The Role of Team Members
* Medical Examiner *
* Law Enforcement *
* Public Health *
* Pediatrician *
* Hospitals *
* Educators *
The role of team members can be flexible to meet the needs of particular communities. The individual abilities of members should be tapped to enhance team effectiveness. Each member should:
- Contribute information from his or her records.
- Serve as a liaison to respective professional counterparts.
- Provide definitions of professional terminology.
- Interpret agency procedures and policies.
- Explain the legal responsibilities or limitations of his or her profession.
They should also assist with referrals for services or provide direct aid to surviving family members. All team members must have a clear understanding of their own and other professional and agency roles and responsibilities in their community's response to child fatalities. In addition, team members need to be aware of and respect the expertise and resources offered by each profession and agency. The integration of these roles is key to well coordinated community child death response systems.
Medical examiners are central to the functions of both child death review teams and child death investigations. State law requires that all unexpected child deaths be reported to and investigated by a county medical examiner. In Michigan, medical examiners are physicians. Medical examiners have the responsibility and the right to determine cause and manner of death. Medical examiners lay the groundwork for discussion by presenting basic information about cause and manner of death, including findings from the scene investigation, autopsy and medical history. Medical examiners can legally obtain records from other investigating agencies. Medical examiners have the right to access information from police, paramedics, hospitals, CPS and others to determine cause of death. Usually, no other agency has such wide latitude. The county prosecutor’s office can obtain these records, but only for deaths the office is pursuing for criminal prosecution. The medical examiner’s office can obtain such records for any death, whether due to homicide, accident, suicide, or natural causes. Medical examiners can also interpret clinical findings and provide additional details that help teams better understand a cause of death ruling.
Law enforcement team members provide information on criminal investigations of child deaths under team review. They also check criminal histories of children and/or family members and of suspects in intentional child death cases. To ensure sufficient representation, both the sheriff's department and the police department with the largest jurisdictions should have members on the team. Law enforcement team members serve as liaisons between the team and other local law enforcement departments. They assist in persuading officers from other agencies to participate in reviews of deaths in their jurisdictions. Law enforcement professionals are usually the team members best trained in scene investigation and interrogation, essential skills for determining how a child died. Such expertise provides useful information and training to other members.
DHS has the legal authority and responsibility to investigate child deaths and to provide protection to siblings who might be at risk. As team members, DHS representatives can provide detailed information on families and on their investigations into child deaths. DHS may have prior agency contact information including reports of neglect or abuse on a child or siblings, and of services previously or currently provided to a family. They may be able to provide information on a family's history and sociological factors that influence family dynamics, such as unemployment, divorce, previous deaths, history of domestic violence or drug abuse, and previous child abuse. When reviews indicate a need, DHS representatives can provide services to surviving family members. Their knowledge on issues related to child abuse and neglect cases is essential to team effectiveness.
Prosecutors educate child death review teams on criminal law and provide information about criminal and civil actions taken against those involved in the child deaths reviewed. They can also explain when a case can or cannot be pursued and provide information about previous contact or criminal prosecutions of family members or suspects in child deaths.
Public health agencies facilitate and coordinate preventive health services and community health education programs. Public health child death review team members can provide vital records and epidemiological risk profiles of families for early detection and prevention of child deaths, as well as information on county public health services. Public health doctors or nurses help identify public health issues that arise in child deaths and provide medical explanations. If a child was treated in a local public health facility or received home visits, they can provide medical histories and explain previous treatments, especially helpful in the review of infant deaths. Many local public health agencies can provide information on risk factors and services available to high risk pregnant women and their families.
Pediatricians provide child death review teams with medical explanations and the benefit of their perspective, gained by having examined thousands of living children. They can access medical records from hospitals and from other doctors. If a pediatrician testifies regularly in child abuse trials, his or her expert opinion regarding medical evidence can be useful. It is preferable to have pediatrician team members experienced in treating victims of child abuse and neglect. If a pediatrician is unavailable, teams can select a physician who specializes in family practice or has a general practice.
EMS is frequently first at the scene and observes critical information regarding the scene and circumstances of a child death, including the behavior of witnesses. The EMS run report can also be useful in determining body position at death and identification of other evidence that may have been moved before an investigator’s arrival at a scene. EMS also has well established relationships with local hospitals and can provide a perspective from these agencies.
Local hospital representatives on child death review teams can be emergency room staff, quality assurance officers, social workers or key administrators. Their participation can facilitate the sharing of medical records with a team. When a child is transported to an emergency room, hospital representatives can provide a review team with pertinent information. They can also obtain valuable information from reviews to help improve hospital practices.
The mental health representative on a child death review team provides information and insight regarding psychological issues related to events that caused a child death. Although federal guidelines preclude community mental health from sharing case-specific information unless consent is obtained, they can suggest when counseling or other mental health service referrals may be appropriate. Their participation at the review can provide valuable insight into their own agency policies and practices.
Juvenile probation officers can provide child death review teams with information on crimes and delinquencies involving older children. A large number of teenagers die as a result of suicide and homicide. Records from juvenile probation workers can assist in reviews of such deaths. The court can also provide information related to child abuse and neglect. The courts can also learn from reviews and improve child protection and juvenile court proceedings.
Educators can provide child death review teams with perspective on child health, growth and development. Although federal laws preclude educators from sharing student case records with review teams, their presence at reviews enhances the delivery of support services and interventions. This is especially true in cases of traumatic death, particularly in developing school support services in the event of suicides and homicides. The schools are also able to provide leadership in implementing review team prevention recommendations.