Origins of Child Fatality Review in Texas

In Texas, more than 4,000 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 percent 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; and
  
• 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.