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DHS News December 2009 

View the pdf.gif December 2009 DHS News Newsletter in a printable format. 

DHS staff contribute and learn as Review Team participants

Child Fatality/Near Fatality (CF/NF) Review Team carry a heavy burden: reviewing the circumstances that surround every fatality or near fatality* suspected to be the result of child abuse or neglect and determining what future actions should be taken to reduce the likelihood of future incidents. DHS Director Marc Cherna is a strong supporter of the work of the team.

“It’s a valuable, important process,” Cherna said. “It brings together everyone involved to find out what happened and what can be done better on all levels to avoid a similar tragedy.”

CF/NF Review Teams in Pennsylvania are not static groups. According to Pennsylvania law, each team must consist of at least six individuals representing any or all of the following disciplines:

• county child welfare
• advisory to the county child welfare agency
• health care
• education, child care or early childhood development
• law enforcement
• legal representation of children
• mental health
• child advocacy
• forensic pathology
• domestic violence
• substance abuse
• parent advocacy
• any other appropriate discipline the county agency or CF/NF Review Team determines is necessary to assist the team in performing its duties.

In addition, in Allegheny County core members are always joined by others with particular expertise in the special circumstances surrounding each case.

As mandated by state legislation passed in 2008, Allegheny County developed a core CF/NF Review Team in December 2008. This 24-member team is comprised of DHS staff and community leaders who are well-versed in the field of child abuse. The Allegheny County CF/NF Review Team is chaired by Dr. Mary Carrasco, long time champion of child abuse prevention and Director of International and Community Health for Pittsburgh Mercy Health System.

Allegheny County convenes the CF/NF Review Team within 31 days of receiving a suspected child abuse report that resulted in a child death or near death. In advance of the review meeting, staff from the DHS Office of Data Analysis, Research and Evaluation (DARE) support the Review Team’s charge by exhaustively researching the case, using a three-part, fact-finding process.

• Independent, Comprehensive and Critical Review of Case Records
DHS DARE staff from the Quality Improvement Team thoroughly and critically review past and current CYF case records, while asking the following types of questions: If CYF was involved with the family, what are the details of that involvement? What other DHS offices and systems of care were involved with the child and family? What steps did we take to identify and address known safety factors? Who are the people (family, informal supports, professionals) who have played a role in the life of the child and family? What information is provided by medical professionals, law enforcement, education professionals and others?

Review of Service Histories for the Child, Family and Caregivers
By utilizing DHS electronic data systems, DARE staff track the service histories of the child, family and caregivers, including the alleged perpetrator. Information including dates, types of services and providers of services are stored in these confidential, password-protected DHS applications.

• Interviews with DHS Staff and Providers
DARE staff interview DHS staff, especially staff from CYF, that have current and past involvement with the child and family. These interviews allow DARE staff to gather additional information that assists in the review process. These interviews also allow DARE staff to crosscheck the information they have gathered to that point with the professionals directly involved in the case.

DARE staff summarizes findings that tell the story of the child, family and service community, including details surrounding the child’s death or near death. A smaller pre-review team, comprised of staff from several DHS offices – and facilitated by Dr. Edward Sites, Professor Emeritus from the University of Pittsburgh, School of Social Work – reviews the summarized information, identifies gaps in information and asks the casework staff for clarification of information.

This meeting serves to bring all participants to full knowledge about what information, possible questions and recommendations will be presented at the full CF/NF Review Team meeting.

When the full CF/NF Review Team convenes, core members and case-specific attendees, including the CYF caseworkers and supervisors as well as professionals from other related disciplines, are encouraged to share what they know about the case in an open and candid way with the rest of the team. During the process, the Chair keeps the tone of the meetings non-adversarial, positive, and focused on solutions, not blame.

Based on all gathered information and subsequent discussions, the Team generates a written report that is approved by the Chair and then sent to the Pennsylvania Department of Public Welfare. The report includes recommendations for changes at the state and local levels on reducing the likelihood of future child fatalities or near fatalities related to child abuse. The public also has the right to a redacted version of the reports.

Above and beyond
As evidence of members’ deeply held convictions about the value of their work, the Allegheny County CF/NF Review Team has also chosen to take a critical look at other local cases of child fatalities and near fatalities that are not mandated for review but that may offer suggestions for improving services to our children and families.

The goal stays the same – to learn something of value in the face of these tragedies and to initiate change to prevent others in the future. Dr. Carrasco has a powerful connection to the work of the team.

“It is gratifying to watch the CF/NF Review Team develop a better understanding of regulatory roles as we improve communication across disciplines,” Dr. Carrasco said. “It is unfortunate that we have to review the cases of children with the poorest outcomes to help us understand issues that may need to be improved within and across various systems.”

It is hoped that new practices, inspired by the work of the CF/NF Review Team, will improve outcomes for all children and families in Allegheny County.

*As per Act 33, a near fatality is defined as an act that, as certified by a physician, places a child in serious or critical medical condition. Read the legislation in its entirety

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