Shahid Perwez

Caught in the Cross Fire: Adult Issues Putting Children and Young People at Risk 11th March 2008: Leicester Preventing Future Child Deaths: Messages for Practice Dr Catherine Powell Consultant Nurse Safeguarding Children/Visiting Senior Lecturer

The University of Southampton

The University of Sheffield

The other members of the research team….. • • • •

Dr Peter Sidebotham Professor Jan Horwath John Fox Shahid Perwez

Background & Literature Review

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Key points…. • Death of a child has always been a matter of concern for the family & society • The concept of systematic & multi-agency child death review is a relatively recent development • First documented 1978 in LA….by 2007 all but one state in US had established a child death review team

• Initially set up to address underestimation of child maltreatment fatalities • Broadened to understand childhood deaths from natural causes and unintentional injuries • Focus is now on understanding of all child deaths in order to prevent harm to other children

Preventable death…. ‘one in which, with retrospective analysis, the review team determines that a reasonable intervention (e.g. medical, educational, social, legal, psychological), might have prevented the death.’ ‘Reasonable is defined by taking into consideration the conditions, circumstances or resources available.’ Durfee (2002)

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The potential of child death reviews… ‘…can serve a valuable public health function in providing contemporary and comprehensive information on patterns of child death, promote action to prevent child deaths and support wider aspects of inter-agency working to safeguard children and promote their welfare.’

‘So getting people’s heads clear around that [difference between HMR & CDOP] particularly when they’ve been in the habit of running mortality meetings …. and shifting sideways and taking the emphasis off the medical bits and did the SHO get out of bed or did somebody write down the pulse rate, towards collecting wider information about, when did this mother book for antenatal care or what do we know about father’s drug use, really much more relevant.’

Study of ‘Early Starters’

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Qualitative research approach.. • • • •

Questionnaire to all LSCBs Selection of nine ‘early starter’ panels Audit tool Structured observation of panel meetings • In-depth interview with Chair of Panel • Data analysis

Systems and Structures • • • • • • • • •

Development of the CDOP & RR Purpose Structure Membership Team functioning Protocols and procedures Relationship with other processes Resources Audit and governance

Process and Function • • • • • •

Criteria for review Data Processing Liaison & Information Sharing Team meetings Analysis Outcomes

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Preventing Childhood Deaths: Interim findings

Membership • Small core membership – Paediatricians & nursing – Children & family social care – Police – Public Health

• Wider co-opted membership • Met 4-10 times per year • Meetings lasted 2-3 hours

Team functioning • Good working relationships & atmosphere of trust • Independent chair who has a broad-based knowledge in relation to children’s issues • Members may have to declare an interest (e.g. line management) & trust their colleagues to be supportive.

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Case selection & discussion • • • •

Nine panel meetings attended Total of 24 child deaths discussed in depth Age range: 2 days - 19 years In 17:24 cases preventable factors identified in: – – – –

child/young person themselves parents/carers the environment Service provision

Examples The chair of one panel identified an unexpectedly high infant mortality rate which led to an audit by the PCT identifying issues around prematurity, consanguinity and diversity all of which could affect clinical management.

Two two deaths of children in swimming pools abroad led to: • Background work exploring the published literature on drowning in the UK and abroad, and the legislation surrounding swimming pool safety; • A planned public awareness campaign; • The lobbying of an MEP to press for EU legislation in relation to swimming pool safety.

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The chair of a panel reported that their child death overview process had led to improvements in the bereavement support services for families, with better management in A&E, improved communication with primary care, and information about local services for families.

Emerging recommendations

Recommendations for LSCBs • Define terms of reference & establish core membership • Consider lay membership • Appoint an administrative team (Chair, Co-ordinator, clerical officer) • Establish mechanisms for informing & involving parents & other family members • Establish operational procedures (notification, information gathering, case discussion, analysis) • Outcomes (lessons to be learnt, preventative actions to be taken, reports to LSCB)

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Recommendations for DCSF • Resources • Systems for notification & data collection • Guidance on information sharing, confidentiality & FOI • Systems for national collation & analysis • Training materials

What has helped establish child death review processes in the ‘early starter’ sites… • Local champions • Agency commitment & good relationships • Already having some structure in place e.g. protocol for SUDI/SUDC • Current tools for data collection • Impact & success of CEMACH (in two areas) • Regular meetings & good administrative support • Defined responsibilities in job plans • Agreed funding from LSCB/constituent agencies

What worked well in the US…. • • • • • • • • •

Links to a State-wide structure/mandates Strong public health lead/involvement Size of population – 300,000 Excellence in administration Timing +/- six months after death Structured reviews/tools Annual reports – County and State Prevention activities & campaigns Having the right people there: • Appropriate agencies: law enforcement, health, public health, first responders, children’s services, education • Enthused representatives – links to strategic leaders

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Montgomery County, Ohio Safe Sleep Campaign • Child Death Review Process commenced in 1997 • Concern regarding numbers of deaths identified as sleep-related (overlays, positional asphyxia, unsafe sleep environment) • Development of brochure on safe-sleep, plan of action including additional printed material, TV & radio announcements, creation of a video • Raised community awareness of the importance of a safe sleep environment for infants • Have begun to see a decline in the number of these types of deaths.

Thank you for listening….

• For further information: http://www.everychildmatters.gov.uk/socialcare/ safeguarding/childdeathreview/

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