Remembering Their Names

Host Teresa Huizar speaks with Dr. Emily Putnam-Hornstein and Dr. Sarah Font, co-principal investigators of Lives Cut Short, about the persistent issue of child abuse fatalities and why progress in reducing these deaths has stalled. The episode delves into the emotional impact of child abuse cases, the challenges of accurate data collection, the reluctance to discuss child safety, and the need for systemic changes. They also highlight the importance of transparency and evidence-based interventions, and recommend practical steps that policymakers can take to better protect vulnerable children.

Editor's note: Dr. Font's connection during the interview was inconsistent due to a storm in her area, leading to some glitches in her audio that we worked to troubleshoot. We apologize for the lower quality. Please see transcript for clarity in Dr. Font's answers.

Time and Topic

00:00 Introduction and Episode Overview

00:30 Personal Story: The Case That Stuck

02:35 Interview with Dr. Emily Putnam-Hornstein and Dr. Sarah Font

04:14 Challenges in Child Abuse Fatality Data

08:10 State-Level Data and Reporting Issues

25:10 Policy Recommendations and Future Directions

47:44 Conclusion and Final Thoughts

Resources:

Drs. Emily Putnam-Hornstein and Sarah Font are co-principal investigators of Lives Cut Short, a join project of the University of North Carolina at Chapel Hill and the American Enterprise Institute.

Maryland recorded an alarming rise in child deaths from abuse and neglect. No one noticed; Jessica Calefati, The Baltimore Banner; February 3, 2025

One in Ten; Prediction as Prevention, with Dr. Emily Putnam-Hornstein; Season 1, Episode 7, August 5, 2019

Transcript

Teresa Huizar (TH): Hi, I'm Teresa Huizar, your host of One in Ten. In today's episode, remembering their Names. I speak with Dr. Emily Putnam-Hornstein and Dr. Sarah Font researchers and co-principal investigators. At Lives Cut short, a joint project of UNC, Chapel Hill and the American Enterprise Institute. Now, we all have that case.

You know the one I'm talking about, the one that sticks in our mind over the years, the one that jolted us out of our own complacency for the time period before we really knew anything about child abuse. And the one with the. Think about in quiet moments when we reflect on our own work and why it's so important and so vital for these kids.

For me, one of those cases is a child abuse fatality. A small boy fatally beaten his autopsy photos. I can still see in my own mind right now. Just as clear as I saw them 25 years ago for the first time. When I think about him, of course my first thought goes to his fear, his pain, his suffering. But I also think about his surviving sibling, a little boy who grew up to be a man who had to know that his mother murdered his sibling.

And I think about all the ways the community and the system failed him, failed to notice. That his mother was completely overwhelmed, failed to intervene when she expressed her anger and lack of feeling for him to social workers and failed to take his vulnerability seriously and what seemed like an otherwise good family, Danny, and of course this isn't his real name, was not alone that year.

There were 2000 other children who were fatally beaten, abused, or neglected. And every year since in those intervening 25 years, and in fact there will be approximately 2000 this year and every year far into the future, unless we take the protection of these little lives, were seriously. Why haven't we made better progress in reducing and eliminating child abuse deaths?

What would it mean to prioritize child safety and child welfare? And how do we as professionals intervene before it is too late for these little lives? I know you'll find this conversation as thought provoking as I did. Please take a listen.

Hi, Emily and Sarah. Welcome to One in Ten. 

Dr. Emily Putnam-Hornstein (EPH): Hi Teresa. Good to see you. 

Dr. Sarah Font (SF): Thanks for having us. 

TH: Good to see you. Delighted to have you. And let me tell you, I was so happy. I had no idea what you guys were working on these days. And I read the article that was in the Baltimore paper about child abuse fatalities. And I have to tell you, my first reaction to it was, thank goodness somebody's talking about this again. And the reason I felt that way is because years ago. 20 12, 20 13. Well, even leading up to it, because we were very instrumental in getting the Protect Our Kids Act passed, we were very involved in this issue.

And as you know, there was the Congressional Commission and the issue to report. And various folks have updated that report. And as far as I can tell, not one thing has happened with it. And I wanna ask you to comment on that. I'll be the person to stand, but I reread it today and I was like. Many of those are still great recommendations and it's too darn bad.

Nobody ever did any of them. So all of this to say, when I saw that two world-class researchers were not only researching this, but analyzing data, putting forth policy recommendations, I could not be more delighted. And I hope that as we talk and listeners listen. That instead of filing that away as sadly happened with the commission's report, that people take note and decide that they might actually wanna do some of this that we talk about today.

So with that and knowing that that was a little edgy, so I don't, I'm not asking you to comment on any of my little editorial right there, but I am wondering how you guys got involved in this work and so, Emily. It sort of took you to this issue around child abuse fatalities because the last time you and I talked some years ago, you were working on predictive analytics.

EPH: Yes. Well, I am still working on predictive analytics, uh, but I just wanna, uh, I appreciate your candid opening remarks, Teresa. Because I think it's something that Sarah and I also have very much observed, as have others. And what I would say there is that it feels as if it's not just, we haven't been talking about child fatalities or following through with any of the recommendations, but I think it's also been that we have stepped back from talking about child protection and child welfare agencies, and we have stopped talking about child safety.

And so one of the reasons that Sarah and I came to the table wanting to set up this project with Naomi Riley and others is we realized that one of the best ways to kind of remind the community of what is at stake is to try to remind ourselves of the lives that are lost when we have very serious abuse and neglect.

We know that only a very small subset of those child deaths are covered by the media, which is why we really are dependent upon our public agencies and federal leadership to make sure that those data are available and those stories are told. And it's been, what, almost 10 years? Um, I think since the, the kind of the first hearing of that National Commission. And so, it feels like a good time for us to really reset and refocus. 

TH: I'm gonna talk more about the website with you in a minute because one of the things I did love and that you touched on is that you have the faces and stories of the children themselves, and I think that's critical. You know, we're going to talk about numbers in a minute, and that's really important, but it's also really important not to disregard these little lives and really remember that beyond the statistics there are.

Families affected and siblings that were affected, and of course the children who were killed themselves. So Sarah, I'm wondering for people who may not be as conversant in this literature, and they may not understand much about how common this is and what the trend lines are looking at, can you just talk a little bit about this, you know.

What do we know? And I'm using that loosely because there's a whole discussion to have about how good the data is and all the, you know, its flaws and those things, but to the extent we know anything now, what do we know about child abuse fatalities? 

SF: So actually, related to how I became interested in this subject is that it's so hard to measure child safety in general.

And so, often the statistics rely on things like substantiation, which we all know to be a bad measure. And if anything is concretely notable, we should think that death is concretely measurable, and yet we still really struggle to categorize those correctly. So, in the national data from NCCAN, they tend to hover around 2,000 deaths a year, but if you look state by state, the patterns are all over the place, both within state, over time and across state, suggesting that they might not be counting the same thing at the same time in the same way. So, I think there's some concerns in recent years that death have been ticking upward, but it's really hard to be confident of anything from the NCCAN data alone.

We can get a little more of a lens from state-specific inquiry where they do more comprehensive reviews and there are states that have come out and said, yeah, our numbers are going upward, but at the national level, I think the picture is still murky. 

TH: Let's talk about, related to that, Maryland, for a second. Because one of the things I found really fascinating about the newspaper article and kind of the back and forth around that was it was pointed out that sadly these numbers were trending up in Maryland and had for a while, and that's sad and something that we should look into, obviously, right. It was the state's reaction to that that I found.

I'm just gonna say puzzling, because basically their answer was, well, that's 'cause the data is just wrong. Like, okay, well confession is good for the soul. That's good that you've let us know that that's erroneous or whatever. But I mean, to what extent do you think that the problem is. Under reporting. In other words, there are cases that should fall into this mix that for whatever reason, don't, maybe they are never identified as being a child abuse death, even though they really are.

Versus folks just either misclassifying information or. In whatever way, not using uniform definitions in a way that would allow you to have better accuracy. I guess what I'm trying to figure out is it is one thing if there are all these obstacles to having accurate data, but that that is sort of solved by policy and money if you decide to apply it and have the political will to do it versus how much of it is.

I'm not saying this about Maryland, but just in America, do we just not care enough to know what the actual answer is to the question of how many kids die every year there? 

EPH: Sarah, I'm happy to jump in with that one, but uh, you can as well. I think there's a lot wrapped up in there, so I wanna kind of break it apart a little bit, Teresa, so I do feel as if people care, um, but I also feel as if there is a resignation that these deaths are inevitable.

And that there is no point in spending much time tracking or studying them because there is very little to be learned. I think that's something where Sarah and I as researchers feel that that is absolutely not true and that there is a lot to be learned. But I think there is this sense that these are, I, I think we've heard them talked about as kind of a needle in the haystack.

There's not much to be learned and that there's also this resignation that, that there's not much to be done. I do wanna say something about Maryland specifically though, which is that yes, I, I share, and I think we communicated our surprise that the numbers had been trending upwards, that frankly, Maryland's numbers were also significantly higher than the national average.

But no one at the federal government level in Maryland or in our research community had said, why is that and is Maryland perhaps doing a better job? Accounting and capturing its deaths, and is there something to be learned from that or have Maryland made some other policy or practice changes that are leaving that many more children endangered?

And is there also something to be learned and course corrected from that? So I do find that shocking, but I just wanna kind of mention that in the face of of some of those conversations. Sarah and I actually have chatted with leadership in Maryland who I think share all of our same goals of increased transparency, improved data collection, so.

I think a part of this is just that we expect our child welfare agencies to be responsible to so many different communities for so many different outcomes that fatalities and child safety have somehow or other just been put on the back burner. And that's an opportunity for all of us to, as I said earlier, really refocus some of our efforts.

Sarah, I don't know if you, if you wanna add anything to that? 

SF: Yeah. We need to focus on child fatalities, or even serious harm to children broadly because of the concern that that might lead to an increase in foster care entry. So, there's this idea of, well, you know, we are worried about children dying, then we put more kids in foster care and that's that.

And so, I think we also have to acknowledge that discomfort with the solutions to the safety threats facing children leads us to not wanting to talk about them, which is not a great outcome. 

TH: You know, you two have put it out. Several things that I think are worth unpacking here. One, I wanna stick with the data just for a minute. To what extent are the data issues around child abuse fatalities different from the data issues that exist Just by virtue of the fact that we don't have a national system, really? We have sort of an endless variation of definitions of child abuse. The data quality varies widely. So, in other words, is this just another example of the same issue, Sarah, or is it something else?

Is there something unique about the quality or problems with child abuse, fatalities data that needs other solutions? 

SF: Yeah, I think there's a distinct problem with fatalities, which is that whereas, generally allegations of child maltreatment all go to the child welfare system or the child protection system and become part of their data system, that's not true of all child maltreatment fatalities.

So, in some states, the Child Protection Agency is the sort of primary source of that information, but in other states, we see cases that actively involve families or where their surviving, sibling go through there and the rest of those maltreatment related deaths end up in another system of child death reviews or these other kinds of things that never get reconciled.

TH: Well, that's interesting because, you know, I was aware that like medical examiners have sets of data and that those, I just remember back from, you know what now feels like a hundred years ago, I. Related to the hearings and the formation of that report there. You know, that was one of the key issues at that time, was that there's no pooling of data.

There's not been any national efforts. I'm not speaking about within any given state, but any national efforts to really make sure that all of these individual data sources somehow. Or pull together into the same data set where you can really look at solid numbers. What I'm wondering is, do you see within any states any positive variance from that?

In other words, is there a state that you would say they're doing a bang up job in terms of their data collection efforts? And Emily, I'm just gonna ask you because I can see you wanting to sort of roll your eyes, and… 

EPH: No, that was, that was not an eye roll. So, what I would say is that I can think of a number of examples where I think to myself, the state is doing something really well, but I can't necessarily think of a state that's doing all things really well.

And so I can give a a few examples. One is quite random. I was actually just looking today. At some of the numbers we've been able to gather for Lives Cut Short relative to what is reported in NCCAN’s. And I was looking at some of the Mississippi data and we know that Mississippi is a state that actually has, um, a very high rate of child maltreatment fatalities.

Relative to the nation at large. We also know that they fare less well when it comes to all sorts of child wellbeing measures, so, so perhaps that's not shocking, but I was looking more closely at the notes that Mississippi as a state submits to the feds to talk about their process or gathering that data because anytime I see a state that actually has a high number of child fatalities. I don't want to immediately assume that they're doing something wrong, as opposed to maybe they're actually doing something. Well, and I was struck by the fact that Mississippi has made some, I think, very strategic investments and decisions such that when a child fatality is called into their hotline, they have a special investigative unit.

Where they have workers that have been trained to actually investigate the circumstances related to the child fatality. So understandably, those actually may produce more deaths that are correctly classified as maltreatment fatality. So that's kind of one example on the investigation side and how that feeds into accurate classifications and potentially accurate and better data.

Also, Sarah and I were talking the other day about Pennsylvania. Pennsylvania does some things really well. I appreciate that they are, try to be quite transparent and they will put out quarterly narrative data. They are releasing more information than some other states. But we were also struck by all of the things that they were supposed to release and still haven't.

And so that was a discussion of you can have some states where perhaps legislators got it right, but we don't always have the implementation. And then I also want to highlight Arizona and Florida as to states that seem to be doing quite well on the transparency front in terms of sharing information with the communities.

Although again, not perfect on all dimensions. So, I guess that's my long-winded way of saying that there's not one state, but if our goal is to take best practices and examples and combine that into a model for what this could and should look like, I think that's totally possible. 

TH: You know, as you were talking about that, I was thinking that one of the things that's missing overall as well is, and maybe to your point about the fact that this is something that we don't seem to wanna discuss as much as we should.

It's hard to lift up examples of positive variants if you don't wanna talk about it. You know, or if you're busily talking around it or about other things, but not about child abuse fatalities themselves. And to what extent, just that reluctance is also meaning that people are not learning from their peers about what works and what doesn't and those kinds of things.

I'm just sort of curious about that. But one of the things that I just kind of wanna dive into a little bit is this idea that child welfare seems to be focused on other things, but not necessarily child safety, not necessarily these kids who are most eminently at risk of dying from abuse and neglect.

And I'm curious, and I wanna hear from you both, and maybe Sarah, we'll start with you. Why do you think that is? Why is there this reluctance to talk about these kids who are most critically at risk? 

SF: I think because it's very hard to do so in a way that does get characterized as blaming or stigmatizing. And so, I think there's been a real effort to move towards strength, strength-based practice focusing on, you know, avoiding formal child welfare care information, not labeling parents, as perpetrators of maltreatment. I can see all of the good reasons for that. And yet, it means that at the end of the day, you cannot identify which kids are safe, which kids have been victimized, and which kids haven't, because we're not looking at it in that way anymore.

TH: Emily, is there anything you would like to add to that in terms of why you think there's this, you know, reluctant, well, is it reluctance or is it just a change of subject? You know what I mean? I, I sort of feel like the pendulum shifts in child welfare periodically. The thing that was super important one moment isn't anymore.

You know what I mean? And there are good reasons for those shifts, so I'm not denigrating that. But that's a different thing qualitatively than a feeling like you are sort of purposely trying to avoid talking about something because it could bring up other things that you view as problematic. 

EPH: The pendulum definitely shifts. Although it's been interesting, Teresa, I've, I've asked a few colleagues, I'm like, is this a more dramatic kind of shift than you've seen in the past? And I've definitely had some folks I trust who are like, yes, this last period is quite unlike anything that they recall. I, I, I think the one thing I just wanna say is that a part of it is this natural tension that has always existed within child welfare.

It is very challenging for us to create a system where there is the dual role of both protecting children and helping families. And I think that the field has been somewhat bifurcated when it comes to whether the right answer. Is to equip the system that is and should be, in my opinion, focused almost entirely on child safety.

Which has incredible power on behalf of the state because it is the system that can actually remove one's children. I think that the field has been split because there are a lot of folks who want it to be more of a warm, fuzzy helping system. They want to attach more of our public benefits to involvement with that system because these are very vulnerable families.

I think where Sarah and I kind of depart from some of our colleagues who I hold great respect for is I just don't think that that is a tenable arrangement. And I think that as much as we message that one system can do both of those things, we will continue to put our workforce in an incredibly difficult and challenging position.

But I think that the emphasis has been on helping and financial resources and concrete supports and, and. By its very nature, if that's what you're emphasizing, then you're not simultaneously talking about child safety. 

TH: I'm also wondering, what role do you think that the age of the children themselves play into this conversation?

I mean, we know that the children most likely to be fatally abused or neglected are very young, you know, under the age of three. And so I, I mean, I wonder to what extent that what you're talking about now, this like provision of benefits and other things that doesn't really sound necessarily tailored to addressing issues of critical safety with infants and toddlers necessarily.

And so, I'm just curious, you know, and Sarah, Emily, just whoever wants to weigh in on that, in this case. What are your thoughts about this sort of unique population that we're talking about and their unique vulnerability? 

SF: Yeah, so one thing I didn't mention before related to this issue of trying to move away from things that think stigmatizing is really about the incredible threat that parental addiction can pose to infants and young children.

There's a real hesitance to treat that as a safety concern because it's also a medical condition. And we, you know, say, move into this sort of disease model or harm reduction. There's a real concern about identifying that as a threat to child safety, that it is. So we, we can see, um, in the records that we collected, just how pervasive issues rock substance use are in child fatality.

Children, you know, smothered in sleep-related instances when the parents intoxicated, getting it into their parents' drug supply children who are often already medically fragile because of prenatal substance exposure and being born premature. So yeah, I think that's a huge part of the story is that we're kind of ignoring this really vulnerable young child population where it's mostly an issue of substance abuse and addiction.

TH: You know, this reminds me of other conversations I've had with other folks who've come onto the program to talk about neglect, because you know, you can imagine that overwhelming burden on child welfare. That neglect is that substance abuse is really wrapped up in that. And the fact that we have completely inadequate systems to respond to that in this country.

It's hard to get treatment. It's hard to get treatment repeatedly. All of that really drives a lot of harm for kids. Just overall, I mean, no matter how you characterize substance use and abuse, the fact that a caregiver even who wants treatment is going to struggle to get it, is problematic I think, in terms of child safety.

So, you know, one of the things that I was thinking about as I was looking through all of the materials that you have on the website is that you have some, I would say, very practical suggestions about. The way in which it would be possible to bring these stories to light more and in a way that's actionable.

Emily could talk a little bit about just sort of the recommendations that you had that just your own analysis turned up, that you're like, you know what, if we could do these things, perhaps we could get policymaker attention enough. Perhaps we could get the public's attention enough to take action. 

EPH: Yeah. I think where my head goes, Teresa, and it's partly because I do believe that the public cares deeply about child safety. I was talking to someone the other day and I was like, you know, we just need to remind people this is an 80-20 issue. There have been some very loud. Activist voices calling for abolition.

But if you look at some of the incredible Harris polling data that was recently gathered, like the American public very much understands that there is an important role for child protection and child welfare and cares about child safety. And so the natural extension of that is that. I think we need to make sure more of this information makes it out to the public and to the local communities.

We talk all the time about wanting to keep child welfare and accountability for child welfare in the community, but I think the nature of what is being released really prevents that from happening. If an agency. Releases data about what may be a real cluster of child fatalities that happened, perhaps related to substance use.

Perhaps because we didn't have enough resources in the community, perhaps because our threshold for intervening was wrong, and it's five years ago. It becomes, first of all, the media's not gonna be interested. And secondly, it becomes far too easy for us to all let ourselves off the hook and say, that was, then things are better.

So, I think that one of the most important things we can do is to push for much greater transparency and release of information to local communities who will help to make sure that their child welfare agency is being responsive to the children in the community. And I wanna add just one other thing, which is that.

I think there is an assumption that child welfare agency leaders somehow want to keep this information hidden and are shielding the public with the inappropriate use of confidentiality laws or concerned. Maybe that's true in some situations, but I actually believe it's just that you get a ton of lawyers.

Getting involved and there hasn't been necessarily strong federal guidance and people get confused. And so the kind of natural tendency is to always keep things kind of secret and hidden as opposed to putting them out there. So I actually think that if we can just be clear that this is expected and that this is okay, and this is welcomed, I think you would see many more agencies willingly stepping up to release this information to the public, because I actually think it allows them to make the case for what they are or aren't doing, and to advocate for some of those resources that you mentioned much more effectively. 

TH: Well, from your lips to God's ears, because I would love to see them releasing some information at a time, it can actually be useful. You know, it is true that we shouldn't let ourselves off the hook.

If kids have been dying at a rate of about 2000 a year that we know of for decades, then I don't think five years ago data is actually obsolete. But at the same time, I think people feel more motivated when they're learning about something in real time and feel like there's something that they can do now about that.

One of the things that I was also thinking about as you were talking about child welfare leaders is that in the US there's this tendency, and it was true in 2012, and it's true today, that when you have a child abuse fatality, what happens is, especially if it had prior CPS involvement, is that everybody learns that they're outraged.

That there were a report, two reports, three reports, five reports, whatever it is to child welfare, the child dies. And the director gets fired and then it starts all over again. And so I'm just wondering, I mean, it's a strange dynamic in which we seem to have groundhog Day every day when it comes to child's abuse fatalities.

First of all, do you feel. Sarah weigh in here. Do you feel that that's changing at all? That we're actually beginning to learn from our mistakes and that we are setting systems in place that if we know that no, not every child who dies is system involved, but lots are so because of that, maybe we should set up flagging mechanisms that when kids are being repeatedly reported for low level things, that we don't just ignore it and treat it like.

It's an isolated incident every single time it happens, or do you feel like we're still in that place where, because maybe we have lost hope about, or feel resigned about it always happening. It's just sort of easier to scapegoat somebody and move on.

SF: I can't say that I feel super optimistic and I have a lot of dignity for the agency.

I think they get yelled at when they don't intervene and something bad happens, they get yelled at. If they intervene before something really bad happens. Maybe they didn't need to do that. Right? And so they're really in a no-win situation when it comes to how they balance, um, how the media covers things, how advocacy groups, you know, what they put out about it.

So, I think there's a problem of really bad incentives here too, which is that when you look at the states that had really high reported child fatality counts which is likely because of just better counting, it's like, oh, they're doing the worst. And so, there's really not a strong incentive to do a better job counting if it just makes you look worse and people aren't necessarily going to understand what's behind the scenes there.

TH: I think that's a really valid point, especially depending on how incentives get created. Right. And especially for those most high profile roles in which the absolute last thing you want is media attention. 'cause it's always gonna be negative, you know, like when was the last time you read a great expose on the wonderful activities of a child welfare leader?

I wish that would happen, but it doesn't really happen very much. What do you think that policy makers. Don't know or are confused about or have locked themselves onto a myth that is really unhelpful when it comes to child abuse fatalities. Emily, do you have any thoughts about that?

EPH: Sarah should take herself off mute. She may have have thoughts. It's funny because I, I didn't know you were going to necessarily attach it to the fatality piece, so of course Teresa, the first place my head went was, well, policymakers I think have increasingly become convinced that the child welfare system is regularly misunderstanding and calling what is nothing more than poverty, neglect.

And I think that is. A very problematic and just incredibly incorrect message. I guess Sarah, what I'm thinking about is we totally recognize that the way in which we are gathering data for lives cut short, which is heavily dependent upon media coverage, means that we may be presenting a somewhat biased and distorted picture of all the children who die of fatalities, because the cases that are the most likely to receive media coverage are those where they are.

Egregious abuse or torture deaths and adult is arrested so often we still won't even know the name of the child victim, but there will be media coverage because an adult has been identified and arrested. As we start to dive into some of the medical examiner records that we have been able to gain access to from counties, Sarah and I have been just incredibly struck by the number of.

Deaths where it's acute methamphetamine exposure coded as an accident for a 2-year-old. And so I think we've just been really struck by the extent to which the public is not paying attention to some of those substance related deaths. After birth and during the early childhood years, and of course when Sarah and I look at those deaths, we have no idea was child welfare involved or not.

We don't know whether they are being counted in the official NCAS numbers, but my strong suspicion is that in a very significant number of them, they are not. And that's partly something that you alluded to early on, which is the. The Miscategorizing and misclassification. So often these deaths are coded as accidents are undetermined, which means we're not necessarily getting a homicide classification or an investigation by child protection.

TH: It's interesting as you were talking, because I was thinking about the daycare case in, gosh, where was it? The Bronx maybe, but the one where the kid was exposed to Fentanyl and because it was hidden somewhere, somehow this child, small child wound up happening onto it and was fatally exposed to it and they just convicted.

I don't know if it was the brother's spouse of the daycare owner and the daycare owner themselves who had been hiding it, if you can believe it, in a family run daycare, which contributed to the exposure and to your point, that got a lot of attention. I don't know that people stop and think those cases are not primarily happening in daycares, right?

They're happening in homes. That is where kids are having this drug exposure that may lead to an accidental fatal overdose for them when they happen onto a pill or even touch something that's so potent and so powerful, especially for a little one. So, you know, you started talking about neglect for a minute and I kind of wanna touch on that just for a second because I do think that there is an intersection here that when the media reports cases, you're right, a lot of it's child torture or it's a child who's been, who has abusive head trauma or something like that.

When we think about child abuse fatalities, and I don't think that the general public really realizes what percentage of those are. Are neglect cases essentially that have a child has been neglected to death. And I'm wondering because to your point, there's first of all, kind of this feeling that neglect cases are not real.

That's pervading things, not just around poverty, but just in general. It's sort of like. This is something else. It's not something that's so serious. And I'm wondering, since these neglect cases, in fact, do make up the majority of child fatalities from abuse and maltreatment and neglect, is that another reason that you think that people, I'm not gonna say they poo pooh it, but are reluctant to pick it up, are reluctant to talk about it.

Treating it like it's something that we don't really want to necessarily dive into because then we have to talk about neglect generally. Then we have to talk about what is neglect and what are the standards in which, irrespective of substance abuse, dv, serious mental illness, all the things that we know are co the cocktail that make up the category of what gets captured by neglect. We have to start talking about all of those things. 

EPH: I think one of the reasons I think you're right, and I also think that we need to be honest about the extent to which we do not have strong evidence-based interventions to deal with many of the conditions that give rise to our neglect cases. Arguably, it is much easier to take a father who is using excessive corporal punishment with a 10-year-old and figure out how to try to intervene there than it is to figure out what to do with a young mother with a newborn who is in the throes of a fentanyl addiction and has had two other children removed from her custody. I think that is a very real part of it.

It's, you know, not to take us down a completely different path, but I feel like it can't not be discussed, which is that related to everything that's been happening over the last period of this pendulum swing. Of course, a large part of that is the. Passage of the Family First Prevention Services Act in 2018, and this desire and belief that children were ending up in foster care.

'cause that was the only place where the federal government was providing kind of support to the states. And so that became the easy intervention as opposed to theoretically all that could have been done within home services. And I think one of the reasons that legislation has been very difficult for states to implement is that we just don't have that many in evidence-based intervention.

I know we, we talk about the lack of what's on the clearing house, but it really is fascinating. Just as an aside, I was looking the other day at some of the programs that had been reviewed. And there just aren't that many substance abuse programs on there. But what do we have? We actually have a program that is deemed promising related to adult eating disorders and bulimia.

Now, how that was ever reviewed, but I just point that out because I feel like we're spinning our wheel and we just need to be honest about the fact that severe mental illness and substance use are painful, real. Kind of medical disorders where when we have very young children and we have adults that are struggling with those, unfortunately one of the only interventions we may have is foster care and a removal.

SF: Just one thing to add to that, child welfare really doesn't want to stay involved with families long term. And the thing that we know about substance use and mental illness is that the probability of that being a recurring issue is very high. And so, I think a lot of times these families that are reported multiple times, like what you think about child welfare, you know, they monitor maybe for a few months and they're like, okay, we're good now. Right? And that's just not realistic. And I think we really have to let go of that as a model. 

TH:I'm wondering what you both thought, because when the 2023 Child Maltreatment numbers came out, and especially the helpful brief that I think the University of New Hampshire put out that. They've been doing this for a while.

That sort of looks at rates over a 40 year period, so I wanna kind of hang up in the neglect on the child fatality lines here for a second. I have to say, when I saw the drop in neglect and I saw the increase in child abuse fatalities, I wondered what the relationship was between those two things, and here's why I wondered because.

I wonder to what extent that drop in neglect because we're overwhelmed with neglect cases because as you're saying, we don't have resources or don't choose to use our resources in a way that provides the level of substance abuse, evidence supported substance abuse treatment and treat for mental health as long as people would need it to really sustain them and their families.

Are we just sort of. Defining a way, neglect in a way that is making the world a riskier place for these most vulnerable kids. And as we continue to go, that's not neglect. That's something else. This isn't neglect. It's something else should we expect to see. And a continued uptick in child abuse fatalities.

SF: I don't know. I do think that despite some promising sites in terms of reduced adult overdose deaths in Fentanyl, that seems to largely be because fentanyl has become less potent, which doesn't necessarily mean fewer people addicted. So, I think we in the long term, are gonna continue to be at high levels of fatalities and serious neglect to young children until we have a real handle on the addiction crisis.

EPH: I just add one thing. So Teresa, when I looked at that data, it's interesting, I didn't immediately say, okay, we're just defining a way neglect, although maybe we are. What I saw was, oh, this is what happens when we say we're going to pursue plans of safe care for substance exposed infants. But nobody actually owns the implementation and coordination and oversight of services for young mothers because as our conversation started, we know that overwhelming numbers of children who do die of abuse and neglect are very, very young.

And so any policy or practice change that is entirely focused on our very youngest children. With mothers who may be struggling with addiction. I mean, that's the kind of space where I would immediately expect there to be fairly immediate and detectable changes in safety measures, including fatalities.

TH: Interesting. So I'm just wondering, as we've been talking, if you could just wave your magic wand and have policymakers go, you know what? I've listened to this. We're gonna do better. What would be your sort of top recommendations? What's top on your wishlist? Maybe three things that you're just like, if they would just do these things, it wouldn't be perfect, but it would certainly be a vast improvement. So, Sarah, let's start with you. What are your three policymaker wishes? 

SF: So one would be for each state to have a single source or agency that is responsible for all child maltreatment and reporting, fatality reporting, instead of having it siloed into different buckets. The second related to that would be to improve the way we fund or resource autopsy processes because one of the things that leads to these really long delays is pending autopsy reports.

And in some of the states that do issue reports, they're waiting for autopsy reports for six to nine months, and that is really just not going to help the data be actionable. The third thing I think would be to require that states use multiple sources of information to try to detect all possible maltreatment fatalities, because one of the things that we found is when we cross reference media, state issued fatality summaries, um, medical examiner records, each source is providing cases that aren’t in either other source.

We're almost always missing something if we rely on a single source 

TH: And, Emily?

EPH: So, Sarah presented some fabulous ones, all of which I strongly endorse. If any policy makers are out listening, I'm going to. Offer up three that are not directly related to child maltreatment fatalities, but I believe would all be incredibly important if our goal is to prevent more of those and improve child safety.

So the first is that, and this ties back to my early podcast, Teresa, I, I would love to see people demanding an audit of the risk and safety tools that we are currently asking child welfare workers to use, because I think that the availability of data and technology today allow for so much more than that, that I think the minute people took a closer look at what was.

Being used versus what was available, they would shift gears and I really think that would help our workforce, and I think that would help families and I think it would improve child safety. The second, and related to that is that I would love to see much greater investments in training and paying our child welfare workers, particularly those who are conducting front end investigations.

I think it's just so incredibly important and it's important for child safety, and it's important to make sure we don't make mistakes, because obviously I care a ton about family integrity as well. And then the final piece is I'm amazed at how. Much data we have, but how little we understand what the navigation of services in the community really looks like for families.

I think we need to hold ourselves much more accountable for that. I understand why public agencies will often contract out, but the extent to which my colleagues working in public agencies are struggling to gain access to information that would allow them to even understand whether the contracted provider is visiting.

Or connecting the family or following up on stuff. That's really critical and I think there needs to be a lot more focus on that. So that's, those would be my three. 

TH: Well, I think they're all excellent and I second them and even if policymakers don't hear this, I think plenty of child abuse professionals who talk to policymakers do. So. I hope that people will make a difference where they are and with the means they have on this. And I also think, as you were talking, I was like, there's a whole other podcast episode that would be great on technology. And it's possible uses in child welfare because it is just so far behind. You know, honestly, there's so much that we could learn even from the vast treasure trove of sad cases that exist and patterns of behavior and everything else.

If we could actually dive into that. Emily and Sarah, it's been a true pleasure to talk with you. I'm so grateful for the work you're doing on this. I think it’s such an incredibly important issue that doesn't get enough attention, and I hope that it'll continue to garner media attention and the attention of policy makers and come back anytime.

SF: Thank you. 

EPH: Thanks so much for navigating the conversation too around this topic, so we appreciate it.

TH: Thanks for listening to One in Ten. If you like this episode, please share it with a friend or colleague and join us at NCAforCACs on YouTube if you'd like to watch the conversation for more information about this episode. Or any of our other ones, please visit our podcast website at oneintenpodcast.org.