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A Guide for Effective Child Death Reviews Developed by the Michigan Child Death Review Program Michigan Department of Human Services and the National MCH Center for Child Death Review Health Resources and Services Administration Michigan Public Health Institute Updated May 2005 Guide to Effective Reviews The Goal of Child Death Review is to understand Why children die and to take action to prevent other deaths. To Use this Guide This guide can be used as you review specific causes of child deaths. Use the guide to help determine what records should be brought to your meeting, what risk factors to evaluate, the types of services your team should ensure are provided, and evidence-based prevention activities your team may consider. Effective review team meetings require team members to: Come prepared with information on the deaths to be reviewed Share their information openly and honestly Seek solutions instead of blame At each case review, members should seek to answer: Is the investigation complete, or should we recommend further investigation? If so, what more do we need to know? Are there services we should provide to family members, other children and other persons in the community as a result of this death? Could this death have been prevented and if so, what risk factors were involved in this child’s death? What changes in behaviors, technologies, agency systems and/or laws could minimize these risk factors and prevent another death? What are our best recommendations for helping to make these changes? Who should take the lead in implementing our recommendations? Is our review of this case complete or do we need to discuss it at our next meeting? “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.” - Margaret Mead Additional copies may be downloaded at www.keepingkidsalive.org Effective Reviews - Natural Deaths to Infants Facts Services to Consider Natural deaths to infants comprise the largest group of Bereavement services. child deaths in the state, almost 50% of all deaths. These Specialized burial services for stillborn or fetal deaths. include deaths due to congenital anomalies, infants born Preconception and pregnancy planning. prematurely and of low birth weight, respiratory Specialized services for surviving siblings. complications, infections, and other medical conditions. Genetic counseling for certain congenital anomalies. Infant death rates are calculated differently than other child death rates. They are the number of deaths per Improvements to Agency Practices 1,000 live births. Much of prevention is closely related to agency practices The greatest numbers of natural deaths are of infants who surrounding maternal health. Many of these practices are die within the first 24 – 48 hours of life. Black infants are considered prevention and described in the next section. more than twice as likely to die in their first year than white infants. Effective Prevention Actions Many infant deaths can be prevented through Ensure that all women have available preconception care improvements to maternal prenatal health. and counseling and prenatal care that is acceptable, Prematurity refers to infants born at less than 37 weeks accessible and appropriate. gestation, and low birth weight refers to infants weighing Ensure that all women have postpartum care options less than five pounds, five ounces at birth. available that include pregnancy planning. Work with hospitals and providers to make sure that Records Needed every infant that leaves the hospital has a primary care Public Health birth records provider established. Health records for well and sick visits and immunizations Improve local provider knowledge of pre-conception Death certificates health care issues. Prenatal care records Improve emergency response and transport systems. Hospital birth records Provide maternal and infant support services to improve Emergency Department records the social/psychological environment for women and Any support services utilized, including WIC and families at risk. Family Planning Encourage the comprehensive assessment of risks due to Police reports STIs, substance abuse including alcohol, smoking, Prior CPS reports on caregivers domestic violence, depression, social support, housing, Home visitation reports employment, transportation, etc. by all local providers and perhaps as a local hospital delivery policy. Risk Factors Develop and distribute community resource directories to Prior pre-term delivery. raise awareness of where to go for help and services. Previous infant or fetal loss. Provide mentoring, support, outreach and advocacy at Inadequate prenatal care (late entry, missed the community level utilizing paraprofessionals, appointments). indigenous health workers and faith-based initiatives. Medical conditions of the mother. Develop systems to provide transportation and childcare - Maternal age (under 20, over 35) to women seeking prenatal care. - Infections, including sexually transmitted (STI) Coordination of care between programs and parts of the - Hypertension health care system. - Diabetes Forums to raise awareness of consumers, providers and - Poor nutritional status policy makers of infant mortality issues. - Obesity Local community/business/health care partnerships to - Short inter-pregnancy interval broaden the number of stakeholders. Poverty. Enhanced community education to include unplanned/ Substance, alcohol and tobacco use. unwanted pregnancy prevention, including teen Stressors and lack of social support. pregnancy prevention services and early detection of Less than 12th grade education. signs and symptoms of pre-term labor. Unintended pregnancy. Unmarried or lack of male involvement in pregnancy. For More Information Physical and emotional abuse of mother. National Fetal and Infant Mortality Review Program www.acog.com March of Dimes www.modimes.org Effective Reviews - Natural Deaths Ages 1 - 18 Facts Services to Consider Death from natural causes is the second leading cause of Bereavement services. mortality to children over one year of age, following Specialized services for surviving siblings. unintentional injuries. Crisis responses for friends of decedent, including in Cancer, congenital anomalies and cardiac conditions are schools. the top three causes of natural death. Burial payments for families needing financial assistance. Fatalities from illnesses such as asthma, infectious diseases and some screenable genetic disorders, under Improvements to Agency Practices certain circumstances, can and should be prevented. Were services in place for chronically ill children? Asthma affects approximately five million children a year Were referrals made and followed up for repeat health in the U.S. The asthma death rate for ages 19 years and care visits and other care? younger increased by 78% between 1980 and 1993, many Were efforts made to obtain full complement of available believe due to environmental conditions. public services for eligible families? Failure to seek medical care for ill children can be fatal in Was investigation coordinated with CPS and other some instances. agencies? Was death referred to medical examiner if medical neglect Records Needed was suspected? Public Health birth records Pediatric records for well and sick visits Effective Prevention Actions Death certificates Provide coordinated wrap-around services for chronically Hospital birth records ill children. Emergency Department records Develop community education campaigns surrounding Public Health immunization records chronic health problems in children, such as asthma. Names, ages and genders of other children in home Ensure that schools are provided sufficient information Police reports and training for children with chronic health problems. CPS reports on caregivers and child Conduct assessments and seek removal of suspected Home visitation reports environmental health hazards. ISD records, if applicable For More Information Risk Factors American Academy of Pediatrics Children with chronic health conditions or congenital www.aap.org anomalies. American Lung Association Exposure to environmental hazards, especially of www.lungusa.org vulnerable children. Easter Seal Society Non-compliance with prescribed treatment regimens. www.easter-seals.org Parental or caregiver failures to seek adequate medical March of Dimes attention. www.modimes.org Effective Reviews – Asthma Facts Services to Consider Asthma is one of the most common chronic diseases of Bereavement services for family and friends. childhood. Crisis responses for friends of decedent, including in An estimated 4 million children under age 18 have had an schools. asthma attack in the past 12 months. Burial payments for families needing financial assistance. Asthma fatalities can usually be prevented. The asthma death rate for ages 19 and younger increased Improvements to Agency Practices by 78% between 1980 and 1993, many believe due to Were referrals made and followed up on for health care environmental conditions. visits for poorly controlled asthma and other care? Failure to seek medical care for asthmatic children can be Were efforts made to obtain full complement of available fatal. public services for schools and eligible families? Even though asthma cannot be cured, it can almost Was investigation coordinated with CPS and other always be controlled. agencies? Was death referred to medical examiner if medical neglect Records Needed was suspected? Death certificates If the child was in foster care, were there asthma triggers Pediatric records for well and sick visits, including info on present in the foster home? medications prescribed, asthma management plan, pulmonary function testing, specialty referrals Effective Prevention Actions Emergency Department/EMS records Develop community education campaigns regarding Any support services, such as school asthma management childhood asthma. programs Ensure that schools are provided sufficient information CPS reports on caregivers and child and training to respond to students’ asthma attacks. Conduct assessments and seek removal of suspected Risk Factors environmental health hazards. Lack of steroid inhalers or peak flow meters Educate health care providers on the need to prescribe African-American and low-income children; children corticosteroids, the need for timely referrals to specialists, with allergies and the need to limit refills for rescue medications Children living in crowded conditions, which leads to without a physician visit or attention. increased exposure to allergens and infections Educate parents and children on the severity of asthma Exposure to environmental hazards such as tobacco and its dangers. smoke, air pollution, strong odors, aerosols and paint Develop system for pharmacies to notify practitioners of fumes excessive bronchodilator use by their patients. Non-compliance with prescribed treatment regimens Parental or caregiver failures to recognize seriousness of For More Information attacks and seek adequate medical attention American Academy of Pediatrics www.aap.org American Lung Association www.lungusa.org Centers for Disease Control and Prevention www.cdc.gov Allergy/Asthma Network Mothers of Asthmatics www.aanma.org Effective Reviews – Children with Disabilities Facts Services to Consider Based on underlying cause only, developmental Bereavement services for parents and other family disabilities are the 5th leading cause of non-traumatic members. death for children 1-14 years and 3rd leading cause for Burial payments for families needing financial assistance. children 15-19 years. Nine percent of all children have disabilities. Improvements to Agency/School Practices Child abuse is estimated to cause approximately 25% of Do professionals know how to appropriately manage and all developmental disabilities in children. respond to disability? Children with disabilities are at the greatest risk of burn- Are parents adequately educated to care for and manage related deaths and injury. disability and health safely, including use of medical Children with disabilities are abused at approximately equipment, and recognizing signs of distress and what twice the rate of children without disabilities. reaction is needed The most common form of homicidal event against Is there a team approach to identify and respond to risk children with cerebral palsy is starvation. factors of children with disabilities? Immobility is the single best predictor of mortality risk of Are there appropriate autopsy protocols for children with children with disabilities, followed by feeding ability. disabilities? Function, rather than diagnostic category, is most Do schools have effective information and training about predictive of early mortality. disability, and adhere to best practices in use of Positive Aspiration, constipation, dehydration and epileptic Behavioral Services? seizures are the four major health issues that can cause Do newborns with disabilities leaving hospitals have care death in people with developmental disabilities. The 1 st plans, service coordinators and follow-up plans? three can go unrecognized until major illness or death. Were parents of children with disabilities in poverty Children with disabilities may not be able to express referred to Medicaid, EPSDT and other free health discomfort or indicate they don’t feel well. insurance for children? It can be difficult to differentiate the disability from other Does child have access to effective medical care for signs of abuse. complexity of disability? Did parents have sufficient support, including respite Records Needed care? Autopsy reports Birth records if under age one Effective Prevention Actions Emergency Department Records Support parents adequately to provide safe, effective care. Police Reports Collaborate among disability agencies and child abuse Prior CPS reports on caregivers protection agencies. Any support services utilized Educate caregivers, schools and other professionals to Medical records and medication records recognize health danger signs. School records Teach children with disabilities fire safety and survival skills and develop emergency plans for them. Risk Factors Train parents of children with disabilities on subjects of Reduced mobility neglect and sexual abuse. Feeding difficulty Ban or closely regulate use of restraints for children with Feeding tube disabilities by schools, families and service agencies. Use of restraints Identify trends and direct training needs; recommend Quality of supervision / Multiple supervisors development and/or modification of provider policies; Competency of supervisor to manage disability modify state policies to address systemic issues that are Poorly controlled seizures identified during review. Prematurity and extreme prematurity Develop medical homes for children with disabilities Complex, uncommon medical issues using coordination of care model. Parents not trained to recognize symptoms For More Information Lack of medical continuity/follow-up by caretakers Easter Seal Society Lack of suitable childcare www.easterseals.com Unrecognized disability March of Dimes www.modimes.org Effective Reviews - Sudden Infant Death Syndrome Facts Services Sudden Infant Death Syndrome (SIDS) is the sudden Bereavement services for parents and other family death of an infant under one year of age, which remains members. unexplained after a comprehensive investigation. This Referral to Tomorrow’s Child for professional and peer must include an autopsy, examination of the death scene support. and review of the baby’s health history. Provision of cribs or beds for other children still in home. SIDS is a diagnosis of exclusion and can only be made if Safety assessment by CPS if neglect was suspected. there is no other possible cause of death. If the death Burial payments for families needing financial assistance. scene indicates there was a possibility of suffocation, SIDS Provide links to services such as family planning. should not be listed as the cause of death. Critical Incident Stress Debriefing for persons responding Most SIDS occurs to babies between two and four months to scene. old, during winter months. African American and American Indian SIDS rates are two to three times higher Improvements to Agency Practices than the white SIDS rate. Are investigations coordinated with medical examiners, The mechanism causing SIDS is still unknown, although law enforcement and CPS? many believe that SIDS occurs when an infant is at a Are autopsy protocols in place, which include a process vulnerable age, is exposed to environmental risk factors for sending scene investigation materials to the and has a neural defect that prevents the child from pathologist performing the autopsy? responding to oxygen depletion. Are comprehensive scene investigations conducted at the The National Back to Sleep campaign has reduced the place of death, as soon as possible, including scene SIDS rate by more than half since 1994. reenactments and interviews? Are referrals made for bereavement services? Records Needed at Review Are high-risk families with newborns and young infants Autopsy reports provided prevention services? Scene investigation reports and recreation photos Is a process in place to contact the Consumer Product Prenatal, birth and health records Safety Commission when faulty products could be Interviews with family members involved in causing a death? Child Care Licensing investigative reports EMS run reports Effective Prevention Actions Emergency Department reports Education at childbirth classes and in hospitals to Prior CPS history on child, caregivers and person expectant and new parents on safe infant sleep supervising child at time of death environments. Criminal background checks on person supervising the In-hospital assessments by nurses with parents to assess a child at time of death baby’s sleep environment when he/she goes home. Reports of home visits from public health or other Crib distribution programs for families. services Smoking cessation education and support for pregnant Any information on prior deaths of children in family and parenting women and other caregivers. Working with hospitals and providers to make sure that Risk Factors every infant that leaves the hospital has a primary care Infants sleeping on their stomachs. provider established. Soft infant sleep surfaces and loose bedding. “Back to Sleep” and other safe sleep campaigns. Maternal smoking during pregnancy. Specific messages targeted to families and childcare Second-hand smoke exposure. providers who traditionally practice stomach sleep. Overheating. Education to health care providers on giving guidance on Prematurity or low birthweight. SIDS risk reduction to parents and caregivers. Heavy or soft bedding and other objects near infant. Licensing requirements for childcare providers on safe Faulty design of cribs or beds. sleep environments and infant sleep positions. Other persons sleeping with child. Obesity, fatigue, drug or alcohol use by persons For more information supervising or sleeping with infant. The National SIDS Resource Center Poor supervision at time of death. http://www.sidscenter.org/ Family’s inability to provide safe sleep or play The American Academy of Pediatrics environment for infant. http://www.aap.org/ Consumer Product Safety Commission http://www.cpsc.gov/ Tomorrow’s Child/Michigan SIDS http://www.tomorrowschildmi.org/ Effective Reviews - Suffocation Facts Suffocation is caused by either: If hanging, child’s developmental age consistent with Overlay: a person who is sleeping with a child rolls activity causing strangulation. onto the child and unintentionally smothers the child. Family’s inability to provide safe sleep or play Positional asphyxia: a child’s face becomes trapped in environment for child. soft bedding or wedged or trapped in a small space Prior child deaths or repeated reports of apnea episodes such as between a mattress and a wall or couch by caregiver. cushions. Covering of face or chest: an object covers a child’s face Services or compresses the chest, such as plastic bags, heavy Bereavement and crisis services for family members and blankets or furniture. friends. Choking: a child chokes on an object such as a piece of Provision of cribs/other beds for children still in home. food or small toy. Safety assessment by CPS if neglect was suspected. Confinement: a child is trapped in an airtight place such Burial payments for families needing financial as an unused refrigerator or toy chest. assistance. Strangulation: a rope, cord, hands or other objects Critical Incident Stress Debriefing for persons strangle a child. responding to scene. Infants and toddlers are most often the victims. The majority of suffocations occur to infants while sleeping Improvements to Agency Practices in unsafe environments. Are investigations coordinated with medical examiners, It is often difficult to distinguish an unintentional law enforcement and CPS? suffocation from SIDS or a homicide. Autopsies and scene Are autopsy protocols in place? investigations are essential. Are comprehensive scene investigations conducted at Rates of infant suffocations are increasing as investigators place of death, as soon as possible, including scene better distinguish suffocation from SIDS. reenactments and interviews? Are referrals made for bereavement and crisis services? Records Needed at Review Are high-risk families with newborns and young infants Autopsy reports provided prevention services? Scene investigation reports and recreation photos Is CPS notified in cases of suspicious deaths? Interviews with family members Is a process in place to contact Consumer Product Safety Child Care Licensing investigative reports, if occurred in Commission if death involved consumer product? child care setting EMS run reports Effective Prevention Actions Emergency Department reports Education at childbirth classes and in hospitals to Prior CPS history on child, caregivers and person expectant and new parents on safe infant sleep supervising child at time of death environments. Child’s health history In-hospital assessments by nurses with parents to assess Criminal background checks on person supervising child at babies’ sleep environments. time of death Culturally competent public education campaigns on Reports of home visits from public health or other services safe infant sleep environments. Any information on prior deaths of children in family Crib distribution programs for needy families. Any information on prior reports that child had difficulty Education to professionals on risks of infant suffocation. breathing Notification to CPSC and continued product safety Downloaded information from apnea monitors recalls on choking and strangulation hazards. Licensing requirements for child care providers on safe Risk Factors infant sleep environments and sleep position. Unsafe infant sleep environment. Prone position of infant while sleeping. For More Information Heavy or soft bedding and other objects near infant. The National SIDS Resource Center Faulty design of cribs, beds or other hazards. http://www.sidscenter.org/ Other persons sleeping with infant. The American Academy of Pediatrics Obesity, fatigue, or drug or alcohol use by persons http://www.aap.org supervising or sleeping with infant/child. Consumer Product Safety Commission Poor quality of supervision at time of death. http://www.cpsc.gov/ Child’s ability to gain access to objects causing choking or Tomorrow’s Child/Michigan SIDS confinement. http://www.tomorrowschildmi.org/ Effective Reviews - Fires Facts Most fire-related deaths to children occur in house fires, Services and the cause of death is most often asphyxia due to Bereavement and crisis services for family members and smoke inhalation, not burns. friends. Toddlers, especially African American and American Provision of emergency shelter for surviving family Indian males, are most often the victims. members. The vast majority of fire deaths occur in low-income Safety assessment by CPS if neglect was suspected. neighborhoods. Burial payments for families needing financial assistance. Children playing with matches or lighters start most of Critical Incident Stress Debriefing for persons responding to the fires that kill children. scene. Young children tend to hide from the fire, making it Juvenile fire-setter counseling when appropriate. difficult for family members or rescue personnel to locate them. Improvements to Agency Practices Functioning smoke detectors are highly protective Are investigations coordinated with medical examiner, against fire fatalities. police, fire marshal and CPS? The risk of death in a fire increases significantly when a Are referrals made for bereavement and crisis services? supervising adult is intoxicated. Are high-risk families with young children provided prevention services? Records Needed at Review Do well-baby or other routine health visits include Autopsy reports questioning parents about smoke detectors? Scene investigation reports and photos Is there a process in place to contact Consumer Product Fire marshal reports that include source of fire and Safety Commission when faulty products lead to death? presence of detectors Do mental health providers routinely screen and provide EMS run reports treatment for child fire-setters? Emergency Department records Information on zoning or code inspections and Effective Prevention Actions violations Smoke detector distribution programs that are targeted in Prior CPS history on child, caregivers and persons low-income neighborhoods, providing non-removable, supervising child at time of death lithium batteries. Names, ages and genders of other children in home Legislation requiring installation of detectors in new and Criminal background checks on persons supervising existing housing, especially when combined with child at time of death multifaceted community education and detector give- Reports of home visits from public health or other aways. services Risk Watch or similar programs in schools, preschools and Any information on prior deaths of children in family child care settings to teach fire safety and home fire escape. Utilization of mobile “Smoke Houses” by fire departments Risk Factors to teach children how fires start, how fast they can spread, Lack of working smoke detectors in the home. and how best to escape a burning house. Poor quality of supervision at time of death. Codes requiring hard-wired detectors in new housing stock. Drug or alcohol use by supervising adults. Passage and enforcement of local ordinances regarding the Child’s ability to gain access to lighters, matches or inspection of rental units for fire safety, especially for the other incendiary devices. presence of working smoke detectors. Members of household falling asleep while smoking or leaving candles burning. For More Information No exposure of victim to fire safety education. Harborview Injury Prevention and Research Center: Lack or no practice of home fire escape plan. http://depts.washington.edu/hiprc/ Use of alternative heating sources, substandard United States Fire Administration: appliances or outdated wiring. http://www.usfa.fema.gov/safety/ Failure of property to maintain code requirements. National Fire Protection Association: Lack of prompt fire rescue response. http://www.nfpa.org/Education/index.asp National SAFEKIDS www.safekids.org Effective Reviews - Drowning Facts Improvements to Agency Practices Most drowning deaths to children occur when there is a Are investigations coordinated with medical examiner, lapse in adult supervision. police and CPS? Toddlers, especially males, are most at risk of Are referrals made for bereavement and crisis services? drowning. Are high-risk families with young children provided Babies most often drown in bathtubs; toddlers in pools; prevention services, including parenting skills and safety older children and teenagers in open bodies of water. concerns? Infants can drown in water less than five inches deep, Do well-baby visits include information about bathtub in less than five minutes. safety for infants? When adequate supervision is combined with Is there local enforcement of building codes for pool approved personal flotation devices, drowning fencing? occurrences are rare. Was there adequate emergency response and equipment for Most toddlers who drown in pools enter the water a water rescue? unseen and unheard by others. Effective Prevention Actions Records Needed at Review Strong support and local enforcement of building codes Autopsy reports regarding proper pool and pond enclosures. Scene investigation reports Placement of signage near bodies of water to warn of water EMS run reports dangers such as strong currents and drop-offs. Prior CPS history on child, caregivers and persons Public awareness campaigns and water safety classes for supervising child at time of death parents of young children, emphasizing constant adult Names, ages and genders of other children in home supervision and use of personal floatation devices. Information on zoning and code inspections and Children’s swim and water safety classes for children over violations regarding pools or ponds age four. Parent education at childbirth classes and well-baby visits Risk Factors on bathtub safety for infants. Lack of adequate adult supervision. Drug or alcohol use by supervising adults. For More Information Child’s ability to gain access to pools. The National Children’s Center for Rural and Agricultural Child not able to swim. Health and Safety: Lack of use of personal floatation devices. http://research.marshfieldclinic.org/children/Resources/ Drowning/drowning.htm Services National Center for Injury Prevention and Control (Centers Bereavement and crisis services for family members for Disease Control and Prevention): and friends. http://www.cdc.gov/ncipc/factsheets/drown.htm Safety assessment by CPS if neglect was suspected. Harborview Injury Prevention and Research Center: Burial payments for families needing financial http://depts.washington.edu/hiprc/ assistance. US Consumer Product Safety Commission: Critical Incident Stress Debriefing for persons http://www.cpsc.gov/cpscpub/pubs/chdrown.html responding to scene. National SAFEKIDS www.safekids.org Effective Reviews - Child Abuse and Neglect Facts Services Abusive Head Trauma: Most child abuse deaths are the Involving CPS in assessing the removal of remaining result of injuries to the head due to violent shaking, children from the home. slamming or striking the head. Bereavement services for parents and other family Blunt force injury to the abdomen: The second most members. common cause of child abuse fatality is from punches or Burial payments for families needing financial assistance. kicks to the abdomen leading to internal bleeding. Critical Incident Stress Debriefing for persons responding Other likely causes: Smothering, drowning and to scene. immersion into hot water. One-time event: Although children who die from Improvements to Agency Practices physical abuse have often been abused over time, a one- Are investigations coordinated with medical examiners, time event often causes a death. law enforcement and CPS? Common “triggers”: Caretakers who abuse their children Are autopsy protocols in place? usually cite crying, bedwetting, fussy eating and Are comprehensive scene investigations conducted at disobedience as the reason they lost their patience. place of death, as soon as possible, including scene Young children are most vulnerable: children under 6 reenactments and interviews? years of age account for four-fifths of all maltreatment Are referrals made for bereavement services? deaths; infants account for roughly half of these deaths. Are high-risk families with newborns and young infants Fathers and mothers’ boyfriends are the most common provided prevention services? perpetrators of abuse fatalities. Did mandatory reporters comply with requirements of Mothers are more often at fault in neglect deaths. child protection laws? Fatal abuse is often interrelated with poverty, domestic Were prior inflicted injuries identified and reported? violence and substance abuse. Did CPS conduct a full investigation and make The majority of children and their perpetrators had no appropriate referrals and recommendations? prior contact with CPS at the time of the death. It can be very difficult to investigate, identify and Effective Prevention Actions prosecute fatal child abuse. Training hospital emergency room staff to improve their ability to identify child abuse injuries and improve Records Needed at Review reporting to the appropriate agencies. Autopsy reports Providing an advisory on the mandated reporting of child Scene investigation reports and photos abuse and neglect to local human service agencies, Interviews with family members hospitals and physicians. Names, ages and genders of other children in home Case management, referral and follow-up of infants sent Child Care Licensing investigative reports home with serious health or developmental problems. EMS run reports Media campaigns to enlighten and inform the general Emergency Department records public on known fatality-producing behaviors, i.e., Prior CPS history on child, caregivers and person violently shaking a child out of frustration. supervising child at time of death Crisis Nurseries which serve as havens for parents “on Child’s health history the edge” where they can leave their children for a Criminal background checks on person supervising child specified period of time, at no charge. at time of death Intensive home visiting services to parents of at-risk Home visit records from public health or other services infants and toddlers. Any information on prior deaths of children in family Education programs for parents such as the Parent Any pertinent out-of-state history Effectiveness Training (P.E.T.), the Parent Nurturing Program and Systematic Training for Effective Parenting Risk Factors (S.T.E.P.). Younger children, especially under the age of five. For More Information Parents or caregivers who are under the age of 30. National Clearinghouse on Child Abuse and Neglect Low income, single-parent families experiencing major http://nccanch.acf.hhs.gov/ stresses. National Exchange Club Foundation Children left with male caregivers who lack emotional http://preventchildabuse.com attachment to the child. Prevent Child Abuse America Children with emotional and health problems. http://www.preventchildabuse.org Lack of suitable childcare. American Professional Society on the Abuse of Children Substance abuse among caregivers. http://apsac.fmhi.usf.edu/ Parents and caregivers with unrealistic expectations of child development and behavior. Effective Reviews - Motor Vehicle Deaths Facts Services Motor vehicle deaths include those involving cars, trucks, Bereavement and crisis services for family and friends. SUVs, bicycles, trains, snowmobiles, motorcycles, buses, Critical Incident Stress Debriefing for persons responding tractors and all-terrain vehicles. to scene. Victims include drivers, passengers and pedestrians. Young people ages 15-20 make up 6.7% of the total Improvements to Agency Practices driving population in this country, but are involved in Are investigations coordinated with medical examiners, 14% of all fatal crashes. Most of these crashes involve local and state law enforcement? recklessness, speeding or inattention. Are comprehensive scene investigations conducted, Sixteen-year-olds driving with one teen passenger are including type of restraint needed and used? 39% more likely to get killed than those driving alone, Was the primary cause of the incident determined? increasing to 86% with two and 182% with three or more teen passengers. Effective Prevention Actions Studies show that more than 80% of all infant and toddler Children Under 16 car safety seats are not properly installed or used. Lower Anchors and Tethers for Children (LATCH): Children weighing 40-80 pounds (ages 4-9) should be USDOT requires all new child safety seats meet stricter seated in booster seats, but most are not. head protection standards. Helmets can prevent the majority of bicycle-related Legislation linked with public education to increase fatalities. booster seat usage for children weighing 40 - 80 pounds. Child safety seat inspection programs: programs that Records Needed at Review train auto dealers, law enforcement officers and others to Autopsy reports provide on-site safety seat inspection and training. Scene investigation reports and photos Free or low-cost car safety seat distribution. Interviews with witnesses Bicycle helmet laws paired with free or reduced-cost EMS run reports helmets to children. State Uniform Crash Reports with road and weather Truck bed laws prohibiting children from riding in truck conditions at time of crash beds; KIDS AREN’T CARGO is an education campaign Emergency Department records discouraging truck bed riding. Blood alcohol and/or drug concentrations on driver Re-engineering of roads and improved signage. Previous violations such as drunk driving or speeding Children Over 16 Any out-of-state history Graduated Licensing Laws: including supervised Graduated Licensing laws and violations practice; crash and conviction free requirements for a Information on other crashes at the same location minimum of six months; limits on number of teen passengers; nighttime driving restrictions and manda- Risk Factors tory seat belt use for all occupants. Children Under 16 Teen Driver Monitoring Programs: Street Watch and Riding in the front seat of vehicles. SAV-TEEN marks teen cars and allow anyone observing Not using or improper use of child seats and seatbelts. poor driving habits to report them to law enforcement. Not wearing adequate safety equipment, especially Law enforcement either visits the teen’s home or reports bicycle helmets. the incident to the parents or owner of the car. Unskilled drivers of recreational vehicles, such as ATVs Driver’s Education: Customize local programs to and snowmobiles. emphasize most common risk factors, e.g., off-road Riding in the bed of a pickup truck. recovery, gravel roads, poor weather conditions. Young children playing in and around vehicles Seat Belts: Education to increase adolescent seat belt use Young children crossing streets without supervision. and primary seat belt enforcement laws. Children Over 16 Re-engineering of roads and improved signage. Exceeding safe speeds for driving conditions. Riding as a passenger in a vehicle with a new driver. For More Information Riding in a vehicle with three or more teen passengers. National Highway Traffic Safety Administration Driving/riding between 12 midnight and 6:00 a.m. www.nhtsa.dot.gov Not using safety belts appropriately. National SAFE KIDS Campaign www.safekids.org Alcohol use by drivers or passengers. Ford Motor Company – Boost America! Riding in the bed of a pickup truck. www.ford.com/en/goodWorks/community/booster Unskilled drivers of recreational vehicles, such as ATVs Seats.htm?source=rt&referrer=safety_childSafety and snowmobiles. DaimlerChrysler – Fit for a Kid www.fit4akid.org Effective Reviews - Suicides Facts Services Suicide is the third leading cause of death for adolescents, Bereavement services for parents and other family following motor vehicles and firearm homicides. More members. young people die from suicide than from cancer, heart Burial payments for families needing financial assistance. disease, AIDS, birth defects, stroke, pneumonia, influenza Critical Incident Stress Debriefing for persons responding and chronic lung disease combined. to scene. The methods used most often to complete suicide include School crisis response teams. firearms, hanging and poisoning. The risk for suicide is highest among young white males. Improvements to Agency Practices Adolescent males of all races are four times more likely to Are investigations coordinated with medical examiners, commit suicide than females. Adolescent females are law enforcement and Children’s Protective Services? twice as likely as adolescent males to attempt suicide. Are autopsy protocols in place for suicides? Are There appears to be an increase in rates for ages 12-14. toxicology screens done routinely? Males are more successful in their attempts because they Are comprehensive scene investigations conducted as most often use firearms. soon as possible, including interviews? Depression, coupled with significant precipitating events, Are referrals made for bereavement services? leads to most suicides in young persons. Some of these Are friends of the victims closely monitored for warning precipitating events may seem insignificant to adults, but signs of suicide in schools by teachers, administrators, are very serious to vulnerable teens. janitors, bus drivers, etc? The school setting has been identified as a critical place to recognize warning signs of suicide and to implement Effective Prevention Actions primary and secondary prevention activities. The Yellow Ribbon Suicide Prevention Campaign to help Cluster suicides, those committed by other teens youth identify places to get help when they or their following a friend’s suicide, are not uncommon. Any teen friends are troubled. suicide should trigger watches on other vulnerable teens. School gatekeeper training to help school staff identify and refer students at risk and respond to suicide or other Records Needed crises in the school. Autopsy reports, including toxicology screens Community gatekeeper/suicide risk assessment to train Scene investigation reports and photos community members who interact frequently with teens. Suicide notes General suicide education to target teens to help them Downloads of decedent’s computer understand warning signs and supportive resources. Interviews with family and friends Screening programs, including those in schools, to EMS run reports identify students with problems that could be related to Emergency Department records suicide, depression and impulsive or aggressive Prior CPS history on child, caregivers and person behaviors. supervising child at time of death Peer support programs to foster positive peer Child’s mental health history, if available relationships and competency in social skills among high- School records and/or school representative at meeting risk adolescents and young adults. Names, ages and genders of other children in home Crisis centers and hotlines. History of prior suicide attempts Restriction of access to lethal means of suicide, including Substance/alcohol abuse history removal of firearms in homes of high-risk teens. Any information on recent significant life events, Interventions after a suicide that focus on friends and including trouble with the law or in school relatives of persons who have committed suicide, to help If a firearm was used in the suicide, information on the prevent or contain suicide clusters and to help adolescents storage of the firearm and young adults cope effectively with the feelings of loss that follow the sudden death or suicide of a peer. Risk Factors Development of assessment tools for evaluating suicide Long term or serious depression. risk for students who are expelled from school or arrested Previous suicide attempt. for minor offenses. Mood disorders and mental illness. Substance abuse. For More Information Childhood maltreatment. Youth Suicide Prevention Program Parental separation or divorce. http://www.yspp.org/ Inappropriate access to firearms. National Yellow Ribbon Program www.yellowribbon.org Interpersonal conflicts or losses without social support. National Strategy for Suicide Prevention Previous suicide by a relative or close friend. www.mentalhealth.org/suicideprevention Other significant struggles such as bullying or issues of Suicide Prevention Resource Center sexuality. www.sprc.org Effective Reviews - Teen Homicides Facts Services to Consider Youth homicides represent the greatest proportion of all Bereavement services. firearm deaths. Each day in the U.S., firearms kill an Neighborhood-based crisis intervention. average of 10 children and teens, even though the number Witness protection services. of teens killed by firearms in the U.S. has dropped by 35% in the past four years. Improvements to Agency Practices In 2000, the Youth Risk Behavior Surveillance Survey Are comprehensive investigations conducted on all youth reported that almost one-fifth of the 10th and 12th graders homicides? reported that they had carried a firearm within the Are crime surveillance efforts targeted to neighborhoods previous 30 days for self-defense or to settle disputes. with high rates of teen violence? Youth homicide is mostly a serious problem in large Do schools have policies in place to address threats made urban areas, especially among black males. Homicides to students? are the number one cause of death for black and Hispanic Are witnesses to violence provided appropriate services? teens. When socio-economic status is held constant, differences Effective Prevention Actions in homicide rates by race become insignificant. Intensive, early intervention services for high-risk Homicides are usually committed by casual parents. acquaintances of the same gender, race and age, using Targeted activities in neighborhoods with high homicide inexpensive, easily acquired handguns. rates, including: Drug dealing and gang involvement are often the cause of - Enhanced police presence and gun deterrence in hot disputes leading to homicides. spots. The majority of firearm homicides occur in small pockets - Involvement of political leaders. of large cities. - Widespread mobilization of neighbors and community members. Records Needed - After-school recreation programs. Scene investigation reports - Neighborhood Watch. Police and crime lab reports Interdiction of illegal guns and focused prosecution of CPS histories on family, child and perpetrators gun offenders. Names, ages and genders of other children in home Dropout prevention programs and alternative education Ballistics information on firearms opportunities. Prior crime records in neighborhood Mentoring, therapy and bullying prevention support Juvenile and criminal records of teen and perpetrators programs. Interviews with witnesses Multi-systemic therapy for troubled youth. Information from gang squad For more information Risk Factors Johns Hopkins Center for Gun Policy and Research Easy availability of and access to firearms. www.jhsph.edu/gunpolicy/ Youth living in neighborhoods with high rates of poverty, Department of Justice social isolation and family violence. http://www.usdoj.gov/youthviolence.htm Youth active in drug and gang activity. Early school failure, delinquency and violence. Youth with little or no adult supervision. Prior witnessing of violence.
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