Special Efforts Being Made in Alaska to Eliminate Child Abuse and Neglect Fatalities

Alaska is working with Eckerd Kids to implement Eckerd Rapid Safety Feedback®, a unique process relying on real-time data analytics to flag high-risk child welfare cases for intensive monitoring and caseworker coaching.  In Alaska, the project involves identification of high risk cases of children less than three years of age in the initial assessment phase of service. The cases will be reviewed for safety management utilizing a standardized tool. Cases needing enhanced safety management will be reviewed with OCS staff, and a plan for needed changes will be made. The staffing process follows a coaching model. The cases continue to be monitored to ensure the plan is implemented until the cases is moved to Family Services or closed. The intent of the project is to reduce reports to three or less for high risk children under the age of three years. The state’s Continuous Quality Improvement staff has received extensive training from the Eckerd Kids staff. [Recommendation 7.2]

Alaska is also leading the country in developing a process to accurately identify and count all child maltreatment deaths.  Leadership provided by the Maternal and Child Health Epidemiology Program in the State’s Health Department uses Alaska’s child death review team to categorize suspected child maltreatment deaths. CECANF recommended the development of a national child maltreatment surveillance system to collect, analyze and report data on fatalities and life-threatening injuries from maltreatment. Child death review (CDR) processes and resulting data are considered by many to be the best available model for this surveillance system. For CDR data to fill this need, child maltreatment must be clearly defined, and this definition must be objectively applied. Alaska is working to improve the identification and classification of maltreatment deaths through the CDR model. The Alaska Maternal Child Death Review (MCDR) program is systematically evaluating the CDR process for identifying and classifying maltreatment deaths. Operating under a public health model for broad population-based classification of maltreatment, MCDR recently completed and published a study assessing the reliability of maltreatment classification by CDR panels. Using a blinded time-delay review, this study highlighted the fact that CDR teams struggle with consistently classifying neglect-related fatalities. Much of this inconsistency is related to inconsistent assessment of supervision and protection from hazard situations.

Based on these findings, Alaska is now working on expanding its CDR model to include better and more refined definitions and decision matrixes, to help panels more accurately and consistently interpret information leading to standardized classifications. The current development of the model is based on ensuring that the CDR purpose is established; qualifying the population under review for identification; ensuring a minimum preparation and that records are available for quality review; and using a decision matrix for consistent classification of intentional abuse, intentional neglect, and safety concerns related to hazard exposure and supervision. Using this classification tool, the MCDR can report on various levels of jurisdictional need and create a centralized source of maltreatment fatality data, which will prevent confusion when the sensitivity of definitions between jurisdictions is needed (e.g., child welfare fatalities meeting CAPTA requirements, sensitive public health definitions). Although Alaska is geographically large, its small population and centralized services allow for a single review process and access to multiple records required for a quality review. With support, Alaska’s continued focus on improving the CDR process of maltreatment classification could translate well to a national model to better count maltreatment deaths. [Recommendation 6.2a]