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

                        PROPOSAL TO REDUCE 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

                                 SECOND SESSION

                                   __________

                               DECEMBER 12, 2012

                                   __________

                              Serial No. 112-HR16

                                   __________

             Printed for the use of the Committee on Ways and Means

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                          COMMITTEE ON WAYS AND MEANS

                         DAVE CAMP, Michigan, Chairman

    WALLY HERGER, California             SANDER M. LEVIN, Michigan
    SAM JOHNSON, Texas                   CHARLES B. RANGEL, New York
    KEVIN BRADY, Texas                   FORTNEY PETE STARK, California
    PAUL RYAN, Wisconsin                 JIM MCDERMOTT, Washington
    DEVIN NUNES, California              JOHN LEWIS, Georgia
    PATRICK J. TIBERI, Ohio              RICHARD E. NEAL, Massachusetts
    DAVID G. REICHERT, Washington        XAVIER BECERRA, California
    CHARLES W. BOUSTANY, JR., Louisiana  LLOYD DOGGETT, Texas
    PETER J. ROSKAM, Illinois            MIKE THOMPSON, California
    JIM GERLACH, Pennsylvania            JOHN B. LARSON, Connecticut
    TOM PRICE, Georgia                   EARL BLUMENAUER, Oregon
    VERN BUCHANAN, Florida               RON KIND, Wisconsin
    ADRIAN SMITH, Nebraska               BILL PASCRELL, JR., New Jersey
    AARON SCHOCK, Illinois               SHELLEY BERKLEY, Nevada
    LYNN JENKINS, Kansas                 JOSEPH CROWLEY, New York
    ERIK PAULSEN, Minnesota
    KENNY MARCHANT, Texas
    RICK BERG, North Dakota
    DIANE BLACK, Tennessee
    TOM REED, New York

                       Jennifer Safavian, Staff Director

                       Janice Mays, Minority Chief Cousel

                                     ______

                        SUBCOMMITTEE ON HUMAN RESOURCES

                    ERIK PAULSEN, Minnesota, Acting Chairman

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

                                C O N T E N T S

                                   __________
                                                                       Page

    Advisory of December 12, 2012 announcing the hearing.............     2

                                   WITNESSES

    The Honorable Bill Frenzel
      Guest Scholar, Brookings Institution (former Member of
        Congress; former
      Chairman, Pew Commission on Children in Foster Care)
        Testimony....................................................     9
    Teresa Huizar
      Executive Director, National Children's Alliance (NCA)
        Testimony....................................................    16
    Madeline McClure
      Executive Director, TexProtects (The Texas Association for the
        Protection
      of Children)
        Testimony....................................................    23
    David Sanders, Ph.D.
      Executive Vice President of Systems Improvement, Casey Family
        Programs
        Testimony....................................................    34

                           SUBMISSIONS FOR THE RECORD

    Alliance for Children and Families...............................    49
    American Psychological Association...............................    52
    Children's Advocacy Institute....................................    55
    First Focus......................................................    59
    George Lithco....................................................    63
    Michael Durfee...................................................    69
    Michigan Department of Human Services............................    78
    National Association of Social Workers...........................    81
    Stephanie Bingham Doss...........................................    89
    Sylvia Randolph..................................................    92

              PROPOSAL TO REDUCE CHILD DEATHS DUE TO MALTREATMENT

                                  ----------

                          WEDNESDAY, DECEMBER 12, 2012

                         U.S. House of Representatives,
                                   Committee on Ways and Means,
                                                        Washington, DC.
        The subcommittee met, pursuant to call, at 2:11 p.m., in
    Room 1100, Longworth House Office Building, the Honorable Erik
    Paulsen [Acting Chairman of the Subcommittee] presiding.
        [The advisory of the hearing follows:]

    HEARING ADVISORY

                  Acting Chairman Paulsen Announces Hearing on

              Proposal to Reduce Child Deaths Due to Maltreatment

    Wednesday, December 05, 2012
    By (202) 225-3625

        Congressman Erik Paulsen (R-MN), Acting Chairman of the
    Subcommittee on Human Resources of the Committee on Ways and Means,
    today announced that the Subcommittee will hold a hearing to discuss a
    bipartisan proposal to establish a commission tasked with developing
    recommendations for reducing child deaths due to maltreatment. The
    hearing will take place at 2:00 pm on Wednesday, December 12, 2012, in
    Room 1100 of the Longworth 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 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 1,500 children in the U.S. died in
    FY 2010 due to maltreatment. However, research has shown that these
    reports substantially understate the number of children who die due to
    maltreatment each year. To gain a clearer understanding of this issue,
    Ways and Means Committee Chairman Dave Camp (R-MI) asked the Government
    Accountability Office (GAO) to review 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) has done to support
    the collection and accurate reporting of this information. GAO
    testified about the findings of their review and released its report
    during an earlier Human Resources Subcommittee hearing held on Tuesday,
    July 12, 2011.
        Since the earlier hearing, Members have continued bipartisan
    discussions on ways to reduce fatalities due to maltreatment.
    Specifically, full Committee Chairman Dave Camp (R-MI) and Subcommittee
    Ranking Member Lloyd Doggett (D-TX) have developed a proposal, the
    Protect our Kids Act, to establish a commission that would examine the
    issue and recommend ways to improve current policy and practices. The
    purpose of this hearing is to review that proposal and solicit input
    from key stakeholders and other experts on how such a commission might
    best undertake this work. A draft of this proposal, on which witnesses
    will be asked to comment in their testimony, can be found at the
    following link: http://waysandmeans.house.gov/UploadedFiles/
    Commission_Draft.pdf.
        In announcing the hearing, Acting Chairman Paulsen stated, ``The
    death of any child is a tragedy, but there is nothing more
    heartbreaking than when a child dies at the hand of someone who should
    have cared for them most. Our hearing last year highlighted this issue
    and what can be done to collect better information on the problem. Now
    we have a bipartisan proposal to investigate this issue further and
    produce real reforms. I look forward to hearing our witnesses' thoughts
    on this proposal so we can ensure that more kids are protected from
    abuse and neglect.''

    FOCUS OF THE HEARING:

        The hearing will focus on the bipartisan proposal, the Protect our
    Kids Act. The draft legislation establishes a commission to examine the
    issue of child fatalities from abuse and neglect, review the
    effectiveness of current programs and policies, and recommend ways to
    reduce child fatalities due to maltreatment.

    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 Wednesday, December 26, 2012. 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/.

        Mr. PAULSEN. Good afternoon. I call the subcommittee
    hearing to order.
        The purpose of today's hearing is to discuss a proposal
    designed to reduce the number of children who die from abuse
    and neglect.
        I would like to thank our colleague, Mr. Doggett, as well
    as Chairman Camp, for their work on this very important
    proposal that we will consider today. There are tragically too
    many examples, like Devin Drake, of why this is an important
    issue. Three-year old Devin Drake was brought to Mercy Hospital
    in Minneapolis, Minnesota, by his mother, Elizabeth Moorman, on
    August 30, 2011. She said that Devin had been completely normal
    until he collapsed at home just a few minutes earlier. After
    questioning by medical staff, and later police, her boyfriend,
    Anthony Urban, admitted to punching Devin the day before. He
    said the boy then fell off a stool and hit his head on the
    bathroom ceramic floor. Even though Devin had trouble standing
    up and was obviously seriously injured, neither his mother nor
    her boyfriend took time to bring him to the hospital. The next
    day, even after Devin's condition worsened, they still did not
    get help for him. Finally, it was that evening that Devin's mom
    took him to the hospital.
        Police reports revealed that this was not the first time
    that Devin had suffered abuse. Before his birth, Devin's mother
    was convicted on drug charges. After Devin was born, social
    workers contacted his mother because of alleged drug abuse. At
    the time of Devin's hospital visit, his mother had outstanding
    warrants for her arrest, which no doubt contributed to her
    reluctance to take her son to the hospital.
        Her boyfriend had two felony drug convictions. Neighbors
    said they noticed Devin recently had had a black eye. One
    neighbor said she had planned to go to authorities the very day
    that Devin was taken to the hospital.
        When Devin arrived at the hospital, medical staff realized
    his injuries were no accident. He was diagnosed with severe
    head trauma, punctured lungs, and a number of contusions. He
    was airlifted to Hennepin County Medical Center, where his
    injuries were found to be consistent with severe abuse.
        Four days later, 3-year old Devin Drake died. Nothing is
    more breathtaking, heartbreaking than when a child like Devin
    dies at the hands of someone who should have cared for him the
    most.
        And that is why we are here today, to review a proposal
    designed to reduce the number of these tragedies. Ultimately,
    the real solutions will come through the incredible work done
    by local child welfare agencies, education providers, police,
    healthcare providers and workers and many others.
        While it won't be the Federal Government that solves this
    problem, we have a role to play. As the legislation before us
    suggests, we can bring together experts to review which of
    today's practices work, and don't work, to highlight what
    additional steps hold the most promise and ultimately help
    local officials incorporate that knowledge into their best
    practices.
        In July 2011, we heard about the magnitude of the problem,
    including the fact that hundreds of child abuse deaths go
    unreported each year. Today we will review a bipartisan
    proposal to establish a commission to consider these issues and
    develop recommendations to ultimately reduce the number of
    those deaths.
        This legislation would have a very small cost, which we
    would make sure is fully paid for by other savings. We believe
    it can move forward quickly through the House and then,
    hopefully, through the Senate.
        Most importantly, we think it will help prevent future
    child abuse deaths. While that will come too late for Devin, we
    do owe it to the many vulnerable children who might be saved in
    the years ahead to make any progress that we can.
        I look forward today to all of the testimony from our
    panel's witnesses and advancing the bipartisan legislation
    offered by Chairman Camp and Representative Doggett.
        Without objection, each Member will have the opportunity to
    submit a written statement and have it included in the record
    at this point.
        Mr. Doggett, would you care to make an opening statement?
        Mr. DOGGETT. I would, Mr. Chairman, and thank you so much,
    Mr. Chairman, for the work that you and your staff have shown
    on this measure.
        I am pleased that, with your personal leadership and that
    of Chairman Dave Camp, we are moving forward in a bipartisan
    manner to pass legislation to reduce the number of children who
    are exposed each year to abuse and neglect.
        It is my hope that we can use today's hearing and the
    expert witnesses that we have together with us in the hearing
    to perfect this legislation before its bipartisan consideration
    here in the House.
        At the hearing that we had in July of 2011 in this
    subcommittee, I expressed hope that we would be able to work
    together, and I think these more recent developments suggest we
    are doing that.
        You know, as a grandfather myself of three little girls,
    who bring such tremendous joy to our family, it is just painful
    to even imagine a child being subjected to neglect and abuse,
    especially from a family member.
        Yet we recognize each year that there are thousands of
    children who face this cruel fate. As District Judge Darlene
    Byrne, a leader in establishing, really across the country, but
    beginning in Travis County in Texas, our child protection
    courts, has said, ``Childhood should be a time of innocence and
    freedom, but it is a sad fact that many children are vulnerable
    to injury and abuse. Our Nation's children need good leaders to
    stand up at a national level and find creative ways to protect
    them from harm. The creation of a national commission to end
    child fatalities is an important step in that direction.''
        We need thoughtful consideration of everything we can do to
    protect vulnerable children. And in some cases, we just need to
    share what is already working, what has been developed in some
    communities to try to avoid tragedy. And a lot of what we will
    hear today is that there are many areas of improvement in the
    fight against child abuse and neglect that we can, in fact,
    make.
        The draft legislation that we are reviewing today
    represents an improved version of the original H.R. 3653, that
    I introduced exactly 1 year from tomorrow, and that is pretty
    quick for Congress to act.
        It would establish a national commission to develop
    recommendations to reduce child fatalities stemming from abuse
    and neglect. In my home State of Texas, groups like
    TexProtects, Voices for Children San Antonio, CASA, children's
    shelters in Austin and San Antonio serve as a voice for the
    voiceless, protecting and advocating for children, as their
    counterparts do in other States around the country. Local
    leaders, like Texas State Senator Carlos Uresti, was a driving
    force behind getting our Texas Blue Ribbon Task Force to combat
    child abuse and neglect set up, and getting Bexar County's own
    task force to combat these problems.
        There are a number of similar organizations in Chairman
    Camp's home State of Michigan, and I am sure in Minnesota as
    well, like Michigan's Early Childhood Investment Corporation,
    Michigan's Council on Maternal and Child Health, and the
    Michigan office of Great Start. The important work that these
    folks are doing has been critical to improving the lives of at-
    risk children. Yet despite these developments, fatalities
    stemming from child abuse and neglect remain at epidemic
    proportions in Texas and in San Antonio, in particular. Last
    year there were almost 6,000 confirmed cases in Bexar County,
    that is San Antonio, the highest number in Texas, higher than
    even Houston and Harris County, which has a population that is
    about twice as large.
        In the decade from 2000 to 2010, Texas had over 2,000
    reported deaths from child abuse and neglect. And last year,
    Texas had nearly 66,000 confirmed cases of child abuse and
    neglect, and over 200 deaths during that one year alone. So
    there is much we need to focus on in my home State and around
    the country.
        Mr. Chairman, in so many cases, we may never fully
    understand what causes this abuse and neglect, but we can
    understand ways to reduce it. And I think, by creating this
    national commission, we will be taking a step, an important
    step in the right direction. Thank you.
        Mr. PAULSEN. Thank you, Mr. Doggett.
        I want to remind our witnesses to limit their oral
    statements to 5 minutes. However, without objection, all of the
    written testimony will be made part of the permanent record.
        On a panel this afternoon, we will be hearing from Bill
    Frenzel, guest scholar at the Brookings Institution; Teresa
    Huizar, executive director, National Children's Alliance;
    Madeline McClure, executive director, TexProtects; and David
    Sanders, Ph.D., executive vice president of Systems
    Improvement, the Casey Family Programs.
        I would like to now introduce our very first witness, Mr.
    Frenzel. Bill Frenzel is a former Member of the United States
    House of Representatives, representing my district, actually,
    in Minnesota's Third Congressional District, where he had a
    very distinguished career for 20 years. He served as a member
    of this committee as well as a ranking member of the House
    Budget Committee and the House Administration Committee.
        Upon leaving the House, Mr. Frenzel continued his public
    service, serving as a special advisor to President Clinton on
    NAFTA, as well as chairman of the President's Advisory
    Commissions on Trade Policy and Negotiations from 2002 to 2011.
        Mr. Frenzel also served as the chairman of the Pew
    Commission on Children in Foster Care from 2003 to 2008.
        It is an honor to have him testify here before the
    committee today.
        Mr. Frenzel, please proceed with your testimony.

        STATEMENT OF THE HONORABLE BILL FRENZEL, GUEST SCHOLAR,
     BROOKINGS INSTITUTION, FORMER MEMBER OF CONGRESS, AND FORMER
          CHAIRMAN, PEW COMMISSION ON CHILDREN IN FOSTER CARE

        Mr. FRENZEL. Mr. Chairman, thank you.
        Chairman and Members of the Committee, it may be bad form,
    but I want to say, first of all, what a great privilege and
    pleasure it is for me to testify before a committee chaired by
    a Congressman From the Third District of Minnesota. My elation
    knows no bounds.
        Mr. Chairman, I want to testify on the structure of the
    committee and the remarks that I make are based on my own
    experience in a number of commissions and panels. And I hope
    that they will be helpful, and I realize that there are lots of
    other points of view that will be and can be made.
        First of all, the draft bill of Congressmen Doggett and
    Camp, provides for a Presidentially appointed commission. And
    that is a good idea if you are looking for prestige. However,
    Presidential commissions don't have a glorious history of
    success. My guess is that this particular commission is going
    to succeed no matter who appoints it, but I believe you are
    likely to come to a better outcome if you appoint it through
    the Congress.
        The trouble with Presidential appointments is that you
    aren't there to see that they get made. You may have trouble
    with what I call geographical distribution, which I think is
    important and I will talk about more later. And the President
    may want to reward other people, and his personnel department
    may have restrictions that make it difficult to put the kind of
    people you want on there.
        So I would say it would be a lot better to have the
    commission selected by Congress, and by your subcommittee and
    its Senate counterpart, I think they could work with the
    appointing authorities, all four of them in Congress, to get
    the right kind of commission.
        With respect to size, I think the draft bill has it about
    right. I would suggest a few more, but certainly no more than
    20. So I think you are okay there.
        The qualifications are something that I am not myself
    qualified to speak about, but it looks like you have the bases
    pretty well covered.
        I think, however, I am going to suggest that you might try
    some former Members of Congress in leadership jobs, and they
    might not qualify under the qualifications listed in the draft
    bill.
        I talked about regionality before. You need to get a
    spread. The States are all different. The regions are all
    different. You can't avoid California and New York, where
    certainly a lot of these problems exist, and you need a spread
    elsewhere. That is one of the reasons why I prefer a little
    larger commission than is outlined in the draft bill.
        With respect to congressional membership, it is up to you.
    I believe that Members have got a lot of things to do, and
    probably shouldn't be on the commission and might not be
    reliable attendees.
        As to commission leadership, I have always thought that
    having a former Congressman to enforce management and
    leadership and look for consensus is a really great idea. I had
    a wonderful experience on the Pew Commission on Children in
    Foster Care working with Bill Gray, who had formerly been
    chairman of the Budget Committee when I was the ranking member.
    And I think neither of us knew very much about children in
    foster care, but I think we kept the commission going and aimed
    in the right direction.
        I have a note here on consensus. It is, I believe, very
    important to have the members come to a fairly unanimous
    agreement. Separate or minority remarks blunt the thrust of
    these kinds of commissions. I think that proper leadership will
    get you there.
        My time is expiring, but let me just say, with respect to
    congressional approval, I hope that this committee would see
    that there is some kind of action immediately following the
    report, because then, local agencies, private organizations,
    State, and other agencies will pay a lot more attention to it
    if they believe that the Congress thinks it is a good report.
        Congress may not be able to pass a bill to say this, but I
    think the committee could indicate approval somewhere along the
    line.
        Mr. Chairman, I have other thoughts, and I will leave them
    for the question period. Thank you very much.
        Mr. PAULSEN. Thank you, Mr. Frenzel, very much.
        [The prepared statement of Mr. Frenzel follows:]

        [GRAPHIC(S) NOT AVAILABLE TIFF FORMAT]

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

       STATEMENT OF TERESA HUIZAR, EXECUTIVE DIRECTOR, NATIONAL
                       CHILDREN'S ALLIANCE (NCA)

        Ms. HUIZAR. Thank you.
        Chairman Paulsen, Ranking Member Doggett, and Members of
    the Subcommittee, thank you for holding this important hearing
    on child abuse fatalities and the effort to establish a
    commission that would shed light on this issue, highlight
    evidence-supported interventions, and convene a national
    dialogue about the protection of the nation's most vulnerable
    children.
        I represent National Children's Alliance, which is the
    national association and accrediting body for the nation's 750
    Children's Advocacy Centers. CACs coordinate a
    multidisciplinary team approach to the investigation,
    prosecution, and treatment of child abuse. In the case of child
    abuse fatalities, our CACs are often used for the interviews
    conducted with other siblings and child witnesses of these
    tragedies. So we know far too well the tragedy of children
    killed by their caretakers and the toll this takes on
    communities, the remaining family members, and the
    professionals who must investigate these sad cases.
        Because we believe these deaths are preventable, NCA has
    joined with other members of the National Coalition to End
    Child Abuse Deaths to raise awareness of the problem.
        Over the past decade significant gains have been made in
    child abuse prevention and intervention generally. The overall
    rates of sexual and physical abuse have declined, but what has
    not declined and in fact has either remained flat or increased,
    is the rate of child abuse fatalities or near fatalities. The
    horrifying persistence of fatal child abuse, despite the
    implementation of effective prevention and intervention
    measures for most other forms of abuse, calls for a deeper
    examination of its causes and scope.
        Official child welfare records indicate that at least 1,500
    children are fatally abused annually. However, that number does
    not capture the scope of the problem, nor the scope of the
    suffering. Indeed, a recent GAO report indicates that the
    NCANDS data due to the voluntary nature of the data collection
    and the fact that in many States only one data source is used
    for the reporting, substantially undercounts fatal child abuse.
    And moreover, restrictive confidentiality laws and regulations
    make it difficult to thoroughly examine abuse fatalities when
    they occur so that we can learn how to prevent them and what
    risk factors are associated with them.
        What is sorely lacking in all of this is a comprehensive
    national strategy to combat the tragedy of child abuse
    fatalities. Rather than a piecemeal approach to preventing
    these deaths, children at risk of eminent harm need and require
    the government's protection. And as a public health problem,
    child abuse fatalities can be approached as any other and
    successfully combatted.
        Key to this national strategy is the establishment of a
    bipartisan commission empowered by Congress to thoroughly
    examine the problem, particularly as it relates to children
    within or previously known to the child welfare system. States
    vary widely in their child abuse fatality rates. Guidance
    provided through the work of a commission can ensure that a
    child's chance of surviving his or her childhood is not an
    accident of geography.
        By scrutinizing the effectiveness of Federal, State, and
    local data systems and identifying the most effective
    prevention and intervention practices, the commission can lift
    up successful examples for widespread dissemination.
        Reducing child abuse fatalities is a complex matter. It
    requires investigating and addressing many issues, including
    evidence-supported prevention and intervention efforts aimed at
    strengthening families and preventing maltreatment in the first
    place; workforce training; a risk-assessment practice within
    Child Protective Services; strengthening child death review
    teams; encouraging CAC's to expand their services;
    strengthening the medical examiner and coroner systems within
    the U.S. to ensure accurate designations of the cause of death
    in these cases, which are often among the most medically
    complex; providing training to law enforcement and prosecutors
    to hold offenders accountable; and creating data-sharing
    systems that allow agency to cross share information so that
    children can be saved and research can inform our practice; and
    of course, educating the public so the communities can protect
    their own children.
        Because of the complexity of these issues, a coordinated
    and thoughtful approach is critical and can only be achieved
    through the work of a commission to end child abuse and neglect
    fatalities. Our efforts on behalf of these children must go
    beyond finger pointing, the blaming and firing of individual
    caseworkers, and scattered prevention and intervention
    strategies if we are to prevent future deaths. Our best hope of
    reaching a comprehensive strategy is the establishment of a
    commission to end child abuse and neglect fatalities, empowered
    to investigate, make thoughtful recommendations, and lift up
    promising practices. The lives of more than 1,500 children each
    year absolutely depend upon it.
        Thank you.
        Mr. PAULSEN. Thank you very much, Ms. Huizar.
        [The prepared statement of Ms. Huizar follows:]

        [GRAPHIC(S) NOT AVAILABLE TIFF FORMAT]

        Mr. PAULSEN. Mr. Doggett, I understand you would like to
    introduce our next witness, Ms. McClure, who I understand is
    from your home State of Texas.
        Mr. DOGGETT. She is, indeed, Mr. Chairman.
        Thank you. I am pleased to formally introduce Madeline
    McClure, who is the Director of the Texas Association for the
    Protection of Children. She serves as the appointee of
    Lieutenant Governor David Dewhurst and Texas House Speaker Joe
    Straus on the Texas Blue Ribbon Task Force on Child Abuse,
    Prevention, and Child Welfare, and she is the chair of the
    Child Protection Roundtable, which she founded.
        She has a career of about a decade making money
    successfully on Wall Street before she turned to making lives
    better for children on Texas streets. She also works as a
    therapist now, has worked as a therapist with the Dallas
    Children's Advocacy Center. I believe she has done much to help
    prevent abuse and neglect in Texas, more than anyone I know,
    and is a tireless advocate to have made this special trip from
    Dallas to be here today.
        Thank you, Madeline, for coming to join us.
        Mr. PAULSEN. Thank you, Mr. Doggett.
        Ms. McClure, you may proceed.

    STATEMENT OF MADELINE McCLURE, EXECUTIVE DIRECTOR, TEXPROTECTS,
          THE TEXAS ASSOCIATION FOR THE PROTECTION OF CHILDREN

        Ms. McCLURE. Thank you for that lovely introduction,
    Ranking Member Doggett, and Chair Paulsen, and committee
    members, thank you so much for inviting me to testify today on
    this most critical issue of child maltreatment fatalities. I am
    honored to be here.
        Given that child maltreatment deaths stem primarily from
    child physical abuse and child neglect, I am going to focus my
    comments today on child maltreatment prevention, and given my
    background in economics and social work as you just outlined, I
    think it would be most helpful for the committee if I talk a
    bit more about monetizing the benefits and the costs, if that
    would be all right.
        So, first, let me put into perspective the incidence. We
    need to know what the size of the problem is before we attempt
    solutions. As you may know, the National Data Collection
    Systems and the National Incidence Studies, as well as national
    surveys, showed that 1 to 10 percent of our child population
    are abused annually. That is a big range. But whether it is
    750,000 children or 7.5 million children, one abused child is
    one child too many.
        So just to put this in perspective on the screen, imagine
    an aerial view of the following stadiums filled to capacity.
    Hopefully, most of these are from your hometowns, the Hubert
    Humphrey Metrodome, Dallas Cowboys Stadium, the Cotton Bowl,
    Yankee Stadium, Sanford Stadium, Neyland Stadium, Tiger,
    Century Links Field, and the Rose Bowl.
        There wasn't a stadium from North Dakota that was large
    enough that I could include in this, sorry, Congressman Berg.
        But imagine that instead of adult fans filling those seats,
    picture all of those seats now filled with children, abused
    children, almost 50 percent that are less than 4 years old. So
    hold those nine stadiums, packed to the gills, brimming with
    just children. That is what 753,000 looks like. And that is the
    lowest incidence number, just to contextualize the problem.
        The consequences of child abuse and neglect, I think this
    committee has heard several times. But just because you
    mentioned Devin and his parents, Chairman Paulsen, I want to
    remind us that children that are abused and neglected have
    impaired brain development, 85 percent more likely to have that
    and, in stepwise fashion, very often have cognitive
    difficulties, impaired learning disorders and then self-
    anesthetizing abusing substances which leads to doing poorly in
    school and also, teen pregnancy and school dropout, often
    leading to juvenile delinquency.
        We talk about the associations, but there is a lot of cause
    and effect here. Most importantly, children that are abused are
    six times more likely to abuse their own children. I can only
    imagine what Devin's parents had gone through in their earlier
    lives.
        But child abuse also exacts a very high financial price. As
    you can see on this next slide, the Center for Disease
    Control's recent study monetizing the outcomes of the
    consequences of child abuse and neglect found that for every
    child abused in their lifetime it will cost $210,000 per
    victim. That is for those who survive abuse. For those who die,
    for every child abuse fatality, we as taxpayers spend $1.3
    million per victim. So, in 2012 inflation-adjusted dollars,
    that is $124 billion that we are throwing out the window just
    on the consequences of child abuse.
        But the monetary calculations cannot begin to place a value
    on the incalculable cost of lives lost, unseen scars of
    potentials quenched, spirits extinguished, and souls murdered.
        These human and financial costs are unacceptable and
    unsustainable, and they do represent an enormous financial
    burden on our taxpayers.
        The good news is that child abuse is largely preventable.
    We have found net cost savings of child abuse prevention
    programs that are of high quality that return on average $3.50
    for every dollar invested, up to $14.50 for every dollar
    invested. Here is an example of a program that is entitled The
    Positive Parenting Program, and this particular program
    actually is cost neutral within a year. But it returns about $6
    for every $1 invested, as you can see in terms of the costs of
    reducing out-of-home placements and also CPS cost, and other
    costs.
        So for a relatively modest investment up front, we will not
    only break the intergenerational cycle of violence, we can
    reduce an enormous economic tax burden on taxpayers immediately
    and the long term.
        And where we are today in preventing child abuse is akin to
    where Congress was 70 years ago in exploring the use of
    antibiotics to kill infections. So when you look back, or your
    children, or your grandchildren look back on this 10, 20, 50,
    70 years from now, this is going to be that inflection point
    where we really go through this process of putting enough money
    up front to change that whole trajectory, not only for at-risk
    kids and their families, but our great country at large.
        This national commission is a right first step, and I
    really am excited about this commission helping all of the
    States have an accessible blueprint for implementing a
    meaningful child abuse prevention strategy. I thank you for
    your time.
        Mr. PAULSEN. Thank you, Ms. McClure.
        [The prepared statement of Ms. McClure follows:]

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        Mr. PAULSEN. Mr. Sanders, you may proceed.

    STATEMENT OF DAVID SANDERS, PH.D., EXECUTIVE VICE PRESIDENT OF
               SYSTEMS IMPROVEMENT, CASEY FAMILY PROGRAMS

        Mr. SANDERS. Good afternoon, Chairman Paulsen, Ranking
    Member Doggett, and Members of the Subcommittee. I am David
    Sanders, executive vice president of Systems Improvement at
    Casey Family Programs, a national foundation committed to
    improving the lives of vulnerable children and families in
    America by building Communities of Hope.
        We thank the committee and, in particular, Chairman Camp,
    Subcommittee Chairman Paulsen, and Subcommittee Ranking Member
    Doggett, for their leadership and commitment to reducing child
    fatalities due to abuse and neglect.
        The discussion draft that has been shared would establish a
    commission to develop a national strategy and recommendations
    on this issue. We commend the vision and overall believe that
    such a commission would provide an incredible opportunity to
    better understand how we can prevent child fatalities.
        We offer two comments for your consideration. First, we
    agree it is important the 12 commission members represent a
    number of key expertise areas outlined in the draft. While the
    discussion draft states that each member should possess at
    least one area of expertise, it is important that the
    commission represent a broad range of issues. As currently
    drafted, it appears possible that all of the commission members
    could come from a single area of expertise.
        Second, the discussion draft limits the purview of the
    commission to programs funded under Titles IV and XX of the
    Social Security Act. There are a broad array of programs that
    provide upfront prevention and intervention services, such as
    Medicaid, maternal and child health programs, and substance
    abuse funding. We, therefore, urge the inclusion of a broader
    spectrum of programs.
        In an effort to influence and mobilize national efforts to
    prevent child maltreatment-related fatalities, Casey Family
    Programs launched a series of forums in the fall of 2011. The
    Administration on Children, Youth and Families, the Centers for
    Disease Control joined Casey Family Programs in hosting these
    events that were attended by experts, policymakers, advocates,
    researchers, practitioners, and child welfare leaders, as well
    as public health leaders. These forums provided us a tremendous
    opportunity to explore the issue of child fatalities from
    different perspectives.
        Findings explored in the Safety Forums that will guide our
    future work and recommendation center around four areas: Number
    one, risk factors for severe maltreatment and fatalities.
    Research in California linking birth records and CPS records
    has found that a report for child maltreatment before the age
    of 5, whether substantiated or not, is a risk factor for a
    later fatality from intentional or unintentional injuries.
    Other researchers found the rates of abusive head trauma
    identified among children under 5 years of age increased
    significantly at several major pediatric hospitals during the
    2007 and 2009 period and were associated with increased
    economic hardship at the community level.
        Number two, child maltreatment is a public health issue. A
    significant proportion of child maltreatment-related deaths
    occur in families who have no history of involvement in the
    child welfare system. Therefore, it would be prudent for us to
    look at the issue of child deaths, not just through the lens of
    child welfare but from a broader public health perspective.
        Number three, informing child protection policies and
    practices for reducing child maltreatment-related fatalities.
    There are several areas we need to consider to improve child
    protection policies and practices. The public's perception of
    child welfare in this country is generally painted by media
    reports of isolated cases of tragedy. The gap between public
    perception and the realities of child welfare administration
    drives public policy in ways that are not always the best for
    keeping children safe.
        And finally, number four, measurement and classification of
    child fatalities. Experts agree that improving the measurement
    and classification of child fatalities is critical to
    understanding and preventing child maltreatment and fatalities.
    Building effective cross-sector multi-agency collaborations is
    essential for obtaining accurate data on the incidence of
    preventable child deaths and serious injuries, and implementing
    successful prevention strategies. Multidisciplinary local and
    State child death reviews teams play a critical role in
    identifying patterns in child death and serious injuries,
    identifying common risk factors, and developing and
    implementing preventive efforts.
        The work of Casey Family Programs' Safety Forums has led us
    to believe that we can succeed in this. Successful strategies
    are comprehensive. Strategies are not limited to one sector or
    agency. Successful strategies are focused. High quality data,
    as well as other kinds of research evidence, are essential to
    inform strategies and assess results, and finally, we currently
    have some important knowledge and experience in regards to
    data, but there are glaring gaps; gaps that we can close.
        Casey Family Programs has used its national platform and
    its resources to work with State child welfare administrators
    and other key voices to elevate this issue. We stand ready to
    work with this commission or any other group or organization
    focused on child fatality.
        Thank you and I am happy to address any questions you might
    have.
        Mr. PAULSEN. Thank you very much, Mr. Sanders.
        [The prepared statement of Mr. Sanders follows:]

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        Mr. PAULSEN. Mr. Frenzel, in your testimony, you mentioned
    that you feel a number of commissions have been unable to
    achieve their objectives. What do you think contributes to that
    failure? Is it that the missions are too broad or the
    recommendations are too difficult to implement, or something
    else?
        Mr. FRENZEL. Well, I think those commissions, Mr. Chairman,
    and members, that we all know about, are the very high-profile,
    very difficult ones, such as the Simpson-Bowles Commission,
    usually dealing with economics or budget affairs. They only go
    to the commissions after the problems have become intractable
    and hard for the Congress and the President to deal with
    together.
        It is very hard to move a report of one of those
    commissions, especially when the President designates the
    commission and the Congress is not interested in following it
    up. I cite the Bush 43's Commission on Social Security and one
    on tax reform. In that case, in the latter case, the part of
    Congress that didn't want to deal with it was President Bush's
    own party. And so it is just a long shot, I think. The problems
    are too tough.
        This would be quite different. I think this would be
    something on which everyone can get together, and the reason I
    suggest that you might not want a Presidential commission, is
    that I am afraid you might not get the right people or the
    right spread of people. And therefore, I suggest a
    congressionally appointed panel. But the failure of the
    Presidential commissions is that the subjects were too tough to
    begin with, and they weren't going to be solved at that time.
        Mr. PAULSEN. Do you have any other thoughts about what we
    might do to make sure that the recommendations of the
    commission remain within budgetary and political reason and
    don't become too expensive or too controversial for Congress to
    actually approve in the end?
        Mr. FRENZEL. The reason I suggested you get a former Member
    of Congress to chair that commission is exactly that. I had
    some experience on the Pew Commission for Children in Foster
    Care where we had a lot of wonderful advocates for children who
    knew lots about the subject, but my cochairman and I were able
    to bring them back to reality, to a position where most of
    their recommendations could be passed.
        You can have the best report in the world. If you can't
    pass it, the whole thing sinks. And you can't hold these
    people's enthusiasm back, but you can give them, I hope,
    leadership that won't let the enthusiasm run away with them.
        Mr. PAULSEN. Ms. McClure, you are currently serving on a
    commission in Texas that is focused on preventing child abuse,
    and this commission has had to develop recommendations for
    State policymakers to consider and approve. What mechanisms
    does your commission have in place to actually see that the
    recommendations are adopted?
        Ms. McCLURE. A reality check. I think, as the Congressman
    just mentioned, we have to be realistic. We can put out a
    report looking at the utopia or the ultimate solutions maybe
    for 20, 30 years, but we certainly have 2-, 4-, and 6-year
    goals that are realistic, given the resources, or scarce
    resources, I should say, and the political realities of our
    State. So I agree that what the Congressman is mentioning, you
    have to have the enthusiasts at the table, the experts, but we
    need some political and economic realists there as well.
        Mr. PAULSEN. Thank you.
        Mr. Doggett is recognized for 5 minutes.
        Mr. DOGGETT. Thank you very much, Mr. Chairman.
        And I think first I want to say to Ms. Huizar, I believe
    that it was your Coalition to End Deaths that really provided
    the impetus for the original legislation that I introduced and
    was introduced in the Senate last year, and I appreciate that
    and I think you helped to craft a good measure.
        The changes that have been made in the bill since then, are
    to address some of the concerns that have been raised here
    today and also recognize the jurisdiction of the various
    committees and of this subcommittee. One of those changes
    really is designed to address precisely what Congressman
    Frenzel raised; we are not interested in just another report to
    sit on the shelf. We want some people who are actively
    involved, and so, since last year, changing it to have half of
    those appointees come from within the Congress in hoping that
    we will have people who work with the leadership here in the
    Congress, and the House, and the Senate to actually see
    something happen.
        With reference to your comments, and particularly Mr.
    Sander's comments about Title IV and Title XX, that is the
    jurisdictional basis for this Committee. It is not my intention
    as an author to tie the hands of this commission. The
    commission may well consider matters that weren't even
    mentioned in the bill last year in trying to decide how to
    fulfill its mission. But as it reports back, the focus of this
    Subcommittee is Title IV and Title XX of the Social Security
    Act. It may deal with, as it looks at these issues, some advice
    to the States that it found some practice in Minnesota, or New
    York, or Michigan that is particularly valuable for a State or
    a city to use.
        So I just wanted to make clear, while very sympathetic to
    the comments that you made, Mr. Sanders, that it was not my
    intention as we redrafted the bill to tie the hands of the
    commission or to deny it an opportunity to go wherever the
    evidence suggests. Even though its goal is to stick with a
    Title IV and Title XX, certainly our goal is to focus on
    prevention, and not just responses after this happens.
        And I think Ms. McClure has made it especially clear, the
    dollar savings we can have, which is also something all of us
    are very interested in; how can we see the most efficient use
    of our Federal and other resources to address this problem?
        Let me ask you, rather than use all of my time commenting
    on the excellent testimony that each of you gave, Ms. McClure,
    just to pick up with what the chairman was asking. From your
    work there on the Texas Blue Ribbon Task Force, which I
    understand is still a work in progress, and thinking about
    those experiences, if we have a State commission, and I am sure
    Texas is not the only State with a State commission, and there
    are a number of city commissions, what advantages do you
    believe we would gain from having a national commission to
    continue the review?
        Ms. McCLURE. Well, first off, Congressman Doggett, let me
    just point out that one of the reasons we do have a commission
    in Texas is, alluding to your earlier comments, is that our
    child fatality deaths grew by 124 percent over a 15-year period
    compared to our population growth of 19 percent. Over that same
    time frame, we went from 103 children dying from child abuse to
    281 child deaths over a period of 15 years.
        So that was the impetus for the commission, but as we
    started getting deeper, we realized, what we really do need to
    do is address the root problem. But when we looked at national
    research, all of the national Web sites, and tried to study who
    has got a good blueprint or turnkey kit, if you will, on a
    child abuse prevention strategy, there really wasn't anything.
    So we ferreted out different States' prevention plans and
    strategies, and we found about seven or eight States that had
    something in place, but what we couldn't find was outcomes from
    the implementation, nor evaluation of performance outcomes from
    these plans.
        So what I see this commission doing is really putting the
    best of the best together and formulating something that is a
    flexible model that States can implement and access, of course,
    if they desire. It can be a kind of clearinghouse for a place
    to go that will be adaptable to each State's unique needs, and
    population, and culture. So I really wish we had had something
    like this in place to go to to make our 4 years of work a bit
    easier. It will be a great resource.
        Mr. DOGGETT. My thanks to each of you. I think your
    testimony is really helpful and your ongoing participation. We
    still do have the possibility of action this year, and
    hopefully, with your input, not only to us, but to our
    colleagues in the Senate, we can get some movement and some
    action and get this underway none too soon.
        Thank you, Mr. Chairman.
        Ms. McCLURE. Thank you.
        Mr. PAULSEN. Thank you, Mr. Berg is recognized for 5
    minutes.
        Mr. BERG. Thank you, Mr. Chairman.
        I want to thank you, Chairman Paulsen, for holding this
    hearing, and certainly Mr. Camp and Mr. Doggett for being
    cosponsors. I think one good way to determine whether or not
    something coming out of this commission will be heard is when
    you have the ranking member as the sponsor of the legislation.
    So, hopefully they will be able to work through those things.
        It is really unfortunate that child abuse is a challenge
    throughout our country. We just had a situation on one of our
    reservations in North Dakota that has really brought to light
    this very serious issue. It is unfortunate because it is out
    there all the time, and then you have one situation that comes
    up, and all of a sudden, it is on everyone's mind in the State
    and all of the elected officials, and then it kind of goes
    away. So I think part of why this is important to me is it is
    obviously important to our State right now. It has been an
    alarm.
        So I am wondering if better communications from the
    different organizations involved could help move this along?
    And Ms. Huizar, I would like you to respond to whether or not
    there is a way to create a better communication process within
    the organizations.
        Ms. HUIZAR. Sure. Thank you very much, Congressman, for
    asking that question. I think there are several ways to
    approach this. One, is in terms of collecting information
    itself, one of the things that we should probably recognize is
    that NCANDS right now, the information that States turn over to
    the Federal Government in regards to these records, doesn't
    even really require turning anything over in regard to near
    fatalities. There is no field for that. And so there is a lot
    of information that just gets missed in that way.
        I think, at the local level, though, you see even
    misunderstandings about CAPTA confidentiality requirements and
    what information can be shared.
        There was some recent clarification that HHS put out to
    indicate that in child abuse fatalities, that information
    involving the child who had died, that that information could
    be shared as a part of policymaking, and the investigation to
    determine what could be done to prevent these deaths. However,
    it did not clarify whether, in fact, information on other cases
    involving that child, prior cases of abuse, or even cases
    involving other siblings in the family could be shared. And you
    can imagine that because, as Mr. Sanders pointed out, in many
    of these cases, there had been prior reports and that is a
    factor in future death, that would be a very important thing to
    know. So I think that there are some significant issues yet to
    be clarified that could be very helpful in that way.
        And finally, I would say that data systems can make that
    work easier. In our own Children's Advocacy Centers and
    multidisciplinary teams, the reason there such open information
    sharing is because we have systems in place that make that
    possible, including the use of technology in doing that. And in
    the absence of that, it is tremendously difficult for all of
    the professionals who need to share that information to do so.
    So I think there are some very practical steps we can take
    along this line that would make that job easier.
        Mr. BERG. Well, maybe you can expand on that little bit.
    You have the data sharing between groups, getting on the same
    kind of platform, so same definitions maybe for abuse, or are
    some best practices that you can say, you know, here is how
    these groups can work better.
        Ms. HUIZAR. Absolutely. Well, I would like to think that
    certainly that Children's Advocacy Centers are an excellent
    example of that multidisciplinary teamwork really coming
    together and sharing that sort of information. And what they
    have been able to demonstrate over 25 years in terms of their
    effectiveness in working in these cases, I think could be
    expanded to work in this arena as well. I think child death
    review teams are another excellent example, but their work has
    been somewhat limited. I mean, as you know, the resources that
    are actually going toward the work of those teams has have been
    very small. And so while there have been some good pilot
    projects in terms of cross sharing of information, there is a
    lot of work yet to be done, some of which will really require
    some additional resources.
        And then you also touched on a critical matter which is
    this lack of standardized definitions. I mean, this is really
    core in lots of areas where there are problems in child abuse
    reporting overall, in counting fatalities, and many other
    things. The lack of standardized definition makes it very
    difficult to get our arms around this problem, and I think if
    we can address that, it is a good first step to addressing some
    of the other matters.
        Mr. BERG. Thank you, and I yield back.
        Mr. PAULSEN. Thank you. The gentleman's time is expired.
        Mr. Reed is recognized 5 minutes.
        Mr. REED. Thank you, Mr. Chairman.
        And thank you, Mr. Doggett, for this important matter. I
    look forward to supporting it and working with you to get this
    to the finish line.
        And I appreciate the witnesses' testimony today. And I
    wanted to continue on the issue of the standardization of
    definitions. This is one thing that, as I serve on this
    subcommittee, I am very interested in trying to pursue, making
    uniform, to make consistent the different terminology and
    language and data points that are being provided to the Federal
    Government, because I see a lot of just basic miscommunication
    and inefficiency associated with that. And so when we looked in
    particular at the definition of, for example, maltreatment, it
    varies State by State. And we have had a hearing on it back in
    July of 2011, and I am interested in hearing from the panel.
    Maybe Mr. Sanders to start with, why do the States do that? And
    what are the arguments for and against having those different
    definitional standards?
        Mr. SANDERS. Thank you for the question.
        I think there are a couple of perspectives on that. One is
    the Federal Government actually gives flexibility to States in
    the definition beyond the focus on physical abuse, sexual abuse
    and neglect. And States have taken that opportunity. And one
    example is educational, young children missing school. In some
    States, that is defined as maltreatment; in other States, it is
    not. And my guess is that it emerges as a concern from the
    local community or from the State as an issue that they want to
    address and feel that should be addressed under their child
    welfare agencies. So that would be an example of maltreatment
    being defined differently from State to State.
        I think that the other piece of that is it is important for
    this issue to come to some consensus to develop consistency in
    reporting, because I think that to address this issue, there is
    going to have to be accurate measurement of how many children
    are dying due to abuse or neglect. So I think it is quite
    possible to come to that and I think that the commission really
    offers an opportunity for that to happen.
        Mr. REED. Well, I appreciate that and I join in that
    sentiment. So if I am understanding your answer correctly, you
    think primarily the difference is the basic difference between
    communities coast to coast, north to south and the different
    community needs that they are identifying in the states where
    they have different definitions.
        Are there any practical effects? Is there any funding that
    is tied to these different numbers? I am trying to see if there
    is something else that is driving this distinction, other than
    just the uniqueness of the areas of the country upon which the
    terms are being defined differently? Does anyone have anything
    to offer on that side? Is there any policy reason why they
    would be making those distinctions?
        Ms. McClure.
        Ms. McCLURE. I would just say that almost every legislative
    session in Texas, there are proposals to change the definition
    of child abuse and neglect in some way. So those definitions
    are, I think they are more culturally defined. I don't think
    that there is anything financial involved in making definition
    changes.
        But back to your point on how to standardize measures, I
    think one of the ways of looking at child maltreatment
    fatalities is not so unlike looking at homicides versus
    manslaughter. So, in other words, an intentional death of a
    father, beating a child and putting him in the oven, versus the
    mom who is depressed, asleep, and her child runs out and gets
    hit by a car, are really different types of child deaths that
    we really need to consider.
        So I would say that there are quite a few deaths due to
    neglect, but mostly they are physical abuse. And I would look
    at those very differently. I don't think it would cost the
    States much to stratify and come up with a consensus on a
    definition that would be acceptable to everyone, as long as
    they knew that the bottom line is that we are helping, trying
    to provide some tools to alleviate the problem.
        Mr. REED. That is a great point, and that leads to one last
    quick question. So do you see any barriers that we would have
    at the Federal level coming up with a common definition that we
    would have to overcome in order to implement it? Are there
    parameters that we should be focusing on in regards to defining
    that term, maltreatment? Anyone? Do you see any barriers?
        Ms. HUIZAR. Well, one thing that I would say is that your
    primary barrier may be people's just innate sense of attachment
    to what they are already doing and reluctance to change.
    Exactly, reluctance to make change. I think it is important to
    know that the CDC did a tremendous amount of work on setting up
    standardized definitions in the area of child maltreatment, and
    I think encouraging their usage might be a first good place to
    start in that regard because they certainly did very fine work.
    And it, you know, reflected a consensus of experts and others.
    So----
        Mr. REED. Good. All right.
        Well, thank you very much.
        With that, my time is expired. I yield back, Mr. Chairman.
        Mr. PAULSEN. Thank you.
        With that, I just want to thank all of the panelists and
    witnesses for taking the time to be here.
        I think, hopefully, we will be hearing from Chairman Camp
    and Mr. Doggett as they fine-tune some final changes that are
    consistent with today's testimony.
        And with that, we are adjourned.
        [Whereupon, at 3:02 p.m., the subcommittee was adjourned.]
        [Submissions for the Record follow:]

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