. Paulsen.  Thank you, Mr. Frenzel, very much.

[The statement of Mr. Frenzel follows:]

Mr. Paulsen.  Ms. Huizar, please proceed with your testimony, you are recognized.

Ms. Huizar.  Thank you.

Chairman Paulsen, Ranking Member Doggett, and members of the subcommittee, thank you for holding this important hearing on child abuse fatalities and the effort to establish a commission that would shed light on this issue, highlight evidence‑supported interventions, and convene a national dialogue about the protection of the nation’s most vulnerable children. 

I represent National Children’s Alliance, which is the national association and accrediting body for the nation’s 750 Children’s Advocacy Centers.  CACs coordinate a multidisciplinary team approach to the investigation, prosecution, and treatment of child abuse.  In the case of child abuse fatalities, our CACs are often used for the interviews conducted with other siblings and child witnesses of these tragedies.  So we know far too well the tragedy of children killed by their caretakers and the toll this takes on communities, the remaining family members, and the professionals who must investigate these sad cases. 

Because we believe these deaths are preventable, NCA has joined with other members of the National Coalition to End Child Abuse Deaths to raise awareness of the problem. 

Over the past decade significant gains have been made in child abuse prevention and intervention generally.  The overall rates of sexual and physical abuse have declined, but what has not declined and in fact has either remained flat or increased, is the rate of child abuse fatalities or near fatalities.  The horrifying persistence of fatal child abuse, despite the implementation of effective prevention and intervention measures for most other forms of abuse, calls for a deeper examination of its causes and scope. 

Official child welfare records indicate that at least 1,500 children are fatally abused annually.  However, that number does not capture the scope of the problem, nor the scope of the suffering.  Indeed, a recent GAO report indicates that the NCANDS data due to the voluntary nature of the data collection and the fact that in many States only one data source is used for the reporting, substantially undercounts fatal child abuse.  And moreover, restrictive confidentiality laws and regulations make it difficult to thoroughly examine abuse fatalities when they occur so that we can learn how to prevent them and what risk factors are associated with them. 

What is sorely lacking in all of this is a comprehensive national strategy to combat the tragedy of child abuse fatalities.  Rather than a piecemeal approach to preventing these deaths, children at risk of eminent harm need and require the government’s protection.  And as a public health problem, child abuse fatalities can be approached as any other and successfully combatted. 

Key to this national strategy is the establishment of a bipartisan commission empowered by Congress to thoroughly examine the problem, particularly as it relates to children within or previously known to the child welfare system.  States vary widely in their child abuse fatality rates.  Guidance provided through the work of a commission can ensure that a child’s chance of surviving his or her childhood is not an accident of geography. 

By scrutinizing the effectiveness of Federal, State, and local data systems and identifying the most effective prevention and intervention practices, the commission can lift up successful examples for widespread dissemination. 

Reducing child abuse fatalities is a complex matter.  It requires investigating and addressing many issues, including evidence‑supported prevention and intervention efforts aimed at strengthening families and preventing maltreatment in the first place; workforce training; a risk‑assessment practice within Child Protective Services; strengthening child death review teams; encouraging CAC’s to expand their services; strengthening the medical examiner and coroner systems within the U.S. to ensure accurate designations of the cause of death in these cases, which are often among the most medically complex; providing training to law enforcement and prosecutors to hold offenders accountable; and creating data‑sharing systems that allow agency to cross share information so that children can be saved and research can inform our practice; and of course, educating the public so the communities can protect their own children. 

Because of the complexity of these issues, a coordinated and thoughtful approach is critical and can only be achieved through the work of a commission to end child abuse and neglect fatalities.  Our efforts on behalf of these children must go beyond finger pointing, the blaming and firing of individual caseworkers, and scattered prevention and intervention strategies if we are to prevent future deaths.  Our best hope of reaching a comprehensive strategy is the establishment of a commission to end child abuse and neglect fatalities, empowered to investigate, make thoughtful recommendations, and lift up promising practices.  The lives of more than 1,500 children each year absolutely depend upon it. 

Thank you. 

Mr. Paulsen.  Thank you very much, Ms. Huizar.

[The statement of Ms. Huizar follows:]

Mr. Paulsen.  Mr. Doggett, I understand you would like to introduce our next witness, Ms. McClure, who I understand is from your home State of Texas. 

Mr. Doggett.  She is, indeed, Mr. Chairman. 

Thank you.  I am pleased to formally introduce Madeline McClure, who is the Director of the Texas Association for the Protection of Children.  She serves as the appointee of Lieutenant Governor David Dewhurst and Texas House Speaker Joe Straus on the Texas Blue Ribbon Task Force on Child Abuse, Prevention, and Child Welfare, and she is the chair of the Child Protection Roundtable, which she founded. 

She has a career of about a decade making money successfully on Wall Street before she turned to making lives better for children on Texas streets.  She also works as a therapist now, has worked as a therapist with the Dallas Children’s Advocacy Center.  I believe she has done much to help prevent abuse and neglect in Texas, more than anyone I know, and is a tireless advocate to have made this special trip from Dallas to be here today. 

Thank you, Madeline, for coming to join us. 

Mr. Paulsen.  Thank you, Mr. Doggett. 

Ms. McClure, you may proceed.


Ms. McClure.  Thank you for that lovely introduction, Ranking Member Doggett, and Chair Paulsen, and committee members, thank you so much for inviting me to testify today on this most critical issue of child maltreatment fatalities.  I am honored to be here. 

Given that child maltreatment deaths stem primarily from child physical abuse and child neglect, I am going to focus my comments today on child maltreatment prevention, and given my background in economics and social work as you just outlined, I think it would be most helpful for the committee if I talk a bit more about monetizing the benefits and the costs, if that would be all right. 

So, first, let me put into perspective the incidence.  We need to know what the size of the problem is before we attempt solutions.  As you may know, the National Data Collection Systems and the National Incidence Studies, as well as national surveys, showed that 1 to 10 percent of our child population are abused annually.  That is a big range.  But whether it is 750,000 children or 7.5 million children, one abused child is one child too many. 

So just to put this in perspective on the screen, imagine an aerial view of the following stadiums filled to capacity.  Hopefully, most of these are from your hometowns, the Hubert Humphrey Metrodome, Dallas Cowboys Stadium, the Cotton Bowl, Yankee Stadium, Sanford Stadium, Neyland Stadium, Tiger, Century Links Field, and the Rose Bowl. 

There wasn’t a stadium from North Dakota that was large enough that I could include in this, sorry, Congressman Berg. 

But imagine that instead of adult fans filling those seats, picture all of those seats now filled with children, abused children, almost 50 percent that are less than 4 years old.  So hold those nine stadiums, packed to the gills, brimming with just children.  That is what 753,000 looks like.  And that is the lowest incidence number, just to contextualize the problem. 

The consequences of child abuse and neglect, I think this committee has heard several times.  But just because you mentioned Devin and his parents, Chairman Paulsen, I want to remind us that children that are abused and neglected have impaired brain development, 85 percent more likely to have that and, in stepwise fashion, very often have cognitive difficulties, impaired learning disorders and then self‑anesthetizing abusing substances which leads to doing poorly in school and also, teen pregnancy and school dropout, often leading to juvenile delinquency. 

We talk about the associations, but there is a lot of cause and effect here.  Most importantly, children that are abused are six times more likely to abuse their own children.  I can only imagine what Devin’s parents had gone through in their earlier lives. 

But child abuse also exacts a very high financial price.  As you can see on this next slide, the Center for Disease Control’s recent study monetizing the outcomes of the consequences of child abuse and neglect found that for every child abused in their lifetime it will cost $210,000 per victim.  That is for those who survive abuse.  For those who die, for every child abuse fatality, we as taxpayers spend $1.3 million per victim.  So, in 2012 inflation‑adjusted dollars, that is $124 billion that we are throwing out the window just on the consequences of child abuse. 

But the monetary calculations cannot begin to place a value on the incalculable cost of lives lost, unseen scars of potentials quenched, spirits extinguished, and souls murdered. 

These human and financial costs are unacceptable and unsustainable, and they do represent an enormous financial burden on our taxpayers. 

The good news is that child abuse is largely preventable.  We have found net cost savings of child abuse prevention programs that are of high quality that return on average $3.50 for every dollar invested, up to $14.50 for every dollar invested.  Here is an example of a program that is entitled The Positive Parenting Program, and this particular program actually is cost neutral within a year.  But it returns about $6 for every $1 invested, as you can see in terms of the costs of reducing out‑of‑home placements and also CPS cost, and other costs. 

So for a relatively modest investment up front, we will not only break the intergenerational cycle of violence, we can reduce an enormous economic tax burden on taxpayers immediately and the long term. 

And where we are today in preventing child abuse is akin to where Congress was 70 years ago in exploring the use of antibiotics to kill infections.  So when you look back, or your children, or your grandchildren look back on this 10, 20, 50, 70 years from now, this is going to be that inflection point where we really go through this process of putting enough money up front to change that whole trajectory, not only for at‑risk kids and their families, but our great country at large. 

This national commission is a right first step, and I really am excited about this commission helping all of the States have an accessible blueprint for implementing a meaningful child abuse prevention strategy.  I thank you for your time. 

Mr. Paulsen.  Thank you, Ms. McClure. 

[The statement of Ms. McClure follows:]

Mr. Paulsen.  Mr. Sanders, you may proceed.

Mr. Sanders.  Good afternoon, Chairman Paulsen, Ranking Member Doggett, and members of the subcommittee.  I am David Sanders, executive vice president of Systems Improvement at Casey Family Programs, a national foundation committed to improving the lives of vulnerable children and families in America by building Communities of Hope. 

We thank the committee and, in particular, Chairman Camp, Subcommittee Chairman Paulsen, and Subcommittee Ranking Member Doggett, for their leadership and commitment to reducing child fatalities due to abuse and neglect. 

The discussion draft that has been shared would establish a commission to develop a national strategy and recommendations on this issue.  We commend the vision and overall believe that such a commission would provide an incredible opportunity to better understand how we can prevent child fatalities. 

We offer two comments for your consideration.  First, we agree it is important the 12 commission members represent a number of key expertise areas outlined in the draft.  While the discussion draft states that each member should possess at least one area of expertise, it is important that the commission represent a broad range of issues.  As currently drafted, it appears possible that all of the commission members could come from a single area of expertise. 

Second, the discussion draft limits the purview of the commission to programs funded under Titles IV and XX of the Social Security Act.  There are a broad array of programs that provide upfront prevention and intervention services, such as Medicaid, maternal and child health programs, and substance abuse funding.  We, therefore, urge the inclusion of a broader spectrum of programs. 

In an effort to influence and mobilize national efforts to prevent child maltreatment‑related fatalities, Casey Family Programs launched a series of forums in the fall of 2011.  The Administration on Children, Youth and Families, the Centers for Disease Control joined Casey Family Programs in hosting these events that were attended by experts, policymakers, advocates, researchers, practitioners, and child welfare leaders, as well as public health leaders.  These forums provided us a tremendous opportunity to explore the issue of child fatalities from different perspectives. 

Findings explored in the Safety Forums that will guide our future work and recommendation center around four areas:  Number one, risk factors for severe maltreatment and fatalities.  Research in California linking birth records and CPS records has found that a report for child maltreatment before the age of 5, whether substantiated or not, is a risk factor for a later fatality from intentional or unintentional injuries.  Other researchers found the rates of abusive head trauma identified among children under 5 years of age increased significantly at several major pediatric hospitals during the 2007 and 2009 period and were associated with increased economic hardship at the community level. 

Number two, child maltreatment is a public health issue.  A significant proportion of child maltreatment‑related deaths occur in families who have no history of involvement in the child welfare system.  Therefore, it would be prudent for us to look at the issue of child deaths, not just through the lens of child welfare but from a broader public health perspective. 

Number three, informing child protection policies and practices for reducing child maltreatment‑related fatalities.  There are several areas we need to consider to improve child protection policies and practices.  The public’s perception of child welfare in this country is generally painted by media reports of isolated cases of tragedy.  The gap between public perception and the realities of child welfare administration drives public policy in ways that are not always the best for keeping children safe. 

And finally, number four, measurement and classification of child fatalities.  Experts agree that improving the measurement and classification of child fatalities is critical to understanding and preventing child maltreatment and fatalities.  Building effective cross‑sector multi‑agency collaborations is essential for obtaining accurate data on the incidence of preventable child deaths and serious injuries, and implementing successful prevention strategies.  Multidisciplinary local and State child death reviews teams play a critical role in identifying patterns in child death and serious injuries, identifying common risk factors, and developing and implementing preventive efforts.  

The work of Casey Family Programs’ Safety Forums has led to us believe that we can succeed in this.  Successful strategies are comprehensive.  Strategies are not limited to one sector or agency.  Successful strategies are focused.  High quality data, as well as other kinds of research evidence, are essential to inform strategies and assess results, and finally, we currently have some important knowledge and experience in regards to data, but there are glaring gaps; gaps that we can close. 

Casey Family Programs has used its national platform and its resources to work with State child welfare administrators and other key voices to elevate this issue.  We stand ready to work with this commission or any other group or organization focused on child fatality. 

Thank you and I am happy to address any questions you might have. 

Mr. Paulsen.  Thank you very much, Mr. Sanders.

[The statement of Mr. Sanders follows:]

Mr. Paulsen.  Mr. Frenzel, in your testimony, you mentioned that you feel a number of commissions have been unable to achieve their objectives.  What do you think contributes to that failure?  Is it that the missions are too broad or the recommendations are too difficult to implement, or something else? 

Mr. Frenzel.  Well, I think those commissions, Mr. Chairman, and members, that we all know about, are the very high‑profile, very difficult ones, such as the Simpson‑Bowles Commission, usually dealing with economics or budget affairs.  They only go to the commissions after the problems have become intractable and hard for the Congress and the President to deal with together. 

It is very hard to move a report of one of those commissions, especially when the President designates the commission and the Congress is not interested in following it up.  I cite the Bush 43’s Commission on Social Security and one on tax reform.  In that case, in the latter case, the part of Congress that didn’t want to deal with it was President Bush’s own party.  And so it is just a long shot, I think.  The problems are too tough. 

This would be quite different.  I think this would be something on which everyone can get together, and the reason I suggest that you might not want a Presidential commission, is that I am afraid you might not get the right people or the right spread of people.  And therefore, I suggest a congressionally appointed panel.  But the failure of the Presidential commissions is that the subjects were too tough to begin with, and they weren’t going to be solved at that time. 

Mr. Paulsen.  Do you have any other thoughts about what we might do to make sure that the recommendations of the commission remain within budgetary and political reason and don’t become too expensive or too controversial for Congress to actually approve in the end? 

Mr. Frenzel.  The reason I suggested you get a former Member of Congress to chair that commission is exactly that.  I had some experience on the Pew Commission for Children in Foster Care where we had a lot of wonderful advocates for children who knew lots about the subject, but my cochairman and I were able to bring them back to reality, to a position where most of their recommendations could be passed. 

You can have the best report in the world.  If you can’t pass it, the whole thing sinks.  And you can’t hold these people’s enthusiasm back, but you can give them, I hope, leadership that won’t let the enthusiasm run away with them. 

Mr. Paulsen.  Ms. McClure, you are currently serving on a commission in Texas that is focused on preventing child abuse, and this commission has had to develop recommendations for State policymakers to consider and approve.  What mechanisms does your commission have in place to actually see that the recommendations are adopted? 

Ms. McClure.  A reality check.  I think, as the Congressman just mentioned, we have to be realistic.  We can put out a report looking at the utopia or the ultimate solutions maybe for 20, 30 years, but we certainly have 2‑, 4‑, and 6‑year goals that are realistic, given the resources, or scarce resources, I should say, and the political realities of our State.  So I agree that what the Congressman is mentioning, you have to have the enthusiasts at the table, the experts, but we need some political and economic realists there as well. 

Mr. Paulsen.  Thank you. 

Mr. Doggett is recognized for 5 minutes. 

Mr. Doggett.  Thank you very much, Mr. Chairman. 

And I think first I want to say to Ms. Huizar, I believe that it was your Coalition to End Deaths that really provided the impetus for the original legislation that I introduced and was introduced in the Senate last year, and I appreciate that and I think you helped to craft a good measure. 

The changes that have been made in the bill since then, are to address some of the concerns that have been raised here today and also recognize the jurisdiction of the various committees and of this subcommittee.  One of those changes really is designed to address precisely what Congressman Frenzel raised; we are not interested in just another report to sit on the shelf.  We want some people who are actively involved, and so, since last year, changing it to have half of those appointees come from within the Congress in hoping that we will have people who work with the leadership here in the Congress, and the House, and the Senate to actually see something happen. 

With reference to your comments, and particularly Mr. Sander’s comments about Title IV and Title XX, that is the jurisdictional basis for this Committee.  It is not my intention as an author to tie the hands of this commission.  The commission may well consider matters that weren’t even mentioned in the bill last year in trying to decide how to fulfill its mission.  But as it reports back, the focus of this Subcommittee is Title IV and Title XX of the Social Security Act.  It may deal with, as it looks at these issues, some advice to the States that it found some practice in Minnesota, or New York, or Michigan that is particularly valuable for a State or a city to use. 

So I just wanted to make clear, while very sympathetic to the comments that you made, Mr. Sanders, that it was not my intention as we redrafted the bill to tie the hands of the commission or to deny it an opportunity to go wherever the evidence suggests.  Even though its goal is to stick with a Title IV and Title XX, certainly our goal is to focus on prevention, and not just responses after this happens. 

And I think Ms. McClure has made it especially clear, the dollar savings we can have, which is also something all of us are very interested in; how can we see the most efficient use of our Federal and other resources to address this problem? 

Let me ask you, rather than use all of my time commenting on the excellent testimony that each of you gave, Ms. McClure, just to pick up with what the chairman was asking.  From your work there on the Texas Blue Ribbon Task Force, which I understand is still a work in progress, and thinking about those experiences, if we have a State commission, and I am sure Texas is not the only State with a State commission, and there are a number of city commissions, what advantages do you believe we would gain from having a national commission to continue the review? 

Ms. McClure.  Well, first off, Congressman Doggett, let me just point out that one of the reasons we do have a commission in Texas is, alluding to your earlier comments, is that our child fatality deaths grew by 124 percent over a 15‑year period compared to our population growth of 19 percent. Over that same time frame, we went from 103 children dying from child abuse to 281 child deaths over a period of 15 years. 

So that was the impetus for the commission, but as we started getting deeper, we realized, what we really do need to do is address the root problem.  But when we looked at national research, all of the national Web sites, and tried to study who has got a good blueprint or turnkey kit, if you will, on a child abuse prevention strategy, there really wasn’t anything.  So we ferreted out different States’ prevention plans and strategies, and we found about seven or eight States that had something in place, but what we couldn’t find was outcomes from the implementation, nor evaluation of performance outcomes from these plans. 

So what I see this commission doing is really putting the best of the best together and formulating something that is a flexible model that States can implement and access, of course, if they desire.  It can be a kind of clearinghouse for a place to go that will be adaptable to each State’s unique needs, and population, and culture.  So I really wish we had had something like this in place to go to to make our 4 years of work a bit easier.  It will be a great resource. 

Mr. Doggett.  My thanks to each of you.  I think your testimony is really helpful and your ongoing participation.  We still do have the possibility of action this year, and hopefully, with your input, not only to us, but to our colleagues in the Senate, we can get some movement and some action and get this underway none too soon. 

Thank you, Mr. Chairman. 

Ms. McClure.  Thank you.

Mr. Paulsen.  Thank you, Mr. Berg is recognized for 5 minutes.

Mr. Berg.  Thank you, Mr. Chairman. 

I want to thank you, Chairman Paulsen, for holding this hearing, and certainly Mr. Camp and Mr. Doggett for being cosponsors. I think one good way to determine whether or not something coming out of this commission will be heard is when you have the ranking member as the sponsor of the legislation.  So, hopefully they will be able to work through those things. 

It is really unfortunate that child abuse is a challenge throughout our country.  We just had a situation on one of our reservations in North Dakota that has really brought to light this very serious issue.  It is unfortunate because it is out there all the time, and then you have one situation that comes up, and all of a sudden, it is on everyone’s mind in the State and all of the elected officials, and then it kind of goes away.  So I think part of why this is important to me is it is obviously important to our State right now.  It has been an alarm. 

So I am wondering if better communications from the different organizations involved could help move this along?  And Ms. Huizar, I would like you to respond to whether or not there is a way to create a better communication process within the organizations.

Ms. Huizar.  Sure. Thank you very much, Congressman, for asking that question.  I think there are several ways to approach this.  One, is in terms of collecting information itself, one of the things that we should probably recognize is that NCANDS right now, the information that States turn over to the Federal Government in regards to these records, doesn’t even really require turning anything over in regard to near fatalities.  There is no field for that.  And so there is a lot of information that just gets missed in that way. 

I think, at the local level, though, you see even misunderstandings about CAPTA confidentiality requirements and what information can be shared. 

There was some recent clarification that HHS put out to indicate that in child abuse fatalities, that information involving the child who had died, that that information could be shared as a part of policymaking, and the investigation to determine what could be done to prevent these deaths.  However, it did not clarify whether, in fact, information on other cases involving that child, prior cases of abuse, or even cases involving other siblings in the family could be shared.  And you can imagine that because, as Mr. Sanders pointed out, in many of these cases, there had been prior reports and that is a factor in future death, that would be a very important thing to know.  So I think that there are some significant issues yet to be clarified that could be very helpful in that way. 

And finally, I would say that data systems can make that work easier.  In our own Children’s Advocacy Centers and multidisciplinary teams, the reason there such open information sharing is because we have systems in place that make that possible, including the use of technology in doing that.  And in the absence of that, it is tremendously difficult for all of the professionals who need to share that information to do so.  So I think there are some very practical steps we can take along this line that would make that job easier.

Mr. Berg.  Well, maybe you can expand on that little bit.  You have the data sharing between groups, getting on the same kind of platform, so same definitions maybe for abuse, or are some best practices that you can say, you know, here is how these groups can work better. 

Ms. Huizar.  Absolutely.  Well, I would like to think that certainly that Children’s Advocacy Centers are an excellent example of that multidisciplinary teamwork really coming together and sharing that sort of information.  And what they have been able to demonstrate over 25 years in terms of their effectiveness in working in these cases, I think could be expanded to work in this arena as well.  I think child death review teams are another excellent example, but their work has been somewhat limited.  I mean, as you know, the resources that are actually going toward the work of those teams has have been very small.  And so while there have been some good pilot projects in terms of cross sharing of information, there is a lot of work yet to be done, some of which will really require some additional resources. 

And then you also touched on a critical matter which is this lack of standardized definitions.  I mean, this is really core in lots of areas where there are problems in child abuse reporting overall, in counting fatalities, and many other things.  The lack of standardized definition makes it very difficult to get our arms around this problem, and I think if we can address that, it is a good first step to addressing some of the other matters.

Mr. Berg.  Thank you, and I yield back. 

Mr. Paulsen.  Thank you.  The gentleman’s time is expired. 

Mr. Reed is recognized 5 minutes. 

Mr. Reed.  Thank you, Mr. Chairman. 

And thank you, Mr. Doggett, for this important matter.  I look forward to supporting it and working with you to get this to the finish line. 

And I appreciate the witnesses’ testimony today.  And I wanted to continue on the issue of the standardization of definitions.  This is one thing that, as I serve on this subcommittee, I am very interested in trying to pursue, making uniform, to make consistent the different terminology and language and data points that are being provided to the Federal Government, because I see a lot of just basic miscommunication and inefficiency associated with that.  And so when we looked in particular at the definition of, for example, maltreatment, it varies State by State.  And we have had a hearing on it back in July of 2011, and I am interested in hearing from the panel.  Maybe Mr. Sanders to start with, why do the States do that?  And what are the arguments for and against having those different definitional standards? 

Mr. Sanders.  Thank you for the question. 

I think there are a couple of perspectives on that.  One is the Federal Government actually gives flexibility to States in the definition beyond the focus on physical abuse, sexual abuse and neglect.  And States have taken that opportunity.  And one example is educational, so young children missing school.  In some States, that is defined as maltreatment; in other States, it is not.  And my guess is that it emerges as a concern from the local community or from the State as an issue that they want to address and feel that should be addressed under their child welfare agencies.  So that would be an example of maltreatment being defined differently from State to State. 

I think that the other piece of that is it is important for this issue to come to some consensus to develop consistency in reporting, because I think that to address this issue, there is going to have to be accurate measurement of how many children are dying due to abuse or neglect.  So I think it is quite possible to come to that and I think that the commission really offers an opportunity for that to happen. 

Mr. Reed.  Well, I appreciate that and I join in that sentiment.  So if I am understanding your answer correctly, you think primarily the difference is the basic difference between communities coast to coast, north to south and the different community needs that they are identifying in the states where they have different definitions. 

Are there any practical effects?  Is there any funding that is tied to these different numbers? I am trying to see if there is something else that is driving this distinction, other than just the uniqueness of the areas of the country upon which the terms are being defined differently?  Does anyone have anything to offer on that side?  Is there any policy reason why they would be making those distinctions? 

Ms. McClure? 

Ms. McClure. I would just say that almost every legislative session in Texas, there are proposals to change the definition of child abuse and neglect in some way.  So those definitions are, I think they are more culturally defined.  I don’t think that there is anything financial involved in making definition changes. 

But back to your point on how to standardize measures, I think one of the ways of looking at child maltreatment fatalities is not so unlike looking at homicides versus manslaughter.  So, in other words, an intentional death of a father, beating a child and putting him in the oven, versus the mom who is depressed, asleep, and her child runs out and gets hit by a car, are really different types of child deaths that we really need to consider. 

So I would say that there are quite a few deaths due to neglect, but mostly they are physical abuse.  And I would look at those very differently.  I don’t think it would cost the States much to stratify and come up with a consensus on a definition that would be acceptable to everyone, as long as they knew that the bottom line is that we are helping, trying to provide some tools to alleviate the problem. 

Mr. Reed.  That is a great point, and that leads to one last quick question.  So do you see any barriers that we would have at the Federal level coming up with a common definition that we would have to overcome in order to implement it?  Are there parameters that we should be focusing on in regards to defining that term, maltreatment?  Anyone?  Do you see any barriers?

Ms. Huizar.  Well, one thing that I would say is that your primary barrier may be people’s just innate sense of attachment to what they are already doing and reluctance to change.  Exactly, reluctance to make change.  I think it is important to know that the CDC did a tremendous amount of work on setting up standardized definitions in the area of child maltreatment, and I think encouraging their usage might be a first good place to start in that regard because they certainly did very fine work.  And it, you know, reflected a consensus of experts and others.  So ‑‑

Mr. Reed.  Good.  All right. 

Well, thank you very much. 

With that, my time is expired.  I yield back, Mr. Chairman. 

Mr. Paulsen.  Thank you. 

With that, I just want to thank all of the panelists and witnesses for taking the time to be here. 

I think, hopefully, we will be hearing from Chairman Camp and Mr. Doggett as they fine‑tune some final changes that are consistent with today’s testimony.

And with that, we are adjourned.

[Whereupon, at 3:02 p.m., the subcommittee was adjourned.]

Public Submissions For The Record

Alliance for Children and Families
American Psychological Association
Children’s Advocacy Institute
First Focus
George Lithco
Michael Durfee
Michigan Department of Human Services
National Association of Social Workers
Stephanie Bingham Doss
Sylvia Randolph