Bad Records

Across the country,
child injury data goes


How states fail to
accurately track day care injuries,
leaving a safety gap

Photo by Jay Janner

Austin American-Statesman | Dec. 6 2018

Last fiscal year, Texas officials reported that 818 children sustained “serious injuries” while in child care — about twice the number as in Nebraska.

Yet Texas has more than five times as many licensed child cares as Nebraska.

According to its most recent figures, Colorado, with one-sixth the day care age population of Texas, reported one and a half times D as many children hurt at child care facilities as Texas.

The numbers reflect the wildly uneven reporting of day care injuries across the country, which experts say undermines efforts to make child care safer and makes it difficult to determine which safety strategies have been effective.

In 2014, a federal report lamented the scarcity of reliable information about how many children get hurt while in child care settings. The last time any comprehensive study had been done was a decade earlier D.

“Unfortunately, only about half of states require licensed child care programs to report serious incidents,” the Administration for Children and Families concluded.

In an effort to close the information gap, that year the agency announced that any state receiving money from it — all of them do — must report to the federal government each time a child was seriously injured in a day care facility. The information would then be posted on an easy-to-find website so that parents could use it to make important decisions about their children’s out-of-home care.

Four years later, however, several states have yet to comply with the 2014 directive. Even for those that do, including Texas, comparing states with each other to assess their relative safety is impossible.

Trying to analyze year-to-year information within states is often an exercise in futility as well. Underpinning the entire system is the fact that regulators rely on providers to self-report the incidents — something that many child care operations haven’t done, the American-Statesman found.

The findings are part of the American-Statesman’s yearlong investigation into these and other problems at Texas child care facilities. The newspaper read thousands of documents, researched dozens of day care safety records, analyzed existing data and built its own database to find patterns and trends.

What the Statesman found was that dangerous conditions exist inside many Texas day care facilities, leaving hundreds of children in need of medical care and nearly 90 children dead as a result of abuse or neglect since 2007. In this series, the newspaper explores problems such as day care sexual abuse, deaths, injuries, illegal operations and state oversight. The newspaper also presents potential solutions to some of those problems.

Different measures

Overall, kids are considerably less likely to be injured at a child care than they are at their homes, according to a 2005 Georgia study D. Another study D, published by City University of New York, concluded, “Overall child care is quite safe,” adding, however, that “there are striking differences in fatality rates across types of care. Center care is significantly safer than care offered in private homes.”

Information about children who get hurt or die while being cared for by someone other than a parent has been collected in bits and pieces over the years. The federal Children’s Bureau of the Administration for Children and Families has published a child maltreatment report for the past 22 years.

The report tallies fatalities due to abuse and neglect in a number of settings. The latest report, from 2016, shows that nationwide 24 children died in child care facilities from abuse or neglect — about 2 percent of all maltreatment fatalities. (The overwhelming majority of such fatalities are children killed by their parents.) Yet the report does not separate out the child care fatalities by state.

The child maltreatment reports do tally nonfatal abuse and neglect cases by state, another problematic metric. In 2016 in Texas, 289 day care providers were found to have been the perpetrators of abuse or neglect — more than any other state, though minuscule compared with just over 35,000 Texas parents held responsible for their children’s abuse or neglect.

Yet a neglect finding does not necessarily mean a child was hurt. A day care provider who fails to notice that a 5-year-old has wandered off the premises could be judged guilty of neglect, even if the child is returned unscathed.

Wild swings in the maltreatment report numbers also raise questions about the accuracy of the information.

In 2013, Pennsylvania reported that 521 child care providers had been identified as perpetrators in abuse and neglect cases. In 2015, the number fell to 17.

Trying to add it all up

Because the federal government has not analyzed the data from the surveys it began requesting in 2014, the American-Statesman filed open records requests with all 50 states. Thirty-five replied.

Several conceded they had not yet complied with the federal mandate to collect and post the data. “Currently, we do not have the ability to track this information,” Anya Weber, a spokeswoman for Kentucky’s Cabinet for Health and Family Services wrote.

Minnesota’s Department of Human Services will begin displaying its numbers next year, according to spokeswoman Jeanine Nistler. Maryland posted its first child care injury information only this fall.

A spokesman for New York’s Office of Children and Family Services said it would need up to five months to compile the data that, by federal rule, it is supposed to have displayed on its website.

Some states reported numbers that are statistically unlikely. Florida, for example, tallied five deaths occurring at child care facilities in 2017. Yet for the same year, there were only six serious injuries, according to the state’s Department of Children and Families. That’s 1/100th of the number reported the same year by North Carolina, whose preschool population is about half the size of Florida’s.

There are several reasons for the scattered numbers, said Brett Reeder, director of Strategic Operations for the Colorado Office of Early Childhood. He said, for example, that Colorado saw its serious injury numbers soar when it installed a system allowing child care operators to self-report the incidents online, instead of on paper forms.

“As we’ve put more time into this measure, the numbers tend to go up,” he said. “Not because more kids are getting hurt, but because we’re getting more compliance.”

Differences between state regulations further complicate and skew the numbers. Not all states license day care providers in the same way, meaning that the number of businesses legally required to make the reports vary.

The federal government’s rules also left the definition of what constitutes a “serious injury” up to each state. As a result, the counts are seldom comparable.

In Delaware, child care providers must report as serious any incident in which there is an “impact or injury to a child’s head or any physical injury which creates a substantial risk of death, or which causes serious and prolonged disfigurement, prolonged impairment of health, or prolonged loss or impairment of the function of a body part.”

Arizona, by comparison, demands reporting for “any injury requiring medical attention.” In Connecticut, providers need only divulge incidents in which a child was hospitalized. West Virginia counts all “serious occurrences,” which, in addition to injuries, includes communicable diseases and legal actions.

Tweaking the definition midstream also can have a dramatic impact on the perception of a state’s relative safety. In 2016, Louisiana child care facilities reported 133 injuries that “required medical attention.”

After the state’s Department of Education tightened up the definition, however, last year the figure dropped to five.