Georgia Child Fatality Review Panel executive summary report 2005 calendar year

Georgia Child Fatality Review Panel
Executive Summary Report 2005 Calendar Year

Judge Edward Lukemire Chairperson

December 2007

Honorable Sonny Perdue Governor

| Georgia Child Fatality Review Panel

Preface
In the United States, our social, economic, and political climates indicate that we are a nation in crisis. Divorce rates, unemployment, poverty, political scandals, and violence in homes, schools, and communities are all indicators of the crisis we face.
Georgians have not gone unscathed by the challenges occurring in our nation. We too are faced with poverty, single-parent households, domestic violence, child maltreatment, school violence, and lack of adequate health care. Too often, child fatality review teams witness the fallout of families in crisis--child deaths. Children are most vulnerable to societal ills and least able to protect themselves.
Healthy People 20101 is a Federal initiative aimed at improving the health and safety of families (see Appendix A). Some of the Healthy People 2010 Objectives are relevant to the work of child fatality review teams, and include: Increase the number of States where 100 percent of deaths to children aged 17 years and under that are due to exter-
nal causes are reviewed by a child fatality review team Reduction of infant deaths related to preterm, sudden infant death syndrome and unexpected deaths Reduction of child deaths related to injuries, specifically the top three causes: motor vehicle crashes, drowning, and
fires/burns Reduction of adolescent deaths related to injuries, specifically motor vehicle crashes, homicides and suicides Reduce maltreatment and maltreatment fatalities of children
These reductions aimed at protecting children must not involve intervention alone. Protecting children means creating environments that are not charged with everyday crises. Real protection means prevention. The spectrum of prevention provides us with tools to change organizational practices and influence policy and legislation. The collection of more complete and accurate data by child fatality review teams will allow for prevention efforts that are more population specific and goal oriented. We can do better. We must do better.

Summary

Each year, the Georgia Child Fatality Review Panel (Panel) publishes a report detailing the circumstances of death for children in Georgia. Child deaths are identified through death certificates filed by the Bureau of Vital Records of the Division of Public Health. Local Child Fatality Review (CFR) committees convene a review only for those deaths that are considered eligible for review by legislation, that is, those deaths that are unexpected, unexplained, or due

to suspicious circumstances. The circumstances of each death are recorded on a standardized form which is the basis for the data analyses presented in the annual report. Analyses of these data create opportunities for identifying prevention strategies which, if implemented, could significantly reduce the number of children injured or killed each year.Death certificate data indicated a total of 1,723 deaths to children under the age of 18 in 2005.

Of those deaths: 529 met the criteria requiring review 479 of the 529 were reviewed by local child fatality
review committees (91%) Committees reviewed an additional 144 child deaths
with circumstances that were felt to warrant additional investigation Of those 144 additional deaths reviewed, 26 had no death certificate available In total, local CFR committees reviewed 623 child deaths that occurred in 2005

FINDING: Local CFR Committees determined that 82% of all
reviewed child deaths were definitely or possibly preventable

Table : Preventability, All Reviewed Infant/Child Deaths, Georgia, 2005 (N=623)

N

%

Definitely Preventable

265

42.7%

Possibly Preventable

245

39.5%

Not Preventable

110

17.7%

Missing information

3

Total

623

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All Child Deaths

The number of child deaths in Georgia continues to show a slight decline from previous years.
1,794 deaths in 2003 1,760 deaths in 2004 1,723 deaths in 2005

poverty, quality early education, income disparities, homelessness, and access to quality nutrition and critical health services.
Death certificate data indicate a total of 1,723 child deaths in Georgia in 2005.

However, Georgia's child death rate of 73.2 (deaths per 100,000 children) continues to be higher compared to children living in other regions of the country.
According to an article in the December 2005 edition of the Pediatrics journal2 (see Appendix A), the reasons for these regional disparities are complex and may be related to social, economic, political and other factors which affect

Of those: 65% were infants (1,124) Teens ages 15-17 accounted for the second largest
age group of deaths (216) 860 were White children 793 were African-American children 70 were children of "Other" race

Cause of Death

Figure : Deaths to Children Under Age 8 in Georgia, All Causes Based on Death Certificate, Georgia, 2005 (N=1723)

M e dical 68.9%

M V 8.9%

SIDS 7.3%

Hom icide 2.9%

50

Othe r Injury 2.4%

41

Drow ning 2.2%

38

Unk now n 1.7% 30

As phyxia 1.7% 29

Suicide 1.4% 24

Fire 0.8% 14

Pois on 0.8% 13

Unk now n Inte nt 0.5% 8

Othe r SIDS 0.4% 7

Fire arm 0.2% 3

0

154 125
200

400

600

800

Num be r of De aths

1000

1187

1200

1400

FINDINGS: 69% of all child deaths were due to medical causes (infants accounted for 78% of all medical deaths) Motor vehicle incidents were the second leading cause of death (154)

3 | Georgia Child Fatality Review Panel

All Reviewed Child Deaths

The purpose of the child fatality review process is to analyze all aspects of a child's death using a multidisciplinary, multi-agency approach in a confidential forum. Local CFR committees reviewed a total of 623 child deaths that occurred in 2005.

More than one-third (231) of the total reviewed deaths were infants (younger than one)
Teens ages 15-17, accounted for the second-largest age group of deaths (163)

Cause of Death

Figure 2: Cause of Death, All Reviewed Infant/Child Deaths, Georgia, 2005 (N=623)

MV 26.5%

165

Medic al 15.6%

97

SIDS 15.4%

96

Homic ide 8.0%

50

SUID 7.5% Drow ning 6.9% A s phy x ia 6.1%
Suic ide 3.2% Fire 2.6%
Unknow n 2.2% Other Injury 2.1%
Pois on 1.9% Unknow n Intent 1.0%
Firearm 1.0%

20 16 14 13 12 6 6

47 43 38

0

20

40

60

80

100

120

140

160

180

Re vie w e d De aths

FINDINGS: Motor vehicle related incidents remain the leading cause of reviewed deaths for children Reviewed medical deaths increased in 2005, representing 15% of all reviewed deaths

4 | Georgia Child Fatality Review Panel

Child Abuse / Neglect Child Deaths

There are generally four recognized forms of child maltreatment: neglect, physical abuse, sexual abuse, and psychological or emotional maltreatment. Most victims of maltreatment are very young, with almost three-fourths being younger than 5 years old. Males and infants are more likely to be victims of abuse or neglect. Committees reviewed 136 deaths with abuse or neglect findings.

Of those: 85 were males and 51 were females 57 were infants 46 were toddlers ages 1 to 4 22 were youth/adolescents ages 5 to 14 11 were teens ages 15 to 17

Figure 3: Relationship of Perpetrator to Decedent in Reviewed Deaths with Abuse/Neglect Findings, Georgia, 2005

Natural Father 28.9% Natural Mother 20.6% MMooththeer 'rs'sSSigignnififciciaannttOOtthheerr 99..33%%
Stranger 8.2% Baby s itter/Childc are w orker 6.2%
Self 5.2% A c quAaqinutaeinatannccee44.1.1%%
Friend 4.1% Other Relativ e 3.1%
Stepfather 3.1% Father's Signif ic ant Other 2.1%
Sibling 2.1% Other 1.0% Foster Mother 1.0% Step Mother1.0%

6 5 4 4 3 3 2 2 1 1 1

0

5

20 9 8

10

15

20

Re vie w e d De a ths

28

25

30

FINDINGS: 48 parents were identified as perpetrators in deaths with suspected or confirmed child abuse/neglect The mother's significant other (e.g., boyfriend or romantic partner) represented the third largest category
of perpetrators

5 | Georgia Child Fatality Review Panel

Child Abuse / Neglect Child Deaths (con't)

Table 2: Infant/Child Deaths with Prior Agency Involvement, by Abuse / Neglect Status*

Abuse and/or Neglect

Agency

No

%

Yes

%

Court

64

13.2

20

14.7

Dept. of Juvenile

39

8.0

11

8.1

Justice

Public Health

153

31.5

57

41.9

Dept. of Family &

155

31.9

72

52.9

Children Svcs

Other

34

7.0

22

16.2

*A child or family was often involved with more than one agency; therefore, the number of involvements children/families had with agencies exceeded the number of abuse/neglect-related child deaths.

FINDINGS: 75% of children with abuse/neglect related deaths had prior
agency involvement (an increase from 65% in 2004) 53% had involvement with DFCS 42% had involvement with Public Health

Opportunities for Prevention - Child Abuse/Neglect 1. Promote the less considered but critically important resources for
child protection, such as faith-based communities, extended families, friends and neighbors, and other community resources that support families and guide parents in the proper care and nurturance of their children 2. Increase access and availability of substance abuse treatment programs. National research shows that nearly one-half of substantiated cases of child abuse and neglect are associated with parental alcohol or drug abuse

6 | Georgia Child Fatality Review Panel

Reviewed Medical / Natural Child Deaths

Medical deaths are reviewable by child fatality review teams if the death occurs while unattended by a physician, in a suspicious or unusual manner, or occurs to an otherwise healthy child. There were 97 medical deaths reviewed by committees.

Of those: One-third of the reviewed medical deaths occurred
among infants (32) Ages 5-14 were the second largest age group of deaths
in this category (26) There were 51 reviews for White children 42 reviews for African- American children 4 reviews for children of "Other" races

Figure 4: Medical Deaths Reviewed by Review Criteria, Georgia 2005 F(Nig=u9r7e) 4: Medical Deaths Reviewed by Review Criteria

Unattended by P hys ic ian, 19

None, 4

Inm ate, 1

S us pic ious , 2

Sudden/ Unexpected, 71

FINDINGS: 73% of reviewed medical deaths were determined to be "sudden/unexpected" Of the 97 medical deaths, 19 died while in the hospital, and 8 died after being treated by a physician and
released

Opportunities for Prevention - Reviewed Medical 1. Children should have regular visits with a health-care provider to check for any illnesses or abnormalities in wellness
and development 2. School systems should enhance the quality and frequency of youth sports physicals to ensure more children are fully
screened for potentially life-threatening conditions
7 | Georgia Child Fatality Review Panel

Sudden Infant Death Syndrome (SIDS) Sudden Unexplained Infant Death (SUID)
Infant mortality from SIDS (death of an infant that remains unexplained after an investigation, autopsy, and review of clinical history) has declined over the past few years, however SIDS, and now the use of the term SUID (a death that appears to be SIDS, but has possible contributing factors present), continue to be important issues to research, because they continue to be the number one cause of reviewed infant deaths in Georgia.

From a national perspective, SIDS occurs most often between 2 and 4 months and then declines, whereas in Georgia, SIDS deaths remain highest between 1 and 4 months of age. While we do not know the cause of SIDS, we do know that by eliminating known risk factors, we may increase the rate of infant survival. Risk factors include maternal smoking, illegal drug exposure, soft bedding, overheating, and sleeping on stomach.

In Georgia, sleep-related deaths are the number one cause of reviewed deaths to infants. During 2005, 143 infants died from SIDS or SUID, and included:
34% White males (49) 24% African-American males (35) 19% White females (27) 19% African-American females (27) < 1% children of "Other" races (5)

Figure 5: Location at Time of Death for Infants who Died of SIDS/SUID, 2005 (N=44)

other, 12, 8%
floor, 3, 2%
couch, 10, 7%

unknown, 7,

5%

not indic ated,

3, 2%

c rib, 30, 21%
playpen, 4, 3%

FINDING: The majority of infants who died were
not sleeping in a crib, which is considered the safest sleep environment for infants

bed, 75, 52%

Opportunities for Prevention - SIDS/SUID 1. Consider sleeping in the same room with the infant (co-sleeping) instead of in the same bed (bed-sharing), and pro-
mote the use of "co-sleepers" (infant beds designed to be attached to parents' beds while protecting the child's sleep safety). There is growing evidence that room sharing (infant sleeping in the parent's room) without bed-sharing is associated with a reduced risk of SIDS (American Academy of Pediatrics Task Force on SIDS, 2005) 2. Avoid smoking during pregnancy

Unintentional Injury Related Child Deaths

Despite tremendous progress toward the reduction in unintentional injury-related child deaths, these types of injuries continue to remain the number one cause of death for children over age one, regardless of gender, race, or economic status. Each age groups exhibits unique characteristics which present different levels of risk and are associated with deaths to children. Infants were at higher risk of death from asphyxia 1-4 year olds were at higher risk of death from drown-
ing and motor vehicle incidents 5-17 year olds were at higher risk of death from motor
vehicle incidents

Unintentional injury-related death occurs among children of all ages and is often related to a child's developmental abilities as well as a parent's belief of their child's risk and actual ability (Safe Kids, 2003). Awareness and supervision by parent or caregiver is critical for young children to be safe and free from injury.

In this report, we have classified unintentional injury-related deaths into the following categories:

Motor Vehicle Incidents Fire/Burn/Smoke Inhalation

Drowning

Other Injury

Asphyxia

Poisoning/Overdose

Firearm

8 | Georgia Child Fatality Review Panel

Motor Vehicle Related Child Deaths

Motor vehicle related injuries account for the majority of deaths in children ages 1 to 17. In Georgia, motor vehicle related injuries claimed the lives of 165 children in 2005.
Of those: 89 were in the 15-17 age group (54%) 45 were in the 5-14 age group (27%) White males represented 42% White females represented 27%

We have done a good job reducing infant deaths in motor vehicles, but research shows more work is needed for older children. For children who were killed while outside of a vehicle, more deaths occurred as pedestrians (e.g., in a driveway) than as bicyclists. Though reduction of such injuries is challenging, it is possible with stricter legislation, enforcement, and public education.

Figure 6: Reviewed Motor Vehicle-Related Deaths by Location at Injury, 2005 (N=65)

Other 19 12%

Unknown 9 5%

Bicyclist 4 2%

Driver 49 30%

Back Seat Passenger 37
22%

Front S eat Passenger 31
19%

P edestrian 16 10%

FINDINGS: The most common vehicle location
for children who died in motor vehicle incidents was the driver/operator position (30%) Some examples of "Other" motor vehicle incident locations include: back of a pick-up truck, back of a motorcycle, skateboard, and sitting on the lap of another person

Table 3: Demographics of Reviewed Motor Vehicle Crash Deaths, 2005 (N = 65)

Category

Number %

Rate (per 100,000)

Age

Infant

5

3.0% 3.5

1 to 4

26

15.8% 4.7

5 to 14

44

26.7% 3.4

15 to 17

90

54.5% 23.3

Race/

White Male

70

Gender

White Female

45

42.4% 9.5 27.3% 6.5

African-American 24 Male

14.5% 5.8

African-American 15 Female

9.1% 3.7

Other Male

6

3.6% 10.6

Other Female

5

3.0% 9.3

FINDINGS: Older adolescents ages 15-17 had the
highest rate of motor vehicle related deaths (23%); they were almost 7 times more likely to have a motor vehicle related death than the age group of the lowest rate (5-9 year olds) White children made up 70% of all motor vehicle related deaths involving children Males made up 61% of motor vehicle related child deaths

Opportunities for Prevention - Motor Vehicle 1. Pedestrian safety must incorporate proper supervision, overall education for children and immediate caregivers, and
environmental changes incorporating sidewalks on heavily traveled roadways 2. Continue state-supported child safety seat distribution programs to help families in need 3. Aggressive fines for teenage drivers who do not buckle up and for parents of unrestrained children 4. Advocate for residential speed bumps
9 | Georgia Child Fatality Review Panel

Drowning Related Child Deaths

In 2005, 43 children died from drowning, which continues to be the second leading cause of unintentional injury death for all children older than one year. Drowning deaths occurred as frequently as motor vehicle related deaths in children ages 1 to 4 years. Most drowning related child deaths occurred when children were unsupervised momentarily

and have access to bodies of water (inadequate barriers). Of the 43 drowning related child deaths: 19 occurred in private pools 18 occurred in natural bodies of water 3 occurred in bathtubs 3 occurred in other locations

Table 4: Demographics of Reviewed Motor Vehicle Crash Deaths, 2005 (N = 65)

Category

Number %

Rate (per 100,000)

Age

Infant

5

3.0% 3.5

1 to 4

26

15.8% 4.7

5 to 14

44

26.7% 3.4

15 to 17

90

54.5% 23.3

Race/ White Male Gender White Female

70

42.4% 9.5

45

27.3% 6.5

African-American Male 24

14.5% 5.8

African-American

15

Female

9.1% 3.7

FINDINGS: 61% of drowning deaths occurred
among children 1-4 years of age Committees determined that in 18
of the 26 drowning deaths for 1-4 year olds, the children were inadequately supervised (suggesting that 8 children who drowned were properly supervised at the time of death)

Opportunities for Prevention - Drowning Increase environmental health staffing positions to provide inspections on residential and commercial pools for fenc-
ing violations in order to comply with local ordinances that require fences and gate locks Mandate that all pools, including hot tubs, be installed with a safety device such as a water motion sensor as part of
the pool inspection process, furnish all pool owners with the proper replacement drain covers in order to help prevent entrapment
Unintentional Asphyxia Related Child Deaths

In Georgia, 38 children died from unintentional asphyxia

infant or if the infant is sleeping on a surface where they

related deaths. Most unintentional asphyxia related child

may get wedged and cannot breathe. For older children,

deaths are caused by overlay, positional asphyxia, choking, asphyxia related deaths occur commonly with choking

confinement, or strangulation. For infants, asphyxia may

games, strangulations, and/or unintentional hangings.

occur during bed sharing if another person rolls over on the These types of deaths are definitely preventable and can

Table 5: Demographics of Reviewed Asphyxia Deaths, 2005 (N = 38)

be decreased through education of younger children who may be unaware of potential risks, improvement of infant sleep environ-

Category

Number %

Rate (per

ments, and encouraging open communication

100,000)

with older teenagers.

Age

Infant

28

73.7% 19.6

Race/ Gender

1 to 4 5 to 14 White Male White Female

5

13.2% 0.9

5

13.2% 0.4

9

23.7% 1.2

6

15.8% 0.9

FINDINGS: Infants were most at risk for asphyxia
related deaths African-American children accounted
for more than 50% of all asphyxia

African-American Male 10

African-American Female 10

Other Male

3

26.3% 2.4 26.3% 2.5 7.9% -

related child deaths, and had higher rates than the other race/gender groups 58% of asphyxia related child deaths

Opportunities for Prevention Unintentional Asphyxia

occurred among males

1. More consistent and widely-disbursed safe sleep messages

2. Infants should be placed to sleep in a safety approved crib with a firm mattress and tightly fitted sheet

3. Children and parents should be educated regarding the dangers associated with any games that restrict the intake of

oxygen

0 | Georgia Child Fatality Review Panel

Fire Related Child Deaths

During 2005, 16 children died in Georgia from fire related deaths, including burns and smoke inhalation. Fire related deaths accounted for 40 child deaths in 2004, almost 2.5 times higher than in 2005.
In the last decade, fire related child deaths have been as high as 53 in 1996 and as low as 10 in 1999. While one fire related child death is too many, Georgia has begun doing great work in the area of prevention in fire related deaths. One such effort involved a grant received by Safe

Kids Georgia from the Federal Emergency Management Agency to help assess and conduct a smoke alarm installation program in four counties to analyze specific geographic areas of risks for residential fire related deaths. Also, Georgia's DHR Injury Prevention Section received a grant from CDC to coordinate residential fire safety prevention programs in 25 areas across the state and 5000 homes were visited to provide information on proper installation of smoke alarms.

Table 6: Demographics of Reviewed Fire Deaths, 2005 (N = 6)

Category

Number %

Rate (per 100,000)

Age Infant

2

12.5% 1.4

1 to 4

8

50.0% 1.5

5 to 14

6

37.5% 0.5

Race/ White Male

1

Gender White Female

4

6.3% 0.1 25.0% 0.8

African-American 10 Male

62.5% 2.4

African-American 1 Female

6.3% 0.2

FINDINGS: More African-American males died from
fire related incidents than any other race/gender group (63%), and had the highest rate compared to the other race/ gender groups Although toddlers aged 1 to 4 accounted from 50% of the fire related deaths, their risk of fire related death was equivalent to that of infants (rates of 1.5 and 1.4, respectively) There were no reviewed fire-related deaths for 15-17 year olds

Opportunities for Prevention - Fire 1. Address known risk factors, such as non-working smoke alarms and lack of a fire escape plan 2. Store matches and lighters out of children's reach and supervise use of candles

Intentional Injury Related Child Deaths

Younger children are more often intentionally injured at home or during domestic violence incidents between their parents/caregivers, while older children and teens are more often injured outside of the home during arguments with siblings or peers (acquaintances), or may injure themselves as a result of depression or recent difficulties. Males are

more likely to be both perpetrators and victims of intentional injury (homicide and suicide). Females are more likely to threaten or attempt injury to themselves or others but less likely to become victims or perpetrators. Firearms are most often used as the mechanism of intentional injury, partly due to their easy access among children

| Georgia Child Fatality Review Panel

Homicide Child Deaths

The U.S. has the highest homicide rate for children of any than strangers. Older children and teens are more likely to

industrialized nation in the world. In Georgia, homicide is be killed by friends, acquaintances, and strangers. While

the leading cause of injury-related death for infants (67%

gang violence is less prevalent in smaller towns, it remains

higher than the number of motor vehicle deaths to infants). a problem in urban areas and is usually attributed to fear

Young children are generally murdered via abandonment, and retaliation, often involving unidentified assailants.

starvation, asphyxia, drowning, strangulation, or beating.

While school-related homicides have received substan-

They are more likely to die at the hands of parents, siblings, tial attention in the media, they still remain relatively rare

friends or acquaintances, or other family members, rather events.

FINDINGS:

Table 7: Demographics of Reviewed Homicide Deaths, 2005 (N = 50) Of the 50 child homicides reviewed,

Category

Age

Infant

1 to 4

Number %

8

16.0%

15

30.0%

Rate (per 100,000)
5.6
2.7

40% were among older teens (20). Infants and 5-14 year olds had the lowest percentage of homicides (16% and 14%, respectively) There were 30 homicides among

5 to 14

7

14.0% 0.5

African-American males (60%), and

Race/ Gender

15 to 17 White Male White Female

20

40.0% 5.2

9

18.0% 1.2

4

8.0% 0.6

only 4 homicides (8%) among White females Of the highest-risk group of homicides (African-American males), 50% oc-

African-American Male

30

African-American Female 7

60.0% 7.3 14.0% 1.7

curred among older teens (15). There were no reviewed homicides among children of Other races

Opportunities for Prevention - Homicides

Firearms were used in 23 of the 50

1. Make efforts to address and reduce risk factors that increase the likeli-

homicides reviewed

hood of child homicide, including: child abuse and/or neglect, domestic

violence, poverty, inequality, unemployment, criminal activity, the use of

drugs and/or alcohol, and the availability of weapons

2. Teach conflict resolution and anger management to young children, teens, and parents to reduce the likelihood of

violent or deadly confrontations

Suicide Child Deaths

In the United States, more than four times as many male

suggests that the increase in suicide rates among younger

youth die by suicide, but females attempt suicide more

children may be due to increased exposure to critical risk

often and report higher rates of depression. Youth are

factors, such as serious depression, drugs and alcohol.

much more likely to think about and attempt suicide if they Studies have found that for younger children exposed to

are depressed. Younger children may be less likely to com- such risk factors, the suicide rate is similar to that for older

plete suicide because they do not have the cognitive ability teens. to plan and carry out a suicide attempt, but research also
Table 8: Demographics of Reviewed Suicide Deaths, 2005 (N = 20)

FINDINGS: Of the 20 child suicides reviewed,
70% were among older teens (14).

Category

Number %

Rate (per

Five to 14 year olds made up the

100,000)

other 30% of reviewed suicides (6)

Age

5 to 14

15 to 17

6

30.0% 0.5

14

70.0% 3.6

Males were at higher risk for suicide than females
Of the highest-risk group of sui-

Race/

White Male

12

60.0% 1.6

cides (White males), 50% occurred

Gender White Female

1

African-American Male

6

African-American Female 1

5.0% 0.1 30.0% 1.5 5.0% 0.2

among the 15-17 year old age group (10) There were no reviewed suicides among children of Other races

Opportunities for Prevention - Suicide 1. Become aware of risk factors of suicide: impulsive or aggressive behavior, use of alcohol or drugs, family instability or
significant family conflict, talk of suicide, and exposure to another suicide 2. Open talk and genuine concern are a source of relief and key elements in preventing the immediate danger of suicide.
Talking about suicide does not create or increase risk; it actually reduces it 3. Provide affordable mental health care for youth

2 | Georgia Child Fatality Review Panel

Child Deaths Among Hispanic Population

Children's health depends on a wide range of factors, including the family's economic circumstances, access to health care, and knowledge of children's health care needs and how to address them. The correlation between a family's socio-economic status and child health and development is well documented.

The 2005 Kids Count Data Book reports that African-American and Hispanic children are more likely to live in poverty than are White children. In 2005, 29% of Hispanic and 36% of African American children were living in families with incomes below the Federal poverty level, compared to 11% of White children.

Figure 7: Reviewed Hispanic Deaths by Cause of Death, 2005 (N=54)

Cause of Death

MV 2 7 .8 % Me d ica l 2 5 .9 % SID S/SU ID 2 4 .1 % H o m icid e 9 .3 % Oth e r In ju ry 5 .6 % As p h yxia 3 .7 % D ro w n in g 3 .7 %

5 3 2 2

15 14 13

0

5

10

15

20

N um ber of D eaths

FINDING: Among deaths eligible for review, motor vehicle incidents were the leading cause of deaths for Hispanic children

Opportunities for Prevention - Hispanic Population 1. Make English language classes more accessible at health and human service sites (i.e., Health Departments and
Family and Children Services) to facilitate teaching relevant health and safety information

3 | Georgia Child Fatality Review Panel

Georgia Child Fatality Investigation Program

The Georgia Child Fatality Investigation Team (CFIT) Program, administered through the Georgia Child Fatality Review Panel, in collaboration with the Georgia Bureau of Investigation and the Department of Family and Children Services, was founded to promote the utilization of best practices in the area of the investigation of suspicious child deaths in Georgia. Recognizing the importance of an immediate and comprehensive response in such cases, experts around the country suggest the utilization of a multi-disciplinary team approach from the inception of such investigations. These teams utilize highly trained representatives from their own district attorney's offices, coroners and/or medical examiners, local law enforcement agencies, and the Department of Family and Children Services. These teams immediately respond and share information from the point of the child's death.
In 2005, 623 child deaths were reviewed by Child Fatality Review teams. Fifty of those deaths were deemed to be homicides by Review Teams. Therefore, given that nearly 1 child a week is a victim of homicide in Georgia, the need for the best quality in investigations seems apparent.
Members of a team recently participated in a multi-agency advanced training after noting serious problems within the jurisdiction with multi-agency communication. Data were kept over a three-year period in the jurisdiction and reflected that in 2005, the district attorney was only notified timely in one of seven deaths in which the team should have been activated. The problem continued in 2006, with the district attorney's office being notified timely of only one death out of eight. Subsequent to the group's re-training late in 2007,

which included law enforcement, representatives of the district attorney's office and DFCS, team members reported that they felt more comfortable communicating with one another and found it useful to specifically address issues with the team approach in their jurisdiction. They further noted an appreciation for hearing the perspectives of team members from different disciplines. Subsequent to the training, this team reported timely notification of the district attorney on a case involving a surviving victim of potentially lethal abuse.
Utilizing 2005 CFR data from two jurisdictions, one employing a team approach, and one employing the traditional approach, participation in scene investigation was reviewed. An interview of the member jurisdiction was also performed by the CFIT program. The data gleaned from the report and interview revealed that in the jurisdiction employing a team approach, the team activated and then continued to communicate in every case of child death encompassed by their protocol, a total of thirteen cases in 2005. In the jurisdiction utilizing a traditional approach only law enforcement was the only agency reporting to every scene. By including the district attorney early in investigations, team-based jurisdictions can benefit from expert legal advice as well as practical information on securing a conviction beyond making an arrest. By including DFCS, teams can benefit from the family histories already available with the agency from prior contact in many cases. Further, DFCS investigators are uniquely qualified to interview surviving siblings and collaterals. A multi-disciplinary team approach facilitates better communication, more thorough information gathering, and a more complete investigation.

For more detailed information, please visit our website (after January 1, 2008) at:
www.gacfr.dhr.georgia.gov
Georgia Child Fatality Review Panel Office of Child Fatality Review 506 Roswell Street, Suite 230 Marietta, GA 30060 (770) 528-3988 gacfrstaff@dhr.state.ga.us

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Appendix A References & Glossary
References 1. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000 2. Jeffrey Goldhagen, MD, MPH, et al. The Health Status of Southern Children: A Neglected Regional Disparity. PEDIATRICS Vol. 116 No. 6 December 2005
Glossary CDC Centers for Disease Control and Prevention CFIT Child Fatality Investigation Team, a collaboration among agencies involved with the Georgia Child Fatality Investigation Program DHR Georgia Department of Human Resources SIDS - The sudden death of an infant under 1 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 SUID sudden, unexplained death of an infant under 1 year of age, in which investigation, autopsy, medical history review, and appropriate laboratory testing fails to identify a specific cause of death
We would like to thank Our Partners... Local Child Fatality Review Committee Members in all 159 Counties Department of Human Resources (DHR) The Office of Health Information Policy (OHIP) The Division of Family and Children Services (DFCS) The Office of Vital Records The Public Health Injury Prevention Section The Public Health Epidemiology Section Emory University Rollins School of Public Health Department of Epidemiology Dr. John T. Carter, Chief Epidemiologist
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For Policy Makers

RECOMMENDATIONS

1. Provide sufficient funding to the Georgia Child Fatality Review Panel to fulfill statutory requirements which include annual statewide training, providing sufficient informational technologies for data analyses and sharing among state agencies, child death report reviews, and consultation with counties as indicated
2. Require an autopsy, including toxicology analysis, for every death of a child under the age of seven with the exception of a child who is known to have died of a disease process while attended by a physician. Further, require complete skeletal X-ray (following established pediatric and radiological protocol) of the bodies of children who died before their second birthday. Fully fund aforementioned requirements
3. Require local units of government to adopt and enforce pool-fencing regulations 4. Require local units of government to adopt and enforce regulations requiring smoke
alarm installation and maintenance in rental properties 5. Provide sufficient funding to state Fire Marshals Office to offer fire safety education for
young children at the local level 6. Amend current Graduated Driver Licensing to place restrictions on the number of pas-
sengers under the age of 21 allowed in vehicles driven by teens during the first two years of licensure 7. Enhance the Safe Place for Newborns Act to allow for increased accessibility, improved publicity and marketing, and elimination of the identification requirement 8. Require more comprehensive physical exams for all youth athletes, and enhanced the mental health services for all youth

For Parents and Caregivers
1. Supervise all children under ten years of age in and around cars at all times 2. Infants should be placed to sleep on their backs and in a safety approved crib with a
firm mattress 3. Install smoke alarms on every floor and outside all sleeping areas of your home 4. When you are near any body of water, always designate one responsible adult to keep
sight of the children at all times 5. Make sure all guns are stored locked and unloaded at all times

For Agencies
. DFCS: Make ongoing visits to the surviving children in a home after a child had died due to parental or caretaker neglect or aggression. Ongoing visits for a minimum of three months can help assess their safety and well-being, and enable referrals to appropriate services
2. Public Health: Continue the statewide campaign to promote awareness and practice of safe infant sleep environments, specifically the crib matching program and culturally appropriate media initiative
3. Coroners and Medical Examiners: Continue conducting death scene investigations for any child death that is suspicious, unexpected, and/or unexplained

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