State Technical Assistance Team
Missouri Child Fatality Review Program

Missouri Child Fatality Review Program - Background

The legislation mandating child fatality review panels in every Missouri county also requires that all autopsies for children, birth through age 17, be performed by a certified child death pathologist.

The State Technical Assistance Team, in conjunction with the Department of Health, maintains a "network" of child death pathologists who must meet certification requirements and follow specific policies and guidelines, including a uniform autopsy protocol.

STAT also manages a program of state-financed autopsy reimbursements to the Child Pathologist Network members. This guarantees that the decision to autopsy will not be influenced by county budget constraints.

In 1989-1990, a cooperative study by the Departments of Social Services and Health and the University of Missouri found that a significant number of child deaths (birth through age 5) were not being accurately reported. The study revealed the causes of death were also not being adequately investigated or identified. In August 1990, as a result of this study, Gary Stangler, Director of the Department of Social Services, appointed a task force to further study child fatalities. The task force made recommendations that became the basis for House Bill 185 (HB 185), which established a statewide county-based system of child fatality review panels. This bill was passed in May 1991 and signed into law by Governor John Ashcroft in June 1991. The law, RSMo 210.192, became effective August 28, 1991, and Missouri's Child Fatality Review Program (CFRP) was implemented on January 1, 1992.

RSMo 210.192, et al., requires that every county in Missouri (114 counties and the City of St. Louis) establish a multidisciplinary CFRP panel to examine the deaths of all children, birth through age 17, that occur in Missouri. Counties have been grouped into seven regions, and regional coordinators offer oversight, technical assistance and systemic evaluation to the counties in their region. The State Technical Assistance Team (STAT) assists the regions and individual panels with expert training and investigative assistance. A state CFRP panel provides oversight and makes recommendations for change and refinement to STAT.

RSMo 210.192, et al., provides a mechanism for the legal exchange of information between cooperating disciplines and agencies. Every child death is evaluated. If the death meets specific criteria, it is referred to the county's CFRP panel. Unlike an inquest, no vote or consensus of opinion is sought at the conclusion of the panel review. This is not an attempt to criminalize all child deaths, but to obtain a more accurate and timely determination of cause of death and an appropriate community response.

The CFRP panels consist of local community professionals who bring their own expertise and skills to the review and attempt to identify the cause and circumstances of child deaths. The value of the CFRP panel's work is measured by the improvement in the services provided by the individual participating disciplines. The conclusions drawn from findings of a comprehensive review of child fatalities by each county can be used to determine trends, target prevention strategies, identify specific family/community needs or, when appropriate, support criminal justice intervention. The findings of each CFRP panel review are shared through established channels and become valuable, retrievable statistics linked to Department of Health birth and death records, and Children's Division Central Registry child abuse data. These statistics are reviewed by STAT and are used to identify issues, needs and prevention strategies on a statewide level.

While problem identification and resolution can be used for the public's benefit, specific case details are never divulged or discussed outside the CFRP panel meeting. CFRP panel reviews are not open to the public. Each CFRP panel and its members are advocates for the health and welfare of every child in their community; including the reasonable preservation of privacy for the child and family members.

Annual training sessions for all panel members, organized and coordinated by STAT Training and Prevention Units, are held at numerous locations throughout the state. Regional in-service and individual CFRP panel training is also provided. STAT also makes CFRP awareness and educational presentations available to professional and community/civic organizations.

Child Fatality Review Program Goals

  • To establish more accurate causal determinations in child deaths.
  • To develop uniform, consistent and retrievable data collection involving on-going surveillance of all childhood fatalities.
  • To provide relevant training to each professional involved in child protection.
  • To initiate state and local community activities to prevent childhood injuries and fatalities.
  • To facilitate the linkage of identified patterns and trends in child death with agencies and organizations influencing and developing education and deterrent/prevention strategies.