Overview of Program
History of CDR in Michigan
Status of Local Teams
Reporting Review Findings
State Child Death Advisory Team
CDR Support Services
Innovations and Collaborations
Michigan as a National Leader in CDR
The Michigan Child Death Review (CDR) Program builds and supports multidisciplinary teams in all 83 counties. These teams, totaling nearly 1,200 persons, meet regularly to review all of the circumstances surrounding the death of a child. The purpose of CDR is to use the findings from the reviews to improve agency systems and to take action to prevent other deaths.
In 1995, the Governor's Task Force on Children's Justice spearheaded the planning of CDR, in coordination with the Michigan Family Independence Agency (currently known as the Department of Human Services or DHS), Michigan Department of Community Health (MDCH) and Michigan State Police (MSP). With the help of a Children's Justice Act two-year grant of$225,000 to the Michigan Public Health Institute (MPHI), a program was piloted in 17 counties. The results of the pilot led to revisions to the Michigan Child Protection Act, Section 7b (PA 167 of 1997). This enabled CDR, encouraged expansion to all counties, mandated a Child Death State Advisory Committee and required an annual report on child deaths. In 1998, DHS, MDCH and MSP contributed one year of funds for the program, until state general funds were allocated by the Department of Management and Budget (DMB), through DHS. DHS contracted with MPHI in the amount of $500,000 for two years and then $450,000 per year through 2004. By 1999, all of Michigan's counties had organized teams to review deaths. Most other states' CDR teams were established only to review child abuse deaths. Michigan opted for a broader process that would encourage reviews of all preventable deaths to children under age 19, using a public health model.
All Michigan counties have organized teams to review deaths. With a few exceptions in Northern Michigan, all teams meet regularly to conduct reviews. Counties receive no funds for this effort and the process is entirely voluntary. The relative stability of teams speaks to the strong local commitment to the program. The average team is comprised of 15 members, and includes at a minimum the prosecutor, state, county and/or local law enforcement, representatives from DHS, local public health, and the county medical examiners. EMS, mental health, education, pediatricians, hospital staff and other health care providers also serve on teams. Membership on some teams may also include other key community leaders. Teams have wide discretion in selecting their coordinator, team membership and operating procedures. As teams have matured over the past eight years, most have evolved from a focus on investigation and data collection to translating their findings into action to prevent deaths. In 2002, close to 900 deaths were reviewed, which represents almost half of all child deaths, ages 0-18, in the state. Since 1995, teams have reviewed almost 4,000 deaths. Up through 2001, teams recommended 1,149 strategies to prevent deaths and took action to implement at least 596 of these.
Teams complete a case report on each death reviewed. Michigan CDR pioneered a web-based reporting system, now in use in many states. MPHI tabulates these cases and manages the state CDR database. The case reports are confidential, per Public Act 167 of 1997. Local counties can obtain full reports of their reviews, and the annual report on child deaths in Michigan is developed using these findings, as well as MDCH child mortality data. The law requires, at a minimum, an annual tabulation of the total number of child fatalities, by type and cause; the number of fatalities that occur while a child is in foster care; the number of cases where the death occurred within five years after family preservation or unification and trends in child fatalities. There are limitations on who can access the CDR case reports, and current law prevents the use of the identifiable data for research purposes.
The law requires that the Michigan Child Death State Advisory Committee "identify and make recommendations on policy and statutory changes pertaining to child fatalities, and to guide statewide prevention, education and training efforts." This state level team has been meeting at least quarterly since 1998. The director of DHS selects members, with no term limits established. The law requires representation from DHS, MDCH, a county prosecuting attorney, law enforcement, a medical examiner and the Children's Ombudsman. Other members have been appointed to add expertise on multiple causes of child death and prevention. DHS chairs the meetings, which generally include presentations by state experts, data on specific causes of death, review of local CDR findings and development of recommendations for the annual report. Four years ago, DHS also established that the State Advisory Team would serve a dual function as the state's federally mandated (CAPTA) Citizen's Review Panel (CRP) on Child Fatalities. This sub-committee has been meeting regularly to conduct case reviews of suspected child maltreatment deaths and develops recommendations for improvements to the child welfare system. Three CRP annual reports have been presented to DHS directors, the most recent in February 2004.
MPHI, through its contract with DHS, has developed and maintained the CDR program, currently with a staff of 4.5 full-time employees. Services include an annual training for new team members averaging 125 attendees, as well as statewide training on specific causes of death and child death investigation procedures. Annual regional meetings of CDR coordinators are held throughout the state. Staff attend local review meetings regularly to provide technical assistance and encourage prevention efforts. Program support materials include resource guides for effective reviews, protocol manuals, training manuals, investigative protocols, local and state mortality data, prevention resources and a resource website. Staff also author the annual report on child deaths in Michigan.
The program has a successful track record of working with numerous diverse organizations throughout the state to promote child heath and safety. The program also maintains a close relationship with DHS that has led to several innovations. These include the birth-match project, the DHS Report of a Minor's Death Data System, tabulations of fatality data for NCANDS, the Children's Trust Fund Never Shake a Baby Campaign, child safety brochures and waiting room materials, and the CRP on child fatalities. CDR staff also manage the MDCH-funded Fetal and Infant Mortality Review Program (FIMR), which currently has 15 counties conducting more intensive reviews of infant deaths. Michigan's model of CDR and FIMR collaboration is now promoted as a national model. MDCH supports CDR by supplying the program with microfilm tapes of all deaths on a monthly basis, so that local teams can receive notification of all their child deaths. MDCH also provides raw mortality data, looking to CDR to develop the child death statistical profiles for the state. The U.S. Centers for Disease Control and Prevention (CDC) funded MPHI as one of five states to develop a model surveillance system for child maltreatment fatalities. A workgroup of DHS, MDCH, MSP and the University of Michigan have developed a model to more accurately count maltreatment deaths. By melding four sources of data from DHS, CDR, MDCH and MSP, the project identified an additional 57 child maltreatment-related deaths in 2000 than was reported by state vital statistics.
In 2002, the Maternal and Child Health (MCH) Bureau of the Health Resources and Services Administration awarded Michigan a competitive grant to serve as the National MCH Center for Child Death Review. This grant was awarded in part because the Michigan program demonstrated its success as a prevention-based, comprehensive community model, with strong supporting resources. The National Center provides training and technical assistance to all states in the implementation of prevention-oriented CDR models. The Center is developing national standards for CDR and a national web-based reporting system, based on Michigan's model. At least 14 states will be piloting this new system in 2005. The Center is also working with numerous national organizations to promote the CDR agenda and to advocate for child health and safety initiatives based on CDR findings. To date, more than 30 states have received on-site technical assistance and support. The Center is also coordinating a new national network of CDR state programs.