THE NORTH CAROLINA CHILD FATALITY TASK FORCE ITS

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

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.

THREE MAIN COMPONENTS TO NC CFP SYSTEM Local Teams State Team Task Force

NC CHILD FATALITY TASK FORCE: LEGISLATIVE STUDY COMMISSION CREATED VIA STATUTE IN 1991 The “policy arm” of the State’s Child Fatality Prevention System 35 Members: Does NOT review individual cases 20 Appointed; 11 Ex Officio (State agency & community leaders, experts in child health & safety, 10 legislators)

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. § 7 B-1403, -1412

THREE TASK FORCE COMMITTEES WORK TO CREATE A YEARLY “ACTION AGENDA” Intentional Death Prevention Committees rely on CFTF members AND community volunteers. Perinatal Health Full CFT F Unintentional Death Prevention

TASK FORCE PROCESS COMPONENTS Public meetings between legislative sessions Committees propose recommendations to full Task Force Stakeholder or work groups may be convened to address or examine in-depth a particular issue to bring more information back to the CFTF Ongoing information sharing and collaboration among experts and community partners

SOURCES OF ISSUES COMING BEFORE THE CFTF Issue application process Data concern or deeper endorsed by CFTF Relevant national or dive with certain child death statewide initiatives data Carry-over policy issues State Team reports or Updates and education recommendations Monitored items with Study or stakeholder relevant activity groups convened or

CHILD DEATH DATA Released by the Task Force Examined by the Task Force Used to inform Task Force recommendations Good Data Informe d Policymakers Good Polic y

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

Child Deaths by Age Group, 2017 [CATEGOR Y NAME], 11. 0% [CATEGORY NAME], 8. 8% [CATEGORY NAME], 6. 0% [CATEGORY NAME], 9. 1% Source: NC DHHS North Carolina State Center for Health Statistics [CATEGORY NAME], 64. 9%

North Carolina Child Deaths (Ages 0 -17 yrs) by Cause in 2017 [CATEGORY NAME], [VALUE]% [CATEGORY NAME], [VALUE]% Source: NC DHHS North Carolina State Center for Health Statistics [CATEGORY NAME], [VALUE]%

Trends in North Carolina Resident Child Death Rates for Selected Natural Causes of Death (Ages 0 -17 yrs) 2008 -2017 25. 0 20. 0 15. 0 Death per 100, 000 Resident Children 10. 0 5. 0 0. 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Birth Defects 10. 3 9. 9 8. 7 8. 6 9. 0 7. 2 6. 5 8. 1 8. 9 7. 5 Perinatal Conditions 23. 4 18. 8 20. 1 19. 2 20. 8 21. 1 21. 0 19. 7 20. 0 Illnesses 13. 2 12. 2 13. 0 10. 9 11. 1 11. 7 11. 4 11. 9 11. 8 11. 0 Motor Vehicle 5. 5 5. 0 4. 4 4. 3 4. 7 3. 8 4. 2 3. 6 4. 4 4. 3 Source: NC DHHS North Carolina State Center for Health Statistics Other Accidents 5. 6 4. 0 4. 6 4. 7 4. 3 4. 2 3. 5 4. 3 3. 3

CFTF ACCOMPLISHMENTS: A FEW HIGHLIGHTS AMONG MANY. . . Graduated Driver License Program & Strengthened Sex Offender Registry 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 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/Document. Sites/Committees/NCCFTF/in% 20 the%20 spotlight/CFTF%20 Accomplishments. pdf

MORE ABOUT THE NC CHILD FATALITY PREVENTION SYSTEM

LOCAL TEAMS: CCPTS & CFPTS CCPT Most teams are blended Must review deaths involving suspected abuse or neglect where there was CPS involvement/report within previous 12 mos. , as well as selected active CPS cases May review “additional” types of deaths CFPT Reviews “additional” types of deaths when CCPT determines it will not review additional cases See N. C. G. S § 7 B-1406

SUPPORT FOR LOCAL TEAMS CCPTs v. County DSS Directors provide general support, procedures, training, reporting, etc. v. NC Division of Social Services has ongoing responsibility for training materials for local CCPTs (a CCPT Consultant in NC DSS supports this training) v A CCPT State Advisory Board was formed by NC DSS and it facilitates CCPT reporting CFPTs v. Local Health Department Directors distribute procedures, maintain records, provide staff support, facilitate reports, etc. v. A Team Coordinator at NC DPH § provides general support, procedures, training, reporting § provides statistical information on child deaths to CFPTs § Receives and sends reports from CFPTs § evaluates impact of local efforts

STATE CHILD FATALITY PREVENTION TEAM (STATE TEAM) State Team is required to review deaths of children attributed to child abuse or neglect or when decedent reported as abused or neglected In practice, State Team also reviews other 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. § 7 B-1404, -05; State Team website: http: //www. ocme. dhhs. nc. gov/nccfpp/index. shtml

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

CFTF 2019 RECOMMENDATIONS TO STRENGTHEN THE CHILD FATALITY PREVENTION SYSTEM

The Journey. . . Ø CFTF Exec Committee’s identification of need (and statutory responsibility) to look at whole CFP System Ø Administrative item on 2018 CFTF Action Agenda to support CFP Summit and report back to CFTF Ø Two-day Child Fatality Prevention System Summit April 2018 Ø 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 Ø Recommendations and findings in the Preliminary Reform Plan from the Center for the Support of Families Ø Consultation with national child fatality prevention experts, research on other states’ child fatality prevention systems Ø 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 3 rd. 24

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. More detail on recommendations: https: //www. ncleg. net/Document. Sites/Committees/NCCFTF/in%20 the%20 spotlight/CFTF%20 Child%20 Fatality%20 Prevention%20 Syst Recommendations were also made to maintain current CFP funding and appropriate em%20 Recommendations%20 for%202019. pdf 25

Illustration of Major Components of Proposed Child Fatality Prevention System Structure Child Fatality Prevention Central Office All CFP System support functions Fatality Review & Data Group Centralized Information System & National System 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. Abuse neglect intensive reviews Intentional Death Unintentional Death Perinatal Health Local Teams (Single or Multi-County) Potential specialized Infant Reviews Child Fatality Task Force Other causes of death OCME Child Fatality (Chief ME & Staff) Local Health Departments (they already support local CFPTs and have agreements with NC DPH) 26

Illustration of Flow of Information in Proposed CFP System Structure 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 Local Government Groups (e. g. Boards of County Commissioners, Social Services & Public Health Boards) 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. Fatality Review & Data Group Centralized Data & Information System (liaison of info between CFTF & local teams, OCME) (with participation in national system) 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 CFTF Committees • Perinatal Health • Unintentional Death • Intentional Death Child Fatality Task Force 27

HOW TO LEARN MORE CFTF Website: https: //www. ncleg. net/documentsites/committees/nccftf/homep age/ 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: