Title: Do "Accidents" Happen? An Examination of Injury Mortality Among Maltreated Children.
Name: Emily Putnam-Hornstein
Year: 2010
Type: Dissertation Fellowship

My dissertation research (funded through a grant from the HF Guggenheim Foundation) was based on a unique data set constructed by probabilistically linking records across three independent sources of California data: 1) vital birth records, 2) administrative child protective service records, and 3) vital death records. The final data set captured 4.3 million children born in California between 1999 and 2006 and includes maltreatment allegation information for over 500,000 children who were reported to child protective services (CPS), as well as death reports on 2,000 children who were fatally injured before age five.

This study represents the most rigorous longitudinal analysis of mortality outcomes following a report to CPS to date, with several key findings emerging. First, these data indicate that a prior non-fatal report of maltreatment is the single strongest predictor of injury death during the first five years of life. Children reported for maltreatment died from accidental injuries at twice the rate of their unreported, demographically similar peers, and from intentional injuries at five times the rate. This finding underscores that a childs report to CPS is not random, nor is it simply a function of poverty. Rather, a report to CPS signals a level of risk, including a risk of death, that is greater than sociodemographic factors would alone predict.

A second and related finding to emerge is that children whose report of maltreatment was screened out over the phone without an in-person CPS investigation died of injuries at twice the rate of children who had never been reported, after adjusting for other risk factors. The decision to screen these children out without an investigation, under the logic that these children are at no greater risk of harm than other demographically similar children, is not supported by the empirical evidence generated from this study. Finally, these data highlight that although there has been a recent emphasis on the unmet service needs of children reported for neglect, it is young children reported for physical abuse who face the greatest risk of death. Children with a prior allegation of physical abuse died from injuries at rates that were significantly higher than children reported for reasons of sexual abuse, neglect, or other forms of maltreatment. Given that physical abuse allegations represent a minority of reports received by CPS, these data suggest that a different protocol for investigating and monitoring cases in which physical abuse is alleged may be justified.


Putnam-Hornstein E, Schneiderman JU, Cleves MA, Magruder J, & Krous HF. (2014). A prospective analysis of sudden unexpected infant death following reported maltreatment. Journal of Pediatrics, 164(1), 142-148. [PMID: 24139442]

Putnam-Hornstein E, Cleves MA, *Licht R, & Needell B. (2013). Risk of fatal injury in young children following abuse allegations: evidence from a prospective, population-based study. American Journal of Public Health, 103(10), e39-e44. [PMID: 23947328]

Putnam-Hornstein E. (2012). Preventable injury deaths: a population-based proxy of child maltreatment risk. Public Health Reports, 127(2), 163-172. [PMID: 22379216

Putnam-Hornstein E. (2011). Report of maltreatment as a risk factor for injury death: a prospective birth cohort study. Child Maltreatment, 16(3), 163-174. [PMID: 21680641]

Putnam-Hornstein E & Needell B. (2011). Predictors of child welfare contact between birth and age five: an examination of Californias 2002 birth cohort. Children & Youth Services Review, 33 (11), 2400-2407.