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, Children’s 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.
Examining Child Fatality Reviews and CrossSystem Fatality Reviews to Promote the Safety
of Children and Youth at Risk
• Funded by the Administration on Children, Youth and
Families, Children’s Bureau
• 9/26/2011 through 9/25/2012
• Contract Number: HHSP23320095656WC
Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities
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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
Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities
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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_mortality_pub.pdf
Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities
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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: <2%
Benign Neoplasms: 1%
COPD: 1%
Infant mortality rate is at
an all time low:
6.39 infants deaths
per 1,000 live births
• Other causes: 27%
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Background on a Review of Selected Records
NCDR-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.)
Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities
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NCANDS
CHILD
MALTREATMENT
FATALITY
RATES,
NCANDS,
2002–2010
• 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.
Working Together to Prevent Child Fatalities: Collaboration Among Review Teams, Child Welfare Agencies, and Communities
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Child Maltreatment Fatalities by Age,
NCANDS,2010
N=44 States (unique count)
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Race of 0 and 1-4 Fatality Cohorts
Race of Age, 0
Race of Age, 1-4
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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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Background
The Web
of Reviews
•
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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Fatalities/
Near
Fatalities
Foster
Care
Adoption
CRP
The Web of Reviews
Child
Death
Review
State/Local/
Regional
CDR
Prevention
Internal
Agency
Fatality
Review
FIMR
DVR
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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 doesn’t 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@ACF.hhs.gov
• Ying-Ying Yuan, Ph.D.
yyyuan@wrma.com
• Teri Covington, M.P.H.
tcovingt@mphi.org
• Liz Oppenheim, J.D.
loppenheim@wrma.com
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