Models of Review Copyright Michigan Public Health Institute September
2005
Child
death review programs typically will fit one of four different models.
The models vary by what core functions they perform, by whether reviews
are conducted at the state or local level, by the types of deaths they
review and by where their authority lies.
1.
Local
only reviews of individual cases, state reviews of local findings and state
and local responses to findings.
A
state agency provides oversight and coordination to a network of local
review teams. The state provides protocols or guidelines for local reviews,
with varying degrees of authority. States usually provide training and
technical assistance to their local team members and have a state CDR coordinator
staff position.
Most
reviews are conducted at the local level and recommendations are made for
improvements to local policies and practices. Prevention initiatives are
implemented locally. Local review teams
may serve county, city and/or regional
jurisdictions and the agency coordinating
the local teams varies. These teams usually
submit case review reports to a state agency
or state CDR program office. Then a state
advisory team reviews the aggregate or
individual findings of local teams and
makes recommendations for improvements
to state policies and practices. Most states
using this method produce an annual report
with child mortality data, CDR findings
and recommendations. States utilizing this
approach may focus on child abuse deaths
or on all preventable deaths.
States
vary as to whether local teams receive funding for reviews, but in all
but a few states, they do not. States also vary in whether local reviews
are mandated or are voluntary. Teams may also have sub-committees reviewing
specific causes of deaths and report these findings to their local or state
CDR team.
Most
review meetings are held as Retrospective
Reviews.
These usually take place after the investigation is mostly completed and
case information is readily available. Some teams have Immediate
Response Reviews
that typically occur shortly after a death, usually of those that are unexpected
or unexplained. Using this method, the team is able to discuss case information
immediately, thereby affecting the processes and procedures used during
the active investigation of a child death. This type of review may also
assist protective services in their work to protect other children involved.
Because immediate response review meetings are unscheduled, the team coordinator
usually contacts each team member to arrange these reviews. Teams should
establish criteria to identify deaths that require immediate response reviews.
Often only a select sub-group of the full team will participate in these
types of reviews. If a team chooses an immediate response review but has
standing meeting dates for retrospective reviews as well, then it is likely
that the case will go through both types of review. In this way, the CDR
process acts as a tool for coordinating death investigations and delivery
of services, as well as a source of information for identification of risk
factors and prevention of other deaths in the future.
2.
State
and local review of individual cases and state and local response to findings.
A
state-level committee reviews certain types of deaths or a representative
sample of cases, while local teams review cases independent of the state
team. There may be little or no coordination between the local and state
reviews or the state may review the local findings. The local review teams
may not operate under mandated or suggested state guidelines. Local teams
rarely receive state funds for their reviews. As with the other approaches,
the agency lead varies by jurisdiction.
3.
State
only reviews of individual cases and state-level responses to findings.
A
state-level CDR committee reviews child death cases and issues a state-level
report of findings, and no community reviews take place. These review panels
usually involve state agency representatives. Most state-level reviews
started as child abuse reviews but some have expanded into other preventable
causes of death. In a number of states, comprehensive case records are
made available to an abstractor who prepares the case for the review team.
In other states, agencies bring their own records to the review. The types
and numbers of deaths reviewed usually represent only a proportion of all
deaths in the state.
A
variation of this model is that a state agency may have an internal review
team comprised of their own agency representatives. In this model, the
deaths reviewed are usually of children that were in the care and custody
of that agency, for example, deaths of children in foster care. The state
committee may also serve as the state’s Child Abuse Prevention and Treatment
Act (CAPTA) mandated Citizens Review Panel (CRP) and conduct case reviews
or review local case reviews of child abuse deaths.
4. Local
only review of individual cases and local response to findings.
These
teams operate independently of the state, although in some cases a state-level
person may help to bring some of the teams together for training and/or
technical assistance. Reviews are conducted in city or county jurisdictions.
Some teams issue written reports of their findings.
