190993 Improving California's surveillance system for fatal child maltreatment

Tuesday, October 28, 2008

Stephen Wirtz, PhD , Epidemiology and Prevention for Injury Control (EPIC) Branch, California Department of Public Health, Sacramento, CA
Sibylle Lob, MD, MPH , Institute for Health and Aging, University of California, San Francisco, Sacramento, CA
Dale A. Rose, PhD, MSc , Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA
Christine Brennan, MPH , Institute for Health and Aging, University of California, San Francisco, Sacramento, CA
Patrick Fox, PhD , Institute for Health and Aging, University of California, San Francisco, San Francisco, CA
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.

Learning Objectives:
1. Recognize three limitations of existing archival data for child maltreatment (CM) surveillance; 2. Articulate the value of child death review teams (CDRTs) as a source for active surveillance of fatal CM; 3. Describe the reconciliation audit as an active surveillance process and how it addresses many of the limitations in existing approaches to fatal CM surveillance; 4. Describe the propose CM classification system for CDRTs and the four conditions that must be present in order to classify a CM death; 5. Explain how this CM classification system is being formally tested and describe the results of the study; and 6. Assess the implications of the CM classification system for surveillance and prevention of CM.

Keywords: Child Abuse, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This presentation represents a central part of my daily work and I am the primary contributor to all aspects of the presentation and oversee the involvement of all my other team colleagues.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.