The Problem of Child Maltreatment
Child maltreatment is a considerable social and public health problem in the United States. In 2004,
data collected from Child Protective Services (CPS) determined approximately 900,000 children in
the United States were victims of child maltreatment and about 1,500 children died because of abuse or
neglect (US DHHS, 2006). Unfortunately, these numbers likely underestimate the number of children
affected by maltreatment due to underreporting and focus on a single data source.
Research into the consequences of child maltreatment has identified various acute and severe negative
outcomes such as death, injury, and traumatic brain injury. Research has also uncovered many deleterious
long-term developmental outcomes: academic problems, anxiety, conduct disorder, childhood aggression,
delinquency, depression, increased risk for suicide, high-risk sexual behavior, interpersonal problems,
poor physical health, posttraumatic stress disorder, risky health behaviors, substance abuse, and youth
violence (e.g., Bolger, Patterson, and Kupersmidt 1998; Cerezo and Frias 1994; Felitti et al. 1998; Kang
et al. 1999; Mannarino and Cohen 1996; Widom 1999). Along with the legal and medical consequences,
these substantial short- and long-term sequelae make prevention, early identification, and intervention a
necessity.
The Need for Consistent Definitions and Data Elements
Calculation of child victimization rates for maltreatment depends on how the definition of maltreatment is
operationalized. To date, the multiple sectors addressing this issue (CPS, legal and medical communities,
public health officials, researchers, practitioners, and advocates) often use their own definitions, thus
limiting communication across disciplines and hampering efforts to identify, assess, track, treat, and
prevent child abuse and neglect effectively. In addition, victimization rates are often based on reports from
a single source, for example, vital statistics or CPS (e.g., National Child Abuse and Neglect Data System
[NCANDS]). e most recent NCANDS estimate is 11.9 per 1,000 children, or 872,000 victims per
year in 2004 (US DHHS, 2006). However, the ird National Incidence Study, with its more inclusive
ascertainment methods (e.g., multiple sources), suggests CPS may investigate fewer than half the actual
number of maltreatment cases (Sedlak and Broadhurst 1996).
Estimates for child fatalities due to maltreatment vary to an even greater extent depending on the
methodologies, definitions, and sources used (Crume et al. 2002; Herman-Giddens et al. 1999; McClain,
Sacks, Frohlke, and Ewigman 1993). On the one hand, death certificate data from 2002 suggest rates as
low as 0.28 per 100,000 children 0 to 17 years of age (N = 204) (CDC Wonder website: http://wonder.
cdc.gov/). On the other hand, the NCANDS Child Maltreatment 2004 report estimates 2.0 per 100,000
children 0 to 17 years of age (N ~ 1,500). Fatality rates vary inversely by age as well, with the rate for
infants varying by source from 2.4 per 100,000 for vital statistics to 17.5 per 100,000 for CPS sources.
is lack of consistent information about the number of children affected by maltreatment limits the
ability of the public health community to respond to the problem in several ways. First, it limits ability
to gauge the magnitude of child maltreatment in relation to other public health problems. Second,
it limits ability to identify those groups at highest risk who might benefit from focused intervention
or increased services. Finally, it limits ability to monitor changes in the incidence and prevalence of
child maltreatment over time. In turn, this limits the ability to monitor the effectiveness of child
maltreatment prevention and intervention activities (Saltzman et al. 1999).
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