Child Death Review

The Power to Prevent Deaths and Keep Children Safe and Healthy

CDR is:

• An engaged, multidisciplinary community, telling a child’s story, one child at a time, to understand the causal pathway that leads to a child’s death to identify pre-existing vulnerabilities and circumstances- in order to identify how to interrupt the pathway for other children

• ….By generating a broad spectrum of data for an ecological understanding of the individual, community, and societal factors that interact at different levels to influence child health and safety

• ….Then taking action to improve systems and prevent deaths.

It’s all aabout

prevention

CDR: Where Good Shift Happens

Moving from Bad things happen toWe can prevent this

Coordinated and Comprehensive Investigations Risk Factor Analysis

Determination of Manner and Cause Effective Recommendations

Agency Practices and Policies Prevention ACTIONS:

Systems of Care Policy, Programs, Services

Justice

Family Support

Systems Improvements Prevention

Child Death Review in 2014

CDR in 50 states

1250 local and state

Guam

Department of Defense

Tribes

Department of DefenseDoD directive requires CDR when a child abuse death of an active duty soldier is suspected.Reviews managed by Office of Family Advocacy

Army: reviews conducted at installation level;Navy, Air Force, Marines: Command level in Washington, DC

Approximately 50-60 per yearNavy also reviewing all SUID deathsAnnual fatality summit in DCMajor worries: deployment related;

gaming addiction; off-base families

By the Numbers

43 states using the System

Over 2300 authorized users

Over 1050 CDR teams have recorded a

death in the System

More than 150,000 deaths have been entered

• 99% deaths

• 54% infants

• 75% cases from 2005-2012

• 59% males

• 51% natural deaths; 24% accidents

Using the Review to Take Action to Prevent Other Deaths

Translating CDR Data into Action

• 50,000 plus recommendations13,000 and more interventions

Transportation

Public Health

Scope of Deaths

All preventable child deaths

Potential child abuse or

neglect related deaths Deaths

known or open to

CPS

Reviewing Maltreatment Deaths

CDR

Legislative mandated panels and/or citizens review Panels/Internal Reviews/audits

WE NEED A CLOSER LOOK HERE

Data Source

Year

2000 2001 2002 2003 2004 2005

FCANS

Reconciliation Audit 129 133 140

Not

conducted

Not

conducted 185

Vital Statistics Death

Statistics Master File 21 30 23 30 20 21

Supplemental

Homicide File 79 77 78 90 76 82

Child Abuse Centeral

Index 34 24 30 18 36 59

Child Welfare

Services/Case

Management System 21 50 59

Not

included

Not

included

Not

included

Child Death Review

Teams - FCANS 62* 116 105 134 107 124

California:Child Maltreatment Deaths Reported to Multiple Data

Sources, 2000-2005

Major Policy Changes Made Following Reviews

186 deaths in 1999-2001 264 findings

170 deaths in 2002-2004 172 findings

9% drop in deaths 35% drop in findings

Vincent J. Palusci, Steve Yager, Theresa M. Covington. Effects of a Citizens Review Panel in preventing child maltreatment fatalities, Child Abuse and Neglect, 09: September

High level of interest from:• Federal partners

HRSA MCHB, ACF, NTSB, NHTSA, CPSC, SAMHSA, CDC, DOD, NTSB Study on Non-Users of Car Seats

• Industry: pool, window and crib manufacturers

• Advocacy Groups: Parent Heart Watch, Kids and Cars, Safe Kids

Local reviews effect national policy…..

DATE TO ACTIONUsing the Data for National Policy

Release of special reports, Injury Prevention Supplement

Release of counts

Dissemination of data base to researchers

Understanding Limitations of Data and Data Quality