[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
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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.
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From the Committee homepage, http://waysandmeans.house.gov, select
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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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