Throughout the U.S., fatality review programs have been established in all states and in thousands of communities. These programs support multi-disciplinary team case reviews during which individual deaths are closely studied. Today in the United States, there are active networks of maternal mortality reviews (MMR), fetal and infant mortality reviews (FIMR), child death reviews (CDR), specialized child maltreatment reviews through citizens review panels (CRP), domestic violence fatality reviews (DVFR), and elder abuse fatality reviews (EAFR). The unifying feature of these different types of fatality reviews is that they are wide angle, multidisciplinary case studies conducted in a climate that promotes open discovery of information.
In December 2011, the National Center sponsored a meeting of representatives of MMR, FIMR, CDR, CRP, DVFR, and EAFR to explore the value of coordination and how to make it happen. The proceedings of the meeting were published and disseminated widely in The Coordination & Integration of Fatality Reviews: Improving Health and Safety Outcomes Across the Life Course, Findings from the National Invitational Meeting December 7-8 2011.
Types of Reviews
Maternal Mortality Review
Maternal Mortality Review (MMR) was the first type of formal death review in the U.S., with most states having reviews in the early 1900s. Its purpose is to identify pregnancy-related and/ or pregnancy associated deaths, and review the factors that led to those deaths to prevent other deaths. A distinguishing characteristic of MMRs is that they typically utilize a medical model for review with extensive reviews of maternal medical histories. Membership is primarily comprised of medical and public health professionals, with a heavy emphasis on professionals with expertise in perinatal specialties. Because maternal mortality is a rare event, most MMRs in the U.S. are state-level rather than local. They are based in state medical societies, public health or academic institutions. There are no national standardized protocols for MMRs. The U.S. Centers for Disease Control and Prevention (CDC) has developed a data abstraction tool and a number of administrative tools for teams. There is no national resource center for MMR, although the CDC provides guidance to state MMR teams and also conducts MMR reviews at the national level.
Domestic Violence Fatality Review
Following a national DOJ summit in 1998 to introduce and encourage DVFR, there was a rapid expansion throughout the U.S. The primary purpose of DVFR is to preserve the safety of battered victims, hold accountable both the perpetrators of domestic violence and the multiple agencies and organizations that come into contact with the parties, and prevent other deaths. DVFR teams review the murders of persons that occurred during domestic disputes or in relation to ongoing family violence. Most of the reviews are of the deaths of women and/or their children, and many are paired with suicides of the perpetrator. One unique component of domestic violence review is analysis of the protections afforded victims prior to their deaths. Teams tend to have more representation from law enforcement, the court systems, and victim advocates than other reviews. The administrative home varies by state but most teams are based out of the attorney general or state court offices. Twenty-three states have local DVFR teams; 18 have state teams. Five of these states have both local and state level reviews. There are standardized protocols for DVFR but no national reporting tool. Most states with DVFR have case report instruments and issue state level reports, but no nationally aggregated data is compiled from the reviews. Training and technical assistance is provided by the National Domestic Violence Death Review Initiative with partial funding from the Office on Violence Against Women at the U.S. Department of Justice (DOJ).
Elder Abuse/Vulnerable Adults Fatality Review
Elder Abuse Fatality Reviews (EAFR) were established in the states of Maine and California in the 1990s and are beginning to expand to other states. The purpose is to identify systems improvements and prevention action to prevent elder abuse fatalities. Some EAFRs examine dependent adult deaths as well as elder abuse deaths. All examine both home and institutional deaths. In their reviews, the teams examine information about the victim, the perpetrator, and the victim’s contact with various public systems. Membership on teams typically includes the same types of member agencies as CDR and DVFR, but also includes financial exploitation experts. Although the Elder Abuse Fatality Review Team concept is still relatively new, there are now teams in at least 13 states. A recent survey found that Florida has six teams, Texas two, New Hampshire one, Illinois four, and California has thirty-three. New York will soon have two teams. There are no national standards or reporting tools, although the American Bar Association and Office for Victims of Crime published Elder Abuse Fatality Review Teams: A Replication Manual in 2005. This comprehensive guide provides information on establishing and maintaining review teams.4 Currently there is no national resource center supporting Elder Abuse teams, but the National Adult Protective Services Resource Center at National Adult Protective Services Association is partnering with the National Center for the Review and Prevention of Child Deaths to develop a plan to provide technical assistance and promote development of teams.
The District of Columbia has a Mental Retardation and Disabilities Fatality Review Program, run out of the DC Medical Examiner’s Office.
CAPTA-Required Citizens Review Panels
Citizens Review Panels (CRP) were established in 1996, when Congress reauthorized the Child Abuse Protection and Treatment Act (CAPTA). In order for states to receive CAPTA funds, they are required to establish at least three CRPs that meet at least quarterly and produce an annual report available to the public. States are required to include maltreatment fatalities and near fatalities as a component of their reviews. The primary purpose of CRP is to determine whether state and local agencies are meeting their federally mandated child protection responsibilities and to make recommendations for improvements in the state’s child welfare system. Membership includes persons across a wide spectrum of citizens and agencies working in child welfare and human services. There is a mix across the U.S. of state and/or local review panels. Twenty-eight states have local citizens review panels, 33 have state panels and 12 states have both although not all currently review fatalities. Twenty states use their state CDR team as their fatality CRP. All CRPs are administered by state social services. There is no standardized protocol for CRP reviews and no national reporting tools. Training and technical assistance is provided by the National CRP Resource Center at the University of Kentucky, with partial funding from the Children’s Bureau at ACF.
For more information contact:
Blake L. Jones, MSW, LCSW
Citizens Review Panels
College of Social Work
University of Kentucky
1 Quality Street, 7th Floor, Suite A
Lexington, KY 40507
Phone: (859) 257-7210
Fax: (859) 257-3918
Department of Defense/Military Reviews
In August 2004, the Department of Defense issued a directive mandating the review of domestic violence and child abuse related deaths. All four of the Services authorize coordination with local level civilian review teams, including allowing military personnel to participate on CDRTs as needed. Moreover, findings and recommendations of civilian CDRTs can be disclosed to appropriate local military personnel, using the Family Advocacy Program manager as the point of contact. If there is a local military CDRT, civilians are authorized to attend and present relevant information. However, the Federal Advisory Committee Act precludes civilians from participating in the discussion/preparation of recommendations pertinent to the military, and information about military personnel and their family members that identifies them can only be disclosed to civilians in accordance with the Federal Privacy Act.
The National Center can provide CDR programs with nearby military contacts.