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 September 12, 2018

The Child Fatality task Force is part of a larger statewide child fatality prevention system Every county in NC participates in the CFP System; every county DSS has a role.

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

Primary process for recommendations Per Statute* Community Child Protection Teams (CCPTs) Local Teams CCPTs CFPTs (fatality reviews) State Child Fatality Prevention Team Child Fatality Task Force (Policy Only) Child Fatality Prevention Teams (CFPTs) recommendations Aggregated findings & recommendations recommendations Board of County Commissioners Board of County Commissioners *In addition to this process per statute, policy and practice also result in certain recommendations being routed as appropriate to additional individuals and organizations. Reports & recommendations See Article 14 of NC Juvenile Code

The “policy arm” of the State’s Child Fatality Prevention System NC Child Fatality Task Force: Legislative study commission created via statute in 1991 The “policy arm” of the State’s Child Fatality Prevention System Does NOT review individual cases 35 Members: 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. §7B-1403, -1412

Three Task Force Committees work to create a yearly “Action agenda” Full CFTF Intentional Death Prevention Perinatal Health Unintentional Death Prevention Committees rely on CFTF members AND community volunteers.

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 Ongoing information sharing and collaboration among experts and community partners

Sources of Issues Coming Before the CFTF Issue application process Relevant national or statewide initiatives Data concern or deeper dive with certain child death data Carry-over policy issues State Team reports or recommendations Updates and education Monitored items with relevant activity Study or stakeholder groups convened or endorsed by CFTF

Informed Policy-makers Child Death Data Released by the Task Force Examined by the Task Force Used to inform Task Force recommendations Good Data Informed Policy-makers Good Policy

Leading Causes of Child Death (ages 0-17), North carolina Residents 2016 Cause of Death Total Deaths Perinatal Conditions 452 Illnesses 270 Birth Defects 204 Unintentional Injuries 201 Homicide 51 Suicide 44 All Other 138 TOTAL DEATHS 1,360 Source: NC DHHS North Carolina State Center for Health Statistics

Source: NC DHHS North Carolina State Center for Health Statistics

1992-2016 Trends in North Carolina Resident Child Death Rates by Race/Ethnicity, Ages Birth Through 17 Years Rate for African American is twice that of White Non Hispanics over time African American rate in 2016 is 23% greater than White Non Hispanic rate in 1992 Source: NC DHHS North Carolina State Center for Health Statistics

2007-2016 Trends in North Carolina Resident Child Death Rates for Selected Natural Causes of Death, Ages Birth Through 17 Years Source: NC DHHS North Carolina State Center for Health Statistics

2016 n.c. resident child deaths due to suicide (TOTAL 44 deaths) By Means By Age Group Source: NC DHHS North Carolina State Center for Health Statistics

Intentional death prevention Committee 2018 Agenda Legislation to strengthen infant safe surrender law Legislation to require suicide prevention training and risk referral protocol in schools (HB 285; HB 894) Funding of $5 million to add 100 school nurses in high need communities Funding for three-year lead suicide prevention coordinator Fund school social worker consultant position at DPI Studying during current meeting cycle: Child sex abuse prevention training for child care workers Child abuse and neglect reporting & education about mandatory reporting Carry-over items from 2018

CFTF Accomplishments: a few highlights among many . . . Graduated Driver License Program & various teen driver safety measures Strengthened Sex Offender Registry Laws addressing smoke alarms & CO detectors Child passenger safety laws, school bus safety laws Law requiring child-proofing and labeling for E-cig nicotine liquid containers Measures to combat opioid epidemic (improved CSRS, access to overdose reversal drug, safe disposal) Safe Sleep awareness Support for programs providing child maltreatment prevention, diagnosis, and treatment Infant Safe Surrender Law Pulse Oximetry Newborn Screening (for certain congenital heart conditions) A longer list of accomplishments is posted on the CFTF website: http://www.ncleg.net/DocumentSites/Committees/NCCFTF/in%20the%20spotlight/CFTF%20Accomplishments.pdf

More about the NC child fatality prevention system Who does what?

Local Teams: CCPTs & CFPTs 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 Most teams are blended See N.C.G.S §7B-1406

Local team Reports, findings, recommendations CCPTs Activity reports go to local DSS board BCC rec’s go to NC DSS (per policy) End of Year Report to NC DSS (per policy) Both Submit any recommendations to Board of County Commissioners Advocate for system improvements and needed resources where gaps and deficiencies exist CFPTs Activity reports go to local board of health Reports on findings and rec’s go to Team Coordinator(state-level) who submits aggregated findings to State Team & other Local Teams

Support for Local Teams CCPTs County DSS Directors provide general support, procedures, training, reporting, etc. NC Division of Social Services has ongoing responsibility for training materials for local CCPTs (a CCPT Consultant in NC DSS supports this training) A CCPT State Advisory Board was formed by NC DSS and it facilitates CCPT reporting CFPTs Local Health Department Directors distribute procedures, maintain records, provide staff support, facilitate reports, etc. 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. §7B-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

Child Fatality Prevention System Summit April 9th and 10th, 2018 First-of-its-kind event bringing together over 200 professionals from across the state. Participants learned from state and national experts, state leaders, and shared best practices and challenges. Local and state initiatives were launched focused on strengthening the CFP System.

Post-Summit work currently taking place Focus is on three areas: System Structure CFP Data Support and Collaboration for Child Death Review Teams of all Types Tapping local and state-level stakeholders as well as national experts and resources Simultaneous evaluation/report from Center for Support of Families Work is being reported back to Child Fatality Task Force who may make recommendations to Governor and General Assembly

How to learn more CFTF Website: https://www.ncleg.net/documentsites/committees/nccftf/homepage/ CFTF Annual Report has other details Fact sheets for many legislative items available on CFTF website Issue applications are typically due annually, in August or September New meeting cycle just started– meetings are public and meeting materials are on CFTF website Join the CFTF email list (let me know: kella.hatcher@dhhs.nc.gov)