Child deaths from preventable or intentional causes have been the impetus for child death review teams (committees) worldwide. In the United States alone, an estimated 1,400 children died as a result of abuse or neglect in 2002. The majority of these children were under the age of 4. Child death reviews provide information on the underlying dynamics of child abuse and neglect cases, thereby offering the best opportunity for developing prevention interventions. By reviewing cases, the team endeavors to identify gaps or breakdowns in systems providing service to the child and family. Child death reviews can also be effective in reducing the incidence of accidental deaths involving children, and many of the reviews in the United States have now widened to include preventable deaths not caused by physical abuse or neglect. A death is considered preventable if an individual or the community could have done something that would have changed the circumstances that led to the death. Child death reviews have helped to inform policy and legislation in areas such as child physical abuse and neglect, shaken baby syndrome, abandoned infants, sudden infant death syndrome (SIDS), daycare licensing, child car seats, graduated driver’s licensing, suicide prevention, smoke detectors, and fire-retardant clothing.
Background
Child death review teams date back to the late 1970s when Los Angeles, California; North Carolina; and Oregon created teams to better identify and respond to child fatalities related to abuse and neglect. For these communities and others, the awareness that the statistics they had available about child deaths offered little in the way of understanding the risk factors or circumstances that led to the death, or what could be done to prevent a death, prompted initiatives for improvement. In addition, the growing concern about the accuracy of SIDS findings led to an awareness of the need to understand how deaths were being investigated and whether services provided to children and families were adequately focused on child safety. The first review teams uncovered important indicators of maltreatment in cases that had been ruled as accidental or unintentional deaths. In 1990, a Missouri study concluded that child deaths due to maltreatment were grossly underreported and, as a result, this state became the first to enact a law requiring multidisciplinary review of child deaths involving children under the age of 15. Since that time, teams have developed in 50 states in the United States as well as nine Canadian provinces, parts of New Zealand, Australia, and South Africa. The scope of the reviews has broadened, from identifying and focusing on fatalities that are a result of maltreatment to understanding all causes of death and recommending improvements in all areas of child health and safety. Addressing system failures, particularly in abuse and neglect fatalities, is still a critical function of child death review teams.
Major Components Of Child Death Reviews
Purpose And Goals
Child death reviews examine the circumstances surrounding child deaths to ensure that (a) there is accurate and unified reporting; (b) there is improved agency response to child deaths from the child protective sector; (c) there are improved criminal investigations and prosecutions; (d) there are improvements to other community services, including better communication between service sectors and better coordination of services; (e) the barriers to services are identified; (f) there are improvements to legislation or policies that protect children; and (g) there is increased public awareness of the issues related to child deaths.
Models
Each jurisdiction has its own model for reviewing deaths. Common elements of these models typically include the following: (a) having both state (or provincial) and local teams that review individual cases; (b) having a set protocol for identifying cases to be reviewed; (c) reviewing all available records, including medical records, coroner reports, police records, child protection files and any internal agency death reviews conducted, and other sources as deemed relevant to the case; (d) having protocols for confidentiality; (e) having computerized databases for gathering and analyzing information; (f) holding child death investigation and child death review meetings; and (g) providing annual reports on state or provincial findings. Most jurisdictions have the review team’s mandate written into law or government regulations.
Types Of Deaths Reviewed
Each jurisdiction has its own set of criteria for flagging child death cases for review, depending on the size of the jurisdiction and the available resources. All reviews include child death as a result of homicide, suicide, neglect, or cases in which the death is unexplained. Additionally, some jurisdictions target a review of all deaths in which child protection services have been involved within a year prior to the death. Many of the reviews consider deaths of children under the age of 18; however, some only review the deaths of younger children.
Composition Of The Review Team
Typically the case review team is a multidisciplinary one that includes medical examiners and health care professionals, law enforcement and prosecuting lawyers, and child protection experts. Some teams also include representatives from schools, mental health agencies, and crisis services.
Future Considerations
National studies conducted in both Canada and the United States have identified concerns with respect to child death review processes lacking uniformity across states or provinces. This lack of uniformity makes it impossible to compare programs in terms of effectiveness in preventing deaths or to identify trends and patterns of child deaths at a national level. These studies have identified the need for a national protocol for reviewing child deaths that would include (a) determining standard eligibility criteria for cases being reviewed; (b) developing criteria for gathering records and information and using standard data collection forms; (c) developing standard criteria for conducting reviews, including the composition of the review team, the purpose and scope of the reviews, the funding of review processes, and the development of standards criteria for determining whether a death will be deemed intentional, accidental, or due to abuse or neglect; and (d) annual reporting that identifies trends or patterns of child deaths at a national level. In addition, the integration of other review processes, such as domestic violence fatality reviews, could serve to strengthen prevention efforts for children given the overlap of child abuse and domestic violence.
Bibliography:
- British Columbia Coroners Service Child Death Review. (2005).
- Annual report. Victoria, BC: Ministry of Public Safety & Solicitor General. Durfee, M., Durfee, D., & West, M. (2002).
- Child fatality review: An international movement. Child Abuse & Neglect, 26, 619–636. State Child Death Review Council. (2005). Child deaths in Sacramento: Attorney General of California.
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