Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Prevention of Infant/Child Abuse and Neglect

Summer 2004

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Size of the Problem

Over 68,000 births are recorded annually in Minnesota [1]. In 1990-1999, 38 infants died of intentional injuries (homicide) in their first year of life [2]. Over 17,000 child maltreatment reports (13% are ages 0-2 yrs) are filed annually with Minnesota county human service agencies [3].

Seriousness

People affected by abuse and neglect
The Minnesota 2004 goals related to infant/child abuse and neglect include: Reduce by 15% child maltreatment cases in Minnesota (baseline rate is 738 per 100,000 in 1996); and Reduce by 20% the number of homicides in Minnesota (baseline rate is 6.2 per 100,000 infants from 1988 to 1992) [4].

What is considered abuse/neglect in Minnesota?
Neglect is the most common form of maltreatment. It is defined as failure of the child's caregiver to supply the child with necessary food, clothing, shelter, medical, or mental health care, education or appropriate supervision. The caregiver is expected to protect the child from conditions or actions that endanger the child and take steps to ensure that a child is educated according to the law. Exposing a child to certain drugs during pregnancy and causing emotional harm to a child may also be considered neglect.

Physical abuse is any physical injury, threat of harm or substantial injury, inflicted by a caregiver upon a child other than by accidental means. Physical abuse can range from minor bruises to severe internal injuries and death.

Mental injury is harm to the child's psychological capacity or emotional stability evidenced by an observable and substantial impairment of the child's functioning.

Minnesota Child Maltreatment Trends, 2000-2001
Year Reports of Maltreatment Substantiated Maltreatment
2000
17,408
7,728
2001
17,798
6,767
Source:DHS. Minnesota’s Child Welfare Report. 2001, 2002

National research indicates that battering is the leading cause of pediatric injuries for infants between the ages of 3-5 months [5]. In Minnesota, the highest rates of homicide occur in children under the age of one (based on 1988-1993 data). Nationally, homicide was also the leading cause of injury deaths in infants < 1 year of age with a rate of 6.72/100,000 live births [6]. Maltreatment of children with disabilities is substantiated at a rate that is nearly twice that of their non-disabled peers [4].

Unintentional injury of infant/children may sometimes mask abuse. One study reported that 59% of cases presented at regional children’s hospital and trauma centers were later confirmed as abuse [7].

Disparities
The Minnesota Department of Human Services prepares the Child Welfare Report annually. African American and Native American children were over seven times more likely to be determined victims of maltreatment than white children. DHS examined child welfare outcomes of African American children in Minnesota and found additional disparities [8].

Child Protection Outcomes by Race, Minnesota 2000
  Rate/1,000 children
Outcome African American Child White Child
Victim placed in out-of-home
6
0.4
Children determined as victims
47.3
6
Children assessed for maltreatment
83.3
13
Source: DHS. Study of Outcomes for African American Children in Minnesota’s Child Protection System. April 2002.

Economic
Minnesota’s child maltreatment response costs were $295,992,014 (1993 dollars) [4].

Interventions

Specific interventions have been recommended including:

  • The CDC Task Force on Community Preventive Services recommends early childhood home visitation for prevention of child abuse and neglect in families at risk for maltreatment, including disadvantaged populations and families with low birth weight infants. Programs delivered by nurses demonstrated a median reduction in child abuse of 48% [9].
  • The American Academy of Pediatrics, Committee on Child Abuse and Neglect issued a policy paper in 2001 with recommendations for physicians in dealing with infant deaths that may be suspected child abuse/neglect [10].
  • Information on Shaken Baby Syndrome (SBS) prevention models are available at www.health.state,mn.us/divs/fh/mch/fhv/strategies/sbs/index.html [Attn: Non-MDH Link]

Effectiveness of Interventions
Studies have documented the effectiveness of prevention initiatives, such as home visits to new families to reduce child abuse [9]. The Wilder evaluation of the Minnesota Home Visiting program to Prevent Child Abuse and Neglect (PCAN) found it had an impact on reducing risks of child maltreatment and strengthening families with risk factors for maltreatment [11]. David Olds and associates conducted research over the past 20 years in three different locations. The effectiveness of nurse home visits included a 79% drop in child abuse and neglect, among other measurable outcomes [12].

Status

Minnesota Resources
Public health programs and strategies that promote prevention of infant/child abuse and neglect include:

  • Public health nurse and other home visiting programs to provide education to parents.
  • Minnesota’s Crisis Nursery system.
  • Parent support groups and information available from www.pcamn.org [Attn: Non-MDH Link]
  • Child abuse prevention programs in a variety of Minnesota locations were recognized at an April 2004 conference and included Wakanheza Program in Ramsey County and Stearns County “Keep Kids Safe in Cars” program.
  • The Minnesota State Child Mortality Review Panel meets monthly at DHS to review deaths or near fatalities of infants/children resulting from maltreatment or suspected maltreatment. The panel operates under the authority of MN Statute 256.01, Subd. 12.

Community Awareness
No data available that documents community awareness in Minnesota for infant neglect and abuse.

References

1. Minnesota Center for Health Statistics. 2003
2. MDH. Ten Leading Causes of Mortality by age group, Minnesota 1990-1999.Viewed 6-04 www.health.state.mn.us/injury/pub/mort/mcauses21.htm
3. DHS. Minnesota’s Child Welfare Report for 2001. April 2003.
4. MDH. Healthy Minnesotans: Public Health Improvement Goals 2004. September 1998.
5. Pickett W, Streight S, Simpson K, Brison RJ. Injuries experienced by infant children: a population-based epidemiological analysis. Pediatrics. 111(4):365-370. 2003.
6. Brenner, RE, Overpeck MD, Trumble AC, et al. Deaths attributable to injuries in infants, United states, 1983-1991. pediatrics 103(5):968-974. 1999.
7. Feldman KW, Bethel R, Shugerman RP, et al. The cause of infant and toddler subdural hemorrage: a prospective study. Pediatrics 108(3):636-646. 2001.
8. DHS. Study of Outcomes for African American Children in Minnesota’s Child Protection System. April 2002.
9. CDC. First reports evaluating the effectiveness of strategies for preventing violence: early childhood home visitation. MMWR. October 3, 2003.
10. Committee on Child Abuse and Neglect. Distin-guishing Sudden Infant Death Syndrome from Child Abuse Fatalities. Pediatrics. 2001. 107(2):437-441.
11. MDH. Executive Summary of the Home Visiting Program to Prevent Child Abuse and Neglect, Wilder Research Center Accessed 7-13-04. www.health.state.mn.us/divs/fh/mch/fhv/reports/finalreport/pcan-summary.pdf
12. Kitzman H, Olds DL, et al. Enduring effects of nurse home visitation on maternal lifecourse: a 3-year follow-up of a randomized trial. JAMA. April 19, 2000. 283(15):1983-1989.