National Center for Fatality Review and Prevention. Agenda. Facebook and Twitter 4/5/2018. Abby Collier, MS Director

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fetal infant mortality review (FIMR) Data collection in NFR CRS and a look at opiate

1 National Center for Fatality Review and Prevention Abby Collier, MS Director Agenda What is fatality review Introduction to child death review (CDR) Introduction to fetal infant mortality review (FIMR) Data collection in NFR CRS and a look at opiate data Steps to effective reviews Sample outcomes from CDR and FIMR teams Facebook and Twitter 1

MCHB vision for the integrated National Center One coordinated data and technical support center that builds upon data collection and coordinated strategies to prevent fetal, infant, and child deaths

2 MCHB vision for the integrated National Center One coordinated data and technical support center that builds upon data collection and coordinated strategies to prevent fetal, infant, and child deaths while preserving unique components of these two diverse processes. Improvement in the quality and effectiveness of the CDR and FIMR processes and data collected. State and community CDR and FIMR programs use their data to design and propose changes to policy and practice which can reduce adverse maternal, infant, child, and adolescent outcomes. Dissemination of results nationally and increased availability and use of data to inform prevention efforts. What we do 1. Expand and support standardized data collection and quality improvement. 2. Provide leadership, training, and technical support to the FIMR and CDR programs. 3. Develop a centralized national network to coordinate and disseminate information and findings related to FIMR and CDR. 4. Facilitate the translation of recommendations from CDR and FIMR programs into action and practice. Rules for fatality reviews 1. Don t break any state/federal laws 2. Use a prevention lens 2

Why opiate reviews Allows a complete picture of policies, services, assumptions and perceptions. Improve inter agency collaboration and relationships. Data collected often confirm hunches.

3 Why opiate reviews Allows a complete picture of policies, services, assumptions and perceptions. Improve inter agency collaboration and relationships. Data collected often confirm hunches. Informed prevention work. Public health implications Fetal, Infant, and Child Death review are core Public Health Surveillance activities and exemplify the 3 Core Public Health Functions: Assessment Policy Development Assurance The web of reviews Military Child Fatality Review Maternal Mortality Review Child Fatality Internal Child Welfare Agency Review State Child Fatality Review Citizen Review Panel Regional Child Fatality Review Local Child Fatality Review Elder Death Review Fetal & Infant Mortality Review Domestic Violence Fatality Review Military Domestic Violence Fatality Review 3

Fatality review in Wisconsin Child Death Review (CDR) Fetal Infant Mortality Review

Focused on improving systems and prevention of deaths, not culpability.

4 Fatality review in Wisconsin Child Death Review (CDR) Fetal Infant Mortality Review (FIMR) Maternal Mortality (MM) Homicide Review Commission Suicide Review Essential elements of review Multi disciplinary. Telling a story through the sharing of case information from multiple sources. Focused on improving systems and prevention of deaths, not culpability. Balance between individual cases and use of population data for trends. CDR: Where the good shift happens Tell the story Collect data Take action 4

~1,350 local teams and 34 state teams Guam Military Teams, DOD has own reviews Tribal engagement (separate team as well as county based) CDR is An engaged, multidisciplinary community, telling a

5 Where are teams CDR in all 50 states and Washington D.C. ~1,350 local teams and 34 state teams Guam Military Teams, DOD has own reviews Tribal engagement (separate team as well as county based) CDR is An engaged, multidisciplinary community, telling a child s story, one child at a time, to understand the causal pathway that leads to a child s death to identify pre-existing vulnerabilities and circumstances- in order to identify how to interrupt the pathway for other children. Local Team: Case Selection Teams bring records to review Case Review Local Action for Policy, Practice, Prevention Recommendations and Data Entry into National CDR CRS State Advisory Board State Action for Policy, Practice, Prevention Who participates Medical examiner/coroner Forensic pathologist Law enforcement Child protective services Local public health Health care provider District attorney Emergency medical services Mental health Women, Infants and Children program Home visiting Education Community based organizations Child advocacy centers Content experts 5

6 Data sources Birth/death certificate Law enforcement records Medical examiner/coroner report School records Medical records (primary and specialty) Social services, including child protective records Other public health records Home visiting Discussion points Is there enough information to proceed? What services should be provided to the family and community as a result of the death? Are any other children at risk of harm? What risk factors were present? What changes to policy/practice should be recommended? Who is going to take the lead? Fetal Infant Mortality Review Changes in Community Systems The FIMR Cycle of Improvement Data Gathering Community Action Case Review 6

FIMR teams by state, April 2018 Key: FIMR Teams Yes (n=33)* No * Including 30 States, DC, Puerto

Records Maternal abstraction interview Creation of Case summary FIMR PROCESS: Case Review

health The maternal interview Gives insight into the mother s experience before and during

7 FIMR teams by state, April 2018 Key: FIMR Teams Yes (n=33)* No * Including 30 States, DC, Puerto Rico, and Commonwealth of the Northern Mariana Islands FIMR is Case Selection Family contacted Records Maternal abstraction interview Creation of Case summary FIMR PROCESS: Case Review Continuous Quality Improvement (CQI) Community Action Team Goal: Fix system gaps to improve health The maternal interview Gives insight into the mother s experience before and during pregnancy, and the time of the infant s death. Conveys the mother s story of her encounters with local service systems. 7

8 Who participates Medical examiner/coroner Child protective services Local public health Health care provider Emergency medical services Women, Infants and Children program Mental health Home visiting Community based organizations Child advocacy centers Content experts Data sources Birth/death certificate Law enforcement records Medical examiner/coroner report School records Medical records (primary and specialty) Social services, including child protective records Other public health records Home visiting Discussion points Is there enough information to proceed? What services should be provided to the family and community as a result of the death? Are any other children at risk of harm? What did we learn from the maternal interview? What risk factors were present? What changes to policy/practice should be recommended? Who is going to take the lead? 8

Prevention Systems Improvements Investigation, Improved agency Identification, diagnosis systems Improved Investigation Review identification, diagnosis and reporting Improved communication Review

9 Prevention Systems Improvements Investigation, Improved agency Identification, diagnosis systems Improved Investigation Review identification, diagnosis and reporting Improved communication Review NFR CRS: Building the system Developed by 30 person workgroup from 18 states over 2 years Analyzed variables from 32 existing state databases; developed standard data elements, data dictionary, and 33 standardized reports 5 major releases 2005 pilot phase in 19 states 2008 updated 2010 added module on Sudden Unexplained Infant Deaths (SUID) 2013 SUID version for all states; updates 2015 added module on Sudden Death in the Young Coming Soon April 2018 adding larger FIMR module NFR CRS Web based system with servers housed at MPHI Data Center Easy to use Comprehensive; prevention focused Enter, search, print, download data, and create standardized reports Extensive support Senior Data Analysts meet with MPHI IT on weekly basis to discuss issues, modifications, future enhancements Transaction tracking National Center maintains Help desk ( , telephone) Training site available to all users Data Use Agreement required to participate FREE!! 9

By the numbers On average 65 new cases entered per

have recorded a death in the System More than 200,000

CRS, April 2018 Key: Use NFR-CRS Yes (n=44) No FIMR

10 By the numbers On average 65 new cases entered per weekday Over 2100 authorized users Over 1350 CDR teams have recorded a death in the System More than 200,000 deaths have been entered CDR Teams by State Using NFR CRS, April 2018 Key: Use NFR-CRS Yes (n=44) No FIMR Teams by State Using NFR CRS, April 2018 Key: Use NFR-CRS Yes (n=15) No 10

11 NFR CRS Paper Form Specific questions related to overdose Opiate data from NFR CRS Race Gender Place of incident Prevention recommendations 11

Follow through 7. Address conflict 8. Seek education 9. Practice self care 10.

12 Opiate data from NFR CRS 10 steps to effective reviews 1. Be prepared 2. Train all members 3. Stay focused on the purpose 4. Share, question and clarify 5. Stay focused on prevention 6. Follow through 7. Address conflict 8. Seek education 9. Practice self care 10. Enter data in a timely manner Step 1: Be prepared Set regular meeting dates and times Set agenda Keep a consistent meeting format Develop team agreements 12

13 Step 2: Training Ask team members to explain their jobs Retrain all team members every three years Work with guests and new members Adhere to state standards Seek ongoing education Step 3: Purpose Build consensus on a team purpose Display purpose during meetings Begin meetings with team purpose The death of a child should invoke a community response. The circumstances involved in most child deaths are multidimensional with many factors, and responsibility should not rest in any one place Step 4: Share, question and clarify Order for conducting the review Most information to least. Call on each team member Ask open ended questions Stay curious 13

Step 5: Prevention Use data to drive prevention CDR teams are expected to catalyze prevention Set achievable goals Network with other teams or similar coalitions Celebrate success, not matter how

14 Step 5: Prevention Use data to drive prevention CDR teams are expected to catalyze prevention Set achievable goals Network with other teams or similar coalitions Celebrate success, not matter how small Step 5: Prevention cont Remember the three E s of prevention: Enforcement Education Environment Keep track of accomplishments Step 6: Follow through Follow up as soon as possible on all items Builds team trust and legitimizes the process Build in accountability checks 14

experts Learn about prevention activities Ask team members to provide education Step 9:

15 Step 7: Address conflict Set clear expectations Use team guidelines as a guide Handle conflict immediately Watch for emotional triggers Utilize state staff Step 8: Seek education Use content experts Learn about prevention activities Ask team members to provide education Step 9: Practice self care Know the signs of stress Build resiliency Practice self care at work and at home 15

Step 10: Enter data Adhere to state standards Ask for assistance You can only get out of the data system what you put into it Outcomes from the field https://vimeo.

16 Step 10: Enter data Adhere to state standards Ask for assistance You can only get out of the data system what you put into it Outcomes from the field Outcomes from the field Provided death scene training resulting in improved investigations, doll reenactments Media training for responsible reporting Tracked ACE scores in 2016 on all FIMR, CDR and MMR cases Promoted and implemented DOSE program Increased collaboration between emergency rooms and OTP Implementing a one front door policy 16

17 For more information Abby Collier (517)

10 steps to maintaining an effective review team 1. Be prepared a. Set regular meeting times b. Agenda c. Develop and respect team agreements 2. Train all team members a.

20 10 steps to maintaining an effective review team 1. Be prepared a. Set regular meeting times b. Agenda c. Develop and respect team agreements 2. Train all team members a. Retrain whole team every three years b. Orienting new members c. Prepare guests 3. Stay focused on the purpose of the team a. Keep mission and/or vision of the team present during review meetings b. Revisit every few years 4. Share, question and clarify all information a. Share, question and clarify all case information b. Discuss the investigation c. Discuss the delivery of services d. Identify risk factors e. Recommend systems improvements f. Identify and be a catalyst for action to implement prevention recommendations 5. Stay focused on prevention a. Remember teams are expected to catalyze prevention b. Prevention can be policy change, environmental change or education and changes in law 6. Follow through 7. Address conflict a. Be direct and use team guidelines b. Work with state staff c. Address problem team members 8. Seek education a. Bring in local experts b. Utilize state staff c. Work with professional organizations 9. Practice self-care a. Recognize signs of burnout and compassion fatigue b. Implement self-care practices in your team meetings 10. Enter data in a timely manner

Maternal Mortality Review (MMR)

Maternal Mortality Review (MMR) Child Death, Near Death, and Stillbirth Commission (CDNDSC) Policy and Procedure Review of Maternal Deaths Purpose: The goal of the Delaware Maternal Mortality Review (MMR)