Implementing California’s Fatal Child Abuse and Neglect Surveillance (FCANS) Program Implementing California’s Fatal Child Abuse and Neglect Surveillance (FCANS) Program

Steve Wirtz, Ph.D. Epidemiology and Prevention for Injury

Control (EPIC) BranchCalifornia Department of Health Services

Presentation for:American Public Health Association

129th Annual Meeting Atlanta, GA

October 23, 2001

Outline of Presentation HandoutOutline of Presentation Handout

Problem Statement Creating Solutions Fatal Child Abuse and Neglect

Surveillance (FCANS) Program Challenges Next Steps

Contact: swirtz@dhs.ca.gov; Handouts are available by hyperlink from the online abstracts

Plan for Oral PresentationPlan for Oral Presentation

Brief background of CDR in California Description of the FCANS program 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

Problem StatementProblem Statement

CAN is a serious societal problem Fatal CAN is the most extreme consequence The true incidence of fatal CAN is not known Serious limitations with existing data sources

in California for counting CAN fatalities Better/more detailed information is needed Prevention of all types of childhood injuries

would benefit from detailed case information

Child Maltreatment Injury Pyramid for California, 1996-8

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.

Why focus on Fatal CAN?Why focus on Fatal CAN?

Fatal CAN is often difficult to identify– Definitions– Identification– Investigations

Detailed information on contributing causes & circumstances is often not available

CAN fatalities are not systematically reported or documented in statewide data systems

Fatal Child Abuse and Neglect by Data Source, California 1990-1998

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)

0

25

50

75

100

125

150

175

1990 1991 1992 1993 1994 1995 1996 1997 1998

Year

Child Abuse Central Index**

Homicide Files

Vital Statistics

Num

ber

152

135

Top Five Injury Causes for Children Under Five, California, 1999

Top Five Injury Causes for Children Under Five, California, 1999

Fatal Injuries < 1– Homicide– Suffocation– Drowning– MVT-Occupant– MVT-Unspecified

Fatal Injuries 1-4– Drowning– Homicide– MVT-Pedestrian– Pedestrian-Other– MVT-Occupant

Creating Solutions in CaliforniaCreating Solutions in California

Local Child Death Review Team (CDRT) formed without mandate or funds in 1980-90’s

CDRTs mixed criminal justice and public health approaches

State focused initially on CAN State authority protected information sharing State expanding to public health perspective

Child Death Review Teams (CDRTs) in California

Child Death Review Teams (CDRTs) in California

First team started in Los Angeles, 1978 Multi-disciplinary, multi-agency review team Teams now exist in nearly every county (56) Case selection criteria (e.g., all child deaths

0-17 years; Coroner cases only) Retrospective or concurrent multi-agency

review during investigations

California State Child Death Review Council (SCDRC)

California State Child Death Review Council (SCDRC)

Legislation established SCDRC in 1992 Coordinate and support state and local CDRT

efforts Provide training for CDRTs Establish data tracking system for CAN

fatalities (e.g., Reconciliation audits) FCANS Program authorized as of July 2000

through legislation and budget allocation

Description of FCANS ProgramDescription of FCANS Program Functions under auspices of SCDRC as authorized

in California Penal Code Implemented by EPIC Branch of California

Department of Health Services Primary purpose is to collect standard data on CAN-

related child deaths Local CDRTs are reimbursed for data on a fee-for-

case basis Promote prevention at local and state levels

Case Review Selection Criteria for CDRTs

Case Review Selection Criteria for CDRTs

Criteria ProposedStandard(s): Idealand Minimum

Current Practiceby CDRTs

A. Source ofCases

Ideal: All child deathsMinimum: Coronercases

All child deaths;Coroner cases;Coroner casesscreened

B. Age ofVictims

Ideal: 0 through 17(< 18) years of ageMinimum: 0 - 14

< 18 yrs.; < 12 yrs.;<19 yrs.

C. Causes ofDeath

Ideal: All childdeaths;Minimum: Sudden,unexpected and/ortrauma deaths

All child deaths;Sudden,unexpected traumadeaths

FCANS Data Collection Form for CDRTs

FCANS Data Collection Form for CDRTs

Identifying information Matrix for classifying Death investigation information Background information Cause and circumstance of death

– Intentional– Unintentional

Conclusions from review Recommendations and actions

Matrix for Classifying CAN Fatalities

Matrix for Classifying CAN Fatalities

Child Abuse Deaths Child Neglect Deaths

1. No child abuse 1. No child neglect

2. Child abuse history 2. Child neglect history

3. Suspicious or questionable abuse

3. Suspicious or questionable neglect

4. Definite abuse related 4. Definite neglect related

5. Definite abuse as primary cause

5. Definite neglect as primary cause

Sample Cases from FCANS Sample Cases from FCANS

Use overheads to display FCANS forms

– Case #1 - Suspected child abuse homicide

– Case #2 - Unintentional injury case

Value of Child Death Review Process

Value of Child Death Review Process

Improved local handling of CAN deaths Improved local protocols and practices Improved state surveillance Changes in state legislation and agency

regulations Increased focus on preventable and

unintentional deaths

Next StepsNext Steps Support, (fund), and train local CDRTs Improve Management Information System Standardize CAN definitions Expand reviews to all preventable and

unintentional deaths Improve process for developing

recommendations and taking action Network with other state CDR programs Link with CDC’s national surveillance efforts