Hidden in Plain Sight:
The Path Away From Child Maltreatment Fatalities
(Originally published April 2016)
Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities, the 123 page report of the Commission to Eliminate Child Abuse and Neglect Fatalities, contains half a dozen brief comments regarding explanations of child maltreatment fatalities. The lengthiest of these comments is as follows:
We realize the parents and families of children who die from abuse are often struggling and have backgrounds of trauma themselves. They may have drug addictions, mental illnesses, cognitive disabilities, or previous criminal histories. They may face domestic violence at home or live in unsafe, crime ridden communities. Many suffer from a lack of financial resources, inconsistent employment, and housing instability. Often these parents are young; some have had prior experience with foster care or the juvenile justice system. Some have recently returned from deployment in the military and may be suffering from post traumatic stress syndrome. These conditions, as dysfunctional as they may be, are not meant to excuse harmful behaviors toward children, but they do help to explain them.
This paragraph describes a large number of families with open CPS cases, but does not provide an explanation of either child maltreatment or child maltreatment fatalities. It says nothing (nor does the larger report) about the motivations of parents who kill their children, either intentionally or unintentionally, nothing about the relationships or interactions between parents and deceased children prior to fatal incidents, very little about characteristics of children (other than their age and ethnicity) who die from maltreatment, and nothing regarding the extent to which maltreatment related child deaths have similar or different dynamics than non-fatal abuse and neglect. The Commission, like many scholars and program developers, was far more concerned with “solutions” than with explanations and more interested in prediction than in understanding causes of child fatalities. As a result, Within Our Reach has little or nothing to say regarding ideas that could guide the development of effective programs, despite hearing the testimony of dozens of scholars, advocates and child welfare leaders for almost two years. First and foremost, there needs to be a better understanding of child maltreatment fatalities before effective steps can be taken to reduce them.
Degrees of Difficulty in Parenting Young Children
There are a few consistent findings from the National Child Abuse and Neglect Data System (NCANDS) that are valuable clues regarding the dynamics of child maltreatment fatalities:
Four-fifths of child victims are 0-3; and 40-50% of victims are 0-1 year of age.
Almost 58% of child victims are male.
A significant fraction of child victims have been both abused and neglected, i.e., maltreated in multiple ways.
The large gender difference in maltreatment fatalities is usually passed over without comment in scholarly articles, but in my view is of great significance. Gender is arguably a proxy for disabilities and possibly for temperamental behavior. Boys are far more likely to have disabilities than girls and more likely to die in childhood than girls from a wide range of causes. The elevated physical vulnerability of boys in early childhood suggests the following principle: the more difficult a child is to care for in their preschool years, the more likely the child is to be seriously abused or neglected and to die from abuse or neglect. According to this principle, other groups of young children at elevated risk of serious harm and death include premature babies, children with chronic medical conditions and highly sensitive babies who are difficult to calm down.
According to NCANDS, infants die in abuse/neglect related incidents at a rate six times higher than 1-5 year olds. Until recently, I assumed that the physical vulnerability of infants accounted for their elevated risk of maltreatment death, but this may only be part of the story. Infants present extraordinarily difficult child care challenges due to their complete dependence on caregivers, the persistence of their urgent needs and the way in which these needs are expressed, i.e., through crying, sometimes inconsolable crying. As a rule, caregivers tolerate and delight in the care of infants and toddlers because of reciprocal emotional bonds developed through day in day out emotionally responsive interactions. However some babies and toddlers are cared for on a regular basis by caregivers who have not developed these bonds, for example mother's boyfriends or parents who have been separated from their babies for lengthy periods of time due to health or mental health conditions, incarceration, foster care or for other reasons. Difficult to care for babies and toddlers whose caregivers lack a deep emotional connection to these children, and who perceive a baby's crying or fussy behavior as aggression or rejection, are in mortal danger.
A strategy to reduce child maltreatment fatalities should begin with a focus on the most vulnerable child populations: infants and toddlers with conditions and temperaments that make them difficult to care for, and on children and caregivers who have been separated from one another for long periods of time during the first two years of life.
Some children are much more difficult to care for than others, but other factors with which CPS programs are intimately familiar increase the difficulty of parenting. In the highest risk families, (a) parents have severe functional impairments due to substance abuse, mental health conditions and or domestic violence (b) extreme economic hardship threatens the health and safety of all family members and (c) strong emotional connections between a difficult to care for child and caregivers have not developed or been disrupted due to lack of familial relationships or early separations of a child and the child's caregivers. CPS caseworkers should focus on four questions in their risk and safety assessments:
Does this young (0-4) child, or sibling group present unusually difficult child care challenges due to disability, medical condition, temperament or behavior problems?
Does the parent (or parents) have severe functional impairments due to substance abuse, mental health conditions, domestic violence or cognitive limitations?
Does the family lack decent housing, food security, medical/dental coverage and enough income to pay for necessities?
Does any caregiver in the home lack a strong emotional connection to the child or sibling group due to the lack of biological ties or lengthy early separations of child and caregivers?
Children in families with three or four "yes" answers are at highly elevated risk of serious injury or death due to child maltreatment.
Medium to large communities need service programs that address all four concerns with a variety of services and programs that provide emotional support, skill development, child care, respite care on demand, housing vouchers, income support, residential treatment programs that allow substance abusing and/or depressed mothers to retain custody of children, DV crisis intervention, and parenting programs that coach Serve and Return, i.e., emotionally responsive interactions. In recent Sounding Boards, I have discussed Oregon's Relief Nurseries, Washington's PCAP program and Kentucky's START program as examples of the types of programs needed to protect infants and toddlers. Seattle's Childhaven Program should also be widely replicated.
A Darkness Worse Than Night
Even devotees of Michael Connelly's Harry Bosch detective novels may have difficulty coming to grips with news stories about the death of Gabriel Fernandez, an 8 year old child killed in Los Angeles in 2012. An April 8 Tacoma News Tribune story states that Gabriel's mother and her boyfriend “doused him with pepper spray, forced him to eat his own vomit and locked him in a cabinet with a sock stuck in his mouth to muffle his screams.” Other news stories describe more horrendous abuse suffered by this child: beatings with a small bat, metal hanger and belt buckle over a period of months, teeth knocked out in these beatings, bb gun pellets in Gabriel's chest. Gabriel was also forced to wear girl's clothes to school; like all torturers his caregivers sought to degrade and dehumanize him in addition to inflicting pain and suffering. A few child welfare staff in Los Angeles have been indicted for their alleged failure to protect this child.
During recent years, children who died from abuse have been dropped from bridges,
killed and stuffed in storage lockers, beaten repeatedly and mercilessly, force fed or systematically starved and denied water, chained and forced to sleep in the yard and scapegoated by family members, including other children in the family. Some children have had dozens of old injuries indicating abuse that occurred for weeks or months. These cases of prolonged cruelty and torture are not the most common type of child maltreatment death, but neither are they rare, especially as children become older and less likely to be killed in a single abusive incident. These types of torture deaths have occurred in other English speaking countries and Western Europe as well, and have led to massive public outrage when child protection systems failed to protect children despite multiple opportunities. Some of these children have been killed by adoptive parents and foster parents, as well as by birth parents and their paramours.
For information regarding these horrendous deaths, interested persons must usually depend on media accounts or child death reviews. Child welfare scholars have had little or nothing to say about these cases in this country and, of course, the CECANF report does not mention these types of child deaths. I cannot remember reading a single thoughtful discussion of these types of child homicides in a child welfare journal in recent decades, though the New Yorker and other magazines have occasionally published articles about specific cases.
As painful as it is to do so, scholars, advocates and practitioners need to think carefully and objectively about these types of child homicides. Even veteran CPS staff seem to be emotionally and conceptually unprepared to recognize the torture of children. Much fatal maltreatment of children has the same dynamics, the same factors, as most non-fatal abuse: combinations of substance abuse, mental health conditions, domestic violence and poverty. However, the torture of children resulting in serious injury or death is something different than the abuse and neglect of children that CPS staff encounter daily. My impression from reading news stories about children who died after prolonged cruelty and from participation on child death review teams is that a few parents who kill children after inflicting prolonged cruelty are mentally ill, but most are not mentally ill. Rather, caregivers were drawn into power struggles with emotionally troubled and maltreated children, and became determined to break a child's will at whatever cost. Many of these cases have had the following features:
The mother's boyfriend had an active role in abuse of the child, with the mother's complicity and sometimes her full participation.
The power struggle between caregivers and a young child had a rational logic in the initial stages, but this logic quickly became a rationale for any and all cruel behavior.
Caregivers initially became desensitized to the harm they were inflicting, and gradually came to enjoy hurting and degrading the deceased child.
Deceased children were emotionally abused to an extreme degree and isolated from the observation of professionals.
In some cases, parents were advised or encouraged by a physician or therapist to engage in bizarre punishments, such as systematic denial of food and water.
I mentioned earlier that in a significant percentage of child maltreatment deaths children have been both abused and neglected; histories of multiple types of maltreatment is a marker for families with multiple CPS reports. In some of these chronically referring families (approximately one-fifth of open CPS cases) early neglect leads to stubborn oppositional child behavior which results in abusive incidents and extreme disciplinary practices such as locking children in closets or chaining them to a bed. CPS caseworkers should be responding differently to families with chronic referral histories and allegations of multiple maltreatment than to other cases. Investigations/assessments should focus on patterns of maltreatment rather than alleged incidents, use developmental screening of children on a routine basis and become adept at assessing the nurturing environment in which children are being raised.
CPS caseworkers and supervisors must be trained to recognize indicators of torture (as described above) which is made more difficult when child welfare training programs seek to inculcate false pieties such as “Everyone is doing their best,” and “All parents love their children.” I don't doubt that the great majority of parents love their children, nevertheless, it takes impenetrable denial to miss the ugliness of feelings evident in the murder of children following pronged cruelty and torture.
Social Norms are Powerful
The beliefs and attitudes of a society and of local communities have tremendous influence on the care of children and of their mistreatment over a period of decades. As important as federal
policies are in prevention initiatives, social attitudes and beliefs are more important and more powerful in reducing child maltreatment deaths. The views of professionals regarding how children should be disciplined and socialized exert a powerful influence on parenting practices. It is time for professionals and for clergy to take three strong unequivocal stands:
1. There can be no acceptable rationale for breaking a child's will at all costs; cruelty to children is never justified, regardless of the alleged rationale or perpetrator. This standard should be applied to child care programs, juvenile detention facilities and schools, as well as parents and other caregivers.
2. There should be no physical punishment of children, 0-2, whatsoever, and physical punishment of children older than two should be discouraged.
3. The emotional abuse and neglect of children, including scapegoating, rejecting, demeaning and isolating of children must stop. CPS programs should be as concerned with the emotional maltreatment of children as with physical abuse and neglect.
Professional opinion, persistently and strongly expressed, will gradually lead to the widespread acceptance of these standards, which will, in turn, will reduce serious child maltreatment injuries and child maltreatment deaths.
In the next Sounding Board, I will discuss administrative structures and collaborations and measurement practices needed to reduce child maltreatment deaths.