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ACF and CDC to Discuss Maltreatment of Infants Study

Moderator: Lola Russell, April 3, 2008, 12:00 p.m. ET

OPERATOR: Good afternoon, and thank you all, for holding. At this time your lines have been placed on listen-only until we open up for questions and answers. Please be advised, today′s conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the conference over to Ms. Lola Russell. Please go ahead.

LOLA RUSSELL, DIVISION OF MEDIA RELATIONS, CDC: Again, this is Lola Russell with CDC′s Division of Media Relations. And today we will be discussing child abuse and neglect based on today′s findings in our Morbidity and Mortality Weekly Report. Ms. Joan Ohl, that is Joan, J-O-A-N, Ohl, capital O-H-L, commissioner for the Administration for Children, Youth and Families in the Administration of Children and Families and Dr. Ileana Arias. That is Ileana capital I-L-E-A-N-A Arias, capital A-R-I-A-S, director of CDC′s National Center for Injury Prevention and Control will be talking with you today. Dr. Rebecca Leeb, that is Rebecca, R-E-B-E-C-C-A, Leeb, L-E-E-B, Lead CDC author of the MMWR Study will be on the line to take questions.

I will now turn it over to Ms. Ohl. If you have questions following the press briefing, you can call the CDC media line at 404-639-3286. Or the ACF media line at 202-401-9215. Ms. Ohl.

JOAN E. OHL, COMMISSIONER FOR CHILDREN, YOUTH AND FAMILIES, ADMINISTRATION FOR CHILDREN AND FAMILIES: Thank you, Lola. I am pleased to be here with CDC today. As you may know, the primary responsibility of the Administration for Children and Families is the safety permanency and well being of America′s children.

Today we mark the start of Child Abuse Prevention Month, and the release of our annual report, Child Maltreatment 2006. During 2006 about 905,000 children were the victims of abuse and neglect. These stark but illuminating statistics point us toward research, program, and policy development that will get us to our common goal, a significant reduction in child abuse.

We′ve learned that overcoming a complicated problem like child maltreatment requires multiple responses involving multiple partnerships like the one we forged with CDC and other federal agencies. Our overarching principal is to support approaches that have been shown to work, such as home visiting programs that prevent abuse by helping parents deal with the stresses of raising children.

We also know that children born to parents who use drugs are at especially high risk. And so we are supporting programs to minimize that risk. We know that children who have strong relationships with their fathers tend to do better in life, so we′ve established a center to develop more knowledge about engaging fathers. And these are a few examples of the positive steps we′re taking.

And really, child abuse prevention begins in the community. People constantly ask what can I do? To help answer that question, we have a wealth of information on our web site at childwelfare.gov, including resources on prevention, promoting healthy families, positive parenting, and more. And now I will turn the microphone over to Dr. Arias.

ILEANA ARIAS, Ph.D., DIRECTOR, CDC NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL: Thank you for joining us today. Child maltreatment is a serious public health problem. Children who are abused or neglected are at greater risk for poor health outcomes and risky health behaviors in adolescence and adulthood. CDC is committed to helping children grow strong and safe. CDC′s injury center has identified child maltreatment as one of its priority injury prevention areas, and is working to ensure that children and infants have safe, stable, and nurturing environments in which to grow and develop.

Nationwide statistics indicate that 19 percent of child maltreatment fatalities occur among infants less than one year old, and the risk of death appears to be greatest in the first week of life. Today′s study is the first national level examination of the risk for nonfatal maltreatment among infants less than one year old.

To determine the extent of nonfatal infant maltreatment in the United States, CDC and ACF analyzed data collected in 2006 from the National Child Abuse and Neglect Data System as described by Ms. Ohl. The report released today in CDC′s Morbidity and Mortality Weekly Report summarizes the results; which show that in 2006 a total of 91,278 infants were victims of nonfatal maltreatment in the first year of life.

Almost 40 percent of those infants had documented abuse during the first month of life; and of these, over 80 percent had documented abuse in the first week of life. Neglect, or the failure to provide for a child′s basic physical and emotional needs, or to protect a child from harm accounted for the majority of the documented reports of maltreated infants less than one week old.

Most reports of neglect were made in the first days after birth by doctors, nurses, and other medical professionals. A small percentage of infants less than one week old were victims of physical abuse, or the use of intentional force by a parent or caregiver that results in physical injury.

The NCANDS data doesn′t provide specific information about the circumstances or the context of neglect and physical abuse. These findings beg for additional research to clarify the causes and maximize strategies to prevent child maltreatment. However, the findings do demonstrate a clear pattern of early neglect and physical abuse that is largely preventable.

Our ultimate goal is to prevent child maltreatment before it starts. Establishing safe, stable, and nurturing relationships between children and adults is the vaccine against child abuse and neglect. The strategy protects infants and children, and promotes their safety and health throughout life. We must support programs that inform and provide support for parents, families, and health professionals on how to ensure protected and nurturing environments for children.

It′s important that we protect children and help every child live his or her life to its full potential. We ask that anybody who becomes aware of a possible maltreatment of a child call the– the Childhelp National Abuse Hotline at 1-800-4-A-CHILD. The line is open 24 hours a day, seven days a week, and all calls are anonymous.

Now we′d be glad to take your questions.

OPERATOR: Thank you. And at this time, if you would like to ask a question, please press star followed by one on your touch-tone phone. You′ll be prompted to record your name for proper registration. And once again, to ask a question, please press star followed by one. One moment for the first questions.

Our first question comes from Will Dunham with Reuters. Please go ahead.

WILL DUNHAM, REUTERS: Hello. This is Will Dunham with Reuters in Washington. Does anybody have an estimate of - I know this study looked at nonfatal maltreatment cases. But any estimate of the number of deaths of infants up to age one annually, just so we can have that component of it? And is there any feeling for what kind of trends we′re seeing in terms of whether this is better or worse than in the past overall?

DR. ARIAS: Hi, this is Ileana Arias at CDC. We know that child maltreatment is the leading cause of death and injury among kids. It′s the third leading cause of death for kids under the age of one. And the fifth leading cause of death for children between the ages of one and nine. About 19 percent of child maltreatment deaths occur among babies who are less than one year of age.

OPERATOR: Thank you. Our next question comes from Sandra Hughes, CBS Network News. Please go ahead.

SANDRA HUGHES, CBS NETWORK NEWS: Yes, first of all, I have two questions. One is why do you think this is the first time this sort of study was done? And secondly, you say you want sort of a vaccine against abuse and neglect. Could you just sort of elaborate that on that further? I mean what do these findings tell you that will lead to this sort of vaccine idea?

REBECCA LEEB, Ph.D., DIRECTOR, CDC NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL: This is Dr. Leeb at CDC. Thanks – we know that the zero to three age group is a highly vulnerable age group. And we know that they are more often maltreated than other age groups. But this is the first opportunity we′ve had to look within that age group so that we can pinpoint time periods where we can go in and look at prevention strategies that can stop maltreatment before it begins.

Could you repeat your second question?

SANDRA HUGHES: Me?

DR. LEEB: I am sorry I …

DR. ARIAS: This is Ileana Arias from CDC. Some of the things that we are very committed to doing is making sure that we prevent any instance of maltreatment. That is, we want to get to kids before they are ever either hit or neglected in any way shape or form. A lot of the focus traditionally has been for obvious reasons, on kids who are already being maltreated, and therefore come to the attention of social services, criminal justice sector, various others.

What we are trying to do now is sort of move the dial back a little bit earlier, and make sure that there never is an occasion for somebody to pick up the phone on a hotline and report that a child is being maltreated. So that this study now is the first – sort of the beginning of trying to look at what are the earliest points of intervention so that we can prevent child maltreatment in the same way that you know we have come to prevent other kinds of conditions that unfortunately take a toll on children′s health.

SANDRA HUGHES: That was – my question, which was your findings in this that – that infants are being maltreated in that first week of life. You were hoping that intervention in that first week, finding out that kids are being neglected in one form or another is going to lead you to that early intervention. Is that the idea?

DR. ARIAS: Yes. That is – what the data are suggesting is that maltreatment is taking place earlier on than we had been focusing on. And so what we need to do is identify what are the best points of intervention, and the best ways of intervening in order to make sure that that doesn′t happen. One is, while mothers – new mothers and their infants are still in the hospital. But then the other is sort of prenatal work as well.

So what′s the kind of preparatory work that we have to do with mothers-to-be so that again, we never have that maltreated child?

MS. OHL: This – I′d like to add on to that. This is Joan Ohl. I wanted to indicate and respond to this question, that this is the first year that we broke out the one and under. Before it was zero to three. And it always – it had a high incident rate. And so based upon that, this is the first year that we broke out the data. We have partnered with CDC in looking at it. And ACF has already been doing a significant amount of work in order to strengthen our early childhood systems.

And so as a part of that in breaking this out, we saw this was a way to get a better understanding of the issues. And we were interested in looking at maltreatment in young infants. And so – and we also have been doing work – we funded last year some home visit – some nurse home visitation programs. And we′ll be funding some additional home visitation programs this spring and summer.

So all of this tied together – and I agree with Dr. Ileana Arias in terms of how it is that we intervene earlier. What is it that we do prenatally, and postnatally in order to help to strengthen families.

OPERATOR: Thank you. Our next question comes from Rob Stein, The Washington Post.

ROB STEIN, THE WASHINGTON POST: Yes hi. Thanks very much for taking my questions. Just getting back to the first question about the number of fatal cases. Do you know what that translates into in terms of total numbers of fatal cases? And also, do you have any sense of the trends?

MS. OHL: Rob, this is Joan Ohl. It translates into the less than one, the incident rate per 100,000 is 16.7. And the number of fatalities is 499. The national number of fatalities in 2006 is 1,530. We don′t know – and the other part of your question, knowing trends, this is the first year that as I said a minute ago, this is the first year that we looked at this specific data of under one year of age. So I don′t have a – I don′t have any trends from before.

OPERATOR: Thank you. Our next question comes from Mike Stobbe, The Associated Press.

MIKE STOBBE, THE ASSOCIATED PRESS: Hi. Thanks for taking the question. If I understood correctly, what we′re talking about mostly is neglect, no abuse. And especially in the week – one-week-old and younger, it′s cases that were reported by medical professionals. To what extent do you think that lack of health insurance is a driver of these numbers?

DR. LEEB: Hi Mike, this is Dr. Leeb. The answer to your question is, we don′t have that kind of data to look at the specific causes of neglect. We know that there are programs that we can implement to reduce child maltreatment and increase safe and secure relationships between children and parents. But we don′t have the data to look at the specific causes of neglect.

OPERATOR: Thank you. Our next question comes from Jennifer Pifer, CNN. Please go ahead.

JENNIFER PIFER, CNN: Hi, thank you for taking my call. Question for you, what are some of the – I know that you didn′t – you don′t have specific information in some of these areas. But what are some of the ways that children are neglected under a week old? Are there any general examples you can give us?

DR. LEEB: The National Child Abuse and Neglect Data System or NCANDS includes things like abandonment and prenatal child exposure to drugs as part of neglect. But because we can′t break it down we don′t know the specific incidents of those different types of neglect.

OPERATOR: Thank you. Our next questions comes from Radha Chitale, ABC News.

RADHA CHITALE, ABC NEWS: Hi everyone, thank you so much. Ileana, I think you mentioned that children are at risk for poor health outcomes as adults as a result of this abuse. I wonder if you could expend on that a little bit for me.

DR. ARIAS: Sure. This Ileana Arias from CDC. Data that has been collected in other studies essentially shows that children or individuals who survive child maltreatment of various forms have a higher risk for number one, engaging in risky behaviors during adolescence and adulthood. And then of course, because of those risk behaviors also have higher risk of developing chronic conditions in adulthood, and in adolescence.

So for example, individuals who have been maltreated during childhood are more likely to develop diabetes, cancer, cardiovascular disease, et cetera. Part of the relationship is indirect, that is because of the intervening risk factors so that individuals who grow up being maltreated are more likely to abuse drugs, alcohol, smoke, and not eat properly et cetera.

But the other is that we know that there is some direct connection as well. So that kids unfortunately who are being maltreated show problems in brain development that then unfortunately set a trajectory of a number of negative outcomes, including health outcomes.

OPERATOR: Thank you. And as a reminder, if you would like to ask a question, please press star followed by one. We have a follow up question from Will Dunham with Reuters. Please go ahead.

WILL DUNHAM: Yes hi. Just a follow up on the statistics provided earlier by Joan Ohl. The 499 figure that you provided, is that the estimated or actual number of deaths of babies under age one in a given year?

MS. OHL: It is the actual reported.

WILL DUNHAM: Of babies under age one.

MS. OHL: Under age one.

WILL DUNHAM: For that year for the year – the same year we are talking about here?

MS. OHL: 2006.

WILL DUNHAM: Thank you.

MS. OHL: And that is in our child maltreatment report, which in effect we have posted this morning. And you can access that on the ACF Web site. Go to children′s bureau and go under research and statistics. And the entire report is there. And it has a state-by-state breakdown.

OPERATOR: Thank you. We do have another follow-up from Jennifer Pifer, CNN.

PIFER: Hi. The one question that I have, it is kind of a very basic questions is, I mean you look at these numbers and it just seems so incredibly high. Why do you think that is?

DR. ARIAS: This is Ileana Arias. I don′t think we know exactly why. We can speculate a number of things that already have been mentioned. We know that unfortunately infants and young babies are more vulnerable. And therefore the behaviors that may not lead to any negative consequence in a two-year-old, a three-year-old, or a four-year-old, for a one-week-old baby it is significantly consequential. So that may be part of it.

We also then have – may have a situation where you know, there isn′t routine training of individuals on how to deal with infants, or how to parent, which unfortunately may increase the risk as well. So that there are some things that we can think about that we need to look at and verify. If for no other reason to actually guide the strategies that then we put out there to try to start bringing those numbers down.

MS. OHL: This is Joan Ohl. I think Dr. Arias is absolutely correct. It drives the agenda both for research, policy development, program development. I mentioned a little bit ago in terms of some of the programs that we funded some nurse visitation programs. This last year we will be funding some home visitation programs this year.

I think there are other things. As I said, this is the first time we have broke that data down below a year-old. But you look at some other things that we′re doing, focusing on strengthening families, fatherhood involvement, looking at one of the things, as you may know, Head Start was reauthorized in 2007. Most recently. And as a part of that reauthorization, once the rules are promulgated, the grantees can convert slots that they currently have for Head Start, to Early Head Start.

And as you may know, that is a program that works with both children and mothers. And so it is both a prenatal program as well as a postnatal program for the mothers. And then obviously is an early childhood program with strong research findings et cetera up to age three.

So I think there are lots of things that we need to delve down into from a research standpoint. But we also are programmatically doing a number of things to try to address this.

LOLA RUSSELL: Is that the last question? Do we have anymore?

OPERATOR: We actually have a few more questions. Our next question is from Denise Grady with the New York Times.

LOLA RUSSELL: Thank you.

DENISE GRADY, NEW YORK TIMES: Thank you. I just want to ask a very basic question please. The report says that there were 49 states that provided data. So first of all, who did not? And then it later says that data was not available from five states. So I am confused about whose data we have and don′t have here. If you could straighten me out I would appreciate that.

MS. OHL: This is Joan. The one state that we did not have data from is the state of Maryland. In addition, we had data – partial data from other states that is a part of this study. Where we had partial data that came from the states of Alaska, North Dakota, Pennsylvania, and Vermont.

In some of these cases what happened, the state didn′t provide the – you know for instance the date of birth. One state is mandated not to report race or ethnicity. And one state didn′t report any victims younger than one week. So there is a difference. And it is a (INAUDIBLE) going back on this point. The NCANDS system, which is the National Child Abuse and Neglect Data System is a voluntary data collection program.

OPERATOR: We have a follow-up question from Mike Stobbe, Associated Press.

MIKE STOBBE: Hi, thanks. I saw there is discussion of race and ethnicity on page 337. Could you – or maybe off-line could I follow-up and find out what the actual racial ethnic breakdown of all the infants was so I can tell what′s proportioned and what is disproportioned? And also, do you have any information about education or income levels? What did you find on that count?

MS. OHL: We do not have information on education and income levels. But we′re more than happy to follow with you off-line in terms of if you want to call our press office, we′ll talk with you in terms of the race and ethnicity issue that you have got questions about.

OPERATOR: Thank you. And our final question comes from Rob Stein, The Washington Post.

ROB STEIN: Yes hi, thanks. I just two questions. One was, were you surprised at the magnitude of the problem that you found in this data? And the second one is, can you tell us anything more about when you say neglect, what did that constitute?

DR. ARIAS: This is Ileana Arias from CDC. We had done work previously working at fatalities showing that unfortunately that first month and that first week is a significant risk period. Nonetheless, when we got these numbers, we were – I don′t know if surprised is the word. We certainly were distressed.

I mean it is a picture that you don′t even want to imagine that this number of infants are being maltreated, again in ways that are largely preventable so that we find it incredibly distressing and unacceptable that children nowadays are being subjected to these kinds of behaviors. And we′re fully committed to get behind any effort that is going to change that.

The – you know neglect is officially defined as the failure to meet a child′s basic needs. And that can include anything involving you know the provision of housing, or appropriate housing, food, clothing, education, and even access to medical care. It is a very broad definition. Again, although it is very broad, it needs to be that broad in order to make sure that what kids need to start right and then grow up right is being provided for them from the very beginning.

LOLA RUSSELL: Thank you for your questions and your interest and calling attention to child maltreatment as a serious and preventable public health problem. As I mentioned earlier, please feel free to call the CDC or ACF press offices for further questions. Thank you.

MS. OHL: Thank you very much.

DR. ARIAS: Thank you.

OPERATOR: This does conclude today′s conference call. You may disconnect at this time. Thank you.

END

####

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