2013 child fatality analysis

GEORGIA DIVISION OF FAMILY AND CHILDREN
SERVICES 2013 CHILD
FATALITY ANALYSIS
Nathan Deal, Governor Bobby D. Cagle, Interim Director

Georgia Division of Family and Children Services

August 2014

DFCS VISION, MISSION AND CORE VALUES

Vision
Stronger Families for a Stronger Georgia

Mission
Strengthen Georgia by providing Individuals and Families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults.

Core Values
Provide access to resources that offer support and empower Georgians and their families.
Deliver services professionally and treat all clients with dignity and respect.
Manage business operations effectively and efficiently by aligning resources across the agency.
Promote accountability, transparency and quality in all services we deliver and programs we administer.
Develop our employees at all levels of the agency.

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Georgia Division of Family and Children Services
TABLE OF CONTENTS

August 2014

Section 1: Purpose of the Child Fatality Analysis ............................................... 3 Section 2: Methodology of the Fatality Analysis..................................................4 Section 2: Summary of Statistics.............................................................................5
Figure 2.1 DFCS Regions ........................................................................................... 6 Table 2.1 Child Fatalities by Region.......................................................................... 6 Figure 2.2 Child Fatalities by Month ........................................................................ 7 Table 2.2 Ages of Children at the Time of Death ...................................................... 8 Section 3: Classification of Child Fatalities by Cause and Manner ................. 9 Figure 3.1 2013 Manners of Death by Percentage .................................................. 11 Figure 3.2 2012 Manners of Death by Percentage .................................................. 11 Table 3.1 2013 Manners of Death for Children Under the Age of One................... 12 Table 3.2 2012 Manners of Death for Children Under the Age of One................... 12 Table 3.3 Manners of Death by Region.................................................................... 13 Table 3.4 Causes of Death by Year Natural ......................................................... 14 Table 3.5 Causes of Death by Year Suicide ......................................................... 14 Table 3.6 Causes of Death by Year Accident ....................................................... 15 Table 3.7 Causes of Death by Year Undetermined ............................................. 15 Table 3.8 Causes of Death by Year Homicide ...................................................... 16 Section 4: Child Fatalities and Prior DFCS Involvement ................................ 17 Table 4.1 Length of Time Between Prior DFCS Involvement and Fatalities......... 17 Table 4.2 Fatalities with Open DFCS Cases at the Time of Death ....................... 18 Table 4.3 Type of DFCS Prior History by Year ....................................................... 18 Section 5: Conclusion .............................................................................................. 19

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Georgia Division of Family and Children Services

August 2014

PURPOSE OF THE CHILD FATALITY ANALYSIS

As the main state agency charged with intervening on behalf of vulnerable children in Georgia, the Division of Family and Children Services (DFCS) must continually review its practice and inform the public of its efforts to mitigate and reduce the risk of child abuse and neglect in Georgia.
The data included in the 2013 Child Fatality Analysis details the manners and causes of death for children whose families had been the subject of a report or investigation of maltreatment in Georgia in the last five years.1 Through this report, the agency endeavors to provide information over and above the federal requirements2 for states to review and analyze child fatalities, and offer additional insight on a specific population with previously reported or identified risks of abuse and/or neglect.
For a child's death to be included in this report, the child must have been in the custody of DFCS or his or her family must have had Child Protective Services history with DFCS within the previous 5 years. Child Protective Services history covers a wide array of potential encounters between DFCS and a family, ranging from a report that did not rise to the level of agency intervention to intensive involvement with the family. Such historical context can provide further insight into risk factors and circumstances surrounding a child's death. These previously identified risk factors such as allegations of domestic violence and substance abuse factored in with the details of a child's death, may yield an understanding that improves the agency's intervention efforts and overall child safety in Georgia.
The information that follows is meant to supplement the work of the Georgia Child Fatality Review, aiding the agency and the public in improving intervention efforts and developing community-based solutions to reduce the risk of harm to Georgia's children.

1 Official Code of Georgia (O.C.G.A.) 15-11-741 defines a child as "an individual receiving protective services from DFCS, for whom DFCS has an open case file, or who has been, or whose siblings, parents, or other caretakers have been, the subject of a report to DFCS within the previous 5 years."1 2 Per 42 U.S. C. Sec. 5106a(b)(2)(B)(x) of the Child Abuse Prevention and Treatment Act.
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Georgia Division of Family and Children Services

August 2014

METHODOLOGY OF THE FATALITY ANALYSIS

Since 2011, the Division has sought to improve data collection methods and strengthen reporting mechanisms for child deaths with DFCS history.
Recent efforts to engage external stakeholders on the need to obtain accurate data on the deaths of children with DFCS history have resulted in more consistent reporting of child deaths that may not have routinely been reported in the past.
This collaboration has improved the agency's collection of child death data in Georgia, and will result in a more comprehensive analysis of agency practice going forward. Additionally, DFCS' child death review team has aggressively pursued policy requirements regarding the reporting of child deaths, thereby improving data collection.
The 2013 Child Fatality Analysis is the second such report published by the Division. This report reflects data collected on child deaths that occurred between January 1, 2013 and December 31, 2013 and were reported to DFCS by local Child Fatality Review committees, employees of local DFCS offices or other external partners, including law enforcement and medical personnel.
All deaths included in this report were of children whose families had prior contact with the agency within the last five years.
Data for the 2013 Child Fatality Analysis was compiled and reviewed in June and July of 2014. This is a change from the Division's 2012 Child Death Report, which was completed during the first three months of 2013 when data elements for some deaths were not available.
In 2014, the Division will continue to enhance data collection methods and improve collaborations with community agencies and law enforcement to develop a more consistent protocol for making DFCS aware of child deaths.

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Georgia Division of Family and Children Services

August 2014

SUMMARY OF STATISTICS

Between January 1 and December 31, 2013, the deaths of 180 children whose families had prior DFCS history were reported to the agency.
63 percent of these deaths were determined to be a result of natural causes and unintentional injuries. For the remaining deaths, causes were either undetermined or ruled as homicides or suicides. (Figure 3.1)
23 percent of deaths were infants whose cause of death was sleep related. (Page 12)
48 percent of the deaths were of children under the age of 1. (Table 3.1) 42 percent of the deaths were of children whose families had an open case at
the time of their deaths. Of these, 77 percent of the cases were open as a result of the incident that led to the child's death. (Tables 4.1 and 4.2)
The following data provides a snapshot of the Division's overall Child Protective Services response for 2013:
The total number of reports to DFCS: 76,995 The total number of reports assigned to a caseworker: 54,101 The total number of children in foster care at some point in 2013: 13,067 The total number of Family Preservation3 cases: 6,057 The total number of child deaths in the state of Georgia (per the Georgia
Department of Public Health): 1,4754 The total number of deaths reported to DFCS: 3175

3 Family Preservation cases are opened following an investigation where maltreatment may have been present but the identified safety threat has been either mitigated or eliminated, meaning the children can safely remain in the home. In these cases, DFCS develops a safety plan to address identified concerns. The goal of the plan is to keep the family together, utilizing a wide array of services, involvement of family members, to find solutions that guarantee the safety of the children. 4 Public Health data is an estimate based on preliminary data. 5 180 of whose families had prior history with the DFCS.
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Georgia Division of Family and Children Services
Figure 2.1 -- DFCS Regions:

August 2014
DFCS is currently divided into 15 regions, which cover all 159 counties throughout the state (see Figure 2.1 at left). Each county office is responsible for providing reports directly to the state office when a child fatality is reported in their county and the child (or family) has had prior DFCS involvement.

Table 2.1 -- Below is a comparison of deaths within each region for CY2012 and CY2013.

Region 1 2
3 4 5 6

Counties Within the Region
Catoosa, Chattooga, Dade, Fannin, Gilmer, Gordon, Murray, Pickens,
Walker, Whitfield Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin,
Rabun, Stephens, Towns, Union, White
Bartow, Cherokee, Douglas, Floyd, Haralson, Paulding, Polk
Butts, Carroll, Coweta, Fayette, Heard, Lamar, Meriwether, Pike,
Spalding, Troup, Upson Barrow, Clarke, Elbert, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee, Oglethorpe, Walton Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Putnam,
Twiggs, Wilkinson

Total Number of Fatalities for CY2013
8

Total Number of Fatalities for CY2012
6

16

8

11

9

13

15

8

6

10

13

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Georgia Division of Family and Children Services

August 2014

Region 7 8 9
10 11 12 13 14 15

Counties Within the Region
Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie,
Richmond, Screven, Taliaferro, Warren, Washington, Wilkes Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, Webster Appling, Bleckley, Candler, Dodge, Emanuel, Evans, Jeff Davis, Johnson, Laurens, Montgomery, Pulaski, Tattnall, Telfair, Toombs, Treutlen,
Wayne, Wheeler, Wilcox Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas,
Worth Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Charlton, Clinch, Coffee, Cook, Echols, Irwin, Lanier, Lowndes, Pierce, Tift, Turner, Ware Bryan, Bulloch, Camden, Chatham, Effingham, Glynn, Liberty, Long,
McIntosh Clayton, Henry, Rockdale
DeKalb, Fulton
Cobb, Gwinnett

Total Number of Fatalities for CY2013
8
11
10
10
14
15 14 25 7

Total Number of Fatalities for CY2012
9
7
5
16
12
9 11 18 8

Totals

Statewide

180

152

Figure 2.2 -- Child Fatalities by Month:

30

Child Fatalities by Month -- 2012 and 2013

25
20
20 15 17
10
5

24

16

16

15

13

13

11

14 11 10
10 8

18 14
13 13

15 15

2013
16

13

9

8

2012

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

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Georgia Division of Family and Children Services

August 2014

Table 2.2 -- Ages of Children at the Time of Death:

Age of Child

Number of

Percentage of

Number of Percentage of

at Time of Children in 2013 Child Deaths in Children in 2012 Child Deaths in

Death

2013

2012

0-6 months

64

36%

58

38%

6-12 months

22

12%

20

13%

1

18

10%

12

8%

2

9

5%

12

8%

3

8

4%

5

3%

4

8

4%

7

5%

5

4

2%

3

2%

6

4

2%

0

0%

7

3

2%

3

2%

8

0

0%

0

0%

9

6

3%

2

1%

10

4

2%

4

3%

11

2

1%

0

0%

12

3

2%

6

4%

13

5

3%

4

3%

14

3

2%

2

1%

15

3

2%

3

2%

16

8

4%

7

5%

17

6

3%

4

3%

Note: Further detail regarding the deaths of children under the age of 1 will be provided later in the analysis.

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Georgia Division of Family and Children Services

August 2014

CLASSIFICATION OF CHILD FATALITIES BY CAUSE AND MANNER

Defining the Causes and Manners of Death:
To better understand the appropriate context related to child fatalities, it is important to know how the causes and manners of death are defined.
The Cause of Death refers to a specific forensic finding of how the death occurred (e.g. drowning, gunshot, suffocation or Sudden Unexpected Infant Death Syndrome).
The Manner of Death is an official classification by a coroner or Medical Examiner of how the cause of death occurred. Each manner of death included in this report is individually defined below. Definitions were provided by the Georgia Bureau of Investigation. Note that within each manner of death, there are multiple causes of death. Additionally, it is important to note than an official cause and manner of death does not necessarily always correlate with whether there was a finding of abuse or neglect. For example, a child may die as a result of an accident (such as a drowning) but maltreatment may also be found in that a caretaker's actions (substance use) or inaction (lack of supervision) may have indirectly resulted in the death of the child.
Accident: This classification is due to an unintended death -- there is no evidence of intent to harm.
Examples:
Unintentional hanging while playing on a rope swing. House fires. Asphyxiation of an infant while sleeping in a crib.
Homicide: This classification is due to a volitional act of another person with the intent to cause fear, harm or death. It is important to note this classification does not always indicate a criminal homicide, which is determined by the legal process and not by the certifier of death. Thus, murders are always homicides but homicides are not always murders.
Example: Children who were placed in foster care after being critically injured by acts committed by their caretakers. These children died as a result of the injuries sustained prior to being placed in foster care. Some children in this category had no prior

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Georgia Division of Family and Children Services

August 2014

DFCS history before the injury that led to their deaths, and some children had a delayed death due to their injuries.
Natural: This classification is due to diseases or medical conditions. Examples: Children who were born prematurely and developed medical conditions due to their lack of development. Children who were diagnosed with diseases such as Leukemia or Cerebral Palsy, and whose deaths were due to complications from these medical conditions. Many SIDS (Sudden Infant Death Syndrome) causes are categorized as natural deaths.
Suicide: The classification is due to an injury that is intentionally selfinflicted. Examples: A child who hangs him or herself; A self-inflicted gunshot wound.
Undetermined: This specific classification is given when there is inadequate information regarding the circumstances of death to determine manner, or there are multiple possibilities and not a preponderance of information or evidence available to definitively choose one.
Examples: Several of the undetermined deaths were children less than 1 year of age whose deaths occurred during a sleep-related incident; Children who die as a result of a house fire with an unknown cause may be classified with this manner; Many SUIDS (Sudden Unexpected Infant Death) causes are captured in this manner.

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Georgia Division of Family and Children Services
Figures 3.1 and 3.2 -- Manners of Death by Percentage:

2013

Suicide

3% Homicide
14%

Natural

Undetermined 19%

42%

Accident

21%

August 2014

Figure 3.1

2012

Suicide 3%
Homicide 14%
Undetermined 22%

Natural 37%

Accident 24%

Figure 3.2

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Georgia Division of Family and Children Services

August 2014

Table 3.1 -- Manners of Death in 2013 for Children under the Age of One:

Age

Accident Homicide Natural Undetermined

0-6 months

for 2013

7

4

27

26

0-6 months

12

2

20

25

for 2012

6-12 months

3

5

9

5

for 2013

6-12 months for 2012

6

0

10

3

Total

Number for

10

9

36

31

2013

Total

Number for

18

2

30

28

2012

Sleep Related Deaths and Children Under the Age of One:
Twenty-six (26) of the undetermined deaths, nine (9) of the natural deaths, and seven (7) of the accidental deaths occurred while the child was sleeping. This accounts for 23% of all deaths in 2013, and nearly half of deaths for children under the age of one. Co-sleeping with siblings or adults, or unsafe sleeping environments, such as a sofa, car seat or a crib with blankets and pillows, may have been a contributing factor in the deaths.
In 2012, 57 of the 152 deaths were sleep-related. After co-sleeping was identified as a trend in sleep-related deaths, the Division developed a campaign to educate families on the dangers of co-sleeping and the importance of safe sleep habits.

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Georgia Division of Family and Children Services

August 2014

Table 3.3 -- Manners of Death by Region:

Region

Natural Accident Homicide Suicide Undetermined

1

4

1

0

0

3

2

5

3

2

2

4

3

3

5

3

0

0

4

4

1

2

1

5

5

3

2

0

0

3

6

3

3

2

0

2

7

5

0

0

1

2

8

6

0

1

0

4

9

5

2

1

0

2

10

5

3

2

0

0

11

5

4

2

1

2

12

6

4

4

0

1

13

3

5

2

1

3

14

16

4

1

0

4

15

3

0

4

0

0

2013 Totals

76

37

26

6

35

2012 Totals

55

37

22

5

33

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Georgia Division of Family and Children Services

August 2014

Causes of Death by Year: Table 3.4 Natural This classification is due to natural disease processes.

Natural

Total for Each Cause Total for Each Cause in

in 2013

2012

Congenital or pre-

existing medical

condition and/or

68

43

contracted

illness/condition

SIDS/SUIDS

6

6

Other

2

6

Total

76

55

Table 3.5 Suicide -- This classification is due to an injury that occurred with the intent to induce self-harm or cause one's own death.

Suicide

Total for Each Cause in 2013

Total for Each Cause in 2012

Gunshot

4

2

Hanging

2

2

Overdose

0

1

Total

6

5

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Georgia Division of Family and Children Services

August 2014

Table 3.6 Accident This classification is due to an injury when there is no evidence of intent to harm.

Accident

Total for Each Cause in Total for Each Cause in

2013

2012

House fire/smoke inhalation

8

4

Asphyxia

8

4

Motor Vehicle Accident

6

0

Drowning

5

7

Run over by Motor Vehicle

5

3

Sleep-related Suffocation

0

13

Other

5

6

Total

37

37

Table 3.7 Undetermined -- This classification is given when there is inadequate information regarding the circumstances of death to determine manner.

Undetermined

Total for Each Cause in 2013

Total for Each Cause in 2012

Undetermined

12

10

SUIDS

20

17

Smoke Inhalation

3

0

Other

0

6

Total

35

33

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Georgia Division of Family and Children Services

August 2014

Table 3.8 Homicide -- This classification is due to a volitional act of another person with the intent to cause fear, harm or death.

Homicide

Total for Each Cause in 2013

Total for Each Cause in 2012

Blunt Force Head Trauma

13

7

Gunshot

6

6

Multiple Blunt Force Injuries

3

3

Traumatic Brain Injury

2

0

Other

2

6

Total

26

22

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Georgia Division of Family and Children Services

August 2014

CHILD FATALITIES AND PRIOR DFCS INVOLVEMENT

CPS history always originates from the parents or caregivers, and includes anything from a screened-out report to intensive family interventions. Any report that does not meet Georgia statute and DFCS policy requirements for child abuse and/or neglect is screened out and not acted on further by the agency.6 For the purposes of this report, DFCS history does include families where the only history was a screened-out report. While each child included in this report had parents or caregivers with a history of DFCS involvement, the child who died may or may not have been a part of that history. For 29 of the children listed below, DFCS' prior involvement pre-dated the birth of the child. In other instances, the child may have been placed in foster care due to injuries sustained by the parent or caregiver, but then later died from those injuries. While there may not have been history prior to the foster care placement, the case was open due to the necessity for placement at the time of death. That child would therefore be included in this report.

Table 4.1 -- Below is a breakdown by manner of death and length of time between prior DFCS involvement and child fatalities for CY2012 and CY2013.

Length of Time between Prior
DFCS Involvement with
the Family & Child's Death

Homicide

Suicide

Accident Natural Undetermined Totals for 2013

Totals for 2012

0-12 months*

20

3

13-24 months

1

2

25-36 months

3

0

37-48 months

2

1

49-60 months

0

0

24

55

24

8

14

5

3

2

0

2

3

2

0

2

4

126

87

30

39

8

15

10

4

6

7

6 If a report does not meet Georgia statute and DFCS policy requirements for child abuse or neglect, but indicates the family has unmet needs that are not related to safety, DFCS will refer the family to community resources that could provide needed support.

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Georgia Division of Family and Children Services

August 2014

Table 4.2 -- 2013 fatalities when there was an open case at the time of death.7

Length of Time in 2013 between Prior DFCS
Involvement with Family & Child's Death

Homicide

Suicide

Accident

Natural Undetermined

Case open prior to incident

4

that led to the death

1

6

34

12

Case open due to incident that led to the death

9

0

3

6

0

Total number of open cases

13

1

9

40

12

Table 4.3 -- Type of DFCS history for deaths that occurred in 2012 and 2013.8

DFCS History Type

Totals for 2013

Totals for 2012

Investigation for abuse or neglect

132

84

Family Preservation

44

23

Family Support Services (practice began April 1, 2012)

44

9

Previous Diversion case (practice ended March 31, 2012)

55

66

Case open at the time of death

75

48

Children in foster care at death

21

13

7 It is important to note that in 2013 there were 75 children with open DFCS cases at the time of their death. This includes those children who had been placed in foster care and then died from the injuries related to the abuse that caused them to be placed in care and cases that were opened unrelated to the child's death. Table 4.2 is a subset of the 126 deaths that occurred within 0-12 months of agency contact, as detailed in Table 4.1.
8 The total number of types of DFCS prior history is higher than the total number of child deaths for the year. This is due to the fact that some of the children had more than one type of prior history with DFCS; for example, the family may have had a prior investigation as well as a prior Diversion or Family Support case.8

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Georgia Division of Family and Children Services
CONCLUSION

August 2014

The Georgia Division of Family and Children Services, in collaboration with stakeholders and other partner agencies, has taken and will continue to take proactive measures to learn from every child fatality. DFCS has committed to analyzing and evaluating these cases to develop trends, ensure sound practice and policy, increase prevention awareness, and train staff to respond thoroughly and appropriately to all reports of child maltreatment. For the CY2013 report, DFCS and external stakeholders conducted an in-depth staffing on 114 reported child deaths with identified DFCS history and an allegation of maltreatment. The purpose of the case staffing is to enhance policy and practice and improve intervention efforts for families with identified risk factors.

Preliminary Findings and Lessons Learned:
The data show that of the 1809 children:
67 children had been classified as having special medical needs; 12 infants died of natural causes and never left the hospital after birth.
42 of the deaths were sleep related;
78 children had caretakers who were alleged to be using drugs at some time during the agency's involvement with the family;
54 children were in families where domestic violence (DV) had been indicated (due to a reluctance to disclose DV, this number could be underreported and may actually be higher);
48 children had a prior substantiated finding of child abuse and neglect10;
56 children had a substantiated finding in relation to their deaths;

9 The total number for the bullet points above add up to more than 180, as several of the points mentioned applied to many of the fatalities. 10 According to DFCS policy, a substantiated finding is when "an investigation disposition by an abuse investigator concludes that the allegation of maltreatment, as defined by state law and CPS requirements, is supported by a preponderance of the evidence." [Source: http://www.odis.dhr.state.ga.us/3000_fam/3030_cps/manuals/chapter4/2104_23.doc]

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Georgia Division of Family and Children Services

August 2014

Critical Considerations in the Assessment of Child Fatalities:
Children Younger than Two: Fifty-eight percent (58%) of the deaths in 2013 occurred in children younger than 2 years of age. Investigating case managers must assess nonverbal children carefully utilizing both a visual assessment and pertinent corroborating evidence. The assessment of nonverbal children is an area of emphasis for the Agency. Case managers are receiving specialized training to increase this skill set.
Substance Abuse: Caretaker substance abuse continues to be a contributing factor in child safety. Effectively assessing whether a substance-abusing caretaker is adequately equipped to care for a child is challenging for case managers. Denial of drug use by caretakers often detracts from the assessment process and can influence a case outcome. Gathering supportive evidence, including drug testing, remains a critical component of ensuring child safety.
Historical Context: The child protective service (CPS) history must always be reviewed and integrated into the current assessment for child safety. When prior CPS history is not thoroughly reviewed, a meaningful historical context cannot be created and valuable information may be overlooked. Reviewing prior history and incorporating it into the assessment provides a comprehensive evaluation of family functioning.
Verification of Evidence: Case managers are expected to verify evidence collected during assessments. Validation of information, including contact with collaterals and reporters, assists the agency in being able to make sound overall safety determinations. Before cases are closed, the reviewing entity needs to ensure that all discrepancies found during the assessment have been clarified. Case managers may be too deferential to a parent's account of a situation and will sometimes disregard a child's statement. Children must be taken seriously and the information they provide is critical to assessing their safety.

Recommendations for Future Reports:
Improving Data Reporting Methods: DFCS is currently enhancing our internal child fatality review team to include experts in data collection and trend analysis.

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Georgia Division of Family and Children Services

August 2014

Action Items:
Developing predictive analytics to guide new child death and serious injury model: DFCS is exploring a variety of predictive analytics models that will assist the agency with identifying risk factors and improving intervention efforts to ensure the safety of Georgia's children.
Strengthening case managers' interviewing and assessment skills through specialized training: In partnership with the Children's Advocacy Centers of Georgia mandatory training has been developed and implemented for frontline staff and supervisors to enhance interviewing techniques. These improved skills will strengthen agency assessments of family functioning.
Collaborating with experts to improve care for medically-fragile children: DFCS is committed to a continued and enhanced collaboration with Children's Healthcare of Atlanta (CHOA) and entities such as Child Kind to improve its assessments of medically-fragile children, as well as training for frontline workers and foster families caring for these children.
Data Collection and Evaluation: Georgia DFCS continues to collaborate with other state partners, such as the Office of the Child Advocate, Public Health, Children's Healthcare of Atlanta and the Georgia Bureau of Investigation, in order to gather accurate and complete data on the families and children we encounter. This multi-disciplinary approach is progressive and the shared investment of all of the agencies helps provide a comprehensive analysis of ways to offer assistance to at-risk families.

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