RHODE ISLAND'S CHILD DEATH REVIEW TEAM

Medicine and Health Rhode Island,  Sep 2005  by Laposata, Elizabeth,  Verhoek-Oftedahl, Wendy

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The death of a child is a singularly tragic event. Especially tragic is a death that could have been prevented.

Originally child death review teams were established to identify and to prevent child deaths caused by abuse and neglect. However, like a number of other states, Rhode Island has opted for a broader review process that addresses all preventable child deaths from a public health perspective. This approach not only addresses maltreatment-related deaths but also promotes better understanding and greater awareness of all the causes of child deaths.

HISTORY

In 1998 the Rhode Island Department of Children, Youth and Families (DCYF) established the Rhode Island Child Death and Injury Review Team (RICDIRT) to review deaths and serious injuries of children in the state. In 2004, the RICDIRT responsibilities were divided. The review of fatalities became the responsibility of the Rhode Island Child Death Review Team, organized under the Rhode Island Medical Examiners Office. Beginning with the review of calendar year 2000 child deaths, the Chief Medical Examiner has coordinated the Rhode Island Child Death Review Team.

MISSION AND GOALS

The RICDIRT is committed to the systematic multidisciplinary comprehensive review of child deaths. It is designed to provide detailed information beyond that available from analysis of death certificates alone. These findings can be used by community-based partners, legislators, and public policy makers to take action to prevent other deaths and improve the safety and well-being of all children. The ultimate goal of the team is to reduce the number of child deaths in the state.

OPERATION OF CHILD DEATH REVIEW TEAMS

Child fatality team members represent many disciplines, including investigation, Healthcare, or other service delivery.1,2

Even team members that might not consider themselves to be in a preventive role contribute to the identification of potentially premature death. For example, law enforcement officers know the causes of motor vehicle crashes. Prosecutors understand the legal remedies in child abuse and neglect. Pediatricians understand the challenges of health care delivery. The medical examiner knows the circumstances and causes of death. DCYF knows the complexity of monitoring the safety of children.

Teams approach the analysis of child fatalities systematically. 3'4 They start their review of deaths due to injuries by

* Knowing where and how often they occur;

* Understanding who is most at risk and why;

* Postulating effective interventions that might have immunized them or other children from harm; and

* Understanding that injuries to children do not just happen at random but are predictable and understandable, and, therefore preventable.

The team need not design and implement the prevention activity, but the team is the catalyst of information and can be key in connecting with crucial resources and community partners.

The team can also foster accountability as well as recognize and reward community efforts.

OPERATION OF THE RHODE ISLAND CHILD DEATH REVIEW TEAM

The RICDRT is a multidisciplinary team that reviews childhood deaths to identify risk factors and trends, and to inform prevention efforts. [Table 1] The Team is not a peer review of agencies or organizations, or of medical practice. It examines systems issues and potential preventability of deaths, not the performance of individuals. In Rhode Island, all deaths under 18 years of age regardless of cause must be reported to the Medical Examiners Office [Gen laws 4-7(2e)]. This allows for a complete database of all child deaths.

Beginning with the review of child deaths in 2000, Rhode Island child death review has been a two-step process. 5,6,7 First, the RICDRT conducts initial reviews of child deaths. second, the RICDRT conducts indepth case reviews based on interests identified from the initial reviews..

The initial child death review process is as follows:

1) Prior to team review, the details of each death are abstracted by the National Maternal and Child Health (MCH) Center for Child Death Review. A trained data manager abstracts the information, including autopsy, police, hospital, and social service records. The information is entered into the Rhode Island Child Death Review database. Ultimately, Rhode Island will participate with 16 other states to pilot the MCH Bureau National Child Death Review Surveillance System. Computerization of data will then be conducted using web-based software supported by the MCH Bureau National Child Death Review Program that will also enable de-identified Rhode Island data to be combined with de-identified data from other states for the initial phase of a National Child Death Review Surveillance System.

2) At the time of the RICDRT review meeting, the history and autopsy findings for each death are presented from the Medical Examiner's case summary and from the abstracted information compiled from Medical Examiner investigator reports, police reports, medical records, child protective services records, and interviews with witnesses and other involved parties.