Measuring Fatal Neglect

[Lisa_Sanbonmatsu/Student/KSG@xxxxxxxxxxxxxxx]

I am a doctoral student trying to develop a proxy for neglect fatalities using
death certificate data (International Classification of Diseases-9th Revision).
This is similar to McClain et al.?s (1993)  work except that I am focusing
specifically on neglect.  Does anyone have any suggestions concerning diagnoses
that may be indicative of fatal neglect?

Currently, I am focusing on fatalities that may involve 1) inadequate
supervision (i.e., a toddler struck by a car, a young child who falls out of a
window, a young child who chokes to death), 2) lack of medical care (i.e.,
deaths due to medical conditions which are generally treatable), or 3) physical
neglect (i.e., deaths from exposure or malnutrition).

I am hoping that by using specific diagnoses and age ranges, I will be able to
develop a rough measure of fatal neglect.  However, there are numerous
obstacles.  Some stem from the difficulty of separating out neglect deaths from
both abuse deaths (deliberate withholding of food, physical abuse injuries
falsely attributed to an accident, etc.) and from deaths that have little to do
with a caretakers? actions (deaths due to unforeseeable events, environmental
hazards, or congenital conditions).  Other difficulties arise from the variation
in coding across states.

Any thoughts?  Does anyone know a member of a child death review team who might
be willing to be interviewed about the decision making process?

Thank you.


Lisa Sanbonmatsu
Malcolm Wiener Center for Social Policy
79 JFK Street
Harvard University
Cambridge, MA 02138
sanbonm@ksg.harvard.edu
(617) 495-5131


References

Margolin, L. (1990).  Fatal Child Neglect.  Child Welfare, 69 (4), 309-319.

McClain, P.W., Sacks, J.J., Froehlke, R.G., & Ewigman, B.G. (1993).  Estimates
of fatal child abuse and neglect, United States, 1979 through 1988.  Pediatrics,
91, 338-343.

U.S. Advisory Board on Child Abuse and Neglect.  (1995).  A Nation?s Shame:
Fatal Child Abuse and Neglect in the United States.  Washington, DC:  U.S.
Department of Health and Human Services.