Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities

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Working Together to Prevent Child Fatalities
Collaboration Among Review Teams, Child Welfare
Agencies, and Communities 

• David P. Kelly, J.D., M.A.
• Administration for Children and Families,
  Childrens Bureau
• Ying-Ying Yuan, Ph.D.
• Walter R. McDonald Associates, Inc.
• Teri Covington, M.P.H.
• National Center for the Review and Prevention of
  Child Deaths
• Liz Oppenheim, J.D.
• Walter R. McDonald Associates, Inc.

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Examining Child Fatality Reviews and
Cross-System Fatality Reviews to Promote the
Safety of Children and Youth at Risk

• Funded by the Administration on Children, Youth
  and Families, Childrens Bureau
• 9/26/2011 through 9/25/2012
• Contract Number HHSP23320095656WC

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Overview of Presentation

• Study Purpose
• Identify promising practices for fatality reviews
  and furthering collaboration among reviews
• Methods
• Literature Review
• Review of Recommendations and Outcomes
• Site Visits/Telephone Interviews
• National Meeting
• What Do Fatality Statistics Tell Us?
• Fatality Review Structures Processes
• Fatality Review Recommendations
• Summary

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What Do Fatality Statistics Tell Us?

• Several data sources for national statistics
• Vital Statistics
• National Resource Center for the Review and
  Prevention of Child Deaths
• National Child Abuse and Neglect Data System
  (NCANDS)
• Children younger than 1 and 1-4 are at highest
  risk

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Child Mortality Has Decreased Dramatically for 1-
4 Year Olds1

• Overall death rate has consistently downward
  trend
• 1,419 deaths per 100,000 in 1907
• 28.6 deaths per 100,000 in 2007
• Homicide rate increased between 1970-2007 by 26
  (points in time)
• Homicide percentages increased from 2 to 8
• Racial/ethnic, socioeconomic and geographic
  disparities continue
• Black children 50 higher mortality risk than
  White counterparts and socioeconomic disparities
  increasing
• 1Singh G.K. (2010). Child Mortality in the United
  States, 1935-2007 Large Racial and Socioeconomic
  Disparities Have Persisted Over Time. A 75th
  Anniversary Publication. Health
• Resources and Services Administration, Maternal
  and Child Health Bureau. Rockville, MD US
  Department of Health and Human Services.
  Available from
• http//www.hrsa.gov/healthit/images/mchb_child_mor
  tality_pub.pdf

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Leading Causes of Death for 1- 4 Year Olds, 2007
(Singh, 2010)

• Unintentional injuries 34
• 1/3 of these relate to motor vehicle accidents
• Birth defects 12
• Homicides 8
• Diseases
• Cancer 8
• Heart Disease 4
• Less than 2
• Pneumonia 2
• Septicemia 2
• Perinatal conditions lt2
• Benign Neoplasms 1
• COPD 1
• Other causes 27

Infant mortality rate is at an all time low 6.39
infants deaths per 1,000 live births
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Background on a Review of Selected
RecordsNCDR-CRS

• 34,000 records of deaths of children between 0-5
  years of age were reviewed from 36 States
• A subset of the 49,000 records (2008-2011)
• Using a very broad definition of CAN related, 13
  or 4,500 deaths were CAN-related
• The data are from 36 States but may not be all
  deaths in all years from each State.

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Causes of Death Related to CAN

• More than half of deaths from assault or drowning
  had a relationship to CAN
• 78 of deaths from assault (including use of
  weapons)
• 53 of deaths from drowning
• A third to a fifth of deaths from burns, asphxia,
  and motor vehicles were considered CAN related
• 33 of deaths from fire and burns
• 25 of deaths from asphxia
• 20 of deaths from motor vehicles
• Smaller percentages for other causes of death
• 11 from SIDS
• 2 from perinatal causes (prematurity, LBW etc.)

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CHILD MALTREAT- MENT FATALITY RATES, NCANDS,
20022010
NCANDS

• The National Child Abuse and Neglect Data System
• collects data from all States on the CPS
  investigation or assessment of alleged
  maltreatment, including deaths
• 11,600 fatalities are in the case level database
  from 2002-2012.
• The majority of the information is provided at
  the case level, but many States report on
  additional deaths.

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Child Maltreatment Fatalities, NCANDS

• Number of child fatalities due to maltreatment
  has fluctuated during the past 5 years since
  2007 on a decrease
• Explanations included system improvements that
  reduced case backlog and successful prevention
  programs.

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Child Maltreatment Fatalities by Age, NCANDS,2010
N44 States (unique count)
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Race of 0 and 1-4 Fatality Cohorts

• Race of Age, 1-4

• Race of Age, 0

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Maltreatment Types of 0 and 1-4 Fatality Cohorts,
NCANDS, 2010

• Maltreatment Types of Age, 0
• Maltreatment Types of Age, 1-4

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Perpetrator Relationship of 0 and 1-4 Fatality
Cohorts

• Perpetrator Relationship Age, 0

• Perpetrator Relationship Age,1-4

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Summary

• Child fatalities due to abuse and neglect can be
  understood within a context of all deaths of
  young children
• Social and community decisions contribute to the
  definitions of child abuse and neglect deaths
• We seek to reduce child fatalities through
• Better identification of causes and factors
  leading to death
• More targeted prevention programs
• Involvement of all sectors of society

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Fatality Review Structures Processes

• The web of reviews
• Shared perspectives
• Fatality review structures and processes
• Collaboration for improving administration and
  processes

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The Web of Reviews
Background

• 50 States and the District of Columbia have an
  active CDR program (at the State and/or local or
  regional level)
• 17 States use their CDR team as the citizen
  review panel for review of fatalities
• Many child welfare agencies conduct internal
  child fatality reviews
• 200 Fetal and Infant Mortality Review (FIMR)
  programs in 40 States
• 144 Domestic Violence Fatality Review (DVFR)
  teams at the State and local level

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The Web of Reviews
State/Local/Regional CDR
CRP
DVR
FIMR
Internal Agency
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Shared Perspectives

• Deaths and serious injuries are sentinel events
  
• markers for the health and safety of people.
• Environmental, social, economic, health and
  behavioral factors impact the death or injury.
• These factors are so multidimensional that
  responsibility for a death or injury doesnt
  belong to any one agency or organization.
• Reviews focus on what went wrong and how can we
  fix it, not who is at fault and who should we
  blame.
• The best reviews are multi-disciplinary.

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Fatality Review Structures Processes

• Membership
• All are multidisciplinary
• May not always have all the needed
  representatives
• Administrative Homes
• Many different administrative homes
• Data collection
• All team processes include data collection
  activities
• For some teams, legislation provides access to
  needed information
• Some teams rely on information brought to reviews
  by team members
• Some teams conduct interviews with family members

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Benefits of Collaboration

• Legislative support
• More cases
• More information
• More knowledge about agencies
• Existing multidisciplinary team
• More resources
• Near fatalities
• Access to citizen participation
• Coordinated prevention

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Strategies for Collaboration

• Administrative home
• Membership
• Case identification
• Data collection
• Joint meetings
• Cross pollination/communication
• Identification of cross-cutting issues
• Joint training
• Develop joint recommendations

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Fatality Review Recommendations

• Findings
• Types of recommendations made
• Implementation of recommendations
• Results
• Writing effective recommendations

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Prevalence and Types of Recommendations

• Most of the recommendations were for
• increasing public awareness and education
• improving policies and legislation
• strengthening organizational capacity
• Agency, persons, or organizations often not
  identified
• Many global statements indicating that parents
  should make specific changes in behavior or that
  communities should provide particular supports or
  services

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Prevalence and Types of Recommendations

• No mention of collaboration to enhance injury
  prevention
• CDR and FIMR teams made recommendations regarding
  SIDS
• DVFR teams acknowledged the impact of DV on
  children
• All teams acknowledged that collaboration among
  many agencies and providers was necessary in
  order to effectively implement recommendations

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Prevalence and Types of Recommendations

• CAN Related Recommendations
• 78.8 of the recommendations pertained to some
  type of educational activity
• 28.5 of the recommendations were for parent
  education
• Non-CAN Related Recommendations
• 78.8 of the recommendations pertained to some
  type of educational activity
• 27.5 of the recommendations were for parent
  education

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Implementation of Recommendations

• Commitment to prevention
• Each team member must commit to use review
  information to educate their own agencies and
  advocate for needed changes
• Dissemination strategies
• Disseminate reports far and wide
• Select the right messenger(s)
• Work with the media
• Make in-person presentations
• Increasing Likelihood of Implementation
• Include people with authority to effect change
• Conduct advocacy with legislators and elected
  officials
• Implement a separate Community Action Team (CAT)
• Develop memoranda of understanding regarding next
  steps

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Results of Fatality Review Team Recommendations

• Improved interagency communication
• Numerous strategies to promote public awareness
  and education
• Prevention strategies focused on high risk
  populations
• Strengthened organizational capacity
• Changes in policy and legislation
• Improved service delivery

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Writing Effective Recommendations

• Assessment of the Problem
• Describe particular risks or protective factors
• Include information on best and promising
  practices
• Discuss current efforts, resources, and capacity
• Process
• Develop or review recommendations with agencies
  identified
• to implement them
• Prioritize recommendations
• Recommendation
• Discuss the primary outcome sought
• Tie recommendations to specific findings
• Indentify the agency, persons, or organizations
• Identify target population
• Include detailed plan of action

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Strategies for Collaboration

• Develop an integrated database of fatality review
  findings and recommendations
• Assessing risk factors
• Identify shared prevention strategies
• Develop joint training
• Share information about best and promising
  practices
• Hold joint meetings to create/share findings and
  recommendations
• Develop joint reports

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Summary

• A lot of time, effort, and hard work is being
  dedicated to conducting fatality reviews.
• There are a number of creative and effective
  strategies in place for effective review meetings
  and collaboration among reviews.
• Many of the recommendations of fatality review
  teams have resulted in increased public awareness
  and education.
• Improvements in organizational capacity,
  improved practice and policy, and new
  legislation.
• There is a lot to learn from one another about
  improving review processes, recommendations and
  outcomes.

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Resource Center Websites

• National Center on Substance Abuse and Child
  Welfare
• http//www.ncsacw.samsha.gov
• National Child Welfare Resource Center for
  Organizational Improvement
• http//muskie.usm.maine.edu/helpkids/index.htm
• National Child Welfare Workforce Institute
• http//www.ncwwi.org/
• National Domestic Violence Fatality Review
  Initiative
• http//www.ndvfri.org/

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Resource Center Websites (continued)

• National Fetal and Infant Mortality Review
  Program
• http//www.nfimr.org
• National Resource Center for Child Protective
  Services
• http//www.acf.hhs.gov/programs/cb/tta/neccps.htm
• National Center for the Review and Prevention of
  Child Fatalities
• http//childdeathreview.org/
• National Citizens Review Panel Virtual Community
• http//www.uky.edu/SocialWork/crp/

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Contact Information

• David P. Kelly, J.D., M.A.
• David.Kelly_at_ACF.hhs.gov
• Ying-Ying Yuan, Ph.D.
• yyyuan_at_wrma.com
• Teri Covington, M.P.H.
• tcovingt_at_mphi.org
• Liz Oppenheim, J.D.
• loppenheim_at_wrma.com