Early Detection to Stop Infant Abuse and Prevent Fatalities Act

II 116TH CONGRESS 1ST SESSION S. 1009 To establish a demonstration program to explore effective practices to improve early detection and management of injuries indicative of potential abuse in infants under the age of 7 months, in order to prevent future cases of child abuse and related fatalities. IN THE SENATE OF THE UNITED STATES APRIL 3, 2019 Ms. BALDWIN (for herself and Mr. CASSIDY) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To establish a demonstration program to explore effective practices to improve early detection and management of injuries indicative of potential abuse in infants under the age of 7 months, in order to prevent future cases of child abuse and related fatalities. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Early Detection to 4 Stop Infant Abuse and Prevent Fatalities Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds as follows: 7 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1009 IS (1) According to the National Child Abuse and 1 Neglect Data System, an estimated 1,720 children 2 died from abuse or neglect in the United States in 3 fiscal year 2017. Seventy-two percent of child fatali- 4 ties involved children younger than 3 years, and 50 5 percent involved infants younger than 1 year. 6 (2) According to the Commission to Eliminate 7 Child Abuse and Neglect Fatalities, infants and tod- 8 dlers are at high risk of an abuse or neglect fatality 9 compared to other age groups and require special at- 10 tention. Because these young children are seen by 11 health care professionals, the Commission rec- 12 ommended coordinated, cross-system approaches to 13 prevention. 14 (3) Multiple studies have found that relatively 15 minor, visible injuries in young infants, including 16 bruising and intraoral injuries, are often indicators 17 of abuse. Such injuries are commonly overlooked by 18 medical providers, caregivers, and child welfare pro- 19 fessionals because they seem trivial. Without early 20 intervention, physical abuse can escalate, resulting 21 in severe injuries or even fatalities. Many child 22 abuse professionals refer to such injuries as ‘‘sen- 23 tinel injuries’’ in young infants because of their im- 24 portance as early warning signs of abuse. 25 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1009 IS (4) Research conducted in Wisconsin showed 1 that previous sentinel injuries were identified in 27.5 2 percent of abused infants and 30 percent of infants 3 who suffer abusive head trauma but were rare in in- 4 fants who had not been abused. Other studies have 5 demonstrated similar rates of missed opportunities 6 to identify abuse in young infants. 7 (5) Proper identification of, and response to, 8 such suspicious injuries provides an opportunity for 9 early recognition and intervention to protect vulner- 10 able children and prevent many cases of abuse and 11 related fatalities, as well as an opportunity to detect 12 medical conditions that require urgent treatment. 13 (6) Early detection of such injuries and effec- 14 tive evaluation and intervention requires education 15 of caregivers of young infants, child protective work- 16 ers, and medical professionals about the significance 17 of such injuries in young infants. 18 (7) Best practices and protocols need to be de- 19 veloped to ensure an effective response by medical 20 professionals, child protective services, and other 21 professionals when sentinel injuries are detected. 22 SEC. 3. DEMONSTRATION PROGRAM. 23 (a) IN GENERAL.—The Secretary of Health and 24 Human Services (referred to in this section as the ‘‘Sec- 25 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1009 IS retary’’) shall establish a demonstration program to award 1 grants to eligible entities in order to test effective practices 2 to improve early detection and management of injuries in- 3 dicative of potential abuse in infants under the age of 7 4 months to prevent future cases of child abuse and related 5 fatalities. 6 (b) ACTIVITIES.—Recipients of grants under this sec- 7 tion— 8 (1) shall use such award to— 9 (A) develop, implement, or expand training 10 and best practices to assist medical profes- 11 sionals in identifying, assessing, and responding 12 to injuries indicative of potential abuse in in- 13 fants under the age of 7 months, particularly 14 bruising and oral injuries; 15 (B) develop protocols and policies that im- 16 prove communication and coordination between 17 mandatory reporters and child protective serv- 18 ices when such reporters identify such injuries; 19 and 20 (C) conduct the evaluation under sub- 21 section (e); and 22 (2) may use such award— 23 (A) to raise awareness regarding the sig- 24 nificance of such injuries by mandatory report- 25 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1009 IS ers, health professionals, the public, profes- 1 sionals caring for children, home visitors, child 2 care workers, and child protective services staff; 3 and 4 (B) for other purposes, as the Secretary 5 determines appropriate, including using the ap- 6 proaches described in subparagraphs (A) 7 through (C) of paragraph (1) to address inju- 8 ries indicative of potential abuse in children 9 aged 7 months and older. 10 (c) ELIGIBLE ENTITIES.— 11 (1) IN GENERAL.—To be eligible to receive a 12 grant under this section, an entity shall— 13 (A) demonstrate knowledge and experience 14 providing health services to children and identi- 15 fying and responding to child maltreatment; 16 and 17 (B) submit to the Secretary an application 18 at such time, in such manner, and containing 19 such information as the Secretary may require, 20 including— 21 (i) a description of the entity’s 22 planned activities, including— 23 (I) plans to reduce child re-vic- 24 timization and child fatalities; and 25 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1009 IS (II) plans to evaluate success, in- 1 cluding pertinent data sources that 2 will be developed or utilized; and 3 (ii) entities with whom the applicant 4 will collaborate in carrying out the activi- 5 ties under the grant. 6 (2) MULTIDISCLIPLINARY PARTNERSHIPS.—An 7 eligible entity shall be a multidisciplinary partner- 8 ship of stakeholders with knowledge and experience 9 providing health services to children and identifying 10 and responding to child maltreatment, which may in- 11 clude nonprofit organizations, community-based or- 12 ganizations, administrators of any programs funded 13 under the Child Abuse Prevention and Treatment 14 Act (42 U.S.C. 5101 et seq.), children’s health care 15 providers, board-certified child abuse pediatricians, 16 child protective services, child advocates, State child 17 death review boards, child advocacy centers, State 18 department of justice officials, children’s hospitals, 19 disability organizations, and mental health and so- 20 cial services providers. 21 (d) GRANT PERIOD.—Grants awarded under this sec- 22 tion are for a 3-year period. 23 (e) EVALUATIONS.—The Secretary shall require each 24 recipient of a grant under this section to— 25 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1009 IS (1) evaluate and assess— 1 (A) the efficacy of the projects carried out 2 with grant funds; and 3 (B) the extent to which such projects re- 4 duced re-victimization of children and child fa- 5 talities; and 6 (2) submit a report on such evaluation and per- 7 tinent data to the Secretary. 8 (f) REPORT TO CONGRESS.—Not later than 1 year 9 after the conclusion of the demonstration program under 10 this section and the submission of the report and data 11 under subsection (e)(1), the Secretary shall submit to 12 Congress a report that includes— 13 (1) an analysis of the strengths and opportuni- 14 ties of the program; 15 (2) barriers or challenges for implementing or 16 replicating best practices under the program; 17 (3) the feasibility of a national educational cam- 18 paign on injuries indicative of potential abuse in in- 19 fants under the age of 7 months; and 20 (4) areas for further research or evaluation to 21 improve early detection of such injuries. 22 VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1009 IS (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there is authorized to be appropriated 2 $10,000,000 for the period of 2020 through 2022. 3 Æ VerDate Sep 11 2014 23:53 Apr 08, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S1009.IS S1009 pamtmann on DSKBFK8HB2PROD with BILLS