Improving California's surveillance system for fatal child maltreatment

Research has identified significant variability and undercounting of fatal child maltreatment (CM) among existing data sources. Use of multiple data sources, active surveillance by child death review teams (CDRTs), and standardized case definitions have been proposed as ways to improve fatal CM surveillance.

California has incorporated all three proposed solutions into its CM surveillance system that includes a county CDRT network, regional and state-level coordination, and the Department of Public Health's mandated Fatal Child Abuse and Neglect Surveillance Program. We just completed a reconciliation audit of existing 2005 data using CDRTs as the relative “gold standard”. The multiple data sources included 21, 57, 78, and 125 CM deaths from Vital Statistics, Child Abuse Central Index, Supplemental Homicide Files, and CDRTs, respectively. The audit determined there were 186 CM deaths in 2005, significantly higher than reported in any single source and a 33% increase from the 2002 estimate.

We have also completed the first phase of a study to test our new classification system developed to improve CDRTs consistency in defining CM deaths. A conceptual framework, a training curriculum and manual, and explicit guidelines were created that “operationalize” existing state and national CM definitions. This system was field tested among nearly 100 CDRT members and is currently being tested with a formal pre-post study. The “pre-test” (before training) using hypothetical case scenarios highlighted substantial variability in judgments across teams (n=10) with only 50-60% of teams agreeing on their classifications. Practical implications for state and national fatal CM surveillance will be highlighted.