• For more information please review the Delaware Child Death Review Legislation

Reports

Annual Reports

• Child Death, Near Death and Stillbirth Commission Consolidated Annual Report for Fiscal Year 2008 and Fiscal Year 2009
• Child Death, Near Death and Stillbirth Commission Consolidated Annual Report (2003, 2004, 2005, 2006, 2007)
• Child Death, Near Death and Stillbirth Commission Annual Report (2003)
• Child Death and Stillbirth Commission Consolidated Annual Report (2000, 2001, 2002)
• Delaware Child Death and Stillbirth Commission 1996 Annual Report

General Reports

• Child Death, Near Death, Stillbirth Commission/Child Protection Accountability Joint Commission: Final Report of the Multi-Disciplinary Use of History in Decision Making Subcommittee, April 11, 2008
• Reducing Infant Mortality in Delaware, May 2005
• The Fetal and Infant Mortality Review Process in Delaware: Findings from the Pilot Study and Lessons Learned about Implementing a Statewide FIMR, August 2005
• Compilation of Delaware's Child Protection Issues and Recommendations from Child Abuse/Neglect Death and Near Death Case Reviews, June 30, 2009

Associations

• Child Protection Accountability Commission
• Delaware Healthy Mother Infant Consortium http://www.dhss.delaware.gov/dph/chca/imdhmichome.html

Mortality Statistics

• Delaware Child Mortality Data, 2002
• Delaware Child Mortality Data, 2003
• Delaware Child Mortality Data, 2005
• Delaware Child Mortality Data, 2006

Delaware’s child death review process was established by legislation passed on July 19, 1995, after a pilot project showed the effectiveness of such a review process for preventing future child deaths. The legislation established the Child Death Review Commission, which has the power to create up to three regional Review Panels, establishes confidentiality for the reviews, and provides the Commission with the ability to secure pertinent records. In addition, it provides protection to members of the Commission and regional Review Panels from claims, suits, liability and damages, and any other recourse, civil or criminal. The state allocated funding (Fiscal Year 05) for three full time employees to operate the program.  Part of this effort was to develop a strong collaboration with the Child Protection Accountability Commission to satisfy CAPTA requirements for near death reviews.  In Fiscal Year 06, three FIMR (fetal infant mortality review) positions were allocated to CDNDSC. The CDNDSC program is housed out of the Administrative Offices of the Court for administrative purposes only.  An executive committee of the Delaware Child Death, Near Death and Still birth Commission supervises the program.

The Commission has established three panels. The New Castle and Kent/Sussex Review Panels review all non-child abuse or neglect deaths. The Child Abuse/Neglect Review Panel reviews deaths and near deaths due to child abuse/neglect statewide. Each of the three panels conducts monthly child death reviews. The Commission has met at least quarterly to review and approve the work of the Panels. The CDNDSC statute was amended in 2002, changing the name from the Delaware Child Death Review Commission to the Child Death and Stillbirth Commission. Another significant legislative change in 2002 added the expedited review process for child death due to abuse and neglect. Deaths involving abuse and/or neglect are reviewed within six months (this timeframe was a statute change in FY08) 2 of a report to the Commission, notwithstanding unresolved criminal charges. In 2004, the statute was amended a second time to change the Commission’s name to the Child Death, Near Death and Stillbirth Commission, among other updates. For instance, the scope of infant review was changed from 27 weeks’ gestation to 20 weeks’ gestation. Also, the statutory change required the Commission to investigate and review all the facts and circumstances of the death or near death3 of an abused and/or neglected child within three months of notification of said child. The amended statute also required that system-wide recommendations arising from an expedited review of a death or near death due to child abuse or neglect be made to the governor and General Assembly, as well as any members of the public requesting the recommendations, within 20 days of the completion of such investigation and review. In addition, the chair of the Child Protection Accountability Commission (CPAC) was added as a member of the CDNDSC and it was legislated that the two Commissions would meet at least annually to discuss recommendations and system improvements. Finally, a fiscal note was attached to the 2004 legislation in order to fund three staff positions dedicated to supporting the Commission. In fiscal year (FY) 2005, CDNDSC worked in collaboration with the Division of Public Health (DPH) to implement a Fetal Infant Mortality Review (FIMR) pilot project under the leadership of the Governor’s Infant Mortality Task Force. In FY2006, FIMR’s budgetary positions were placed with the CDNDSC. These three positions include a registered nurse III (FIMR Program coordinator), senior medical social worker, and an administrative specialist.

Delaware reviews the deaths of children under the age of 18, near deaths of abused and/or neglected children and stillbirths occurring after at least 20 weeks of gestation.  Cases not due to abuse or neglect are not reviewed if court proceedings are pending.  Child maltreatment deaths and near deaths now go through an expedited review process and a final review process after the prosecution is finalized.  This is done in an attempt to alleviate any immediate system concerns that may have led to the system failing the child.  A near death is defined as a child in serious or critical condition as a result of child abuse or neglect as determined by a physician.

The Commission's mission is to safeguard the children of Delaware by examining the deaths of children under the age of 18.

Standardized data reporting forms are completed for all reviews. This is required by state policy. CDNDSC utilizes the national child death data tool for data entry.  Our Fetal Infant Mortality Review program utilizes the database, Baby Abstracting System and Information NETwork (BASINET), supported by Go Beyond, L.L.C.  Data is used from both databases to complete the annual report, which includes trends and recommendations. The Delaware CDNDSC program has access to state vital statistics. Delaware CDNDSC receives death certificates, fetal death certificates and birth information on all children from Delaware's Vital Statistics.

CDNDSC statute requires that an annual report be produced by the Commission.  However, due to fiscal constraints this has not been produced yearly.  The report is distributed to public officials and interested citizens.  The recommendations from the expedited reviews of abuse/neglect cases are immediately sent to the Governor, General Assembly, CDNDSC and the Child Protection Accountability Commission to satisfy CAPTA requirements.

Abusive Head Trauma Program

After CDNDSC reviewed 13 deaths and near deaths involving abusive head trauma, the need for preventive parent education on abusive head trauma was demonstrated. CDNDSC partnered with Prevent Child Abuse Delaware to form a comprehensive Parent Education Abusive Head Trauma Program. After review of nationwide parent education programs, Delaware selected an evidence-based model6 from Pennsylvania. When replicated in other states, this program has demonstrated a reduction in the number of infant abusive head trauma cases. The Delaware program was made possible by a grant from AstraZeneca. The Delaware program has a nurse educator train all of the nursing staff in the birthing hospitals within the state. After training, the hospital nursing staff will show each mother and father or significant other a 10- minute DVD before they are discharged from the hospital. The DVD shows a father who becomes overwhelmed by his baby’s crying and shakes the baby. The results of shaking a baby are listed and include the possible outcomes of death for the baby and arrest for the father. After watching the DVD, the parents will sign a form stating that they watched the DVD and have the voluntary opportunity to list their phone number for a follow-up phone call, which is made by a social worker six to seven weeks after the baby is born. If the parent needs additional support at the time of the phone call, appropriate referrals and resources will be given to the parent. This six- to seven-week period has been shown to be the peak of an infant’s crying and, by extension, the timeframe of greatest risk for abusive head trauma. Prevent Child Abuse Delaware will complete the research gathered from the initial follow-up phone calls to determine the efficacy of the program. If a child has been abused, this will be reflected through medical record abstraction by CDNDSC at the Child Abuse and Neglect Panel. This training will be implemented in the fall of 2009.

Child Abuse Identification and Reporting Guidelines for Delaware Medical Providers

In FY2009, CPAC’s Abuse Intervention Subcommittee, through its Medical Subcommittee, finalized the development of and launched its training program Child Abuse Identification and Reporting Guidelines for Delaware Medical Providers. This training was developed as a direct result of 11 cases of death and near death in which medical providers saw the child prior to the death or near death and failed to diagnose and/or report child abuse and neglect. The inaugural training was co-presented by a local physician and a Division of Family Services (DFS) staff member with great success on March 24, 2009, at Kent General Hospital to doctors, nurses, and social workers. CDNDSC, the training facilitator, has received a small grant to facilitate ongoing training throughout the state. In FY2010, CDNDSC hopes to continue to schedule most hospitals and private family practices for this training.

Infant Safe Sleeping Practice Subcommittee

The Infant Safe Sleeping Practice Subcommittee was created in FY2006 after the Commission reviewed 57 infant and child sleep-related deaths during fiscal years 2003–2007. The subcommittee, a community action team, immediately went to work to address this significant problem in Delaware. During July 2007, the subcommittee embarked on a media campaign to increase awareness of safe sleeping practices. This campaign included exterior and interior prevention messages on DART buses throughout the state. CDNDSC received a grant from the Delaware SIDS (Sudden Infant Death Syndrome) Affiliate to fund this campaign. Public service announcements were recorded at no cost from B101 as a community project and sent to the local Delaware Valley radio stations. The executive director of CDNDSC was interviewed for the B101 Women’s File segment on infant safe sleeping practices. The strong visual images from this campaign led to the development of posters and billboards with the same images. Through collaboration with the Delaware Healthy Mother Infant Consortium and the Division of Public Health, 4,000 posters were developed in English and Spanish and distributed to licensed daycares throughout the state.

Delaware has a variety of protocols in place including a procedure manual and policies.  All procedure and protocols must be voted upon by the Commission prior to implementation.

CDNDSC staff continue to provide training to the panels on an as needed basis.  Recently, the Child Abuse/Neglect panel was given vicarious traumatization training in December 2009. The CDNDSC sponsored, together with the Child Protection Accountability Commission (CPAC), a multidisciplinary conference in May 2008. The title of the conference was Protecting Delaware’s Children. This two-day conference was geared toward the multidisciplinary team professional involved in law enforcement, investigation, child fatality review, prosecution, treatment, and the prevention of child abuse. This conference was a great success, with more than 400 participants, including judges, attorneys, advocates, service providers, law enforcement officials, medical providers, and others. The 400 participants who attended the Protecting Delaware’s Children conference were afforded opportunities to learn, share, and grow along with representatives from every child welfare discipline in Delaware during the 25 workshops offered. Of those speakers imparting their research, wisdom, and insights through the conference workshops, almost half were national experts in their field, with the balance being Delaware’s experts in the First State’s child welfare system. The pairing of the national and local perspectives fostered information sharing, collaboration, and ingenuity over the course of the two-day conference.