Child fatality or serious injury through maltreatment: Making sense of outcomes

There is a moral and a legal imperative to learn the lessons from the outcomes of child fatality or serious injury through maltreatment to prevent or at least reduce their reoccurrence. A conclusion of a study, funded by the English Government, of a full cohort of 161 'serious case reviews' of child death and serious injury through abuse, was that most of these worst outcome cases were mostly too complex to be predictable or preventable. Limitations to learning from these high profile cases, which often dominate policy and practice internationally are illustrated by this study. Three groups of cases are identified: 'serious physical assault of young babies', 'neglect', and 'older, hard to help young people'. Learning is offered about safer practice and better recognition of abuse across three levels of intervention -- universal services, known maltreatment risks, and late intervention which may have some cross-national implications. Professional judgment, based on a sound theoretical understanding, is argued to be a better route to safe practice than over adherence to performance indicators. Findings from in-depth studies of small populations of worst cases can be misrepresented and learning from these idiosyncratic studies needs to be linked more clearly to large population studies.