Child Fatality Review

Origins of Child Fatality Review in Texas

In Texas, more than 4000 children, between the ages of birth and 17, die annually.  Prior to 1995, apart from death certificate data collected through the Texas Bureau of Vital Statistics, no single agency tracked or assessed all of the child deaths in the state.  In response, in 1994, Texas applied for and received grant funding through the Children’s Justice Act Grant (CJA), to underwrite a Child Fatality Review Team Project.  The United States Congress passed the CJA legislation in 1986 with funding derived from a mandatory diversion of 4.5% of all fines paid by federal offenders, which was provided to the states for the purpose of improving the handling of child abuse, neglect, and maltreatment cases.  CJA began supporting efforts to develop multi-disciplinary, multi-agency child fatality review in Texas in 1992, and in 1994 formed a statewide committee to review the child death response system and make recommendations to the legislature.  Texas Governor, George W. Bush, signed the legislation and the Child Fatality Review Team statute went into effect on September 1, 1995.  Titled as Child Fatality Review and Investigation, the child fatality review team law is located in the Texas Family Code, Title 5, Chapter 264, Subchapter F, §264.501 – §264.515 of the statute, and was administered initially through the Texas Department of Family and Protective Services.  In the 79th Legislative session, Senate Bill 6, an amendment to the existing code, was passed, transferring responsibility for the support and coordination of the Texas Child Fatality Review Team Committee (CFRTC) and all local Child Fatality Review Teams (CFRT) to the Texas Department of State Health Services.

 

The State Committee, or CFRTC, is a multi-disciplinary group of professionals selected from across the state with a membership reflecting the “geographical, cultural, racial, and ethnic diversity of the state” §264.502 (d), and has a tripartite purpose:

• To understand the causes and incidence of child deaths in Texas;
• To identify procedures within the representative agencies to reduce the number of preventable child deaths
• To stimulate public awareness and make recommendations to the governor and legislature for effective changes in law, policy, and practices.

Local CFRT’s mirror the format of the CFRTC through death reviews on the local level utilizing the public health model.  Reviewing local child deaths and the associated circumstances allows teams to identify community trends, develop prevention strategies, and promote public awareness while enhancing investigative findings through improved inter-agency collaboration.  In Texas, CFRT’s complete a retrospective review of all sudden and unexpected deaths of children under the age of 18, with the criteria for case acceptance varying by team based on local needs and resources.

 

Why Review Teams Are Needed

 

A primary reason for the development and utilization of local child fatality review teams is to identify and prevent child deaths caused by abuse and neglect.  Texas has broadened the scope of review to include all preventable child deaths, with a focus on the public health perspective.  In the mid-1990’s, Texas led the country in child abuse and neglect-related fatalities, and was also identified as having poor social conditions associated with child health and safety (e.g., poverty, unemployment, poor education, violence, lack of available health care, teen pregnancy, and a large minority population).  Child fatality review in Texas was established to address preventable deaths associated with those societal issues.

 

Beginnings and Purposes

 

Texas’ first local review team was started in Dallas in 1992 through a one-year-duration pilot project funded by CJA and administered by the Texas Department of Protective and Regulatory Service (TDPRS).  The Tarrant County Child Fatality Review Team (CFRT) was the second team in the state to participate in the pilot project and receive CJA funding; organized in 1992, the team began reviewing child deaths in 1993.  In 2008, there were 53 operating child fatality review teams in Texas, most of which are hosted by hospitals, child advocacy centers, and law enforcement agencies.  Tarrant County CFRT, partnered with the Denton and Parker County components of the Tarrant County Medical Examiner District, reviews deaths from those three jurisdictions.

 

Ten purposes of a CFRT have been identified by the CFRTC:

• To accurately identify and record the cause of every child death.
• To collect uniform and accurate statistics on child deaths.
• To identify circumstances surrounding deaths that could prevent future deaths and initiate preventive efforts.
• To promote collaboration and coordination among the participating agencies.
• To improve criminal investigation and prosecution of child abuse homicides.
• To design and implement cooperative protocols for investigation of certain categories of child deaths.
• To improve communication among agencies and the timely notification of agencies when a child dies.
• To provide a confidential forum for agencies to meet and discuss common issues or resolove conflicts.
• To propose needed changes in legislation, policies, and procedures.
• To identify and address public health issues.