Child Fatalities Resulting From Caregiver Behavior: A Public Health Approach to Child Maltreatment Classification

Area of Science:

• Public Health
• Child Welfare
• Forensic Pathology

Background:

• Limited research exists on applying a public health approach to classifying fatal child maltreatment.
• Standardized terminology and tools are needed to improve consistency in classifying deaths due to caregiver actions.

Purpose of the Study:

• To develop and assess a classification tool for fatal child maltreatment.
• To evaluate the accuracy and acceptability of the tool among Child Death Review (CDR) staff.

Main Methods:

• A six-criterion classification tool was created through expert review of over 100 child death cases.
• Staff from various CDR programs nationally were invited to classify case scenarios using the tool.
• Accuracy (sensitivity, specificity) and reliability were assessed based on respondent classifications.

Main Results:

• The tool achieved an overall accuracy of 0.84 (sensitivity 0.87, specificity 0.77).
• Accuracy varied by criterion, ranging from 74% to 97%.
• 66% of respondents found the tool helpful, indicating moderate reliability, but difficulties in applying specific criteria were noted.

Conclusions:

• The developed classification tool shows promise for improving consistency in fatal child maltreatment classification.
• Modifications to the tool are recommended to enhance its reliability and potential for universal adoption in Child Death Review programs.