Taking Action to Prevent Child Deaths
The most important reason to review child deaths is to improve the health and safety of children and to prevent other children from dying. Child Death Review team members may come to the table mostly interested in improving investigations, services or in finding those at fault for a child’s death. Moving the focus of reviews to prevention can be a new arena for many team members. But focusing on prevention can help your team find meaning and purpose over the long haul.
CDR is a great opportunity to mobilize persons from across your communities. For example, law enforcement knows the causes of motor vehicle crashes. Child protective services has insight into the families involved in child abuse and neglect. Schools often know the general history of the teens that die from suicide. These professionals can work together to increase the chances of success of a prevention idea. For example, if your team publicizes that it is important for the county to place improved warning signs at a certain train crossing, this may give the idea greater weight and may lead to quicker action.
Determine if the Death was Preventable
The Data Dictionary of the CDR Case Reporting System states that a child’s death is preventable “if the community or an individual could reasonably have done something that would have changed the circumstances that led to the death.”
Incidents causing injury and death may be viewed as random "accidents.” However, most injuries to children are predictable, understandable and therefore preventable. You will probably focus prevention efforts on manners of death we usually think of as preventable: accidents, homicides and suicides.
CDR teams should also consider risk factors that can be addressed to prevent natural deaths. For example, perinatal deaths could be impacted by a variety of modifiable factors, such as maternal health and prenatal care, and mother’s exposure to domestic violence or substance use during pregnancy. For child deaths due to medical conditions, your team may discuss the availability and adequacy of health care, compliance with treatment plans and barriers to persons seeking or obtaining quality care.
Determine the Best Strategy(ies) for Prevention
There are numerous frameworks you can use to determine the best strategy for prevention. For example, the field of injury has identified the Four E’s: Education, Engineering, Enactment and Enforcement.
The Spectrum of Prevention is a model that your team can use to create long-lasting, positive changes in the community. It describes seven levels at which prevention activities can take place, and moves beyond individual services and community education. The Spectrum of Prevention model was created by Larry Cohen, MSW, and is based on the work of Dr. Marshall Swift. It encourages creative and effective prevention projects, and can help communities develop activities that are likely to be more successful since they complement the strengths that already exist within a community.
The seven levels in the spectrum are:
- Strengthening Individual Knowledge and Skills
Assisting individuals to increase their knowledge and capacity to act can lead to behavior change. Many health providers and community agencies currently apply this strategy through education, counseling and other individual services to encourage individuals to change their behavior.
- Promoting Community Education
Reach groups of people with information and resources to build support for healthier behavior and community norms. Since the media is so predominant in our society, skillful attention to the media can advance community education efforts.
- Training Providers
Providers can influence others. They can be professionals, paraprofessionals, community activists or peers. It is critical to ensure that those who provide training, advice or serve as role models have the information, skills, capacity and motivation to effectively promote prevention with youth, parents, colleagues and policy makers.
- Fostering Coalitions and Networks
Creating or strengthening the ability of people and organizations to join together to work on a specific problem is useful for accomplishing a broad range of goals that reach beyond the capacity of any individual member or agency. These goals may range from information sharing to coordination of services to community education or advocacy for major regulatory or legislative changes. Or it may be as simple as improved interagency communication.
- Changing Organizational Practices
Change can focus on internal business and agency policies, regulations, practices and norms. Looking at the practices of key groups, such as law enforcement, health departments and schools has potential for affecting the health, safety and satisfaction of the greater community. Also, every organization should look at its own practices to see what could be changed or strengthened.
- Mobilizing Neighborhoods and Communities
Engage community members in your process of making changes. This can be a catalyst for neighborhoods and communities to be empowered to make a difference. Buy-in from the citizens affected will make your initiatives more likely to be successful.
- Influencing Policy and Legislation
Work to change laws or regulations at the local and state levels. Sometimes the greatest improvement in prevention, affecting the largest number of people, can be accomplished by attention to policy issues and regulation. And if a policy or regulation works at one or more localities, the state may take an interest and implement them as well.
Identify Specific Prevention Activities
To identify the best prevention strategies and activities, teams should weigh the following:
- Ease of implementation
- Community acceptance
- Political reality
- Unintended Consequences
Even with a desire to take action, there are other things to keep in mind when planning prevention:
- Don't reinvent the wheel. Prevention programs have been developed and implemented throughout the country. In researching prevention activity outcomes, you can learn from others' mistakes and build on what has been successful elsewhere. Also use your community consultant from MPHI to assist you with determining what may have been successful (or not successful) in other areas.
- Prevention research has shown that combinations of strategies and activities will be more effective than any one single activity. Types of prevention actions your team could consider, across four areas: public or other targeted education, agency change in policy or practice, new laws or regulations, and changes to a public or private space. Oftentimes, the best recommendations will be a combination of these actions.
Take Action or Share Your Findings to Ensure that Action will be Taken
Teams do not have to implement their proposed prevention strategies and activities, but the team should follow through to make sure that someone or some agency has assumed responsibility. The team can serve as an effective catalyst, to foster accountability as well as recognize and reward community efforts. It is important that your team:
- Identifies someone willing to take the lead.
- Identifies resources.
- Identifies someone to follow-up and report back to the team.
- Provides recognition to those implementing the CDR recommendations.
Local teams can send recommendations to local agencies for local action. You can also send them to the state, which can then use them to advocate for or develop state-level prevention actions. The following is a list of possible recipients:
- Individual CDR team member(s)
- State CDR team(s)
- The media
- State organizations (AAP, ACOG, SAFE KIDS, etc)
- State Agencies (child protection, public health, public safety and others)
- Community leaders
- Parents/teachers/student organizations
- Not for profit organizations
- Civic organizations
In sharing your findings, choose an appropriate format, such as formal presentations or formal letters to agencies. Remember NOT to include case-specific information that would violate confidentiality.