# Presentation: 663347

## Linking State Title V and Child Death Review	

- Sally Fogerty, B.S.N, M.Ed.
- Associate Commissioner
- Center for Community Health
- Massachusetts Department of Public Health

**Notes:**
Q.  Thank you Mary.  We’ll now hear from Sally Fogerty, who as Michael mentioned earlier, is Associate Commissioner of the Center for Community Health, for the State of Massachusetts.  Sally, we’re delighted you could be here with us today.

## Primary Purposes of CDR as Identified by Title V Program Directors

- Identify the circumstances causing a death (36 of 41)
- Improve service delivery systems (37 of 41)
- Develop policy (33 of 41)
- Improve community resources
- (26 of 41)

**Notes:**
 Some of our audience may not be aware that you recently completed a term as President of the Association for Maternal and child Health Programs. Can you give us an overview of AMCHP’s role in promoting Child Death Review?

A. Yes, and thank you Beth for inviting me here today.  In September 1997, AMCHP recognized that death review was a growing movement across States. Together with the MCHB and the National FIMR resource center we surveyed all Title V directors.  The purpose was to identify the types of maternal, infant and child mortality programs and reviews that were occurring in each State.  We were surprised to find in the survey results that 41 State MCH Title V programs reported that they have a role in at least one type of mortality review.

The survey also found that the majority of the Title V Directors had a perspective on death review that was very much rooted in the public health model.  This slide shows what the directors thought the primary purposes of CDR should be-and as Stephanie described in the first set of slides, this purpose resonates today through most of the States. 

## Why Should Title V Link to CDR?

- Title V:
- Has valuable epidemiology information and can help interpret mortality statistics
- Can bring a knowledge base, especially on infant mortality prevention, child injury prevention, and adolescent health
- Can link CDR teams to resources in communities
- Can be a team player in helping CDR meet its legislative mandates and reporting requirements
- Implement strategies to reduce future deaths

**Notes:**
Sally, what benefit is it to child death review to link up with Title V program?  

A.  Linking to Title V programs can help to build or improve CDR programs.  Title V roles included providing technical assistance and funding, receiving mortality review reports and using data from the reviews to complement or expand their assessment. 

Run through the bullets

## Funding Child Death Review Where’s the Money?

- CDR has never been heavily funded and relies on volunteer efforts, especially locally
- Funding ranges from $800,000 to nothing
- Median State funding is $50,000
- Federal funds used by States include OCAN, CAPTA and CJA, CDC Core injury and NVDRS, MCH Title V and EMSC grants
- Only six States fund local teams

**Notes:**
Q.  According to the National Center's State profiles, although 22 States are administratively located within Title V, only five States report that they use title V funds to support child death review.  Can you offer suggestions on how States can use dollars creatively to support CDR?

A.  

## CDR can Inform Title V

- Assessment and the Title V performance measures
- Assurance
- Policy development

- www.mchdata.net
- https://performance.hrsa.gov/mchb/mchreports

**Notes:**
Q.  You described some benefits of CDR linking to Title V-what are the benefits of Title V reaching out and working with CDR?

 A.  The review process can help to inform MCH assessment, assurance and policy development-the core functions of Title V.  

Title V legislation directs States to conduct a Statewide maternal and child health needs assessment every 5 years to identify the need for preventive and primary care services for pregnant women, mothers, infants, children, and children with special health care needs.  Child death review can be an important part of this assessment.  

And from this  assessment, States select 7 to 10 priorities for focused programmatic efforts over the succeeding 5 years, in addition to 19 national performance measures and 6 national outcome measures.  Many of these are directly related to lowering mortality rates.  For example, in Massachusetts one of our priority areas is to develop and implement initiatives that address violence against women, children, and youth.  CDR can help us, especially in identifying and understanding child abuse fatalities, teen suicides and youth gun violence deaths.  We can use our CDR findings to ensure appropriate program develop targeted to the most at risk populations.

You can go to the MCH data website to find your own States performance and outcome measures.

## National Outcome Measures

- The infant mortality rate per 1,000 live births
- The ratio of the Black infant mortality rate to the White infant mortality rate
- The neonatal mortality rate per 1,000 live births
- The postneonatal mortality rate per 1,000 live births
- The perinatal mortality rate per 1,000 live births plus fetal deaths
- The child death rate per 100,000 children aged 1 through 14

**Notes:**
These are the 6 national outcome measures that States can report on annually.  As you can see, all of these address the lowering of mortality rates for infants and children.  Review teams that focus on prevention can do a great deal to help inform us on the causes of mortality and can work with us to advocate for prevention strategies to help lower rates.  

## Performance Measures

- Performance measure 08  The rate of deaths to children aged 14 years and younger caused by motor vehicle crashes per 100,000 children
- Performance measure 16  The rate (per 100,000) of suicide deaths among youths aged 1519

**Notes:**
Q.  There are two national performance measures all of the States must report on annually that address child mortality, motor  vehicles deaths of children under age 15 and  and youth suicides of children age 15 to 19.  Has child death review been able to have an impact in lowering these rates in Massachusetts 

In my own State, Child Death Review has helped us with these performance measures, not only in the assessment but informing policy but by encouraging prevention programs. Sally-need examples here.

This is true also in a number of other States.  I can name 4-5 States that have or are developing youth suicide prevention plans and programs as a direct result of child death review findings.  
Arizona published a paper in ______ that described characteristics of their teen firearm suicides, using child death review data.  As States become more savvy in reporting on their reviews, I expect we’ll see more publications like this one.  

## Summary

- Child Death Review can help inform Title V programs
- Contact your State and/or local CDR Program Coordinator to get involved!

**Notes:**
Q.  How should Title V go about getting involved with CDR if they haven’t been in the past?

A.  Contact the State CDR program lead and ask about the programs activities.  Request copies of annual reports and suggest a meeting is scheduled so ideas for collaboration can be discussed.