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Public Health Efforts to Build a Surveillance System for Child Maltreatment Mortality: Lessons Learned for Stakeholder Engagement

Smith, Lucia Rojas DrPH, MPH; Gibbs, Deborah MPH; Wetterhall, Scott MD, MPH; Schnitzer, Patricia G. PhD; Farris, Tonya MPH; Crosby, Alex E. MD, MPH; Leeb, Rebecca T. PhD

Journal of Public Health Management and Practice: November/December 2011 - Volume 17 - Issue 6 - p 542–549
doi: 10.1097/PHH.0b013e3182126b6b

Context: Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts.

Objective: We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance.

Design: Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance.

Participants: Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states.

Results: Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non–public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement.

Conclusions: The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.

This article describes the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for child maltreatment surveillance.

RTI International, Washington, District of Columbia (Dr Rojas Smith and Ms Farris); RTI International, Research Triangle Park, North Carolina (Ms Gibbs); RTI International, Atlanta, Georgia (Dr Wetterhall); Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Crosby and Leeb); University of Missouri Sinclair School of Nursing, Columbia, Missouri (Dr Schnitzer).

Correspondence: Lucia Rojas Smith, DrPH, MPH, RTI International, 701 13th St, N. W. Suite 750, Washington, DC 20005-3967 (

CDC disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Funding for this evaluation was provided by the Centers for Disease Control and Prevention, contract 200-2005-F-14668.

The authors thank their Centers for Disease Control and Prevention colleagues at the National Center for Injury Prevention and Control for their support and guidance. They also sincerely thank their colleagues at the California Department of Public Health Epidemiology and Prevention for Injury Control Branch, the Michigan Public Health Institute, the Michigan Department of Community Injury and Violence Prevention Section, and the Oregon Department of Human Services Office of Disease Prevention and Epidemiology for their participation and input in this effort.

Disclosure: The authors declare no conflict of interest.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.