Monday, September 19, 2011

Study: In Times of Recession, Abusive Head Trauma Increases

The impacts of a recession are profound.

In a study appearing today in Pediatrics, Dr. Rachel Berger reports on the rise in the number of cases during the recent recession, which suggests that the rising tide of economic stress is causing a rise in the number of cases of Abusive Head Trauma/Shaken Baby Syndrome. Link to article

The story is receiving a lot of media attention, so it would be a good time to contact your elected officials and let them know that there are opportunities to help parents keep their children safe.


As the coverage points out, if the rate reported in the study applies nationwide, it's now more likely that a child will be the victim of abuse head injury than pediatric diabetes.

CBS News includes a couple of tips from Dr. Peter Sherman at Montefiore Medical Center.

Sherman noted that most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially.

Still, the recession affected many lower-income families, and Sherman said the study highlights "a very important issue."

He said pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Just asking parents about stress and acknowledging their struggles can sometimes help, he said.

Most parents who abuse young children aren't "ill-intentioned," he said. "Most of it is kind of just snapping...maybe being sleep-deprived and just losing it. It's something that can happen to anyone."

Friday, September 16, 2011

Legislative Alert: Congressional Action on “Child and Family Services Improvement and Innovation Act” (S. 1542/H.R. 2883)

News and Analysis from the National Conference of State Legislatures...

Legislative Action: Child Welfare Waiver Restoration/ Reauthorization of the Promoting Safe and Stable Families Act (Title IV-B) Goes to House Floor,
Legislative Summary: “Child and Family Services Improvement and Innovation Act”
Link to Senate Bill S. 1542
Link to House Bill H.R. 2883

On September 12, 2011, Senators Max Baucus (D-Mont.) and Orrin Hatch (R-Utah), and Representatives Geoff Davis (R-Ky.) and Lloyd Doggett (D-Texas) introduced S. 1542/H.R.2883, the “Child and Family Services Improvement and Innovation Act”.

This bipartisan legislation would reauthorize child and family service programs under Title IV-B of the Social Security Act and renew Title IV-E state child welfare waiver authority for the U.S. Department of Health and Human Services (HHS). The legislation has two Titles; Title I-Extension of Child and Family Service Programs and Title II-Child Welfare Demonstration Projects. PSSF and the other programs in Title IV-B parts one and two expire on September 30, 2011.

It took three years, but NCSL succeeded this week in starting the renewal process for state child welfare demonstration projects. This state-friendly legislation is a compromise between the Senate and House and dropped a Maintenance of Effort (MOE) requirement, which was included previously. The MOE would have eliminated many states from participating in a waiver demonstration project due to difficult fiscal conditions. NCSL strongly supports this legislation and sent the House Ways and Means Committee a letter letting them know our stand.

To read the letter, click here:

House: On September 14, H.R. 2883 passed out of the House Ways and Means Committee by a voice vote. The bill is scheduled for the House Floor to be voted on under suspension of the rules on September 21.

Senate: S. 1542 is referred to the Senate Finance Committee. We are currently waiting for the Committee to schedule at time for a hearing/vote on S.1542. Whether it heads to markup or Senate leadership decides to take action on a House-passed H.R. 2882 is uncertain at this time.

Title I: Extension of Child and Family Service Programs

As mentioned above, the first Title of S. 1542/H.R. 2883 would renew Title IV-B of the Social Security Act. Title IV-B programs include the Promoting Safe and Stable Families (PSSF) program. Title IV-B programs are the only federal programs focused on preventing child abuse and neglect as well as providing services to families once a finding of child abuse/neglect is substantiated. This bill would require states to make several changes to their child welfare state plans, require the Secretary of HHS to standardize the data collected, and broadens the substance abuse grants by expanding beyond methamphetamine abuse.

The legislation would require states to amend their state plans to include protocols regarding the appropriate use and monitoring of psychotropic medications and how the state will address emotional trauma associated with being a child that is maltreated and removed from their home. Additionally, states would need to describe the activities undertaken to reduce the length of time children under five do not have a permanent placement. The state plan would also need to include a description of data sources used to compile information on child maltreatment deaths, and if there are data sources not included, a plan to figure out how to include missing data sources in the future. Finally, states would be required to ensure the total number of visits caseworkers make to children placed in care is not less than 90 percent during the fiscal year. States would make this calculation by dividing the total number of visits made during the fiscal year to each child in foster care by the number of visits that should have been made to visit each child for the entire fiscal year. The legislation would require states to make 95 percent of visits to children placed in care starting in 2015.

Title I: Promoting Safe and Stable Families Program Reauthorization

The legislation would level fund PSSF at $345 million and would authorize Congress to appropriate up to $200 million in discretionary spending each fiscal year. Of the $345 million, $30 million is earmarked for the Court Improvement Program. Because of this earmark, some states may see a decrease of the PSSF funding not used for court improvement.

The bills propose several policy changes to the PSSF program. PSSF would be reauthorized through 2016. As mentioned above, the legislation would broaden the use of substance abuse grants by expanding beyond methamphetamine abuse. S. 1542/H.R. 2883 would not provide funding for the Mentoring the Children of Prisoners grant program.

Title I: Additional Changes

The legislation would strengthen adoption maintenance of effort requirements set forth in the Fostering Connections Act (P.L. 110-351) by requiring states to report on all money spent on adoption services, including post-adoption services spending. Additionally, the bills clarify that educational stability be a priority for each placement in foster care. States would also be required to assist each foster youth who is 16 obtain a credit report each year they are in placement to help prevent identity theft.

HHS would be required to establish by rule standard data elements to improve data matching. In developing the standard data elements, HHS would be required to consult with the Office of Management and Budget (OMB) interagency work group and would “consider state perspectives”. The new data standards would take effect October 1, 2012.

Finally, S.1542/H.R. 2883 would require the Government Accountability Office (GAO) to conduct a study on the additional federal funding services states are using to provide services similar to those provided by Title IV-B programs as well as the availability of services to families in need. Examples of services GAO will look into include the amount of time families need to wait for substance abuse and other preventative services and supports provided to caseworkers who investigate and manage child welfare cases.

Title II: Child Welfare Demonstration Projects

These bills would allow the Secretary of HHS to authorize ten waiver demonstration projects for three fiscal years (2012-2014), for a total of 30 waivers. Initially, a state would be granted a waiver to conduct a demonstration project for five years, unless the Secretary of HHS determines that it would be best to continue the demonstration project. This bill would sunset all waiver demonstration projects in 2019, including the demonstration projects authorized prior to the introduction of this legislation. If a tribe is operating a IV-E program, it is considered a state for purposes of applying for a waiver. This bill does not apply to current waiver demonstration projects, which can continue at the discretion of the Secretary (like they have before).

To be eligible for a waiver, states must take the following steps:

Identify one or more goals that the demonstration project is designed to accomplish. These goals include: Increase permanency for all infants, children and youth in foster care, including promoting a successful transition to adulthood for older youth; increase positive outcomes for children, youth and families in their homes and communities; and/or prevent child abuse and neglect as well as the re-entry of children into foster care.

A state must demonstrate readiness through a narrative description of the state’s capacity to effectively carry-out a demonstration projects.

A state must demonstrate that it has implemented, or plans to implement within three years of the date of application submission, at least two child welfare improvement policies, which are outlined in the bill. These improvement policies range from establishing a bill of rights for infants, children, and youth in foster care to increasing the number of sibling placements with the baseline year being 2008.

After three years, HHS can terminate the waiver demonstration project if the Secretary determines the state has not made “significant progress in implementing the child welfare improvement policies proposed by the state”. Finally, the demonstration projects are not subject to random assignment for the purposes of a control group and must be evaluated by an independent contractor.
Final Words

At this time, it is unclear how the Joint Committee on Deficit Reduction (the “Super Committee”), set up by the Budget Control Act (P.L. 112-25), will address Title IV-B funding, particularly the discretionary funds. There is an urgency to passing these bills because Title IV-B programs expire September 30. If these programs are not reauthorized, it would make them more vulnerable to Super Committee cuts. The deadlines set up by P.L.112-25 are fast approaching, with Senate and House Committees required to report to the Super Committee their recommendations for cuts by October 14, 2011. The House and Senate must vote on the legislation produced by the Super Committee on or before December 23, 2011.


Please call your state delegation, particularly your Senators, to pass this bipartisan, bicameral legislation to pass these bills expeditiously.

To read a draft of either S. 1542 or H.R.2883, go here:

For further information, please contact either Sheri Steisel or Emily Wengrovius at or NCSL’s Washington DC office at 202-624-5400.

Reminder: 2011 NYC AHT/SBS Conference

Reminder that the Queen's District Attorney's Office is sponsoring a conference on Abusive Head Trauma/Shaken Baby Syndrome in New York City next week. 

It's hosted at the Medical Examiner's office in Manhattan on September 22 and 23.

ADAs Marjy Fisher and Leigh Bishop put together a very interesting program on Shaken Baby Syndrome.

The Thursday program is good, especially if you want a refresher on diagnosis and treatment, but it's the morning panel on Friday that should be really includes Emily Bazelon, who wrote the NY Times magazine cover story on SBS earlier this year, and two defense doctors who appeared in that article.


Wednesday, September 14, 2011

Sleeping Babies: Who Knew It Was So Complicated?

Very interesting article by Perri Klass in the New York Times.

It asks the question every first year parent wants to know:

What makes a child nap? Most parents cherish toddlers’ naps as moments of respite and recharging, for parent and child alike; we are all familiar with the increased crankiness that comes when a nap is unduly delayed or evaded. But napping behavior has been somewhat taken for granted, even by sleep scientists, and napping problems have often been treated by pediatricians as parents’ “limit-setting” problems.

Now, researchers are learning that it is not so simple: napping in children actually is a complex behavior, a mix of individual biology, including neurologic and hormonal development, cultural expectations and family dynamics.

Hence, the popularity of books in the vein of Go the F**k to Sleep."

Treat:  link to GTFTS narrated by Samuel L. Jackson

While uncontrollable crying is cited as the principal trigger for inflicted injury, the real trigger is the caregiver's response.

A nap allows everyone involved a bit of respite.

To a sleep deprived parent, getting an infant to sleep may be as frustrating as crying. As the article notes,

But for parents and scientists alike, there are many unanswered questions: When is it too early to give up a nap? Too late to hold on to a nap? How do domestic patterns and cultural norms affect the circadian and homeostatic processes?

“I think there’s a dire need for adults in general to be in tune with individual children’s physiology,” Dr. LeBourgeois said. “What are the capabilities, and what are the limits?

For an interesting look at SBS/AHT, and the PURPLE program, seek out this work by Rebecca Sullivan at Cook's

Thursday, September 08, 2011

Resources: 2011 New York City (NYC) Shaken Baby (SBS/AHT) Conference

The Queens District Attorney's Office is sponsoring a conference on Shaken Baby Syndrome on September 23-24.

It's a two day program, with a great agenda of speakers including Bob Block, Mark Dias, Mary Case, Chris Greeley and Carole Jenny.

For dessert on Friday morning, a panel discussion among Emily Bazelon, Ronald Uscinski, Patrick Barnes, Chris Greeley and Mary Case.

Register on line and send payment ($25) by September 9

Link to agenda and registration: