1. Implementing California’s Fatal Child Abuse and Neglect Surveillance (FCANS) Program Steve Wirtz, Ph.D. Epidemiology and Prevention for Injury Control (EPIC) Branch California Department of Health Services Presentation for: American Public Health Association 129th Annual Meeting Atlanta, GA October 23, 2001

2. Outline of Presentation Handout n Problem Statement n Creating Solutions n Fatal Child Abuse and Neglect Surveillance (FCANS) Program n Challenges n Next Steps Contact: swirtz@dhs.ca.gov; Handouts are available by hyperlink from the online abstracts

3. Plan for Oral Presentation n Brief background of CDR in California n Description of the FCANS program n Focus on: –Case definitions - child abuse and neglect (CAN) –Data collection form for all child deaths –Examples of case reviews –Challenges for local, state and national –Next steps

4. Problem Statement n CAN is a serious societal problem n Fatal CAN is the most extreme consequence n The true incidence of fatal CAN is not known n Serious limitations with existing data sources in California for counting CAN fatalities n Better/more detailed information is needed n Prevention of all types of childhood injuries would benefit from detailed case information

5. Child Maltreatment Injury Pyramid for California, 1996-8 –CAN Fatalities (135-152) –Serious and Severe Hospitalization (438-525) –CAN Incidences (182,000) –Reported CAN (463,000) –Unreported Cases Prepared by DHS EPIC Branch from Reconciliation Audits, 1996-7, OSHPD Hospital Discharge Data, 1997-8, and DSS Preplacement Preventive Services for Children in California Annual Statistical Report, 1996.

6. Why focus on Fatal CAN? n Fatal CAN is often difficult to identify –Definitions –Identification –Investigations n Detailed information on contributing causes & circumstances is often not available n CAN fatalities are not systematically reported or documented in statewide data systems

7. Fatal Child Abuse and Neglect by Data Source, California 1990-1998 Source: CA DHS Death Records, 1990-8; CA DOJ Homicide Files, 1990-8 & CACI 1991-78 Prepared by CA DHS EPIC Branch, 11/00; ** CACI slope NE 0 (p=.03) Number 152 135

8. Top Five Injury Causes for Children Under Five, California, 1999 n Fatal Injuries < 1 –Homicide –Suffocation –Drowning –MVT-Occupant –MVT-Unspecified n Fatal Injuries 1-4 –Drowning –Homicide –MVT-Pedestrian –Pedestrian-Other –MVT-Occupant

9. Creating Solutions in California n Local Child Death Review Team (CDRT) formed without mandate or funds in 1980-90’s n CDRTs mixed criminal justice and public health approaches n State focused initially on CAN n State authority protected information sharing n State expanding to public health perspective

10. Child Death Review Teams (CDRTs) in California n First team started in Los Angeles, 1978 n Multi-disciplinary, multi-agency review team n Teams now exist in nearly every county (56) n Case selection criteria (e.g., all child deaths 0- 17 years; Coroner cases only) n Retrospective or concurrent multi-agency review during investigations

11. California State Child Death Review Council (SCDRC) n Legislation established SCDRC in 1992 n Coordinate and support state and local CDRT efforts n Provide training for CDRTs n Establish data tracking system for CAN fatalities (e.g., Reconciliation audits) n FCANS Program authorized as of July 2000 through legislation and budget allocation

12. Description of FCANS Program n Functions under auspices of SCDRC as authorized in California Penal Code n Implemented by EPIC Branch of California Department of Health Services n Primary purpose is to collect standard data on CAN-related child deaths n Local CDRTs are reimbursed for data on a fee-for-case basis n Promote prevention at local and state levels

13. Case Review Selection Criteria for CDRTs

14. FCANS Data Collection Form for CDRTs n Identifying information n Matrix for classifying n Death investigation information n Background information n Cause and circumstance of death –Intentional –Unintentional n Conclusions from review n Recommendations and actions

15. Matrix for Classifying CAN Fatalities

16. Sample Cases from FCANS n Use overheads to display FCANS forms –Case #1 - Suspected child abuse homicide –Case #2 - Unintentional injury case

17. Value of Child Death Review Process n Improved local handling of CAN deaths n Improved local protocols and practices n Improved state surveillance n Changes in state legislation and agency regulations n Increased focus on preventable and unintentional deaths

18. Challenges n Maintain/expand local capacity n Standardize case definitions n Standardize data collection n Expand focus to preventable and unintentional deaths n Translating findings into recommendations and action n Connection to national surveillance system

19. Next Steps n Support, (fund), and train local CDRTs n Improve Management Information System n Standardize CAN definitions n Expand reviews to all preventable and unintentional deaths n Improve process for developing recommendations and taking action n Network with other state CDR programs n Link with CDC’s national surveillance efforts