Defining the Problem


Strong relationships between children and their caregivers is a key ingredient for healthy brain development. These interactions teach young children how to respond socially. When young children face severe adversity, such as the conditions of poverty or abuse, the structure of their brain can change forever.  For some children who experience major or multiple adversities, their body’s response to stress can be permanently set on high-alert and result in long-term health consequences.1 Caregivers play an active role in shielding children from feeling the burden of overwhelming amounts of stress. 

Child maltreatment is defined as abuse and neglect of a child under the age of 18 by a parent, guardian, or other caregiver. While child maltreatment occurs within families from all economic backgrounds, it is more common among children in low-income families.2 Factors that can contribute to child maltreatment include the presence of adults who face substance use disorders, mental illness (notably maternal depression), and intimate partner violence.3 

Since child maltreatment comes with such severe negative effects, reducing rates of child maltreatment was identified in the Early Childhood Action Plan as the main focus for achieving North Carolina’s commitment to ensure that babies, toddlers, and young children will grow up with safe and nurturing family and caregiver relationships. 

Goal 5 Target 

Maltreatment Rates per 1,000 Children in North Carolina by Age Group

Data Source: North Carolina Division of Social Services Central Registry, and NC FAST

*Technical note: Maltreatment rates are calculated using the number of cases that are screened in for assessment. It is critical to note the limitations of these data, including that minority populations are disproportionately reported, investigated, and substantiated for cases of maltreatment.

Sub-Targets

Sub-Target 1: Adverse Childhood Experiences 

Percent of North Carolina Children Ages 0 – 8 with Two or More Adverse Childhood Experiences, 2016-2017

Data Source: National Survey of Children’s Health (NSCH), U.S. Department of Health and Human Services 

*Technical note: The National Survey of Children's Health indicator for adverse childhood experiences is based on nine dichotomous 'Yes/No' questions coded as adverse childhood experiences for 'Yes' responses.  Public-use files were combined for survey years 2016 and 2017 to calculate values for children ages 0 - 8. 95% Confidence Interval = (13.5 - 24.0) for 2 or more adverse childhood experiences in above chart.

Sub-Target 2: Screening for Maternal Postpartum Depression 

Percent of Children in North Carolina with at Least One Documented Maternal Depression Screen for the Mother, April 2017 - March 2018

Data Source: Care Coordination for Children (CC4C), Community Care for North Carolina (CCNC)

*Technical note: This data measures the percentage of children who turned 6 months old during the measurement period who have documentation of screening of postpartum depression for the mother. Numerator statement: children with at least one documented maternal depression screen (CPT:96161) for the mother. Denominator statement: Children six months of age with at least five months of Medicaid enrollment during the measurement year. The above rate is based on claims ending March 31, 2018 with a year look back. 

Sub-Target 3: Rates of Emergency Department Visits for Injuries 

Rates of Emergency Department Visits for Injuries per 1,000 Children Ages 0 – 8 in North Carolina

Data Source: NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool): ED Visit Data. Analysis by NC DPH Injury and Violence Prevention Branch.

*Technical note: Case definitions for injuries are based on the CDC Injury Matrix.  In October 2015, there was a change in the coding system used in administrative data sets. Because of this change, data are unavailable for 2015 and data pre-2015 are not comparable to data collected after this change occurred.Rates are calculated as the number of emergency department visits for injuries for children ages 0 - 8 in a year divided by the total population of children ages 0 - 8 in the same year. Rates are shown as number of visits per 1,000 children ages 0 - 8.   

*Disclaimer: “The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is an advanced, statewide public health surveillance system. NC DETECT is funded with federal funds by North Carolina Division of Public Health (NC DPH), Public Health Emergency Preparedness Grant (PHEP), and managed through a collaboration between NC DPH and the University of North Carolina at Chapel Hill Department of Emergency Medicine's Carolina Center for Health Informatics (UNC CCHI). The NC DETECT Data Oversight Committee does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses, or conclusions presented. The NC DETECT Data Oversight Committee (DOC) includes representatives from the NC DPH, UNC NC DETECT Team and NC Hospital Association.” The NC DETECT Data Oversight Committee (DOC) includes representatives from the NCDPH, UNC NC DETECT Team and NC Hospital Association.

Rates of Emergency Department Visits for Injuries per 1,000 Children Ages 0 – 8 in North Carolina by County, 2017

Data Source: NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool): ED Visit Data. Analysis by NC DPH Injury and Violence Prevention Branch.

*Technical note: Case definitions for injuries are based on the CDC Injury Matrix.  

*Disclaimer: “The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is an advanced, statewide public health surveillance system. NC DETECT is funded with federal funds by North Carolina Division of Public Health (NC DPH), Public Health Emergency Preparedness Grant (PHEP), and managed through a collaboration between NC DPH and the University of North Carolina at Chapel Hill Department of Emergency Medicine's Carolina Center for Health Informatics (UNC CCHI). The NC DETECT Data Oversight Committee does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses, or conclusions presented. The NC DETECT Data Oversight Committee (DOC) includes representatives from the NC DPH, UNC NC DETECT Team and NC Hospital Association.” The NC DETECT Data Oversight Committee (DOC) includes representatives from the NCDPH, UNC NC DETECT Team and NC Hospital Association.