Meeting of the North Carolina Child Fatality Task Force September 20, 2021

 
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Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Meeting of the
North Carolina Child
Fatality Task Force

September 20, 2021
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Roll Call Attendance &
Approval of Minutes

Minutes from last meeting on 1-11-21 have
been posted on the CFTF website, the link has
been sent out and is also linked to on your
agenda.
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
COVID-19 and Children

Elizabeth Cuervo Tilson, MD, MPH
State Health Director
Chief Medical Officer

Child Fatality Task Force
September 20, 2021

                             NC DHHS COVID – 19 Response
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Four Key Metrics – All Quickly Rising
              Daily Cases by Date Reported                 Positive Tests as a Percent of Total Tests

                                                            What Percentage of ED Visits this Season are for
      Daily Number of People Currently Hospitalized        COVID-like Illness Compared to Previous Seasons?

Source:  https://covid19.ncdhhs.gov/dashboard
  North Carolina Department of Health and Human Services                                                4
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Case Rates Increasing Statewide

https://covid.cdc.gov/covid-data-tracker/#county-view
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Delta variant is
the most common
variant in NC

Spreads easily
because it's highly
contagious

North Carolina Department of Health and Human Services   6
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Case Rates Declining, but
   Children age 0-17 years have highest case rates for first time in pandemic

             COVID Cases per 100K Population by Age Group and Report Date
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Case Rates Highest for School Aged Children

     High school and middle school highest among school aged children
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
PCR Test Positivity Highest in Children
            Test positivity rates have plateaued in recent weeks
           across most age groups; remain highest for children.
Meeting of the North Carolina Child Fatality Task Force September 20, 2021
Percent of ED Visits for CLI

                                                      0.00%
                                                              5.00%
                                                                        10.00%
                                                                                            15.00%
                                                                                                     20.00%
                                                                                                              25.00%

                                          9/26/2020
                                          10/3/2020

Source: NC DETECT
Generated: 09/13/21
                                         10/10/2020
                                         10/17/2020
                                         10/24/2020
                                         10/31/2020
                                          11/7/2020
                                         11/14/2020
                                         11/21/2020
                                         11/28/2020
                                          12/5/2020
                                         12/12/2020
                                         12/19/2020
                                         12/26/2020
                                           1/2/2021
                                           1/9/2021
                                          1/16/2021
                                          1/23/2021
                                          1/30/2021

0-18
                                           2/6/2021
                                          2/13/2021
                                          2/20/2021

19-24
                                          2/27/2021
                                           3/6/2021
                                          3/13/2021

25-44
                                          3/20/2021
                                          3/27/2021
                      Week Ending Date

                                           4/3/2021
45-64

                                          4/10/2021
                                          4/17/2021
                                          4/24/2021
65+

                                           5/1/2021
                                           5/8/2021
                                          5/15/2021
                                          5/22/2021
                                          5/29/2021
                                           6/5/2021
                                          6/12/2021
                                                                                                                       Percent of NC ED Visits for COVID-Like-Illness (Not Flu) Within Each Age Group by Week

                                          6/19/2021
                                          6/26/2021
                                           7/3/2021
                                          7/10/2021
                                          7/17/2021
                                          7/24/2021
                                          7/31/2021
                                           8/7/2021
                                          8/14/2021
                                          8/21/2021
                                          8/28/2021
                                           9/4/2021
                                          9/11/2021
Pediatric Hospitalizations in Southeastern United States

            https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions
Multi-System Inflammatory Syndrome in Children (MIS0C)

    https://covid19.ncdhhs.gov/dashboard/cli-surveillance
North Carolina Department of Health and Human Services       12
Children can transmit to others – including
adults at higher risk – Teachers, staff, family members

                                    Record Number of Cases in K12 Clusters

                Cases Linked with Any Educational Cluster                             K-12 Cluster Metrics
                Child Care   Camp     K12 School     College/University
          800                                                              Since June 2020, there have been 462 K-12
                                                                            clusters
          700
                                                                             –   362 at public schools
          600
                                                                             –   100 at private schools
          500
                                                                           There are currently 192 active clusters
  Cases

          400
                                                                             –   178 at public schools
          300
                                                                             –   14 at private schools
          200
                                                                           In total, there are 4,277 cases associated with
          100                                                               all K-12 clusters
           0                                                                 –   3,387 cases among students
                                                                             –   890 cases among staff
                                                                             –   3,194 cases at public schools

                              Week of Illness Identification                 –   1,083 cases at private schools
MULTI-LAYERED PROTECTION CAN GREATLY REDUCE RISK OF
SPREAD

                                                      14
Vaccines are Working
                                People who are fully vaccinated are 3.96 times less likely to be get COVID-19 and
                                             more than 13 times less likely to die from COVID-19.

                                           Age-Adjusted Case and Mortality Rates in Vaccinated vs. Unvaccinated Populations

                                                                                                                                                                                                                                                                         incomplete
                                                                                                                                                                                                                                                                         Data in shaded area may be
                                                                    Cases                                                                                                                                                   Deaths

                                                                                                                          incomplete
                                                                                                                          Data in shaded area may be
                                                                                                                                                                                7
                          600
                                                                                                                                                                                6
Attack Rate per 100,000

                                                                                                                                                       Death Rate per 100,000
                                                                                                                                                                                5
                          400
                                                                                                                                                                                4

                                                                                                                                                                                3

                          200                                                                                                                                                   2

                                                                                                                                                                                1

                           0                                                                                                                                                    0

                                                                       Week End Date                                                                                                                                  Week End Date

                                  Age Adjusted Attack Rate in Unvaccinated       Age Adjusted Attack Rate in Vaccinated                                                             Age Adjusted Death Rate in Vaccinated      Age Adjusted Death Rate in Unvaccinated

                                      Attack Rate Ratio (week ending 8/28): 3.96                                                                                                             Death Rate Ratio (week ending 8/28): 13.47
VACCINATION STATUS BY AGE
                                                            0-12 years – 0%

                                                            Not currently eligible for
                                                            vaccination

        https://covid19.ncdhhs.gov/dashboard/vaccinations                                16
North Carolina Department of Health and Human Services   17
Q&A

Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs – Updated

                                        NC DHHS COVID – 19 Response                                         27
NC Department of Health and Human Services

                                                             Injury Surveillance Update

                                                                        Child Fatality Task Force
                                                                         Shana Geary, MPH
                                                                         NC Division of Public Health
                                                                         September 20, 2021

NCDHHS Division of Public Health| Safe States Annual Conf| September 10, 2020                             19
Outline
      •     Overall Child (ages 0-17) Injury Trends
      •     Child Injury Deaths and ED visits by injury type
              •     Motor vehicle traffic (MVT) injuries
              •     Firearm
              •     Self-inflicted/Suicide
              •     Unintentional medication/drug overdose
              •     Child maltreatment

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   20
Overall Injury Trends

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   21
There were 319 child injury deaths in 2020*, a
                     15% increase from 2019 (n=277).
                     Note: 2020 data are provisional
                     Number of
                     Child Deaths                                               2019             2020*

                       45
                       40
                       35
                       30
                       25
                       20
                       15
                       10
                        5
                        0
                                  Jan        Feb        Mar        Apr        May          Jun   Jul     Aug   Sep   Oct   Nov   Dec
                   Total Child Injury Deaths: 2019 n=277; 2020 n=319
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                               22
Child firearm deaths almost doubled in 2020*.
                    Motor vehicle traffic (MVT) deaths decreased.
                                                                             2019                              2020*
                                               MVT - Unintentional                                        83                     63

                                                  Firearm - Assault                             36                               64

                                    Suffocation - Unintentional                                 35                          34

                                           Firearm - Self-Inflicted                   15                                    31

                                       Drowning - Unintentional                            25                        18

                                     Suffocation - Self-Inflicted                     18                               21

                                       Poisoning - Unintentional                  8                                  15

                                             Unspecified - Assault                10                             8

                                                                  Other                              47                          65
                   Total Child Injury Deaths: 2019 n=277; 2020 n=319
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                              23
NC experienced a 18% decrease in overall ED
                  visits between 2019 and 2020

                                                                                           There are known data quality gaps for May-June 2021 that are impacting
                                                                                                 the shown trends. Interpret the data for these months with caution

                   Note: Provisional 2020 and 2021 data as of 9/13/2021, limited to NC residents
                         Weeks begin at 01/01 and end at 12/30 for 2019 and 12/29 for 2020
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                                              24
There was a 31% decrease in injury ED visits
                   among children (0-17) between 2019-2020.

                                                                                           There are known data quality gaps for May-June 2021 that are impacting
                                                                                                 the shown trends. Interpret the data for these months with caution

                   Total Child Injury ED Visits: 2019 n=191,531; 2020 n=132,937
                   Note: Provisional 2020 and 2021 data as of 9/13/2021, limited to NC residents ages 0-17
                         Weeks begin at 01/01 and end at 12/30 for 2019 and 12/29 for 2020
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                                              25
The number of child injury ED visits decreased
                  across all injury categories in 2020.
                                                                                 2019 Child Injury ED Visits          2020* Child Injury ED Visits
                                                   Fall - Unintentional                                      40,292                   26,427

                                                  MVT - Unintentional                          17,518                        12,457

                              Struck By/Against - Unintentional                                 18,902                      10,062

                                       Unspecified - Unintentional                             16,530                       9,621

                        Natural/Environmental - Unintentional                              11,428                          7,613

                                        Cut/Pierce - Unintentional                     5,998                             4,891

                                       Overexertion - Unintentional                    6,084                            3,370

                                          Poisoning - Unintentional                 3,149                               2,667

                                                                      Other                         26,219                          21,679
                   Total Child Injury ED Visits: 2019 n=191,531; 2020 n=132,937
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visit Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                             26
MVT Injuries

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   27
Child MVT Deaths decreased by 32% in 2020.
                    Most deaths were among children ages 15-17 and males.

                      Number of child MVT deaths by age and sex
                         2019          2020

                                                                                                               41        42
                                                                                                                              40
                                                                                      38
                                                                                              32

                                                                                                                    23
                                                                  17
                          14                  14      13
                                  10
                                                                           7

                             0-4                 5-9                10-14                  15-17               Female     Male

                   Total Child MVT Deaths: 2019 n=83; 2020 n=63
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                           28
Most MVT deaths were among white children.
                    The Hispanic MVT death rate increased in 2020.
                    Number of Child MVT Deaths                                             Rate per 100,000
                                2019 2020*                                                 5.0
                                                                                    42
                    NH White                                           29                  4.0
                                                                    26                                            Hispanic
                    NH Black                               17                              3.0                    NH Black
                                                    10                                                            NH White
                     Hispanic                         13                                   2.0
                                           2
                    NH Asian                                                               1.0
                                          1                                                0.0
                   NH AI/AN                    4
                                                                                              2019             2020*
                                           2
                    Unknown
                   Total Child MVT Deaths: 2019 n=83; 2020 n=63; NH – non-Hispanic
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                     29
The proportion of child MVT ED visits has
                    increased in 2021.
                    % of Child Injury
                    ED Visits                                                  2019         2020*        2021*

                   18.0%
                   16.0%
                   14.0%
                   12.0%
                   10.0%
                    8.0%
                    6.0%
                    4.0%
                    2.0%
                    0.0%
                                    Jan        Feb         Mar         Apr        May      Jun   Jul      Aug        Sep   Oct   Nov   Dec
                   Total Child MVT Injury ED Visits: 2019 n=17,537; 2020 n=12,468
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                     30
Firearm Injuries

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   31
Child firearm deaths increased by 88% in 2020
                   Most deaths were homicides followed by suicides.
                                                              2019 Child Firearm Deaths           2020* Child Firearm Deaths

                                          Assault                             36                                       64

                              Self-Inflicted                         15                                        31

                            Unintentional                        4                                      9

                           Undetermined                         1                                   1

                   Total Child Firearm Deaths: 2019 n=56; 2020 n=105
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                       32
The number of child firearm deaths among
                      ages 15-17 almost doubled in 2020.
                      Most deaths were among males.

                      Number of child firearm deaths by age and sex
                           2019         2020
                                                                                                                             86

                                                                                           66

                                                                                                                        47
                                                                                     34
                                                                         25
                                                                                                                   19
                                                                 14
                                   8                   6                                                       9
                         4                   4

                             0-4                 5-9              10-14               15-17                    Female    Male

                   Total Child Firearm Deaths: 2019 n=56; 2020 n=105
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                          33
The number of firearm deaths tripled among NH
                    white children in 2020*. Rates increased the most
                    among NH Black children.
                    Number of child firearm deaths                                         Rate of child firearm deaths per 100,000
                                             2019          2020*                           10.0
                                              7                                                                               NH Black
                     Hispanic                  10                                           8.0
                                                 14
                    White NH                                   42                           6.0
                                                          33
                    Black NH                                                                4.0
                                                                  49                                                        NH White
                   AI/AN NH
                                          2                                                                                 Hispanic
                                                                                            2.0
                                         0
                    Asian NH                                                                0.0
                                          3
                                                                                               2019                     2020*
                                         0
                    Other NH
                   Total Child Firearm Deaths: 2019 n=56; 2020 n=105; NH – non-Hispanic
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                 34
The proportion of child firearm injury ED visits
                    increased by 89% between 2019 and 2020.
                    % of Child Injury
                    ED Visits                                                  2019          2020*        2021*

                     0.6%

                     0.5%

                     0.4%

                     0.3%

                     0.2%

                     0.1%

                     0.0%
                                   Jan         Feb        Mar         Apr        May       Jun   Jul     Aug         Sep   Oct   Nov   Dec

                   Total Child Firearm Injury ED Visits: 2019 n=334; 2020 n=438
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                     35
Most child ED visits for firearm injuries
                          were unintentional.
                          Percentage of child firearm injury ED visits                             Percentage of 2020* child firearm
                                                        2019       2020*                           injury ED visits by age and sex
                                                                                       77%            0-4            7%
                            Unintentional
                                                                                           82%        5-9            6%
                                                                21%                                10-14                  19%
                                       Assault
                                                             14%
                                                                                                   15-17                        68%
                                                       1%
                              Self-Inflicted
                                                        1%
                                                                                                 Female               16%
                                                        2%
                            Undetermined
                                                        2%                                          Male                              83%

                   Total Child Firearm Injury ED Visits: 2019 n=334; 2020 n=438
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                    36
NC Firearm Injury Surveillance Through Emergency
   Rooms (FASTER)
                           • NC one of 10 states funded for enhanced
                             surveillance of non-fatal firearm injuries.
                           • Goals of NC-FASTER:
                           1. Increase the timeliness of aggregate reporting of
                              ED visits for nonfatal firearm injuries.
                           2. Disseminate surveillance findings to key partners
                              working to prevent or respond to firearm injuries.

NCDHHS, Division | Suicide and Self-Inflicted Injury Update | 3/5/2021             37
Suicide and
                          Self-Inflicted Injuries

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   38
Child Suicide deaths increased by 53% in 2020.
                   Most deaths involved firearms followed by suffocation.
                                                              2019 Child Suicide Deaths           2020* Child Suicide Deaths

                                         Firearm                          15                                         31

                                 Suffocation                                 18                                20

                                     Poisoning                  1                                     3

                                              Other              2                                  1

                   Total Child Suicide Deaths: 2019 n=36; 2020 n=55
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                       39
Most suicide deaths were among children
                         ages 15-17 and males.
                          Number of child firearm deaths by age and sex
                              2019           2020*
                                                                                                                         38
                                                                      35

                                                                                                                    27

                                           20               21
                                                                                                               17
                                15
                                                                                                        9

                                   10-14                      15-17                                      Female      Male

                   Total Child Suicide Deaths: 2019 n=36; 2020 n=55
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                      40
The number of suicide deaths almost doubled
                    for NH white children in 2020*.
                                 2019 Child Suicide Deaths                                  2020* Child Suicide Deaths
                                                                     6           Hispanic        3

                                                 20                             White NH                            37

                                                                 8              Black NH              9

                                                                         2     AI/AN NH      1

                                                                                Asian NH         4

                                                                                Other NH     1

                   Total Child Suicide Deaths: 2019 n=36; 2020 n=55; NH – non-Hispanic
                   *2020 Provisional Data as of 9/1/2021; Data limited to North Carolina residents ages 0-17
                   Source: NC State Center for Health Statistics Death Certificate Data, 2019-2020
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                 41
The proportion of child self-inflicted injury ED
                    visits increased by 44% between 2019 and 2020.

                    % of Child Injury
                    ED Visits                                                 2019           2020*      2021*
                    5.0%

                    4.0%

                    3.0%

                    2.0%

                    1.0%

                    0.0%
                                   Jan        Feb        Mar         Apr        May        Jun   Jul    Aug          Sep   Oct   Nov   Dec

                   Total Child Self-Inflicted Injury ED Visits: 2019 n=2,742; 2020 n=2,745
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                     42
Medication/Drug
                          Overdose

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   43
The proportion of unintentional med/drug overdose
                    ED visits among children 15-17 increased by 43%
                    between 2019 and 2020.
                     % of Child Injury
                     ED Visits                                                2019          2020*      2021*
                      3.0%
                      2.5%
                      2.0%
                      1.5%
                      1.0%
                      0.5%
                      0.0%
                                    Jan        Feb        Mar        Apr        May        Jun   Jul   Aug      Sep   Oct   Nov   Dec
                   Total Unintentional Med/Drug Overdose ED Visits: 2019 n=366; 2020
                   n=352
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 15-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                44
Child Maltreatment

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   45
The proportion of child abuse/neglect* ED visits
                    increased by 24% between 2019 and 2020.

                    % of Child Injury
                    ED Visits                                                  2019              2020*         2021*
                     2.5%

                     2.0%

                     1.5%

                     1.0%

                     0.5%

                     0.0%
                                   Jan       Feb        Mar        Apr       May           Jun    Jul    Aug    Sep    Oct   Nov     Dec Total

                   *Total Child Abuse/Neglect ED Visits: 2019 n=1,968; 2020 n=1,698; includes suspected or confirmed abuse/neglect
                   Note: 2020 Provisional Data as of 8/10/2020; Data limited to North Carolina residents ages 0-17
                   Source: NC DETECT ED Visits, 2019-2021
NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021                                                         46
Questions?
                                                 Shana Geary
                                           Shana.Geary@dhhs.nc.gov

                                     Scott Proescholdbell
                              Scott.Proescholdbell@dhhs.nc.gov

                                    www.injuryfreenc.ncdhhs.gov

NCDHHS, Division of Public Health | CFTF Injury Surveillance Update | September 20, 2021   47
Review of 2021 CFTF
Legislative Action Agenda
Items and Legislative Update
Karen McLeod, MSW
Chair, Child Fatality Task Force
The recommendations addressed in the
                                             bill involve agency action, changes in
                                             law, new state funding to do the
                                             following:
                                             •   Create a State Office of Child Fatality
                                                 Prevention to put state support for
Child Fatality   • SB 703 addresses CFTF         system all in one place to coordinate
                                                 and support local teams, data, and
                   recommendations               whole CFP System.
Prevention       • Sponsors are Sen.         •   Implement a centralized electronic
                                                 data and information system that
System             Edwards, Sen. Bergin          includes NC joining 45 other states in
                                                 a national electronic data system.

Strengthening    • SB 703 is in the Senate   •   Reduce the volume of team reviews
                                                 to focus on certain categories most
                   Rules Committee and           likely to yield prevention
                   has not received a            opportunities.

                   hearing                   •   Reduce the number and types of
                                                 teams performing fatality reviews by
                                                 combining the functions of the four
                 • Funding is not in House       current types of teams into one local
                   or Senate budget              team.
                                             •   Formalize Task Force functioning and
                                                 expand reporting by the Task Force.
                                             •   Appropriate funding to support this
                                                 restructuring and system work.
A FEW DATA POINTS:
                                           • From 2010 to 2019 (ten years),
                                              460 child deaths in NC due to
                                              firearm injury (age 17 and

Statewide      • Addressed in HB 427;
                 sponsors are Rep.
                                              younger)
                                           • From 2016 to 2019 (five years),

Firearm Safe     Hanig, Carter, C. Smith
                                              437 hospitalizations & 1,246 ED
                                              visits

Storage
                                           • In NC, firearms are used in
               • Passed House on a vote       almost half of youth suicides
                 of 116 to 1               • More than 75% of guns used in
Awareness      • HB 427 is included in
                                              suicide attempts and
                                              unintentional injuries of kids
Initiative       the House version of
                 the budget; not
                                              were stored in the home of the
                                              victim, relative, or a friend
                                              (national study)
                 included in Senate        • Dramatic rise in gun purchases
                 version                      in 2020
                                           • Appears to be significant rise in
                                              firearm-related deaths to
                                              children in 2020 (based on
                                              provisional data; final 2020 data
                                              not yet available)
Funding to Prevent Infant Deaths Associated
with Unsafe Sleep Environments

                             • SB 537 addressed this CFTF
                               recommendation for
                               additional $85K (current
                               funding is only $45K)
                             • Sponsors are Sen. Bergin,
                               Sen Krawiec
                             • SB 537 did not get a
                               hearing; funding is not
                               included in House or
                               Senate budget
CFTF recommendations were
                                            for changes in law to make it
              • HB 473 addresses CFTF       more likely the law will be
                recommendations;            used in circumstances for
Strengthen      sponsored by Rep.
                                            which it was intended to
                                            protect a newborn infant at
                White, Rep. Bradford,
Infant Safe     Rep. Riddell
                                            risk of abandonment or harm
                                            by making legislative changes
                                            to accomplish the following:
Surrender     • HB 473 passed the            1) remove “any adult” from
                House unanimously and
Law             is currently in Senate
                                            those designated to accept a
                                            surrendered infant;
                Rules (no funding in this    2) provide information to a
                bill)                       surrendering parent;
                                             3) strengthen protection of a
              • SB 535, nearly identical    surrendering parent’s identity;
                to HB 473, sponsored         4) incorporate steps to help
                by Sen. Burgin, Sen.        ensure the law is only applied
                Krawiec; no hearing         when criteria are met.
Funding to
increase the
number of school
nurses, social
workers,
counselors,
psychologists to
move toward
nationally         • Senate budget appropriates recurring funding for 115
recommended          additional school psychologists
ratios             • House budget includes $1.7 million to establish a school
                     psychologist grant program
                   • No recurring funding in either House or Senate budget
                     to increase number of school nurses, social workers,
                     counselors
Legislation that    • No bill introduced.
would add child     • Bill that relates to child abuse and neglect
abuse and             reporting (not CFTF-related) is SB 693 which
                      became Session Law 2021-132 and requires:
neglect reporting
                        • DHHS to develop a plan to create and
requirements to            implement a statewide child protective
topic list for             services hotline
required mental         • Public schools to provide students with
                           information and resources on child abuse
health training            and neglect via a document provided to
for school                 students yearly and displays posted
                           throughout schools
personnel
Legislation      • HB 402 = SB 183 – bills do not expand the
                   use of ignition interlocks to all DWI offenders
that would         as recommended by the CFTF but the bills
                   would require studying the issue of
require            expanded use.
ignition         • House sponsors: Faircloth, Stevens, Clampitt;
                   Senate sponsors: Britt, Sawyer, Daniel
interlocks for   • S 183 passed the Senate and is now in House
                   Rules Committee after a favorable report
all DWI            from Judiciary 1.
offenders        • H 402 has passed the House and is currently
                   in the Senate Transportation Committee
                   after a favorable report from Judiciary.
Tobacco
prevention    • House budget provides funds from the
funding:        NC settlement with Juul Labs, Inc to
                DPH for tobacco and nicotine
$7 mil. for     dependence prevention activities
youth and       targeted at youth and young adults:
                $13 million nonrecurring.
$3 mil. for   • Not addressed in Senate budget.
Quitline
(endorse)
Workplace
supports:           • S 633 = H 514 addressed pregnancy
pregnancy and         and lactation accommodations but did
lactation             not advance, did not make crossover
accommodations;     • H 875 addressed kin care and safe
kin care and safe     days leave but did not advance, did
days leave            not make crossover
(endorse)
Highlights of two bills not related
to CFTF agenda that impact child
deaths & child well-being
Among its provisions:
Session Law 2021-110 (HB      • Law allows an immunizing pharmacist to
96) related to pharmacist       dispense, deliver, or administer self-
authorization for               administered oral or transdermal
                                contraceptives pursuant to certain
dispensing, delivering, and     requirements related to record keeping,
administering certain           notification of patient’s provider, etc.
treatment and medications
                              • Immunizing pharmacist may also
                                administer to a patient any prescribed,
                                self-administered injectable medication.
                              • If pharmacist administers or dispenses a
                                hormonal contraceptive, the pharmacist
                                shall counsel the patient about
                                preventative care . . .
Medicaid for
               The Senate budget continues
12 months      Medicaid coverage for pregnant
postpartum     women for 12 months
               postpartum.

               The House budget does not
               include this extension.
CFTF Director’s Report

        Kella Hatcher, JD
     Executive Director, NC
    Child Fatality Task Force
At its core, CFTF
 work is about

MAKING KIDS A
  PRIORITY
2021 CFTF Annual Report – access on home page of
             CFTF website
             Represent CFTF in more than a dozen stakeholder
             groups/steering committees
             Work to advance administrative items on CFTF Action
Highlights   Agenda
             Child Fatality Prevention System strengthening work
of ED
Activities   Presentations, materials, and meetings to educate
             about CFTF, CFP System, CFTF recommendations
             Legislative education, monitoring, reporting

             Media: press inquiries, press releases
• Firearm safety/safe storage education and awareness and focus on
                    social drivers that relate to gun deaths
                  • Funding to increase numbers of school nurses, social workers,
                    counselors, psychologists
                  • Strengthen child abuse and neglect reporting education and
                    awareness and prioritize resources to strengthen CPS intake and
State Team 2021     assessment
                  • Expanded efforts to prevent sleep-related infant deaths including
recommendations     expanded program funding and a statewide campaign
to be heard in    • Support for community-based programs supporting families’ health
committees          and well-being through addressing impacts of social determinants of
                    health
                  • Focus on upstream issues (ACES/screening/social determinants of
                    health) in mental health
                  • Support DPI efforts to implement statewide data system
                  • Funding for full toxicology in all medical examiner jurisdiction child
                    fatalities
• Strengthen training on child abuse and
                   neglect awareness and reporting for health
                   care providers and law enforcement
                 • Child Passenger Safety Study – Occupant
                   Protection Task Force
CFTF             • Work on rear seat restraints and
Administrative     strengthening education for teens/driver ed
Items            • Lead suicide prevention coordinator role
                 • Follow implementation of School Mental
                   Health Policy related to strengthening
                   school/community connections to address
                   student mental health
Goal to have less time spent on
                       presentations, more time for discussion

Changes in format      Committee role in prioritizing issues for
for meetings;          study
issue prioritization
and administrative     Committees determine 2-3 legislative
                       recommendations
work
                       More emphasis on what CFTF can
                       accomplish administratively (work that
                       doesn’t involve legislation)
Ten minute
break!
Committee Reports
Overview of Child Fatality
Prevention System, CFTF Role,
 System Strengthening Efforts

            Kella Hatcher, JD
           Executive Director
       NC Child Fatality Task Force
Develop a communitywide approach to
                    child abuse and neglect;
                   Study and understand causes of childhood
Charge of State     death;
Child Fatality
                   Identify gaps in service delivery in systems
Prevention          designed to prevent abuse, neglect, and
System [via         death; and
Article 14 of NC   Make and implement recommendations for
Juvenile Code]      laws, rules, and policies that will support
                    the safe and healthy development of our
                    children and prevent future child abuse,
                    neglect, and death.
MAIN COMPONENTS OF CURRENT NC CFP SYSTEM:
      FOUR TYPES OF REVIEW TEAMS PLUS TASK FORCE
             These three
             components                                                          State Child
                                       Two                                         Fatality
             addressed in
             Article 14 of
                                     Types of                Uses local team       Review
             Juvenile Code             Local                   members              Team
                                      Review
                                      Teams
                                                                                        This component
                       State Child                                                      addressed in G.S.
                         Fatality                                                       §143B-150.20
                       Prevention
                          Team          NC Child
Each type of team                       Fatality                               One case may be
handles data,
information, and
                                          Task                                 reviewed by
reporting                                Force                                 three different
differently; minimal                                                           types of teams
                                           Policy only; no
data is collected
                                           case reviews
• Study, analyze, and report on incidences and
                     causes of child death
                   • Develop a system for multidisciplinary review
                     of child deaths
                   • Receive and consider reports from State Team
    Task Force     • Perform other studies and evaluations as
                     needed in order to carry out its mandate
Responsibilities   • Submit annual report to the Governor and
                     General Assembly with recommendations for
                     changes to any law, rule, or policy that it has
                     determined will promote the safety and well-
                     being of children
                   [See G.S. §7B-1403, -1412]
Current
System                 *
Structure

  *This graphic was
  created in 2018
  and this ED
  position is now at
  DHHS
Current
System
Process
Initial 2017 discussions led to two-day Child Fatality
                 Prevention System Summit April 2018: gathering of
                 over 200 people & local team input
                Post-Summit work involved research on other states’
                 CFP systems, consultation with national experts,
                 stakeholder discussions
Journey of
                CFTF recommendations addressing CFP System
CFP              strengthening adopted in the Child Welfare Reform
                 Plan from the Center for Support of Families
Strengthening   CFTF recommendations were addressed in 2019
Work             Appropriations Act which did not become law (HB 825
                 was included in HB 966)
                NCDHHS has continued work to move
                 recommendations forward because they are aligned
                 with DHHS priorities and were part of Child Welfare
                 Reform Plan; this work has included convening of
                 stakeholder group by NCIOM
• The Task Force met this obligation in the
Why are we (still!)     early 1990s when the system was first set
talking about this?     up
                      • Thirty years later (now!) the Task Force
CFP statute says        has an important role in ensuring a strong
                        multidisciplinary review system and
the Task Force          effective operation of local teams
shall develop a       • A CFP System that is not optimized is a
system for              weak link in protecting children from
multidisciplinary       child death and maltreatment
review of child       • CFP System strengthening
                        recommendations made by CFTF in 2019,
deaths & study          2020, 2021
the operation of      • Legislation has been introduced but has
local teams . . .       not advanced
SB 703 addresses CFTF recommendations

• Creates a State Office of Child Fatality Prevention (State Office) that brings state-level
  support together in one place within DHHS to coordinate and support the work of the
  statewide system with an emphasis on supporting local child death review teams;
  appropriates recurring funding to establish and operate office and support system.
• Restructures the system of team reviews of child deaths in NC to do the following:
    • Combines the functions of the existing four types of review teams into local county
      teams & allows counties to choose whether to be a single or multi-county team.
    • Allows for the addition of needed experts to participate in a particular review on an ad
      hoc basis.
    • Eliminates state-level teams while State Office staff and medical examiner child fatality
      staff help local teams carry out functions previously performed by state teams.
    • Articulates special requirements for the State Office and for local review teams for
      reviews of deaths related to abuse or neglect or where a child was known to child
      protective services.
• Implements a centralized electronic data and information system that includes North Carolina joining 45
  other states to participate in the National Child Death Review Case Reporting System (that is web-based
  and free to use)
• Requires the Task Force to receive and consider local team information (reports addressing aggregate
  data, information, findings and recommendations resulting from local team reviews).
• Changes the types of deaths required to be reviewed to be according to categories of death where
  reviews are most likely to yield prevention opportunities; reviews of other deaths optional.
• Formalizes the current structure of the Task Force and expands the scope of its reporting to include the
  functioning of the whole CFP System; expands on state leaders who must receive the Task Force report.
• Requires NC DSS to ensure the existence of at least three federally required Citizen Review Panels that
  evaluate policies, procedures, and practices of State and local child protection agencies; requires that
  panels be operated and managed by organization independent from DSS; requires an annual report by
  panels that is made public. [The effect of these provisions is to put federal requirements in state law and
  enable DSS to discontinue using all 100 Community Child Protection Teams to satisfy federal requirements
  for Citizen Review Panels while ensuring that panels have appropriate access to and protection of
  information.]

         SB 703 addresses CFTF recommendations (continued)
Proposed Model Strengthens Team Reviews, Data, State-level Support, Reporting

   Local Review                                State Office of                                     NC Child
      Teams               Review info           Child Fatality            State Office           Fatality Task
 Counties choose to       goes into              Prevention
                          national data
                                                                          Staff report on           Force
 be single or multi-                         Whole-system                 whole system
                          system                                                                Studies data from
 county teams                                coordination & technical     functioning           local teams &
                                             support for local teams                            other sources
 One team for all         Makes local                                     Aggregate
 types of reviews, but    reports (e.g. to   Centralized Information      information &         Makes policy
 different procedures,    County             System including use of      recs from local       recommendations
 required participants,   Commissioners)     national data system         teams is              & reports on
 and degree of state-     which also go to                                reported
                                             Fatality Review & Data                             whole CFP
 level assistance for     State CFP
                          Office             Group looks at aggregate                           system to General
 different types of
                                             local team info & OCME                             Assembly,
 reviews (e.g.
                                             info to be liaison of info                         Governor, other
 abuse/neglect or
                                             going to Task Force                                state leaders
 infants).

             CAN deaths:
                                                                            Citizen Review Panels:
            7-Day Internal
                                                                          Evaluates CPS functioning
         Reviews by State DSS
• OPTIMIZE LOCAL TEAM EFFORTS: CFP State Office structure, and
                   eliminating duplication supports local teams to optimize work and
Ultimate Goal:     facilitate local prevention efforts to save lives and prevent maltreatment.
                 • DATA TO UNDERSTAND TRENDS: A sophisticated data system that
Prevent Child      collects richer layers of data makes reviews more valuable and facilitates
                   understanding and reacting to what’s happening locally and in NC.
Deaths &         • ADDRESSING INFANT MORTALITY: System strengthening involves best

Maltreatment;      practice attention to infant deaths at a time when North Carolina’s infant
                   mortality rate has been among the worst dozen in the nation, disparities
                   persist, and infant deaths make up two-thirds of all child deaths.
Support Child    • ENSURING USE OF INFORMATION LEARNED: Ensuring that
Safety &           information/recommendations from reviews reaches appropriate
                   agencies and leaders is critical to making reviews effective.

Wellbeing        • MORE STATE-LEVEL PREVENTION WORK: CFP State Office provides a
                   structure for facilitating or implementing various prevention initiatives,
                   including efforts to seek grant opportunities.
Local Teams: CCPTs & CFPTs in every county

     CCPT                        Most teams
                                                          CFPT
                                 are blended
        Must review deaths involving
         suspected abuse or neglect                                Reviews
            where there was CPS                                 “additional”
         involvement/report within                            types of deaths
        previous 12 mos., as well as                             when CCPT
          selected active CPS cases                            determines it
                                                               will not review
                                                                 additional
       May review “additional”                                       cases
          types of deaths

                                               See N.C.G.S §7B-1406
• Local Social Services    • Guardian ad Litem
Local teams consist   • Local Health             • Health Care Provider
of community            Department               • Emergency medical or
leaders; teams are    • Law Enforcement            firefighter
rich in expertise &   • District Attorney        • District Court Judge
ripe for              • Local Community          • County Medical
collaboration           Action Agency              Examiner
needed to             • Local School             • Local childcare facility
strengthen health       Superintendent             or Head Start
and safety in their   • County Board of Social   • Parent of child who
communities.            Services                   died
                      • Mental Health
Local team reports, findings, recommendations
        CCPTs                      Both                    CFPTs
Activity reports go to    Submit any            Activity reports go to
 local DSS board            recommendations to     local board of health
BCC rec’s go to NC DSS     Board of County       Reports on findings and
 (per policy)               Commissioners (BCC)    rec’s from reviews go to
                                                   Team Coordinator
End of Year Report to     Advocate for system    (state-level DPH) who
 NC DSS (per policy)        improvements and       submits aggregated
 [Note: no case-specific    needed resources       findings to State Team
 information reported]      where gaps and
                            deficiencies exist
Support for Local Teams
                   CCPTs                                            CFPTs
County DSS Directors provide general              Local Health Department Directors
 support, procedures, training, reporting, etc.     distribute procedures, maintain records,
                                                    provide staff support, facilitate reports,
NC Division of Social Services has ongoing         etc.
 responsibility for training materials for local
 CCPTs (a consultant in NC DSS is assigned to      A Team Coordinator at NC DPH
 this work)                                           By provides general support,
                                                       procedures, training, reporting
 A CCPT State Advisory Board was formed
 by NC DSS and it facilitates CCPT reporting          provides statistical information on
 aimed at meeting federal law for Citizen              child deaths to CFPTs
 Review Panels                                        Receives and sends reports from
                                                       CFPTs; provides aggregate info to
                                                       State CFPT
Local Team Panel Discussion
• Jennie Kristiansen, Chatham Co. DSS
Director and Chair of combined
CCPT/CFPT
• Paige Rosemond, Wake Co. Human
Services Child Welfare Director, CCPT
member
• Bruce Robistow, Halifax Co. Health
Director and CFPT Chair
• George Bryan, Chair of Forsyth Co. CCPT
and Chair of CCPT Advisory Board
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