Background: Healthy People 2010 sets an Injury / Violence Prevention objective to "extend to all 50 states child death review systems with interdisciplinary teams reviewing at least 75% of deaths due to external causes for children 14 and under, and making recommendation for prevention". Maryland has been engaged informally in CFR since 1991. Though mandated by legislation since 1999, it remains unfunded. The focus of CFR in Maryland has been to understand the factors contributing to all preventible child deaths, reduce morbidity and mortality, and improve service systems.
Methods: Individuals committed to CFR utilized volunteers, students, a part time assistant and a one year grant to build the state level review process. Technical assistance and training for Fetal and Infant Mortality Review (FIMR) in each county was extended to help build local Child Fatality Review teams.
Results: This presentation will describe the effectiveness of several strategies for building state and local CFR teams, and the result of legislation on that process. Low cost, technically feasible CFR database systems have failed due to lack of institutionalization. Data driven service improvements have not occurred in Maryland, yet informal local team processes has resulted in positive change.
Conclusions: Lack of funds does not prevent forming local or state Child Fatality Reviews, but does obstruct data collection and analysis. Optional local CFR programs produce superior local ownership and creativity, but little authority to access information or implement change. Mandated local CFRs have more authority, but resentment of unfunded mandates reduces effective advocacy.
Learning Objectives: After this session, the participant will be able to: 1. Articulate a public health approach to CFR, in contrast to law enforcement or child protective services models. 2. Describe some specific capabilities and limitations of an unfunded CFR program. 3. Describe some specific capabilities and limitations resulting from mandatory CFR legislation. 4. List some factors related to establishing a stable and maintainable CFR case data system.
Keywords: Children, Community Preventive Services
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.