Chapter 2
Detecting, Measuring, and Preventing Child Abuse

Incidence and Prevalence of Child Maltreatment
Collecting Child Maltreatment Data
Victims of Maltreatment
Perpetrators of Child Maltreatment
Reporting Child Abuse
Controversies Surrounding the CPS System

Incidence and Prevalence of Child Maltreatment

Statistics on child abuse are difficult to interpret and compare because there is little consistency in how information is collected. The definitions of abuse vary from study to study, as do the methods of counting incidents of abuse. Some methods count only reported cases of abuse. Some statistics are based on estimates projected from a small study, whereas others are based on interviews.

Researchers use two terms— incidence and prevalence — to describe the estimates of the number of victims of child abuse and neglect. Andrea J. Sedlak and Diane D. Broadhurst, in the Third National Incidence Study of Child Abuse and Neglect (NIS-3 ; 1993, http://www.childwelfare.gov/systemwide/statistics/nis.cfm#n3), define incidence as the number of new cases occurring in the population during a given period. The incidence of child maltreatment is measured in terms of incidence rate: the number of children per one thousand children in the U.S. population who are maltreated annually. Surveys based on official reports by child protective services (CPS) agencies and community professionals are a major source of incidence data. (The term child protective services refers to the services provided by an agency authorized to act on behalf of a child when his or her parents are unable or unwilling to do so. This term is also often used to refer to the agency itself.)

Prevalence, as defined by Sedlak and Broadhurst, refers to the total number of child maltreatment cases in the population at a given time. Some researchers use lifetime prevalence to denote the number of people who have experienced child maltreatment at least once in their life. To measure the prevalence of child maltreatment, researchers use self-reported surveys of parents and child victims. Examples of self-reported surveys are the landmark 1975 National Family Violence Survey and the 1985 National Family Violence Resurvey conducted by Murray A. Straus and Richard J. Gelles.

Studies based on official reports depend on a number of things happening before an incident of abuse is recorded. The victim must be seen by people outside the home, and these people must recognize that the child has been abused. Once they have recognized this fact, they must then decide to report the abuse and find out where to report it. Once CPS receives and screens the report for appropriateness, it can then take action.

For the data to become publicly available, CPS must keep records of its cases and then pass them on to a national group that collects these statistics. Consequently, final reported statistics are understated estimates—they are valuable as indicators but not definitive findings. Because of the hidden nature of child abuse, it is unlikely that statistics that accurately reflect the true scope of maltreatment will ever be available.

Collecting Child Maltreatment Data

The 1974 Child Abuse Prevention and Treatment Act (CAPTA) created the National Center on Child Abuse and Neglect (NCCAN) to coordinate nationwide efforts to protect children from maltreatment. As part of the former U.S. Department of Health, Education, and Welfare, NCCAN commissioned the American Humane Association to collect data from the states.

In 1985 the federal government stopped funding data collection on child maltreatment. In 1986 the National Committee to Prevent Child Abuse (NCPCA; now called Prevent Child Abuse America) picked up where the government left off. The NCPCA started collecting detailed information from the states on the number of children abused, the characteristics of child abuse, the number of child abuse deaths, and the changes in the funding and extent of child welfare services.

In 1988 the Child Abuse Prevention, Adoption, and Family Services Act replaced the 1974 CAPTA. The new law mandated that NCCAN, as part of the U.S. Department of Health and Human Services (HHS), establish a national data collection program on child maltreatment. In 1990 the National Child Abuse and Neglect Data System (NCANDS), which was designed to fulfill this mandate, began collecting and analyzing child maltreatment data from CPS agencies in the fifty states and the District of Columbia. NCANDS has since conducted the Child Maltreatment survey annually. The most recent survey as of August 2008 was Child Maltreatment 2006 (2008, http://www.acf.hhs.gov/programs/cb/pubs/cm06/cm06.pdf), which was published by the Administration for Children, Youth, and Families (ACYF).

The data collected from states are not completely reliable because each state has its own method of gathering and classifying the information. Most states collect data on an incident basis; that is, they count each time a child is reported for abuse or neglect. If the same child is reported several times in one year, each incident is counted. Consequently, the reported number of incidents of child maltreatment may be greater than the reported number of maltreated children that CPS is aware of.

As part of the 1974 CAPTA, Congress also mandated NCCAN to conduct a periodic National Incidence Study of Child Abuse and Neglect (NIS). Data on maltreated children are collected not only from CPS agencies but also from professionals in community agencies, such as law enforcement, public health, juvenile probation, mental health, and voluntary social services, as well as from hospitals, schools, and day care centers. The NIS is the single most comprehensive source of information about the incidence of child maltreatment in the United States, because it analyzes the characteristics of child abuse and neglect that are known to community-based professionals, including those characteristics not reported to CPS. The most recent study is NIS-3. This report is based on a nationally representative sample of more than 5,600 professionals in 842 agencies serving 42 counties. NIS-3 includes not only child victims investigated by CPS agencies but also children seen by community institutions (such as day care centers, schools, and hospitals) and other investigating agencies (such as public health departments, police, and courts). In addition, victim counts were unduplicated, which means that each child was counted only once. Data collection for NIS-4 began in 2004; reports were scheduled to be published beginning in late 2008.

Definition Standards

NIS-3 uses two standardized definitions of abuse and neglect:

• Harm Standard—requires that an act or omission must have resulted in demonstrable harm to be considered as abuse or neglect
• Endangerment Standard—allows children who had not yet been harmed by maltreatment to be counted in the estimates of maltreated children if a non-CPS professional considered them to be at risk of harm or if their maltreatment was substantiated or indicated in a CPS investigation

Victims of Maltreatment

Rates of Victimization

CPS DATA. According to the ACYF, in Child Maltreatment 2006, in 2006 CPS agencies received an estimated 3.3 million referrals, or reports, alleging the maltreatment of about 6 million children, which may include some children who were reported and counted more than once. States may differ in the rates of child maltreatment reported. States differ not only in definitions of maltreatment but also in the methods of counting reports of abuse. Some states count reports based on the number of incidents or the number of families involved, rather than on the number of children allegedly abused. Other states count all reports to CPS, whereas others count only investigated reports.

NCANDS explains that in 2006 forty states, Puerto Rico, and the District of Columbia submitted child-level data for each report of alleged maltreatment. Child-level data include, among other things, the demographics about the children and the perpetrators, types of maltreatment, and dispositions (findings after investigation or assessment of the case). Another nine states reported more general maltreatment data. CPS agencies screened in (accepted for further assessment or investigation) 2 million (61.7%) referrals out of a total of 3.3 million referrals. Overall, the rate of maltreatment referrals (whether accepted for further investigation or not) ranged from 20.9 per 1,000 children in Arizona to 128 per 1,000 children in West Virginia. (See Table 2.1.)

In 2006 an estimated 885,245 children were victims of maltreatment in the United States. (See Table 2.2.) Even though the rate of investigations (dispositions) per 1,000 children rose from 43.8 in 2002 to 47.8 in 2006, the rate of victimization actually fell from 12.3 per 1,000 children in 2002 to 12.1 in 2006. (See Figure 2.1.)

Table 2.2 shows the types of maltreatment children suffered in 2006. In that year, 567,787 of the 885,245 children found maltreated by CPS agencies had suffered neglect. Another 19,180 suffered medical neglect. In other words, 66.3% of all children found to be maltreated by CPS agencies in 2006 were victims of neglect or medical neglect. Another 142,041 (16%) children were victims of physical abuse, 78,120 (8.8%) children were victims of sexual abuse, 58,577 (6.6%) children were victims of emotional, or psychological, maltreatment, and another 133,978 (15.1%) children experienced other types of maltreatment,

including abandonment, congenital drug addiction, and threats to harm them. Some children were victims of more than one type of maltreatment.

CPS statistics indicate that child physical and sexual abuse declined in the 1990s. In “Child Maltreatment Trends in the 1990s: Why Does Neglect Differ from Sexual and Physical Abuse?” (Child Maltreatment, vol. 11, no. 2, 2006), Lisa M. Jones, David Finkelhor, and Stephanie Halter of the University of New Hampshire use corroborating evidence to argue that there is evidence for a real decline in child abuse, not only a decline in reported cases. For example, the National Crime Victimization Survey shows a large decline in sexual assaults against teenagers; the Minnesota Student Survey of Children shows a 22% decline in sexual abuse between 1992 and

2001 and a 12% decline in physical abuse during the same period; and many social problems with recognized connections to child maltreatment have declined, including runaways, teen pregnancy, and adolescent suicide. Jones, Finkelhor, and Halter state that all these declines indicate a “general improvement in the well-being of children across the United States.” Rates of child neglect, however, did not decline over the period. Figure 2.1 shows that rates of child maltreatment fluctuated somewhat from year to year in the early 2000s, but remained fairly steady between 2002 and 2006.

NIS DATA. The NIS, while providing older data, gives a clearer picture of the incidence of child maltreatment because it collects data not just from CPS agencies but also from other community professionals. In 1996, under the Harm Standard, nearly 1.6 million children were victims of maltreatment, a 67% increase from the Second National Incidence Study of Child Abuse and Neglect (NIS-2 ; 1986) estimate (931,000 children) and a 149% increase from the First National Incidence Study of Child Abuse and Neglect (1980) estimate (625,100 children). (See Table 2.3.) Significant increases occurred for all types

of abuse and neglect, as compared to the two earlier NIS surveys. The 1.6 million child victims of maltreatment in 1993 reflected a yearly incidence rate of 23.1 per 1,000 children under age eighteen.

In 1993, under the Endangerment Standard, more than 2.8 million children experienced some type of maltreatment. (See Table 2.4.) This figure doubled the NIS-2 estimate of 1.4 million. As with the Harm Standard, marked increases occurred for all types of abuse and neglect. The incidence rate was 41.9 per 1,000 children under age eighteen.

Gender of Victims

CPS DATA. In 2006 CPS agencies found a higher rate of child maltreatment among girls (12.7 cases per 1,000 children) than among boys (11.4 cases per 1,000 children).

(See Table 2.5.) About 48.2% of maltreated children were boys and 51.5% were girls.

NIS DATA. NIS data allow comparisons of types of maltreatment suffered by boys and girls. Under both the Harm and Endangerment Standards of NIS-3, more females were subjected to maltreatment than males. Females were sexually abused about three times more often than males.

Males, however, were more likely to experience physical and emotional neglect under the Endangerment Standard. Under both standards, males suffered more physical and emotional neglect, whereas females suffered more educational neglect. (See Table 2.6 and Table 2.7.) Males were at a somewhat greater risk of serious injury and death than females.

Age of Victims

CPS DATA. Younger children represented most of the maltreated victims among CPS agencies in 2006. Older children are less likely to be victimized than younger children. The victimization rate for infants was 24.4 per 1,000 children. (See Figure 2.2.) The rate then dropped to 14.2 per 1,000 toddlers aged one to three and 13.5 per 1,000 children aged four to seven. The rate then dropped again to 10.8 per 1,000 children aged eight to eleven and 10.2 per 1,000 children aged twelve to fifteen. Teens aged sixteen and seventeen had the lowest rate, at 6.3 per 1,000.

Children of different ages suffered different types of maltreatment in 2006. Nearly three-quarters of the youngest children under age three suffered from neglect (72.2% of infants and 72.9% of children aged one to three), whereas only a little more than half (55%) of those aged sixteen and older did. (See Table 2.8.) By contrast, 14.3% of infants under age one and 10.8% of toddlers aged one to three suffered physical abuse and 0.4% of infants and 2.6% of toddlers suffered sexual abuse, whereas 22% of maltreated children aged sixteen and older suffered physical abuse and 16.1% suffered sexual abuse.

NIS DATA. Sedlak and Broadhurst find in NIS-3 alow incidence of maltreatment in younger children, particularly among those under age five. This may be because, before reaching school age, children are less observable to community professionals, especially educators—the group most likely to report suspected maltreatment. The researchers explain that there was a disproportionate increase in the incidence of maltreatment among children as they reached ages six through fourteen. (See Figure 2.3 and Figure 2.4.) Sedlak and Broadhurst note that the incidence of maltreatment among children older than age fourteen decreased. Older children are more likely to escape if the abuse becomes more prevalent or severe. They are also more able to defend themselves and/or fight back.

Under the Harm Standard only ten per one thousand children in the zero-to-two age group experienced overall maltreatment. (See Figure 2.3.) The numbers were significantly higher for children aged six to seventeen. Under the Endangerment Standard twenty-six per one thousand children aged zero to two were subjected to overall maltreatment. (See Figure 2.4.) A slightly higher number of children (thirty-three per one thousand children) in the oldest age group (fifteen- to seventeen-years-old) suffered maltreatment of some type. As with the Harm Standard, children between the ages of six and fourteen had a higher incidence of maltreatment.

Race and Ethnicity of Victims

CPS DATA. In 2006 rates of child maltreatment as recorded by CPS agencies were highest among African-American children (19.8 per 1,000 children) and lowest among Asian-American children (2.5 per 1,000 children). (See Figure 2.5.) Pacific Islanders had a rate of 14.3 per 1,000 children, Native American and Alaskan Native children had a rate of 15.9 per 1,000 children, Hispanics had a rate of 10.8 per 1,000 children, and whites had a rate of 10.7 per 1,000 children.

WHY ARE MINORITY CHILDREN OVERREPRESENTED IN CPS DATA? In Children of Color in the Child Welfare System: Perspectives from the Child Welfare Community (2003, http://www.childwelfare.gov/pubs/otherpubs/children/index.cfm), Susan Chibnall et al. explore the attitudes and perceptions of CPS personnel regarding the overrepresentation of minority children, particularly African-American children, in the child welfare system. According to the researchers, even though African-American children make up 15% of all children in the United States, they represent 25% of substantiated maltreatment victims. In addition, these children account for 45% of all children in foster care.

Chibnall et al. studied nine child welfare agencies across the country. They interviewed agency administrators, supervisors, and caseworkers. The child welfare personnel gave a variety of reasons minority children are overrepresented in the child welfare system, including:

• Poverty and poverty-related issues—child welfare personnel thought that African-American families are more likely than other ethnic and racial groups to be poor, leaving them more vulnerable to social problems such as child maltreatment, domestic violence, and substance abuse. Moreover, these families typically live in areas lacking resources where they can go for assistance.
• Visibility—poor families are more likely to use public services, such as public health care, making them more visible to mandated reporters when they are experiencing problems, including child abuse and neglect.
• Overreporting—many study participants proposed that, because poor families are more visible to mandated reporters such as doctors and nurses, they are more likely to be reported to CPS.
• Worker bias—when investigating particular families, some caseworkers may not understand the cultural norms and practices of minorities; this may influence their decisions at different stages of child welfare services, including child maltreatment reporting, investigation, substantiation, and the child's removal from home and placement in foster care. A caseworker's bias may also make it more likely, for example, that he or she would remove an African-American child than a white child from a comparable home environment.

In African American Children in Foster Care: Additional HHS Assistance Needed to Reduce the Proportion in Care (July 2007, http://www.gao.gov/new.items/d07816.pdf), the U.S. Government Accountability Office (GAO) backs up Chibnall et al.'s study by finding several factors that contribute to the disproportionate number of African-American children in foster care. These factors include higher rates of poverty in the African-American community, the difficulty African-American families face in accessing support services to help prevent the removal of their children, and racial bias and misunderstandings among child welfare workers.

NIS DATA. Sedlak and Broadhurst find in NIS-3 no significant differences in race in the incidence of maltreatment. The researchers note that this finding may be somewhat surprising, considering the overrepresentation of African-American children in the child welfare population and in those served by public agencies. They attribute this lack of race-related difference in maltreatment incidence to the broader range of children identified by NIS-3, compared to the smaller number investigated by public agencies and the even smaller number receiving CPS and other welfare services. NIS-2 had also not found any disproportionate differences in race in relation to maltreatment incidence.

Children with Disabilities Are Particularly at Risk

According to the article “Assessment of Maltreatment of Children with Disabilities” (Pediatrics, vol. 108, no. 2, August 2001), children with disabilities are potentially at risk for maltreatment because society generally treats them as different and less valuable, thus possibly tolerating violence against them. Some parents may feel disappointment at not having a “normal” child. Others may expect too much and feel frustrated if the child does not live up to their expectations. These children require special care and attention, and parents may not have the social support to help ease stressful situations. Caring for children with disabilities can also be expensive, creating even more stress and with it risk of maltreatment. In addition, some disabled children may not be able to distinguish between appropriate and inappropriate touching of their body, leaving them particularly vulnerable to sexual abuse.

In “Violence against Children with Disabilities: Prevention, Public Policy, and Research Implications” (Dorothy K. Marge, ed., A Call to Action: Ending Crimes of Violence against Children and Adults with Disabilities—A Report to the Nation, 2003), Patricia M. Sullivan calls attention to the fact that the federal government does not collect specific data on children with disabilities in its crime statistics systems or in national incidence studies mandated by law. Even though CAPTA required that national incidence studies of child maltreatment include data on children with disabilities, the latest survey, the NIS-3, does not satisfy this mandate. Moreover, NCANDS, which releases annual state data on maltreated children, does not gather information relating to children's disability status.

Sullivan undertook two epidemiological studies on maltreated children with disabilities. (Epidemiological studies consider individuals’ sex, age, race, social class, and other demographics.) Both the incidence and prevalence of maltreatment were measured. The hospital-based study of six thousand children found a 64% prevalence rate of maltreatment among disabled children, twice the prevalence rate (32%) among nondisabled children. The school-based study included 4,954 children; 31% of disabled children had been maltreated, 3.4 times that of the nondisabled comparison group.

Family Characteristics of Victims

The only reliable information on family characteristics of victims come from NIS data, as the living arrangements data on children reported to CPS were incomplete. For example, in Child Maltreatment 2006, the ACYF states that in 2006 only twenty-eight states reported on living arrangements of children, and more than one-third of the reported cases had unknown or missing data and were excluded from the analysis. The following discussion comes from NIS-3.

FAMILY STRUCTURE. Under the Harm Standard, among children living with single parents, an estimated 27.3 per 1,000 under age eighteen suffered some type of maltreatment— almost twice the incidence rate for children living with both parents (15.5 per 1,000). (See Table 2.9.) The same rate held true for all types of abuse and neglect. Children living with single parents also had a greater risk of suffering serious injury (10.5 per 1,000) than did those living with both parents (5.8 per 1,000).

Under the Endangerment Standard an estimated 52 per 1,000 children living with single parents suffered

some type of maltreatment, compared to 26.9 per 1,000 living with both parents. (See Table 2.10.) Children in single-parent households were abused at a 45% higher rate than those in two-parent households (19.6 versus 13.5 per 1,000) and suffered more than twice as much neglect (38.9 versus 17.6 per 1,000).

FAMILY INCOME. Family income was significantly related to the incidence rates of child maltreatment. Under the Harm Standard children in families with annual incomes less than $15,000 had the highest rate of maltreatment (47 per 1,000). The figure is almost twice as high (95.9 per 1,000) using the Endangerment Standard. (See Table 2.11 and Table 2.12.) Children in families earning less than $15,000 annually also sustained more serious injuries than did children living in families earning more than that amount.

Perpetrators of Child Maltreatment

CPS Data

The law considers perpetrators of child abuse to be those people who abuse or neglect children under their care. They may be parents, foster parents, other relatives, or other caretakers. People who victimize children that are not under their care are not considered to have committed child abuse, but assault, battery, rape, or other crimes.

In Child Maltreatment 2006, the ACYF indicates that in 2006 abuse perpetrators were more likely to be women

(57.9%) than men (42.1%). Concerning the victims, 39.9% were maltreated by their mother acting alone and 17.6% experienced maltreatment from their father acting alone. (See Figure 2.6.) Another 17.8% were maltreated by both parents. About 6.1% of the victims were maltreated by their mother and another person whose relationship with the mother was not known, and 1% were maltreated by their father and another person. One out of ten (10%) victims were maltreated by nonparental perpetrators, and another 7.6% were maltreated by unknown individuals. The ACYF indicates that 79.9% of the perpetrators were parents, whereas smaller numbers were other relatives (6.7%), unmarried partner of parents (3.8%), child day care providers (0.6%), or foster parents (0.4%). (See Figure 2.7.)

The ACYF explains that most perpetrators of child maltreatment are in their twenties and thirties. In 2006 the median age (half were older, half were younger) of female perpetrators was thirty-one years, and the median age of male perpetrators was thirty-four years. Almost half of the female perpetrators were younger than thirty (41.3% of twenty- to twenty-nine-year-olds, and 4% of those younger than twenty), whereas only about one-third of male perpetrators were (28.9% of twenty- to twenty-nine-year-olds, and 6.2% of those younger than twenty). (See Figure 2.8.)

NIS Data

In 1993 most (78%) child victims were maltreated by their birth parents. (See Table 2.13.) Parents perpetrated

72% of physical abuse and 81% of emotional abuse. However, almost half (46%) of sexually abused children were violated by someone other than a parent or parent substitute. More than a quarter (29%) were sexually abused by a birth parent, and 25% were sexually abused by a parent substitute, such as a stepparent or a mother's boyfriend. Sexually abused children were the most likely to sustain fatal or serious injuries or impairments when birth parents were the perpetrators.

Overall, children were somewhat more likely to be maltreated by female perpetrators (65%) than by males (54%) in 1993. (See Table 2.14.) Among children maltreated by their natural parents, most (75%) were maltreated by their mothers, and almost half (46%) were maltreated by their fathers—with some children being maltreated by both parents. Children who were maltreated by someone other than parents and parent substitutes were more likely to have been maltreated by a male (85%) than by a female (41%). Of the other adults who maltreated children, 80% were males and 14% were females.

Neglected children differed from abused children with regard to the gender of the perpetrators in 1993. Because mothers or other females tend to be the primary caretakers, children were more likely to suffer all forms of neglect by female perpetrators (87%, versus 43% by male perpetrators). (See Table 2.14.) In contrast, children were more often abused by males (67%) than by females (40%).

Reporting Child Abuse

Mandatory Reporting

In 1974 Congress enacted the first CAPTA, which set guidelines for the reporting, investigation, and treatment

of child maltreatment. States had to meet these requirements to receive federal funding to assist child victims of abuse and neglect. Among its many provisions, CAPTA required the states to enact mandatory reporting laws and procedures so that CPS agencies could take action to protect children from further abuse. Each state now designates mandatory reporters, including health care workers, mental health professionals, social workers, school personnel, child care providers, and law enforcement officers. According to the Child Welfare Information Gateway, in “Mandatory Reporters of Child Abuse and Neglect” (January 2008, http://www.childwelfare.gov/systemwide/laws_policies/statutes/manda.pdf), in 2008 eighteen states and Puerto Rico mandated all people must report suspected abuse or neglect, not only designated professionals. Most states did not recognize the right for communications between certain professionals and their clients to remain confidential—called “privileged communications” —in the case of suspected child abuse.

All states offer immunity to individuals who report incidents of child maltreatment “in good faith” or with sincerity. Besides physical injury and neglect, most states include mental injury, sexual abuse, and the sexual exploitation of minors as cases to be reported.

Who Reports Child Abuse?

In 2006 more than half of all reports of alleged child maltreatment came from professional sources—educators (16.5%); legal, law enforcement, and criminal justice personnel (15.8%); social services personnel (10%); medical personnel (8.4%); mental health personnel (4.1%);