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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) Branch California Department of Health Services Presentation for: American Public Health Association 129th Annual Meeting

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

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  1. Implementing California’s Fatal Child Abuse and Neglect Surveillance (FCANS) Program • Steve Wirtz, Ph.D. • Epidemiology and Prevention for Injury Control (EPIC) Branch • California Department of Health Services • Presentation for: • American Public Health Association • 129th Annual Meeting • Atlanta, GA • October 23, 2001

  2. Problem Statement Creating Solutions Fatal Child Abuse and Neglect Surveillance (FCANS) Program Challenges Next Steps Outline of Presentation Handout Contact: swirtz@dhs.ca.gov; Handouts are available by hyperlink from the online abstracts

  3. 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 Plan for Oral Presentation

  4. Problem 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

  5. 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.

  6. 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

  7. Fatal Child Abuse and Neglect by Data Source, California 1990-1998 152 135 Number 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)

  8. Fatal Injuries < 1 Homicide Suffocation Drowning MVT-Occupant MVT-Unspecified Fatal Injuries 1-4 Drowning Homicide MVT-Pedestrian Pedestrian-Other MVT-Occupant Top Five Injury Causes for Children Under Five, California, 1999

  9. Creating 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

  10. 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

  11. 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

  12. Description 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

  13. Case Review Selection Criteria for CDRTs

  14. 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

  15. Matrix for Classifying CAN Fatalities

  16. Sample Cases from FCANS • Use overheads to display FCANS forms • Case #1 - Suspected child abuse homicide • Case #2 - Unintentional injury case

  17. 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

  18. Next 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

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