GEORGIA CHILD FATALITY REVIEW PANEL Annual Report Calendar Year 2001 Office of Child Fatality Review 506 Roswell Street, Suite 230 Marietta, Georgia 30060 Phone: (770) 528-3988 Fax: (770) 528-3989 Website: www.gacfr.org GEORGIA CHILD FATALITY REVIEW PANEL MISSION To serve Georgia's children by promoting more accurate identification and reporting of child fatalities, evaluating the prevalence and circumstances of both child abuse cases and child fatality investigations, and monitoring the implementation and impact of the statewide child abuse prevention plan in order to prevent and reduce incidents of child abuse and fatalities in the State. Acknowledgements The Georgia Child Fatality Review Panel wishes to acknowledge those whose enormous commitment, dedication, and unwavering support to child fatality review have made this report possible. These include: Dr. John T. Carter, Ph.D., Jill Andrews, Mathew Sacrinty, and associates of the Epidemiology Department of Emory University, Rollins School of Public Health All the members of county child abuse protocol and child fatality review committees All the public/private agencies that have so willingly collaborated with this office and provided support 2 GEORGIA CHILD FATALITY REVIEW PANEL MEMBERS Chairperson Duncan D. Wheale Superior Court Judge, Augusta Judicial Circuit Ms. DeAlvah Simms Child Advocate for the Protection of Children3 Dr. Todd Jarrell, M.D. Board Chair, Dept. of Human Resources3 Sharon Hill, Associate Judge Fulton County Juvenile Court Mr. Vernon Keenan, Acting Director Georgia Bureau of Investigation3 Ms. Carol O. Ball, SAFE KIDS of GA. Representative Georganna T. Sinkfield Member, GA House of Representatives2 Kathleen Toomey, M.D. Director, Division of Public Health3 Ms. Juanita Blount-Clark, Director Division of Family & Children Services3 Ms. Vanita Hullander Coroner, Catoosa County Dr. Kris Sperry Chief Medical Examiner3, GBI Ms. L. Gale Buckner Executive Director Criminal Justice Coordinating Council3 Randall Alexander, M.D. Morehouse College Center for Child Abuse Detective Charles Spann Cobb County Department of Public Safety Senator Nadine Thomas Member, GA Senate1 Mr. J. Tom Morgan District Attorney, Stone Mountain Judicial Circuit STAFF Eva Y. Pattillo Executive Director Kim Washington Karen Robinson Program Manager Research Data Contractor ________________________________________ Suhda Nuguru Administrative Assistant The Georgia Child Fatality Review Panel is an appointed body of 16 representatives that oversees the county child fatality review process, reports to the governor annually on the incidence of child deaths, and recommends prevention measures based on the data. Two year appointments are made by the governor except as otherwise noted. 1 Appointed by the Lieutenant Governor 2 Appointed by the Speaker of the House of Representatives 3 Ex-Officio 3 MESSAGE FROM THE CHAIR 4 TABLE OF CONTENTS Mission..............................................................................................................................................................2 Members ..........................................................................................................................................................3 Message from the Chair ....................................................................................................................................4 List of Figures....................................................................................................................................................6 Executive Summary ..........................................................................................................................................7 Recommendations ............................................................................................................................................9 Child Deaths in Georgia ..................................................................................................................................10 Summary of All Child Deaths ..........................................................................................................10 All 2001 Reviewed Deaths ................................................................................................................13 Child Abuse and Neglect ..................................................................................................................14 Prior Agency Involvement ................................................................................................................16 Sudden Infant Death Syndrome........................................................................................................17 Unintentional Injury-Related Deaths ................................................................................................19 Motor Vehicle-Related ......................................................................................................................19 Drowning..........................................................................................................................................21 Fire-Related ......................................................................................................................................22 Intentional Injury Deaths..................................................................................................................24 Homicides ........................................................................................................................................24 Suicides ............................................................................................................................................26 Firearm Deaths ................................................................................................................................27 Race, Ethnicity and Disproportionate Deaths ..................................................................................................29 History of Child Fatality Review in Georgia ....................................................................................................30 Appendices......................................................................................................................................................31 5 LIST OF FIGURES AND TABLES Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11. Figure 12. Figure 13. Figure 14. Figure 15. Figure 16. Figure 17. Figure 18. Figure 19. Figure 20. Figure 21. Figure 22. Figure 23. Figure 24. Figure 25. Figure 26. Figure 27. Figure 28. Figure 29. Figure 30. Figure 31. Figure 32. Figure 33. Figure 34. Figure 35. Figure 36. Figure 37. Figure 38. Figure 39. Figure 40. Figure 41. Figure 42. Deaths to Children Under 18 in Georgia, All Causes All Child Deaths by Race and Gender All Causes of Death, Age <1 All Causes of Death, Age 1-4 All Causes of Death, Age 5-14 All Causes of Death, Age 15-17 Number of Reviewed Child Deaths by Cause of Death Circumstances of Death for Reviewed Deaths with Abuse/Neglect Findings Relationship of Perpetrators to Decedent in Reviewed Cases with Abuse and Neglect Findings Age Distribution for Reviewed Deaths with Abuse or Neglect Findings Reviewed Deaths with Abuse or Neglect Findings by Race and Gender Agency Involvement: Reviewed Deaths with No Child Abuse/Neglect Findings Agency Involvement: Reviewed Deaths With Child Abuse/Neglect Findings Reviewed SIDS Deaths by Age Reviewed SIDS Deaths by Race and Gender Sleeping Positions At the Time of Death for Infants Who Died of SIDS SIDS Death Rates per 1,000: Age <1, 1994-2001 Reviewed Unintentional Injury-Related Deaths by Cause Reviewed Motor Vehicle-Related Deaths by Age Reviewed Motor Vehicle-Related Deaths by Race and Gender Motor Vehicle Fatality Rates per 100,000: Ages 15-17, 1994-2001 Reviewed Deaths Due to Drowning by Age Reviewed Drowning Deaths by Race and Gender Place of Drowning Drowning Fatality Rates per 100,000: Ages <18, 1994-2001 Reviewed Deaths Due to Fire by Age Reviewed Deaths Due to Fire by Race and Gender Fire-Related Fatality Rates per 100,000: Ages <18, 1994-2001 Reviewed Homicides by Circumstances of Death Reviewed Homicide Deaths by Age Reviewed Homicide Deaths by Race and Gender Death Rates for Teen Homicides per 100,000: Ages 15-17, 1994-2001 Reviewed Suicide Deaths by Age Reviewed Suicide Deaths by Race and Gender Suicide Death Rates per 100,000: Ages 15-17, 1994-2001 Reviewed Firearm Deaths by Manner of Death Reviewed Firearm Deaths by Age Reviewed Firearm Deaths by Race and Gender Reviewed Firearm Deaths by Type of Firearm Firearm Death Rates per 100,000: Ages 15-17, 1994-2001 Deaths to Children <1 and Percent of Population in Georgia, by Race and Gender Deaths to Children 1-17 and Percent of Population in Georgia, by Race and Gender APPENDICES Appendix A Criteria for Child Death Reviews Appendix B Child Fatality Review Timeframes and Responsibilities Appendix C.1 2001 Total Child Fatalities by Age, Race, Gender, and Cause of Death Appendix C.2 2001 Reviewed Deaths by Age, Race, Gender, and Cause of Death Appendix C.3 2001 Reviewed Deaths with Abuse Findings by Age, Race, Gender, and Cause of Death Appendix C.4 Prevention Potential by Cause of Death, by Abuse Classification Appendix D County Compliance with Reviewing Eligible Deaths (Map) Appendix E 2001 Child Fatality Reviews by County, by Age Group Appendix F Definitions of Terms and Abbreviations Used in this Report 6 Prevention - A popular term used today that we're all familiar with, and whose essence we subscribe to in many areas of our lives...or do we really? Prevention necessitates purposeful thought and plan if it is to be successful. Prevention often means foregoing the "norm" and our "business as usual" attitude, and requires us to construct a new paradigm to direct our actions. The term "prevention" is frequently used in discussions regarding safety and protection of children. Study after study has shown that employing prevention measures to safeguard children are much less costly in the long run. Not only are they less costly economically, but also emotionally and socially for families, communities, and the state. Prevention also produces a more desirable outcome - healthy children growing up to become productive adults. Too often our budgets, policies, and procedures, belie our declaration regarding prevention. A look at the number of child deaths both nationally and in Georgia reveals a need for all of us - government, communities, individuals - to develop a sound, well thoughtout, prevention plan. During this past legislative session, the Governor and Georgia General Assembly again increased funding for child protection. Increased funding is essential to adequately serve and protect children who have been abused. However, to protect children from the risk of all injuries, including abuse, our resolve must be to invest the resources necessary on the front end (prevention) that will afford our children an opportunity to survive and become healthy adults. In 2001, 1,799 children died in Georgia according to Vital Records. The Georgia Child Fatality Review Panel publishes an annual report which contains detailed information regarding deaths which were sudden, unexpected, and/or unexplained. This information is compiled from reports submitted by local county child fatality review committees. The Georgia Child Fatality Review Panel is charged with not only tracking the numbers and causes of child deaths, but also identifying and recommending prevention strategies that could reduce the number of child deaths. Key Findings EXECUTIVE SUMMARY Fatal Child Abuse/Neglect Child fatality review committees determined that 94 child deaths resulted from suspected or confirmed abuse and/or neglect. Thirty-seven (37) of those abuse related deaths were ruled homicides. Children under the age of 5 accounted for (78%) of homicides resulting from abuse. Perpetrators were identified in 47 of the child abuse related deaths and 63% of those perpetrators were parents. Natural Death certificate data indicated a total of 1,322 children under the age of 18 died of natural causes (including SIDS). Infants accounted for the vast majority (1,079) of those deaths. The leading causes of infant deaths continued to be congenital anomalies, low birth weight, and prematurity. There were 116 SIDS deaths. Child fatality review committees reviewed 186 deaths from natural causes. One hundred-three (103) of those deaths were SIDS. Committees are required to review all SIDS deaths, and medical deaths that are unexpected or unattended by a physician. Unintentional Injuries Death certificate data indicated that 63% of deaths (415) in children ages 1 17 resulted from injuries. Seventy-six percent (76%) of all injuries in this age group resulting in death were unintentional. The 3 leading causes of unintentional injury related deaths in all age groups included: 224 motor vehicle incidents 40 Drowning Incidents 31 Suffocations The most marked increase in deaths from 2000 was deaths from poisoning (43%), and the most marked decrease was suffocation (21%). Child fatality review committees reviewed 264 deaths determined to have resulted from unintentional injuries. 7 Intentional Injuries Death certificate data indicated 105 children died from injuries intentionally inflicted by themselves or by others (suicide and homicide). In 2001, there were 71 homicides ( a 7% decrease from 2000), and 34 suicides (a 13% increase). Child fatality review committees reviewed 87 deaths from intentional causes 54 homicides and 33 suicides. Firearm Deaths Death certificate data indicated firearms were used in 47 child deaths. Twenty-seven (27) of those deaths were ruled homicides, fifteen (15) suicides, and five (5) unintentional shootings. Child fatality review committees reviewed 37 firearm related deaths. Eighty-seven percent (87%) were intentional. The type of firearm was identified in 35 of the 37 reviewed firearm related deaths. Handguns were most frequently used (21 of the 37 reviewed firearm deaths). Preventability A primary function of the child fatality review process is to identify those deaths believed to be preventable. The issue of preventability was addressed in 530 of the 537 child deaths reviewed. Child fatality review committees determined that 410 (77%) of the 530 child deaths were definitely or possibly preventable. Agency Involvement/Intervention Child fatality review committees reported that in 82% (77) child abuse/neglect related deaths, the child and/or family had prior involvement with at least one state or local agency. Committees identified 6 instances in which agency intervention could have prevented child abuse/neglect related deaths. 8 ACCOMPLISHMENTS, RECOMMENDATIONS, AND GOALS OF THE GEORGIA CHILD FATALITY REVIEW PANEL Accomplishments: Agency Recommendations: 1. Secured funding for on-line reporting system to assist counties with filing child fatality reports 2. Successfully engaged in collaborative efforts with other agencies, including: - Access to the GBI autopsy database - Agreement with GBI to assist with further development of child death investigation teams across the state 3. More timely response in provision of training and consultation of county child fatality review committees 4. Eight percent (8%) increase in county reporting compliance 5. Wider distribution of Panel's Annual Report (from 500 in year 2000 to 1000 copies in 2001) Legislative Recommendations: 1. Fully implement recommendations of the Child Protective Service Task Force to improve the state's ability to protect children from child abuse and neglect 2. Fund expansion of home-based family support models that promote and enable appropriate parenting skills for prevention of child abuse and neglect 3. Require fences and gates in public and private swimming pools statewide 4. Require an autopsy, including toxicology studies, for every death of a child under the age of seven with the exception of children who are known to have died of a disease process while attended by a physician. Further, require complete skeletal x-rays (following established pediatric and radiological protocol), of the bodies of children who died before their second birthday 5. Pass a "Child Endangerment Law" to hold adults accountable who knowingly create or allow children to be placed in dangerous situations 6. Provide sufficient funding to the Georgia Child Fatality Review Panel to fulfill statutory requirements 7. Expand funding for mental health services for children, especially those identified as "at risk" 1. DFCS: The Panel recommends that all cases of newborns whose mothers have a positive drug screen be referred to Juvenile Court 2. DFCS: The Panel recommends that when a child dies due to a parent or caretaker's neglect or aggression, ongoing efforts be made to visit the surviving children in that home to assess their safety and well-being, and enable voluntary referrals to appropriate services 3. Coroner & Medical Examiner's Office: The Panel recommends that a death scene investigation be conducted for any child death suspected of being accidental, a homicide, or of unknown causes. No case should be classified as SIDS unless a death scene investigation and review of the clinical circumstances are completed Goals: 1. Development of a "Best Practices" manual for county child abuse protocol committees 2. Publish and distribute "Child Fatality Review Policy and Procedures" manual 3. Facilitate a 10% increase in county reporting of child fatalities 9 CHILD DEATHS IN GEORGIA Child death in Georgia has been the focus of many news articles, task forces, and legislative efforts. In 2001, 1,799 children died in Georgia, which was equivalent to almost five child deaths a day. Most of those deaths were due to medical causes (1,206),and occurred among infants (963). The remaining deaths (593) were the main focus of child fatality review committees. (Medical deaths are indicated for review only if unexpected or unattended by a physician.) The purpose of the child fatality review process is to analyze all circumstances of child deaths. This process is critical in identifying prevention strategies that can help reduce these needless deaths and improve the well-being of Georgia's future generations. Information Sources Child fatality review reports are the primary source of data for this report. Child fatality review reports are submitted on deaths that are identified by the county coroner, medical examiner, or child fatality review committee. In addition to the SIDS and unintentional/ intentional deaths, the committee may identify other deaths as appropriate for review. Child fatality review reports provide details of the cause and circumstance of death, supervision at time of death, prior history of abuse or neglect, perpetrator(s) in child abuse-related deaths, and prior agency involvement. Reports also contain information regarding whether a death might have been prevented and what measures might be taken to lessen the likelihood of a similar death occurring in the future. The 2001 Vital Records death certificate file was used to describe all child deaths. This file was also used to identify the subset of deaths that met the criteria for review. The child fatality review file was linked with the death certificate file. The death certificate provides demographic information and states the official cause of death. These two data sources do not always agree on the cause or manner of death. Child fatality review committees determined 4 child deaths to have resulted from a different cause than that reported on the death certificate. Of the 1,799 child death certificates filed in 2001, 593 met the criteria requiring review. Child fatality review committees reviewed 443 (75%) of those eligible deaths, in addition to 11 deaths for which no death certificate was issued, and 83 deaths related to medical causes. A total of 537 deaths were reviewed and are included in Appendix C.2 of this report. Except as noted, information and figures from child fatality review reports are designated by the term "Reviewed Deaths", and include a total of 454 child deaths (injury-related and SIDS). All information on "Trends" is based on death certificate data. SUMMARY OF ALL DEATHS Figure 1 shows the causes of all 1,799 child deaths in Georgia in 2001. Natural causes were responsible for 73% (1,322) of all deaths, with 82% (1079) of those deaths occurring before age one. The term "medical" when used in this report as a cause of death for infants does not include SIDS. Findings Figure 1. Deaths to Children Under 18 in Georgia All Causes based on Death Certificate The total number of infant/child deaths (1,799) is higher than the totals for each of the preceding 3 years (an average of 1,734 for 1997 through 2000). In 2001, the largest increase in deaths was associated with motor vehicles (from 195 in 2000 to 224) Changes in the number of deaths in other cause categories are consistent with annual fluctuations Medical (not to scale) Motor Vehicle SIDS Homicide Drowning Suicide Suffocation Other Accident Fire / Burns 116 71 40 34 31 24 23 1206 224 Unknown 20 10 Poisoning 10 0 50 100 150 200 250 Deaths Figure 2. Race and Gender of All Child Deaths Other Male, AA 23 Female, 339 Other Female, 18 White Male, 571 AA Male, 490 White Female, 358 Findings African American children make up 34% of the child population; however, their deaths make up 46% of all child deaths Although not shown in the figure, there was an increase in deaths among Hispanic children (85 in 2000 to 95 in 2001) Ninety-one (91) of the 95 Hispanic deaths report race as "White" Figure 3. All Causes of Death, Age < 1 Medical (not to scale) SIDS Suffocation Unknown Other Accident Homicide Motor Vehicle 18 15 13 10 6 963 116 0 50 100 150 Deaths Findings Only 62 (5%) infant deaths resulted from unintentional or intentional injuries. This was a slight decrease from last year (65), but higher than the 48 in 1999 Of defined causes, suffocation (18) represented the largest single injury-related category Of the 95 Hispanic deaths discussed in Figure 2 Findings, 76% (73) were due to natural causes, with 78% (57) of those being infant deaths 11 Figure 4. All Causes of Death, Age 1-4 Medical Causes Motor Vehicle 34 Homicide 28 Drowning 16 Fire / Burns 13 Other Unintentional 11 Suffocation 6 Unknown 3 0 20 40 60 Deaths 92 Findings Deaths among this age group increased in 2001 (from 174 in 2000 to 203) The largest increase was in homicide deaths - from 16 in 2000 to 28 in 2001 Deaths due to fire, MV, and drowning also increased 80 100 Figure 5. All Causes of Death, Age 5-14 Medical Causes Motor Vehicle Drowning Homicide Suicide Suffocation Other Unintentional Fire / Burns 14 13 7 7 6 6 106 77 0 20 40 60 80 100 120 Findings Deaths 55% of deaths in this age group were caused by injuries 59% of those injuries were motor vehicle related, representing an increase from 2000 (47%) Figure 6. All Causes of Death, Age 15-17 Motor Vehicle 107 Findings Medical Causes 45 There was little change in the Suicide 27 number of deaths to older teens - from 225 in 2000 to 219 in Homicide 20 2001 80% of all deaths were due to unintentional and Drowning 8 Poisoning 5 intentional injuries Over 60% of injury related Other Unintentional 5 deaths were due to motor vehi- Unknown 2 cle crashes 12 0 20 40 60 80 100 120 Deaths In 2001, 593 of the total 1,799 child deaths met the criteria requiring review (injuries and SIDS) according to death certificate data. Committees filed reports for 75% (443) of those deaths within the reporting period, representing an increase of 8% since calendar year 2000. (This increase is attributed to the availability of more resources to local child fatality review committees for training and technical assistance.) Committees reviewed an additional 94 child deaths for a total of 537 deaths reviewed. The distribution of child deaths in Georgia is generally proportional to the county population. The 14 counties with 10 or more reviewable deaths in 2001 have 50% of the child population and 44% of all reviewable deaths. Those counties ALL 2001 REVIEWED DEATHS reviewed 85% (222) of their 262 reviewable deaths. Only one of the 14 counties reviewed less than 50% of the reviewable deaths One hundred thirteen (113) counties with from 1 to 9 reviewable deaths had a total of 331 reviewable deaths and reviewed 67% (221) of the deaths. Thirty-four of the 113 counties did not review any of their reviewable deaths Nine counties had no child fatalities in 2001, and an additional 23 counties had no child fatalities that met the review criteria Four hundred fifty-four deaths, (injuries and SIDS), are discussed in the "Reviewed Deaths" sections of this report. Reviews of medical deaths are not included unless noted. Figure7. Number of Reviewed Child Deaths by Cause (includes medical) Motor Vehicle 151 SIDS 103 Medical Causes 83 Homicide 54 Suicide 33 Suffocation 29 Other Unintentional 29 Drowning 28 Fire / Burns 21 Unknown 6 0 50 100 150 200 Finding Reviewed Deaths Injuries due to motor vehicle incidents continued as a leading cause of death among children Preventability Each child fatality review report asks the team to determine whether the death could have been The CFR committees' determination of preventability depends on the cause of death (see Appendix C.4). prevented. Only 7 of the 537 reviews submitted in Less than 5% of the reviewed "Natural" deaths were 2001 omitted this information. Of the remaining 530 judged "Definitely Preventable". However, more reports addressing preventability, teams reported the than 50% of homicide and unintentional deaths were following: determined to be "Definitely Preventable". Fifty (50) of the 58 deaths (86%) with confirmed child abuse Definitely Preventable 39% Possibly Preventable 38% Not Preventable 23% were considered to be preventable, while 32% of deaths with no findings of abuse were determined to be definitely preventable. 13 In 2001, there were 63,488 cases of child abuse/ neglect investigated in Georgia. Thirty-five percent (35%) of those cases were confirmed. Ninety-four (94) reviewed child deaths were determined by Child Fatality Review Committees to have been suspected (36) or confirmed (58) child abuse and/or neglect. (Data on the cause of death, CHILD ABUSE AND NEGLECT age, race and gender for those deaths are included in Appendix C.3 of this report.) A history of domestic violence in the home of the decedent was also associated with a committee finding of child abuse. Sixteen percent (16%) of deaths with an abuse finding had a history of domestic violence compared to only 5% of deaths with no abuse findings. Figure 8. Circumstances of Reviewed Deaths with Abuse/Neglect Findings findingHs owmeirceidheomicides Drowning 10 Motor Vehicle 9 Suffocation 7 SIDS 7 Fire/Burns 7 Other Unintentional 4 Poison 4 Unknown 3 Suicide 3 Medical 3 0 10 20 30 Reviewed Deaths Perpetrators 37 Findings 39% of reviewed deaths with child abuse or neglect findings were homicides Of the 37 homicides, 3 were confirmed to be the result of Shaken Baby/Sudden Impact Syndrome, and an additional one as the result of being crushed 40 Figure 9. Relationship of Perpetrator to Decedent in Reviewed Cases with Abuse and Neglect Parent Paramour of Parent Other Non-relative Friend/Acquaintance Child Care Worker Grandmother Missing 8 5 4 1 1 32 47 0 10 20 30 40 50 Reviewed Deaths Findings Local Child Fatality Review Committees identified a total of 51 perpetrators in 47 of the deaths (50%) Among the identified 51 perpetrators, 63% (32) were the child's natural parent * Total = 51, reflecting 4 cases with 2 perpetrators identified 14 Figure 10. Age Distribution for Reviewed Deaths with Abuse or Neglect Findings Reviewed Deaths 50 40 30 26 20 10 0 <1 47 14 1-4 5 - 14 Age Range (years) 7 15 - 17 Findings 78% were under the age of 5 28% were under the age of 1 In 2000, there were more cases of infant abuse (42) than of abuse to 1-4 year olds (25) compared to 2001 Figure 11. Reviewed Deaths with Abuse or Neglect Findings by Race and Gender AA Female, 20 AA Male, 32 White Male, 25 Other Female, 4 White Female, 13 Findings 55% (52) of deaths were to African American children 61% (57) of deaths were to males and 34% (32) were to African American males Opportunities for Prevention Promote prevention of child maltreatment as a community endeavor, adhering to proven prevention practices within all sectors of the community Expand home-based family support and visitation programs to prevent abuse and neglect Adopt a Child Endangerment law that penalizes adults who knowingly place children in dangerous situations and circumstances Authorize DFACS to access law enforcement and court records regarding domestic violence in order to better assess the safety of children referred to their care Encourage Child Abuse Protocol Committees and Child Fatality Review Committees to take a proactive role in informing communities about prevention needs and successful prevention strategies For more information on Child Abuse Prevention please contact Prevent Child Abuse Georgia (800) 532-3208 or www.preventchildabuse.org 15 Sixty three percent (336) of all 537 child fatality review reports received for 2001 indicated that one or more community agencies had prior interaction with the deceased child or his/her family. Agencies were not necessarily actively involved with children or families at the time of the deaths. The PRIOR AGENCY INVOLVEMENT following figures list the agencies and the number of deaths in which they were identified. A child or family was often involved with more than one agency; therefore, the number of agency involvements exceed the number of deaths. Figure 12. Agency Involvement: Reviewed Deaths with No Child Abuse/Neglect Findings No Agency Indicated Health Department DFCS/CPS Law Enforcement Court DFCS/Public Assistance DJJ Other Agency 55 54 47 38 38 184 148 111 Findings 58% of deaths (259) with no abuse find- ings had prior agency involvement Families had involvement with an average of 1.9 agencies 36% of families had involvement with the Department Family & Children Services 33% of families had involvement with Public Health 0 50 100 150 200 Number of Deaths Figure 13. Agency Involvement: Reviewed Deaths With Child Abuse/Neglect Findings Findings 82% of deaths (77) with abuse findings had Health Department prior agency involvement DFCS/CPS Families had involvement with an average 2.2 agencies Law Enforcement 60% of families had involvement with the Court Department of Family & Children Services No Agency Indicated 49% of families had involvement with Public Health DFCS/Public Assistance For the 44 children/families known to Child Other Agency Protective Services, 8 reports did not indicate the nature of the involvement. For the DJJ remaining 36 children/families, involvement 0 was as follows: 46 44 28 18 17 12 10 8 10 20 30 40 5 Number of Deaths Decedent 9 Both decedent and another child in the family 11 Another child in the family, not the decedent 10 Decedent, another child in family, and caretaker 3 Caretaker 1 Other child and caretaker 1 Decedent and caretaker 1 16 SUDDEN INFANT DEATH SYNDROME Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under one year of age that remains unexplained after completion of 1) an autopsy, 2) a thorough investigation of the death scene, and 3) a review of the clinical history. SIDS is the most common cause of death among normal birth-weight infants between one month and one year of age. It is estimated that at least 3,000 infants within the U.S. die as a result of SIDS each year. SIDS continued to be a leading cause of infant death in Georgia. In 2001, death certificates listed 116 infant deaths as SIDS. Child fatality review committees reviewed 103 deaths that were determined to be SIDS. Prior to 1999, SIDS was a "definition by exclusion", meaning all known causes were to be ruled out before selecting SIDS as a cause of death. However, since the introduction of a new coding system (ICD10) for classifying diseases, SIDS is no longer defined by exclusion of all other causes. Georgia death certificates included 112 deaths with SIDS as the underlying cause and an additional 6 deaths with SIDS as a secondary cause. For the child fatality review analysis, 4 of the 6 deaths with SIDS as a secondary cause were included in the total SIDS deaths based on additional information obtained in the child fatality review process. Child fatality review committees reviewed several infant deaths that related to "co-sleeping". Cosleeping is a term used to describe an infant sleeping in the same bed with one or more individuals. The coding of SIDS on death certificates appears to acknowledge that co-sleeping (and suffocation of the infant) is a possible cause of death. Twenty Georgia death certificates in 2001 had a combination of SIDS and "suffocation, unknown intent" for the underlying secondary causes of death. The good news is that the SIDS death rate in Georgia has declined by over 40% since 1990, according to the Office of Infant and Child Health Services of the Division of Public Health. Figure 14. Reviewed SIDS Death by Age Number of Deaths 40 30 30 20 20 15 12 12 10 2 0 412211 0 1 2 3 4 5 6 7 8 9 10 11 Age (months) * 1 death missing DOB and DOD FIGURE 15. Reviewed SIDS Death by Race and Gender Other Male, 3 AA Female, 23 Other Female, 2 White Male, 33 AA Male, 24 White Female, 18 Finding 65% (67) of SIDS deaths occurred among infants 0 to 3 months of age Findings 46% (47) of SIDS victims were African American 58% (60) of SIDS victims were male 17 FIGURE 16. Sleeping Position of Infants Who Died of SIDS Unknown, 29 On Stomach, 37 On Side, 12 On Back, 25 Findings Committees responded to the question regarding sleep position for 102 SIDS deaths. Sleep position was known in 73% (74) of those deaths For known sleeping positions, 50% (37) of the victims were reported to be sleeping on their stomachs, and 34% (25) were reported to be sleeping on their backs SIDS TRENDS Figure 17. SIDS Deaths Rates Per 1,000, Age <1, 1994-2001 Death Rate (per 1,000 births) 3.159096 1997 1998 1999 2000 2001 31 35 36 28 31 23 40 236.00 27 27 22 17 21 20 35 28 27 26 31 47 27 329.50 16 22 25 26 22 24 131 109 115 102 108 113 112 2.00 1.159096 1997 1998 1999 2000 2001 1996 1997 1998 1999 2000 2001 0.814.00 0.94 0.93 0.70 0.74 0.54 0.92 01..77048 .50 0.76 1.44 0.73 1.33 0.58 1.25 0.43 1.45 0.51 2.09 0.48 1.22 21..01077 .00 0.84 0.96 1.13 0.97 1.22 0.83 1.25 0.85 1.00 0.85 1.11 0.84 1994 1995 1996 1997 1998 1999 2000 2001 White Males White Females AA Males AA Females Findings There has been little apparent change in the rate of infant deaths due to SIDS over the past six years. The striking decrease that occurred in the early `90s (and has been attributed to the "Back to Sleep" message) has not continued The annual number of infant deaths in Georgia attributed to SIDS has averaged 110 for the past six years. The current death rate (aproximately .85 per 1000 births) is less than half the rate during the early `90s Male infants are about 50% more likely to die due to SIDS than female infants, and African Americans are about twice as likely as white infants to die due to SIDS Opportunities for Prevention Educate the public (targeting African American communities) about risk reduction including back sleeping, breastfeeding, prenatal smoking cessation, smoke free environment and use of firm bedding materials Incorporate risk reduction information in prenatal education for expectant parents Promote a statewide public education program on the risks of overlay when bed-sharing For more information on SIDS, contact Georgia DHR Office of Infant and Child Health at (404) 657-4143 or SIDS Alliance (National) 1-800-221-SIDS (7437) 18 UNINTENTIONAL INJURY RELATED DEATHS According to death certificate data, injuries were responsible for 477 child deaths. Three hundred seventy-two (372) of those deaths were unintentional. Child fatality review committees reviewed 264 injury-related deaths determined to be unintentional. Figure 18 shows the distribution of those deaths by type of injury. Committees could not determine the manner of death in 6 instances. Figure 18. Reviewed Unintentional Injury-Related Deaths by Cause Motor Vehicle 151 Suff/Strang 29 Drowning 28 Fire 21 Other Unintentional 11 Poisoning 9 Unknown 6 Gun 5 Fall 4 accidents under the a0ge of 5 50 100 150 200 Number of Deaths Findings 57% (151) of deaths resulted from motor vehicle-related incidents 36% (96) of injury-related deaths occurred among children under the age of 5 MOTOR VEHICLERELATED DEATHS Nationally, motor vehicle crashes remain the leading cause of unintentional injury-related deaths for children 1-14 years old. Twenty-five percent of those children killed between the ages of 5 and 9 were pedestrians. Two out of five deaths among U.S. teens are the result of motor vehicle crashes. In Georgia, motor vehicle incidents continue to be the leading cause of death among teens 15-17 and the leading cause of unintentional injury-related deaths to children between ages 1-17. Death certificate data indicated that 224 child deaths resulted from motor vehicle incidents. Child fatality review committees reviewed 151 child deaths that were related to motor vehicle incidents. Of the 151 reviewed motor vehicle-related deaths, 72 (48%) involved children who were passengers, and 34 (22%) were operators of cars, trucks, SUVs, or vans. Information on the presence of restraints was provided for 77 of the reviewed deaths. It was determined that restraints were not used in 30 (42%) incidents in which a vehicle was known to be equipped with a restraint (71). The remaining 30% of the 151 reviewed motor vehicle-related deaths involved bicycles (2), all terrain vehicles (4), motorcycles (3), tractor trailers (2), other farm vehicles (1), 1 passenger in an aircraft, and 32 pedestrians. Of the 9 children on bicycles, ATV's, and motorcycles, 4 were not wearing safety helmets. FIGURE 19. Reviewed Motor Vehicle-Related Deaths by Age 80 75 70 Number of Deaths 60 50 40 30 28 21 22 20 1a0mong te5ens ages 15-17 of death0s increased as follows: <1 1-4 Age 15 12 deaths 5 - 9AAggee 111670 - 133421 ddeeaa1tt5hhss- 17 Age Range (years) Findings 50% of reviewed motor vehicle-related deaths occurred among teens ages 15-17 As teens achieved legal driving age, the number of deaths increased as follows: Age 15 12 deaths Age 16 32 deaths Age 17 31 deaths 19 Figure 20. Reviewed Motor Vehicle-Related Deaths by Race and Gender AA Female, 15 AA Male, 37 Other Male, 3 White Male, 56 Findings 64% (96) of deaths were white children 64% (96) of deaths were male children White Female, 40 Motor Vehicle Trends Figure 21. Motor Vehicle Fatality Rates per 100,000: Age 15-17, 1994-2001 Death Rate (per 100,000) 197970.00 1998 60 60.0400 38 50.0303 19 10 40.01058 128 30.0908 1999 47 26 17 5 95 2000 48 21 20 10 99 2001 44 51 26 28 16 21 6 6 94 107 20.00 10.00 19970.00 1998 1999 2000 2001 333841...5181751994 1942294695...7631303996 1942397513...0271984198 1994229066...2803001600 2004231673...678903 White Male White Female AA Male AA Female Findings The fatality rate due to motor vehicle crashes among young teens (ages 15-17) has been fairly stable for the past five years. There are approximately 28 deaths per year per 100,000 teens in that age group. The motor vehicle death rate is higher among white teens than among African American teens, and the rates among males are higher than among females Opportunities for Prevention Enforce the Teenage and Adult Driver Responsibility Act Support statewide availability of driver education programs Continue to promote bicycle helmet use including education about proper fit and wearing position and establish funding to support community programs that provide helmets to families with young children in need of financial assistance to purchase safety equipment Promote educational programs to teach proper installation and use of car seats and proper use of vehicle restraints Encourage communities to provide car seats to families with infants and young children who need financial assistance to purchase safety equipment Encourage pedestrian safety campaigns For more information on prevention of motor vehicle crashes and the proper use of child safety seats & seat belts, please contact the National Highway Traffic Safety Administration, 1-888-DASH-2-DOT or the National 20 Center for Injury Prevention and Control (770) 488-1506 www.cdc.gov Drowning Drowning is the second leading cause of injuryrelated deaths for children 1 through 14 years of age in the United States. Most children drown in swimming pools at the child's own home. For the nation as a whole, drowning rates are three times higher in rural areas. According to death certificate data in Georgia, 40 children died as a result of drowning which was a 15% decrease from 2000. Child fatality review committees reviewed 28 drowning deaths of children under the age of 18 years. Information on the use of floatation devices was provided in 28 reviews which indicated none of the children wore a floatation device. Information regarding supervision was addressed in 26 of the 28 reviewed deaths. Committees determined that in 62% of drowning deaths, supervision was inadequate. Figure 22. Reviewed Deaths Due to Drowning by Age 14 Number of Deaths 12 10 8 6 4 2 the age02s of 1 and 4 <1 12 7 4 1-4 5 - 9 10 - 14 Finding Age Range (years) 50% of drowning victims were children under the age of 5 3 15 - 17 Figure 23. Reviewed Drowning Deaths by Race and Gender AA Female, 2 White Male, 10 Finding 4.6 times as many drowning deaths occurred among males as females males as females AA Male, 13 White Female, 3 Figure 24. Place of Drowning Pool, 10 Natural, 10 Findings 36% of drowning victims died in a natural body of water 36% of drowning victims died in a swimming pool The total number of drowning deaths in pools 8 in 2001 Bathtub, 8 remained the same from 2000 to 2001 (10) Drowning deaths in bathtubs increased from 2 in 2000 to 8 in 2001 21 Drowning Trends Figure 25. Drowning Fatality Rates per 100,000: Age < 18, 1994-2001 Death Rate (per 100,000) 1996 67..1000001997 5.00 4.1070 1998 22 11 1999 15 19 2000 22 20 2001 20 10 16 12 9White Male 16White Female 3.3060 51 41 56 53 39AA Male 2.00 AA Female 1.00 1996 0.001997 1998 1999 2000 2001 1.62 0.34 5.82 1994 13139...95165199 1996 12059...93657674 1998 13159...94369329 2000 23140...00471876 1.82 1.29 5.18 1.79 2.62 0.28 1.11 1.63 0.80 Findings Over the past eight years, an average of 46 chil- dren drowned each year in Georgia The number of drowning deaths fluctuates, but there is not any apparent trend The rate of drowning deaths among African American males is consistently the highest of all race/sex groups Opportunities for Prevention Increase public education efforts that teach water safety and skills among school age children Promote regulations and enforcement to limit alcohol use by operators of recreational boats Encourage Department of Natural Resources to establish stronger rescue capabilities at state swimming facilities Enact and enforce statewide ordinances related to fences and gates in public and private swimming pools For more information on prevention of drowning please contact the National SAFEKIDS Campaign at 202- 662-0600 www.safekids.org or American Red Cross (202) 639-3520 www.redcross.org Fire /Burn Related Deaths Residential fires are the most common cause of fire related mortality in the United States. Approximately half of deaths resulting from residential fires occur in homes without smoke alarms. Death certificate data for Georgia indicated a total of 23 fire-related deaths that represent a decrease from 2000 (26). Child fatality review committees reviewed 21 fire/burn related deaths in 2001. Two of those deaths resulted from burns due to hot water scalds. Number of Deaths Figure 26. Reviewed Deaths Due to Fire by Age 15 12 10 5 1 the 0age of 10 <1 3 3 2 1-4 5 - 9 10 - 14 Age Range (years) 15 - 17 Finding 76% of victims of fire related deaths were under the age of 10 22 Figure 27. Reviewed Deaths Due to Fire by Race and Gender AA Female, 6 White Male, 7 from 8 in 2000 to 1 in 2001 AA Male, 7 White Female, 1 Finding African American children accounted for 24% more fire-related deaths than White children Fire-Related Trends Figure 28. Fire-Related Fatality Rates per 100,000 Ages < 18, 1994-2001 Death Rate (per 100,000) 19967.00 1997 1998 1999 2000 2001 6.0150 6 6 5 4 9 5.00 White Male 7 4.011750 5 14 4 4 1 2 5 7 10 8 White Female 3.0540 15 25 12 21 28 AA Male 2.00 AA Female 1.00 19960.00 1997 1998 1999 2000 2001 20..45311994 10099..90560 1996 1009..991757 1998 0019..769869 2000 002..0680221 1.37 0.16 4.36 1.42 3.88 0.27 1.32 2.59 Findings There have been an average of 30 fire- related deaths per year for the past eight years There were an average of 47 deaths per year for 19941996, and the number dropped to 20 per year for the past three years (1999-2001) African American children are twice as likely to die in fires as White children Opportunities for Prevention Continue to expand school fire safety programs that teach critical messages like "stop, drop and roll" and those that help families plan fire escape routes Continue to expand community programs to provide smoke detectors and batteries to families who cannot afford them Promote public education about the importance of changing smoke detector batteries every six months For more information on the prevention of fire related deaths and burn prevention, please contact the United States Fire Administration, www.usfa.gov or the Georgia Firefighters Burn Foundation, (404 320-6223), www.gfbf.org, or SAFE Kids Campaign (203) 662-0600 23 The total number of deaths resulting from homicide and suicide (105) for 2001 changed little from 2000 (106), based on death certificate data. In 2001, local Child Fatality Review Committees reviewed a Homicide is the second leading cause of death for people ages 10-19 in the United States. Child Fatality Review Committees reported 54 homicide INTENTIONAL INJURY DEATHS total of 87 deaths (54 homicides and 33 suicides) determined to be the result of intentional injuries. Thirty seven (37) of the 94 reported abuse related deaths were homicides. Homicide deaths. The figure below presents reviewed homicide deaths by circumstance of death. Figure 29 Reviewed Homicide Deaths by Circumstance of Death Firearm Struck 18 11 Poison 6 Fire 5 Suffocation 4 Undetermined 4 Shaken 3 Cut/Stabbed 2 homicCidreusshed 1 from being struck or stabbed 0 5 10 15 20 Findings: Number of Deaths Firearms were the cause of 1/3 of all reviewed homicides 24% (13) of homicide deaths were due to injuries resulting from being struck or stabbed 11% (6) of homicide deaths were due to poisoning Figure 30. Reviewed Homicide Deaths by Age 25 23 Number of Deaths 20 15 10 9 5 rheovmieiwcie0dde homicide deaths deaths <1 1-4 4 5 5 - 9 10 - 14 Age Range (years) 13 15 - 17 Findings: Children under 5 years of age represented 59% of all reviewed homicide deaths Teenagers ages 15-17 years represented 24% of all reviewed homicides which was a decrease from 2000 (33%) 24 Figure 31. Reviewed Homicide Deaths by Race and Gender Findings 63% of homicide victims were male 56% of homicide victims were African American compared to 47% in 2000 Other Male, 1 AA Female, 11 Other Female, 3 AA Male, 19 Homicide Trends Figure 32. Death Rates for Teen Homicides per 100,000, Ages 15-17, 1994-2001 White Male, 14 White Female, 6 Death Rate (per 100,000) 189096.00 1997 2 60.00 6 27 40.0022 40 20.0035 1998 10 17 34 1999 7 17 33 2000 5 16 27 2001 9 11 26 5White Male 14White Female AA Male 21AA Female 0.00 1.98 1996 5.189694191997959.614991699189967.616991899199949.70202000002080.134 2001 4.58 Findin2gs12 2 09 2 07 5 12 3 03 1 00 1 98 The number of teen homicides (ages 15-17) has decreased continuously during the past 8 years. The average number of deaths per year over a three-year period has dropped from 42 (1994-1996) to 25 (1999-2001), and the rate has decreased from 16 per 100,000 to 6 per 100,000 Over 60% of all Georgia teen homicide victims were African American males, and their homicide rate over the past three years has been >20 deaths per 100,000 Opportunities for Prevention Promote school and after-school programs teaching conflict resolution, impulse control, anger management and empathy Support legislation and public service announcements promoting responsible gun ownership including use of firearm safety locks, safe firearm storage, and warnings to parents and other adults of the dangers to children, and liabilities to parents, of keeping loaded firearms in homes occupied or visited by children Support legislation requiring American made guns to be subject to federal safety standards as are other consumer products 25 In 2001, local Child Fatality Review Committees reviewed 33 deaths of children who took their own lives. Death certificate data indicated a total of 34 suicide deaths which was an increase from 2000 (30). Firearms were used in 42% (14) of reviewed Findings 76% (25) of reviewed suicide deaths occurred to teens 15-17 The youngest reviewed suicide victim (11 years old) died of injuries sustained from strangulation due to hanging Suicide suicides. Strangulation (hanging) was the circumstance of death for another 16 reviewed deaths. Two deaths resulted from falls, and one death resulted from poisoning. Figure 33. Reviewed Suicide Deaths by Age 30 25 25 Number of Deaths 20 15-17 y1e5ars old died o1f0injuries sustain8ed from stangulation due to hanging 5 0 10 - 14 15 - 17 Age Range (years) Figure 34. Reviewed Suicide Deaths by Race and Gender AA Female, 2 AA Male, 1 White Female, 5 Other Male, 2 Suicide Trends White Male, 23 Findings 85% of all reviewed suicide victims were White children 79% of all reviewed suicide victims were males 70% of all reviewed suicide victims were White males Figure 35. Suicide Death Rates per 100,000, Ages 15-17, 1994-2001 Death Rate (per 100,000) Findings The average annual number of teen suicides (22) has been lower the past 4 years (1998-2001) than the prior 4 years (31) Suicide rates for all 15-17 year olds declined each year from 1994 (11.3) through 1999 (4.94). Rates increased in 2000 (6.84) and again in 2001 (7.55) White males comprise over 60% of the suicide victims over the eight-year period, and their suicide death rate has averaged about 13 per 100,000 over the past four years Opportunities for Prevention 21599.060 1997 1998 1999 2000 2001 20 20.00 18 15 13 10 12 15.00 10.00 1 1 1 32 5.00 28 28 21 17 24 0.00 19.82 1996171.95994 11999975141.94976 11999987121.39798191999999.2309002020000111.13 2001 18 4.24 3.14 5.17 5.12 5.06 6.00 3 W20hite Male White Female AA1 Male A2A7 Female Increase the access and availability of mental health and substance abuse prevention and treatment services to children and youth Increase awareness among parents, caretakers and communities of suicide warning signs, and promote prompt action when warning signs are recognized 26 Develop community intervention resources for children at risk of suicide Advocate for safe home storage of firearms FIREARM DEATHS Firearm deaths include homicides, suicides, and unintentional injuries. It is estimated that every two hours in the U.S., a child is killed with a loaded gun. Most young homicide victims are killed with firearms. Ninety percent (90%) of unintentional shootings involving children are linked to easy-to-find, loaded handguns in the home. In Georgia, death certificate data indicated a total of 47 deaths caused by firearms. Child Fatality Review Committees reviewed 37 deaths caused by firearms. Child fatality review reports ask for information not available on death certificates, including source of the firearm, type of firearm, who was using the firearm at the time of death, and the age of the firearm handler. This information provides important guidance for prevention. Figure 36. Reviewed Firearm Deaths by Manner of Death Count FA Source on Uni5ntePnatiorenanlt, e 4 P5arent e 1 Acquaintance e 13 Unknown 7 Parent 1 Acquaintance Suicide6, 1U4nknown Homicide, 18 Finding 49% of firearm-related deaths were homicides Figure 37. Reviewed Firearm Related Deaths by Age Number of Deaths Age 15-17 Circ Count 2515 - 17 Hom 11 23 201155 - 17 17 Suic Unintent 10 2 15 10 9 ag5ed 15-17 2 3 olds, 48%0 (11) were homicides and 43% (10) were suicides 1-4 5-9 10 - 14 15 - 17 Age Range (years) Findings 62% of reviewed firearm deaths occurred to children aged 15- 17 Of reviewed firearm deaths among 15-17 years olds, 48% (11) were homicides and 43% (10) were suicides Figure 38. Reviewed Firearm Deaths by Race and Gender AA Female, 2 AA Male, 9 White hildren Female, 2 White Male, 24 Findings 70% of reviewed firearm deaths occurred to White children 89% of reviewed firearm deaths were males Source of Firearm In 49% (18) of reviewed firearm deaths, the firearm was obtained from someone the child knew (a parent, other relative or acquaintance) Parents were the source of the firearm in 50% (7 of the 14) of reviewed suicides by firearm The source of the firearm was unknown in 51% (19) of reviewed firearm related deaths 27 Type of Firearm Figure 39. Reviewed Firearm Deaths by Type of Firearm Number of Deaths HaSnudicg2uF5nA Type 21 Count 6 RShifoletg2un0 3 4 Other15 1 Hom FA Type Handgun Rifle Shotgun Unknown Count 14 1 2 1 10 7 7 5 1 1 0 comparedHtaon6d6%guinn 2000Rifle Shotgun Other Unknown were to 5% (2) in 2000 committed with a firearm. TOyf tpheesoe,f6Fdireeaathrsm(43%) involved a Findings 57% (21) of the firearms were handguns com- pared to 66% in 2000 19% (7) of the firearms were shotguns compared to 5% (2) in 2000 14 of the 33 reviewed suicide deaths were com- mitted with a firearm: 6 (43%) = handgun 4 = shotgun 3 = rifle 1 = other type Of the 54 reviewed homicides, 33% (18) were committed with a firearm: 14 (78%) = handgun 2 = shotgun 1 = rifle 1 = firearm type unknown Usage In 76% of firearm deaths (28) the shooter was aiming at himself or at someone else Three deaths were the result of the shooter "playing" with the firearm Storage Storage of the firearm was only indicated in 7 of the 37 reviewed firearm deaths Of the 7 cases in which storage location was known, 6 indicated the firearm had not been secured to prevent use by children or unauthorized adults Age of Handler The shooter was under the age of 15 in 3 of 5 unintentional deaths The shooter was 15 or over in 66% (21) of all intentional deaths Firearm Trends Figure 40. Firearm Death Rates per 100,000, Ages 15-17, 1994-2001 Death Rate (per 100,000) Findings All deaths attributed to firearms have declined over the eight-year period. The average annual number of deaths was 67 for 1994-1996, and dropped to 31 for 1999 to 2001 1001.90906 1680.00 3260.00 40.00 5920.00 1997 28 26 66 1998 24 22 57 1999 17 18 47 2000 8 17 31 2001 12 White M15ale 13 White F13emale AA Male 32 AA Fem29ale However, most of the decline in firearm 0.00 deaths has been in the African American male population. The firearm death rate in this population has declined from a high of 80 per 100,000 in 1994 to about 21 per 100,000 in 19961994 191995917996 199179918998 199919290900 20012000 2001 15.85 27.37 23.14 16.18 7.51 11.13 13.73 Opportunities for Prevention 2000 and 2001 Promote school and community-based risk reduction and firearm safety programs for children, parents and other caretakers Promote the use of firearm safety devices, including trigger locks 28 Support efforts to limit minors' access to firearms RACE, ETHNICITY AND DISPROPORTIONATE DEATHS Data are presented in this report by race and gender for each type of death to enable more detailed analysis. The terms "White", "AfricanAmerican" (A-A) and "Other" are used to identify racial groups throughout the report. "Other" refers to children of Asian, Pacific Islander, or Native American origin. Death certificate data includes ethnicity information that can identify children of Hispanic origin. Ninety-one (91) of 95 deaths identified as Hispanic indicated the race as "White." The 4 remaining deaths identified as Hispanic indicated the race to be "Other". Figure 41. Deaths to Children < 1 and Percent of Population in Georgia By Race and Gender 7.18 35 30 5.24 15.32 10.93 6.23 25 Percent dea(1th312s.1505ocpecru1r,r0e0d0 among Black infants births) was more than double the rate for White infants (6.23 per 1,000 10 5 0 White Males White Females AA Males AA Females Findings A disproportionate number of deaths occurred among African-American infants % Deaths % Population All A-A Infants A-A-Male Infants % of Deaths 50.3 29.6 % of Population 32.3 16.3 A-A Female Infants 20.7 15.9 The infant mortality rate for African-American infants (13.5 per 1,000 births) was more than double the rate for white infants (6.2 deaths per 1,000 births) Figure 42. Deaths to Children 1-17 and Percent of Population in Georgia, By Race and Gender 50 adnedat1h7s34ao00rcecuarbroeudta5m0%ongmmoraelelikcehlyildtorednie than females in the same age range Percent 20 10 0 White Males White Females AA Males AA Females % Deaths % Population Findings A disproportionate number of deaths % of Deaths % of Population occurred among male children All Males 117 62.9 51.3 Males between the ages of 1 and 17 are about 50% more likely to die than AA-Males 117 23.1 17.5 females in the same age range White Males 1-17 39.2 29.7 29 THE HISTORY OF CHILD FATALITY REVIEW IN GEORGIA 1990 - 1993 Legislation established the Statewide Child Fatality Review Panel with responsibility for compiling statistics on child fatalities and for making recommendations to the Governor and General Assembly based on the data. It established local county protocol committees and directed that they develop county-based written protocols for the investigation of alleged child abuse and neglect cases. Statutory amendments were adopted to: Establish a separate child fatality review team in each county and determine procedures for conducting reviews and completing reports Change the name of the Statewide Child Fatality Review Panel to the Statewide Child Abuse Prevention Panel and require the Panel to: Submit an annual report documenting the prevalence and circumstances of all child fatalities with special emphasis on deaths associated with child abuse Recommend measures to reduce child fatalities to the Governor, the Lieutenant Governor, and the Speaker of the Georgia House of Representatives Establish a protocol for the review of policies, procedures and operations of the Division of Family and Children Services for child abuse cases Monitor implementation of the State Child Abuse Prevention Plan 1996 - 1998 The Statewide Child Abuse Prevention Panel established the Office of Child Fatality Review with a full-time director to administer the activities of the Panel An evaluation of the child fatality review process was conducted by researchers from Emory University and Georgia State University. The evaluation concluded that there were policy, procedure, and funding issues that limited the effectiveness of the review process. Recommendations for improvement were made to the General Assembly Statutory amendments were adopted to: - Identify agencies required to be represented on child fatality review teams, and establish penalties for non-participation - Require that all child deaths be reported to the coroner/medical examiner in each county - Establish additional requirements for county child fatality review committees 1999 - 2002 Child death investigation teams were initially developed in four judicial circuits as a pilot project, with six additional teams later added. Team members were identified as law enforcement, coroner or medical examiner, district attorney representative, and department of family and children services representative. Teams assumed responsibility for conducting death scene investigations of child deaths within their judicial circuit that met established criteria Statutory amendments were adopted which resulted in the Code section governing the Child Fatality Review Panel, child fatality review committees, and child abuse protocol committees being completely rewritten. The name of the Statewide Child Abuse Prevention Panel was changed to the Georgia Child Fatality Review Panel The Panel's budget was increased to allow for 2 additional staff persons, and establishment of physical office space. Funding was secured to purchase an on-line reporting system 30 APPENDIX A CRITERIA FOR CHILD DEATH REVIEWS Child Fatality Review Teams are required to review the deaths of all children under the age of 18 that meet the criteria for a coroner/medical examiner's investigation. "Eligible" Deaths or Deaths to be Reviewed by Child Fatality Review Teams O.C.G.A. 19-15-3(e) The death of a child under the age of 18 must be reviewed when the death is suspicious, unusual, or unexpected. Included in this definition are incidents when a child dies: 1. as a result of violence 2. by suicide 3. by a casualty (i.e., car crash, fire) 4. suddenly when in apparent good health 5. when unattended by a physician 6. in any suspicious or unusual manner, especially if under 16 years of age 7. after birth but before seven years of age if the death is unexpected or unexplained 8. while an inmate of a state hospital or a state, county, or city penal institution 9. as a result of a death penalty execution 31 APPENDIX B CHILD FATALITY REVIEW TIMEFRAMES AND RESPONSIBILITIES 32 APPENDIX C.1 Total Child Fatalities Based on Death Certificate Infant (Age < 1) Infant (Ages 1 to 4) Cause of Death Drowning Fire / Burns Homicide Medical Causes Other Accident Poisoning SIDS Suffocation Unknown Vehicle Accident Total Cause of Death Drowning Fire / Burns Homicide Medical Causes Other Accident Poisoning Suffocation Unknown Vehicle Accident Total Infant (Ages 5 to 14) Cause of Death Drowning Fire / Burns Homicide Medical Causes Other Accident Suffocation Suicide Vehicle Accident Total White Male Female 1 1 1 1 1 257 184 1 2 1 39 22 8 2 3 5 1 2 313 219 White Male Female 6 6 5 8 4 37 17 6 1 1 1 1 14 11 78 40 White Male Female 1 1 2 5 4 35 23 5 2 3 4 1 25 21 79 53 Black Male Female 1 5 3 292 197 2 1 2 28 26 5 2 3 4 1 2 338 236 Black Male Female 4 2 6 6 10 22 14 1 1 3 2 1 1 6 3 44 38 Black Male Female 11 1 3 1 3 1 14 34 1 2 1 20 11 54 49 Other Male Female 18 15 1 1 19 16 Other Male Female 1 1 1 1 2 Other Male Female 1 1 Total 2 2 10 963 6 3 116 18 15 6 1141 Total 16 13 28 92 9 2 6 3 34 203 Total 14 6 13 106 6 7 7 77 236 Infant (Ages White Black Other 15 to 17) Cause of Death Male Female Male Female Male Female Total Drowning 4 1 2 1 8 Fire / Burns 2 2 Homicide 4 2 14 20 Medical Causes 13 10 14 8 45 Other Accident 3 3 Poisoning 5 5 Suicide 20 4 1 1 1 27 Unknown 1 1 2 Vehicle Accident 51 28 21 6 1 107 Total 101 46 54 16 2 219 33 APPENDIX C.2 Total Reviewed Child Fatalities 2001 White Black Other Infant (Age < 1) Cause of Death Male Female Male Female Male Female Total Drowning 1 1 2 Fall 2 1 3 Fire / Burns 1 1 Homicide 1 4 3 1 9 Medical Causes 7 12 18 2 1 40 Other Accident 1 1 Poisoning 1 1 2 SIDS 33 18 24 23 3 2 103 Suffocation 5 1 6 1 1 2 16 Unknown 2 1 3 Vehicle Accident 1 2 1 1 5 Total 49 23 52 49 6 6 185 White Black Other Ages 1 to 4 Cause of Death Male Female Male Female Male Female Total Drowning 6 2 4 12 Fall 1 1 Fire / Burns 5 2 5 12 Firearm 1 1 Homicide 7 3 5 7 1 23 Medical Causes 6 4 4 1 2 17 Other Accident 3 1 1 1 6 Poisoning 1 1 2 Suffocation 1 3 2 6 Unknown 1 1 2 Vehicle Accident 7 7 5 2 21 Total 39 17 23 18 4 2 103 White Black Other Ages 5 to 14 Cause of Death Male Female Male Female Male Female Total Drowning 1 1 8 1 11 Fire / Burns 2 3 1 6 Firearm 2 2 Homicide 3 3 1 1 1 9 Medical Causes 7 3 4 7 21 Other Accident 2 1 3 Suffocation 1 3 3 7 Suicide 5 1 1 1 8 Vehicle Accident 16 12 13 8 1 50 Total 39 23 33 19 2 1 117 White Black Other Ages 15 to 17 Cause of Death Male Female Male Female Male Female Total Drowning 2 1 3 Fire / Burns 2 2 Firearm 2 2 Homicide 3 9 1 13 Medical Causes 1 1 2 1 5 Other Accident 1 1 Poisoning 5 5 Suicide 18 4 1 1 1 25 34 Unknown 1 Vehicle Accident 32 19 18 6 1 75 Total 65 24 33 8 2 132 APPENDIX C.3 Reviewed Child Fatalities with Abuse Findings 2001 Infant (Age < 1) Cause of Death Drowning Fire / Burns Homicide Medical Causes Poisoning SIDS Suffocation Unknown Total Ages 1 to 4 Cause of Death Other Accident Drowning Fall Fire / Burns Homicide Vehicle Accident Poisoning Suffocation Unknown Total Ages 5 to 14 Cause of Death Drowning Fire / Burns Homicide Vehicle Accident Suffocation Suicide Total Ages 15 to 17 Cause of Death Homicide Medical Causes Vehicle Accident Suicide Total White Male Female 1 1 1 2 1 3 3 White Male Female 1 1 1 1 3 6 2 1 2 1 1 15 5 White Male Female 2 3 1 1 1 1 4 5 White Male Female 1 2 3 Black Male Female 1 4 2 1 1 1 4 1 2 1 13 5 Black Male Female 1 4 1 1 5 7 2 1 1 1 1 13 12 Black Male Female 3 1 1 3 2 Black Male Female 3 1 3 1 Other Female 1 1 2 Other Female 1 1 2 Other Female Other Female Total 1 1 8 2 2 7 4 1 26 Total 3 6 1 5 21 5 2 2 2 47 Total 3 1 5 3 1 1 14 Total 3 1 1 2 7 35 APPENDIX C.4 Prevention Potential of Reviewed Child Fatalities by Abuse Classification and Cause of Death Cause of Death Medical SIDS Homicide Vehicle Crashes All Other Acc. Total Cause of Death Medical SIDS Homicide Suicide Vehicle Crashes All Other Acc. Total Cause of Death Medical SIDS Homicide Suicide Vehicle Crashes All Other Acc. Total Confirmed Abuse Prevention Finding Missing Not Preventable Possibly 1 3 2 1 1 4 4 Suspected (but not confirmed) Abuse Prevention Finding Missing Not Preventable Possibly 1 6 2 1 3 6 19 No Abuse Finding Prevention Finding Missing Not Preventable Possibly 1 58 18 2 33 58 1 4 4 14 2 16 53 2 4 32 7 116 179 Definitely 1 1 26 4 18 50 Definitely 4 2 2 9 17 Definitely 3 3 12 11 71 41 141 Total 2 1 31 4 20 58 Total 1 6 6 3 5 15 36 Total 80 96 17 29 142 79 443 36 APPENDIX D COUNTY COMPLIANCE WITH REVIEWING ELIGIBLE DEATHS Percent of Reviewable Deaths Reviewed, 2001, by County Note: Counties without a percent had no reviewable deaths for 2001 Dade 50.0 Caloosa 100.0 Walker 0.0 Whitfield 100.0 Murray 50.0 Fannin 100.0 Gilmer 50.0 Union 100.0 Towns 100.0 Rabun 100.0 White Habersham Chattooga 100.0 Floyd 100.0 Gordon 75.0 Bartow 91.7 Pickens 100.0 Cherokee 100.0 Lumpkin 100.0 Dawson 80.0 Forsyth 100.0 100.0 100.0 Hall Banks 80.0 0.0 Jackson 0.0 Stephens 100.0 Franklin 100.0 Madison 100.0 Hart Elbert Polk 0.0 Haralson 0.0 Carroll 27.3 Heard 100.0 Paulding 70.0 Cobb 100.0 Gwinnett 89.9 Barrow 50.0 Clarke 40.0 Oconee Douglas 14.0 DeKalb 75.8 Walton Fulton 96.6 Clayton Rockdale 100.0 Newton 100.0 100.0 50.00 Morgan 100.0 Coweta 75.0 Fayette 0.0 Henry 85.7 Spalding 80.0 Butts 100.0 Jasper Putnam 75.0 Oglethorpe Wilkes 100.0 Lincoln Greene 100.0 Taliaferra Columbia McDuffie 100.00 Warren 100.0 Richmond Hancock 72.7 100.0 Glascock Troup 80.0 Pike Lamar Meriwether Monroe 0.0 100.0 Jones 0.0 Baldwin 100.0 Upson Harris 0.0 0.0 Talbot Bibb 50.0 Crawford Wilkinson 0.0 Twiggs 0.0 Muscogee 94.1 Chattahoochee 100.0 Marian 100.0 Taylor Schley 0.0 Macon 0.0 Stewart 100.0 Webster Sumter 50.0 Peach 75.0 Houston 100.0 Bleckley 100.0 Dooly Pulaski 0.0 Dodge 0.0 Crisp Wilcox Quikman 100.0 100.0 Randolph 100.0 Terrell 0.0 Lee Turner Ben Hill Washington 0.0 Jefferson 0.0 Laurens 00.0 Johnson Treutlen 0.0 Emanuel 0.0 Montgomery Wheeler Toombs 00.7 Telfair 100.0 Jeff Davis 0.0 Appling 80.0 Burke 0.0 Jenkins Screven 100.0 Candler 100.0 Bulloch 100.0 Effingham 0.0 Evans 0.0 Tallnall 100.0 Lang Bryan 25.0 Liberty 100.0 Chatham 80.0 Clay Calhoun Dougherty 100.0 Early 100.0 Miller 0.0 Baker Mitchell 100.0 Seminole 100.0 Decatur 25.0 Grady 100.0 Worth 100.0 Tift 100.0 Irwin 100.0 Coffee 100.0 Colquitt 100.0 Berrien 0.0 Atkinson 0.0 Coak 0.0 Lanier Thomas 0.0 Brooks 100.0 Lawndes 100.0 Clinch Echols Bacon 0.0 Ware 80.0 Wayne 0.0 Pierce 0.0 Brantley 0.0 McIntosh 100.0 Glynn 00.0 Charltan Camden 100.0 37 APPENDIX E 2001 CHILD FATALITY REVIEWS, BY COUNTY, BY AGE GROUPS Appendix E presents county level data for the Child Fatality Review process in 2001. The data is presented for four age groups (infants less than 1 year old, children from 1 to 4 years of age, children 5 through 14, and teenagers ages 15 through 17). Four numbers are provided for each age group: Total Deaths: The total number of deaths (all causes) for that age group. This number is based on Georgia death certificate data and only includes deaths to Georgia residents under the age of 18. This does include deaths of Georgia residents that occurred in other states and were reported back to Georgia, but it does not include deaths of out-of-state residents that occurred in Georgia. Eligible Deaths: The number of SIDS, unintentional, or violence-related deaths (eligible deaths) according to the death certificate classifications. Although other deaths due to medical or natural causes may be eligible for review according to OCGA 19-15-3(e), SIDS deaths are explicitly required to be reviewed, and unintentional/violence related deaths should be reviewed as "sudden or unexpected deaths." Thus, this number represents a minimum number of deaths that should be reviewed. This is a subset of total deaths (DTH). Eligible Deaths Reviewed: The number of SIDS, unintentional, or violence related deaths that were reviewed. This number is a measure of how well a county identified and reviewed the minimum number of appropriate deaths. This is a subset of the total "eligible" deaths. Total Deaths Reviewed: This is the total number of child deaths in 2001 for which a Child Fatality Review Report was submitted. It includes deaths due to medical causes (other than SIDS) in addition to those deaths which were identified as eligible for review. This is based on the county of residence identified from the death certificate. 38 Appendix E Child Fatality Reviews, by Death Certificate County of Residence County Total Deaths AGE <1 1-4 5-14 15-17 Total Appling 533 11 Atkinson 311 5 Bacon 12 3 Baker 0 Baldwin 11 2 2 2 17 Banks 112 Barrow 4 116 Bartow 8 4 1 5 18 Ben Hill 2 1 3 Berrien 2 013 Bibb 36 3 9 7 55 Bleckley 1 012 Brantley 1 012 Brooks 112 Bryan 11125 Bulloch 6 1 1 3 11 Burke 111 3 Butts 3 036 Calhoun 1 0 1 Camden 51017 Candler 3 2 5 Carroll 9 6 3 6 24 Catoosa 61018 Charlton 3 0 3 Chatham 40 3 7 1 51 Chattahoochee 3 0 3 Chattooga 210 3 Cherokee 8 2 3 5 18 Clarke 9 2 4 3 18 Clay 0 Clayton 35 3 8 6 52 Clinch 0 Cobb 84 14 11 11 120 "Reviewable" Deaths <1 1-4 5-14 15-17 Total "Reviewable" Deaths Reviewed <1 1-4 5-14 15-17 Total 122 5 110 2 2 2 0 1 214 112 2 114 5 1 1 5 12 0 011 3 6 6 15 011 011 112 1124 1124 10 1 1 034 0 011 2 2 1 4 0 6 11 1012 0 6 5 1 12 1 0 1 110 2 11147 1 135 0 4 2 2 3 11 0 5 9 4 6 24 121 4 0 0 0 1 214 0 1 1 2 5 1 1 4 11 0 0 2 428 011 0 112 1 1 1124 0 1 034 0 011 2 2 1 023 1012 0 6 4 10 1 0 1 110 2 11147 1 012 0 4 2 2 3 11 0 5 9 4 6 24 Total Deaths Reviewed <1 1-4 5-14 15-17 Total 31 4 0 0 0 21216 0 1 1 2 5 2 1 5 13 0 0 3 328 1 012 0 112 1 1 1124 0 1 034 1 0 1 1 012 2 2 21025 1012 0 7 6 13 1 0 1 110 2 11147 3 014 0 5 3 4 3 15 0 8 12 6 6 32 39 40 Appendix E Child Fatality Reviews, by Death Certificate County of Residence County Total Deaths AGE <1 1-4 5-14 15-17 Total Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene 7 1 2 3 13 4 2 1 3 10 4 1 4 3 12 210 3 6 4 10 2 0 2 6 2 2 1 11 21025 3 036 6 3 9 90 10 14 15 129 42129 4 0 4 19 5 0 24 14 1 4 19 310 4 0 31217 0 4 4 2 1 11 310 4 3 115 3 6 3 3 15 11 2 0 3 16 10 2 3 15 3 216 99 15 22 21 157 1 023 1 0 1 16 1 1 2 20 31116 41128 11114 "Reviewable" Deaths <1 1-4 5-14 15-17 Total "Reviewable" Deaths Reviewed <1 1-4 5-14 15-17 Total 2 1 1 1 2 110 1 3 111 0 2 0 2 2 11 6 6 1 220 313 1 0 11 140 110 2 0 22 520 412 1 2 23 13 8 0 3 0 111 111 1 36 13 35 2 4 0 14 22 35 4 10 33 23 0 4 7 1 0 13 0 16 2 13 37 3 10 7 14 15 59 22 0 25 14 3 1 2 1 1 1 2 3 111 0 1 0 1 0 10 3 3 220 10 1 0 2 0 520 412 1 2 22 12 8 0 2 0 11 111 1 36 13 35 0 3 0 14 11 34 1 9 25 0 0 4 1 1 0 0 0 0 0 13 0 3 10 7 14 15 57 11 0 13 13 3 1 Total Deaths Reviewed <1 1-4 5-14 15-17 Total 2 136 2 114 21227 0 3 3 0 12216 1 1 1 034 0 16 6 7 9 38 0 0 410 5 0 110 2 0 0 0 0 0 2 013 0 5 2 0 3 10 413 8 1 315 28 13 13 19 73 011 0 2 013 1113 211 4 1 1 Appendix E Child Fatality Reviews, by Death Certificate County of Residence County Total Deaths AGE <1 1-4 5-14 15-17 Total Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether 70 15 15 10 110 410 5 29 4 4 4 41 1 1 2 6 039 21115 1 0 1 4 0 4 18 1 6 2 27 19 2 3 1 25 3 0 3 7 2 0 1 10 1 1 2 3 1 4 411 6 1 0 1 1 0 1 21115 2 0 2 1 0 1 51118 1 1 2 11 5 1 17 0 1 0 1 24 1 2 6 33 120 3 112 4 21115 110 2 8 0 2 10 1 012 220 4 "Reviewable" Deaths "Reviewable" Deaths Reviewed <1 1-4 5-14 15-17 Total <1 1-4 5-14 15-17 Total 4 10 4 9 27 210 3 5 1 0 4 10 1 1 011 112 0 2 0 2 527 12317 2 0 2 210 3 0 1 1 10 1 0 0 1012 0 0 2 1 3 0 131 5 0 0 3 148 10 1 1 1 1113 10 1 2 013 011 10 1 3 10 4 7 24 210 3 31048 1 1 0 0 0 2 0 2 426 12317 2 0 2 0 0 0 0 0 0 0 0 0 1 1 0 131 5 0 0 3 148 10 1 0 1113 10 1 2 013 011 0 Total Deaths Reviewed <1 1-4 5-14 15-17 Total 3 9 4 7 23 210 3 31149 1 1 0 0 0 2 0 2 12429 12418 2 0 2 0 1 1 2 0 0 0 0 0 0 0 123 1 1 2 231 6 0 0 4 1 1 5 11 10 1 0 1113 10 1 1 012 011 0 41 42 Appendix E Child Fatality Reviews, by Death Certificate County of Residence County Total Deaths AGE <1 1-4 5-14 15-17 Total Miller 10 1 Mitchell 420 6 Monroe 6 017 Montgomery 1 0 1 Morgan 21014 Murray 6 2 8 Muscogee 58 7 6 3 74 Newton 7 3 0 1 11 Oconee 3 227 Oglethorpe 3 0 3 Paulding 8 1 4 3 16 Peach 411 6 Pickens 3 115 Pierce 10 1 Pike 1 0 1 Polk 210 3 Pulaski 10 1 Putnam 7 119 Quitman 10 1 Rabun 3 0 3 Randolph 1 2 3 Richmond 31 4 4 7 46 Rockdale 521 8 Schley 12 3 Screven 2 1 3 Seminole 1 023 Spalding 952 16 Stephens 23016 Stewart 1 0 1 Sumter 613 10 Talbot 111 3 Taliaferro 1 0 1 Tattnall 2 1 3 "Reviewable" Deaths "Reviewable" Deaths Reviewed <1 1-4 5-14 15-17 Total <1 1-4 5-14 15-17 Total 10 1 110 2 1 012 0 1012 2 2 4 10 1 3 3 17 12014 224 0 3 1 4 2 10 211 4 112 10 1 0 10 1 10 1 2 114 10 1 1 0 1 2 2 5 1 5 11 111 3 1 1 1 1 022 131 5 3014 1 0 1 112 4 0 0 1 0 1 0 110 2 1 012 0 1012 1 1 2 9 1 3 3 16 12014 2 2 0 21317 2 1 3 112 0 0 0 0 1 113 10 1 1 0 1 2 2 3 148 111 3 0 1 1 022 130 4 3014 1 0 1 110 2 0 0 1 0 1 Total Deaths Reviewed <1 1-4 5-14 15-17 Total 0 220 4 1 012 0 1012 1 1 2 11 1 3 3 18 12014 2 2 0 11316 2 1 3 1 1 0 0 0 0 1 2 3 10 1 1 0 1 2 2 6 1 2 4 13 111 3 0 1 1 022 140 5 3014 1 0 1 311 5 0 0 1 0 1 Appendix E Child Fatality Reviews, by Death Certificate County of Residence County Total Deaths AGE <1 1-4 5-14 15-17 Total Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth 2 0 2 1124 1 113 11 1 2 14 5 2 7 3 126 1 012 3 0 3 10 2 1 4 17 111 3 2 013 2 046 1 2 3 510 6 5 0 5 4 3 3 10 0 2 2 7 2 2 2 13 0 0 31116 17 4 2 3 26 1 0 1 2 024 2 3 5 3 014 "Reviewable" Deaths "Reviewable" Deaths Reviewed <1 1-4 5-14 15-17 Total <1 1-4 5-14 15-17 Total 0 1023 112 2 114 1 1 123 011 1 0 1 21036 0 011 2 035 1 1 2 110 2 0 1 315 0 2 2 1 124 0 0 1 113 32139 0 022 3 3 1 0 1 0 1023 0 0 1 1 112 011 0 21025 0 0 2 035 0 0 0 1 214 0 0 0 0 0 1 113 32139 0 022 0 1 0 1 Total Deaths Reviewed <1 1-4 5-14 15-17 Total 0 11024 0 0 1 1 1 1 011 0 2 024 0 0 2 035 0 0 21 3 1 315 0 0 0 0 0 1 113 3 5 1 3 12 0 022 0 2 0 2 Georgia Total * 1141 203 236 219 1799 178 111 130 174 593 Total Deaths Reviewed is based on the review county for the CFR. 143 81 90 129 443 185 103 117 132 537 43 APPENDIX F DEFINITIONS OF TERMS AND ABBREVIATIONS USED IN THIS REPORT A-A African-American Child Abuse Protocol Committee County level representatives from the office of the sheriff, county department of family and children services, office of the district attorney, juvenile court, magistrate court, county board of education, office of the chief of police, office of the chief of police of the largest municipality in county, and office of the coroner or medical examiner. The committee is charged with developing local protocols to investigate and prosecute alleged cases of child abuse. Child Fatality Review Report A standardized form required for collecting data on child fatalities meeting the criteria for review by child fatality review committees. Child Fatality Review Committee County level representatives from the office of the coroner or medical examiner, county department of family and children services, public health department, juvenile court, office of the district attorney, law enforcement, and mental health. Eligible Death Death meeting the criteria for review including death resulting from SIDS, unintentional injuries, intentional injuries, medical conditions when unattended by a physician, or any manner that is suspicious or unusual. Form 1 A standardized form required for collecting data on all child fatalities by corners or medical examiners. Injury Refers to any force whether it be physical, chemical (poisoning), thermal (fire), or electrical that resulted in death. Intentional Refers to the act that resulted in death being one that was deliberate, willful, or planned. Medical Cause Refers to death resulting from a natural cause other than SIDS. Natural Cause Refers to death resulting from an inherent, existing condition. Natural causes include congenital anomalies, diseases of the nervous system, diseases of the respiratory system, other medical causes and SIDS. "Other" Race Refers to those of Asian, Pacific Islander, or Native American origin. "Other" as Category of Death Includes deaths from suffocation, choking, poisoning, and falls (unless otherwise indicated). Perpetrator Person(s) who committed an act that resulted in the death of a child. Preventable Death One in which with retrospective analysis it is determined that a reasonable intervention could have prevented the death. Interventions include medical, educational, social, legal, technological, or psychological. Reviewed Death Death which has been reviewed by a local child fatality review committee and a completed Child Fatality Review Report has been submitted to the Georgia Child Fatality Review Panel. Risk Factor Refers to persons, things, events, etc. that put an individual at an increased likelihood of dying. Georgia Child Fatality Review Panel An appointed body of 16 representatives that oversees the county child fatality review process, reports to the governor annually on the incidence of child deaths, and recommends prevention measures based on the data. Sudden Infant Death Syndrome (SIDS) Sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene and review of the clinical history. In this report, SIDS is not considered a "medical" cause. Trend Refers to changes occurring in the number and distribution of child deaths. In this report, the actual number of deaths for each cause is relatively small for the purpose of statistical analysis, which causes some uncertainty in estimating the risk of death. Therefore, caution is advised in making conclusions based on these year-to-year changes which may only reflect statistical fluctuations. Unintentional Death Refers to the act that resulted in death being one that was not deliberate, willful, or planned. 44