In the last year I have been honored to become a member representing the Dignity Health’s Sacramento area hospitals in the Sacramento County Child Death Review Team (CDRT). It is a way for me to contribute forensic emergency medicine knowledge towards improving the health of all county children.
The CDRT is a multidisciplinary group which meets once a month to review deaths of all Sacramento county children age birth-17 years. This consists of children who die in-county and county residents who die in another county in California. The team has reviewed county child deaths since 1990 and functions to catalog and identify trends that can assist county agencies in employing resources for preventable deaths. Our aim is to create a snapshot of child well-being in the county by reviewing all child deaths, not just those deemed suspicious, and in doing so we are able to get a richer understanding of risk factors. Reports are produced yearly, presented to the Sacramento County board of supervisors and made available to the public.
Participating agencies include all area hospital systems, city and county police/highway patrol, fire/EMS, District Attorney’s office, Coroner, Probation, Child Protective Services, Children’s services and other public agencies. Other non-member agencies or parties may be invited to give information as well.
During this meeting, each death within a given month is discussed using the child’s health history and circumstances of death. Agencies give any information they may have on the child to the team, and as a group we discuss all these elements to determine an ultimate cause of the child’s death. Each death is considered under review until a cause is agreed upon. This may be similar to, but not the same as the coroner’s determination. We aim to produce a more accurate picture of child death than is gleaned from state death certificate data.
The data offered by each agency in the CDRT is vital in finding patterns as well as unique instances of child abuse and neglect. Special sub-groups, including fetal/ infant and youth (ages 10-17) deaths also meet. Data is stored on a secure server at the Child Abuse Prevention Council (CPAC) and all findings discussed within the meeting are confidential. Once all cases for a given year are reviewed and causes determined, the aggregate data is reviewed and recommendations to county agencies are made.
Identifying issues contributing to child abuse and neglect are compiled in aggregate each year and used to make recommendations to agencies in areas we feel can be better addressed. In addition, we can uncover safety risks within the county that may have nothing explicit to do with abuse or neglect but represent a risk to county children nonetheless.
While I’m currently the only emergency physician on the team, I feel it’s useful to share our perspective as most cases involve emergency care. We are the first to see and document injuries when they are fresh and can review ED records to find details that may have been lost during long hospitalizations. We can also detail previous ED visits to identify injury patterns in a particular child before the time of their death. By having all hospital systems present, visits to different EDs that otherwise might have been missed can give a telling picture.
One especially exciting announcement is that last year, we were one of five sites awarded a grant by the US Department of Justice’s Office of Victims of Crime. We will receive technical assistance for three years to help create evidence-based processes to reduce child fatalities. The robust collaboration in our team was cited as one of the reasons we are selected, and the engagement of our team during our meetings was singled out as a unique feature during the DOJ visit- indeed we were the only county team selected for the grant. Our goal in the project is to develop a model for a coordinated response in recurring causes of preventable death. We will create a Prevention Cabinet to expand our data collection and use social determinants of health to identify the most at-risk neighborhoods within the county.
As a Sacramento emergency physician as well as a parent, I am proud to donate my time and knowledge towards ensuring a better future for all children in this community.
Jacque Johnsen DO