Homicide is the leading cause of child fatalities in Baltimore, according to a new city analysis of the unusual and unexpected deaths of 208 minors that occurred over the last five years.
The report, written by the Child Fatality Review child fatality team and released Friday, said that new policies and additional resources in child welfare, education, public health and criminal justice systems are needed to bolster prevention and intervention efforts. About 60% of the deceased children’s families did not come to the attention of Baltimore’s child welfare system before the deaths.
Deaths fell along lines of age, race, class and gender: infants, toddlers and older youth made up most deaths and boys were twice as likely to die as girls. About 88% of fatalities were to children in low-income families; 85% of fatalities were to Black children.
“We cannot lift our Black and brown communities out of poverty and overcome systematic disinvestment without specifically prioritizing the safety of our youth,” Mayor Brandon Scott said Friday at a news conference outside the Center for Hope in Park Heights.
From 2016 to 2020, 24 children from birth to age seven were killed by a parent or caregiver who engaged in abuse, neglect, poor supervision or exposed children to hazards. These adults were found to have mental health disorders and substance abuse issues, as well as their own histories of enduring domestic violence, abuse, neglect and poverty.
Most older minors were killed by non-family members. The report found that 45 youth ages seven to 17 died at the hands of people unrelated to them; 93% died due to gunshot wounds. Nearly 70% had been charged in the juvenile justice system before their deaths.
The minors also overwhelmingly struggled within Baltimore City Public Schools: 89% were chronically absent, 62% had experienced at least two unexpected school transfers, 51% had repeated a grade and 40% had been suspended at least twice. Nearly two-thirds had received mental health treatment at some point.
The 208 deaths represent a quarter of all child fatalities in the state over the last five years. This rate has decreased since it was last studied; from 2011 to 2015, 236 city children died unusual and unexpected deaths, a label used by the Baltimore City Child Fatality Review team. Researchers used data including the autopsy reports and health, law enforcement, school and social services records to compile the report.
The second highest cause of death was sleep-related; 60 infants died from such factors such as sleeping outside a crib or co-sleeping with caretakers.
“Child fatalities are what we call sentinel events. They represent the worst possible outcome and should urge a community to action,” health commissioner Dr. Letitia Dzirasa said.
The report said that Baltimore should bolster child abuse prevention systems, such as increasing support for parents, particularly those who have substance abuse issues or are involved in the drug trade, as well increasing long-term outreach to families identified as being at greatest risk for domestic abuse.
Immediate actions can include creating a two-generation intervention program for families involved in the drug trade, offering culturally responsive individual and family therapy and bolstering an existing infant sleeping safety campaign that provides education and free cribs.
The report said the city should also require that all major prenatal care providers use the health department’s Prenatal Risk Assessment, which screens pregnant mothers for psychosocial risks such as substance use disorder. Additionally, hospitals with birthing services should have families take the Postpartum Infant & Maternal Referral (PIMR), a similar psychosocial risk screening. About 85% of the mothers of deceased children between the ages of birth and seven did not receive a PIMR screening.
Another recommendation is strengthening the intervention systems tasked with investigating suspected abuse.
“When systems for patient education, screening, referral, and care coordination work effectively, they can help prevent child fatality; however, when these systems do not function properly or are not properly resourced, children and families fall through the cracks,” the report said.
Immediate recommendations include strengthening wraparound services for youth victims of nonfatal shootings and stabbings, as well as creating a standard information sharing policy for city agencies that investigate abuse and suspicious deaths.
The report also contained long-term recommendations, which would require more funding, staffing and collaboration between agencies. Implementing these strategies over the next three to five years can help reduce child fatalities, the report said.
The suggestions include connecting elementary school students with low attendance rates to support teams, implementing community education on contacting CPS when children are
suspected to be in danger and passing state legislation to mandate that all birthing hospitals provide and document postpartum safe sleep training to parents before their infant is discharged.
The report also noted that clusters of youth homicides committed by non-family members occurred in neighborhoods without community violence intervention programs, such as Safe Streets. Researchers suggested expanding such programs to these areas.
Scott said he will use some of the $50 million in American Rescue Plan Act funding set aside for public efforts to widen the program’s reach.
