Child Maltreatment Surveillance Improvement Opportunities: A Wake County, North Carolina Pilot Project

BACKGROUND As child maltreatment often occurs in private, child welfare numbers underestimate its true prevalence. Child maltreatment surveillance systems have been used to ascertain more accurate counts of children who experience maltreatment. This manuscript describes the results from a pilot child maltreatment surveillance system in Wake County, North Carolina.METHODS We linked 2010 and 2011 data from 3 sources (Child Protective Services, Raleigh Police Department, and Office of the Chief Medical Examiner) to obtain rates of definite and possible child maltreatment. We separately analyzed emergency department visits from 2010 and 2011 to obtain counts of definite and possible child maltreatment. We then compared the results from the surveillance systems to those obtained from Child Protective Services (CPS) data alone.RESULTS In 2010 and 2011, rates of definite child maltreatment were 11.7 and 11.3 per 1,000 children, respectively, when using the linked data, compared to 10.0 and 9.5 per 1,000 children using CPS data alone. The rates of possible maltreatment were 25.3 and 23.8 per 1,000, respectively. In the 2010 and 2011 emergency department data, there were 68 visits and 84 visits, respectively, that met the case definition for maltreatment.LIMITATIONS While 4 data sources were analyzed, only 3 were linked in the current surveillance system. It is likely that we would have identified more cases of maltreatment had more sources been included.CONCLUSION While the surveillance system identified more children who met the case definition of maltreatment than CPS data alone, the rates of definite child maltreatment were not considerably higher than official reports. Rates of possible child maltreatment were much higher than both the definite case definition and child welfare records. Tracking both definite and possible case definitions and using a variety of data sources provides a more complete picture of child maltreatment in North Carolina.