Indiana struggles to fulfill law on child fatality reviews

On July 1, 2013, a new Indiana law (IC 16-49) went into effect, requiring child fatality review teams in each county, with coordination and support for those teams to be provided by the Indiana State Department of Health (ISDH). Prior to this, the local child fatality review teams fell under the Indiana Department of Child Services and were required in each of the 18 DCS regions.

The new state law also required that a coordinator position be created under ISDH to help support the local teams and the Indiana Statewide Child Fatality Review Committee.

Gretchen Martin is the state’s child fatality review program coordinator; she also oversees the state’s fetal and infant mortality review and safe sleep programs.

While the oversight agency has changed, the goals haven’t, she said. The local teams are to “look at fatalities that occur in an area and understand how and why that child died,” she said. They also are to look at risk factors and how those deaths can be prevented in the future. Information gathered is to be forwarded to the state.

The state’s role is to support local teams, review data and trends and identify opportunities for prevention, she said.

‘At different stages’

By law, each county is supposed to have a team in place, although teams can be formed on a regional basis, as is the case for Vigo and surrounding counties.

Martin acknowledged counties throughout the state are “at different stages of implementing the teams ... a few counties I haven’t heard from and some counties have official teams and have submitted child fatality review committee reports.”

Some counties have teams that meet “but haven’t sent official reports yet,” she said.

A map on the state website indicates the status of local teams, as of March 2015. At that time, statuses included official county teams; non-official county teams; unverified county teams; official regional teams; non-official regional teams and no teams.

A current status report provided to the Tribune-Star on Thursday afternoon indicated 90 of 92 counties “are at some point in the process of local team implementation.”

While counties are supposed to have a team, “There is not really a time frame for that necessarily,” Martin said. “I think it’s difficult for some areas because, fortunately, they don’t have many deaths, and so I think some communities and some counties are taking a little longer to get teams in place.”

Asked if those communities are in violation of the law, she responded, “That’s hard for me to answer. We’re not an enforcement agency. My job is to provide support to the teams,” help get them established and provide the information or resources they need.

But there are no consequences for not forming a team, at least “not from our end,” she said.

She praised the efforts the five-county team that includes Vigo. “Your community has had a pretty high-functioning team for awhile. You guys [in Vigo and neighboring counties] have a really good team with a lot of folks at the table,” she said.

Asked if teams are providing the state with child fatality data, Martin said, “Some teams are doing a good job of inputting data so we can look at that ... It is hit and miss. That is part of our plan this year, to provide support to teams and help them understand the need for data collection and data entry into the system so we can look at trends, not only at the state level but community level as well.”

Data ‘hit and miss’

The most recent online annual report of the statewide child fatality review committee was for 2013. When asked for more recent annual reports on Monday, she said she would “check and see what has been submitted.” As of Thursday, the state office provided the Tribune-Star with two more annual reports.

A 2014 report indicated 226 children died as the result of injuries in 2013, while a 2015 report indicated 243 children age 17 and under died from injuries in 2014.

The local child fatality review teams are required to review all deaths of children under the age of 18 that are sudden, unexpected or unexplained, all deaths that are assessed by DCS, and all deaths that are determined to be the result of homicide, suicide, accident or are undetermined.

Under the law, the statewide committee is required to submit an annual report to the Indiana legislative council, governor, DCS, ISDH, and the Commission on Improving the Status of Children in Indiana on or before Dec. 31 of each year. It is to include data for the previous calendar year; trends and patterns; and recommended action or resources to prevent future child fatalities.

The state department “shall make the report available on the state department’s Internet web site.” Also, the report must be made available to the public upon request.

Asked about statewide trends in child fatalities, Martin said she could not provide that based on reports from local fatality teams because “a lot of that data is hit or miss. It wouldn’t be stable or statistically significant.”

She said she would be able to provide statewide injury-related fatalities by age group: ages 0 to 5 years, school-age [6-11] and teenagers [12-18], described as special emphasis reports.

Asked if the change in law has been an effective tool, she said, “I think the fact that we have statutes requiring child fatality review team is a good thing. I think again, when you look at the status of local teams, I think there is more work going on than is reflected on the map.”

Some teams may be reviewing fatalities but perhaps haven’t submitted an official report. “I think it’s working but we still have work to do,” Martin said. “We’re definitely headed in the right direction.”

An emphasis this year is to contact local teams and “offer support, guidance and training” enabling them to conduct comprehensive child fatality reviews and to collect and submit data related to child fatalities, Martin said.

Indiana uses the case reporting system administered by the National Center for the Review and Prevention of Child Deaths.

The National Center for the Review and Prevention of Child Deaths shows Indiana fatality review team reports for 2005, 2006, 2007 and 2010. It also lists Indiana Child Abuse and Neglect Annual Report of Child Fatalities from 2003 through 2011.

It also has Indiana Child Mortality Data for most years from 2002 through 2014.

Efforts to reach some of the legislators associated with the 2013 legislation was unsuccessful. The Tribune-Star attempted to reach former State. Sen. John Broden, now a St. Joseph County Circuit Court Judge; former State Sen. Carlin Yoder, and current State Sen. Travis Holdman (R-Markle), whose press secretary, Brady Hagerty, provided an update on the “current status” of the local review teams.

A current status report provided by Hagery indicated:

• 90 of 92 counties are at some point in the process of local team implementation.

• Many counties do not have high numbers/rates related to child death, so some counties have waited until there is death to implement their team.

• Local child death review teams are created at the discretion of local leaders, operating voluntarily with limited resources.

Even though data entry at the local level may be inconsistent, the teams are meeting and implementing injury prevention activities. Here is a list of some of their activities:

• Death due to consumer product reported to the U.S. Consumer Product Safety Commission resulted in warning labels to prevent strangulation/choking.

• Local teams noticed need for enhanced communication between various stakeholder groups which resulted in new, streamlined communication policies improving systems response.

• Safe Sleep education in local high schools became integral part of ongoing health curriculum.

• Public forums have been scheduled and coordinated to increase awareness and discuss prevention opportunities.

• Many teams hold prevention events on topics such as: water safety, gun safety, and safe sleep.