Fourth National Incidence Study of Child Abuse and Neglect (NIS–4)

eveal the maltreatment to persons in the first, second, or third levels, but that the latterdid not recognize the maltreatment as such. (This would include CPS screening out achild in the fourth level.)In the fifth level are those children no one recognizes as maltreated. Theseare cases where the individuals involved do not themselves regard their behavior orexperiences as child maltreatment and where their situations have not come to theattention of outside observers who would identify them as abuse and neglect.The model conveys the inherent difficulty of efforts to measure the incidenceof child maltreatment. Cases in the fifth level are by definition impossible to document(unless they can be brought into the fourth level). In principle, it should be possible toidentify children in the fourth level through methods such as surveys of parents, children,and/or neighbors. Several such surveys have been conducted, but the stigmatizing natureof acknowledgments of abuse and neglect introduces serious (and unknown degrees of)underreporting bias into estimates of cases at this level. As a result, all NIS efforts havefocused on assessing the incidence of cases identified only in the first, second, and thirdlevels.Main study design. The NIS uses a survey methodology that begins with anationally representative sample of counties. In each county, the NIS collects data on allchildren investigated by child protective service (CPS) agencies during the studyreference period as well as on maltreated children identified in a specific set ofcommunity agencies by “sentinels.” Sentinels are professionals who regularly come intocontact with children and families and who have sufficient contact to recognize childrenwho are maltreated and provide the information needed to determine whether theirsituations fit the study definitions of abuse or neglect. They watch for maltreatedchildren during the study reference period.Figure 2–2 depicts these NIS data sources, showing that both CPS andsentinels submit data to NIS. Sentinels report some children they recognize as maltreatedto CPS and these children enter the NIS both through CPS data collection and directlyfrom participating sentinels. Sentinels report other maltreated children only to NISdirectly, which provides information about the numbers of children in the second andthird levels of figure 2–1. Also, other sources report children to CPS who enter NIS only2–4