Delaware’s child death review process was statutorily established on July 19, 1995, after a pilot project showed the effectiveness of such a review process for preventing future child deaths. The legislation established the Child Death Review Commission, which has been charged to create up to three regional Review Panels, establish confidentiality for the reviews, and provide the Commission with the ability to secure pertinent records. In addition, legislation provides protection to members of the Commission and regional Review Panels from civil or criminal liability.
The Commission has established three child death review panels. The Sudden Death in the Young (SDY) Panel, the secondary medical SDY panel, and the child death review (CDR) panel (state-wide review of all deaths not reviewed at SDY panel). The panels meet bi-monthly or quarterly as caseload dictates. The goal is that all cases are reviewed within six months of the death, unless there is pending prosecution. The Commission meets quarterly to review and approve the work of the Panels.
The Commission’s statute was amended in 2002, changing the name from the Delaware Child Death Review Commission to the Child Death and Stillbirth Commission. Another significant legislative change in 2002 added the expedited review process for child death due to abuse and neglect.
In 2004, the statute was amended a second time to change the Commission’s name to the Child Death, Near Death and Stillbirth Commission. Among other updates, the scope of infant review was broadened to include fetal and infant deaths from 27 weeks gestation to 20 weeks gestation. Also, the statutory change required the Commission to investigate and review all the facts and circumstances of the death or near death of an abused and/or neglected child expeditiously. The amended statute also required that system-wide recommendations arising from an expedited review of a death or near death due to child abuse or neglect be made to the Governor and General Assembly, as well as any members of the public requesting the recommendations, within 20 days following the expedited review.
In FY05, the Commission worked in collaboration with the Division of Public Health (DPH) to implement a Fetal Infant Mortality Review (FIMR) pilot project under the leadership of the Governor’s Infant Mortality Task Force. In FY06, FIMR’s budgetary positions were placed with the Commission. These three positions include a registered nurse III (FIMR Program coordinator), senior medical social worker, and an administrative specialist.
The most significant accomplishment for FY07 was the full implementation of the Fetal Infant Mortality Review Process. The bi-annual joint reviews with the Domestic Violence Coordinating Council’s Fatal Incident Review Team began in April 2007. The cases reviewed involved child deaths and near deaths with domestic violence as a significant risk factor in the death or near death. In an effort to streamline these types of reviews, a member of the Domestic Violence Coordinating Council is now a participant at every child death panel.
During FY08, the Commission’s statute was amended to include Maternal Death Review and allow for public disclosure of deaths and near deaths due to abuse and neglect, after prosecution, to fulfill the federal CAPTA (Federal Child Abuse Prevention and Treatment Act) statute mandate.
On September 20, 2015, the Governor signed legislation transferring the Child Abuse/Neglect Panel (which reviews all deaths/near deaths due to abuse/neglect) to the Child Protection Accountability Commission. CDRC will attend these meetings and will be responsible for entering these deaths into the national data tool. In addition, cases for the SDY panel or CDR panel will be jointly reviewed with the CAN panel if there are significant child welfare issues noted. As a part of this legislation, the name of the Commission was reverted to the Child Death Review Commission.
The state team would be considered the Commission as outlined in state statute.
The Commission reviews the work of three child death panels, two FIMR case review teams and one Maternal Death review team. Delaware reviews the deaths of mothers within 364 days of giving birth, children under the age of 18, and stillbirths occurring after at least 20 weeks of gestation.
The Commission’s mission is to safeguard the children of Delaware by examining the deaths of children under the age of 18.
Standardized data reporting forms are completed for all reviews. This is required by state policy. CDRC utilizes the national child death data tool for data entry. Our Fetal Infant Mortality Review program has also started to utilize the NFIMR database which is housed under the Michigan Public Health Institute. This change occurred on 1/1/2016. The program utilized the database, Baby Abstracting System and Information NETwork (BASINET), supported by Go Beyond, L.L.C. until 12/31/2015. Data is used from both databases to complete the annual report, which includes trends and recommendations. The Delaware CDRC program has access to state vital statistics. Delaware CDRC receives death certificates, fetal death certificates and birth information on all children from Delaware’s Vital Statistics.
CDRC statute requires that an annual report be produced by the Commission. However, due to staffing resources this has not been produced yearly. The report is distributed to public officials and interested citizens.
Abusive Head Trauma Program
In 2009, CDRC in collaboration with PCAD developed and implemented a statewide hospital based educational program on AHT. The program was based on the Mark Diaz Model1, which like the Period of PURPLE Crying®2 is considered the first generation of evidence-based educational media addressing AHT.
The “All Babies Cry”® abusive head trauma program is based on the Strengthening Families and Model and the Theory of Planned Behavior. The ABC program has been assessed for efficacy, using a mixed-method, quasi-experimental staged evaluation design. The results of the study showed that the program is well received, appears effective in improving mediators of behavior, and may change parental behavior. Parents are the most common perpetrators of abusive head injuries. The period of greatest risk for shaking coincides with the newborn period, particularly at eight weeks of age, when crying peaks. Childbirth is usually a time of almost universal contact between parents and the health care community. In addition, adult learning theories suggest that adults are more willing to engage in learning before, after, or during a life-changing event.
The components of the program are as follows:
- All parents at all birthing hospitals and parents that have had their infants transferred to the NICU at the states only children’s hospital will receive this education prior to discharge.
- All parents will be given the opportunity to view an 11-minute video at the hospital, as well as the website where the video can be viewed at home following discharge. The goal is that 75% of all birthing parents will view the 11-minute DVD.
- All parents will receive a modified ABC booklet. The booklet will continue to provide information on how to access the website and the new phone “APP”. The website will provide the full 28-page, 4 color booklet with checklists, activities, hotline numbers and other resources. This booklet will also be available to download via pdf from the website.
- Parents will be asked to voluntarily sign the commitment statements (CS) which state that they have received the CS and understood the information presented. The CS is produced in triplicate format. The first copy remains with the mother’s medical record. The second copy goes home with the parents/caregivers. The third copy goes to the CDRC. A statement on the CS asks the caregiver if a representative from the program may call then in six – eight weeks, to participate in a brief survey. All identifying information is blocked on the third copy to follow HIPPA regulations.
- One-on-one discussion with a nurse is vital to the success of this program. A sample script was provided for nurses and requires no more than 5 minutes of their time. Nurses are also asked to document that education was offered.
- Addressed stamped envelopes are provided to each hospital for each month of the year. At the end of the month, hospitals send the accumulated CS to CDRC.
- A CDRC social worker continues to place follow up telephone calls and ask parents/caregivers to complete a brief survey.
- The AHT Coordinator continues to remain in close contact with all hospitals to discuss their needs and how the program is going.
DELAWARE CRIBS FOR KIDS
Since 1998, through the donation of thousands of cribs, National Cribs for Kids® has been making an impact on the rate of babies dying of SIDS and from accidental suffocation. Cribs for Kids® is a safe-sleep education program to help reduce the risk of injury and death of infants due to unsafe sleep environments. Currently, Cribs for Kids® has 310 partner programs in 43 states throughout the country that provide a Graco Pack ‘n Play® crib and educational materials regarding safe sleeping and other important safety tips.3
In June 2009, a partnership was developed between the Delaware Division of Public Health, Nemours Health and Prevention Services of the Nemours Foundation (Nemours), Christiana Care and CDRC to implement the first Cribs for Kids® program in Delaware. As a result of this program, a crib is provided to any Delaware mother if she is unable to purchase a crib on her own and meets the following criteria: is due to deliver the baby within six weeks or the infant is younger than six months of age; and the family has not previously received a crib from the program. The first crib was distributed in November 2009. This program is one of the biggest accomplishments from the Joint Commission infant safe sleeping community action team.
On December 23, 2011, CDRC assumed more responsibility for this program and became the gatekeeper for all crib distribution. The designated new telephone number is 302-255-1743. The education will be provided to the family by a Division of Public Health nurse or other trained staff within the community. The preventive part of the program is the education that must be given by the nurse on unsafe sleeping practices for infants. Delaware is the only state that offers this education in the home, and has been recognized by national leaders as the gold standard versus the client picking up the crib at an office or facility. Cribs for Kids® is an evidence-based program that has had successful outcomes in other states in reducing infant unsafe sleeping deaths and is an excellent example of collaborative partnerships in Delaware on behalf of children. This program is completely funded through grants, monetary donations, and fundraising efforts.
Delaware has a variety of protocols in place including a procedure manual and policies. All procedure and protocols must be voted upon by the Commission prior to implementation.
Policies and Procedures:
- Child Death Review Commission By Laws (September 8, 2017)
- Child Death Review Commission (CDRC) Policy and Procedure: Child Death Review (CDR) Panel Policy
- Child Death Review Commission (CDRC) Policy and Procedure: Fetal and Infant Mortality Review (FIMR)
- Child Death Review Commission (CDRC) Policy and Procedure: Maternal Mortality Review (MMR)
- Child Death Review Commission (CDRC) Policy and Procedure: Statutory Duties to Report
- Child Death Review Commission (CDRC) Policy and Procedure: Sudden Death in the Young Case Registry
- Informed Consent—The Sudden Death in the Young Case Registry: Research, Diagnostic Testing and DNA Banking
- SDY Case Registry Algorithm
- Guidebook for Commissioners and Review Team Members (April 7, 2017)
A one-day Advanced Training Course was offered to MDT members in partnership with the Child Protection Accountability Commission and the Centers for Disease Control and Prevention (CDC) Sudden Death in the Young Grant. It was attended by 112 professionals with direct responsibility for the investigation and prosecution of child abuse cases. Participants were given a brief introduction to the MOU for the Multidisciplinary Response to Child Abuse and Neglect. In addition, national experts taught participants how to conduct sudden unexpected infant death investigations, which included visually recreating an infant death scene using a doll; explaining the reenactment to the caregiver; demonstrating the infant’s positions; photographing the reenactment; and debriefing the family. Several doll re-enactment kits were distributed to law enforcement agencies and the Division of Forensic Science1.
1Diaz, M., Smith, K., deGuehery, K., Mazur, P., Li, V., & Shaffer, M. (2005). Preventing abusive head trauma among infants and young children: A hospital based parent education program. Pediatrics Vol. 115 No.4 470-477.
2Barr, r., Rivara, F., Barr, M., Cummings, P., Taylor, J., Lengua, L., & Meredith-Benitz, E. (2009). Effectiveness of Educational Material Designed to Change Knowledge and Behaviors Regarding Crying and Shaken-Baby-Syndrome in Mothers of Newborns: A Randomized, Controlled Trial. Pediatrics Vol 123 No.3 972-980.
3Through compelling research by SIDS of Pennsylvania’s Cribs for Kids® Program, a safe-sleep environment has been identified as a key factor in reducing the rates of infant death. Babies, who sleep in unsafe sleep environments, including adult beds, are at a 40 times greater risk of dying. (www.CribsforKids.org)
Last Updated: January 2019