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

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


1
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.

2
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

3
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

4
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

5
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

6
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
7
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.

8
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.)

9
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.

10
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.

11
Child Maltreatment Fatalities by Age, NCANDS,2010
N44 States (unique count)
12
Race of 0 and 1-4 Fatality Cohorts
  • Race of Age, 1-4
  • Race of Age, 0

13
Maltreatment Types of 0 and 1-4 Fatality Cohorts,
NCANDS, 2010
  • Maltreatment Types of Age, 0
  • Maltreatment Types of Age, 1-4

14
Perpetrator Relationship of 0 and 1-4 Fatality
Cohorts
  • Perpetrator Relationship Age, 0
  • Perpetrator Relationship Age,1-4

15
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

16
Fatality Review Structures Processes
  • The web of reviews
  • Shared perspectives
  • Fatality review structures and processes
  • Collaboration for improving administration and
    processes

17
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

18
The Web of Reviews
State/Local/Regional CDR
CRP
DVR
FIMR
Internal Agency
19
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.

20
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

21
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

22
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

23
Fatality Review Recommendations
  • Findings
  • Types of recommendations made
  • Implementation of recommendations
  • Results
  • Writing effective recommendations

24
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

25
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

26
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

27

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

28
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

29
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

30
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

31
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.

32
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/

33
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/

34
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
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