Spotlight – Virginia

Jane C. Tingley, MPH
Infant and Child Fatality Projects Coordinator
Office of the Chief Medical Examiner
737 North 5th Street, Suite 301
Richmond, VA 23219
Phone: 804-205-3853
Fax: 804-786-1877
Email: jane.tingley@vdh.virginia.gov

Website: http://www.vdh.virginia.gov/medical-examiner/fatality-review-surveillance-programs-reports/child-fatality-review-in-virginia/

Tools

Reports

Mortality Statistics

Program Description

Administration
Virginia’s Child Fatality Review Program was established by statute in 1994. It has an annual budget of approximately $75,000 that is funded by the MCH Block grant. Funding for the program is on a year to year basis. The program is housed in the Office of the Chief Medical Examiner, which is part of the Virginia Department of Health. There is one paid state CFR employee.

Teams
Virginia has state and regional teams. The Citizen’s Review Panel is included in Virginia’s CDR efforts.

State Team:
The State Child Fatality Review Team is comprised of at least 15 members and meets six times a year. Most of their meeting time is spent reviewing cases. By statute, the team has access to all records related to the decedent child and to the perinatal records of the mother that are related to the decedent child. State team meetings must be advertised as public but are closed when cases are discussed. Before the meeting takes place, state team members are divided into pairs that read individual case files and prepare a case summary document. At the meeting, the pairs present case information to the entire team. The team then determines the degree of preventability of the case and generates ideas for prevention and intervention. The team uses a consensus model to agree on preventability. When the state team develops recommendations, the CFR coordinator calls the agency that the recommendation will affect, discusses the impact of the recommendation on the agency, and reports back to the team. This process supports stronger targeted recommendations.

Local Teams:
There are five regional teams, one in each Virginia Department of Social Services region. The teams meet with varying schedules depending on their individual caseload. By statute, teams invite investigating agencies to attend team meetings to orally present their case file and participate in the team’s review of the case. The regional teams review cases investigated for abuse or neglect by a local department of social services.

Reviews
By statute, the Virginia State Child Fatality Review Team can review the following kinds of deaths to children under 18 years of age: (1) violent and unnatural child deaths; (2) sudden child deaths occurring within the first eighteen months of life and (3) those fatalities for which the cause or manner of death was not determined with reasonable medical certainty. By statute, the Virginia local or regional CFR teams review deaths to children under 18 years of age. The state team does not review all child deaths for every year. Instead, the Virginia state team selects categories of child death (e.g. caretaker homicide or motor vehicle) for each review.

Purpose
The purpose of the Virginia CFR Program is prevention. Teams have always focused on prevention and public health interventions.

Data
Standardized data reporting forms are completed for cases reviewed by regional teams. The State Team does not complete standardized data reporting forms due to the nature of its review process. The collection of data is not required by legislation or policy. Virginia’s CFRT has access to state vital statistics. Vital statistics are used to place reviewed child deaths within the context of all child deaths in the state. CFR data is stored on a computer and is analyzed using SPSS.

Annual Report
Virginia produces a report at the conclusion of each review. This report is distributed to injury prevention groups, domestic violence advocates, police chiefs, sheriff departments, medical examiners, social services directors, child protective services supervisors, members of the Virginia General Assembly, Commonwealth’s Attorneys, SAFE KIDS coalitions, and other child advocate organizations.

Prevention Initiatives
Virginia CFR efforts have influenced policy changes. Statewide examples of this include a legislative changes requiring mandatory stiffer civil penalties for violations of child safety restraint laws where the money from penalties is reinvested into the Child Restraint Device Special Fund, the addition of emergency medical services personnel to the list of mandated reporters, and requiring safe sleep education as part of labor and delivery discharge. Local community examples include community level education on SIDS and co-sleeping, collaboration with Drive Smart Virginia on safe driving among teenagers, shaken baby awareness campaign through a local hospital and collaboration with branches of the military on preventing child abuse and neglect among military families. Examples of how CFR findings have motivated prevention activities include a re-invigorated safe sleep campaign through the Virginia Department of Health, a review of child suicides led to the development of a statewide youth suicide prevention plan and review of caretaker homicides led to an initiative to educate local health department personnel about shaken baby syndrome.

Protocols
Virginia has confidentiality and CFR meeting protocols in place.

Training
Training is provided to new state team members and to any new local or regional child fatality review team as needed or requested.

Last Updated: February 2018