Nonfatal / severe child abuse and neglect

BACKGROUND Fatal Child Abuse programs have been followed by Federal requests state for data on “near fatal” child abuse/neglect. California law SB 39 requires public disclosure on fatalities and near fatalities with parent / guardian suspects. Some states and counties already review such cases. California’s report on 2010 data listed 121 near fatal cases.

METHODOLOGY Near fatal designation requires over 24 hours of intensive care. We include near fatal and other injuries under “nonfatal severe” adding loss of function and major scars. This includes loss of vision, organic brain disorder with damaged thought process. We will consider adding child sex abuse that causes pregnancy or HIV, burns with significant scarring and PTSD. The ICAN California Hospital Network has 130 hospitals with 25+ pediatric Intensive Care Units. PICU staff will help define this process.  Case management will involve Multi Agency Child Death Review Teams. 

DISCUSSION ICAN created California Guidelines on investigation of Nonfatal Severe child abuse (2009) that will be shared with all PICU asking for a critique. The ICAN Chief Consultant will add input from the Helfer International Society for physicians specializing in child abuse that is also addressing nonfatal severe child abuse. Psychological damage with chronic PTSD may be added for children who survive fatal family violence

CONCLUSION Previous experience with creating and spreading Child Death Review, the ICAN California Hospital Network and Helfer Society make this task reachable with the initial process already underway. Hospital response and draft criteria will be available before this presentation.