Examining Child Fatality Reviews and Cross-System Fatality Reviews

1. Examining Child Fatality Reviews and Cross-System Fatality Reviews David Kelly, J.D., M.A. Children’s Bureau Liz Oppenheim, J.D. Ying-Ying T. Yuan, Ph.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, Children’s Bureau 9/26/2011 through 9/25/2012

3. Project Goals • Gain an understanding of the types or recommendations made by fatality reviews • Gain an understanding of the outcomes and impact of the recommendations • Identify best practices for improving: • Collaboration and increased efficiency within and among fatality reviews • Identification and implementation of cross- cutting prevention strategies

4. Fatality Reviews • Child Death Review (CDR) • Children up to age 18 • Deaths due to accidents, homicides, suicides and fatalities resulting from abuse and/or neglect • Review child deaths to better understand how children die and identify prevention strategies • Citizen Review Panel-Fatality Review (CRP-FR) • Birth to age 18 • Children involved with CPS or child welfare only • Identify child welfare practices and policies that may have been a factor in the fatalities

5. Fatality Reviews • Fetal and Infant Mortality Review (FIMR) • Children younger than one year old • Public health strategy to identify ways to improve services and resources for women, infants, and families to prevent infant deaths • Domestic Violence Fatality Review (DVFR) • Review deaths of adults • Goal is to identify issues in the service delivery systems that may prevent future deaths from domestic violence

6. Project Components • Literature Review • Review of Recommendations and Outcomes • Site Visits • National Meeting

7. Child Fatality Reviews Logic Model Purpose: To increase knowledge about child fatalities and identify promising practices which would reduce preventable child deaths. INTENDED RESULTS REVIEW INPUTS REVIEW PROCESSES OUTCOMES • Authorizing legislation • Multi-agency and multi-disciplinary review teams • Team member training • Case data • Available knowledge about child fatalities, the causes of fatalities, and other research literature • Guidance, direction, and support • National standards • Leaders and champions • Funding • Collaborate with other review teams • Identify circumstances leading to or involved with the death • Identify risk factors: health, social, economic, behavioral, environmental, and systemic • Identify prevention strategies OUTPUTS IMPACT Improved collaboration • Recommendations • Local • State • National/ Federal Increased funding Reduce preventable child death rates Strengthened organizational capacity Implementation Plans Improved policies/legislation • Findings • Case-specific • Aggregate • Systemic Increased public awareness/ education Improved service delivery Data Sources: Literature Review, State Report Reviews, Site Visits, National Meeting

8. Key Findings from Literature Review: Fatality Reviews All States but one have Child Death Review (CDR) teams 17 States use their CDR team as the citizen review panel for review of fatalities 200 Fetal and Infant Mortality Review (FIMR) programs in 40 States 144 Domestic Violence Fatality Review (DVFR) teams at the State and local level

9. Key Findings from Literature Review: Inputs/Processes Coordination and collaboration Authorizing legislation Members Scope Information access and review Identification of risk factors Identification of prevention strategies

10. Key Findings from Literature Review: Outputs Development of recommendations Reporting findings Implementing recommendations

11. Key Findings from Literature Review: Impact • Impact: Reduce preventable child death rates • Difficult to determine • Some examples

12. Key Findings from Literature Review: Outcomes • Impact • Improved collaboration • Increased funding • Strengthened organizational capacity • Improved policies/legislation • Increased public awareness/education • Improved service delivery

13. Key Findings: The National Child Death Review Case Reporting System (NCDR-CRS) • A majority (86.7%) of the child deaths were not identified as CAN related deaths • Largest categories of cause of death for CAN related • 17.9% weapons related • 12.3% asphyxia • 11.2% drowning • Recommendations

14. Four Questions for Small Group Discussion • Have reviews been useful for prevention? If yes, how have they been useful? • Have reviews been useful in strengthening practice? If yes, how have they been useful? • What types of collaboration are being utilized in reviewing and preventing child abuse fatalities? • How could fatality reviews be more useful to child welfare, law enforcement, and the courts?

15. Contact Information David Kelly: david.kelly@acf.hhs.gov Liz Oppenheim: loppenheim@wrma.com Ying-Ying T. Yuan: yyyuan@wrma.com