Local-only reviews of individual cases, state reviews of local findings, and state and local responses to findings.
A state agency provides oversight and coordination to a network of local review teams. The state provides protocols or guidelines for local reviews, with varying degrees of authority. States usually provide training and technical assistance to their local team members and have a state CDR coordinator staff position.
Most reviews are conducted at the local level and recommendations are made for improvements to local policies and practices. Prevention initiatives are implemented locally. Local review teams may serve county, city, and/or regional jurisdictions, and the agency coordinating the local teams varies. These teams usually submit case review reports to a state agency or state CDR program office. Then a state advisory team reviews the aggregate or individual findings of local teams and makes recommendations for improvements to state policies and practices. Most states using this method produce an annual report with child mortality data, CDR findings, and recommendations. States utilizing this approach may focus on child abuse deaths or on all preventable deaths.
States vary as to whether local teams receive funding for reviews, but in all but a few states, they do not. States also vary in whether local reviews are mandated or are voluntary. Teams may also have sub-committees reviewing specific causes of deaths and report these findings to their local or state CDR team.
Most review meetings are held as Retrospective Reviews. These usually take place after the investigation is mostly completed and case information is readily available. Some teams have Immediate Response Reviews that typically occur shortly after a death, usually of those that are unexpected or unexplained. Using this method, the team is able to discuss case information immediately, thereby affecting the processes and procedures used during the active investigation of a child death. This type of review may also assist protective services in their work to protect other children involved. Because immediate response review meetings are unscheduled, the team coordinator usually contacts each team member to arrange these reviews. Teams should establish criteria to identify deaths that require immediate response reviews. Often only a select sub-group of the full team will participate in these types of reviews. If a team chooses an immediate response review but has standing meeting dates for retrospective reviews as well, then it is likely that the case will go through both types of review. In this way, the CDR process acts as a tool for coordinating death investigations and delivery of services, as well as a source of information for identification of risk factors and prevention of other deaths in the future.