south carolina child death fatalities

UPDATE FROM THE SC CHILD FATALITY ADVISORY COMMITTEE

H. Gratin Smith, MDSeptember 11, 2013

Why Does Child Death Review Matter?

Helps to identify trends on a statewide scale Allows for comparison to other states Helps to make sure deaths are accurately

classified to make meaningful analysis possible

Allows for more informed suggestions for change

The CDC has determined that the multidisciplinary approach now in place is the most effective way to help decrease child deaths

An Overview

What is the SC Child Fatality Advisory Committee?

What does the committee do? What are the recent trends and

findings noted by the committee, and what are their recommendations?

Formation of the SC CFAC

In 1993 legislation mandated (but did not provide for funding of) the formation of the State Child Fatality Advisory Committee to identify patterns in child fatalities.

An annual report is produced. This information is to be used by communities, individuals and agencies to decrease the number of preventable child deaths in our state.

The report can be viewed at SC DHEC’s website.

Deaths Reviewed by the SC CFAC The death of any child (<18) that is

unexpected, suspicious, unexplained or occurs when the child is NOT under the direct care of a physician. This includes, but is not limited to SIDS cases.

Traffic/highway deaths are not reviewed by the SC CFAC (unless they occur on private property). They are reviewed by the DMV.

Makeup of the SC CFAC

Members are appointed by the governor after recommendation from the specific state agencies or the committee.

Members of the SC CFAC as specified in the legislation forming the committee

DHEC DDSN SCDE SLED SCAAP-Pediatrician A forensic pathologist SC Criminal Justice

Academy

DSS DYS SC Commission on

Alcohol and Drug Abuse SC Coroner Solicitor SCDMH 2 Child Advocates

SC CFAC Meetings

Full day every other month Guest presenters Reports from members Review @ 40 cases per meeting

during executive session (closed to public). (@ 200-250 cases are reviewed every year)

The Process of Child Death Review A child death occurs Coroner is notified Coroner notifies SLED within 48 hours Case is assigned to an agent Agent gets details, medical records,

DSS notes, LE notes Case report is “completed” by the

agent Case goes to CFAC

What Does the CFAC Actually Do? Case reports are sent to members

before the meeting Agencies involved report on their

involvement with the case Medical aspects of the case are

reviewed The committee tries to determine

how the death may have been prevented by looking at SYSTEMS ISSUES

What Does the CFAC NOT DO? The committee’s function is not to

investigate or solve crimes The goal is not to criticize, but to

offer suggestions for improvement by analyzing system failures.

Recent Findings of the SC CFAC Reviews

The cases are categorized based on the year that they occurred.

The most recent annual review that has been completed is 2009. There were 189 deaths in 2009 that were reviewed.

The statistics in this presentation are from cases that met the definition for review by the SCFAC (not the total number of child deaths in the state)

SC Statistics

Population about 4.5 million Population < 18 y.o. (23%) about

1,035,000 White citizens 66.2% Black citizens 27.9% 17% of citizens below the poverty

level Per cent of 8th graders to graduate-

75% @ 25% of babies born to single

mothers

2009 SC Child Fatalities by Race

81

84

135

2

4

White BlackHispanicBiracialAsian Unknown

2009 SC Child Fatalities by Gender

58%

42%malefemale

Manner of Death Categories For every death there is an assigned

cause of death (very many) and one of 5 “manners of death”

Natural Accidental/Unintentional Injury Homicide Suicide Undetermined

2009 Manner of Child Death by Category

Accident Natural Homicide Undet Pending Suicide0%

5%

10%

15%

20%

25%

30%

35%

40%

Accidental Child Deaths in SC 1993-2009

93 94 95 96 97 98 9920

00 01 02 03 04 05 06 07 08 090

20

40

60

80

100

120

2009 SC Accidental Child Deaths

26

19

13

5

3 2 1

AsphyxiaDrowningFireShootingOverdoseVehicularPoisoning

2009 SC Accidental Child Deaths by Age

<1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.0

5

10

15

20

25

30

2009 SC Accidental Child Deaths by Gender

male female0

5

10

15

20

25

30

35

40

45

50

2009 SC Child Drowning Deaths by Age

1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.0

1

2

3

4

5

6

7

8

9

2009 SC Child Drowning Deaths by Gender

Male Female0

2

4

6

8

10

12

14

2009 SC Child Fire Deaths by Race

75

1

BlackOtherWhite

2009 SC Child Fire Deaths by Home Structure Type

MobileStick Built

2009 SC Child Fire Deaths by Age

<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-170

1

2

3

4

5

6

7

8

In 2009, Five SC Children Died of Accidental Gunshot Wounds

5-9 y.o. 10-14 y.o. 15-17 y.o.0

0.5

1

1.5

2

2.5

In 2009, Two SC Children Died in ATV (4 Wheeler) Accidents

SIDS/SUDI/SUID Cases in SC 1993-2009

93 94 95 96 97 98 9920

0020

01 02 03 04 05 06 07 08 090

10

20

30

40

50

60

70

80

1993-2009 Child Homicide Deaths in SC

93 94 95 96 97 98 9920

00 01 02 03 04 05 06 07 08 090

5

10

15

20

25

30

35

40

45

2009 SC Child Homicide Deaths by Age

<1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-170

2

4

6

8

10

12

14

Perpetrators of Fatal Child Abuse and Neglect in SC 2009

4

4

3

2

1

1

11

17 cases

Mom's BFFatherStrangerUncle MotherStepmomSiblingOther

2009 SC Fatal Child Abuse and Neglect by Category

4

2

8

11

AbusHd TrAsphyxiaBeatingHead TrMalnutrit

Some SC Counties With High Numbers of Child Fatalities 2009 (#), rate (#/100,000)

Sptnbrg (26) 35

Richland (21) 24

Anderson (5) 11.3

Beaufort (7) 21.5

York (7) 12.3

Charleston (16) 22.2

Berkley (6) 13.7

Darlington (6) 37

Greenville (14) 13

Horry (7) 13

Lexington (22) 35

2009 SC Child Suicides, # 8

Males #4 Females #4 10-14 y.o. #2 15-17 y.o. #6 Shooting #2 Hanging #6

Trends Noted by the SC CFAC There are an alarming number of child

deaths involving 4-wheelers Child deaths in fires are much more

common in mobile homes In fire death cases, the absence of

functioning smoke alarms is often noted in the reports

Most sleep related deaths involve some practice recognized as an unsafe sleeping situation