True to Their Cause

For the local group, teamwork is the key concept. That may sound like a rather obvious goal, but it wasn't all that long ago that agencies in this community largely worked at odds with one another, engaging in turf battles and demonstrating an unwillingness to share information. That situation began to change in 1990 following the brutal beating death of two-year-old Christopher Wohlers at the hands of his stepfather. Despite Christopher's long history of abuse and the family's involvement with Child Protective Services, the system clearly failed, due in large part to the lack of coordinated action among agencies, in this instance CPS and the Austin Police Dept.

Wohlers' death was a wrenching experience for the community. Agencies pointed fingers at one another. Newspaper headlines followed the story for months, winding through a labyrinth of emotionally charged legal proceedings which included an initial mistrial, an appeal, a guilty plea by the mother, and the stepfather's conviction of reckless injury (rather than intentional injury) to a child. Free on bond while awaiting an appeals decision, the stepfather recently had his conviction overturned and his case may be tried yet again. This one disastrous case proved to be the catalyst for the establishment of both the Child Protection Team and the Travis Co. Children's Advocacy Center. It was through the work done at the Advocacy Center that the Child Fatality Review Team was ultimately formed. Credit for the team's nascence must also be given to the diligence of public officials like District Attorney Ronnie Earle, who shepherded the process of convincing department heads of the necessity of this cooperative philosophy.

Another issue that had long been a concern among children's advocates was Sudden Infant Death Syndrome (SIDS, or crib death). Are all of these deaths a result of natural causes, or might some be homicides, smotherings, that go undetected for one reason or another? In pre-Review Team days, a SIDS might have been an open-and-shut case. Now, however, these deaths are much more closely scrutinized. Changes in agency protocols stemming from the team's deliberations have, for instance, led professionals who are the first to arrive at the scene of any child fatality to be more cognizant of the possibility that they may be dealing with a potential crime scene.

Similarly, the team is looking more closely into the large percentage of fatalities resulting from the insurmountable complications of many premature births. What are the ages of these mothers? Did they receive prenatal care? Were drugs or alcohol used during pregnancy? These are the obvious questions. A less apparent inquiry, but one that may have profound implications in the area of prevention, is to ask whether there is a history of domestic violence in any of these families. Was a mother beaten or kicked by a partner during her pregnancy, perhaps causing a premature birth? Is domestic violence, then, a possible significant predicating factor in the death of some children? We already know that children who live in families where there is a history of this type of violence are at very high risk of being physically abused.

As this discussion would indicate, we must first know the causes of child deaths in order to develop prevention strategies. And to do that, there must be a uniform, accurate, and comprehensive compiling of information. Amazingly, not until the Review Team began gathering this information and generating statistics did we have any semblance of the overall picture of what was causing the deaths of Travis County children. Previously, fatality information was reported to the Health Department in the form of raw data from the various agencies, but was not made readily available to the public in any organized form. With this knowledge now at hand, we are able to focus on intervention and prevention efforts.

For instance, in the case of Daniel, calling 911 would have seemed the obvious thing to do in an emergency. But perhaps that type of basic information is not readily available to the Spanish-speaking-only community in Austin. How, then, does the community help to alleviate the situation? Clearly, the questions outweigh the solutions. Do we target Spanish-speaking radio stations with public service announcements? Do we disseminate information in schools, health care clinics and Spanish-speaking churches? Do we inform leaders in that particular community who in turn can formulate their own culturally sensitive strategies?

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Numbers Speak Volumes

The Travis Co. Child Fatality Review Team recently published its second annual report, covering 1997. As noted, it is the only comprehensive report of its type available to the public. Its findings bring both good and bad news and plenty of food for thought. The total number of child fatalities in Travis Co. increased by 19% over the previous year (see chart). This contrasts with a decrease of similar proportion from 1995-1996 and might be due in part to the marked population growth in the area (population statistics for 1990-96 show that the rate of increase in the number of children is almost three times that of adults: more children = more fatalities). Deaths due to natural causes rose by more than 21% over 1996, due apparently to a doubling of congenital and infection-related fatalities. Preliminary findings for 1998 indicate that this figure may have gone back down.

Accidental deaths, which include asphyxiation, drownings, and motor vehicle accidents, increased by 38% in 1997. There was a substantial decrease, however, in child homicides between 1996 and 1997. This includes a decline to no deaths from gang-related incidents and a significant drop in homicides involving guns. Does this indicate that APD's community policing and gang intervention strategies are working?

Tragically, two of the four child homicides in 1997 were the result of child abuse by an adult. (A report released in early January by the Texas Department of Protective and Regulatory Services found that, while all other types of violent crime were decreasing, child abuse deaths in the state rose by more than 70% between 1997 and 1998, and more than doubled in the area that includes Travis, Williamson, Hays, and Bastrop counties.) Preliminary reports for 1998 indicate the overall decline in child homicides in 1997 may be reversed.

There were two particularly disturbing findings in this year's report. The first is that African-American children continue to experience a disproportionate risk of death relative to children of all other ethnic groups. Even though they comprise 13% of the child population, African- American children account for 19% of the total fatalities. And African-American girls fare worse than boys. Preliminary reports indicate that these trends may even worsen in 1998. While it may be difficult to pinpoint any one or two specific reasons for these trends, it is safe to infer that children living in poverty are at a far greater risk to their well-being.

The other finding that raises concern is the significant increase in accidental deaths to girls in general. Included here is a rise in the rate of motor vehicle accident fatalities among girls. The risk of homicide to girls in 1997 was about the same as in 1996, but preliminary findings point to a worsening of all these trends in 1998. Why have girls all of a sudden appeared to be more vulnerable? Are they taking more risks, or are they just in the wrong place at the wrong time? On another front, Travis Co. recorded its first child suicide in three years in 1997. Because numbers remain so small, it is hard to draw any conclusions in terms of trends at this time. But certainly if suicides increase, finding commonalities would be helpful in prevention efforts. And on a positive note, there were no fatal drug overdoses among children under 18 in 1997.

One of the complaints of both Review Team reports is that there has been considerable lag time between the period covered in the report and its actual presentation to the public. This report of 1997 findings, for instance, was not publicized until December 1998. A streamlining of the statistical process should remedy this concern, and help facilitate the goal of releasing the team's 1998 findings some time in April, to coincide with National Child Abuse Awareness Month. As well, the report's findings will be available to state legislators who will, it is hoped, use the information to influence public policy.

The death of any child is a tragedy for the entire community, but the Child Fatality Review Team is helping to formulate ways to prevent future fatalities. Most team members would agree that if their time, dedication and expertise were to result in saving just one child's life, then their efforts will have paid off. And maybe, some time in the future, the tragedy that befell young Daniel will not be repeated.