Education on safe sleeping practices, programs aimed at stopping abusive head injuries and better access to mental-health assessments could help prevent child-abuse deaths in Kentucky, according to a state review panel.
The panel also called for drug tests for caregivers in certain child-death cases.
The recommendations were included in a report this week from the Child Fatality and Near Fatality External Review Panel.
It was the first set of recommendations from the panel, created to review cases in which children died or nearly died because of abuse or neglect, and to suggest ways to improve how social workers, hospitals, police and others handle such cases.
The panel considered more than 40 recommendations, but settled on about a dozen that members considered critical because they deal with a pressing issue, or because there was good data to support them, according to the report.
"These were the ones we felt would have the most impact," said Roger Crittenden, a retired circuit judge from Franklin County who chairs the panel.
The panel has much more work to do, however, the report noted.
The Department of Community Based Services — the state's child-protection agency — substantiated reports of abuse or neglect in more than 12,000 reports involving 19,407 children in the most recent full fiscal year.
The report from the review panel said the state provided 116 cases involving deaths or near deaths for members to review, all but one from the fiscal year that ended June 30, 2013.
Of those, 73 involved deaths and 43 were near-fatalities. Some problems showed up in a number of cases, and that's where the review panel focused its recommendations.
For instance, sharing a bed or other unsafe sleeping arrangements played a role in 41 percent of the deaths of children who were less than a year old, according to the report.
That's why the panel recommended that all hospitals with maternity wards educate parents on safe sleeping arrangements, including not sleeping with their infants, and that primary-care doctors, child-care providers and others continue to stress the information as children grow.
The Cabinet for Health and Family Services also should lead a statewide campaign to educate parents on safe sleeping practices, the review panel recommended.
Head trauma showed up as another key concern. More than half of the cases presented to the panel where physical abuse was alleged involved head injuries, most often inflicted by the child's father or the mother's boyfriend, according to the report.
Kentucky children suffering from abuse or neglect are more likely to suffer from such trauma than any other cause, the report said.
The review panel recommended increased education for parents and other caregivers aimed at preventing physical abuse, covering issues such as the danger of shaking an infant or child and ways to cope with a crying infant.
The review panel said it also supports education for people who work with children, as well as communities at large, on the duty to report suspected child abuse and on recognizing warning signs.
Substance abuse also was a recurring theme in abuse and neglect cases, according to the report. However, drugs and alcohol probably played a role in far more cases than the number confirmed by investigations, the panel said.
That's because authorities did not conduct drug tests in at least 95 of the 116 cases the panel received, according to its report.
Other information from the cabinet indicates that substance abuse is a contributing factor in 55 percent of all maltreatment cases, the report said, while the National Center on Substance Abuse and Child Welfare says substance abuse affects up to two-thirds of families in the child-welfare system.
As a result, the review panel recommended that caregivers be drug-tested when authorities investigate the unexpected death of a child.
Crittenden said members of the panel realized the recommendation on drug-testing would be controversial, but felt it would help in investigations.
The report stressed that any policy on drug-testing should recognize the need to be sensitive to grieving parents, and that the ultimate goal should be to get treatment for a caregiver if needed.
State lawmakers would have to approve a requirement for drug-testing in child-death cases, Crittenden said.
Other recommendations from the panel included:
■ Improved access to mental-health assessments for caregivers, with the goal of identifying and dealing with mental-health and substance-abuse problems before they result in abuse.
■ Better coordination among child protection workers, police and others investigating child deaths and near deaths. In addition, the panel said police should consider including certain information, such as visitation restrictions, in law-enforcement databases. In its review, there were cases in which police placed children with parents that the state had barred from having visitation rights, the report said.
■ Birthing hospitals should connect parents of high-risk infants to resources they'll need after leaving the maternity ward, such as food assistance for infants.
■ The cabinet should develop guidelines for hospitals on handling infants born addicted to drugs, including guidelines on helping parents cope.
Some of the recommendations would need little money, but many would require additional spending — a potential roadblock at a time when state government already is stretched thin and many agencies have seen cutbacks. "I think it's a situation where we can't afford not to make some changes in the system," Crittenden said.
The panel said it supports the idea of opening court hearings on neglect and abuse cases as a way to increase public oversight of the system set up to protect vulnerable children.
Such hearings are now closed. Some people argue that private hearings are essential to protecting the best interests of children, but the review panel "believes closed-door hearings can mask systemic defects," according to its report.
Finally, the panel urged a study of the workload for child-protection employees, focusing on frontline workers who deal directly with children at risk. Crittenden said some have complained that the state does not have enough trained workers.
The review panel's report said it did not document a direct link between the workload of social workers and child deaths, but that the workload does affect the quality of services.
Jill Midkiff, a spokeswoman for the Cabinet for Health and Family Services, said social workers handle an average of 18 to 20 ongoing cases at a time.
Midkiff said in a statement that the cabinet respects the work of the review panel and values its suggestions, but had not yet had a chance as of Tuesday to digest the recommendations.
"In the coming weeks, the cabinet will thoroughly review the recommendations directly related to public health, behavioral health and DCBS and evaluate the feasibility and effectiveness of the panel's recommendations," Midkiff said.
Gov. Steve Beshear created the review panel in 2012 in the wake of reports by the Herald-Leader and other newspapers that found problems in how the cabinet had handled some cases involving deaths and injuries, including not conducting required internal reviews. The cabinet said in its most recent annual report that it does all required reviews.