Kella Hatcher Executive Director NC Child Fatality Task Force Children’s Services Committee

1. The North Carolina Child Fatality Task Force & its role in the NC Child Fatality Prevention System Kella Hatcher Executive Director NC Child Fatality Task Force Children’s Services Committee January 9, 2019

2. Charge of State Child Fatality Prevention System [via Article 14 of NC Juvenile Code] • Develop a communitywide approach to child abuse and neglect; • Study and understand causes of childhood death; • Identify gaps in service delivery in systems designed to prevent abuse, neglect, and death; and • Make and implement recommendations for laws, rules, and policies that will support the safe and healthy development of our children and prevent future child abuse, neglect, and death.

3. Three main components to NC cfpsysteM

4. NC Child Fatality Task Force: Legislative study commission created via statute in 1991

5. Task Force Responsibilities • Study, analyze, and report on incidences and causes of child death • Develop a system for multidisciplinary review of child deaths • Receive and consider reports from State Team • Perform other studies and evaluations as needed in order to carry out its mandate • Submit annual report to the Governor and General Assembly with recommendations for changes to any law, rule, or policy that it has determined will promote the safety and well-being of children See G.S. §7B-1403, -1412

6. Three Task Force Committees work to create a yearly “Action agenda” Committees rely on CFTF members AND community volunteers.

7. Task Force Process Components

8. Sources of Issues Coming Before the CFTF • Issue application process • Data concern or deeper dive with certain child death data • State Team reports or recommendations • Study or stakeholder groups convened or endorsed by CFTF • Relevant national or statewide initiatives • Carry-over policy issues • Updates and education • Monitored items with relevant activity

9. Child Death Data • Released by the Task Force • Examined by the Task Force • Used to inform Task Force recommendations

10. Trends in North Carolina Child Death Rates by Race/Ethnicity (Ages 0-17 yrs) 1991-2017 • Rate for African American is twice that of White Non Hispanics over time • Disparity ratio: 2.2 Source: NC DHHS North Carolina State Center for Health Statistics

11. Source: NC DHHS North Carolina State Center for Health Statistics

12. North Carolina Child Deaths (Ages 0-17 yrs) by Cause in 2017 Source: NC DHHS North Carolina State Center for Health Statistics

13. Trends in North Carolina Resident Child Death Rates for Selected Natural Causes of Death (Ages 0-17 yrs) 2008-2017 Source: NC DHHS North Carolina State Center for Health Statistics

15. CFTF Accomplishments: a few highlights among many . . . • Graduated Driver License Program & various teen driver safety measures • Child passenger safety laws, school bus safety laws • Measures to combat opioid epidemic (improved CSRS, access to overdose reversal drug, safe disposal) • Infant Safe Surrender Law • Added conditions for newborn Screening • Strengthened Sex Offender Registry • Laws addressing smoke alarms & CO detectors • Law requiring child-proofing and labeling for E-cig nicotine liquid containers • Safe Sleep awareness • Support for programs providing child maltreatment prevention, diagnosis, and treatment A longer list of accomplishments is posted on the CFTF website: http://www.ncleg.net/DocumentSites/Committees/NCCFTF/in%20the%20spotlight/CFTF%20Accomplishments.pdf

16. More about the NC child fatality prevention system

17. Local Teams: CCPTs & CFPTs Most teams are blended See N.C.G.S §7B-1406

18. Support for Local Teams

19. State Child Fatality Prevention Team (State Team) • State Team is required to reviewdeaths of children attributed to child abuse or neglect or when decedent reported as abused or neglected • In practice, State Team also reviewsother types of child fatalities in NC that are investigated by the statewide Medical Examiner System • OCME Child Fatality staff review all child deaths investigated by the statewide medical examiner system • State Team also provides technical assistance to local teams, receives local team information, and makes reports and recommendations to Task Force. See G.S. §7B-1404, -05; State Team website: http://www.ocme.dhhs.nc.gov/nccfpp/index.shtml

20. BUT WAIT! THERE’S MORE. . . • Three organizations that are not part of the Article 14 statutes addressing the Child Fatality Prevention System have a connection to the system: • NC Child Fatality Review Team (DSS Intensive Reviews) • CCPT State Advisory Board • Federally required Citizen Review Panels

23. CFTF 2019 Recommendations to strengthen the Child fatality prevention system

24. The Journey . . . • CFTF Exec Committee’s identification of need (and statutory responsibility) to look at whole CFP System • Administrative item on 2018 CFTF Action Agenda to support CFP Summit and report back to CFTF • Two-day Child Fatality Prevention System Summit April 2018 • Post-Summit meetings with stakeholders; identification of three areas in need of focus: 1) system structure, 2) data, and 3) support and collaboration for child death review teams • Recommendations and findings in the Preliminary Reform Plan from the Center for the Support of Families • Consultation with national child fatality prevention experts, research on other states’ child fatality prevention systems • Discussion, alteration, and approval of draft proposed changes by CFTF Perinatal Health Committee Oct. 24 (CFP Stakeholders invited to participate), as well as discussion and approval by full CFTF December 3rd.

25. CFP System recommendations I. Implement centralized state-level staff with whole-system oversight in one location; OCME child fatality staff remains in OCME; form new Fatality Review and Data Group to be information liaison. II. Implement a centralized electronic data and information system that includes North Carolina participating in the National Child Death Review Case Reporting System. III. Reduce the volume of team reviews by changing the types of deaths required to be reviewed by fatality review teams to be according to certain categories most likely to yield prevention opportunities. IV. Reduce the number and types of teams performing fatality reviews by combining the functions of the four current types of teams into one with different procedures and required participants for different types of reviews and giving teams the option to choose whether to be single or multi-county teams. V. Formalize the 3 CFTF Committees with certain required members; expand CFTF reports to address whole CFP System and to be distributed to additional state leaders. Recommendations were also made to maintain current CFP funding and appropriate additional funds to support restructuring and to strengthen the system. • More detail on recommendations: https://www.ncleg.net/DocumentSites/Committees/NCCFTF/in%20the%20spotlight/CFTF%20Child%20Fatality%20Prevention%20System%20Recommendations%20for%202019.pdf

26. Illustration of Major Components of Proposed Child Fatality Prevention System Structure Child Fatality Task Force • Child Fatality Prevention Central Office Intentional Death Fatality Review & Data Group All CFP System support functions Unintentional Death Centralized Information System & National System Perinatal Health OCME Child Fatality (Chief ME & Staff) Local Teams (Single or Multi-County) One team for all types of reviews, but different procedures, required participants, and state-level assistance for certain types of reviews such as abuse/neglect intensive. Local Health Departments (they already support local CFPTs and have agreements with NC DPH) Potential specialized Infant Reviews Other causes of death Abuse neglect intensive reviews

27. Illustration of Flow of Information in Proposed CFP System Structure • CFP Central Office Staff • Manages data & info protocols; ensures teams are entering data, submitting reports • Analyzes team data and reports & produces reports of different types for different audiences including all local teams, Task Force, agency leaders, etc. • Information from Team Reviews • Enters info into data system • Produces appropriate reports for government groups; reports also sent to CFP Central office • Can retrieve data on their own team cases (only) from national system Fatality Review & Data Group (liaison of info between CFTF & local teams, OCME) Centralized Data & Information System (with participation in national system) • CFTF Committees • Perinatal Health • Unintentional Death • Intentional Death Local Government Groups (e.g. Boards of County Commissioners, Social Services & Public Health Boards) • OCME Data & Information • Contributes ME data into system & can retrieve data from system • Reports on ME data to FRD committee; can make reports directly to CFTF Governor, General Assembly, other state leaders Child Fatality Task Force

28. How to learn more • CFTF Website: https://www.ncleg.net/documentsites/committees/nccftf/homepage/ • CFTF 2019 Annual Report will have more details • Fact sheets for many legislative items available on CFTF website • Issue applications are typically due annually, in August or September • Meetings are public and meeting materials are on CFTF website • Join the CFTF email list (let me know: kella.hatcher@dhhs.nc.gov)