    [House Hearing, 112 Congress]
    [From the U.S. Government Publishing Office]

                        CHILD DEATHS DUE TO MALTREATMENT

    =======================================================================

                                    HEARING

                                   before the

                        SUBCOMMITTEE ON HUMAN RESOURCES

                                     of the

                          COMMITTEE ON WAYS AND MEANS
                         U.S. HOUSE OF REPRESENTATIVES

                          ONE HUNDRED TWELFTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 JULY 12, 2011

                                   __________

                               Serial No. 112-HR5

                                   __________

             Printed for the use of the Committee on Ways and Means

                                    _____

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    20402-0001

                        SUBCOMMITTEE ON HUMAN RESOURCES

                         GEOFF DAVIS, Georgia, Chairman

    ERIK PAULSEN, Minnesota              LLOYD DOGGETT, Texas, Ranking
    RICK BERG, North Dakota              JIM MCDERMOTT, Washington
    TOM REED, New York                   JOHN LEWIS, Georgia
    TOM PRICE, Georgia                   JOSEPH CROWLEY, New York
    DIANE BLACK, Tennessee
    CHARLES W. BOUSTANY, JR., Louisiana

                                C O N T E N T S

                                   __________

                                                                       Page

    Advisory of July 5, 2011, announcing the hearing.................     2

                                   WITNESSES

    Kay E. Brown, Director, Education, Workforce, and Income
      Security, U.S. Government Accountability Office................     7

                                     ______

    Tamara Tunie, Actor, ``Law and Order: SVU,'' and Spokesperson,
      National Coalition to End Child Abuse Deaths...................    18
    Theresa Covington, M.P.H., Director, The National Center for
      Child Death Review.............................................    21
    Michael Petit, President and Founder, Every Child Matters
      Education Fund.................................................    32
    Carole Jenny, M.D., Director, Child Protection Program, Hasbro
      Children's Hospital............................................    45
    Jane McClure Burstain, Ph.D., Senior Policy Analyst, Center for
      Public Policy Priorities.......................................    52

                           SUBMISSIONS FOR THE RECORD

    American Public Human Services Association, statement............    97
    Andrea Kivolowitz and Ayla Annac, statement......................   108
    Childrens Hospital of Pittsburgh of UPMC, statement..............   116
    National Association of Social Workers, statement................   118
    National Coalition for Child Protection Reform, statement........   125
    Skipper Initiative, statement....................................   135
    Tiffany Conway Perrin Organization, statement....................   152

                        CHILD DEATHS DUE TO MALTREATMENT

                                  ----------

                             TUESDAY, JULY 12, 2011

                 U.S. House of Representatives,
                           Committee on Ways and Means,
                               Subcommittee on Human Resources,
                                                        Washington, DC.

        The Subcommittee met, pursuant to notice, at 10:02 a.m., in
    Room B-318, Rayburn House Office Building, Hon. Geoff Davis
    [Chairman of the Subcommittee] presiding.
        [The advisory announcing the hearing follows:]

    ADVISORY

    FROM THE
    COMMITTEE
     ON WAYS
    AND
    MEANS

                        SUBCOMMITTEE ON HUMAN RESOURCES

                                                    CONTACT: (202) 225-1721
    FOR IMMEDIATE RELEASE
    Tuesday, July 5, 2011
    HR-5

                     Chairman Davis Announces a Hearing on

                        Child Deaths Due to Maltreatment

        Congressman Geoff Davis (R-KY), Chairman of the Subcommittee on
    Human Resources of the Committee on Ways and Means, today announced
    that the Subcommittee will hold a hearing on child deaths due to
    maltreatment. The hearing will take place at 10:00 a.m. on Tuesday,
    July 12, 2011, in room B-318 of the Rayburn House Office Building.

        In view of the limited time available to hear from witnesses, oral
    testimony at this hearing will be from invited witnesses only.
    Witnesses will include the U.S. Government Accountability Office (GAO)
    as well as other experts on child abuse and neglect and child
    fatalities due to maltreatment. However, any individual or organization
    not scheduled for an oral appearance may submit a written statement for
    consideration by the Committee and for inclusion in the printed record
    of the hearing.

    BACKGROUND:

        According to State reports, over 1,700 children died nationally in
    FY 2009 due to maltreatment. However, research has shown that these
    reports may substantially understate the number of child victims each
    year. To gain a clearer understanding of this issue, the Government
    Accountability Office (GAO) has reviewed what is known about the
    circumstances of child deaths and near deaths due to maltreatment,
    State approaches to gathering and reporting this information, and what
    the Department of Health and Human Services (HHS) is doing to support
    the collection and accurate reporting of this information. GAO will
    testify about the findings of their review at the hearing.

        There are currently several sources of data about child deaths due
    to maltreatment. First, since the 1970s, States have participated in a
    voluntary national data collection system reporting data on
    investigations of maltreatment and information on abused children. This
    system, called the National Child Abuse and Neglect Data System
    (NCANDS), is used by HHS to prepare annual reports on child
    maltreatment. Second, the nongovernmental National Center for Child
    Death Review (NCCDR) acts as a resource center for State and local
    teams that review cases of child deaths. These teams collect and report
    information on child fatalities from all causes, and 37 States
    currently report data to the national database. The NCCDR uses this
    data to focus attention on child fatality risks and to develop
    strategies to prevent fatalities in the future. Third, States also have
    data on child fatalities from sources such as law enforcement reports,
    death certificates, or medical records.

        In announcing the hearing, Chairman Davis stated, ``Any child's
    death is tragic, but the death of a child from abuse and neglect is
    especially troubling. Current data on the number of child deaths from
    maltreatment appear incomplete, and the difficulty in even compiling
    complete information undermines States' ability to develop effective
    strategies to prevent these tragedies from repeating. I look forward to
    hearing from GAO on the findings of their report as well as other
    experts on how we can improve our understanding of both how many
    children die from maltreatment and more importantly how we can use this
    information to do a better job preventing such tragedies in the
    future.''

    FOCUS OF THE HEARING:

        The hearing will review data on child deaths due to maltreatment,
    determine how to improve the accuracy of this data, and review how
    improving the accuracy of this data may help prevent future fatalities.

    DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:

        Please Note: Any person(s) and/or organization(s) wishing to submit
    for the hearing record must follow the appropriate link on the hearing
    page of the Committee website and complete the informational forms.
    From the Committee homepage, http://waysandmeans.house.gov, select
    ``Hearings.'' Select the hearing for which you would like to submit,
    and click on the link entitled, ``Click here to provide a submission
    for the record.'' Once you have followed the online instructions,
    submit all requested information. Attach your submission as a Word
    document, in compliance with the formatting requirements listed below,
    by the close of business on Tuesday, July 26, 2011. Finally, please
    note that due to the change in House mail policy, the U.S. Capitol
    Police will refuse sealed-package deliveries to all House Office
    Buildings. For questions, or if you encounter technical problems,
    please call (202) 225-1721 or (202) 225-3625.

    FORMATTING REQUIREMENTS:

        The Committee relies on electronic submissions for printing the
    official hearing record. As always, submissions will be included in the
    record according to the discretion of the Committee. The Committee will
    not alter the content of your submission, but we reserve the right to
    format it according to our guidelines. Any submission provided to the
    Committee by a witness, any supplementary materials submitted for the
    printed record, and any written comments in response to a request for
    written comments must conform to the guidelines listed below. Any
    submission or supplementary item not in compliance with these
    guidelines will not be printed, but will be maintained in the Committee
    files for review and use by the Committee.

        1. All submissions and supplementary materials must be provided in
    Word format and MUST NOT exceed a total of 10 pages, including
    attachments. Witnesses and submitters are advised that the Committee
    relies on electronic submissions for printing the official hearing
    record.

        2. Copies of whole documents submitted as exhibit material will not
    be accepted for printing. Instead, exhibit material should be
    referenced and quoted or paraphrased. All exhibit material not meeting
    these specifications will be maintained in the Committee files for
    review and use by the Committee.

        3. All submissions must include a list of all clients, persons and/
    or organizations on whose behalf the witness appears. A supplemental
    sheet must accompany each submission listing the name, company,
    address, telephone, and fax numbers of each witness.

        The Committee seeks to make its facilities accessible to persons
    with disabilities. If you are in need of special accommodations, please
    call 202-225-1721 or 202-226-3411 TTD/TTY in advance of the event (four
    business days notice is requested). Questions with regard to special
    accommodation needs in general (including availability of Committee
    materials in alternative formats) may be directed to the Committee as
    noted above.

        Note: All Committee advisories and news releases are available on
    the World Wide Web at http://www.waysandmeans.house.gov/.

        Chairman DAVIS. The hearing will now come to order. But
    before we begin, I would like to yield to the Chairman of the
    Ways and Means Committee, Dave Camp, who asked that the report
    from GAO that is the basis of our hearing be commissioned in
    the first place. He has long been a champion of these issues
    regarding children. And with that, I would like to yield to the
    distinguished Chairman, Mr. Camp.
        Chairman CAMP. Well, thank you very much, Chairman Davis. I
    wanted to thank our witnesses for being here today, and also a
    special thanks to GAO for completing this report on abuse and
    neglect and maltreatment of children. And having gotten a
    little bit of what the report may say, I understand that the
    reality is even more dramatic than the official estimates that
    we are getting.
        The purpose of this hearing, obviously, is to focus on
    child deaths due to maltreatment or abuse, neglect, however you
    want to describe it, and what government policies might be able
    to try to deal with this very critical issue.
        I want to thank all of our witnesses here, and Tamara,
    especially you, for highlighting this issue in a very public
    way and a very positive way, so we can hopefully make some
    progress on this.
        And I won't delay the hearing any longer, but appreciate
    the hard work that you and Mr. Doggett are going to be doing
    today. So thank you very much. Thanks a lot.
        Chairman DAVIS. Thank you, Mr. Chairman. With that, we will
    return to regular order. I thank the distinguished gentleman
    from Minnesota for yielding his chair to the Chairman, too.
        This is somewhat of a historic hearing in a couple of ways.
    One, I think the topic is certainly important. But for those of
    us that grew up in the era of black and white cathode ray TV
    tubes, this is the first Ways and Means Subcommittee hearing
    done in high definition.
        [Laughter.]
        Chairman DAVIS. I was told I had a great face for radio by
    my first media consultant. So some of us are going to have a
    particularly challenging experience here today.
        But with that, I appreciate all of the witnesses who have
    come, those concerned citizens, advocates from many different
    streams of thought with one common concern.
        When children die from maltreatment, it makes international
    headlines, as in the Caylee Anthony case that drew the focus of
    millions around the world in recent months. Unfortunately, the
    transience of the hype and passing interest of the population
    belies a much deeper challenge.
        And sometimes the death of a child from maltreatment gains
    attention due to the shocking details of the treatment while
    alive. That is what happened in the case of 13-year-old
    Christian Choate, an Indiana boy killed in 2009 after years of
    abuse, including being allegedly locked in a 3-foot-high dog
    cage.
        After his death, police found letters he had written about
    how he wondered when anyone would check on him or give him food
    or water. Christian asked why nobody liked him and how he just
    wanted to be liked by his family. It is hard to fully
    comprehend the death or the sadness this boy must have
    experienced during his too-short life.
        And sometimes the death of a child from maltreatment does
    not make headlines at all, possibly because it is not recorded
    as a death from maltreatment for a variety of reasons we will
    learn more about today.
        It is hard to know which child deaths are more tragic,
    those we know about or those we do not. But our job today is to
    make sure that all deaths of children due to maltreatment are
    recorded, so we can learn from all of them and use that
    knowledge to work with State and local partners to prevent more
    of these tragedies from occurring in the future.
        Our role here today is to be a voice for the voiceless,
    especially those children whose deaths are missing from
    official data today. The Federal Government estimates that
    1,770 children died due to maltreatment in 2009, the most
    recent year of data we have. But as we will learn today in
    today's hearing, that official data understates the total
    number of children who die due to maltreatment each year for
    numerous reasons. This undercount could be significant.
        GAO indicates that 24 States only report the deaths of
    children who had previous contact with a child welfare agency.
    Another study found child welfare agency records undercounted
    deaths by 55 to 76 percent. The bottom line is States are not
    reporting each child maltreatment death, and that makes it
    harder to prevent these deaths in the future.
        We welcome a range of experts today to help us understand
    how we currently count the number of children who die each year
    due to maltreatment, as well as to discuss flaws in the current
    system. These experts will also help us to determine how these
    systems can be improved, and how better information can help us
    better protect children, which is our ultimate goal.
        I want to commend Chairman Camp, who last year asked GAO to
    review and report on these issues, based on his concern that we
    are unfortunately not getting it right today. That GAO report
    is being released today, and is the backstop of GAO's testimony
    this morning.
        We also welcome experts from the broader community who have
    worked for years to prevent child deaths due to maltreatment.
    Our panel today includes Tamara Tunie, the spokesperson for the
    National Coalition to End Child Deaths, who has worked to raise
    the profile on this issue and better protect children. We look
    forward to all of our witnesses' comments, and thank them for
    their commitment to better protecting children from abuse and
    neglect.
        And I would say in the time that we have worked together on
    the Subcommittee, Ranking Member Doggett and I have had a
    commitment to correcting broken information processes, to be
    able to integrate sources, to remove obstacles and silos. And
    we are continuing to hold hearings like this to identify
    constraints that prevent the service providers, the caregivers,
    from doing their very, very critical job.
        Without objection, each Member will have the opportunity to
    submit a written statement and have it included in the record
    at this point.
        And now I would like to yield to my friend and
    distinguished Ranking Member from Texas, Mr. Doggett, for an
    opening statement.
        Mr. DOGGETT. Thank you, Mr. Chairman. Thank you for your
    commitment to this issue. Each weekend that my wife and I are
    back in Texas, we try to devote a little time to our three
    preschool granddaughters. The joy of being with them, their
    growth, their learning, their creativity, and also their
    innocence and vulnerability are in such contrast in homes where
    they are surrounded by love, with what we see played out in
    national TV with the abuse and death of too many young
    children.
        And so, today we conduct a bipartisan exploration of what
    we can do about the gap between those children, the many
    children in our country that are surrounded by loving and
    supporting families, and those who are not. And I think we
    recognize that the death of even one child due to abuse or
    neglect is just too many.
        We are aware that there are so many, many children across
    the country who lose their lives or are permanently scarred by
    abuse or neglect from a caretaker. We know that there are many
    reasons why this happens. But the goal of today's hearing must
    be to improve our understanding of these causes, and what we
    can do to prevent this kind of maltreatment of children.
    Certainly poverty, teenage parenting, substance abuse, and
    mental health challenges are among the considerations.
        We must ensure that we don't make matters worse than they
    are today by slashing services that are important to assure
    child protection, even though there are many gaps in those
    services. Nor can we afford to slash the wider safety net for
    our families.
        As my neighbor in Austin, Dr. Jane Burstain, eloquently
    states in a written testimony, ``To cut programs that support
    struggling families in tough economic times is the very
    definition of penny wise and pound foolish, and is a choice
    that our children could pay for with their lives.''
        Regrettably, the lives of children have not always gotten
    top priority. They are not necessarily, despite the full house
    today and the many effective advocates who are here, they are
    not necessarily the best lobbied force in the country. In my
    home State of Texas, the legislature just concluded with a 40
    percent cut, actually more than 40 percent, in certain child
    abuse prevention programs, even though my home State of Texas
    has one of the highest rates of child abuse and neglect deaths
    in the country.
        Here in Washington, I have concern about the proposal here
    in the House, the House Republican Budget Resolution, to
    eliminate the Social Services Block Grant program, which
    provides some funding that is very important in child
    protective services.
        And I am also concerned that the child welfare programs
    that we studied in our last Committee hearings, as well the
    TANF program, which is important in so many States for
    providing assistance to low-income families--those programs are
    about to expire. And we hopefully, as a result of the work of
    this Committee, can come up with bipartisan legislation to
    continue them, and learn from the experience.
        I have just recently filed legislation concerning the TANF
    supplemental grants, which were part of the original 1996 law
    that are very important in Texas and 15 other States in
    providing services.
        So, I hope that out of today's hearing we can gain more
    insight from our expert witnesses, and out of this can come
    together with effective legislation to try to respond to some
    of these matters that concern all of us so deeply.
        Thank you, Mr. Chairman.
        Chairman DAVIS. Thank you very much, Mr. Doggett. Before we
    move on to our testimony, I would like to remind all of our
    witnesses to limit their oral statements to 5 minutes. All of
    your statements will be entered into the record, and we will
    allow more time for discussion and for question.
        On our panel this morning we will be hearing from: Kay
    Brown, Director of Education, Work force, and Income Security,
    the U.S. Government Accountability Office; Tamara Tunie, actor
    from Law and Order: Special Victims Unit, and spokesperson for
    the National Coalition to End Child Abuse Deaths; Theresa
    Covington, the Director of the National Center for Child Death
    Review; Michael Petit, President and Founder of Every Child
    Matters Education Fund; Carole Jenny, M.D., Director of the
    Child Protection Program at Hasbro Children's Hospital in
    Providence, Rhode Island; and Jane Burstain, Senior Policy
    Analyst at the Center for Public Policy Priorities in Austin,
    Texas.
        Ms. Brown, please proceed with your opening statement.

    STATEMENT OF KAY E. BROWN, DIRECTOR, EDUCATION, WORKFORCE, AND
         INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE

        Ms. BROWN. Chairman Davis, Ranking Member Doggett, and
    Members of the Subcommittee, thank you for inviting me here
    today to discuss our work on this very important topic of child
    deaths due to maltreatment. My remarks are based on a GAO
    report that is also released today. I plan to cover three
    issues: the number of children who die from maltreatment; State
    reporting challenges; and HHS assistance to States.
        First, on the number of child deaths. Every year, children
    in the United States die after being physically abused,
    severely neglected, or otherwise maltreated, frequently at the
    hands of their parents or other trusted care givers.
    Unfortunately, we don't know for sure how many have died. Based
    on data reported by State child welfare agencies to the
    National Child Abuse and Neglect Data System, or NCANDS, we
    know that there were at least 1,770 deaths in fiscal year 2009.
        But this is likely an undercount. Almost half of these
    State agencies reported only those cases that were already
    known to them. Yet these agencies don't necessarily know about
    all children who die from maltreatment. Some children may not
    have been previously maltreated, or their earlier maltreatment
    may not have been reported.
        However, these deaths may be known to other sources, such
    as law enforcement agencies, medical examiners, coroners, or
    health departments. To illustrate this point, studies in a few
    States have combined information from several of these sources,
    and found that using the State child welfare records alone
    undercounted known fatalities by from 55 to 76 percent.
    Further, a national sample of 122 counties across the country--
    again, using multiple sources--estimated 2,400 child deaths
    from maltreatment.
        Understanding the numbers and circumstances surrounding
    child fatalities from maltreatment can help inform prevention
    efforts. HHS prepares annual reports on the NCANDS data, which
    include a wealth of information on the children who have died,
    the perpetrators, and many other factors. However, we found
    that HHS does not include all of the potentially useful
    information it collects in its reports.
        In addition to NCANDS, State and local multidisciplinary
    child death review teams assess the causes of child fatalities,
    with an eye to improving investigations, services, and
    prevention. These teams, found in all but one State, don't
    review every death, but their reviews can provide more and
    richer detail on each case. Many States are now submitting data
    from these reports to the HHS-funded National Child Death
    Review Center, and the Center is beginning to analyze the data
    specific to fatalities from maltreatment.
        For my second point, States face multiple challenges that
    make it difficult to collect and report these data. For
    example, without definitive evidence, it can be difficult to
    determine that a child's death was, in fact, caused by
    maltreatment, rather than by natural causes. Further, resources
    are limited for autopsies and other tests, which can be
    expensive. Officials investigating fatalities may have
    differing skills, training, and experience, and coordination
    and data sharing across various agencies and jurisdictions may
    be hindered by concerns about privacy or confidentiality
    requirements, or by differing goals and cultures.
        On my third point, HHS provides a variety of technical
    assistance to States to help improve the data that they report
    to NCANDS. However, in our survey, State officials asked for
    additional assistance on collecting child fatality data, using
    it for prevention, and collaborating across agencies. We have
    made recommendations to HHS related to these and other issues.
        In conclusion, any child's death from maltreatment is
    especially distressing, because it involves a failure on the
    part of the adults responsible for protecting them.
    Policymakers and practitioners rely on data to understand the
    numbers and circumstances of these tragic deaths, and to learn
    from them to prevent other deaths. Without improving upon and
    better sharing these data, we lose precious opportunities to
    protect our children.
        This concludes my prepared statement. I am happy to answer
    any questions.
        [The prepared statement of Ms. Brown follows:]

        Chairman DAVIS. Thank you very much, Ms. Brown.
        Ms. Tunie, if you could, give your testimony.

     STATEMENT OF TAMARA TUNIE, ACTOR, ``LAW AND ORDER: SVU,'' AND
       SPOKESPERSON, NATIONAL COALITION TO END CHILD ABUSE DEATHS

        Ms. TUNIE. Good morning, Chairman Davis, Ranking Member
    Doggett, and Members of the Subcommittee. My name is Tamara
    Tunie. Many people know me in my role as Dr. Melinda Warner,
    the medical examiner on ``Law and Order: Special Victims
    Unit.''
        However, I am here today in my role as a concerned citizen,
    and as the spokesperson for the National Coalition to End Child
    Abuse Deaths. The Coalition is made up of five national
    organizations that came together over a common concern for the
    growing number of child abuse and neglect deaths in the United
    States. Those organizations are: The National Association of
    Social Workers; National Children's Alliance; National District
    Attorney's Association; Every Child Matters Education Fund; and
    the National Center for Child Death Review.
        I am honored to be able to speak to you today. On ``Law and
    Order,'' we investigate fictionalized crimes, and often have to
    deal with difficult story lines. But nothing compares to the
    real and tragic cases that we hear about with increasing
    regularity in the national headlines: Caylee Anthony in
    Florida; Marcella Pierce, from my home State of New York; and
    the gruesome story of Nubia Barahona, also in Florida.
        The unfortunate truths about these deaths is how common
    they are. Since becoming the Coalition spokesperson, I have
    learned about the thousands of American children dying at the
    hands of those who are supposed to love and protect them, and I
    am here to say that the need for action is critical.
        Unfortunately, the most startling truth about death from
    child abuse is how common it is. As we have heard and will hear
    today from the experts in this field, an estimated 2,500
    children die each year from abuse and neglect; that is 7
    children a day.
        It is not enough to feel saddened when hearing about the
    loss of innocent lives. We have an obligation, as adults and
    citizens, to protect those who have no power to protect
    themselves, who have no voice to address the powers that be,
    and obligation to prevent these fatalities.
        The first step in ending child abuse and neglect deaths is
    awareness of the problem, including the accurate collection of
    data regarding the number and circumstances of child deaths
    from maltreatment. We are all here today because Chairman David
    Camp, Chairman Geoff Davis, and Ranking Member Doggett, and the
    Members of the Subcommittee on Human Resources believe that
    this important issue deserves attention.
        On behalf of the Coalition, I want to thank you for holding
    a hearing on child abuse and neglect fatalities, and for your
    efforts to bring an end to the preventable deaths of children
    like Caylee, Marcella, and Nubia in the United States.
        Thank you so much for hearing my testimony.
        [The prepared statement of Ms. Tunie follows:]

        Chairman DAVIS. Thank you, Ms. Tunie.
        Ms. Covington.

           STATEMENT OF THERESA COVINGTON, M.P.H., DIRECTOR,
               THE NATIONAL CENTER FOR CHILD DEATH REVIEW

        Ms. COVINGTON. Thank you, Chairman Davis, Ranking Member
    Doggett, and Members of the Subcommittee, for providing me with
    this opportunity to speak to you. I serve as the director of
    the National Center for Child Death Review, with funding from
    the maternal and child health bureau at HRSA, HHS. We assist
    States in improving their child death review processes.
        CDR is a process in which profess--in which professionals
    from many agencies come together to share case records, look at
    the facts in the deaths, and decide what they will do to
    prevent these deaths in the future. Every State, except Idaho,
    tries to review all child abuse and neglect deaths at the State
    or community level.
        As described by the GAO, our center built and now maintains
    the national CDR case reporting system, which 39 States are
    using and submitting reports on all of the child deaths that
    they review. This allows for the collection of comprehensive
    information on child deaths, because it is a compilation of the
    information shared by all the agencies at a review meeting.
        The system collects data on the child, their care givers,
    the supervisors, the perpetrators, the investigation, the
    circumstances in the death, and actions taken to prevent other
    deaths. The report tool has over 1,800 data elements, and as of
    today we have 94,473 deaths in the system, of which 8.3 percent
    were due to child abuse and neglect, which is 7,894 little
    children like Casey Anthony's.
        And the GAO report is right. We know that more children die
    from abuse and neglect than is reported through NCANDS, from
    vital records, or law enforcement databases alone. The CDC had
    funded a child maltreatment surveillance project in seven
    States, and I was the PI in Michigan. In an average year,
    Michigan had reported 16 child abuse deaths through death
    certificates, law enforcement records, 26, child protective
    services, 40 deaths. When child death review synthesized these
    multiple sources of data, the actual number was at least 100
    deaths a year.
        And we just did a quick count of child abuse and neglect
    deaths reported through State child death review annual
    reports, and compared them to the NCANDS data for those same
    years: 15 States reported 1,029 states [sic], compared with 516
    in the NCANDS report.
        I agree with the GAO findings on some of the reasons for
    the under-reporting. Deaths due to neglect are especially
    under-reported, and most deaths from neglect happen when care
    givers egregiously fail to protect a child from hazards:
    toddlers drowning in bath tubs, children dying in-house fires
    when left alone, children left in cars on hot days, infants
    suffocated while sleeping with their intoxicated parents.
        And different States have different definitions of abuse
    and neglect. What Mississippi might call abuse, Connecticut
    might call a bad accident, or vice versa. And States even
    differ on who makes the call, whether it is a CPS worker, the
    coroner, law enforcement, the prosecutor. And States have
    different criteria for how they count the deaths into NCANDS,
    into our system, and into other systems. There is also wide
    variation in the quality of child death investigations across
    the country, so that when the deaths aren't well investigated,
    we don't really know what happened.
        On a positive note, we know that when we count deaths right
    and do reviews well, prevention happens. That is why it is so
    important that we investigate, count, and review all of these
    deaths. I could spend all day here describing efforts
    implemented across the United States through child death
    review. Some specific to your States include: Kentucky
    implementing new fire safety education for families, because of
    deaths in which children died and adults survived. Georgia,
    Louisiana, Michigan, Minnesota, New York, North Dakota, and
    Washington implemented major public awareness campaigns on
    shaken baby prevention and safe infant sleep. North Dakota
    improved death reporting policies to CPS. Tennessee developed
    evidence-based home visiting programs. Texas is training all
    CPS workers in infant death investigation. A number of States
    have changed mandatory reporting policies to CPS, for example,
    requiring reports even if there are no survival siblings [sic].
        And I agree with the GAO recommendations to improve
    comprehensiveness, the quality, and the use of national data on
    maltreatment deaths. And I look forward to being part of the
    solution, working with ACF, NCANDS and others, to identify how
    we can share and use all of our data to prevent these deaths.
        I also ask that you require national standards and child
    maltreatment definitions and in reporting. And I ask that you
    call for a national commission to further study this issue.
        But our States also need additional resources. States
    certainly need emergency help now, as--for child protection, as
    their resource are dwindling while child abuse and neglect is
    increasing. We should not be a nation that fixes its budget at
    the expense of abused and neglected children. Other than the
    $600,000 in funds allocated for our resource center, there is
    no dedicated funding to States for child death review or for
    the reporting system. Fortunately for us, a private company
    based near Goddard recently offered to build our new software
    for us.
        Chairman David, Mr. Doggett, and those of you on this
    Committee, later tonight please think about the 7 or 8 or maybe
    even 10 children who will have died today because someone who
    is supposed to tuck them in at night killed them instead. And
    then tomorrow, begin work on your Committee to take action to
    keep our children alive. Thank you.
        [The prepared statement of Ms. Covington follows:]

        Chairman DAVIS. Thank you, Ms. Covington.
        Mr. Petit.

    STATEMENT OF MICHAEL PETIT, PRESIDENT AND FOUNDER, EVERY CHILD
                         MATTERS EDUCATION FUND

        Mr. PETIT. Chairman Davis, Ranking Member Doggett, Members
    of the Subcommittee, thank you for convening this hearing and
    for the opportunity to testify on this issue. I am Michael
    Petit, president of Every Child Matters Education Fund.
        I have been involved with child maltreatment fatalities for
    over 40 years, and I am sad to say that, despite great
    increases in our overall knowledge about child welfare, the
    situation facing these children has improved very little over
    that period of time. I was formerly with the Child Welfare
    League of America for a dozen years. I served as Maine's human
    services commissioner, which had responsibility for child
    welfare and child protection. I am also the author of a
    publication called, ``We Can Do Better: Child Abuse Deaths in
    America.''
        I will devote my testimony to an overview of child abuse
    fatalities. Others will speak specifically to the data issues
    that are raised in the GAO report.
        To start with, child abuse rates are much higher in the
    U.S. than in other democracies, triple Canada's rate, 11 times
    Italy's rate. The official tally of almost 1,800 deaths a year
    we believe is significantly undercounted, that there are, in
    fact, 2,500-plus deaths a year, about 5 times the number of
    U.S. soldiers killed in 2 wars since the beginning of our
    study.
        Some 80 percent of the children killed are under the age of
    4; 50 percent are under 1. Black children are nearly three
    times more likely to be killed. The vast majority of children
    are from low-income, low-education families. And of the 51
    children randomly selected for our report--some of you may have
    seen this report; if not, we can make it available to you--
    there are 51 children here. In the course of our study period,
    going back to the start of the Afghan-Iraq wars, there were 400
    children behind each one of these pictures. Of the 51 kids that
    we selected at random, only 1 was killed with a knife or a gun.
    The other 50 were principally--the principal cause of death was
    being beaten to death.
        Our collective systems of child protection are stretched
    too thin. Too many troubled families, too few social workers
    and other staff, and too little community support. Few of the
    thousands of child protective units in the States are
    adequately equipped to deal with all the families brought to
    their attention. Consequently, protection for many children is
    a matter of geography. Where a child lives may determine
    whether she lives or dies. Some States appear to have a 10
    times greater death rate than others. Some States appear to
    spend five times more than others on child protection. I say
    ``appear,'' because of a lack of acceptance of standard
    definitions in the field. We don't really know.
        Child abuse flows from extensive child maltreatment in the
    U.S., nearly three million reports a year, and preventable
    deaths are inevitable when we are drawing from such a large
    pool of vulnerable children.
        A major factor, lack of public awareness about the scope
    and size of the problem, directly related to restrictive
    confidentiality laws, which--we hope one of the things that you
    will do is examine those laws and make modifications in them.
    They shield the press, public officials, and the public from
    shortcomings. And we made recommendations for--in 2009 that
    have been presented in this committee; 150 child protection
    experts met for a couple of days.
        Let me say that I have had extensive personal experience in
    dealing with child fatalities where data interfered with the
    protection of a child. During my stint as Maine's commissioner
    of human services, we had a little girl that was presented to
    us by her family at 5:00 on a Friday afternoon.
        Our social worker called the local mental health center and
    said, ``Is the father of this child taking his medications? We
    know that he is a mentally ill individual, and he is not taking
    the medication.'' They said, ``We are not going to share that
    information with you, there are confidentiality issues for the
    parent, and we are not going to give you the information.''
        One hour later, that child was put in an oven, the oven was
    turned on, and the child died in the oven. It was a very tragic
    incident that put our whole State of Maine in a state of shock
    for weeks.
        And I have provided specific consultation to counties all
    across the country on this business of bringing together the
    information from law enforcement, child protection, the mental
    community, mental health. And I am sad to say that, in most
    communities, there is not a sharing of that knowledge. And, in
    many instances, the civil legal protection system for children
    is not enough. The criminal justice system also needs to be
    brought into play, and we need to afford more progress in that.
        Let me say in my remaining moments that the adherence and
    development of national standards in this area is critical. Are
    these children Texas children first, or are they Vermont
    children first, or are they American children first? That is an
    issue, the national standards.
        The support of a commission to examine these child abuse
    deaths is critical, it is a very complex topic. The increase
    in--I mentioned. And then, I think, a public education campaign
    is critical in this area.
        I will close my remarks with that, and I have submitted
    more detailed testimony elsewhere.
        Thank you.
        [The prepared statement of Mr. Petit follows:]

        Chairman DAVIS. Thank you very much, Mr. Petit.
        Dr. Jenny.

      STATEMENT OF CAROLE JENNY, M.D., DIRECTOR, CHILD PROTECTION
                  PROGRAM, HASBRO CHILDREN'S HOSPITAL

        Dr. JENNY. Chairman Davis, Ranking Member Doggett, and
    Members of the Subcommittee, I thank you for the opportunity to
    testify on child deaths due to maltreatment.
        I am a professor of pediatrics at Brown Medical School, and
    the director of the child protection program at Hasbro
    Children's Hospital in Rhode Island. I have a unique
    perspective on this issue, because I may be the only person in
    this room who often has stood at the bedside in the emergency
    department or in the intensive care unit, and actually
    witnessed the deaths of infants and children from maltreatment.
        When the death of a child is the result of abuse or
    neglect, a sad event becomes an immense tragedy. The 1,700-
    yearly child maltreatment deaths officially reported are just
    the tip of the iceberg. As the GAO report points out, counting
    and tracking the number of deaths from maltreatment is
    challenging.
        Sometimes it is very difficult to distinguish between
    accidental and non-accidental death. For example, when a child
    is purposely suffocated with a pillow or a plastic bag, it can
    be impossible to distinguish this act from a death by natural
    causes.
        In addition, many deaths from neglect are not counted as
    such. In Rhode Island, a three-year-old was told by his drunken
    father to go across a busy street to retrieve a discarded lamp
    from a neighbor's trash. He was hit by a car and killed, and
    his death was ruled an accident.
        And what about deaths caused by the late effects of
    maltreatment? If a teenage survivor of horrific sexual abuse
    commits suicide because of her severe depression and post-
    traumatic stress, is that considered a child abuse death? In my
    opinion, the root cause of death in that case is child
    maltreatment.
        My interest is in providing more accurate primary data to
    the agencies that track child maltreatment deaths. These
    agencies cannot perform well if the cases they review have not
    been adequately investigated. The pediatric profession has
    recently made a giant leap in improving this process. The
    American Board of Pediatrics has established the board-
    certified pediatric sub-specialty of child abuse pediatrics.
        These pediatricians complete an additional 3 years of
    fellowship training in child maltreatment, becoming experts in
    the recognition, diagnosis, treatment, and prevention of child
    maltreatment. When a child does die from abuse or neglect,
    these pediatricians can help police, forensic, and social
    service agencies make the correct diagnosis by doing the
    appropriate medical work-up in the hospital, and by ruling out
    conditions that mimic abuse or neglect.
        There are--there is currently no Federal support for
    training pediatric sub-specialists in child abuse pediatrics.
    We need to expand the availability of fellowships, to make sure
    that these doctors are available to all hospitals around the
    country that care for children. The National Association of
    Children's Hospitals and Related Institutions has published
    recommended guidelines for the establishment of child
    protection teams at all children's hospitals, but there are not
    enough trained, board-certified pediatric specialists in the
    field to provide this expertise.
        Another way to increase the accurate counting of child
    maltreatment deaths is to increase the resources available to
    medical examiners and coroners, and to support their
    performance of quality death investigations. Multiple studies
    have shown that only about half of the child maltreatment
    deaths are actually recognized and recorded on death
    certificates and in State vital statistics.
        In summary, in addition to improving our method of counting
    child maltreatment deaths, we need to improve our ability to
    recognize and discern when a death is due to child
    maltreatment. And if we have the resources to diagnose abuse
    and neglect, and provide the necessary treatment and services
    to children and families, we can actually prevent the ultimate
    worst outcome, the death of a child.
        It is important to note that strengthening the quality of
    medical and death investigations in child abuse cases adds
    another protective factor. That is, we will be better able to
    protect innocent parents from allegations of child abuse and
    neglect, and to preserve and promote families.
        Thank you.
        [The prepared statement of Dr. Jenny follows:]

        Chairman DAVIS. Thank you, Dr. Jenny. With that, I would
    like to defer to the distinguished Ranking Member to introduce
    the next witness.
        Mr. DOGGETT. I am very pleased to have join our panel Dr.
    Jane Burstain. Dr. Burstain is responsible for child welfare
    and child protective service budget issues at the Center for
    Public Policy Priorities in Austin, Texas. It is located in the
    same neighborhood that is my home in east Austin. And CPPP is a
    non-profit, non-partisan think tank that has played a vital
    role in Texas, particularly on State legislative issues
    committed to improving the economic and social condition of low
    to moderate-income Texans.
        Before she came to east Austin, Dr. Burstain served as an
    adjunct professor at Pepperdine, where she taught family policy
    classes. And she worked as an attorney representing children in
    the Los Angeles child welfare system. So we really have this
    coast-to-coast problem and insight offered by our panelists
    this morning.
        Thank you, Doctor.

       STATEMENT OF JANE MCCLURE BURSTAIN, PH.D., SENIOR POLICY
              ANALYST, CENTER FOR PUBLIC POLICY PRIORITIES

        Dr. BURSTAIN. Thank you. Chairman Davis, Ranking Member
    Doggett, and Members of the Subcommittee; thank you for the
    opportunity to come testify on this important and tragic issue.
        As Representative Doggett mentioned, I have worked in the
    child welfare arena for more than a decade. I started out as an
    attorney in Los Angeles, and during my six-year tenure there
    representing thousands of abused and neglected children, I
    became interested in taking my experience and translating it
    into systemic improvement. I earned my Ph.D., and in 2008 I
    joined the Center for Public Policy Priorities in Austin,
    Texas.
        At the Center, I conduct research, I participate in State
    and national coalitions, and I educate policymakers on how to
    improve and create better outcomes for children and families.
        Let me start by saying that I absolutely agree with
    Representative Doggett, that even one child death from
    maltreatment is too many. It is the ultimate tragedy for the
    family and the community, and for the individuals who have to
    investigate it. But every single day in the United States more
    than four children are reported to have died from abuse and
    neglect. That is one death every 6 hours. And those are just
    the ones that we know about. As all the witnesses have
    testified here, the number of children dying from maltreatment
    is probably even higher.
        As discussed in my written testimony, and as adequately and
    extensively documented by the witnesses here, we do need to do
    a better job with States getting more quality, comprehensive,
    and consistent data on child maltreatment deaths. But with
    children dying every day, we cannot wait for the data to be
    perfect before we act. So I am going to focus on what we do
    know.
        We know that even taking reporting differences into
    account, some States have higher child maltreatment death rates
    than others. We also know that poverty and having a teen parent
    are significant risk factors for abuse and neglect, and that
    those risk factors are more prevalent in certain States.
        So, I looked at States with high child poverty rates and
    high teen birth rates, which include many of the States
    represented on the panel today in this committee, and I looked
    to see if those States, on average, also had higher child
    maltreatment death rates. I found that States with high child
    poverty had a 43 percent higher death rate, on average. And I
    also found that States that had a
    high teen birth rate had a 61 percent higher death rate, on aver
    age.
        As families struggle and stress levels rise, child
    maltreatment becomes more of a risk. And this risk is only
    growing. The great recession has pushed more families into
    poverty. As compared to 2008, the number and percentage of
    children living in poverty has increased nationwide in
    virtually every State. And although the teen birthrate has
    dropped nationwide, some States still struggle with the issue.
    In Texas, in 2008, there were 55,000 births to teenage girls.
        If we want to reduce child maltreatment, now is not the
    time to cut support to struggling families. But as States
    grapple with huge budget deficits, that is exactly what is
    happening. The number of children receiving child abuse and
    neglect prevention services has declined in 17 States, many of
    which are represented here on the Subcommittee.
        In Texas, with more than 1.6 million children living in
    poverty and at risk for maltreatment, there is only funding for
    about 6,000 to receive direct child abuse and neglect
    prevention services. Budgets are so tight that States are even
    cutting services to children who have been subjected to abuse
    and neglect.
        In 2009, in some States, 2 of every 3 children who are
    child abuse and neglect victims stayed in their home and did
    not receive any ongoing child welfare family support services.
        Early education and child care programs, which have been
    shown to reduce aggressive parenting behavior and maltreatment
    are being cut, as well. Getting children out of the home and
    into daycare reduces parental stress, and makes the children
    more visible to reporters who can identify a problem before it
    escalates into something serious. But in Texas's most recent
    budget, the legislature cut grants to support pre-kindergarten
    by 100 percent, and cut $.20 of every dollar that funds
    subsidized daycare to at-risk children. That is why Federal
    programs which help support struggling families, like title IV-
    B of the Social Security Act, the child care development block
    grant, and the supplemental TANF grant are so important.
        Expanded health insurance options for adults under the
    Patient Protection and Affordable Health Care Act is important,
    as well. With health insurance, poor parents are struggling
    with substance abuse and mental health, can get access to
    services, and thereby reduce the risk factors for reduce and
    neglect, get healthy, and take care of their kids.
        I know that the budget crisis that is facing States extends
    to the Federal Government. But to cut programs that support
    struggling families in tough economic times is the very
    definition of penny wise and pound foolish.
        And if we make that choice, our children will pay for it
    with their lives.
        [The prepared statement of Dr. Burstain follows:]

        Chairman DAVIS. Thank you very much. We will move to
    questions now.
        In today's testimony we have heard a variety of numbers. I
    know, from my professional experience, whether it was in the
    military, in business, and certainly in the morass of
    Washington, D.C., you can't fix what you can't measure. And
    this is going to be one of the central questions, particularly
    numbers of how many children die due to maltreatment each year.
        States reported over 1,700 deaths in 2009 to HHS. GAO cites
    this figure, and also a number from the HHS national incident
    study of child abuse and neglect that estimated 2,400 deaths
    over 2 years, from 2005 through 2006.
        Ms. Tunie mentions 2,500 deaths from maltreatment per year,
    as does Mr. Petit. Ms. Covington speaks more generally about
    the undercount she witnessed in Michigan and reviewed in
    Nevada.
        Ms. Brown, your report details a number of reasons to
    believe current data understates the number of children who die
    from maltreatment. In terms of scale, how many deaths do you
    believe were missing each year? Tens? Hundreds? Thousands? What
    is a better number if the HHS official estimate of 1,770 is an
    undercount?
        Ms. BROWN. The challenge there is finding good research
    that actually measures these issues. And we did a very careful
    literature review of all the research that looked at the
    numbers of child fatalities from maltreatment, and none of them
    are perfect. That is the problem.
        You know, the one that has the relatively high percent of
    child welfare undercounts covers only three States. The one
    that comes up with 2,400 reaches across a number of different
    partners, but it is such a small population that they captured,
    that it is hard to be really, really confident in the data.
        So, we know--we have seen differences in hundreds. We have
    seen as much as 1,000. I would like to see a much better
    process for getting this information, so we can actually know.
        Chairman DAVIS. What were the States that--the three
    States----
        Ms. BROWN. In the study?
        Chairman DAVIS. Yes.
        Ms. BROWN. California, Michigan, and Rhode Island.
        Chairman DAVIS. Okay, thank you. Would anybody else care to
    comment on this issue? Mr. Petit?
        Mr. PETIT. Yes, I would just note that there are three
    peer-reviewed articles that appeared in prestigious health and
    scientific journals that speak to the undercount being at least
    50 percent. One is the Journal of the American Medical
    Association, one is the Journal of Pediatrics, and one is the
    Journal of Public Health. Each of them have extensive
    documentation they put forward that say the number appears to
    be at least a 50 percent undercount, which is how we arrive at
    the 2,500 figure. But no one could defend that number as being
    precise, that being the whole purpose of the GAO study, is to
    help show just how deficient measuring is.
        Chairman DAVIS. Anybody else like to share? Ms. Covington?
        Ms. COVINGTON. I personally believe it is probably 100
    percent undercount. I think we should double the number, when
    you take into account neglect deaths. Just looking at the 15
    States that we did briefly before we came here, we doubled the
    number of States that actually reported--you know, when you
    looked at that versus when was NCANDS, it was double. And I
    think that that is probably true across the country. So, I
    personally would double the number.
        Chairman DAVIS. Okay, thank you. Any other----
        Mr. PETIT. May I just say, as an example of what we get
    at--we had a case one time in which it was an open child
    protective case. They lived on a third or fourth floor. The
    mother experienced an overdose. The two-year-old child went
    down to the street, was run over by a car. And in most States
    that is listed as a pedestrian accident, not the child abuse
    and neglect-related death that it is.
        Chairman DAVIS. So you are saying, for example, connecting
    the different parts of the law enforcement investigation to
    collate that data would be helpful?
        Mr. PETIT. Let me just say that when we have done that with
    law enforcement, the medical community, and others--and
    district attorneys--it is tremendously revealing to see what
    actually happens, the disposition of cases.
        Child welfare can say, ``Here is 100 certified cases in
    which child sexual abuse,'' for example, ``occurred.'' Police
    might say, ``We can identify 75 cases where there was a
    perpetrator.'' There may be 25 cases that are reported to the
    district attorney. The district attorney may choose to
    prosecute 10, because they don't think the data is good enough,
    in terms of supporting the evidence, and you may end up 5
    convictions and 2 or 3 sentences to prison--which I am not
    saying is the answer to this whole problem--but they are not
    tracking those numbers. They are keeping their information
    separately. And when it is blended together they can see where
    the structural problems are in the system.
        Chairman DAVIS. Before I yield to Mr. Doggett, something I
    would throw open to the members of our panel, if you have
    suggested process improvement ideas--particularly as we can tie
    a cost to them, or reduce that cost burden, to get this linkage
    of data. We found, in many institutional settings, a great
    amount of success in removing error, unnecessary cost, and
    other problems--or quality issues, in a more generic sense--but
    in this case it might lead to a solution to these problems.
        With that, I yield to Mr. Doggett.
        Mr. DOGGETT. Thank you, Mr. Chairman. Dr. Burstain has put
    this in terms of one child losing a life every 6 hours. Ms.
    Covington, I gather what you are saying is it could be as much
    as one every three hours, or one every 2 hours. And that is
    what several of you have said with reference to the data, that
    those figures that are widely acknowledged are probably much
    greater than our understanding. Right?
        And I----
        Ms. COVINGTON. Yes, correct.
        Mr. DOGGETT. And I gather that for everyone here, if we
    could do something to prevent just one of these horror stories
    that will take place in the next 6 hours or the next 3 hours or
    the next 2 hours, we would want to do that.
        As policy experts looking more broadly across the country,
    beginning with you, Dr. Burstain, what can we do to prevent
    these tragedies? We want to have an accurate count, certainly,
    and I think there are measures to get a better count. But we
    are not counting beans here. We are counting precious
    children's lives. What are the things that the Congress should
    be doing now, beyond getting a more accurate count, to be sure
    that that rate doesn't go higher?
        Dr. BURSTAIN. Thank you. Well, in addition to funding the
    programs that support struggling families, I think one of the
    things that could really be helpful is the title IV-E waiver
    program that has passed through the House.
        Basically, one of the problems with the child welfare
    system overall is, with the funding streams, you have title IV-
    B, which is a block grant, and that is the money that States
    have flexibility to use for prevention programs, and to keep
    kids safe in their own home. Title IV-E basically covers foster
    care and adoption, so it covers the back end. And that
    represents a much larger part of the Federal financing on child
    welfare.
        And so, if you had a waiver program where States could take
    the money that they would have spent on foster care and spend
    that same money up front to keep kids safe, to prevent child
    abuse and neglect from occurring in the first place, I think it
    would go a long way toward really helping these families keep
    their children safe.
        I think funding child care is another really important
    issue. Child care is something that can really help--just
    getting the child out of the house relieves parental stress.
    And I think, most importantly, the parents, when their kids are
    in child care, know that someone is going to be looking at that
    child. And if there is a problem, and the child is coming with
    a bruise or seems to be unkempt, there is someone who can see
    that child every day and make a report and have the child
    protective services system intervene before a problem occurs.
        Because one of the problems with child maltreatment deaths
    is a lot of those deaths happen, and the child welfare system
    doesn't even know about those kids. And so it is not as if the
    child welfare system is investigating these difficult families
    and not doing a good job of intervening. They don't even have
    an opportunity to intervene, because most of these are young
    kids who are not in school, and so no one sees them. And if you
    get child care for these struggling families, you eliminate
    that problem.
        Mr. DOGGETT. What will be the effect on this problem of
    child abuse, or child deaths, if the Social Services Block
    Grant is eliminated, if TANF supplemental grants in States like
    Texas are not continued, and they are set to expire within
    days, and if we don't have unemployment benefits available for
    families?
        Dr. BURSTAIN. Well, I can tell you with respect to the
    Social Security block grant and the TANF. Those are programs
    that, I know in Texas, they use to directly support child
    welfare services. So those are grants that are not only used to
    help generally families in poverty, but are specifically used
    to help families that are at risk of abuse and neglect, or have
    actually subjected their children to abuse and neglect, and
    they are in the system.
        Mr. DOGGETT. And you are saying--just to interrupt you for
    a minute--that in Texas the cuts have been so severe already,
    even without losing these programs, that some families already
    identified as actually having had cases of abuse or neglect no
    longer get the services?
        Dr. BURSTAIN. Yes. The services rate for child maltreatment
    victims in Texas is at about 45 percent. So about 4 of every 10
    children who have been identified as abuse and neglect victims
    receive ongoing child welfare services. And, as I testified
    about earlier, in some States that rate is even lower, and
    you've got 7 of every 10 children staying in the home and not
    getting services.
        Mr. DOGGETT. Ms. Tunie, you represent an impressive
    coalition of social workers and others. Are there
    recommendations that you have, with regard to what steps we can
    take to prevent this death rate from accelerating, from matters
    getting worse?
        Ms. TUNIE. Yes. In agreement with Dr. Burstain, to simplify
    it--because I am not an expert on this issue--funding is
    critical, and services are critical. And the ability to collect
    the data accurately is critical.
        Mr. DOGGETT. Thank you.
        Chairman DAVIS. Thank you. The gentleman's time has
    expired. I would like to share with Dr. Burstain that Mr.
    McDermott and I introduced the child welfare waiver bill
    addressing this IV-E issue that passed out of the House in May.
    I encourage you to call your friends in the U.S. Senate, and
    encourage them to move faster than their glacial pace to
    address these things.
        [Laughter.]
        Chairman DAVIS. The chair now recognizes Mr. Paulsen from
    Minnesota.
        Mr. PAULSEN. Thank you, Mr. Chairman. Ms. Brown, may I ask
    you a question regarding the report? The report explains the
    two primary sources of data that we have on child maltreatment
    fatalities, and the data reported to HHS and the data reported
    through State child death review teams. What does HHS do with
    the data, exactly, other than just publish summaries of the
    information?
        Ms. BROWN. The NCANDS data that HHS collects is used for--
    because they oversee the State programs--it is used for things
    like checking to see if the States are abiding by their
    expectations when they do their reviews of each State program.
        They also use them to--they have measures that they are
    expected to meet each year,for example, knowing the number of
    deaths from maltreatment and foster care.
        But the other thing, as far as the more on-the-ground
    information, is that they have some technical assistance
    centers, and there is one that deals specifically with child
    protective services. And that center has done some training to
    try to push the information out.
        Mr. PAULSEN. And then what do the States do with their
    child death review team data, the States, specifically?
        Ms. BROWN. I am wondering if I am the right person to
    answer that.
        Mr. PAULSEN. Ms. Covington is nodding her head. Okay,
    please.
        Ms. COVINGTON. Forty-four States require that they use
    their data for a--to publish a State annual report on their
    deaths, which would include child abuse deaths, as well as
    other deaths. Most States are really getting smart about
    actually creating--they--almost all the States have a State-
    level advisory board that reviews those findings before the
    report gets issued, and they make recommendations to their
    Governors and their State legislatures on policy and practice.
        Mr. PAULSEN. Okay.
        Ms. COVINGTON. And some of them have been very successful,
    actually, in getting those things--their recommendations
    implemented.
        Mr. PAULSEN. Sure, Mr. Petit.
        Mr. PETIT. Yes, Mr. Paulsen, if I may say, all together
    there is about $30 billion spent on the child welfare system,
    the formal child welfare system. About 55 percent of that is
    State and local, mostly State. About 45 percent of that is
    Federal.
        There is a very weak Federal oversight of the child welfare
    system. They provide most of the money, and they actually--the
    Federal Government actually provides the statutory framework
    within which most State child welfare systems operate.
        I would assert flatly that virtually every single State in
    the country right now is vulnerable to a successful class
    action litigation being brought against them, and States
    repeatedly lose those when, in fact, such class action
    litigation is brought against them.
        There are very few sanctions ever imposed by the Federal
    Government, even when States are out of compliance for many,
    many years, in contradiction to what Federal standards and
    oversight requirements exist.
        Mr. PAULSEN. And, Ms. Tunie, maybe you can just tell me.
    What does your National organization do with the information in
    general, as you collect the info and get the data?
        Ms. TUNIE. Well, our mission, basically, is to raise
    awareness of the issue, and also to urge Congress to take
    action.
        Mr. PAULSEN. Okay. And, by the way, thank you for helping
    raise awareness on this issue. And, obviously, this hearing is
    a part of that effort. And, I mean, what other recommendations
    do you have for us as individual Members in our own districts,
    in our own States, to also help raise awareness about this
    issue, other than just going through numbers and data.
        Ms. TUNIE. Yes. You know, I think it is really important to
    put a face on it. The book that Mr. Petit put together, where
    you really see the faces of these children, and it really
    becomes a personal, as opposed to just a number or a statistic.
    I think that is a great way to raise awareness.
        Mr. PAULSEN. Thank you, Mr. Chairman.
        Ms. TUNIE. Thank you.
        Mr. PAULSEN. Yield back.
        Chairman DAVIS. Thank you. The chair recognizes the
    gentleman from Washington, Mr. McDermott.
        Mr. MCDERMOTT. Thank you very much. I have watched these
    hearings since 1970, when I was in the State legislature. And
    States always lurch forward after a horrible event. It is over,
    and over, and over, and over again.
        And, Mr. Petit, you just sort of said that there is a
    tremendous problem, and most States would be vulnerable. Let's
    go on the positive side. Tell me the States where they have the
    best system for getting these cases and preventing them.
    Because it seems to me the problem is we are always coming in
    at the back end, looking at the problem, when it is already in
    the hands of the coroner.
        And so, what I am interested in is what States have had the
    best system in place to predict and deal with and prevent?
        Mr. PETIT. Let me--I think that is a more complicated
    question than I am going to spend time answering, in the sense
    that there are literally thousands of child protection offices
    across the country.
        Mr. MCDERMOTT. Yes.
        Mr. PETIT. Many States run it through their county system.
    And we have done studies looking at outcome measurements for
    the States, and they vary wildly, so that the differences
    between virtually any indicator you want to choose, removing
    children from their family, reports of child abuse, fatalities,
    foster care, et cetera, the variations between the bottom State
    and the top States may have multiples of five or tenfold.
        But I will tell you the States that do the best overall are
    the ones that have smaller, whiter populations. So where--which
    translates into less poverty and less complicated issues around
    domestic violence, around imprisonment issues, around substance
    abuse. So all the States experience it, but some States
    experience much more than others.
        If you take a look at the overall distribution of these
    issues, they are concentrated especially most severely in the
    States with large minority populations. And I say that, saying
    that that correlates, in turn, with high rates of poverty in
    those communities.
        But if you wanted to look at a State that probably has had
    a significant effect in dampening down the overall amount of
    child abuse to begin with, which is the ultimate goal that we
    all have, we would say, like, Vermont, where they have
    comprehensive health care services, where there is home
    visiting for virtually all children. There is an extensive
    safety net that is built around welcoming a child and a family
    into the community, and people taking collective responsibility
    for overseeing what is happening with those children and
    families.
        There are a number of other States as well, but when you
    get into the big States--Texas, Florida, California--it is
    very, very challenging to manage the huge volume of cases that
    are brought to their attention in the first place. Remember,
    that number now is about three million reports of child abuse.
    HHS in their national incident study says the true number is
    closer to probably nine million cases of child abuse and
    neglect each year.
        Mr. MCDERMOTT. When you sit at the Federal level, when you
    sit at this dais, and you look out on the United States, and
    you try and figure out what should we do, then the question
    that--I mean, Dr. Jenny raises the question of more pediatric--
    pediatricians trained in looking at the issue. Where are the
    other gaps in training that we should put money or think about?
        I mean we get into these stovepipe things because we try
    and figure out how to deal with it. But I would like to hear
    the other areas where you think there is a need.
        Ms. COVINGTON. I think, without question, our death
    investigation system is--really needs assistance throughout the
    country. In my home State of Michigan there is a number of
    medical examiners that tell you if you die in the first half of
    the year you are going to get a really good autopsy and
    investigation. If you die in the second half, it is going to
    not be so good, because they run out of money. And that is a
    reality.
        And without really quality death investigations, we are
    just not getting the answers we need around these child abuse
    deaths. So I think training and resources for improved death
    investigations would be one area.
        Dr. JENNY. I would like to say that the medical profession
    does a very bad job of recognizing abuse. I did a study and I
    published in Journal of American Medical Association, where we
    looked at 131 abusive head trauma admissions to our hospitals,
    serious abuse. And a third of those kids had a previous head
    injury from abuse, went to the doctor, and the doctor missed
    the diagnosis. Eight of those kids died.
        And I think that there is very little education about
    family violence, about child abuse, in medical schools, in
    residencies. And I think that that is a place where we could
    really ramp up the prevention by early recognition.
        Mr. MCDERMOTT. Is there a place for nurse practitioners in
    that kind of a thing?
        Dr. JENNY. Absolutely. Nurse practitioners, PAs, even
    nurses. I did a study in Colorado where we looked at the amount
    of time in nursing school curriculums that was spent on family
    violence. It was less than 2 hours in a four-year curriculum.
        So, I think that this is something that would be relatively
    easy to do, just by putting more emphasis on this in our
    professional societies and our curriculums in schools.
        Chairman DAVIS. Great, thank you very much.
        Mr. MCDERMOTT. Thank you.
        Chairman DAVIS. The gentleman's time has expired. Mr. Reed
    from New York.
        Mr. REED. Thank you, Mr. Chairman. Thank you to the panel.
    I come at this issue--when I first started my law practice we
    did a lot of law guardian work, and represented many abused and
    neglected children. And there is nothing more touching than
    that experience, and frustrating, and emotional, and it creates
    a lot of anger in me, individually, to see parents abuse their
    children.
        So, that being said--and I get the argument from all the
    testimony--I was reading this last night, and I get the
    argument we need increased funding, we need to protect the
    funding. You know, the environment we live in here in
    Washington, D.C., so--and I don't want to spend a lot of time
    on that issue, just to articulate that I get it, and I
    understand that.
        What I would be interested--what I am interested in talking
    about today is kind of a new way of looking at this issue. I
    think, from all the testimony that I have heard and I have
    read, each of the members of the panel here today would agree
    that poverty is a higher indication of child death from the
    parents from abuse and neglect of parents, and substance
    abuse--would all agree is a higher indication of death of a
    child.
        That being said, I then--does it not beg the question, a
    common sense question of targeting our resources by requiring
    parents who are on public assistance--i.e. public assistance,
    the people that are in poverty are more likely to be on public
    assistance--parents in that program, require them to be drug
    and alcohol tested?
        We are talking about the death of children. And I
    understand there is going to be many parents that are going to
    be alcohol free and substance abuse free, and I get that. But
    if we are talking about saving the death of children, does that
    not trump the benefit that we could receive from identifying
    the higher-risk children through testing their parents for
    substance and alcohol abuse?
        Dr. Burstain, would you have any comment on that?
        Dr. BURSTAIN. Well, first, I think that I completely agree
    with you, that we should be looking at ways that we can prevent
    child abuse and neglect deaths.
        I will say that drug and alcohol testing is expensive. So
    if you are talking about not wanting the Federal Government and
    not wanting the States to have to spend more money----
        Mr. REED. So if we can we get the cost taken care of----
        Dr. BURSTAIN. Well----
        Mr. REED. I mean you are asking for money elsewhere, so if
    you get the money----
        Dr. BURSTAIN. Yes, absolutely. And I would say that that
    money would be better spent, instead of drug and alcohol
    testing, all of the individuals who are receiving public
    assistance, I would say that money would be better spent
    actually getting drug and alcohol treatment.
        Mr. REED. Well, not everyone that is on public assistance,
    just parents that have children in the home be tested. I am
    talking about a very narrow program, trying to narrow it down--
    --
        Dr. BURSTAIN. Wait----
        Mr. REED. Just parents.
        Dr. BURSTAIN. I----
        Mr. REED. Not all those on public assistance.
        Dr. BURSTAIN. I believe the majority of people who are
    receiving public assistance have children.
        Mr. REED. Okay.
        Dr. BURSTAIN. And so the majority of those people would be
    tested. And what I would say is that money that you would spend
    on testing--because what are you going to do if they turn out
    positive? The money would be----
        Mr. REED. We would coordinate that information with CPS and
    with law enforcement, target those individuals, intervene, make
    sure that those parents are getting substance counseling,
    trying to lead them to a substance-free life, and that will
    lower the risk of death to their children, which all of you
    agree has created a higher risk for those children that are
    living in that environment.
        Dr. BURSTAIN. You would be----
        Mr. REED. So that would be my----
        Dr. BURSTAIN. You would be absolutely right, if there was
    money for treatment. But there isn't money for treatment. And
    so, what I would say is, instead of spending your money on
    testing people who you have no basis to believe are actually
    abusing substances, I would spend the money on providing
    services to the people you know are abusing substances.
        Mr. REED. And when they----
        Dr. BURSTAIN. So once they become involved in the child
    welfare system, you need to get them access to substance abuse.
    And, more importantly, mental----
        Mr. REED. So we have to wait until they abuse their
    children before we get--because once they abuse their children,
    they are in the CPS system--then we can get them the substance
    abuse treatment that they need?
        Dr. BURSTAIN. Absolutely you do not have to wait. One of
    the things that I highlighted in my testimony is that, under
    the new Health Care Reform Act, getting people health
    insurance--one of the reasons people don't get treatment, and
    before they actually become involved in the child welfare
    system, is poor adults a lot of times don't have health
    insurance. And so the only way they can get treatment is become
    involved in the child welfare system, and get services through
    the child welfare system.
        Mr. REED. Okay. I notice my time is--Mr. Petit, you are the
    commissioner of----
        Mr. PETIT. Child welfare.
        Mr. REED. Child welfare in Maine.
        Mr. PETIT. I would just note that the Congress and the
    Senate had legislation introduced more than 10 years ago on
    making substance abuse treatment moneys available to State
    child protective agencies whenever that was identified as being
    an issue. And certainly there is a high relationship between
    the two. But the Senate Finance Committee never held a hearing
    on the bill. It was introduced in three consecutive legislative
    sessions to provide assistance in that case.
        Now, that little girl that was baked to death in an oven
    that I mentioned, I remember the Governor saying to me, ``Stop
    this. Take these children from these families and get--stop
    this issue.''
        I said to the Governor, ``This is the first death we have
    had in four years. There are 12,000 children or so in our open
    protective custody in any given moment. And in the course of a
    year, 1 or 2 might die, even though this problem that you just
    described exists maybe in 60, 70, 80 percent of the
    households.''
        So, I think there is a way to target this much more
    specifically, so that you get at what you are talking about.
        May I suggest--I have been doing this for 40 years. This is
    a panel that has been involved with this for a long time. I
    cannot emphasize enough the need for a national commission that
    brings together all of the different disciplines. We are
    talking about nothing less than healthy, human growth and
    development, which is a very complex topic, which hasn't been
    looked at by this congress, by any Administration in decades.
    The last that I know of was the Rockefeller Commission. That
    was almost 20 years ago. We have had no national White House
    conferences in this country since 1970.
        This is an issue that has--receives very scant attention by
    the public. And it needs to be opened up. And that is why I
    would recommend this national commission and, at the same time,
    lift the confidentiality requirements.
        Chairman DAVIS. I appreciate your passion, Mr. Petit. That
    is one of the reasons we are having this hearing today, is to
    move forward----
        Mr. PETIT. Thank you, sir.
        Chairman DAVIS [continuing]. On this. And, with that, we
    will recognize the gentleman from Georgia, Mr. Lewis, for 5
    minutes.
        Mr. LEWIS. Thank you, Mr. Chairman. Thank you, Mr. Chairman
    and Ranking Member Doggett, for holding this hearing.
        I have been here for almost 25 years, and attended many
    hearings. But this has been one of the most painful. What some
    of you have said is almost unreal, unbelievable. But I know it
    is real. I know it is believable. In my own district, in my own
    State of Georgia, just watching the news, reading the
    newspaper, seem like something happened to some little child,
    somebody child, somebody baby, almost every other day.
        And, Mr. Petit, I would really like to know from you. You
    mentioned race and poverty. It is not something that we should
    sweep under the rug or in some dark corner. We should face it,
    and face it head on. Could you tell me--maybe some of you have
    data, information on the State of Georgia--but could you tell
    me or speak to the whole issue of young families where there is
    a father, a mother, a boyfriend, a girlfriend with a child?
    Reading that something happened to this child. The child was
    beaten or left alone and died. What is happening there?
        Ms. Tunie, I love what you said about putting a face on it.
    How do you dramatize that? How do you make it real? How do you
    sensitize and educate the American people that this is a major
    problem and we have to face it?
        I think there is a great undercount, Ms. Brown. I think
    there is a great undercount.
        Mr. PETIT. May I say very directly? The legacy of slavery
    endures. The behavior that we are talking about is
    manufactured. It is not innate to any particular culture or any
    DNA. And in the black community what you have is a very high
    out-of-wedlock birth rate. You have a very high poverty rate.
    You have a very high imprisonment rate of young males.
        The family formation in the black community has been
    extremely challenged in the last few decades, and the research
    that does exist shows that children in a home with an unrelated
    male are almost 100 times more at risk of dying than when there
    is a biological-related father in the household.
        So, I have just made some broad-sweeping statements on
    this. I believe it requires a much closer look. But there are
    realities, in the black community in particular, which shows in
    this report that there is a three times higher fatality rate in
    the black community. But it is manufactured behavior that
    contributes to it.
        Mr. LEWIS. Could you speak about poverty? Ms. Covington,
    you wanted to say something?
        Ms. COVINGTON. I was going to add on to that. There was a
    headline in the Washington Post yesterday. Keith Jackson wrote
    a story, and the headline was, ``Would Anybody Have Cared if
    Caylee Anthony was of a Different Color?'' And I think that is
    really important, because when we look at these deaths across
    the country, there is no question that the white, you know,
    middle-income kids who die at the hands of their care givers
    get a lot of attention. But African American kids are really
    over-representative in the numbers, and poverty is a huge
    correlation in these deaths.
        In fact, in a lot of the neglect cases, that is one of the
    reasons they don't get counted, because, you know, people give
    a little room there when there is poverty issues tied in to
    some of the parental responsibility problems, in terms of--they
    are living in poor families, and so there is--that is one of
    the reasons they don't get counted as well.
        But then it leaves us with numbers that don't make a whole
    lot of sense, and it doesn't give us the ability to actually be
    able to respond to those cases.
        Mr. LEWIS. Any other member of the panel?
        Mr. PETIT. On the poverty question, if I may say, in 1960
    the poorest cohort were seniors, the--children were the second
    poorest cohort. In 2010, children are the most poor cohort and
    seniors are the least poor cohort. The Federal Government is
    spending 7 times more per senior over 65 than per child under
    the age of 18.
        And if you look at the Federal benefits that go to seniors,
    they are the same from one end of the country to the next. They
    are the same in Maine as they are in Texas as they are in
    Hawaii. That is true with Medicare, that is true with Social
    Security.
        When you look at the income security programs for children,
    and the health care programs for children, they are largely
    left up to the States to shape, which, in fact, is attributable
    to some of the poverty that we are talking about, is that there
    is wide variation among the States in dealing with this issue.
        Chairman DAVIS. All right, thank you. The gentleman's time
    has expired. I would like all the Members to know that in the
    back of your packets or binders is State-specific information
    for your home States on this data from the Congressional
    Research Service.
        And with that, I would like to recognize Mr. Berg from
    North Dakota for 5 minutes.
        Mr. BERG. Thank you, Mr. Chairman. This is--you know, has
    to be one of the worst crimes that can be committed, a crime
    against a child. I--you know, these stories you talk about,
    putting a face on it, I mean it is just horrific.
        My wife is a family practice doctor. And one of her most
    difficult days is when she recognizes abuse in a child. And in
    our State of North Dakota, the support for her has been
    outstanding, to get that child in a good environment, a safe as
    possible environment.
        But, you know, in the discussion--I guess, Ms. Brown, the
    discussion really relates around this coordination. And I guess
    I am confused that, you know, almost half the States that are
    reporting this data are just kind of regurgitating data that
    you already have. And it seems to me that these States really
    should be accessing other information that they have in their
    States, whether that is a death certificate, medical
    examination after death, or the child death review team
    structure, which, to me, seems like an outstanding--somewhat
    volunteer, but again, you can bring some real experts into
    that.
        So, I guess I'm just asking, how do we get more accurate
    information? Not necessarily recreating the wheel, but how can
    we get more of a response?
        Ms. BROWN. Well, it seems to me that we have two places in
    the count where the response breaks down. And the first one is
    related to identifying whether a death is caused by
    maltreatment. And we have heard about how challenging that can
    be.
        And then, the second one is, as you referred to, collecting
    the data from the community in a way that can give a more
    complete picture. And I agree that the child death review teams
    that are on the local level can be very, very useful, because
    that is a vehicle for bringing different organizations
    together.
        And part of the issue there is trust, and having personal
    relationships. So, if you have a vehicle that regularly brings
    them together, that could make a difference, and it doesn't
    cost much.
        Mr. BERG. Well, and it--again, our overall objective here
    is really to prevent this from happening. And, you know, we are
    gathering this data, and as I look at this data it is--I mean
    it is as accurate and current as you can get it, but we are
    years and years behind.
        And so, again, it seems to me that what you are talking
    about there on the local area--and again, you have a large
    State, very populous, or a small State--if you could create a
    system where you have local experts that are getting that
    accurate information, but also thinking what steps can be done
    on the local level and on the State level to, you know, again,
    catch these children.
        So that brings up the other question, and I just am always
    frustrated by the lack of communications between different
    agencies. And it seems to me, if you took this further in a
    local, you have the child death review committee and they are
    identifying certain trends, or certain things that really stand
    out--let's take drugs, for example, drug abuse. If they are
    saying that this is something that is a real--it is in almost
    every one of these cases, how can they access the other
    agencies within that local community that could identify and
    share that information, so rather than reactively waiting,
    become more proactive and encouraging these people to get
    treatment or having a higher level of watchfulness over that
    child? Please.
        Dr. JENNY. One thing that I think is very helpful is
    hospital-based child protection teams. Because that is a
    place--in children's hospitals they have teams that meet weekly
    and go over every case that has been in that jurisdiction--not
    of deaths, but of kids that have been abused or neglected. And
    it is a proactive process.
        And having more support in the children's hospitals for
    child protection teams is going to, I think, make a big
    difference because we all talk to each other and we do a lot of
    preventative work up front to avoid those deaths at the back
    end.
        Mr. BERG. Sure.
        Ms. COVINGTON. I think, too, there is a trend in States for
    more improved coordination of just general child protection
    investigations. Some States actually require it, even though
    they don't necessarily follow through on making sure that those
    investigations are done in a coordinated way.
        But in places where they are done in a coordinated way, I
    think there is profound improvements in the way kids are
    identified, because you have got--you have law enforcement, the
    prosecutor, mental health, education, social services, they are
    all at the table--public health, they are all at the table,
    looking at this child from a more comprehensive----
        Mr. BERG. It seems that those are best practices we could
    share with other States, if we had a little more----
        Mr. PETIT. May I say that, actually, there is a lot of this
    going on right now through the Department of Justice? And one
    of our coalition members is the National Children's Alliance.
    And there are some 800 local jurisdictions that have district
    attorneys, child protection, law enforcement, medical, that
    come together, typically around child sexual abuse cases.
        And may I just say in your own State of North Dakota, where
    I had the privilege of spending the better part of a year doing
    a project on child well-being for the North Dakota legislature,
    that year North Dakota ranked first or second in the national
    Kids Count survey. But if you had taken the 7 percent of
    children who are Native American and put them in a new State of
    East Dakota, they would have ranked 51st.
        And so, the data kind of misrepresented what the overall
    well-being was. It took us a year to get data from the Native
    community. It was this question of trust. And they finally put
    their numbers on the table. It created a new North Dakota
    Commission on Indian Affairs and Child Welfare. And I have been
    curious--this was 15 or 20 years ago--to see what impact
    finally putting that data on the table had, which is what the
    legislature was looking for. They didn't know how to help the
    community----
        Mr. BERG. Right.
        Mr. PETIT [continuing]. Without the numbers, and they
    didn't want to start spending money without the numbers.
        Chairman DAVIS. Thank you very much. The gentleman's time
    has expired. And Mr. Crowley from New York, you are recognized
    for 5 minutes.
        Mr. CROWLEY. Thank you, Mr. Chairman. Let me sincerely
    thank you for holding this hearing today, and my colleague, Mr.
    Doggett, for bringing this issue that really, in light of the
    Caylee Anthony case, didn't necessarily need to be highlighted,
    but I think in terms of what we, as a nation, are doing to
    combat the abuse of children is certainly needed.
        And I wonder whether or not the attention we have here
    today would be as strong if it were not for this particular
    case. I--and, Ms. Tunie, I appreciate your lending your voice
    and your face to this issue, and all the panelists here today.
    But this is a disturbing yet necessary subject matter that
    needs to be addressed. And I wonder, though, whether or not we
    would have the same attention we have today--I think you would
    be, and I think all of you and the panelists would be, but I am
    not so sure the media would be as strong as it is today.
        Whether or not the death of Caylee Anthony was by means
    or--of--caused by accidental neglect or first degree murder, at
    the end of the day that young child was killed, and may very
    well have been preventable if signs were--and steps were
    taken--if signs were seen, and proper steps were taken to
    prevent that. And I think the death of any young child, if it
    can be prevented, we should be doing everything we can to do
    that.
        I have been involved in this area for some time, going back
    to my days in the State legislature. I chaired a Subcommittee
    on child product safety. I was concerned by maybe not even
    accidental neglect, just the aspiration of small parts in toys,
    and children dying from what appeared to be the cause of
    pneumonia, when, in fact, it was they had aspirated a small
    plastic piece into their lungs, and therefore, only through
    autopsy later on was this found, to more high-profile today of
    baby cribs.
        I would like to ask the witnesses--you know, because I know
    the GAO report has been focusing on the proper gathering of
    statistics, and questioning whether or not we actually are
    getting all the reportable statistics and compiling them
    correctly to really get an understanding of the breadth and the
    extent of neglect that is taking place. But whether or not--it
    doesn't really address the issues of what to do once we have
    that information.
        And I know my colleagues have asked this in some ways, but
    what else can we be doing to raise awareness? I know in a State
    like mine, in New York, we have--we have seen success in public
    awareness campaigns, especially as it pertains to the issue of
    shaken baby syndrome, as well as safe sleeping for children.
    What else can we be doing? What can we be doing to help parents
    that may not be mindfully neglectful?
        If you just--they have tough lives right now. The economy
    being where it is, and the stress that that brings to bear on
    people's lives, they would never put themselves in the category
    of being accidentally neglectful, you know. What can we be
    doing to help those folks, as well?
        And other care givers that just may be unaware of the
    dangers in everyday situations--for instance, like bath tub
    safety and crib safety and choking hazard safeties? What could
    we be doing to help those folks?
        Dr. JENNY. One thing that your State has done, has been--
    nurse home visitation to young families, particularly at-risk
    young families. And they have done a randomized control trial
    where they have found actually that over the years it decreases
    welfare dependency, it increases the educational level of the
    child in 15, 20-year followups, and also, it decreases the
    abuse rate and also the illness rate.
        So, David Olds model nurse home visitation would be an
    excellent model for prevention.
        Ms. COVINGTON. And that was funded in the Health Care
    Reform Act, and all States are now going to start doing that.
    And I think that that is really, really important, that that
    stay there and be a large part for every State to be able to
    have those dollars to be able to do those family home visits,
    because it is one of the very few demonstrated evidence-based
    practices that we know could actually reduce child
    maltreatment.
        That is part of the things I think we can do, is try to
    figure out what really does work, because the research is
    limited. Funds to figure out what really works for families is
    limited. So there is little research looking at evidence-based
    practices, but I think we need to keep doing that work. And
    then, when we find something that works, make sure it gets out
    to the general public and to communities, so they can start
    implementing these practices.
        Chairman DAVIS. Thank you very much. The gentleman's time
    has expired. I would like to thank all of our witnesses for
    your time and preparation, for your staffs, the investment of
    research, and also helping us understand this very critical
    issue further.
        If Members have additional questions, they will submit them
    directly to you in writing. And what we, on the Committee,
    would ask is that you also send a copy of your response back to
    us at the Subcommittee, so that we can insert it into the
    record, as well.
        Thank you again for highlighting this very critical
    subject. And, with that, the Committee stands adjourned.
        [Whereupon, at 11:26 a.m., the Subcommittee was adjourned.]
        [Questions for the Record follow:]