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The Child Death Review Case Reporting System

1. Data Codebook for Download This document provides the information needed to understand the data in the downloaded tables including the variable names for the questions and the values for the answers Macro to Import Data into Microsoft Access This Access database has been designed for you to be able to import all of the downloaded data tables from the Child Death Review Case Reporting System 28 NATIONAL CENTER FOR CHILD DEATH REVIEW KEEPING KIDS ALIVE Understanding How Ze 4 and Why Children Die wl ip E amp Taking Actions to re Prevent Child Deaths Child Death Review Case Reporting System Data Dictionary Version 2 0 January 1 2008 National Center for Child Death Review The data dictionary can help you complete the Child Death Review Case Report The dictionary provides a definition for terms data elements used in the report and examples for terms that may seem ambiguous or unfamiliar Whenever possible this dictionary uses the same definitions found in nationally accepted health surveillance systems Table of Contents Case Number Case DetmitiOn isesssveessescere vers E E E EN EAE ARARA ees 5 Section A Child Information sssseesessseesseserrerrrssssssserrrreeessrrrsssrerrrreeeeess 6 Section B Primary Caregiver s Information ssscssssesssssrrrrreeesresserrrreressee 17 Section C Supervisor Information ssssssssssssrreressrsrsserrrrrrrrrrererresrrrrrerere 20 Section D In
2. i Protective measures for child Not Needed Present used Present used Present Select one option per row Needed none present correctly incorrectly not used Unknown Airbag l If child seat type Lap belt Shoulder belt O Rear facing Child seat O Front facing Belt positioning booster seat O uK Helmet Other specify 2 FIRE BURN or ELECTROCUTION c For fire child died from a Candles Cooking stove Ignition heat or electrocution source Matches O Cigarette lighter Utility lighter O Cigarette or cigar O Heating stove Space heater Furnace Power line Electrical outlet Electrical wiring Lightning Oxygen tank Hot cooking water Hot bath water Other hot liquid specify Fireworks Other explosives Appliance in water Other specify U K b Type of incident Fire go toc O Scald go to r O Other burn go to t O Electrocution go to s O Other specify go to t O UK gotot Material first ignited Upholstery O Mattress Christmas tree Clothing O Curtain Other specify Type of building on fire O NA O Single home O Duplex Apartment Trailer mobile home Other specify f Building s primary construction material Wood O Steel O Brick stone Aluminum Other specify g Fire started by a person O No O Yes O UK If yes person s age Does person have a history of setting fires No Ores
3. 4 Agencies at review check all that apply O Medical examiner coroner O cps C Other health care OO Mental health O Others list CI Law enforcement CI Other social services OO Fire CI Prosecutor district attorney O Physician O ems CI Substance abuse O Court LI Public health L Hospital L Education L Child advocate 5 Factors that prevented an effective review check all that apply Confidentiality issues among members prevented full exchange of information HIPAA regulations prevented access to or exchange of information Inadequate investigation precluded having enough information for review Team members did not bring adequate information to the meeting Necessary team members were absent Meeting was held too soon after death Meeting was held too long after death Records or information were needed from another locality in state Records or information were needed from another state Team disagreement on circumstances DOORAODOAAAAAD Other factors specify M NARRATIVE Review meeting outcomes check all that apply LI Review led to additional investigation Team disagreed with official manner of death What did team believe manner should be L Team disagreed with official cause of death What did team believe cause should be Because of the review the official cause or manner of death was changed O Review led to the delivery of services Review led to changes in ag
4. CO Robbery burglary C Other assault OO Arson C Illegal border crossing O Auto theft C Other specify O Gang conflict O Prostitution CI Drug trade O Interpersonal violence CO Sexual assault O Witness intimidation I ACTS OF OMISSION OR COMMISSION INCLUDING CHILD ABUSE NEGLECT AND SUICIDE Type of Act 1 Did any action s of omission or commission 2 Was the act s Check only one per column 3 What acts caused or contributed to the death cause or contribute to the death O No go to Sect J page 14 Yes Probable UK go to Sect J page 14 If yes or probable was the act s Check all that apply L The direct cause of death L The contributing cause of death 4 Child abuse type Check all that apply and describe in narrative O Physical go to 5 O Emotional specify and go to 11 m Sexual specify and go to 11 O U K go to 11 9 Child neglect check all that apply O Failure to protect from hazards specify CO Failure to provide necessities Food Shelter Other specify Caused Contributed Unintentional Intentional O Undetermined intent O uK 5 Type of physical abuse check all that apply C Abusive head trauma go to 6 O Chronic Battered Child Syndrome go to 8 L Beating kicking go to 8 oO Scalding or burning go to 8 L Munchausen Syndrome by Proxy go to 8 CI Other specify and go to 8 L UK go to 8 Failure
5. Indicate if child was wearing a personal flotation device at time of incident If yes specify if it was Coast Guard approved and type of device If flotation device was not Coast Guard approved specify type of device used G3n What barriers layers of protection existed to prevent access to water Specify type of barrier s and layer s of protection that were in place to prevent access to water or alert persons that access to water had occurred Check all that apply G30 Fence If fence was present at time of incident as barrier layer of protection specify type height and sides of water it surrounded G3p Gate If gate was present at time of incident as barrier layer of protection check all that apply G3q Door If door was present at time of incident as barrier layer of protection specify type Check all that apply G3r Alarm If alarm was present at time of incident as barrier layer of protection specify type Check all that apply G3s Type of cover If cover was present at time of incident as barrier layer of protection specify type Data Dictionary 35 Section G3 Drowning G3t Local ordinance s regulating access to water Indicate if local ordinance s related to pools hot tubs barriers was were in place at time of incident If yes indicate if they were violated G3u How were layers of protection breached If barriers layers of protection were breached during incident indicate how they were breached Br
6. Other A burglary is the unlawful entry into a building or other structure without the owner s consent with the intent to commit a felony or a theft Interpersonal violence The intentional use of physical force or power threatened or actual against another person or against a group that either results in or has a high likelihood of resulting in injury death psychological harm or deprivation Sexual assault Sexual contact without consent Includes sex with a minor with or without consent Ranges from the non consensual touching of an intimate part of the body to forced manipulated or coerced penetration It can involve verbal coercion and threats physical restraint intimidation and or violence Other assault An unlawful fatal or nonfatal attack by one person upon another To qualify as a serious crime the assault should be an aggravated assault one that involves bodily injury or threat with a deadly weapon Gang conflict Gang members are persons who are members of the same association or organization which has as one of its purposes the commission of crime Gangs include both youth gangs and organized crime organizations Drug trade The buying selling or passing of drugs from one person to another in exchange for goods or money Arson To unlawfully and intentionally damage or attempt to damage any building real estate or personal property by fire or incendiary device Prostitution Performing sexual acts in exchange fo
7. hyperlink to reset the entire page In this question you can reset the answers by checking and unchecking the No recommendations were made checkbox at the beginning 2 To effect this change what specific recommendations and or actions resulted fram the review I No recommendations were made a Current Action Stage Type of Action Level of Action term term campaign E program 12 Section 4 Search for an Existing Case Clicking on the Search for an Existing Case option from the Welcome Page gives you the ability to search for cases already entered into the Internet Child Death Review Case Reporting System Depending on your permissions you may or may not be able to access this section How to Search for a Case Search for Last Name Search for Case Number The navigation menu on the left has changed for use Deat in the Search Section When the Search Page first PEE EER opens it defaults to View All Cases Under this Search for Manner of Death search option all of the cases that you have entered Search for Cause of Death into the system are listed and are sorted in ascending order by case number The total number of cases that Search for Date of Entry have been entered is listed at the top of the View All Search for Entry Incomplete Cases Page regardless of how many cases are E aes ntion Updates displayed on the current page View All Cases If there are a large number of cases returned
8. O uK Other specify O uk e Was asphyxia an autoerotic event O No O Yes O UK Other specify and go to e Q Other specify O UK go toe U K c If strangulation object causing event d Clothing O Leash O Blind cord O Electrical cord O Car seat O Stroller O High chair O Bett O Other specify O Rope string O uK 5 SIDS AND UNDETERMINED CAUSE UNDER ONE YEAR OF AGE Ono O yes O Uk If yes Outside temp ___ deg F If choking object g History of seizures O No O Yes UK If yes witnessed O No causing choking Food specify If yes _ O Yes O UK Toy specify Balloon Other specify O uK O Person answer question G6q f Was child participating in h History of apnea ON Oys O UK If yes witnessed O No O Automobile power window choking game or pass out game O No O Yes UK If yes O Yes O UK i Was Heimlich Maneuver attempted O No O Yes UK or sunroof a Child exposed to 2nd hand smoke b Child overheated O No O Yes UK If yes how often c History of seizures O No O Yes UK If yes d History of apnea Ono O Yes UK Check all that apply If yes Frequently CO Room too hot temp _____ deg F Oo L Too much clothing If yes witnessed No O Yes UK If yes witnessed Occasionally O No O Yes UK O uK e For SIDS go to Section H page 11 For undetermined injury cause to infants also complet
9. Other specify Other vitamins C Herbal remedy C Other specify L Carbon monoxide go tof L Other fume gas vapor C Other specify Cosmetics personal care products Where was the substance stored f Was the incident the result of O Open area Open cabinet Closed cabinet unlocked Closed cabinet locked Other specify Was the product in its original g Was Poison Control h For CO poisoning was a container Accidental overdose O n a O Yes O No O uK Did container have a child called CO detector present ONo T Oye OUK ONo O Yes O UK If yes who called O Child Parent Other caregiver O Medical treatment mishap O Adverse effect but not overdose O Deliberate poisoning If yes how many Acute intoxication O Other specify safety cap O na O yes O No O uK e If prescription was it child s Omno O Yes O UK O uK O First responder Functioning properly O uK O Medical person ONo Oyes O UK Other specify O uK 10 EXPOSURE a Circumstances check all that apply b Condition of exposure c Number of hours d Was child wearing C Abandonment C Lost outdoors Hyperthermia exposed appropriate clothing O No Yes O uK Hypothermia O uK Left in car C1 Illegal border crossing C Other specify O uK O uK Submerged in water m C1 Left in room O E Injured outdoors 11 MEDICAL CONDITION a How long did the c
10. herpes is considered an infectious disease Code the medical complication infection that provides the most specificity e Acute Chronic Lung Disease Disorders affecting the lungs such as asthma chronic obstructive pulmonary disease infections like influenza pneumonia and tuberculosis lung cancer and many other breathing problems e Anemia A condition in which a person s blood has a lower than normal number of red blood cells RBCs or the RBCs don t have enough hemoglobin to carry oxygen from the lungs to the rest of the body e Cardiac Disease A narrowing or blockage of the coronary arteries the blood vessels that supply blood to the heart Disorders involving the valves in the heart or the ability of the heart to pump e Chorioamnionitis Infection of the membranes surrounding the fetus e Chronic Hypertension Elevated Blood Pressure documented before pregnancy B P greater than 140 90 or greater than 10 mm above patient s baseline B P Data Dictionary 12 Section A Child Information Data Dictionary Diabetes Pre existing diabetes is a condition in which levels of sugar in the blood are too high Gestational diabetes arises during pregnancy it results from the effect of hormones and usually subsides after delivery Eclampsia Hypertensive states of pregnancy accompanied by seizures Genital Herpes A sexually transmitted infection that is caused by a herpes simplex virus Genital herpes affects the genitals buttoc
11. Acts of Omission Commission Intent walsaAs Hulpoday aseo yago ul uogsang uoyIas aIGeqoJg 10 SA SB wea Aq papodal sem yeap ay 0 PA NGUjVOI 40 PASNeI UDISSILULUOIUOISSILUO JO uOe alay SASBd je Sapnu ajoujoo4 p uu z pun ieuonuayuun jeuonuayyy pauluiayapuy peuonuayuun Ee c a a a a a p m n y Mee snqe piy a u f N uoisvuadns um mouyun 140 you ynessy 4930 P A N pyd quesqy 100d 45 Report 26 Acts of Omission Commission Child Abuse Information Caused Contributed Deaths Reviewed ee ee ee eee Abusive head trauma Retinal hemorrhages Chronic battered child syndrome Beating kicking Scalding burn Munchausen Syndrome by Proxy Emotional Sexual Unknown Abuse Toilet training mishap Disobedience Feeding problems Domestic argument 46 Contributed o 0 oo ee Pattern in family B E Isolated incident 0 oo Died as infant and born drug alcohol exposed ee ee O Oe Open CPS case at time of death o o 0 Investigation found evidence of prior abuse i o 0 eee Child had history of maltreatment as victim 0 0o e Child placed outside of home C a a eee CPS action taken because of death o 0o 0 Biological parent o 0 0o Adoptive parent Step parent Foster parent Parents partner Other relative Child care worker babysitter Friend or Acquaintance Unknown Person 47 Report 26 Acts of Omission Commission Child Abuse Inf
12. Infants and Children is a nutrition program that helps pregnant women new mothers and young children eat well and stay healthy WIC receives federal funding from the U S Department of Agriculture TANF is the Temporary Assistance for Needy Families Program TANF became effective July 1 1997 and replaced what was then commonly known as welfare Aid to Families with Dependent Children AFDC and the Job Opportunities and Basic Skills Training JOBS programs TANF provides assistance and work opportunities to needy families by granting states the federal funds and wide flexibility to develop and implement their own welfare programs B10 Caregiver s have history of substance abuse Caregiver is perceived by self or others to have a problem with or to be addicted to alcohol or other drugs If tobacco abuse occurred it can be coded in the Other category Code as yes if person was noted as using illegal drugs such as heroin or cocaine abusing prescription medications such as pain relievers or Valium or regularly using inhalants e g sniffing gas If the person is mentioned a using illegal drugs even if addiction or abuse in not specifically mentioned code as Yes A person who is noted as participating in a drug or alcohol rehabilitation program or treatment including self help groups and 12 step program should be coded as yes even if the person was noted as being currently clean and sober A person with short term exp
13. Ke BA NATIONAL MCH CENTER TAa FOR CHILD DEATH REVIEW Dal J KEEPING KIDS ALIVE Porting tog Click here for section A help A Child Information B Primary Caregiver s Information x C Supervisor Information A Child Information D Incident Information E Investigation Information F Official Manner and Primary Cause of Death 1 Child s Name G Detailed Information by Cause First Jane TM Unknown of Death H Other Circumstances of Incident Middle I Acts of Omission or Commission J Services to Family and Last Doe Community as a Result of Death K Prevention Initiatives Resulting from the Review E The Review Meeting 2 Date of Bith 01 01 2005 I Unknown N seca ss ie MM DDIYYYY 3 Date of Death 01701 2005 I Unknown nee i e MM DD YY 4 Age fi Days x I Unknown R 11 Value 10 Field 9 Scroll bar Section 2 Getting In Out and Around the Website Accessing the Website Please use Microsoft Internet Explorer 6 0 for the best possible results Problems are known to occur with earlier versions of Internet Explorer or other browser platforms such as Netscape or Mosaic Microsoft Internet Explorer 6 0 can be downloaded for free at www microsoft com windows ie downloads ie6 Please check with your technology staff before downloading and installing any new software Open your Internet browser and type https www cdrdata org into the address bar of the browser It is important to inclu
14. O Marble tile O Other specify O UK e Barrier in place Check all that apply 2 2 2 ey e ee None Screen Other window guard Fence Railing Stairway Gate Other specify U K f Child in a baby walker O NA O No O Yes O uK g Was child pushed droppped or thrown O No If yes answer G6q page 9 9 POISONING OVERDOSE OR ACUTE INTOXICATION a Type of substance involved check all that apply Prescription drug m Antidepressant O Over the counter drug Diet pills Yes O UK h For crush did child Climb up on object Pull object down Hide behind object O Go behind object Fall out of object Other specify O uK Cleaning substances Blood pressure medication Pain killer opiate Pain killer non opiate Cardiac medication O Stimulants Cough medicine LJ Pain medication Children s vitamins L Iron supplement O Bleach Drain cleaner Alkaline based cleaner Solvent E O E E Other specify i For crush object causing crush Appliance Dirt sand Television Furniture O walls Playground equipment Other specify Animal O Tree branch Boulders rocks Person answer G6q O Commercial equipment O Farm equipment uk Other substances C Plants L Alcohol C Street drugs CI Pesticide C Antifreeze L Other chemical O Oo 1 Methadone Oo E
15. O No O Yes O uK If yes check all that apply Physical specify Child was receiving MH services L Alcohol C1 Other specify L Mental specify O No O Yes O uK O Cocaine Sensory specify Child on medications for MH illness O Marijuana O uk O No O Yes O uK O Methamphetamine If yes was child receiving Children s Issues prevented child from receiving MH services m Opiates Special Health Care Needs services O No O Yes O uK O Prescription drugs O No O Yes Q U K If yes specify C Over the counter drugs 23 Child had history of child maltreatment If yes check all that apply 24 Was there an open CPS case with child 27 Child had history of intimate partner As Victim As Perpetrator As Victim As Perpetrator at time of death violence Check all that apply O NA oO C Physical Ono Ovyes Ouk O wa O O No Neglect 25 Was child ever placed outside of the CI No O O Yes o O Sexual home prior to the death O Yes as victim O O uK Emotional psychological O No O Yes O uK CI Yes as perpetrator If yes how was history identified LI U K 26 Were any siblings placed outside of the O uk O Through CPS CPS referrals home prior to this child s death O O Other sources Substantiations O No O Yes __ O U K 28 Child had delinquent or criminal history 29 Child spent time in juvenile detention 32 If child over age 12 what was child s gender identity O NA Ono Oyes OuK Omna Omno Oves O uK O
16. These other navigation menus will be discussed in later sections Exiting the Website Important Use the Logout option on the Welcome Page navigation menu to exit the website before closing your Internet browser The reason for this has to do with the nature of Web programming If you simply close your Internet browser without using the Logout the Internet Child Death Review Case Reporting System cannot detect your exit and thinks that you are still in the system Therefore your account is locked and the system will not allow you login again for the next 60 minutes which is the time limit for automatic logout due to inactivity If this does occur you can contact your State Administrator or the National Center to unlock your account Section 3 Enter a New Case Clicking on the Enter a New Case option from the Welcome Page brings you to the data entry section of the Internet Child Death Review Case Reporting System Depending on your permissions you may or may not be able to access this section Navigation and Saving Data eae aaa A Child Information The navigation menu on the left has changed for use in ol bless ole dal a ei the data entry section Each option on the data entry C Supervisor Information p navigation menu corresponds to a section of the paper g F Incident Informatio i se inne an Child Death Review Case Report Form The current Investigation Information Official
17. medication should be selected for all drugs typically prescribed for heart disease except for blood pressure medication Check the class for which the drug is most typically used In some instances this may not be the reason for which the drug is prescribed For example Codeine should be checked as pain killer opiate even if it was prescribed as a cough suppressant Street drugs include recreational drugs not generally available by prescription such as heroin cocaine LSD and methamphetamine If the child died from a prescription drug that was obtained illicitly please list the agent in the appropriate prescription drug category In order to obtain data on the exact agents involved in poisoning deaths among children and youth please indicate the actual trade or generic name of each agent contributing to the death in the other specify field for the corresponding category as well as in the narrative For example if codeine was one of the contributors to the death check pain killer opiate and write codeine in the other specify field G9b Where was the substance stored Specify place substance was stored at time of incident This may not be applicable in all cases such as recreation drug use In these situations leave the item blank G9c Was the product in its original container Code as yes if poison was in the container that the manufacturer originally packaged it in or in its original prescription dispensing format G9d
18. which could involve purposefully induced hyper ventilation or the use of ligatures It may be most dangerous when played alone as the child may lose consciousness before being able to release the mechanism of asphyxiation thereby causing death Select U K if the team could not determine if the child was participating in the choking game or intentionally killed him herself Data Dictionary 37 Section G4 Asphyxia G4g History of seizures Indicate whether child had a documented history of seizures A seizure is an involuntary muscular contraction and relaxation originating from the short circuit of the central nervous system Seizures vary in pattern length and intensity Causes include fever tumors injuries or epilepsy If yes were the seizures ever witnessed G4h History of apnea Indicate whether child had a documented history of apnea Apnea is defined as an interruption in the normal breathing patterns of a child If yes was the apnea ever witnessed G4i Was Heimlich Maneuver attempted If child was choking indicate whether the Heimlich maneuver attempted to try to dislodge the item child was choking on Heimlich Maneuver is defined as abdominal thrusts applied manually to dislodge an object blocking the airway Data Dictionary 38 Section G4 Asphyxia Section G5 SIDS and Undetermined Cause Under One Year G5a Child exposed to second hand smoke Child was exposed to second hand smoke regul
19. A Child Information Mental Mental disorders are health conditions characterized by alterations in thinking mood or behavior or some combination thereof associated with distress and or impaired functioning They include any psychiatric disability mental illness or mental retardation Examples may include depression bi polar disorders or Downs Syndrome This includes cognitive learning disabilities Sensory Sensory disorders refer to any disability or chronic disease that impairs the senses including visual auditory and olfactory Examples include blindness and deafness Receiving Children s Special Health Care Needs Services Children s Special Health Care Needs Services are provided by states through their Federal Title V Block Grant and may include medical care family support services counseling and special therapeutic services Each state may name these types of services differently however if the child is receiving any services paid for through the Title V CSHCS this question should be coded as yes A21 Child s mental health Child had received prior mental health services The child had ever received professional treatment for a mental health problem either near the time of death or in the past Child was receiving mental health services The child was in current treatment that is had a current prescription for a psychiatric medication or saw a mental health professional within the past two months Treatment includes seei
20. D UK Burns Smoke inhalation Other specify U K h Did anyone attempt to put out fire O No O Yes O UK i Did escape or rescue efforts worsen fire O No O Yes UK j Did any factors delay fire department arrival No O Yes UK If yes specify O uK O uK k Were barriers preventing safe exit O No O Yes O UK O uK Was building a rental property O No O Yes UK m Were building rental codes violated O No O Yes UK If yes describe in narrative n Were proper working fire extinguishers present O No Yes UK If yes check all that apply o Was sprinkler system present ONo O Yes UK No Yes UK p Were smoke detectors present L Locked door Window grate If yes what type If yes functioning properly If not functioning properly reason Locked window If yes was it working Missing batteries Other U K El E E Ej O Blocked stairway Other specify U K O No O Yes UK L Removable batteries C Non removable batteries L Hardwired O No O No O No O Yes O Yes O Yes O UK O UK O uK El O Oo O uK Ono OvYes O UK Other specify O Yes O UK t Other describe in detail If yes was there an adequate number present O No q Suspected arson O No O Yes UK r For scald was hot water heater s For electrocution what cause set too high Electrical storm O NA O No O
21. Did the container contain a child safety cap The container the poison was in at time of incident was equipped with a child safety cap that was securely on Child safety cap is defined as a lid to a container that requires the level of developmental ability to open it to be equal to that of an eight year old child G9e If prescription was it for child If source of poison was a prescription medication indicate if the medication was prescribed for the child G9f Was the incident the result of e Accidental overdose Unintentionally administering medication above recommended safe dosage levels Also includes children ingesting exposed to Data Dictionary 44 Section G9 Poisoning Overdose or Acute Intoxication agents including nonpharmaceutical agents without knowledge of adverse consequences e Medical treatment mishap Includes medication incorrectly prescribed or incorrectly administered by medical personnel e Adverse effect but not overdose Includes prescribed or over the counter medication administered and prescribed correctly but child had adverse reaction e Deliberate poisoning Refers to intentionally administering medication with the intent to harm the child This includes both suicidal and homicidal poisonings e Acute Intoxication Refers to agents taken as a result of recreational use or addiction It excludes suicide G9g Was Poison Control called If Poison Control was called as a result of incident specify re
22. Male If yes check all that apply 30 Child acutely ill during the two weeks before death O Female C Assaults C Other specify Ono O Yes O uK O uK O Robbery 31 Are child s parents first generation immigrants 33 If child over age 12 what was child s sexual orientation Cl Drugs C U K Ono O Yes O uK O Heterosexual O Bisexual If yes country of origin O Gay O Questioning O Lesbian O UK COMPLETE FOR ALL INFANTS UNDER ONE YEAR 34 Gestational age U K 35 Birth weight UK 36 Multiple birth 37 Number of 38 Month of first prenatal visit Oarams ONo Ouk OPounds ounces O Yes prenatal visits O uK specify 1 9 ON A Ou k weeks 39 During pregnancy did mother check all that apply C Have medical complications infections Check all that apply C Acute Chronic Lung Disease LJLow MSAFP PROM L Anemia O Eclampsia O Genital Herpes Other Infectious Disease Renal Disease Cardiac Disease L Hemoglobinonpathy LPregnancy Related Hypertension Rh Sensitization C High MSAFP Preterm labor Previous Infant 4000 Grams O Chorioamnionitis Uterine Bleeding L Chronic Hypertension CZ Diabetes L Hydramnios Oligohydramnios Other specify CO Incompetent Cervix Previous Preterm Small for Gestation LI Smoke tobacco Ll Experience intimate partner violence O use illicit drugs CI Infant born drug e 40 Were there access or compliance issues relate
23. Password Utility to set this default to a secure password that is known only by you 26 Edit Your Contact Information Your State Administrator has the ability to download the contact information for all of the users in your state The National Center can download the contact information for all of the users of the Internet system This information will be used for mass mailings to keep you apprised of system updates and other important information or to contact you directly if you report a problem Your information will not be used by the National Center for any other purposes Please keep this information current This utility will list all of the contact information that is on file for you If something is incorrect or missing make a change to that field and click on the Save Changes hyperlink Supporting Documents There are several documents that have been made available to aid you in child death review or to help you use the case report form and the Internet system These documents are in pdf format and can be opened and printed using Adobe Acrobat Reader or Adobe Acrobat Professional If you do not have Adobe Acrobat then you can use the Get Adobe Reader hyperlink at the bottom of the Supporting Documents Section to download a free copy of Adobe Acrobat Reader Please check with your technology staff before downloading and installing any new software Child Death Review Program Manual This is a guide for local and stat
24. Report 23 Sleep Related Deaths by Acts that Caused or Contributed to Death Deaths Reviewed Poor absent supervision Child Abuse Child neglect Other negligence Assault not child abuse Medical Condition 0 All Other Causes 0 Footnote Includes all cases where action of omissionicommission caused or contributed to the death was reported by team as Yes or Probable Section Question 1 in CDR Case Reporting System 41 Report 24 Acts of Omission Commission Demographics Hispanic any race Poor Absent Supervision 0 a 0 Other Negligence 0 0 0 Assault not child abuse 0 0 0 42 Report 24 Acts of Omission Commission Demographics Continued Poor Absent Assault not Supervision gle glig child abuse Pacific Islander a3 0 0 0 0 0 0 0 0 0 a am ma ae n S S 43 Report 24 Acts of Omission Commission Demographics Continued Fire burn or electrocution Drowning Footnote Includes all cases where action of amission commission caused or contributed to the death was reported Poor Absent Supervision Child Abuse 0 o o o Other Negligence 0 by team as Yes or Probable Section Question 1 in CDR Case Reporting System Assault not child abuse 0 Suicide 44 Report 25
25. Specify Oo Impaired by disability Specify A note was left Child talked about suicide Prior suicide threats were made Prior attempts were made Suicide was completely unexpected Child had a history of running away Child had a history of self mutilation There is a family history of suicide Suicide was part of a murder suicide Suicide was part of a suicide pact Suicide was part of a suicide cluster 26 Does person have check all that apply Contributed L Prior history of similar acts Prior arrests Prior convictions L No Yes as victim O Yes as perpetrator U K Caused Plead O UK O O Yes O O Uk If yes check all that apply Assaults L Robbery Drugs Other specify U K 27 Legal outcomes in this death check all that apply Contributed No charges filed C Charges pending Charges filed specify O Confession specify C Not guilty verdict Guilty verdict specify O Tort charges specify 29 For suicide was there a history of acute or cumulative personal crisis that may have contributed to the child s despondency Check all that apply CI None known O Family discord H Parents divorce separation O Argument with parents caregivers O Argument with boyfriend girlfriend O Breakup with boyfriend girlfriend O Argument with other friends O Rumor mongering O Suicide by friend or
26. The fourth strip from the top of the window that the user can type in the address for a website or view the address for the web page that is being displayed Navigation menu The area on the left side of the screen that allows a user to access a particular part of the web site Scroll bar The strip at the right side of the window that allows the user to access more information than can be displayed on the monitor at a given time Click above or below the box to see additional information or use the arrows for more control of movement Scroll bars are not displayed in windows where all of the information for that page fits within the window Field Fields are places where information is stored When you answer a question you type information into a field Value Values are the individual choices available for a given field Yes and No are examples of values Hyperlink An underlined text the user can point to and click on to access a different part of the web site or access another web site Mouse pointer The moving arrow or I icon seen on the window that allows users to see where to point and click Examples of Internet terms 7 Address bar 6 Toolbar 12 Hyperlink E sectionA Microsoft Internet Explorer e x File Edit a a View Favorites Tools Help S Back gt Q A Search Favorites Media Address amp https jwww cdrdata org section aspx r A Dear
27. Yes temp setting O uK Faulty wiring Wire product in water O Child playing with outlet O Other specify OWK a Where was child last seen before b What was child last seen doing c Was child forcibly submerged O No O Yes UK d Drowning location drowning Check all that apply Open water go to e Olinwater O O Onshore O C Ondock O Ej LI Poolside before drowning O Playing Boating O UK goton O Pool hot tub spa go to i Bathtub go to w Bucket go to x O Tubing Water skiing O Sleeping Other specify In yard In bathroom O Swimming Bathing O Fishing Surfing O uK For open water contributing In house Well cistern septic go ton Toilet go to z Other specify U K O Other specify and go to n e For open water place Lake Quarry O River O Gravel pit Pond O Canal O Creek O uK O Ocean If boating type of boat O Sailboat Jet ski Motorboat O Canoe Kayak O Raft For pool ownership is O Private O Public O uK For boating was the child piloting boat O Commercial Ono O Yes O UK Other specify environmental factors O weather Drop off Rough waves O Other specify O uK Temperature Current O Riptide undertow O UK i For pool type of pool j O Above ground In ground O Hot tub spa O wading O ux For pool child found Length of time owners had pool hot tu
28. a result of the medical condition If childhood death was expected as a result of the medical condition indicate if death was expected to happen at a later time Gllc Was child receiving health care for the medical condition Indicate if child was receiving health care for medical condition resulting in the death Code as yes even if the child was not diagnosed correctly Indicate if care was provided within 48 hours of the death If the team concludes that the child was receiving care but there was a delay in the diagnosis or the child was misdiagnosed and the delay misdiagnosis contributed to the death this should be included in the narrative section Glld Were the prescribed care plans appropriate for the medical condition Indicate if care plans prescribed by physician were appropriate for the medical condition If no specify why inappropriate Glle Was child family compliant with prescribed care plans Indicate if child family was in compliance with care plans prescribed by physician If not specify part of the plan that child family was out of compliance with If no care plan was in place select N A GlIf Was child up to date with American Academy of Pediatrics immunization schedule According to documentation indicate if child was up to date with recommended immunization schedule based on child s age and the immunization series required These are available at http www cispimmunize org Gllg
29. ability to change your password or edit your contact information and gives you access to various supporting documents for the Internet Child Death Review Case Reporting System If you have any questions or need to report any problems contact information for the National Center for Child Death Review is listed at the top of this page The National Center is open Monday through Friday from 8am to 5pm EST and can be reached at 1 800 656 2434 Email sent to info childdeathreview org will receive a response within 24 business hours Change Your Password We do not require you to change your password every six weeks nor do we require that your password include numbers or symbols However we do encourage you to follow these practices as they are commonly accepted security recommendations To change your password you will be asked to enter your old password and to enter your new password twice to avoid accidental spelling errors or typos Passwords are case sensitive so be sure to watch when you use uppercase and lowercase letters Remember to click on the Change Your Password hyperlink to save your new password Old Password New Password Confirm New Password Change Your Password No one else will be able to view your password If you forget your password then you will need to contact your State Administrator or the National Center to have your password reset to a default We recommend that you use the Change
30. any other Data Dictionary 55 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide injuries inflicted to the child s head during an assault Formal medical documentation of retinal hemorrhages is needed to code as yes I7 _ For abusive head trauma was the child shaken If abusive head trauma indicate if child was shaken based on formal medical forensic pathology or law enforcement documentation If child was shaken indicate if there was or was not impact of the child s head on a surface Impact should be documented by investigators and or medical records I8 Event triggering physical abuse If death occurred as a result of abuse specify trigger for abusive behavior Trigger is defined as an environmental circumstance or action of the child person committing act or another person that led person to cause abuse 19 Child neglect If death occurred as a result of neglect or neglect contributed to the death based on evidence available to the team specify type of neglect Check all that apply 110 Other negligence If other type of negligence was documented as a contributing factor in death specify Does not include child neglect L1 Was act s of omission commission Chronic with child refers to a pattern of ongoing acts of abuse or negligence inflicted specifically on this child A pattern in family or with perpetrator refers to a pattern of ongoing acts of abuse or negligence
31. blunt force trauma 3 a caregiver shaking an infant so hard to cause severe head trauma and death 4 a drunk driver hitting another car causing severe trauma and death to a young child passenger in the other car 5 a young girl taking an overdose of prescription medicines causing her death and 6 even an institutional breakdown in the enforcement of DUI laws Although this is not intended to be exhaustive examples of acts of omission that served as contributing or indirect causes of a child s death include 1 an unsupervised toddler falling into an open residential pool and drowning 2 a child left in a closed car on a hot day who dies from hyperthermia 3 a caregiver failing to get necessary medical attention for an ill child who died of the untreated illness 4 hospital personnel failing to provide Data Dictionary 53 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide the correct medicine in a timely manner that leads to patient death 5 a caregiver who unintentionally rolls onto an infant in an adult bed and the infant suffocates Direct or Contributing Cause of Death The second part of the question simply asks whether the cause s are considered direct or contributory Both choices can be selected if more than one act of commission or omission is present The direct cause of death refers to an act that was the primary event leading directly to the death It describes a specific act of commission or
32. coroner Autopsy was performed Scene investigation was conducted Toxicology screen was conducted X rays were taken CPS record check was conducted as result of death Investigation found prior evidence of abuse i Drowning Asphyxia e Animal Bite Fallor Poisoning Exposure Other Any Medical or Attack Crush CPS action taken because of death Footnote Columns do not add up to total deaths because the factors are not mutually exclusive Other injury causes includes undetermined external other external 14 Motor Vehicle and Other Transport Reports Report 5 Motor Vehicle and Other Transport Death Demographics __Driver_Passenger On Bicycle Pedestrian Unknown lt 1 Year M oo i ts oF gg a EC o g o e e 18 19 Years M A E E E umno fl ooo ee 15 Report 5 Motor Vehicle and Other Transport Death Demographics Continued Driver Passenger OnBicycle Pedestrian Unknown American a a a a i a a urban f lll a fut fl Frontier f o o o o o Unknown f o o o o o 16 Report 6 Vehicle Type Involved in Incident and Position of Child Passenger Not In a Vehicle Semi Tractor trailer Recreational vehicle RV wo em o Footnote Other vehicle includes subway trolley and others Shaded cells in the body ofthe table may contain red numbers which denote the number of cases with potentially conflicting answers 17 Report 7 R
33. drug exposed there must be a documented presence of drugs that were taken by the mother in the child s system at time of birth Documented refers to information from CPS or hospital records e Misuse over the counter or prescription drugs Mother misused over the counter or prescription drugs at any time during pregnancy Misuse of over the counter drugs is defined as a person taking a non prescribed drug in a way other than recommended in product safety warnings or instructed by a supervising physician Misuse of prescription drugs is defined as a person taking a medication that was not prescribed for them taking a prescription drug in a way other than was instructed by the prescribing doctor or a prescription being used in a manner inconsistent with safe prescribing practices e Have alcohol use Mother used any amount of alcohol after her pregnancy was confirmed Data Dictionary 14 Section A Child Information Infant born with fetal alcohol effects or syndrome Child displayed documented effects associated with fetal alcohol syndrome or was diagnosed with fetal alcohol syndrome For questionable or suspicious use of drugs or alcohol add comments in Section M Narrative A40 Were there access or compliance issues related to prenatal care There were compliance with care issues on the part of the mother family or health care providers related to the death Specify issues if appropriate Compliance with care is defined as recommended w
34. eoo0o0o0c0c0cc 0c0 0 i 37 Report 20 Sleep Related Deaths by Cause Asphyxia Medical Undeter All Other Condition Causes et a a a a Sa Footnote Medical condition included unknown medical causes Undetermined included undetermined deaths from both medical and injury causes All other causes include deaths from other unknown causes 38 Report 21 Circumstances Involved in Sleep Related Deaths 8 11Mos 1 4 Yrs Unobstructed by person or object On top of person On top of object Under person Fell or Rolled onto object Tangled in Object Footnote Under and between objects include animals 39 Report 22 Factors Involved in Sleep Related Deaths 2 3Mos 4 5Mos 6 7Mos 8 11Mos 1 4Yrs 5YrsUp Unk Footnote Columns do not add up to to total deaths because the factors are not mutually exclusive If factor is unknown itis not included in these counts Portable cribs may inadvertently be counted as notin a crib or bassinette since they are typically coded as other Unsafe bedding or toys include pillow comforter stuffed toy and other toy Deaths Reviewed Not in a crib or bassinette Not sleeping on back Unsafe bedding or toys Sleeping with other people Obese adult sleeping with child Adult was alcohol impaired Adult was drug impaired Caregiver Supervisor fell asleep while bottle feeding Caregiver Supervisor fell asleep while breast feeding 40
35. equipment present For pool and open body of water deaths indicate if appropriate rescue equipment was present and available at time of incident Appropriate is relative to the place of drowning For example a swimming pool or public beach should have rescue equipment easily accessible Data Dictionary 36 Section G3 Drowning Section G4 Asphyxia G4a Type of Event Specify the type of asphyxiation Suffocation is a broad term that refers to death or serious injury by deprivation of oxygen can involve a variety of mechanisms Strangulation is more narrowly defined as death by asphyxiation caused by some sort of compression of the neck such as in hanging or manual strangulation using the hands Choking refers to asphyxiation caused by an object becoming lodged in the airway G4b If suffocation asphyxia action causing event For cases of suffocation specify the circumstances that led to the asphyxial event Overlay refers to death usually of an infant due to asphyxiation caused inadvertently by another person with whom they are sharing a sleep surface This could be caused by the person rolling over onto the infant or if their body in any other way inhibits the infant s ability to breathe Wedging is when a child usually and infant becomes trapped between objects often a mattress and a wall such that it limits their ability to breathe Asphyxia by gas could include carbon monoxide poisoning or death by huffing or inhalan
36. for your state You will never see a case that you are not authorized to see nor will anyone else see your cases if they are not authorized to do so Once the cases are returned in a search you can sort on case number last name or date of death by selecting on the appropriate column An up arrow will sort the cases in an ascending order a down arrow will sort the cases in a descending manner Search for Last Name You can search for cases by the child s last name Some examples of useful searches include e Enter Sm and it will return all cases with a last name beginning in Sm e Enter Smith to list all cases with a last name of Smith This will also pick up cases where the last name begins with Smith such as Smithson Cases returned by this search will be sorted alphabetically by last name Enter Last Name or partial Search Search for Case Number This search feature is more flexible than the ability to search for an exact case number If you are a local level user then you will be able to enter values for the year of review or sequence of review as your search parameters Some examples of useful searches include e Enter both year of review and sequence of review to locate a particular case e Enter the year of review to list all cases in a review year State County Year Sequence 14 If you are a state level user with the ability to search cases then yo
37. for punching feet for kicking Body part should not be checked if the person was using hands to hold another weapon If body part was weapon how was body part used to create injuries that killed the child This includes child abuse and other assaults Only select Other specify if body part action does not fit into any other category G6m Did person using weapon have history of similar offense Person using weapon has a documented history of weapon related offense G6n Does anyone in child s family have a history of weapon offenses or die of weapons related causes Member of child s family has a documented history of weapon offenses or died of causes due to a weapon related injury G6o Persons handling weapons at time of incident Relationship of person people handling weapon s at time of incident that killed child Partner is defined as a person who lives with and is sexually involved with but is not married to the child s mother or father Select other specify for person people handing weapon s at time of incident only if those person s do not fit into any other category Fatal weapon is the weapon that injured the child Other weapon includes any weapon involved in the incident that did not injure the child G6p Sex of person s handling weapon Sex of person who handled fatal and or other weapon being used at the time of incident G6q Use of weapon at time Specify intended use of the fatal weapon
38. head gear designed to reduce or prevent injuries from occurring while bicycling skateboarding rollerblading riding a motorcycle snowmobile or ATV e Other specify Indicate if other protective measures were used Data Dictionary 30 Section G1 Motor Vehicle and Other Transport Section G2 Fire Burn or Electrocution G2a Ignition heat or electrical source Source from which fire or burn originated Source is the direct cause or start of the fire G2b Type of incident Indicate type of incident child was involved in e g fire scald other burn electrocution other or unknown G2c For fire child died from For child who died during fire ultimate cause of death to child as specified on death certificate A child may have been burned in a house fire but many times the ultimate cause of death was smoke inhalation G2d Material first ignited Type of material that first lit on fire following ignition G2e Type of building on fire Type of building structure that was on fire at time of incident G2f Building s primary construction material Type of material of which building structure was constructed Specify type of material that made up majority of structure building G2g Fire started by person Code as yes if any person s actions ignited the fire regardless of whether the person intentionally set the fire A person with a history of setting fires should have a documented or reported history of se
39. his her girlfriend boyfriend e Breakup with boyfriend girlfriend The child had broken up with his her girlfriend boyfriend e Argument with other friends The child had a major argument with other friend s e Rumor mongering The child was the victim or perpetrator of rumors that created a personal or social crisis for the child or for others e Suicide by friend or relative The child was distraught over or reacting to a suicide of a friend or family member e Other death of friend or relative The child was distraught over or reacting to a death other than suicide of a friend or family member e Bullying as victim The child had been experiencing bullying as a victim Bullying among children and adolescents is aggressive behavior that is intentional and usually persistent It involves an imbalance of power or strength Bullying can take many forms including physical violence teasing and name calling intimidation and social exclusion Bullying can be related to other forms of harassment and social isolation and or intimidation including hostile acts perpetrated against racial and ethnic minorities and gay and lesbian youth Bullying also includes hazing e Bullying as perpetrator The child had been perpetrating bullying Bullying among children and adolescents is aggressive behavior that is intentional and usually persistent It involves an imbalance of power or strength Bullying can take many forms including physical violence t
40. in a Return to Main Menu i ages Saag agp into multiple pages Next and Previous search the Internet system will split the list of cases hyperlinks will become available at the bottom of the page to move through the multiple pages The number of cases that can be displayed on a page is different for everyone and will be dependent on your screen resolution and monitor size 23 cases entered 1235 01 2004 0005 r r r r J o WO eS 2 m le We cm om ico t t Print t in in in in in in in in n g ko z D r r E Johnson a 1 12 33 01 2004 0008 Davidson 4 16 2004 Edit 12 33 01 2004 0010 Edit ek SO WO o pS Lye 12 33 01 2004 0006 Simpson 3 18 2004 E wal z r r E e am n El D g wk D 13 You can conduct searches using the navigation menu on the left There are several different parameter searches by child s last name by case number by date of death by manner of death by cause of death by date of entry by incomplete entry or by prevention updates You also have the option to return to the default View All Cases search at any time The cases returned in a search are specific to your permissions If you are a local level user then you will only have access to the cases for your local team If you are a state level user with the ability to search cases then you will only have access to the cases
41. in foster care adopted C CPS prevention services Oo Family Preservation svcs C Children ever removed 14 Supervisor has delinquent or criminal history O No O Yes O UK INCIDENT INFORMATION Date of incident event Same as date of death If different than date of death O uk mm dd yyyy If yes check all that apply Assaults O uk Robbery Drugs Other specify 2 Approximate time of day that incident occurred 3 L Physical specify L Mental specify LI Sensory specify O u k If mental illness was supervisor receiving MH services ONo OvYes OUK Child abuse _ Child neglect _ Accident Suicide _ SIDS Other Other specify U K 15 At time of incident was supervisor check all that apply oO O Drug impaired C Alcohol impaired Asleep O Distracted oO O AM Hour specify 1 12 O PM O UK Absent O Hours Interval between incident and death O C Impaired by illness Specify C Impaired by disability Specify C Other Specify O uK Weeks C Months Years Minutes Days 4 Place of incident check all that apply 5 Type of area Child s home C Licensed group home LI School Sidewalk Sports area O Urban Relative s home Licensed child care center C Place of work Roadway Other recreation area O Suburban Friend s home Licensed child care home LI Indian Reservation Driveway H
42. make sense to answer both Yes as victim and Unknown Therefore if you have already answered Yes as victim and then click on Unknown your first response in Yes as victim will be cleared and Unknown will stay checked 15 Caregiver s have a history of intimate partner violence One Two O O No V a Yes as victim O O Yes as perpetrator O 0 Unknown When a question asks for a number there is a check to make sure you entered a numeric response rather than text There is also a check to be sure that dates are entered in a mm dd yyyy format In the following example immediately after an invalid answer is entered a red asterisk will appear next to the box This red asterisk indicates that the answer is not valid and should be corrected 13 Number of other children living with child ftwo 13 Number of other children living with child 2 When you save a page you will receive an error message at the top of the page if there are invalid responses that need to be addressed No changes to a page will be saved if there is even a single error message returned The Internet system cannot submit the correct answers while holding back the incorrect one It is an all or nothing process Therefore if you receive an error message you will not be allowed to leave the page until you have addressed all of the issues in the message No data will be lost as long as you address the errors
43. mother spoke a different language than the provider and an interpreter was not available Referrals not made Conditions or circumstances warranting a referral were identified in an assessment but no referral s made to appropriate services Specialist needed not available A needed or required specialist was not located reasonably nearby mother s residence Multiple providers not coordinated Mother received care from more than one provider resulting in sporadic and fragmented care Lack of child care Mother did not have access to quality affordable child care by either relatives support persons or licensed day care during pregnancy Lack of family social support Mother had few or no friends or family members providing emotional financial or physical support during pregnancy Services not available A needed or required clinical service was not located reasonably nearby mother s residence Data Dictionary 15 Section A Child Information e Distrust of health care system The mother s or family s fear or distrust of or dissatisfaction with a provider s was a factor in their not using a service in a timely or effective manner e Unwilling to obtain care Mother unwilling to seek prenatal care regardless of provider encouragement or referrals e Intimate partner would not allow care The mother s intimate partner who could be her husband boyfriend or female partner used violence or threats of violence or termination of the relations
44. oOo a E a E a E ooo a E a 98 9 OF ooo oo 000 ooooeo oO OD kone D e E e E n B oO OOO DS ooo E n E e E a E a O 82 krne E n E a E n B a 99090 82 Cone S e n E a oO OU OD i ooo n Oo OU OU OS ooo 7 OU OO OD ooo OOOO 90 i Report 1 Demographics Ethnicity Race and Age Group by Sex Continued American Indian Native Alaskan Multi racial lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal oo oOo 92700 6 D ooo 000090 0 80 ooo 0700009080 ooo 0000900908 ooo O70 0900900 0 i oo oOo E a S a E e E e E ooo a B a 0090080 ooo e E ee S 000 0 ooo Oo 0 009000 ooo oo 0 000 0 oooo 920000 ooo O00 09090080 ooo oo 0 0200 80 ooo oo 0 0090080 ooo oOo 000 0 Report 1 Demographics Ethnicity Race and Age Group by Sex Continued lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal ooo 7000909080 ooo 970009097080 T E ooo 70 0090808 i Report 2 Infant Death Information Natural Accident Homicide _Undeter
45. occurred it can be coded in the Other category Code as yes if child was noted as using illegal drugs such as heroin or cocaine abusing prescription medications such as pain relievers or Valium or Data Dictionary Section A Child Information regularly using inhalants e g sniffing gas If the child is mentioned a using illegal drugs even if addiction or abuse in not specifically mentioned code as Yes A child who is noted as participating in a drug or alcohol rehabilitation program or treatment including self help groups and 12 step program should be coded as yes even if the child was noted as being currently clean and sober A child with short term experimental use that did not cause life problems and or addictions should be coded no A problem from the past e g five years or more ago that has resolved and no longer appears to apply should still be coded yes Previously attempting suicide via overdose is not sufficient justification for answering yes to this question in the absence of other information A23 Child had history of child maltreatment Child has history of being the victim or the perpetrator of child maltreatment child abuse or neglect History means a referral or substantiation from Child Protective Services or documentation from autopsy law enforcement report or medical records Select N A if the child was too young to perpetrate child maltreatment If referrals were ma
46. omission that in and of itself led to the physiological processes precipitating the child s death Generally the act in question was both necessary and sufficient to kill the child The death may have occurred instantaneously or substantially after the act The contributing cause of death refers to an act that plays a role but not the primary role in the death The contributing or indirect cause of death describes a necessary but not sufficient act of commission or omission that contributed in a substantial manner to the death of the child The act did not in and of itself precipitate or lead inevitably to the physiological processes leading to death However it is understood to have been a necessary element in the child s death The death may have occurred instantaneously or substantially after the act I2 Was the act s In general an intentional act is an act for which the person involved has a purpose or willingness to commit the act regardless of whether it leads to harm An unintentional act is one for which there is no evidence of an intent to either commit or failure to commit the act Undetermined intent means that there is insufficient evidence to determine if an act was intentional or unintentional The determination of intent should be grounded in evidence and professional judgment not emotional reactions or stereotypes See Item I 1 for definition of caused and contributed I3 What act s caused or contributed to the
47. statement will appear that advises you of the number of cases with missing year of death information You can select the case type that you would like included in your reports This is the question found on the Case Definition data entry page with the options of child death child near death event or not born alive The selection criterion also has the option to view all cases Selection Criteria Allcases Cases marked as complete for data entry Year of Review Year of Death Start Review Year 2004 gt Start Death Year End Review Year 2007 End Death Year County Name gt Case Type Child Death 19 If you are a state level user you have an additional control in the selection criteria to run reports by individual counties teams in your state Leaving this control blank is equivalent to running a state report Selection Criteria All cases Cases marked as complete for data entry Year of Review Year of Death There are 452 cases missing a value for year of death These cases will be excluded from reports Start Review Year 2004 Start Death Year 2006 End Review Year 2007 7 End Death Year 2006 County Name Alcona Case Type Child Death Report Generation After you have verified the selection criteria for your reports find the report you wish to run in the list below Click on the Local or State hyperlink in order to genera
48. supervisors attention being diverted off the child and onto something else e Absent Supervisor was not present at time of incident e Impaired by illness specify Impaired by illness refers to a physical illness that renders a person incapable of effectively supervising a child This includes any acute or chronic medical condition that may limit the person s ability to care for a child Impaired by mental illness may include conditions such as depression PTSD bi polar disorder or other diagnosed mental health condition e Impaired by disability specify Impaired by disability refers to a condition that renders a person incapable of effectively supervising a child Impaired by disability may include developmental delays Blindness is an example of a disability that may limit a person s ability to care for a child e Other Specify all other factors that contributed to poor quality of supervision Data Dictionary 22 Section C Supervisor Information Section D Incident Information Incident refers to the place where the event occurred For injury deaths incident refers to the injury event For natural deaths consider the incident as the acute event leading to the death This may be the same as the date of death For example if a child dies from a fatal asthmatic episode the incident date would be the date of the onset of the asthma attack leading to the death For a child with a chronic illness such as cancer the incident date may be th
49. the Print Case opens in Adobe Acrobat you can either print the case or save it to your computer or server If you do not have Adobe Acrobat then you can use the Get Adobe Reader hyperlink in the Help Section to download a free copy of Adobe Acrobat Reader Please check with your technology staff before downloading and installing any new software You also have the ability to print individual sections of a case Select Print This Section from the navigation menu on the left side of the screen to print out only the section that is currently open for entry or editing Important If you have an Internet pop up blocker installed you will need to turn it off in order for Print Case to work properly Delete Case Clicking Delete will remove an existing case from the system A window will open asking if you are sure that you want to delete the selected case If you wish to proceed with deleting the case then click on OK If you wish to keep the case intact then click on Cancel Any cases deleted from the system cannot be retrieved so please use this action with care Microsoft Internet Explorer x 2 re you sure you want to delete case number 23 01 04 2004 0001 last name Smith cne 18 Section 5 Create Standardized Reports Clicking on the Create Standardized Reports option from the Welcome Page gives you the ability to run pre defined aggregate reports for the Internet Child Death
50. years Age of the supervisor C6 Supervisor s sex Sex of the supervisor C7 Does supervisor speak English Indicate if supervisor speaks and understands English Code as yes if supervisor was able to respond to questions surrounding the circumstances of the child s death If supervisor does not speak English specify language spoken C8 Supervisor on active duty in the military Supervisor is documented as being active in military at time of incident Active in the military includes all people performing active duty in the United States Armed Forces This includes those in reserve forces and National Guard performing temporary duties at the time of incident If yes specify branch of military C9 Supervisor has history of substance abuse Supervisor is perceived by self or others to have a problem with or to be addicted to alcohol or other drugs If tobacco abuse exists it can be coded in the Other category Code as yes if supervisor was noted as using illegal drugs such as heroin or cocaine abusing prescription medications such as pain relievers or Valium or regularly using Data Dictionary 20 Section C Supervisor Information inhalants e g sniffing gas If the supervisor is mentioned a using illegal drugs even if addiction or abuse in not specifically mentioned code as Yes A person who is noted as participating in a drug or alcohol rehabilitation program or treatment including self help group
51. Caregiver s have disability or chronic illness Two O No O Yes O uK es check all that apply L Physical specify Mental specify L Sensory specify U K If mental was caregiver receiving services O O No O O Yes O Ouk Children ever removed 14 Caregiver s have prior child deaths If yes cause s Check all that apply 15 Caregiver s have history of 16 Caregiver s have delinquent criminal history Two O No O Yes O uK es check all that apply O Assaults Robbery O Drugs Two L Child abuse Child neglect _ O Accident Suicide O SIDS Other intimate partner violence Two O No O Yes O uK Two No O Yes as victim One O O O Yes as perpetrator O u k One O I O l O I Other specify U K Other specify U K C SUPERVISOR INFORMATION 1 Did child have supervision at time of incident leading to death 2 How long before incident did 3 Is person a primary caregiver as listed O No not needed given developmental age or circumstances go to Sect D O No but needed answer 3 15 O Yes answer 2 15 supervisor last see child Select one in previous section O No O Yes caregiver one go to 15 Child in sight of supervisor O Minutes O Hours O Days 5 Supervisor s age in years Unable to determine try to answer 3 15
52. Case Report Tool available as a paper PDF or web based form 2 A web based application with the following features a Registered users can enter case report data on line to a centralized database find edit delete and print case reports download data from case reports and download standardized formatted reports b The database located on a SQL server at MPHI will store and sort the case report data by local state and national groupings and allow for the data downloads and standardized reports A person designated by your state CDR program serves as your State Administrator This Administrator identifies and registers the local and state users and determines their levels of access to the data based on your state laws and policies A Data Use Agreement is signed between your state and the Michigan Public Health Institute The system has a secure login so that only registered users with passwords are able to access the system via the Internet Users are encouraged to review the supporting material especially the Internet Database User Manual Familiarity with the supporting documents will make your experience entering cases and using the features of the system easier for you The system is free to registered users We continue to welcome any and all feedback regarding the usefulness ease of use and functionality of this case reporting system There are error logs and feedback forms located in the back of this manual For more inf
53. Dictionary 19 Section B Primary Caregiver s Information Section C Supervisor s Information Supervision is defined as a person who has responsibility for care and control of child at time of incident If there were two supervisors at time of incident but one clearly had primary responsibility code person with primary responsibility If responsibility of supervision was divided between two people code person who was in closest proximity with the child prior to incident as the primary supervisor Cl Did child have supervision at time of incident leading to death Indicate if a person had care and control of the child at the time of incident C2 How long before incident did supervisor last see child Approximate amount of time that passed between last time supervisor physically saw child and the incident If time of incident is unknown indicate amount of time that past between last time supervisor physically saw child and time child was found C3 Is person a primary caregiver as listed in previous section Supervisor is listed as a caregiver in Section B If yes go to question 15 C4 Primary person responsible for supervision at time of incident Relationship of supervisor to child If a newborn infant dies in a hospital shortly after birth in most circumstances hospital staff should be listed as the supervisor If hospital staff or institutional staff is selected questions C4 C14 will be hidden C5 Supervisor s age in
54. HER TRANSPORT a Vehicles involved in incident b Position of child c Causes of incident check all that apply d Collision type Total number of vehicles O Driver Speeding over limit C Back over Child not in on a vehicle Child s Other primary vehicle O Passenger Unsafe speed for conditions Rollover but struck by vehicle None O Front seat Recklessness Poor sight line Child in on a vehicle Car O Back seat Van O Truck bed Ran stop sign or red light Car changing lanes struck by other vehicle Driver distraction Road hazard Child in on a vehicle Sport utility vehicle O Other specify Truck uK Mechanical failure Cell phone use while driving Child in on a vehicle Semi tractor trailer O on bicycle Poor tires RV O Pedestrian School bus Walking Other bus O Boarding blading Racing not authorized that struck person object Poor weather O O E O Driver inexperience Animal in road that struck other vehicle O O E Other driver error specify Other event specify Poor visibility Drugs or alcohol use Other specify Motorcycle Other specify Tractor O uK Other farm vehicle O uK Fatigue sleeping E je E E a a ane a E E EE Medical event specify U K All terrain vehicle e Driving conditions check all that apply f Location of incident check all that apply Snowmobile C Normal C1 Other specify City street LC Driveway Bicycle L Loose gravel Residential street Pa
55. IVE bE 4 www childdeathreview org Email info childdeathreview org 1 800 656 2434 National MCH Center for Child Death Review NATIONAL CENTER FOR ee DEATH REVIEW KEEPING KIDS ALIVE KIDS ae Understanding How BE and Why Children Die it amp Taking Actions to vw Prevent Child Deaths The Child Death Review Case Reporting System Standardized Reports For Registered Web Users Version 2 January 1 2008 National MCH Center for Child Death Review TABLE OF CONTENTS How to Generate View and Print a Report ccssccsscccsccescccsccssssssess 4 Selection Criteria e ec a en dea iweacs gece po se eens a EAA cess sean nce AE sees 4 Report Generati n ss sinc ven seat erene sen PEE oa SEK apn enema oensnvnensasenans 5 The Report View Window cccceeee cence ence eee eeeeeeeaeeceaeeceeenieees 5 Savea REDON Sada sl sade ite cae irene rel E Smelt padi N as 6 Pinta REPOU eeen poneren ke Eee N Aes desi ehier ET NE ange RANE 6 ROOFS sae siaiwadsucteaccideaNcanew E EE TE E 7 Infant Child Information Reports l 3 essssssssssreesrrrrrrseeresserrrerresse 7 Incident Information Report 4 ccc eee ee cece ence nee e eee ne ene eceenaeenes 14 Motor Vehicle and Other Transport Reports 5 8 ceceeeee cence es 15 Fire Reports 9 10 noreg eea ea T als hed 2g OU ERE EVE EAER 21 Drowning Reports 11 12 cv vccexen sus innar ta TOE LR EEN EAEAN E aa 24 Suffocation Asphyxia Report 13 0 ce
56. Information 4 Investigation Information Local State The report opens in a new window so we recommend that you modify any pop up blocker software to always allow pop ups from our site https www cdrdata org If the new report window is still not visible check the Windows Task Bar at the very bottom of your screen to see if one of the open programs is the report The Report View Window When the Report View window opens it may only be displaying the first pre defined report page Many of the reports are multiple pages You can determine the report length from the toolbar at the top of the Report View window The example below shows that you are on page of 3 The four arrows to the left of page number are your tools to navigate through the report pages From left to right the arrows are first page previous page next page and last page ye 5 gt N A 3 100 Every report has a header that displays information about the report generated including the report title the start and end review year or start and end death year selected in the criteria your state and if it s a local level report your local team or the county team selected in the criteria the case type selected in the criteria and whether or not the cases have been completed for data entry Demographics Ethnicity Race and Age Group by Sex Death Year Range 2006 to 2006 Michigan Alcona Child Deaths Revie
57. K Select unknown if your team was unable to determine the types of problems the child was experiencing with school Al9 Child s health insurance Indicate type of health insurance child was covered under at time of incident e None Family child had no medical insurance at time of incident e Private Private insurance is defined as family s medical care paid for by private third party payer such as Blue Cross Blue Shield or under a private HMO or managed care program e Medicaid Medicaid is defined as family s medical care paid for by Human Services or other government support non managed care or by a managed care program of Human Services or other government support e State plan State plan is defined as family s medical care being paid for by any type of state sponsored plan except Medicaid e Other specify Family s medical care paid for by any other type of support excluding self support e Unknown CDR team does not know if the child was insured A20 Child had disability or chronic illness Child had a disability or chronic illness prior to the time of incident Chronic implies an impairment or illness that has a substantial long term effect on the child s day to day function or health e Physical Physical includes any anatomical loss physiological disorders cosmetic impairments and or diseases Examples may include paraplegia cerebral palsy cystic fibrosis diabetes cleft palate or cancer Data Dictionary 8g Section
58. Manner and Primary section that is displayed on your screen will be in red at Cause of Death all times Menu options will change to red to indicate G Detailed Information by Cause your selection as you move your mouse pointer over of Death them H Other Circumstances of Incident I Acts of Omission or Commission Y d ci f the d l Sarde is Pap and ou can proceed to a particular section of the data too Community as a Result of Death by clicking on the desired option in the data entry K Prevention Initiatives Resulting navigation menu or you can proceed to the next section from the Review by clicking the Save and Continue hyperlink at the L The Review Meeting bottom right corner of every page Data will be saved if M Narrative you use either the data entry navigation menu or the N Form Completed by ce Save and Continue hyperlink You can also leave the data entry section save your data and return to the Welcome Page at any time by clicking on the Save and A Exit hyperlink at the bottom of the data entry me phe navigation menu Due to security reasons the Internet system will time out after 60 minutes if there has not been a page saved This is technically not the same as inactivity For example if you enter data for 30 minutes and take a conference call for 30 minutes your session will time out and any unsaved data will be lost The Internet system can only recognize that you are still working when
59. NATIONAL CENTER FOR Bu DEATH REVIEW KEEPING KIDS ALIVE KIDS ALIVE Understanding How AA and Why Children Die ie amp Taking Actions to A pe Prevent Child Deaths The Child Death Review Case Reporting System Systems Manual Designed by and for state and local CDR programs in order to maximize the effectiveness of the review process to prevent child deaths Version 2 January 1 2008 National MCH Center for Child Death Review Table of Contents Section One Section Two Section Three Section Four Section Five Section Six Introduction and Description of the System Child Death Review Case Report User Manual Definitions Standard Reports Error Logs Feedback Forms Contact Information Introduction A child s death is a sentinel event that can be a marker in a community for the health and safety of children Child Death Review CDR is a process that works to understand child deaths in order to prevent harm to other children It is a process that brings people together at a state or local level from multiple disciplines to share and discuss comprehensive information on the circumstances leading to the death of a child and the response to that death These reviews can lead to action to prevent other child deaths at a local state or national level As of January 2008 49 states and the District of Columbia have established state and or local CDR teams The Maternal and Child Health Bureau of th
60. O Yes caregiver two go to 15 4 Primary person responsible for supervision Select only one O Friend O Acquaintance O Hospital staff go to C15 Institutional staff go to C15 Q Babysitter 6 Supervisor s sex O Male O Female O uK 8 Supervisor on active military duty O No O Yes O uK If yes specify branch O Biological parent Adoptive parent Ouk O Step parent 7 Does supervisor speak English O no O Yes O uK If no language spoken O Foster parent Mother s partner Licensed child care worker Other specify O UK Father s partner Grandparent O Sibling Other relative 9 Supervisor has substance 10 Supervisor has history of child maltreatment 11 Supervisor has disability 12 Supervisor has prior child deaths O No O Yes If yes check all that apply or chronic illness O No O Yes If yes check all that apply abuse history As Victim As Perpetrator O No OYes OUK O O No If yes check all that apply O O Yes O UK O UK CI Alcohol O Cocaine C Marijuana L Methamphetamine C Opiates L Prescription drugs L Over the counter CI Other specify C u k Supervisor has history of intimate partner violence OO No C1 Yes as victim O Yes as perpetrator O uK O O uK If yes check all that apply Physical o L Neglect Sexual o O Emotional psychological U K _____ CPS referrals Substantiations Ever
61. OK As stated at the bottom of the Print window you may see another window in which you should select Open this file and click OK Adobe will automatically launch with the complete report In Adobe you can either print the report or save it to your desktop 3 Print the Report Microsoft Internet Explorer To Print 1 Inthe next dialog that appears select the Open this file option and click the OK button 2 Click the printer icon on the Acrobat Reader Menu rather than the print button on your internet browser ox Cancel Reports Infant Child Information Reports Report 1 Demographics Ethnicity Race and Age Group by Sex lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal Hispanic Latino any race oo oo 92 O38 9 FCO oo n n E a OOO DS i oooo eo a 9090 i Report 1 Demographics Ethnicity Race and Age Group by Sex Continued Black African American Native Hawaiian Pacific Islander lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years Unknown Subtotal ooo
62. Pending _ Unknown ne ERA Low Birth Weight lt 2500 grams Intrauterine Smoke Exposure Intrauterine Alcohol Exposure Intrauterine Drug Exposure Late gt 6 wks or No Prenatal Care Footnote Columns do not add up to total deaths because the factors are not mutually exclusive Infants should not have a manner of death suicide so this manner is not included in this table 10 Report 3 Manner and Cause of Death by Age Group EE EI EO i Ges Any Injury Asthma Cancer Cardiovascular Congenital anomaly HIV AIDS Influenza Low birth weight Malnutrition dehydration Neurological seizure disorder Pneumonia Prematurity SIDS Other infection Other perinatal condition Other medical condition Undetermined medical cause Unknown Sub Total Soere eee eee eee eee eee Soerereo oo ee eo eee eee ee Seovev ooo eee oe eee eo ee Sov evev oe ee eo eee eee eee Svovevev ooo ooo ee eee ooo Sexvrevev eee eee eee eee eee Sore eo eee eo eee eee ee 11 Report 3 Manner and Cause of Death by Age Group Continued Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Sub Total oooo ooo0oo0oo0o ooo ooo0oo0oo0 ooo0oo0ooo0oo0oo0oo0 oooo ooon ooo ooo0oo0oo0 oooo ewag o eooo eooono eooo eooo eooo eooo Any Medical Cause M
63. Review Case Reporting System Depending on your permission level set by your State Administrator you may or may not be able to generate local level reports or state level reports How to Generate a Report The main Reports Page contains the selection criteria for the reports and the menu list of the reports that you can run grouped into similar types of information Selection Criteria The standardized reports are generated by the year of case review or by year of death The standardized reports also have the ability to filter cases based upon whether the cases have been marked complete for data entry This is the check box Data Entry Completed For This Case in Section N of the report If you would like to run a report for all cases reviewed between 2004 and 2007 select 2004 for the start review year in the drop down box and 2007 for the end review year in the drop down box see first example below If you would like to run a report that included all cases where the year of death was 2006 select 2006 for the start death year and 2006 for end death year see second example below You must select either All Cases or Cases marked complete for data entry Likewise you must select either Year of Review or Year of Death in the selection criteria If you select Year of Death as your selection criteria the reports will automatically exclude those cases that do not have a year of death entered into the data tool A
64. See Item I 1 for definition of caused and contributed 125 At time of incident was person Indicate person s status at time of incident for items a h See Item I 1 for definition of caused and contributed e Drug impaired Drug impaired refers to being under the influence of any intoxicating compound or combination of intoxicating compounds to a degree that impairs a person s ability to function or supervise a child e Alcohol impaired Alcohol impaired refers to being under the influence of alcohol to a degree that impairs a person s ability to function or supervise a child e Asleep Person was sleeping at time of incident e Distracted Distracted refers to person s attention being diverted off the child and onto something else e Absent Person was not present at time of incident e Impaired by illness specify Impaired by illness refers to a physical illness that renders a person incapable of effectively supervising a child This includes any acute or chronic medical condition that may limit the person s ability to function or care for a child Impaired by mental illness may include conditions such as depression PTSD bi polar disorder or other diagnosed mental health condition e Impaired by disability specify Impaired by disability refers to a condition that renders a person incapable of effectively supervising a child Impaired by disability may include developmental delays Blindness is an example of a disability that may lim
65. Type of Action Level of Action Recommendation Planning Implementation Short term Long term Local State National Media campaign School program Community safety project Provider education e oO S 3 ko wW Parent education Public forum Other education New policy ies Revised policy ies New program New services Expanded services New law ordinance Law Amended law ordinance Enforcement of law ordinance Modify a consumer product Recall a consumer product Modify a public space Environment Modify a private space s 00 OO 00 0 0000 0O O00000 OOO oo0ooo0ooo0oo0oo0oo000000000000 oo0ooo0ooo0oo0oo0oo000000000000 o0g0g0o og0ooudoido0iddadououaodidai0 g Other specify Briefly describe the strategies 3 Who took responsibility for championing the prevention strategies Check all that apply O N A no strategies C Mental health Law enforcement Advocacy organization O Other O Noone Schools Medical examiner Local community group specify O Health department Hospital L Coroner New coalition task force H C1 Social services Other health care providers Elected official Youth group O uk L THE REVIEW MEETING PROCESS 1 Date of first review meeting 2 Number of review meetings for this case 3 Is review complete
66. Was medical condition associated with disease outbreak Indicate if medical condition child suffered from was associated with a disease outbreak e g flu virus etc Gllh Was environmental tobacco exposure a contributing factor in the death Code as yes if the team believes that environmental tobacco exposure contributed to the death Do not code yes if the child was a smoker but secondhand smoke was not known to be a contributor Secondhand smoke also known as environmental tobacco smoke is a complex mixture of gases and particles that includes smoke from the burning cigarette cigar or pipe tip sidestream smoke and exhaled mainstream smoke Secondhand smoke contains at least 250 chemicals known to be toxic including more than 50 that can cause cancer National Toxicology Program 11th Report on Carcinogens 2005 Data Dictionary 47 Section G11 Medical Condition Secondhand smoke exposure causes respiratory symptoms in children and slows their lung growth Secondhand smoke causes acute respiratory infections ear problems and more frequent and severe asthma attacks in children There is no risk free level of secondhand smoke exposure Even brief exposure can be dangerous U S Department of Health and Human Services The Health Consequences of Involuntary Exposure to Tobacco Smoke A Report of the Surgeon General 2006 Glli Were there access or compliance issues related to the death If there were compliance wi
67. a page save is initiated Important Please refrain from using the Back button located in the toolbar of your browser while you are in a data entry page The Back button has been disabled in the data tool such that if you click on the Back button you will not be brought back to the last page you visited but will remain in the current section of the data tool In addition you will lose any data that has been entered unless Save and Continue or Save and Exit was clicked prior to hitting the Back button Due to another issue with Web programming you will not be able to use the Enter key or the arrow keys to move from question to question You will need to use either the Tab key or your mouse Defining a Case Number The first data entry page that appears on your screen is the Case Definition Page which corresponds to the Case Number section of the paper form This is where you create the unique identifier for the case you are entering The paper form allows for four levels of information to define a case State County or Team Number Year of Review and Sequence of Review However depending on the profile that your state has established with the National Center you may not see all of these options State This identifier is automatically filled in for you and you cannot edit this field Every state has a unique identifier County States that have county level teams will have this identif
68. ade but not substantiated still select Yes regarding history unless the referral was found to be completely falsified If yes specify type s of maltreatment substantiated If child welfare referral or substantiations are documented indicate total number of CPS referrals and substantiations Indicate if caregiver ever received CPS prevention or Family Preservation services or had children removed B13 Caregiver s have disability or chronic illness Supervisor has a disability or chronic illness Chronic implies an impairment or illness that has a substantial long term effect on day to day functioning or health e Physical Physical includes any anatomical loss physiological disorders cosmetic impairments and or diseases Examples may include paraplegia cerebral palsy cystic fibrosis diabetes cleft palate or cancer e Mental Mental disorders are health conditions characterized by alterations in thinking mood or behavior or some combination thereof associated with distress and or impaired functioning They include any psychiatric disability mental illness or mental retardation Examples may include depression bi polar disorders or Downs Syndrome This includes cognitive learning disabilities o If mental illness was supervisory receiving mental health services Indicate if supervisor was currently receiving services e Sensory Sensory disorders refer to any disability or chronic disease that impairs the senses including vis
69. aged fence LI Fence too short L Door self closer failed C Window left open L Cover not locked C Other specify If yes rules violated Gate latch failed L Door left open L Window screen torn O No Yes UK Gap in gate CI Door unlocked CI Alarm not working Climbed fence L Door broken L Alarm not answered v Child able to swim O N A O Yes O No O UK z Rescue attempt made O N A O No O Yes O UK 4 ASPHYXIA a Type of event w For bathtub child in a bathing aid O No Yes O UK If yes specify type x Warning sign or label posted O NA O Yes O no O UIK aa Did rescuer s also drown O N A O Yes O No O uK If yes number of rescuers y Lifeguard present O N A O Yes O no O uK bb Appropriate rescue equipment present O N A O Yes O No O UK If yes who Check all that apply CI Bystander C Other specify Ol uk O Parent Ll Other child C1 Lifeguard b If suffocation asphyxia action causing event Suffocation go to b Sleep related e g bedding overlay wedged Confined in tight space Swaddled in tight blanket but not sleep related Strangulation go to c Refrigerator freezer O Wedged into tight space but not sleep related Choking go to d Covered in or fell into object but not sleep related Plastic bag Toy chest O Dirt Sand O Asphyxia by gas answer G9a Other specify uk Automobile O Trunk Other specify
70. and save the page using either Save and Continue or the navigation menu 11 Making Changes to Data Entered Changes can be made to any question in both the Enter a New Case mode and the Edit an Existing Case mode to be discussed in Section 4 As previously mentioned data is saved as you move from page to page If you return to a page that you have completed you can change an answer you had previously saved On your next page save these changes will be saved with the new answer Any previous answers to that question including previous answers in follow up questions will be deleted There is one exception to this rule due to an issue with Web programming you will not be able to de select a radial button Please contact the National Center if you need to de select a radial button If you have made changes to a page prior to saving it and have made a mistake that you wish to undo you can use the Undo Changes hyperlink located at the bottom left corner of every data entry page Unlike the familiar undo function in Windows that will undo the last single change clicking on this hyperlink will remove all changes made to the current page since the last save Data that was previously saved remains unchanged There is one place where you can undo changes to a single question Since question 4 in Section K Prevention Initiatives Resulting from Review is so complex there is a quick way to reset it without using the Undo Changes
71. arly during lifetime Second hand smoke is defined as smoke which is exhaled by a smoker or originates from a tobacco product which he she is using to which a child is exposed It includes smoke from a smoldering cigarette cigar pipe or other tobacco material If yes indicate frequency Frequent exposure refers to several times a week Occasional exposure refers to several times a month G5b Child overheated Child was overheated at time of death If yes specify reason for overheating Overheated is defined as a body temperature not caused by a fever that is more than one degree above 98 7 degrees Fahrenheit G5c History of seizures Child had a documented history of seizures A seizure is an involuntary muscular contraction and relaxation originating from the short circuit of the central nervous system Seizures vary in pattern length and intensity Causes include fever tumors injuries or epilepsy If yes were the seizures ever witnessed G5d History of apnea Child had a documented history of apnea Apnea is defined as an interruption in the normal breathing patterns of a child If yes was the apnea ever witnessed Data Dictionary 39 Section G5 SIDS and Undetermined Cause Under One Year Section G6 Weapon Including Person s Body Part G6a Type of weapon Specify type of weapon used in incident to cause injury to the child A firearm is a weapon consisting of a metal tube that fires a projectile at high vel
72. as complete for data entry Year of Review Year of Death Start Review Year 2004 Start Death Year End Review Year 2007 End Death Year County Name gt Case Type Child Death If you are a state level user you have an additional control in the selection criteria to run reports by individual counties teams in your state Leaving this control blank is equivalent to running a state report Selection Criteria C All cases Cases marked as complete for data entry C Year of Review Year of Death There are 452 cases missing a value for year of death These cases will be excluded from reports Start Review Year 2004 Start Death Year 2006 End Review Year 2007 End Death Year 2006 County Name Alcona Case Type Child Death Report Generation After you have verified the selection criteria for your reports find the report you wish to run in the list below Click on the Local or State hyperlink in order to generate a local level or state level report Be sure to click on the hyperlink in the same row as the report that you are interested in Depending on the complexity of the report it may take up to a minute to generate so please be patient Infant Child Information 1 Demographics Ethnicity Race and Age Group by Sex Local State 2 Infant Death Information Local State 3 Manner and Cause of Death by Age Group Local State Incident
73. at time of incident Data Dictionary 41 Section G6 Weapon Including Person s Body Part Section G7 Animal Bite or Attack G7a Type of animal Specify type of animal causing fatal injury even if child died from complications rather than actual injury If insect is selected only answer remaining section questions if applicable G7b Animal access to child Indicate how animal gained access to child G7c Child provoke animal Code as yes if child s actions provoked angered or startled the animal causing a bite or other attack G7d Animal has history of biting or attacking Animal has a documented or reported history of biting or attacking Data Dictionary 42 Section G7 Animal Bite or Attack Section G8 Fall of Crush G amp a Type of incident Indicate if incident was fall or crush G8b Height of fall Estimate the number of feet and inches child fell from This is measured from the lowest point of the child to the surface they fell to The number of feet in one story varies by building architecture If unable to estimate then select Unknown G8c Child fell from Type of place where child fell from An example of a natural elevation would be a cliff man made elevation would be a scaffolding balcony porch or other structure not otherwise listed G8d Surface child fell onto Type of surface onto which child fell G amp e Barriers in place Type of barriers that were in place at time of in
74. ata entry pages for updates to be saved If you want to track when you downloaded the data or you have made multiple downloads it is helpful to store all of the files from a single download in a folder with the date in the title 23 Due to the confidential nature of the data the National Center for Child Death Review recommends that all data downloaded from the Internet Child Death Review Case Reporting System is stored in a folder on your computer or server that has restricted access so that only authorized personnel can view or use it Adequate firewall protection of computers used to download and or enter data is also recommended Download All Sections All Tables zip File Download a Section Table tCase Case Definition Table tINF Section A Table tGl Section B Table tSUP Section C Table tINC Section D Table tINV Section E Table tCAU Section F G12 Table tVEH Section G1 Table tFIR Section G2 Table tDRO Section G3 Table tSUF Section G4 Table tSID Section G5 Table tvVEA Section G6 Table tBIT Section G7 Table tFAL Section GB Table tPOl Section G9 Table tEXP Section G10 Table tMED Section G11 Table tCIR Section H Download All Sections At the top of the page is a hyperlink to download all of the tables at one time Save this file to a secure folder on your computer or server This download is in a zip format and you will need some kind of unzip utility to extract the file
75. ate total number of CPS referrals and substantiations Indicate if person received CPS prevention or Family Preservation services Indicate if person ever had children removed Terminology regarding referrals and substantiations varies by state 121 Person has disability or chronic illness Person has a disability or chronic illness Chronic implies an impairment or illness that has a substantial long term effect on day to day functioning or health e Physical Physical includes any anatomical loss physiological disorders cosmetic impairments and or diseases Examples may include paraplegia cerebral palsy cystic fibrosis diabetes cleft palate or cancer e Mental Mental disorders are health conditions characterized by alterations in thinking mood or behavior or some combination thereof associated with distress and or impaired functioning They include any psychiatric disability mental illness or mental retardation Examples may include depression bi polar disorders or Downs Syndrome This includes cognitive learning disabilities o If mental illness was supervisory receiving mental health services Indicate if supervisor was currently receiving services e Sensory Sensory disorders refer to any disability or chronic disease that impairs the senses including visual auditory and olfactory Examples include blindness and deafness 122 Person has prior child deaths Person has a documented history of having a child anyone 17 years
76. ays of caring for child as prescribed by a physician Lack of money for care Mother or family did not have insurance or other means for paying for prenatal care delivery and or pediatric care Limitations of health insurance coverage Delay loss or inaccessibility of medical services due to problems with health insurance coverage Multiple health insurance not coordinated Mother had multiple health insurance coverage policies resulting in delay or loss of medical care coverage authorizations for treatment etc Lack of transportation Mother did not have reliable public or private transportation to needed services or lack of transportation caused mother to miss appointments or services No phone Home workplace or dwelling where mother resided did not have a working phone nor was a cell phone available Cultural differences Mother exhibited health beliefs inconsistent with standard medical practices in the U S Religious objections to care Mother had religious objections to care expand definition Parents sometimes deny their children the benefits of medical care because of religious beliefs In some jurisdictions exemptions to child abuse and neglect laws can restrict government action to protect children or seek legal redress when the alleged abuse or neglect has occurred in the name of religion Language barriers The mother and provider s were not able to communicate effectively because of language differences For example the
77. b spa O N A O gt 1yr O lt 6 months O uK O 6m 1 yr In the pool hot tub spa On or under the cover O uK m Flotation device used ONA O No What barriers layers of protection existed If yes check all that apply to prevent access to water C Coast Guard approved CI Not Coast Guard approved Check all that apply O Yes O uK m Fence Describe type Fence height in ft Fence surrounds water on Four sides Two or O Three sides O UK t Local ordinance s regulating access to water O No O Yes UK Jacket Correct size Worn correctly O No less sides oO Cushion Lifesaving ring If jacket ONo O Yes O Yes p Gate check all that apply O UK O UK Has self closing latch Has lock Is a double gate Opens to water U K O swim rings O L Air mattress Inner tube or check all that L Patio door C Screen door C1 Steel door C Self closing O Has lock u How were layers of protection breached check all that apply No layers breached Gate left open Gate unlocked E Gap in fence O Other specify apply I C1 Opens to water C Barrier between door and water LC u k CI Door screen torn O None L Alarm go tor OO Fence go to o OO Cover go tos C Gate go top O uk O Door go to q Alarm check all that apply s Type of cover m m O Oo El Door Window Pool Laser U K 1 Cover left off O Dam
78. ce cece cece eee e eee e eee eeaeaeeeesteees 27 Weapon Including Person s Body Part Reports 14 16 0 e 29 Poisoning Overdose or Acute Intoxication Reports 17 18 c 34 Sleep Related Death Reports 19 23 36 Acts of Omission Commission Reports 24 29 E 42 Prevention Initiatives Resulting from Review Reports 30 31 ANERE ET 55 Review Meeting Process Report 32 sssssssessssssesssssrrrrrreeerssseeeresre 58 Data Entry Report gs 2 a en Soe E a E e N i ese ada RT 59 The Child Death Review Case Reporting System includes a number of pre defined aggregate reports which do not contain any case identifiers Depending upon your permission level set by your State Administrator you may or may not be able to generate local level reports or state level reports Not all sections of the Child Death Review Case Report were used in developing these standardized reports For more detailed reports users should consider downloading their entire data set as permissible by their state laws and their state CDR program How to Generate View and Print a Report Clicking on the Create Standardized Reports option from the Welcome Page brings you to the main Reports page window The Reports Page window contains the selection criteria for the reports and the menu list of the reports that you can run grouped into similar types of information Selection Criteria The standardized reports are generated by the year of case revie
79. ced Data Dictionary 61 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide manipulated or coerced penetration It can involve verbal coercion and threats physical restraint intimidation and or violence e Problems with the law Child was arrested for or charged with a misdemeanor or felony crime e Drugs alcohol There was documented use of drugs or alcohol e Sexual orientation Sexual orientation is the pattern of a person s emotional physical sexual attraction and psychological attraction to someone of a particular sex e Religious cultural crisis Child was experiencing a personal conflict with their religion or culture for example child was not allowed to date person or engage in certain activities due to religions prohibitions child was questioning personal belief system as it related to family s cultural practices or religion e Job problems Child had experienced problems with his or her or family s employment including firing disciplinary action difficulty obtaining work or other stresses related to employment e Money problems Child had experienced problems with his or her or family s money including debts stolen money and lack of money for activities e Gambling problems Child was involved in gambling to the extent that the child had debts was suspected of illegal gambling was betting for sports while participating on a team or had a gambling addiction e Involvement in cult ac
80. check child abuse or neglect For example if the team can t determine whether an abandoned baby was born alive or stillborn they could check the I1 Act s of Commission Omission item as Probable and the I3 Cause item as child abuse or child neglect to capture the information about the circumstances surrounding the death without having to classify the case as a child maltreatment death given the question of whether it was a live birth e Other negligence Refers to acts or failures to act that are neglectful including criminal negligence vehicular manslaughter voluntary intoxication but not restricted to the level of criminal culpability See Item I 1 for definition of caused and contributed e Assault not child abuse Refers to those cases where the alleged perpetrator is not in an explicit or implicit caregiver role e Religious or cultural practices Refer to potential mitigating factors that teams might consider in determining that the act s of commission or omission that lead to the child s death should not be classified as maltreatment CDRTs should be free to consider these potential exceptions or not although some states specifically allow for such religious or cultural exceptions But primary consideration should be given to the best interests of the child and the level of risk of harm to the child e Medical misadventure A broad term that encompasses the recognition that unintentional events or errors may oc
81. cident Information sssssuuueensessssssssssssserrrrrrrrerrereresesssse 23 Section E Investigation Information sssssssssssesrerrrerrrrerrererssssssssssererene 25 Section F Official Manner and Primary Cause of Death 27 Section G1 Motor Vehicle and Other Transport sssssrssuuereereresessssssssseseee 28 Section G2 Fire Burn or Electrocution ccc cece ccc c cece eee eee ccc ceeeeeneeeeceuaeues 31 Secon Got TOWN Ro T os odes aa eles aen ye cee AR wien AREA TEATRAR aAa 34 Section 4 ASP aye agave eenen fedex Et E Sea EEEE E O ATEN eE S aant 37 Section G5 SIDS and Undetermined Cause Under One Year of Age 39 Section G6 Weapon Including Person s Body Patt 0 ecceeccee eee eee eee ee eeees 40 section G7 Animal Bite Or Attacks ccvccctassexgievodiins eelecorttavenpiyoediin sie ieee 42 Sections Fall or Criishes cutest nent eet ane sing sudavs E E wan cere EET ai 43 Section G9 Poisoning Overdose or Acute Intoxication cee ceeeeee seen eee eee eeee 44 Secon Gr EXPOSUre a aide haha tadcas eile san ute aia E RE Soume on naeamene eee 46 section G11 Medical Condittoniess suis occ eyaes eves Seed ead dee ate av Se eee ae 47 Section G12 Other Cause Undetermined Cause or Unknown Cause 00005 49 Section H Other Circumstances of Incident 0 cc cece cece eee ee eee eee eneeneeeaeens 50 Section I Acts of Omission or Commission Incl
82. cident to prevent fall Barriers are defined as obstacles or objects placed in the child s way to prevent them from accessing a certain place Other window guard does not include screen but includes metal grates G f Was child in a baby walker Baby walker is defined as a light frame on casters or wheels to help a baby learn to walk G amp g Child pushed dropped or thrown Specify if child was either pushed dropped or thrown If none of these apply leave blank G amp 8h For crush did child If crush was primary cause of death specify child s position in relationship to object at time of incident GSi For crush object causing crush If crush was primary cause of death specify object that crushed child If crush caused by person indicate activity at time of incident Data Dictionary 43 Section G8 Fall or Crush Section G9 Poisoning Overdose or Acute Intoxication G9a Type of substance involved Indicate type of substance involved in incident List all types of substances contributing to the death not just the substance causing death Do not list substances unless they contributed to the death as documented on death certificate or autopsy report Prescription drugs should be listed in the prescription drug category even if the prescription drug was obtained on the street or was prescribed for another person Pain killer opiate should be selected for all prescribed opiates except methadone Cardiac
83. commended instructions were being followed and warnings observed at time of incident H2c Recall in place If death was the consequence of a problem with a consumer product specify if a recall was in place for the product Recall is defined as a request by the manufacturer of a defective product to return the product H2d Did product have safety label Indicate if product had safety label at time of incident that described any known hazards of the product or instructions for safe use Labels on hairdryers warning consumers to avoid water immersion is an example H2e Was Consumer Product Safety Commission notified If the Consumer Product Safety Commission was notified of the incident code as yes Data Dictionary 51 Section H Other Circumstances of Incident H3 Death Occurred During Commission of a Another Crime If yes answer the following question H3a Type of crime If death was the consequence of a crime indicate type of crime committed at time of incident A crime is a serious offense against the public law Definitions vary by state Robbery burglary A robbery is the taking or attempting to take anything of value from another person or persons by force or threat of force or violence If money or goods are stolen without force or threat of force e g a bookkeeper stealing money from a company thieves stealing equipment from a loading dock the theft is not a robbery but larceny and should be coded as
84. cur in medical institutions or by medical practitioners This does not refer to individual s intentional or unintentional misuse of medicines or medical procedures carried out without medical supervision 14 Child abuse type If death occurred as a result of child abuse specify type of abuse as documented by law enforcement CPS or other evidence reviewed by the team Physical abuse is any non accidental act that results in physical injury or the imminent risk of harm Emotional abuse refers to such acts as verbal assault belittling threats and blaming Sexual abuse is a single or series of sexual assault s or sexual exploitation s I5 Type of physical abuse Check category ies and provide brief details Abusive head trauma is a broader term for any child abuse case involving head injury including shaken baby syndrome Chronic battered child syndrome refers to children who have undergone physical abuse multiple times that has left them with both physical and psychological trauma Munchausen s Syndrome by Proxy MSP is a parenting disorder where parents fabricate symptoms in their children thus subjecting the child to unnecessary medical tests and or surgical procedures or inflict injury of children in the process 16 For abusive head trauma were there retinal hemorrhages Abusive head trauma is any injury to the head that was inflicted on the child Types of abuse included here are shaken baby syndrome with or without impact and
85. d because of review Review led to delivery of services Review led to changes in agency policies practices 58 Data Entry Report Report 33 County Team Numbers of cases reviewed oO E Alcona Alger Barry Benzie Berrien Branch Cass Dickinson 48 Grand Traverse Note Only counties or teams which have entered case information into the Child Death Review Case Reporting System will appear in this report Counties or teams with no cases entered into the web tool will not be listed or identified in the report 59 NATIONAL CENTER FOR CHILD DEATH REVIEW KEEPING KIDS ALI Ss Child Death Review Case Reporting System Error Log s f Your participation in the CDR Case Reporting System is highly appreciated Your experience with the system will be the basis for improvements for future releases You may find errors or have difficulty with the report tool and the Internet application Please record those errors and submit them via mail Name Phone Email Date Section of data tool Question What problem are you having don t understand the meaning of a data element term The data element s terms aren t appropriate for our case The skip pattern is not appropriate for our case The web application isn t working correctly received an error message Other describe What actions had you taken just prior to a problem with the
86. d flood tidal currents that are caused by egress and ingress of the tide through inlets and the mouths of estuaries embayments and harbors An undertow occurs after a wave breaks and runs up the beach Most of the water flows seaward this backwash of water can trip waders move them seaward and make them susceptible to immersion from the next incoming wave G3g For boating type of boat If boating related death specify type of boat child was riding in on at time of incident G3h For boating child piloting boat If boating related death specify if child was piloting boat at time of incident Data Dictionary 34 Section G3 Drowning G3i Type of pool If pool death specify type of pool This includes hot tubs and spas G3j Child found If pool death specify if child was found in pool hot tub spa or under cover If neither leave blank G3k For pool ownership Definitions of public and private pools can vary by state and locality Consult your state guidelines for more information In general a private pool includes a swimming pool spa wading pool or portable above ground pool at a single or two family family residence A public pool includes municipal institution hotel apartment mobile home or RV park private club or YMCA facility pools G3l Length of time owners had pool hot tub spa If residential pool spa hot tub death specify length of time person owned pool spa hot tub G3m Flotation device used
87. d to prenatal care O Yes O No O UK If yes check all apply C Lack of money for care C1 Limitations of health insurance coverage C Multiple health insurance not coordinated C Lack of transportation C No phone O Cultural differences B PRIMARY CAREGIVER S INFORMATION 1 Primary caregiver s Select only one per column O a D Two Self go to Sect C Biological parent O Adoptive parent O Step parent O Foster parent Mother s partner O Father s partner Grandparent O Sibling Other relative O Friend Institutional staff Other specify O UK Q O O O O O O O O O O O O O 10 Caregiver s have substance abuse history Two O No O Yes O uK If yes check all that apply L Alcohol Cocaine L Marijuana Methamphetamine O Opiates Prescription drugs L Over the counter Other specify O uk 2 Caregiver s age in years One Two si Years O Ouk Caregiver s sex Two O Male O Female O uK Does caregiver s speak English Two O No O Yes O uK If no language spoken Caregiver s have history of child maltreatment as victim Two O No O Yes O uK If yes check all that apply O_O Physical One O O O Neglect O Sexual Emotional psychological U K ___ CPS referrals Substantiations oO CI Ever in foster care or adopted Hav
88. date of the review meeting in which this case was first discussed L2 Number of review meetings for this case Indicate the number of review meetings that were held to discuss this specific case L3 Is review complete The review is complete if the team has determined that there will be no further meetings on this case For more information on determining if the review is complete check with your state CDR coordinator LA Agencies at review Indicate all agencies organizations that participated in the case review L5 Factors that prevented an effective review Issues that arose during the review process that impacted the team from effectively reviewing the case e Confidentiality issues among members prevented full exchange of information Confidentiality restraints prevented team members from sharing information e HIPAA regulations prevented access to or exchange of information The Health Insurance Portability and Accountability Act of 1996 was cited by a team member or an agency as a reason for not providing or sharing the information needed for an effective review e Inadequate investigation precluded having enough information for review The investigation into this child s death was incomplete The full circumstances surrounding the death were not known to the team because an investigating agency did not collect all crucial pieces of information e Team members did not bring adequate information to the meeting Not enough info
89. de e By selecting unknown cases will be returned where the manner of death was listed as unknown or left blank Search for Manner of Death Natural Accident Suicide Homicide C Undetermined Pending C Unknown Search Search for Cause of Death You can search for cases by the cause of death but can only search for one cause of death atatime Some examples of useful searches include e Select the Unknown checkbox Search for Cause of Death to return all cases where the cause of death was listed as E Unknown unknown or left blank e Select From an injury external cause to return all C From a Undetermined if injury medical cause or medical cause From an injury external cause Motor vehicle and other transport Asthma Cases where the cause of death Fire burn or electrocution Cancer Was listed from an injury Drowning Cardiovascular external cause Asphyxia Congenital anomaly i R m Weapon including person s body part HIV AIDS s Select From a medical cause Animal bite or attack Influenza to return all cases where the Fall or crush Low birth weight cause of death resulted from a Poisoning overdose or acute intoxication Malnutrition dehydration di ause Exposure Neurological seizure disorder eet Undetermined injury Pneumonia e Select a specific type of injury Other cause Prematutity
90. de but not substantiated still select Yes regarding history unless the referral was found to be completely falsified If yes specify type s of maltreatment substantiated If child welfare referral or substantiations are documented indicate total number of CPS referrals and substantiations Terminology regarding referrals and substantiations varies by state A24 Was there an open CPS case with child at time of death A Child Protective Services CPS case was currently open with the child that occurred prior to the incident causing the child s death Code as yes even if abuse or neglect was not substantiated For example services were in place such as family preservation strengthening A25 Was child ever placed outside of the home prior to death Code as yes if child ever had foster parents whether through the death of the biological parents through voluntary or forced adoption or through forced removal from a biological or adoptive home Foster care includes licensed and relative kinship foster homes A26 Were any siblings placed outside of the home prior to child s death If yes indicate number of child s siblings who had been placed in foster care or adopted before time of incident A27 Did child have a history of intimate partner violence Child had a documented history of intimate partner violence IPV as either victim or perpetrator Documented refers to evidence from law enforcement medical or
91. de the s after http otherwise the secured server may not recognize your contact attempt You may want to create a bookmark for this website so that you can easily access it in the future without having to remember the text you would need to type in the address bar To create a bookmark 1 Click on Favorites in the menu bar This will initiate a drop down list of options 2 The first option on this list is Add to Favorites click on this 3 A window will launch in which you have the option of changing the bookmark name and placing it in a folder with other bookmarks If you are unsure which settings you prefer simply click on the OK button 4 When you next click on Favorites this website will be included in the drop down list of options or in a folder in this list if you placed it there Login to the Website The first page of the website is a general information i r page that is available to everyone on the Internet Click on the picture of the running kids as seen on i i f the right to go to the system login page Type your S user name and password in the appropriate places 3 and click on the Login button Login to the CDR Database In order to login to the website you must be a registered user of the Internet Child Death Review Case Reporting System To become a registered user of the system contact your designated State Administrator or the National Center for Child Deat
92. death Acts of omission or commission that caused or contributed to the death of child should be identified by category Only one can be selected for caused and one for contributed if applicable In addition this is the single question that will be used to track child maltreatment cases For the CDR purposes child abuse and child neglect are defined at a minimum as an act or failure to act on the part of a parent or caregiver which results in death or presents an imminent risk of serious harm States may have their own definitions based on these minimum standards CDRTs also have different standards they apply but they should be based on evidence and professional judgments Legal definitions may serve as a baseline although they need not be used as a strict criterion Both a direct cause and a contributed cause of maltreatment can be checked e g direct cause of abuse by shaking a baby and contributing cause of neglect by failure to protect from a known hazard If the team judges that the caregiver behavior caused or contributed to the death but did not reach the level of maltreatment they should check the poor or absent supervision Data Dictionary 54 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide category Also as mentioned in Section I1 if the team is not certain whether to classify a child death as child maltreatment they can also use the initial question I1 to check Probable and then
93. deploys during a crash to act as a cushion for the occupant It creates a broad surface on which to spread the forces of the crash to reduce head and chest injury It is considered supplementary to the lap shoulder belts because it enhances the protection the belt system offers in frontal crashes e Lap belt A safety belt anchored at two points for use across the occupant s thighs hips e Shoulder belt A safety belt anchored at two points for use across the occupant s shoulder e Child seat A crash tested device that is specially designed to provide infant child crash protection o If child seat is selected indicate type A rear facing child seat is a type of child restraint system that is specifically meant for use by children from birth up to approximately 20 pounds and used in the rear facing mode only A front facing child seat is a type of child restraint that is specifically meant for use by children at least age one and at least 20 pounds and up to 40 pounds and used in the forward facing position only State regulations for safety seats may vary The source for the definitions listed here is the National Highway Traffic Safety Administration e Belt positioning booster seat A platform that raises the child to provide a taller sitting height so that adult lap and shoulder belts fit better Some have high backs as well Data Dictionary 29 Section G1 Motor Vehicle and Other Transport e Helmet Activity appropriate protective
94. e G12 page 11 then go to Section H For undetermined or unknown medical cause to infants also complete G11 page 10 then go to Section H Too much bedding 6 WEAPON INCLUDING PERSON S BODY PART a Type of weapon b For firearms type c Firearm licensed d Firearm safety features check all that apply O Firearm go to b Handgun O no O Yes O UK m Trigger lock o Magazine disconnect Sharp instrument go to j Shotgun L Personalization device O Minimum trigger pull Blunt instrument go to k BB gun C External safety drop safety Other specify Person s body part go to I Hunting rifle L Loaded chamber indicator U K O Explosive go to m Assault rifle e Where was firearm stored f Firearm stored with O Rope go to m O Air rifle Not stored Under mattress pillow with ammunition O Pipe go to m O Sawed off shotgun Locked cabinet Other specify O No O Yes UK Biological go to m Other specify Unlocked cabinet g Firearm stored loaded Other specify and go to m O uK O Glove compartment O uK O no O Yes O UK O UK go tom Owner of fatal firearm i Sex of fatal j Type of sharp object k Type of blunt object O UK weapon stolen Grandparent O Co worker firearm owner O Kitchen knife O Bat UK weapon found O Sibling Institutional staff O Male Switchblade O Club O Self O Spouse O Neighbor Female Pocketknife O Stick Biological parent O Other relative Ri
95. e Health Resources and Services Administration funds the National MCH Center for Child Death Review housed at the Michigan Public Health Institute In addition to its training and technical assistance activities the Center has developed and now manages the Child Death Review Case Reporting System In 2004 a work group of 30 persons representing 18 states developed the first version of the system Through consensus and after studying numerous state CDR case reports the workgroup developed a set of data elements and data definitions into the Child Death Review Case Report This case report was developed into both a written report and an internet data entry and database application Following a pilot test in 17 states the work group reconvened to revise the system based on state experiences using the pilot system Version 2 0 was launched in January of 2008 The Child Death Review Case Reporting System provides information on 1 The circumstances of and risk factors in child deaths reviewed by teams including information on the children caregivers supervisors perpetrators and the incidents leading to the deaths The investigations of the deaths Services provided or needed because of the deaths Teams recommendations and actions taken to prevent other deaths Factors affecting the quality of the case review process MAP WN The Child Death Review Case Reporting System includes the following components 1 The Child Death Review
96. e action taken Specify action taken if death occurred in a licensed setting such as child care Data Dictionary 26 Section E Investigation Information Section F Official Manner and Primary Cause of Death F1 Official manner of death from the death certificate Official manner of death as stated on death certificate or if unavailable as stated in medical examiner coroner report If pending update when official manner is available F2 From an injury external cause If death was due to an injury indicate primary injury category causing death Injury refers to any unintentional or intentional damage to the body resulting from acute exposure to thermal mechanical electrical or chemical energy that exceeds a threshold of tolerance in the body or from the absence of such essentials as heat or oxygen For example if a person is involved in a motor vehicle crash and dies from head trauma received during the crash the primary cause of death would be motor vehicle crash and the final cause of death may be head trauma For the purposes of this database the primary cause of death is coded as motor vehicle and other transport F2 From a medical cause If death was due to a medical condition indicate category of primary cause of death This is the cause of death that began the events resulting in the final cause of death SIDS is considered a medical condition according to the International Classification of Diseases ICD F2 U
97. e heavy alcohol use xposed LD Religious objections to care O Language barriers O Referrals not made O Specialist needed not available LI Multiple providers not coordinated O Lack of child care 4 Caregiver s employment status O 5 a Two OQ Employed Unemployed O On disability O Stay at home O Retired O uK 000000 Caregiver s on active military duty 9 Two O No O Yes O uK If yes specify branch 12 Caregiver s have history of child maltreatment as a perpetrator One Two O O no O OYes O Ouk If yes check all that apply m C Physical Neglect C Sexual O uK CPS referrals 5 Caregiver s income months Emotional psychological Substantiations LI CPS prevention services O Family Preservation services O Misuse over the counter or prescription drugs L Infant born with fetal alcohol effects or syndrome L Lack of family social support O Services not available LC Distrust of health care system C Unwilling to obtain care L Intimate partner would not allow care C Other specify 6 Caregiver s education Two O lt High school High school College Post Graduate O UK Two O High Medium Low O uK Caregiver s received social services in the past twelve If yes check all that apply One Two O O wic TANF O Medicaid Food stamps O Other specify 13
98. e same as the date of death with no acute event occurring D1 Date of incident event if different than date of death If date of incident was different than date of death specify date of incident If dates are identical check same For a newborn that did not leave the hospital select Same as data of death D2 Approximate time of day that incident occurred Specify time of day that the incident occurred using a 12 hour clock AM or PM can be selected without proving the specific hour D3 Interval between incident and death If a date was given for question one specify amount of time days weeks months or years that elapsed between incident and date of death If incident and death occurred on the same date provide the approximate time hours or minutes that elapsed Deaths that occurred instantaneously or within seconds should be coded as one minute D4 Place of incident Specify where incident leading to death occurred e g where the child was first injured For designations of specific buildings such as child s home or school include both building itself and area directly outside such as side walk If a child was injured in a variety of locations for example a teen was shot and was pursued by the attacker into a store and shot a second time code the location at which the child was first injured For children that died of natural causes with no acute event leading to the death the incident place i
99. e team members on how to implement and maintain a Child Death Review program We recommend the use of a color printer for printing Guides for Effective Child Death Reviews A tool for review teams that presents guidelines on reviewing different causes of death Information includes type of records to bring to the meeting risk factors and suggested services and prevention activities Child Death Review Case Report Form This is a copy of the paper Child Death Review Report Form We recommend the use of a color printer for printing Internet Database User Manual A copy of this document We recommend the use of a color printer for printing Internet Database Error Report Form This is a faxable form for reporting errors encountered with the Internet system When reporting errors please be sure to describe in detail what you were doing when the error occurred This information is important for staff to be able to replicate diagnose and correct the problem 27 Data Dictionary This is the document that provides more information about the definition of individual questions There are two options for viewing this document as a pdf file that can be printed or as an HTML document The HTML document is the one that is accessible from the top and bottom of every data entry page see example hyperlink below Click here for section A help A Child Information 1 Child s Name First Jane Unknown Middle Last Doe
100. e week B5 Caregiver s income Income level is an estimate based on the local context and costs of living in the community Economic indicators such as education social service enrollment and health insurance type can assist in determining a caregiver s income level If no concrete evidence exists regarding income select unknown B6 Caregiver s education Specify highest level of education which caregiver completed B7 Does caregiver speak English Indicate if caregiver speaks and understands English Code as yes if caregiver was able to respond to questions surrounding the circumstances of the child s death If caregiver does not speak English specify language spoken B8 Caregiver s on active duty in military Caregiver is documented as being active in the military at time of incident Active in the military includes all people performing active duty in the United States Armed Forces This includes those in reserve forces and National Guard performing temporary duties at the time of incident If yes specify branch of military Data Dictionary 17 Section B Primary Caregiver s Information B9 Caregiver receiving social services in past 12 months Caregiver has had contact with social services within the past 12 months Social services are defined as contact with the health and human service systems as in receiving home visits from a health educator receiving assistance through WIC or TANF etc WIC the Women
101. eached is defined as opened not functioning or not well placed G3v Child able to swim For incidents occurring in pool hot tub spa or open body of water indicate if child had ability to swim This is subjective based on investigative reports and relative to child s developmental ability G3w For bathtub was child in a bathing aid Child was left unattended in a bathtub seat or ring at time of incident Bath tub seat or ring is defined as a plastic ringed chair with three or four attached legs that is placed inside a bathtub The infant sits up inside the bathtub seat leaving the caregiver s hands free to wash the child G3x Warning sign or label posted Warning signs or labels were posted at the place of incident or on the object that the child drowned in indicating potentially hazardous conditions Examples could include warning signs at rivers to indicate dangerous currents warning signs at beaches labels on five gallon buckets of water or signs posted at swimming pools indicating that lifeguards were not present G3y Lifeguard present For pool and open body of water deaths indicate if a lifeguard was present at time of incident G3z Rescue attempt made If rescue was attempted indicate who attempted to rescue the child G3aa Did rescuer s also drown If rescue was attempted indicate if person people attempting rescue also drowned Specify number of persons that drowned G3bb Appropriate rescue
102. easing and name calling intimidation and social exclusion Bullying can be related to other forms of harassment and social isolation and or intimidation including hostile acts perpetrated against racial and ethnic minorities and gay and lesbian youth Bullying also includes hazing e School failure The child had experienced a failure at school Examples include receiving a failing or low grade as perceived by the child parent or teacher not making a sports team not winning an election or failing an important test e Move new school Child moved or transferred to a new school within the past year e Other serious school problems The child had experienced other major problems in school This includes suspension or expulsion e Pregnancy If female child was pregnant at the time of death or had been pregnant within the past year If male child s girlfriend was pregnant at the time of death or had been pregnant within the past year e Physical abuse assault Child was the victim or perpetrator of any physical abuse or assault at any time prior to the death Assault refers to an unlawful fatal or nonfatal attack by one person upon another e Rape sexual abuse Child was the victim or perpetrator of any rape sexual assault or sexual abuse at any time prior to the death This refers to sexual contact without consent Includes sex with a minor with or without consent Ranges from the non consensual touching of an intimate part of the body to for
103. ed Caused Contributed O Medical provider Institutional staff Q Babysitter Licensed child care Self go to 25 O Grandparent O Sibling O Other relative O Friend Biological parent O Yes caregiver two go to 25 Adoptive parent O Yes supervisor go to 26 Step parent worker Other specify O uK O Acquaintance O Child s boyfriend or girlfriend O Stranger Foster parent Mother s partner OOO OOO oo0oo0o0o000 Father s partner 14 Person s age in years 15 Person s sex 16 Does person speak English 17 Person on active military duty Caused Contributed Caused Contributed Caused Male O O No O Female O O Yes O O UK O O UK O If no language spoken Contributed Caused Contributed O No O Yes O uK If yes specify branch O Years O O O uK O 12 18 Person have history of substance abuse Caused Contributed O O No O Yes O OUK If yes check all that apply Alcohol O Cocaine Marijuana L Methamphetamine Opiates L Prescription drugs Over the counter CI Other specify U K 19 Person have history of child maltreatment as victim Caused Contributed O O No O O Yes O OUK If yes check all that apply Physical O Neglect Sexual Emotional psychological U K ___ s CPS referrals Substantiations Ever in foster care or adopted 20 Person have history
104. ency policies or practices O Review led to prevention initiatives being implemented Local State O National Use this space to provide more detail on the circumstances of the death and to describe any other relevant information Try not to include identifiers in the narrative N FORM COMPLETED BY PERSON TITLE AGENCY PHONE Continue narrative if necessary on back page EMAIL DATE COMPLETED DATA ENTRY COMPLETED FOR THIS CASE O The development of this report tool was supported in part by Grant No 1 U93 MC 00225 01 from the Maternal and Child Health Bureau Title V Social Security Act Health Resources and Services Administration Department of Health and Human Services NA TIONA L C EI N TE R FOR Data itg M CHILD DEATH REVIEW www childdeathreview org email info childdeathreview org KEEPING KIDS ALIVE 1 800 656 2434 NATIONAL CENTER FOR RU A DEATH REVIEW KEEPING KIDS ALIVE KIDS ALIVE Understanding How AA and Why Children Die amp Taking Actions to vw Prevent Child Deaths Child Death Review Case Reporting System INTERNET DATABASE User Manual Version 2 January 1 2008 National Center for Child Death Review Table of Contents 1 Terminology 2 Getting In Out and Around the Website Accessing the Website Login to the Website The Welcome Page and Website Navigation Exiting the Website 3 Enter a New Case Navigation and Saving Data Definin
105. ented refers to evidence from law enforcement medical or human services IPV is defined as actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse ex spouse current or former boyfriend or girlfriend or current or former dating partner Intimate partners may be heterosexual or of the same sex This may also include domestic disturbance complaints to which law enforcement responded C14 Supervisor has delinquent or criminal history Supervisor has a documented history of delinquent or criminal behaviors or actions This includes any history with the juvenile justice system or the criminal justice system If yes specify type of delinquent or criminal history that is documented Delinquent behavior may include school disciplinary actions charges or convictions for misdemeanor offenses Criminal behavior includes charges or convictions for felony charges C15 At time of incident was supervisor Indicate supervisor s status at time of incident e Drug impaired Drug impaired refers to being under the influence of any intoxicating compound or combination of intoxicating compounds to a degree that impairs a person s ability to supervise a child e Alcohol impaired Alcohol impaired refers to being under the influence of alcohol to a degree that impairs a person s ability to supervise a child e Asleep Supervisor was sleeping at time of incident e Distracted Distracted refers to the
106. er than the fetus can produce new ones the fetus can develop anemia Such destruction is called hemolytic disease of the fetus erythroblastosis fetalis or of the newborn e Uterine Bleeding Most commonly caused by placental problems in pregnancy such as Placental Abruption A condition in which the placenta separates from the inner wall of the uterus before the baby is born Placenta Previa A placenta that is implanted in the lower uterine segment and covers all or part of the cervical os e Other specify Indicate other medical complications infections that occurred during pregnancy e Smoke tobacco Code as yes if Mother smoked any tobacco during her pregnancy e Experience intimate partner violence Mother experienced intimate partner violence at any time during the pregnancy Intimate partner violence is defined as actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse ex spouse current or former boyfriend or girlfriend or current or former dating partner Intimate partners may be heterosexual or of the same sex e Use illicit drugs Mother used illicit drugs at any time during the pregnancy Illicit drugs are defined as controlled substances that possess a high potential for abuse have no currently accepted medical use in the United States and demonstrate a lack of accepted safety for use under medical supervision e Infant born drug exposed For a child to be born
107. er unwilling to provide care O Yes LI Lack of transportation C Multiple providers not coordinated Caregiver s partner would not allow care O UK L No phone C Lack of child care C Other specify CI Cultural differences C Lack of family or social support Oo Religious objections to care O Services not available EWK 12 OTHER CAUSE UNDETERMINED CAUSE OR UNKNOWN CAUSE Specify cause describe in detail H OTHER CIRCUMSTANCES OF INCIDENT ANSWER RELEVANT SECTIONS 1 DID DEATH OCCUR WHILE CHILD SLEEPING OR IN A SLEEPING ENVIRONMENT O No gotoH2 Yes UK go to H2 a Incident sleep place b Child put to sleep c Child found O Crib Playpen O Carseat stroller If adult bed what type On back On back Bassinette Couch O Other specify O Twin O King O On stomach On stomach Adult bed O Chair O Full O Other specify O On side On side O waterbed Floor O ux O Queen O uk Ouk O UK Usual sleep place e Usual sleep position f Was there a crib g Child in new different O Crib OCouch If adutt bed what type O On back bassinette or port a crib environment Bassinette OChair O Twin O King O On stomach in home for child Ono O Yes O UK Adult bed OFloor Full O Other specify O On side ONo O Yes O UK If yes specify O Waterbed OCarseat stroller Queen UK O Playpen OOther specify O uK h Circumstances when child found Child s position most Child s airway was relevant to death With what objec
108. erican 0 ative Hawaiian v acific Islander merican Indian ative Alaskan Footnote Rows do not add up to totals because more than one type of poison could have been involved 34 Prescription Over the Cleaning Drug counter Drug substance Accidental overdose Medical treatment mishap Deliberate poisoning is Adverse effect not oD Acute intoxication Open Area Open cabinet Unlocked closed cabinet Locked closed cabinet Poison control was called Child not supervised but needed Supervisor speaks English Footnote Rows do not add up to totals because more than one type of poison could have been involved 35 Sleep Related Death Reports Report 19 Sleep Related Death Demographics Female Hispanic Latino any 0 1 Months race 2 3 Months 4 5 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total eceoooccc con i eoo0oo0oo0co0c0c 00 i eooooqcocqcoaqo i We Fomaie unknown 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total Black African American 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total Native Hawaiian 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total Pacific Islander 0 1 Months 2 3 Months 4 5 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unkno
109. erimental use that did not cause life problems and or addictions should be coded no A problem from the past e g five years or more ago that has resolved and no longer appears to apply should still be coded yes Previously attempting suicide via overdose is not sufficient justification for answering yes to this question in the absence of other information B11 Caregiver s have history of child maltreatment as a victim Caregiver has documented history of being the victim of child maltreatment child abuse or neglect History means a referral or substantiation from Child Protective Services or documentation from law enforcement report or medical records If referrals were made but not substantiated still select Yes regarding history unless the referral was found to be completely falsified If yes specify type s of maltreatment substantiated If child welfare referral or substantiations are documented indicate total number of CPS referrals and substantiations Indicate if caregiver was ever in foster care or adopted B12 Caregiver s have history of child maltreatment as a perpetrator Caregiver has documented history of being the perpetrator of child maltreatment child abuse or neglect History means a referral or substantiation from Child Protective Services or documentation from law enforcement report or medical records If referrals Data Dictionary 18 Section B Primary Caregiver s Information were m
110. eview an agency will be conducting further investigation s into this death Team disagreed with official manner of death After the review was completed the team disagreed with the official manner of death from the death certificate Specify team s decision regarding manner of death based on their review Team disagreed with official cause of death After the review was completed the team disagreed with the official cause of death from the death certificate Specify team s decision regarding cause of death based on their review Because of the review was the official cause or manner changed The team disagreed with the official manner or cause of death as a result of the review process The team shared their concerns with the medical examiner coroner or physician who ultimately amended the death certificate Review led to the delivery of services As a result of the review an agency will be providing services to the family of the child Review led to changes in agency policies or practices As a result of the review an agency will be amending their internal policies and or practices Review led to prevention initiatives being implemented Because of the review there will be or have been changes made to a policy or practice or a program has been implemented that is designed to prevent similar deaths Data Dictionary Section L The Review Meeting Process 67 Section M The Narrative Use this space to provide more detail so that a full p
111. g a Case Number Question Types Ensuring Data Quality 4 Search for an Existing Case How to Search for a Case Case Actions 5 Create a Standardized Report How to Generate a Report The Report View Window 6 Download Your Data Downloading Data Working with the Download 7 Help Change Your Password Edit Your Contact Information Supporting Documents Section 1 Terminology Becoming familiar with these common Internet terms will help you to understand the instructions provided in this guide The following page has illustrated examples of these terms 10 11 12 13 Internet browser A program that provides a way to look at and interact with all the information on the Internet Common browsers include Microsoft Internet Explorer and Netscape Communicator Window The boxed area on the monitor that the browser s information opens in Web page The collection of information that displays in the window of the Internet browser at one time Often simply referred to as a page Website A collection of related web pages You can think of a web site as a book that arrives a page at a time as you request each one Menu bar The second strip from the top of the window containing words the user can point to and click on to access browser functions Toolbar The third strip from the top of the window containing icons the user can point to and click on that are shortcuts to access browser functions Address bar
112. gument m Hunting Russian Roulette Intervener assisting crime Commission of crime Jealousy O Target shooting Gang related activity victim Good Samaritan Random violence Hate crime m Weapon mistaken for toy Cleaning weapon El O E E Drive by shooting O Intimate partner violence E Playing with weapon Self defense Other specify O E El El Child was a bystander Bullying 0 Showing gun to others Loading weapon U K 7 ANIMAL BITE OR ATTACK a Type of animal b Animal access to child check all that apply c Did child provoke animal O Domesticated dog Insect L Animal on leash O Animal escaped from cage or leash O No Yes UK Domesticated cat Other C Animal caged or inside fence C Animal not caged or leashed If yes how O Snake specify Child reached in O uK Wild mammal Child entered animal area d Animal has history of biting or specify U K UK attacking O No Yes UK 8 FALL OR CRUSH a Type b Height of fall c Child fell from O Fall go to b feet O Open window screen Natural elevation Stairs steps Moving object specify O Animal specify O Crush go to h inches O Screen O Man made elevation Furniture O Bridge Other specify ONbo screen Playground equipment O Bed Overpass O uK O uK OUJMK if screen O Tree Roof O Balcony d Surface child fell onto Cement concrete O Grass Gravel Wood floor O Carpeted floor D Linoleum vinyl
113. h Review at 1 800 656 2434 If an incorrect password is used three times with your user name the system will lock your account for security reasons Should this occur please contact your State Administrator or the National Center to have your account unlocked or your password reset The Welcome Page and Website Navigation After you successfully login you will be directed to your Welcome Page This page gives specific information about your state s child fatality review program and who to contact for more information in your state On this left side of the Welcome Page is the Enter a New Case navigation menu for the website The permissions Search for an Existing Case given to you by your State Administrator Create Standardized Reports determine what you can and cannot access in the Internet system therefore the navigation menu Download Your Data you see may appear slightly different than the Help example given here Logout Each menu option on the Welcome Page represents a different function you can perform To use any navigation menu in the Internet Child Death Review Case Reporting System simply move your mouse pointer to an option such as Create Standardized Reports and the option will change color from blue to red When you click your mouse the option that has changed to red will be selected The navigation menu will then change to the navigation menu specific to that function when the new page appears on your screen
114. hat the child was using or had alcohol or other drugs in their system in the events leading up to or at the time of death This would not include appropriate levels of prescribed or over the counter levels of drugs the child was taking for known medical conditions DII EMS to scene Emergency Medical Services EMS was on site at incident Code only to indicate presence of EMS at scene not to indicate whether any medical services were delivered D12 Child s activity at time of incident Specify activity child was engaged in at time of incident For natural deaths determine if the child s activity contributed to the onset of an acute incident leading to death for example playing may have precipitated an asthma attack If yes answer this question If no leave blank D13 Total number of deaths at incident event Specify total number of deaths including child that occurred as a result of incident For natural deaths this question may not apply Data Dictionary 24 Section D Incident Information Section E Investigation Information El Death referred to Specify if the death was referred to the medical examiner or coroner If medical examiner or coroner were not made aware of the death select not referred E2 Person declaring official cause and manner of death Specify who certified cause and manner of death as recorded on death certificate Qualifications for medical examiners and coroners differ by state E3 Autop
115. hild have Ambient temp degrees F b Was death expected as a result c Was child receiving health care d Were the prescribed care plans for the medical condition O No O Yes UK If yes within 48 hours of the death O No O Yes UK the medical condition of medical condition In utero Weeks Since birth Months Hours Years O Yes Days OTUR O uK e Was child family compliant with the prescribed care plans appropriate for the medical condition O NIA No specify O yes O uK g Was medical condition O N A not previoulsy diagnosed O No CI Butata later time f Was child up to date with associated with an outbreak O No O Yes specify O uK O Appointments American Academy of Pediatrics O N A O No O Yes O UK immunization schedule O N A O No specify O Yes O UK Medications specify If no what wasn t compliant Medical equipment use specify Check all that apply Therapies specify Other specify U K 10 h Was environmental tobacco i Were there access or compliance issues related to the death Ono OvYes OUK If yes check all that apply exposure a contributing factor C Lack of money for care C Language barriers L Caregiver distrust of health care system in death L Limitations of health insurance coverage C Referrals not made L Caregiver unskilled in providing care O No m Multiple health insurance not coordinated O Specialist needed not available L Caregiv
116. hip to prevent her from seeking prenatal care e Other specify Indicate other access or compliance issues related to care Data Dictionary 16 Section A Child Information Section B Primary Caregiver s Information B1 Primary caregiver Primary caregiver is defined as person or persons up to two who had responsibility for care custody and control of child a majority of the time If primary caregiver at time of death was different from primary caregiver at time of incident answer regarding primary caregiver at time of incident If the child was living with his her biological or adoptive parents assume that they were the primary caregivers and had legal custody of the child unless otherwise specified in the records If the biological mother and father of the child have joint custody and the child spent equal time with each code both as primary caregivers If a parent lives outside of the child s home and does not provide the majority of care for the child do not code that person as a primary caregiver If a newborn infant dies in a hospital shortly after birth list at least the birth mother as the primary caregiver Indicate relationship of caregiver to child B2 Age in years Age of caregiver at the time of child s death B3 Caregiver s sex Sex of caregiver B4 Caregiver s employment status Caregiver s employment status at time of incident To be considered unemployed a person does not work at any time during th
117. human services IPV is defined as actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse ex spouse current or former boyfriend or girlfriend or current or former dating partner Intimate partners may Data Dictionary 10 Section A Child Information be heterosexual or of the same sex This may also include domestic disturbance complaints to which law enforcement responded A28 Child had delinquent or criminal history Child had a documented history of delinquent or criminal behaviors or actions This includes any history with the juvenile justice system or the criminal justice system If yes specify type of delinquent or criminal history that is documented Delinquent behavior may include school disciplinary actions charges or convictions for misdemeanor offenses Criminal behavior includes charges or convictions for felony charges A29 Child spent time in juvenile detention Child had documented history of time spent in a juvenile detention center A30 Was child acutely ill in the two weeks prior to death Child was reported to have been sick in the two weeks before the death including an exacerbation of a chronic illness A reported illness refers to documentation from a school district a school referral a pediatrician emergency room hospital first responder police report or autopsy Examples include any acute illness such as an upper respiratory infection strep throa
118. icture of the circumstances and the team s review is apparent to a reader Try not to include identifiers in the narrative Often times the circumstances of a death are not entirely evident from the case report tool alone Providing a description of the incident involving the child is helpful in understanding how a death occurred Include information on past history involving CPS law enforcement public health and others If you would like to add text to the narrative from another document such as a Microsoft Word file you may copy the text and paste it into the CDR Case Reporting System Data Dictionary 68 Section M Narrative Section N Form Completed By Person Enter name of person completing the case report form Title Enter title of person completing the case report form Agency Enter agency of person completing the case report form Phone Enter phone number of person completing the case report form Email Enter email address of person completing the case report form Signature Person completing case report form should sign if using paper copy Data entry finished for this case Code as yes once data entry is finished for this case For more information on determining if data entry is complete contact your state CDR coordinator Date completed Enter date the case report form was completed Data Dictionary 69 Section N Form Completed By NATIONAL CENTER FOR UR EAN ET DEATH REVIEW KEEPING KIDS ALIVE KIDS AL
119. ier Local level users will have this identifier filled in automatically and will not be able to edit this field State level users will be able to select from among the counties in their state to fill in this field Team Number States that have regional teams that encompass multiple counties or that have multiple teams within a county will have this identifier Local level users will have this identifier filled in automatically and will not be able to edit this field State level users will be able to enter a team number from their state into this field Year of Review This identifier is automatically filled in to the current year You can edit this field in order to enter cases from past years Sequence of Review This identifier is automatically filled in to the next highest sequence number for the current year For example if the last sequence number you entered in the current year was 00021 then the next new case you enter will come up as sequence 00022 regardless of whether sequences 00019 or 00020 exist You can edit this field to any sequence number The sequence number must be numeric only no letters or characters allowed Question Types There are six types of questions that you will encounter in data entry We will give some general examples in this section If you need more information about the definition of individual questions please refer to the supporting document entitled Data Dictionary N
120. inflicted on one or more members of a family or household An isolated incident refers to a single event with no documentation of similar prior incidents See Item I 1 for definition of caused and contributed 112 Is person the caregiver supervisor listed in previous section Indicate if person causing act is same person specified as caretaker or supervisor in Section 2 and or 3 See Item I 1 for definition of caused and contributed 113 Prima erson responsible for action s that caused or contributed to the death Relationship of person causing act on child See Item I 1 for definition of caused and contributed 114 Person s age in years Age of person causing act See Item I 1 for definition of caused and contributed 115 Person s sex Sex of person causing act See Item I 1 for definition of caused and contributed 116 Does person speak English Indicate if person speaks and understands English Code as yes if person was able to respond to questions surrounding the circumstances of the child s death If person does Data Dictionary 56 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide not speak English specify language spoken 117 Person on active duty in the military Person is documented as being active in the military at time of incident Active in the military includes all people performing active duty in the United States Armed Forces This includes those in reserve f
121. ing the victim of child maltreatment child abuse or neglect History means a referral or substantiation from Child Protective Services or documentation from autopsy law enforcement report or medical records If referrals were made but not substantiated still select Yes regarding history unless the referral was found to be completely falsified If yes specify type s of maltreatment substantiated See Item I 1 for definition of caused and contributed If child welfare referral or substantiations are documented indicate total number of CPS referrals and substantiations Indicate if person was ever in foster care or adopted Terminology regarding referrals and substantiations varies by State 120 Person has history as a perpetrator of child maltreatment Person has documented history of being the perpetrator of child maltreatment child abuse or neglect Documented means a referral or substantiation from Child Protective Services or documentation from autopsy law enforcement report or medical records If referrals were made but not substantiated still select Yes regarding history unless the Data Dictionary 57 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide referral was found to be completely falsified If yes specify which type of maltreatment was substantiated See Item I 1 for definition of caused and contributed If child welfare referral or substantiations are documented indic
122. ino origin Days O Black O Pacific Islander O No O Male Hours C Asian specify O Yes O Female Minutes L American Indian Tribe O uK O uK U K C Alaskan Native Tribe 8 Residence address O UK 9 Type of residence 10 New residence Street O Parental home O Relative home lt sail Detention in past 30 days O Licensed group home O Living on own O Other specify Ono City O Licensed foster home O Shelter OYes County i O Relative foster home O Homeless O UK Ouk 11 Residence overcrowded 12 Child ever homeless 13 Number of other children living 14 Child s weight U K 15 Child s height O uK Ono Oyes Ouk Ono OYes Ouk with child O uk ___ pounds ounces feet inches 16 Highest education level 17 Child s work status 18 Did child have problems in school 19 Child s health insurance O NA Drop out O NA O No O Yes O uk check all that apply O None O HS graduate O Employed If yes check all that apply O None Preschool College Fulltime LO Academic L Behavioral C Private O Grade K 8 Other specify Part time O Truancy O Expulsion O Medicaid O Grade 9 12 O UK O UK O Suspensions I U K C State plan O Home schooled K 8 O Not working O Other specify L Other specify Home schooled 9 12 O uK C U K 20 Child had disability or chronic illness 21 Child s mental health MH 22 Child had history of substance abuse Ono OvYes Ouk Child had received prior MH services Ono Oys Ouk If yes check all that apply
123. intent e Prior attempts were made There were reports or documentation that the child had made previous suicide attempts regardless of the severity of those attempts e Suicide was completely unexpected There was no indication from any source that the child was considering suicide e Child had a history of running away The child had a documented history of running away from primary residence e Child had a history of self mutilation The child had a documented history of self infliction of wounds such as cuts scratches or bruises or evidence of self mutilation was found at time of autopsy e There is a family history of suicide A member of the child s family either immediate family or extended family had completed suicide prior to the child s death e The suicide was part of a murder suicide The child committed a murder s as part of a series of actions that also led to his or her suicide Do not answer yes if the child committed suicide at a time much later than the murder event for example while incarcerated for the murder e The suicide was part of a suicide pact The child victim killed him herself as part of a mutual agreement s to die by suicide made among people the victim knew The other suicides did not need to be completed as part of the pact for this response to be coded as yes There should be documentation or reports of the pact not rumors ofa pact e The suicide was part of a suicide cluster A suicide clus
124. is held in the table INF INFdodyear INFdodmnth INFdodday rather than in the INC table INCdateyear INCdatemth INCdateday Please contact the National Center if you need assistance with data download and linking tables There are two tools provided under the Internet Child Death Review Case Reporting System Help page in the Supporting Documents section Data Codebook for Download This document provides the information needed to understand the data in the downloaded tables including the variable names for the questions and the values for the answers Macro to Import Data into Microsoft Access This Access database file will open to a screen asking where you have saved the downloaded tables Click on the Select Folder button to open a window where you can browse for the folder in which your Data Download files are located Click OK when you have highlighted the folder Access will then proceed to import all 23 downloaded tables into that database A message will tell you if all of the tables were successfully imported If there is an error a message will tell you which file it had problems importing Please contact the National Center to report any problems with importing or downloading data Access will also remove all of the leading quotation marks from death certificate birth certificate apartment number and zip code 25 Section 7 Help Clicking on the Help option from the Welcome Page gives you the
125. is is a subjective determination to be made by the team based on the number of rooms and the number of persons living in the residence The answer to this question may indicate a risk factor for specific causes of deaths including fires suffocation and violence related deaths Al2 Child ever homeless Homeless is defined as having no fixed address and living in a shelter on the street in a car or in makeshift quarters in an outdoor setting A person who has no home of their own but is staying indefinitely with friends or family is not considered homeless here Al3 Number of other children living with child Number of other children under 18 siblings and non siblings living in child s household at time of incident Al4 Child s weight Child s weight at time of death in pounds and ounces A15 Child s height Child s height at time of death in feet and inches Al6 Highest education level Select the highest level of education that child completed If child received a GED code High School graduate as highest education level Select N A for specific circumstances such as a child being too young to attend school or an inability to attend due to severe disabilities Al7 Child s work status Indicate if child held a job of any type within the past four weeks This includes formal jobs for pay or other compensation informal jobs such as paper delivery child and lawn care if done outside one s family setting v
126. isk Factors of Young Drivers Ages 14 21 Involved in the Crash Child was Driving Driver of Childs Driver of Other Primary Vehicle Vehicle Violating graduated licensing rules Two or more teen passengers ages 14 21 Deaths Reviewed Muddy roads Inadequate lighting Footnote Columns do not add up to totals because the factors are not mutually exclusive 18 Report 8 Motor Vehicle Protective Measures ce Lap Belt 0o o 0 o Shoulder belt po Oo Child seat Booster seat o Child seat o 0 ee ee ossa i o A 0 O C 19 Report 8 Motor Vehicle Protective Measures Continued Driver Passenger OnBicycle Pedestrian Unknown Airbag oO Lap Belt o0 ae E E E C n a a a C fl o o oo Lap Belt o o o o o e aaa a a a a e Footnote Columns do not add up to total because more than one protective measure could have been used 20 Fire Reports Report 9 Fire Death Demographics Singlehome Duplex Apartment Trailer Mobile Home Other Unknown NA Pe eee ee ee ee m A A a k a a D a a M a a EN E EEE 21 Report 9 Fire Death Demographics Continued Single home Duplex Apartment _Trailer Mobile Home Other UnknownNA American 22 Report 10 Factors Involved in Fire Deaths At least one working smoke detector Sprinkler system working Escape or rescue efforts worsened fire Factors delayed Fire Department arrival Barriers p
127. it a person s ability to care for a child e Other Specify all other factors that contributed to poor quality of supervision 126 Does person have A prior history of a similar act would be based on a documented history of acts of omission or commission Prior arrests or convictions would be documented 127 Legal outcomes in this death Evidence of documented report of legal outcomes e g guilty verdict on specific charges sentence given from law enforcement district attorney newspaper etc 128 For suicide check all that apply and describe answers in narrative e A note was left The child left a note email audio tape video or other communication that they intended to kill him herself The existence of a will or folder of financial papers near the child s body does not constitute a suicide note e Child talked about suicide Child had expressed that he or she thought about suicide but child made no mention of or described a plan for suicide Expressions such as I think everyone would be better off without me or I hate my life and want to end it would be considered suicide expressions to friends teachers parents etc Data Dictionary 59 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide e Prior suicide threats were made The child had previously expressed their intent to kill themselves I m going to kill myself or I have made a plan to die are examples of verbal expressions of
128. jet skis or personal water crafts G3c Was child forcibly submerged Force was used to intentionally hold the child under water This would include persons intending to drown the child as well as persons holding a child under water during play without the intent of drowning Do not code as yes if a child was held under water by an object such as being caught by an anchor or raft rope or submerged under debris or hit by a surfboard G3d Drowning location Type of location in which drowning occurred Bath tub includes in home bath tubs with water jets G3e For open water place For open water deaths indicate type of place where incident occurred G3f Contributing environmental factors If any environmental factors contributed to the drowning specify If no environmental factors contributed leave blank Please check all that apply e Current A current can include an ocean current or a river current For example in the ocean a long shore current is located in the surf zone moving generally parallel to the shoreline generated by waves breaking at an angle with the shoreline Rip currents should be included here Rip currents are powerful channeled currents of water flowing away from shore They typically extend from the shoreline through the surf zone and past the line of breaking waves Rip currents can occur at any beach with breaking waves including the Great Lakes e Riptide undertow A riptide includes both ebb an
129. jury external cause select one O From a medical cause select one O Undetermined if injury or C U K O Motor vehicle and other transport go to G1 Asthma go to G11 medical cause go to G12 go to G12 Natural O Fire burn or electrocution go to G2 Accident O Drowning go to G3 Suicide O Asphyxia go to G4 O Homicide O weapon including body part go to G6 O Undetermined O Animal bite or attack go to G7 O Pending O Fall or crush go to G8 Cancer specify and go to G11 Cardiovascular specify and go to G11 Congenital anomaly specify and go to G11 HIV AIDS go to G11 Influenza go to G11 Low birth weight go to G11 O uK O Poisoning overdose or acute intoxication go to G9 O Exposure go to G10 Undetermined If under age one go to G5 amp G12 Malnutrition dehydration go to G11 Neurological seizure disorder go to G11 Pneumonia specify and go to G11 Prematurity go to G11 If over age one go to G12 SIDS go to G5 Other cause go to G12 Ouk go to G12 Other infection specify and go to G11 Other perinatal condition specify and go to G11 Other medical condition specify and go to G11 Undetermined If under age one go to G5 and G11 If over age one go to G11 ooo0oo0oo0000000000000 U K If under age one go to G5 and G11 If over age one go to G11 G DETAILED INFORMATION BY CAUSE OF DEATH CHOOSE ONE SECTION ONLY THAT IS SAME AS THE CAUSE SELECTED ABOVE 1 MOTOR VEHICLE AND OT
130. ked to choose only one cause of death In many cases that have two causes of death one cause is more likely to contribute information for prevention efforts than the other For example in a death where a car went off the road into a pond the cause of death could potentially be both motor vehicle and drowning However information about flotation devices and whether the child could swim could be irrelevant for prevention but information about the incident that caused the car to end up in the pond could be more relevant Section G Detailed Information by Cause of Death is dependent on the primary cause of death selected in Section F If the primary cause of death is Drowning then only the questions from G3 Drowning on the paper form are available when the Section G page loads In turn if the primary cause of death is Cancer then only the questions from G11 Medical Condition on the paper form are available when the Section G page loads There are a few special conditions in death to infants where you are asked to fill out more than one section In these cases the Internet system will automatically load both sections you need 10 Question Validation Certain questions will simply not allow you to enter a response that would lead to conflicting answers in the data The most common examples of this are check all that apply questions or fill in the blank questions with an Unknown checkbox In the following example it would not
131. ks or anal area Mothers can also infect their babies during childbirth Hemoglobinonpathy A group of rare inherited disorders involving abnormal structure of the hemoglobin moleculeclude hemoglobin C disease hemoglocin S C disease sickle cell anemia and various types of thalassemia High MSAFP A screening that examines alpha fetoprotein in the mother s blood during pregnancy It is often part of the triple or quad screen test that assesses whether further diagnostic testing may be needed High levels of AFP may suggest that the developing baby has a neural tube defect such as spina bifida or anencephaly Low levels of AFP and abnormal levels of hCG and estriol may indicate that the developing baby has Trisomy 21 Down syndrome Trisomy 18 Edwards Syndrome or another type of chromosome abnormality Hydramnios Oligohydramnios Hydramnios Polyhydramnios Larger than normal amount of amniotic fluid often associated with certain congenital anomalies or maternal diabetes Oligohydramnios Smaller than normal amount of amniotic fluid Incompetent Cervix A weakened cervix that results in rapid and unexpected premature dilatation of the cervix and repeated spontaneous abortions usually during second trimester Low MSAFP Low levels of AFP and abnormal levels of hCG and estriol may indicate that the developing baby has Trisomy 21 Down syndrome Trisomy 18 Edwards Syndrome or another type of chromosome abnormality Other Infectiou
132. l of the home including the basement e There should be an alarm in all sleeping rooms and guest rooms and outside every sleeping area e All hard wired smoke alarms must be interconnected e In addition if house gt 1000 sq feet excluding garage smoke alarms shall be installed to the equivalent of 1 per every 500 square feet It is important to note that these are national guidelines the actual recommendations and code may vary by state so please consult your state codes or Fire Marshal G2q Suspected arson Cause of fire was documented as a suspected arson incident Data Dictionary 32 Section G2 Fire Burn or Electrocution G2r For scald was hot water heater set too high The standard setting for a water heater is under 120 degrees Fahrenheit Specify temperature setting of hot water heater if known G2s For electrocution cause If incident was electrocution specify cause of electrocution G2t Other describe If incident type was other or unknown not already indicated describe incident and cause of death Data Dictionary Section G2 Fire Burn or Electrocution 33 Section G3 Drowning G3a Where was child last seen before drowning Place where child was last seen before incident leading to drowning Please check all that apply G3b What was child last seen doing before drowning The last known or observed activity of child before incident leading to drowning Please note that boating includes
133. lationship of caller to child G9h For CO poisoning was a CO detector present If carbon monoxide CO poisoning was primary cause of death indicate if CO detector was present If detector was present indicate if it was functioning properly at time of incident Data Dictionary 45 Section G9 Poisoning Overdose or Acute Intoxication Section G10 Exposure Exposure refers to death resulting from lack of protection over prolonged periods from weather or extreme temperatures Gl0a Circumstances Specify circumstances involved in the incident G10b Condition of exposure Indicate if primary cause of death was hyperthermia or hypothermia Hyperthermia is defined as an above normal body temperature Hypothermia is defined as a below normal body temperature Specify ambient temperature of child when found Ambient temperature is defined as the temperature of room or place surrounding where child was found G10c Number of hours exposed Total number of hours child was documented as being exposed to extreme temperature G10d Clothing appropriate If child was wearing appropriate clothing for conditions at time of incident code as 66 29 yes Data Dictionary 46 Section G10 Exposure Section G11 Medical Condition Glla How long did the child have the medical condition Specify general length of time child had medical condition This is often stated on the death certificate Gllb Was death expected as
134. lly conflicting answers 26 Suffocation Asphyxia Report Report 13 Suffocation Asphyxia Death Demographics Sleep related Covered in or Confined in Swaddled in dged Asphyxia by ell into object ight space ight blanket into tight gas space Black African American l A ee ee A A A A A 27 Report 13 Suffocation Asphyxia Death Demographics Continued pee ieee ee eee ey m A a A LZ A OS LAW ec COO ee a m A ae ae a ee A A Child used alcohol drugs prior to incident Supervisor impaired by alcohol drugs 28 Weapon Including Person s Body Part Reports Report 14 Weapon Death Demographics Blunt Person s Rope Biological Body Part 0 14 Years 5 17 Years 8 19 Years 20 24 Years Hispanic Any Race 29 Report 14 Weapon Death Demographics Continued Black African Native Hawaiian Pacific Islander American Indian aa Native Alaskan Bi Biological 30 Report 14 Weapon Death Demographics Continued Sharp Blunt Person s Explosive Rope Biological Body Part Accident Unintentional ee Footnote Acts of omission or commission are defined as any act or failure to act which causes or contributes to the death Cases are included in the last row of this reportif Yes or Probable was selected in Section I Question 1 in the CDR Case Reporting System 31 Report 15 Safety Features and Storage of Firearms Used i
135. m effect on day to day functioning or health e Physical Physical includes any anatomical loss physiological disorders cosmetic impairments and or diseases Examples may include paraplegia cerebral palsy cystic fibrosis diabetes cleft palate or cancer e Mental Mental disorders are health conditions characterized by alterations in thinking mood or behavior or some combination thereof associated with distress and or impaired functioning They include any psychiatric disability mental illness or mental retardation Examples may include depression bi polar disorders or Downs Syndrome This includes cognitive learning disabilities o If mental illness was supervisory receiving mental health services Indicate if supervisor was currently receiving services e Sensory Sensory disorders refer to any disability or chronic disease that impairs the senses including visual auditory and olfactory Examples include blindness and deafness C12 Supervisor has prior child deaths Supervisor has a documented history of having a child anyone 17 years or under die while in his her care custody or control If yes indicate number of prior child deaths due to child abuse child neglect accidental suicide SIDS or other Data Dictionary 21 Section C Supervisor Information C13 Supervisor has history of intimate partner violence Supervisor has a documented history of intimate partner violence IPV as either victim or perpetrator Docum
136. meric Three variables have been added to the table INF to make data analysis more straightforward on child s age birth weight and weight at death The variable INFageinf Age Infant has been added to data download to more easily identify children under the age of one The child s birth weight and weight at death are also automatically converted to grams in data download INFbirthgrams and INFweightgrams Please note that these new variables are not replacing the original information entered into the data tool by you For example if child s birth weight was entered as 9 pounds and 4 ounces the information is still stored as 9 pounds in the field INFbirthwt and 4 ounces in the field INFbirthwtounc Detailed data analysis on the demographics of Caregiver Supervisor and Person Responsible in data download may require linking multiple tables if the same individual is listed in more than one section i e Supervisor was also Caregiver For example you will need to link by id the tables GIV and SUP to download all demographic information about Supervisors If the Supervisor was also the primary Caregiver then the demographic data about the individual is stored in the table GIV Caregiver and not table SUP Supervisor Detailed analysis of the Date of Incident may also require linking multiple tables If you check the box indicating Date of Incident is the Same as Date of Death INCdatesame 1 Yes the date of the incident
137. mes de cock the pistol s hammer and can disengage the trigger mechanism Loaded chamber indicator is defined as a gauge showing when a gun is loaded Magazine disconnect is defined as a device that prevents the gun from firing if the ammunition magazine or part of gun that hold the bullets prior to chambering is removed Minimum trigger pull is defined as a gun feature that only enables a gun to fire if a minimum level of force is placed on trigger G6e Where was firearm stored If firearm was weapon indicate where firearm was stored at time of incident G6f Firearm stored with ammunition If firearm was weapon indicate if it was stored in same place as ammunition G6g Firearm stored loaded If firearm was weapon indicate if it was stored loaded with ammunition G6h Owner of fatal firearm Specify documented owner of weapon Partner is defined as a person who lives with and is sexually involved with but is not married to the child s mother or father Data Dictionary 40 Section G6 Weapon Including Person s Body Part G6i Sex of owner of fatal firearm Sex of person who owned the weapon that killed the child G6j Type of sharp object If sharp object was weapon specify type G6k Type of blunt object If blunt object was weapon specify type of blunt object G6l What did person s body part do Body part includes any part of a person used as the primary instrument of the assault or injury For example fists
138. n Incident med al lia all Safety Features rifle shotgun Personalization 0 0 0 0 device External 0 e Q fe safetyidrop safety Loaded chamber 0 l Q fe indicator Magazine 0 0 0 0 disconnect Minimum trigger i 0 Q 0 pull URN MRAP eee ioi Firearm Stored Locked cabinet Unlocked cabinet Other storage Unloaded but with ammunition Q Unloaded without ammunition Q Footnote Columns do not add up to totals because the factors are not mutually exclusive Other places for firearm storage include glove compartment under a mattress and others 32 Report 16 Owner and Use of Weapon at Time of Incident Weapon Stolen Spouse Other Relative Friend Acquaintance Neighbor Child s boyfriend girlfriend Classmate Law enforcement Weapon Found Footnote Parents include biological adoptive step and foster Other relatives include grandparents Other owners include parent s partner institutional staff stranger and others Footnote Columns do not add up to totals because the factors are not mutually exclusive Blunt instruments include pipes 33 Poisoning Overdose or Acute Intoxication Reports Prescription Over the counter Cleaning Other Unknown Drug Drug substance lt 1 Year 4 Years 9 Years 0 14 Years 5 17 Years 8 19 Years 20 24 Years Hispanic any race Prescription Over the counter Cleaning Unknown Drug Drug substance 0 Black African Am
139. n of omission commission caused or contributed to the death was reported by team as Yes or Probable Section Question 1 in CDR Case Reporting System Child placed outside of home refers to placement in foster care including licensed and relative kinship foster homes Counts for Caused and Contributed for Type of Child Neglect is not available as the information is not collected in this manner in Section of the reporting tool 50 Report 28 Acts of Omission Commission Assault Information Not Child Abuse Caused Contributed Deaths Reviewed Oo o o msnen O o Ec a Sean orreee O o Criminal history on delinquency pw a Spent time in juvenile detention EAA manmanan ooo Ce So co C maemae 51 Report 28 Acts of Omission Commission Assault Information Not Child Abuse Continued a a oc a cc ee ec ec remem a So O o Ce rm parsona ee a ere a 52 Report 28 Acts of Omission Commission Assault Information Not Child Abuse Continued History of disability or chronic illnesss Footnote Includes all cases where action of omission commission caused or contributed to the death was reported by team as Yes or Probable Section Question 1 in CDR Case Reporting System Child placed outside of home refers to placement in foster care including licensed and relative kinship foster homes Report 29 Acts of Omission Commission Suicide Information Deaths Reviewed History of substance abuse Dr
140. ndetermined if injury or medical cause Select this option if the death was not classified as an injury or medical cause For example in some jurisdictions medical examiners coroners are not classifying the sudden unexpected death of an infant in either category F2 Unknown Team does not have information on the primary cause of death Data Dictionary 27 Section F Official Manner and Primary Cause of Death Section G1 Motor Vehicle and Other Transport Gla Vehicles involved in incident Write in the total number of vehicles involved in the incident Indicate the type of vehicle the child was in If child was not in a vehicle check none Determine which vehicle was the other primary vehicle involved in incident This is the vehicle that most affected the incident involving the child Indicate vehicle type for other primary vehicle Glb Position of child Position of child in relation to motor vehicle at time of incident as recorded on motor vehicle crash report e Driver An occupant who is in actual physical control of a transport vehicle or for an out of control vehicle an occupant who was in control until control was lost e Passenger Any occupant of a road vehicle other than its driver Indicate seating position of passenger e On bicycle Any person riding on a bicycle or other non motorized wheeled vehicle with pedals e Pedestrian Any person who is not an occupant of a transport vehicle Specify pedestrian activity at
141. ng Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Undetermined Injury Other Injury Unknown Subtotal ooo0ococ0c o a 56 Report 31 Team Prevention Recommendations Education Agency Law Environment Other None Made Short Term 0 0 0 0 0 Implementation 0 0 0 0 0 Deaths Reviewed Health Department Mental health EE RE E EE a sms C omer nean care provaes 0 tw macaa fener id waes nencacyeroamaten Locacao gt en contontaactrce o amsows ie ar Footnote Columns do not add up to totals becasue the factors are not mutually exclusive More than one recommendation could have been made 57 Review Meeting Process Report Report 32 Review Team Process Fire Burn or Drowning Animal Bite Poisioning Electrocution or Atack Crush Overdose or Injury Cause Acute Intoxication Deaths Reviewed HIPAA regulations prevented full exchange of information Records information needed from another state Review led to additional investigation Team disagreed with official manner of death Team disagreed with official cause of death Fire Burn or Drowning Electrocution Asphyxia Weapon Poisioning or Atack Crush Overdose or Injury Cause Acute Intoxication Official manner or cause was change
142. ng a psychiatrist psychologist medical doctor therapist or other counselor for a mental health or substance abuse problem receiving a prescription for an antidepressant or other psychiatric medication or residing in an inpatient or halfway house facility for mental health problems If the child died of an overdose the existence of an antidepressant or other psychiatric medication in the child s bloodstream is not sufficient evidence of mental health treatment because the medication may not have belonged to the child Child was on medications for mental illness Specify if the child had an active prescription for psychiatric medication at time of death They need not have actually been taking the medication Issues prevented child from receiving mental health services Evidence exists in the records to indicate the child experienced barriers to accessing mental health care applicable only to children noted as having a mental health problem and not being in treatment Code yes if there were obstacles such as lack of insurance coverage transportation problems or long waiting lists or if it is known that treatment was either recommended by a health professional and or identified by the family and care was not received Describe the nature of the barrier in the narrative section A22 Child had history of substance abuse Child was perceived by self or others to have a problem with or to be addicted to alcohol or other drugs If tobacco abuse
143. ng the counties in their state to fill in this field Team Number States that have regional teams that encompass multiple counties or that have multiple teams within a county will have this identifier Local level users will have this identifier filled in automatically and will not be able to edit this field State level users will be able to enter a team number from their state into this field Year of Review This identifier is automatically filled in to the current year You can edit this field in order to enter cases from past years Sequence of Review This identifier is automatically filled in to the next highest sequence number for the current year For example if the last sequence number you entered in the current year was 00021 then the next new case you enter will come up as sequence 00022 regardless of whether sequences 00019 or 00020 exist You can edit this field to any sequence number Number must be numeric only no letters or characters allowed Death Certificate Death certificate number as stated on death certificate Birth Certificate Birth certificate number as stated on birth certificate Data Dictionary Case Number Case Definition 5 Section A Child Information Al Child s name Legal name of child as stated on death certificate Some reporting sites may find that an individual data source will require that unique identifiers such as name or social security number be s
144. o Yes Unknown Choose the answer that best applies In some questions there is also a N A option Questions should be left blank unanswered if the information was not researched questions should be marked unknown if the information was researched but no clear or satisfactory response was obtained 29 Was child acutely ill in the two weeks before death No Yes C Unknown Multiple choice Choose the one answer that best applies This type of question is typically seen as a list of possible answers with round buttons next to them as is seen in the first example Sometimes this type of question is seen as a rectangular box where you click the triangular arrow button in the box to see all of the options you can select from as is seen in the second example 1 Did child have supervision at time of the incident leading to death No not needed given developmental age or circumstances No but needed Yes C Unable to determine 16 Child s highest education level k8 Check all that apply Only questions that have a square box next to a list of possible answers instead of a round button are check all that apply Approach each checkbox as if it is a yes no question If the answer is Yes then check the box If the answer is No then leave the box blank 4 Agencies that conducted a scene investigation Not conducted I Medical examiner I Coroner M ME investigato
145. o the broad definition of act s of commission and omission This is not a determination of blame but rather just an identification of whether there were specific human behaviors involved that caused or contributed to the child s death If one or more acts of commission or omission potentially related to the child s death are not identified and coded here you will not be able to complete any other parts of the Section In the past this has lead to some important data being omitted A new category of Probable has been added to allow coders to include cases where there may not be sufficient evidence for the team to be certain that any particular act s of commission or omission related to the death occurred but there is some reasonable evidence indicating such a link Case in which the Probable category is selected will be treated separately than the cases categorized as Yes For example this Probable category allows the team to check child abuse or child neglect in those situations where they only have reasonable suspicions but are not certain enough to classify the case as child maltreatment Section I 3 Although this is not intended to be exhaustive examples of acts of commission that would count as direct causes of a child s death include 1 someone shooting the child with a gun and the bullet wound causing the death 2 a teen driver falling asleep and crashing his car into a tree causing death due to
146. ocity using an explosive charge as a propellant This definition includes handguns rifles and shotguns A sharp instrument refers not only to knives but also to razors machetes or pointed instruments e g chisel broken glass A person s body part includes any part of a person used as the primary instrument of the assault or injury For example fists for punching feet for kicking Body part should not be checked if the person was using hands to hold another weapon Blunt instrument refers to clubs bats etc Biological weapon is defined as any infectious agent such as a bacteria or virus used intentionally to inflict harm upon others This definition is often expanded to include biologically derived toxins and poisons G6b For firearms type If firearm was weapon specify type G6c Firearm licensed If firearm was weapon indicate if it was licensed to owner G6d Firearm safety features If firearm was weapon specify safety features present on firearm at time of incident Trigger lock is defined as an external device that is attached to the handgun with a key or combination and is designed to prevent a handgun from being discharged unless the device has been deactivated Personalization device is defined as a device installed in a firearm that prevents unauthorized users of any age from firing it External safety or drop safety is defined as a device that blocks the trigger or the hammer from striking the firing pin will someti
147. of a local state or national Consumer Product Safety organization of a product related problem e Other specify Indicate other type s of strategy ies to prevent more deaths Data Dictionary 64 Section K Prevention Initiatives Resulting from the Review K2a Current action stage Identify whether the proposed action is currently at the recommendation stage only or action planning is underway or some form of action to implement the prevention strategy has already begun K2b Type of action Indicate if the proposed preventive action is an immediate short term solution e g drafting a letter holding a public meeting or writing a newspaper article or involves a longer term and or more complex intervention such as development of a home visitation program implementation of a school health curricula or development of a community wide injury prevention plan K2c Level of action Indicate if the proposed action involves local state and or national level activities K3 Who took responsibility for championing the prevention strategies Identify who volunteered or was assigned to take leadership to complete each recommendation or work on the planning or implementation of each proposed strategy activity and to follow up to monitor and report back on what happened Data Dictionary 65 Section K Prevention Initiatives Resulting from the Review Section L The Review Meeting Process L1 Date of first review meeting Enter the
148. of child maltreatment as Caused a perpetrator Contributed O O No O Yes O OUK If yes check all that apply Physical O Neglect Sexual E Emotional psychological U K CPS referrals Substantiations L CPS prevention services Family Preservation svcs L Children ever removed 21 Caused Person have disability or chronic illness Contributed O O No O O Yes O Ouk If yes check all that apply Physical specify CI Mental specify Sensory specify O uk If mental was caregiver receiving services Q O No O O Yes O O UK 22 Person have prior If yes check all that apply Contributed Child abuse 23 Person have history of 24 Person have delinquent criminal history Caused Contributed O O No child deaths Caused intimate partner violence Caused Contributed Caused Contributed O O No O O Yes O Ouk 25 At time of incident was person check all that apply Caused Contributed C Drug impaired Alcohol impaired Asleep Distracted O Absent Other Specify 28 For suicide select yes no or u k for each question Describe answers in narrative Cc o0000000000 ooo0oo00000000g ooo0oo0o0o000000 Child neglect Accident Suicide SIDS Other Other specify U K Caused Impaired by illness
149. olunteer activities for an organized group only e g excluding helping neighbors if not for production working on the family farm Data Dictionary 7 Section A Child Information or ranch if it is production related e g milking a cow on a dairy farm Employment also includes working in a family business regardless of pay if the work contributes to the profitability of the business Sporadic jobs should be considered part time employment Select N A for specific circumstances such as if the child was an infant or if the child was severely disabled Al8 Did child have problems in school Problems in school include those from a documented history from school social services juvenile court or law enforcement records Code as yes if no documented history exists but the child perceived that he or she was experiencing problems Problems in school include e Academic This category should be selected if a student s academic performance was declining e Truancy A chronic failure to attend school e Suspensions Includes all suspensions received for any reason e Behavioral This is a broad category and can include acting out in class disobedience being disruptive bullying or being bullied e Expulsion Refers to the removal of a student from a school for violating rules e Other Select this category if the school problem your team has identified doesn t fit into any other category Please specify the problem in the text field e U
150. on K Prevention Initiatives Resulting from the Review Case Actions After you have located the case that you are searching for you have three action options that you can perform edit print and delete Be sure to click on the hyperlink of the action in the same row as the case that you are interested in The example below illustrates that the edit action will be selected for the first case ET J 23 33 01 2004 0001 1 18 2004 Edt Print Delete 23 33 01 2004 0002 2 2 2004 Eat Print Delete rint 23 33 01 2004 0003 2 11 2004 Edit Print Delete 17 Edit Case Edit is useful if you have started a case under Enter a New Case but need to finish it or add more information at a later time By clicking Edit you will open the selected case in the same data entry pages used for Enter a New Case but the information you have previously saved for that case will be there If you need more information about the data entry pages please refer to Section 3 of this manual Print Case Clicking Print opens a new window where the entire paper Child Death Review Report Form is duplicated for printing All the information that you have saved for that case is filled in Due to space constraints some of the Specify information may be truncated for printing but all of the information you entered has been saved You will need to have Adobe Acrobat Reader or Adobe Acrobat Professional to use Print Case After
151. on for unknown U K A question should be marked unknown if an attempt was made to find the answer but no clear or satisfactory response was obtained questions should be left blank unanswered if no attempt was made to find the answer N A stands for Not Applicable and should be used if the question is not applicable For example use N A for level of education if child is an infant This edition is Version 2 0 effective January 2008 Additional paper forms can be ordered from the National Center at no charge Users interested in participating in the web based case reporting system for data entry and reporting should contact the National Center for Child Death Review Phone 1 800 656 2434 Email info childdeathreview org Website www childdeathreview org Data entry website https cdrdata org This form was developed by a work group of over 26 persons representing 18 states and the Maternal and Child Bureau of HRSA HHS Copyright National Center for Child Death Review Policy and Practice October 2007 CASE NUMBER Death Certificate Number Case Type O Death Near death serious Injury State County Team Number Year of Review Sequence of Review Birth Certificate Number Not born alive A CHILD INFORMATION 1 Child s name First Middle 2 Date of birth U K 3 Date of death O U K Years 5 Race check all that apply U K 6 Hispanic or 7 Sex Months C White O Native Hawaiian Lat
152. onal causing death For example a caregivers arm pressed the child s head into a comforter Data Dictionary 50 Section H Other Circumstances of Incident e Tangled Child was intertwined for example in bedding crib bumper or other object causing death Hli Caregiver supervisor fell asleep while feeding child If caregiver supervisor fell asleep while feeding child specify type of feeding H1j Child sleeping on same surface with person s or animal s If child was sleeping with a person or animal specify number of adults sleeping with child and if they were obese number of other children sleeping with child and their ages and number of animals sleeping with child and type of animal s If age of children or type of animal s is unknown write in unknown Select yes regarding obesity if there was clear evidence that the adult s sharing a sleep surface with the child was in fact obese from photos police reports or other documentation H2 Death a Consequence of a Problem with a Consumer Product If yes answer the following questions H2a Describe product and circumstances If death was the consequence of a problem with a consumer product describe product Examples of consumer products include toys cribs power tools cigarette lighters and household chemicals H2b Was product used properly If death was the consequence of a problem with a consumer product indicate if product was being used properly all re
153. ons at a later date Select this option if you would like to complete this section later after you have more information To identify these cases use the Search for Prevention Updates under Search for Case on the navigation menu of your state welcome page K1 Could the death have been prevented Team s conclusions regarding the preventability of the death A child s death is considered to be preventable if an individual or the community could reasonably have done something that would have changed the circumstances that led to the child s death K2 What specific recommendations and or actions resulted from the review Note If you need to make changes to data entered for question K2 on the web version reset your answers by checking and unchecking the No recommendations were made check box at the beginning Indicate specific prevention strategies developed during the review process In making these judgments the team should consider the feasibility of the proposed solutions and how they compare with other possible suggestions in terms of priority and likely impact A recommendation means that the team made a formal statement that a specific strategy be implemented An action means that the team or others are taking steps to implement the recommendation e Nothing Team could not identify any prevention strategies e Education Media campaign school program community safety project provider education parent education p
154. or medical cause to return cases Unknown injury SIDS due to that particular cause Other perinatal condition e Select Undetermined if injury Other medical condition or medical cause to return all Undetermined medical cause Unknown medical cause cases where the cause of death was not classified as an injury or medical cause Search 16 Search for Date of Entry You can search for all cases by the date entered in the field Date Completed Section N of the form Cases that do not have this date completed will not be included in the search results Some examples of useful searches include e Enter 01 01 2005 in the start date and 12 31 2005 in the end date to list all deaths that were entered in 2005 e Enter the same date in both fields to list all deaths that were entered on a particular day e Enter just the start date to list all cases that were entered on that date and after e Enter just the end date to list all cases that were entered on that date and before Start Date MM DD Y YYY End Date MM DD YY Search Search for Data Entry Incomplete This search retrieves all cases that do not have the check box selected in Data Entry Completed in Section N Form Completed By Search for Prevention Updates This search retrieves all cases that have the check box selected in Mark this case to edit add prevention actions at a later date in Secti
155. or under die while in his her care custody or control If yes indicate number of prior child deaths due to child abuse child neglect accidental suicide SIDS or other See Item I 1 for definition of caused and contributed 123 Person has history of intimate partner violence Person has a documented history of intimate partner violence IPV as either victim or perpetrator Documented refers to evidence from law enforcement medical or human services IPV is defined as actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse ex spouse current or former boyfriend or girlfriend or current or former dating partner Intimate partners may be heterosexual or of the same sex This may also include domestic disturbance complaints to which law enforcement responded See Item I 1 for definition of caused and contributed 124 Person has delinquent or criminal history Person has a documented history of delinquent or criminal behaviors or actions This includes any history with the juvenile justice system or the criminal justice system If yes specify type of delinquent or criminal history that is documented Delinquent behavior may include school disciplinary actions charges or convictions for Data Dictionary 58 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide misdemeanor offenses Criminal behavior includes charges or convictions for felony charges
156. orces and the National Guard performing temporary duties at the time of incident If yes specify the branch of military See Item I 1 for definition of caused and contributed 118 Person has history of substance abuse Person is perceived by self or others to have a problem with or to be addicted to alcohol or other drugs If tobacco abuse exists it can be coded in the Other category Code as yes if person was noted as using illegal drugs such as heroin or cocaine abusing prescription medications such as pain relievers or Valium or regularly using inhalants e g sniffing gas If the person is mentioned a using illegal drugs even if addiction or abuse in not specifically mentioned code as Yes A person who is noted as participating in a drug or alcohol rehabilitation program or treatment including self help groups and 12 step program should be coded as yes even if the person was noted as being currently clean and sober A person with short term experimental use that did not cause life problems and or addictions should be coded no A problem from the past e g five years or more ago that has resolved and no longer appears to apply should still be coded yes Previously attempting suicide via overdose is not sufficient justification for answering yes to this question in the absence of other information 119 Person has history as a victim of child maltreatment Person has documented history of be
157. ormation Continued Caused Contributed mitnpatedatinestnciet o e ee ce een tcinattmeneedin a e es e ett ptr epeetaly ot teatiercrescemer Footnote Includes all cases where action of omission commission caused or contributed to the death was reported by team as Yes or Probable Section Question 1 in CDR Case Reporting System Child placed outside of home refers to placement in foster care including licensed and relative kinship foster homes Counts for Caused and Contributed for Type of Abuse and Triggering Events for Physical Abuse is not available as the information is not collected in this manner in Section of the reporting tool 48 Report 27 Acts of Omission Commission Child Neglect Information Deaths Reviewed se Failure to protect from hazards Failure to provide necessities Medical neglect Emotional neglect Abandonment Chronic with child Pattern in family Isolated incident Died as infant and born drug alcohol exposed Open CPS case at time of death Investigation found evidence of prior abuse Child had history of maltreatment as victim Child placed outside of home CPS action taken because of death 49 Report 27 Acts of Omission Commission Child Neglect Information Continued Biological parent Adoptive parent Step parent Foster parent Parents partner Other relative Child care worker babysitter Other Friend or Acquaintance C ee Footnote Includes all cases where actio
158. ormation please contact us at 1 800 656 2434 e mail info childdeathreview org Child Death Review Case Reporting System From Case Review to Data to Action Step 1 Complete case review of Step 2 Complete CDR Case Report child death Online www cdrdata org Step 4 Servers sort and store lt 4 Step 3 Send Report through Web to data and permit access according servers at the Michigan Public Health to state requirements Institute Step 5 State and local teams and gt Step 6 Reports and data are used to national CDR download standardized develop recommendations reports and or download data to advocate for and take actions to create custom reports prevent child deaths and to keep children healthy and safe NA TIONAL CENTER FOR Understanding How CHILD DEATH REVIEW and Why Children Die amp Taking Actions to KEEPING KIDS ALIVE Prevent Child Deaths Child Death Review Case Reporting System Case Report 2 0 Effective January 2008 Instructions This case report is a component of the web based CDR Case Reporting System It can be used alone as a paper instrument but its full potential is reached when the data from this form is entered into the CDR Case Reporting System This system is available to states from the National Center for Child Death Review and requires a data use agreement for state and local data entry System functions include data entry case report editing and printing data download and s
159. ospital O Rural Unlicensed child care home O Military installation Other parking area Other specify O Frontier Farm C Jail detention facility State or county park U K O uk Licensed foster care home O O O Relative foster care home O 6 Incident state 8 Was 911 or 9 CPR performed 10 At time of incident 11 EMS to scene 12 Child s activity at time of incident 13 Total number of deaths local emergency before EMS leading to the death check all that apply at incident event number called arrived had child used O Sleeping C Other specify O N A ONA alcohol or drugs C Playing Children ages 0 18 O No O No ONA O Yes O Working O uK Adults O Yes O Yes O No O UK LI Eating O UK O uK L Driving vehicle occupant Ouk E INVESTIGATION INFORMATION 1 Death referred to 2 Person declaring official cause 3 Autopsy performed Agencies that conducted a scene investigation check all that apply Medical examiner and manner of death O no O Yes O uK 7 Incident county O Coroner Medical examiner If yes conducted by Not conducted CI Fire investigator Not referred Coroner Forensic pathologist Medical examiner O ems O U K Hospital physician O Pediatric pathologist Coroner L Child Protective Services Mortician Unknown pathologist Coroner investigator O uK O O O Other physician General pathologist O ME investigator C Other specify m O Law enforcement U K Other specify U K 5 Toxicology
160. otor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Sub Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 oooo0 so000 ooog so000 gooo s0000 oooo sono oeoooo0 sea000 eooo eooono eooo eooon0 eooo eooo eooono Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Sub Total eoooo0 cse000 oooo0 s0000 E E E so0000 og n ooog eooo so000 oeoooo sa000 ecoo0o0 oo0oo0oo0ooo0oo0oo0o0 eooo eooono eooo eooo ecooono eooo 12 Report 3 Manner and Cause of Death by Age Group Continued Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush ooocooqo9qo amp ooooccpoco oo Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Sub Total eooo eooo 9n 13 Incident Information Report Report 4 Investigation Information Fire Burn or ea Animal Bite Poisoning Exposure Other Any Medical Electrocution or Attack Overdose Injury Cause or Acute Intoxication Death was referred to medical examiner or coroner Death was NOT referred to medical examiner or
161. r I Coroner investigator M Law enforcement I Fire investigator EMS M Child Protective Services I Other T Unknown Fill in the blank These are questions with simple boxes in which you can answer with text as in the first example numbers as in the second example or a date as in the third example Many of the fill in the blank questions are combined with an Unknown checkbox as illustrated in the examples In these questions you have the option of either answering the fill in the blank or checking unknown 1 Child s Name M Unk First Jane aaa Middle Last Doe 14 Child s weight fl pounds 4 ounces Unknown 3 Date of Death 01 01 2005 M Unknown i e MM DD YY YY Important Users are cautioned to avoid entering identifying information in specify boxes This would primarily include names and county identifiers that could be used to recognize your team or the case For example when referring to local law enforcement use county sheriff rather than Columbia County sheriff See Section 6 of this manual for more information about identified and de identified data Table matrix Similar to a multiple choice question choose the one answer that best applies for that row Some tables like the example below also include checkboxes in the row Approach each checkbox as if it is a yes no question for that row CDR review led to referral Follow up q
162. r money or its equivalent Witness intimidation To intentionally say or do something that would cause a witness of a crime to be fearful of harm to them if they provide information to authorities about the crime or to kill a witness to prevent him her from providing information Data Dictionary 52 Section H Other Circumstances of Incident Section Acts of Omission or Commission including Child Abuse and Neglect and Suicide Completion of this Section is especially important because it provides information about any human behaviors that may be involved in a child s death For example it addresses intentional e g homicides child abuse and neglect suicides unintentional injuries and medical misadventures e g errors Not only can this information serve critical data tracking functions it may be critical to the prevention of both intentional and unintentional injury deaths Ll Did any action s of omission or commission cause or contribute to the death Acts of omission or commission are defined as any act or failure to act which causes i e directly and or substantially contributes to i e indirectly the death of the child Communities may have different standards that apply but they should be based on evidence and professional judgments Legal definitions may serve as a baseline although they need not be used as a strict criterion Because this question serves a gatekeeper role please pay particular attention t
163. relative O Other death of friend or relative m Bullying as victim O Bullying as perpetrator Cl school failure O Move new school m Other serious school problems L Pregnancy m Physical abuse assault O Rape sexual abuse O Problems with the law O Drugs alcohol m Sexual orientation O Religious cultural issues O Job problems O Money problems m Gambling problems O Involvement in cult activities O Involvement in computer or video games m Involvement with the Internet specify O Other specify C uk J SERVICES TO FAMILY AND COMMUNITY AS A RESULT OF DEATH 1 Services Provided Offered but Offered but Should be Needed but CDR review Select one option per row after death refused U K if used offered not available Unknown led to referral Bereavement counseling Economic support Funeral arrangements Emergency shelter Mental health services Foster care Health care Legal services Family planning OOO OOO O OOO OOOO OOO OOO OOOO OO OO 0 0 OO GOO OOOO ooo0oo0000000 0000000000 ooooaanaggoagaai0g Other specify K PREVENTION INITIATIVES RESULTING FROM THE REVIEW Mark this case to edit add prevention actions at at later date 1 Could the death have been prevented O No probably not Yes probably Team could not determine 2 What specific recommendations and or actions resulted from the review Check all that apply No recommendations made go to Section L Current Action Stage
164. report generated including the report title the start and end review year or start and end death year selected in the criteria your state and if it s a local level report your local team or the county team selected in the criteria the case type selected in the criteria and whether or not the cases have been completed for data entry Demographics Ethnicity Race and Age Group by Sex Death Year Range 2006 to 2006 Michigan Alcona Child Deaths Reviewed Cases marked as complete for data entry Many reports also have a footer on the last page that provides more information about the data displayed in the body of the report Other functions on the toolbar are explained below While it is possible to print the Report View window through Internet Explorer we recommend that you use the Export or Print function to get it into an Adobe format first If you do not have Adobe Acrobat then you can download a free copy of Adobe Acrobat Reader at www adobe com Please check with your technology staff before downloading and installing any new software Save a Report The first button on the Report View REE window toolbar is Save Export g File Format Adobe Acrobat PDF x This will launch a new Export window in which you can select the Merosot Excel 87 2000 XLS format that you would like the report ENa ma E o a to be saved We recommend Bal selecting Adobe Acrobat PDF and clicking OK The Export window defaults
165. revented safe exit Fire was suspected arson Building or rental codes violated Child not supervised but needed Child used alcohol drugs prior to incident Supervisor impaired by alcohol drugs Single home Duplex Apartment Trailer Mobile Home Footnote Columns do not add up to total deaths because the factors are not mutually exclusive 23 Drowning Reports Report 11 Drowning Death Demographics Pond Creek Lake River Ocean Quarry Gravel Canal Pool Hot Well Cistern BathTub Other Unknown Pit Tub Spa lt 1 Year 1 4 Years 5 9 Years 10 14 Years 15 17 Years 18 19 Years 20 24 Years 24 Report 11 Drowning Death Demographics Continued Lake River Ocean Quarry Gravel Pool Hot Pond Creek Pit Tub Spa Black African American Native Hawaiian ence Fe American Indian ee ER ee ee Well Cistern BathTub 25 Report 12 Factors Involved in Drowning Deaths Lake River Pond Creek Child wearing flotation device Child could swim Child not supervised but needed Child used alcohol drugs prior to incident Supervisor impaired by alcohol drugs Ocean Quarry Gravel Canal Pool Hot Well Cistern BathTub Other Unknown Pit Tub Spa_ Septic Footnote Columns do not add up to total deaths because the factors are not mutually exclusive Shaded cells in the body of the table may contain red numbers which denote the number cases with potentia
166. rity of the time The sleep place selected should be the usual place for the time the incident occurred For example if the death occurred at a licensed child care home where did the infant usually sleep while at child care Hle Usual sleep position Position child slept most times HIf Was there a crib bassinette port a crib in the home for the child Indicate if there was a crib bassinette or port a crib in the home and or location where the incident occurred Hlg Child in new different sleep environment Child was sleeping in an environment new or different to child up to one week prior to the death A new or different sleep environment refers to an environment that is not part of the child s normal routine If the child went to Grandma s house every Tuesday this is considered part of the usual routine If the child had started attending a new child care this would be considered a new sleep environment Include temporary sleep environments as well such as a hotel stay H1Ih Circumstances when child found Circumstances surrounding the sleeping incident Specify if child s airway was unobstructed fully obstructed or partially obstructed by person or object what position child was found most relevant to the death and what object s person s child was found with e Wedged Child was positioned between two objects for example the wall and bed causing death e Pressed Refers to an act of another intentional or unintenti
167. rking area Train m Muddy O uk Rural road O Off road Subway L Ice Snow Highway O Railroad crossing tracks Trolley m Fog Intersection O Other specify Other specify O wet Shoulder O Construction zone Sidewalk EWK U K L Inadequate lighting OREN O2ONS Or OTORO OCrOLO OOO TOOTOO OrO Or 0 9 OO 6 910 61010 O10 0 Oo O O g Drivers involved in incident check all that apply h Total number of occupants in vehicles Child as driver Child s driver Driver of other primary vehicle In child s vehicle including child Age of Driver O N A child was not in a vehicle Responsible for causing incident Total number occupants Was alcohol drug impaired Number teens ages 14 21 Has no license Total number of deaths Has a learner s permit Total number teen deaths Has a graduated license Has a full license In other primary vehicle involved in incident Has a full license that has been restricted N A incident was a single vehicle crash Has a suspended license Total number occupants O uK If recreational vehicle has driver safety certificate Number teens ages 14 21 U K Other specify Total number of deaths O UK Pogo Goo oe oo0000000090 Be ee eo el 2 ee eS Was violating graduated licensing rules Total number teen deaths O Uk Nighttime driving curfew Passenger restrictions Driving without required supervision Other violations specify U K p a e e
168. rmation was brought to the meeting to answer the team s questions e Necessary team members were absent Team members with information critical to the review process were unable to attend the meeting e Meeting was held too soon after death The CDR meeting was held too soon after the death so that investigative reports autopsy results etc were not complete e Meeting was held too long after death The CDR meeting was held too long after the death Team members may have forgotten relevant details to the case or since so much time has passed the team feels uncomfortable making recommendations for services or interventions for the family that were needed but not provided as a result of the death e Records or information needed from another locality in state The team was unable to collect information for the review process from other localities within their state e Records or information needed from another state The team was unable to collect information for the review process from another state e Team disagreement on circumstances Team members were unable to arrive at a consensus on the actual events surrounding this child s death Data Dictionary 66 Section L The Review Meeting Process Other factors specify Specify any other factors that prevented the team from conducting an effective review L6 Review meeting outcomes Indicate the outcomes of the review process Review led to additional investigation As a result of the r
169. rt Data Dictionary 28 Section G1 Motor Vehicle and Other Transport Glf Location of incident Type of place where incident occurred as specified on law enforcement s motor vehicle crash report City streets typically consist of commercial areas whereas residential streets are predominantly housing Highway includes Interstates Glg Drivers involved in incident Specify details relating to drivers involved in incident If child was driving fill out child as driver column If child was passenger fill out child s driver column Specify driver of other vehicle involved in crash If more than two vehicles were involved in crash report on the vehicle identified in section 1a2 as other primary vehicle involved in crash Glh Total number of occupants in vehicles An occupant is any person who is part of a transport vehicle Specify total number of occupants number of teens ages 14 21 total number of deaths and total number of teen deaths including child in each vehicle involved in crash N A applies to h1 if the child was not in a vehicle N A applies to h2 if the incident was a single vehicle crash Gli Protective measures for child Specify types of protective measures used by child Protective measures are defined as steps taken by child or supervisor to ensure child s safety in the event of a crash Use your own state laws to determine if the use was appropriate e Airbag A passive idle restraint system that automatically
170. s Disease Any significant source of maternal infection including periodontal UTI etc not classified as STI Pregnancy Related Hypertension Hypertensive states of pregnancy that have not been preceded by any chronic high blood pressure Classification 1 Without proteinuria protein in the urine 2 With proteinuria pre eclampsia and 3 Accompanied by seizures eclampsia Preterm labor Onset of Labor before 37 completed weeks gestation Previous Infant 4000 Grams Previous birth to infant weighing more than 4000 grams at birth Previous Preterm Small for Gestation Previous delivery of an infant before 37 completed weeks gestation Birth weigh of the fetus is below the 10th percentile of mean weight for gestational age Premature Rupture of Membranes PROM Spontaneous rupture of the bag of waters any time before the onset of labor 13 Section A Child Information e Renal Disease Damage to the nephrons resulting in kidney disease This damage may leave kidneys unable to remove wastes Commonly associated with diabetes and high blood pressure e Rh Sensitization Rh incompatibility occurs when a pregnant woman has Rh negative blood and the fetus has Rh positive blood If Rh antibodies cross the placenta to the fetus they may destroy some of the fetus s red blood cells Once a woman is sensitized problems are more likely with each subsequent pregnancy in which the fetus s blood is Rh positive If red blood cells are destroyed fast
171. s and 12 step program should be coded as yes even if the person was noted as being currently clean and sober A person with short term experimental use that did not cause life problems and or addictions should be coded no A problem from the past e g five years or more ago that has resolved and no longer appears to apply should still be coded yes Previously attempting suicide via overdose is not sufficient justification for answering yes to this question in the absence of other information C10 Supervisor have history of child maltreatment Supervisor has documented history of being the victim or the perpetrator of child maltreatment child abuse or neglect History means a referral or substantiation from Child Protective Services or documentation from law enforcement report or medical records If referrals were made but not substantiated still select Yes regarding history unless the referral was found to be completely falsified If yes specify type s of maltreatment substantiated If child welfare referral or substantiations are documented indicate total number of CPS referrals and substantiations Indicate if supervisor ever received CPS prevention or Family Preservation services was ever in foster care or adopted or had children removed C11 Supervisor has disability or chronic illness Supervisor has a disability or chronic illness Chronic implies an impairment or illness that has a substantial long ter
172. s ethnicity Ethnicity is usually listed on the death certificate Ethnicity is used to differentiate population groups on the basis of shared cultural characteristics or geographic origins A7 Sex Sex of child as stated on death certificate A8 Residence address Residential address of child as stated on death certificate If a person is currently residing in a short term facility for less than six months use his or her home address as their residential address If a person is residing in a long term facility for over six months such as a college dormitory prison or residential nursing home use the institution s address If they are living in a short term facility and no residential address is noted use the address of the short term facility Data Dictionary 6 Section A Child Information If child was not a resident of the United States select Out of Country in the drop drown list of states and enter the country of residence in the text box Some reporting sites may find that an individual data source will require that unique identifiers such as a specific street address be stored in hard copy only not in the electronic database If this is the case leave this field blank A9 Type of residence Place where child lived a majority of the time A10 New residence in past 30 days Child s place of residence stated in A9 was new to child within last 30 days preceding death All Was the residence overcrowded Th
173. s to make each table available for your use Common extraction utilities include WinZip and PKZip A free unzip utility can be downloaded from www quickzip org Please check with your technology staff before downloading and installing any new software Download a Section If you do not have an unzip utility you will need to download each table individually This is also useful if you wish to download a table after making an alteration to a single page of data Simply click on the hyperlink for the table you want to download and save the file to a secure Table tACT Section 1 27 Table tACT2 Section 28 29 Table tPR V Section J K Table tREY Section L M N folder on your computer or server Working with the Download Each page Sections A N is a separate table in the database A table is simply a container that stores the information you have entered for that section Some tables tCAU tPRV and tREV hold data from more than one page One table tACT is so large that it needed to be split into two tables for the download Data from the same case will have the same number in the id variable across tables This is the key you will use to link all data from a single case together A few variables death certificate birth certificate apartment number and zip code are downloaded with 24 a leading quotation mark to make sure that the analysis program you use will recognize them as text variables instead of nu
174. s usually the same as the place of death D5 Type of area Specify type of area where incident occurred Urban is defined as a large city or densely populated area Suburban is defined as a residential district located on the outskirts of a city A rural area is a community with low population densities and can include agricultural and recreational land Frontier is a very sparsely populated region in which there are less than three persons per square mile D6 Incident state State in which incident occurred as stated on death certificate If incident occurred out of the United States select Out of Country and type in the country where incident occurred D7 Incident county County in which incident occurred as stated on death certificate If incident occurred Data Dictionary 23 Section D Incident Information Out of Country this field will be disabled D8 Was 911 or local emergency number called 911 or local emergency number was documented as being called at time of incident For newborns that never left the hospital or if the incident occurred in a hospital select N A D9 CPR performed before EMS arrived Cardiopulmonary Resuscitation CPR was attempted by any person at time of incident prior to time of EMS or First Responder arrival D10 At time of incident leading to death had child used alcohol or drugs There was documentation by toxicology or reports by witnesses or others including statements t
175. screen 6 X rays taken 7 Was a CPS record check O Other specify O Other physician O O O No C Negative Cl Marijuana Too high prescription drug specify O No conducted as a result of O Yes If yes check all that apply Alcohol C Meth L Too high over the counter drug specify O Yes death O uK C Cocaine LC Opiates Other specify O uK O uK ONo OyYes O uK 8 Did investigation find 9 CPS action taken because of death O No O Yes O uK 10 If death occurred in evidence of prior abuse licensed setting indicate O no O Yes O uK If yes highest level of action If yes services or actions resulting check all that apply action taken If yes from what source taken because of death No action Check all that apply O Report screened out C1 Voluntary services offered L Court ordered out of home O License suspended C From x rays O and not investigated C Voluntary services provided placement O License revoked LI From autopsy Unsubstantiated C Court ordered services provided C Children removed O Investigation ongoing C From CPS review Inconclusive C Voluntary out of home placement C Parental rights terminated O UK L From law enforcement O Substantiated O UK F OFFICIAL MANNER AND PRIMARY CAUSE OF DEATH 1 Official manner of death 2 Primary cause of death Choose only one of four then a specific cause For pending choose most likely case from the death certificate O From an in
176. st all agencies that conducted a scene investigation Specify all agencies that conducted an investigation of the incident at the death scene after the death occurred A scene investigation refers to conducting an investigation at the event place If the child was killed while working include child labor enforcement agencies and or workplace health and safety enforcement agencies e g OSHA under Other E5 Toxicology screen If toxicology screen was conducted on child after death specify results and substances found If toxicology found that therapeutic levels of prescription or over the counter drugs were too low or too high code as Other E6 X rays taken Indicate if X rays of child were taken during the course of the investigation Data Dictionary 25 Section E Investigation Information E7 Was a CPS record check conducted as a result of the death Indicate if CPS records on child were checked by investigating agencies E8 Did investigation find evidence of prior abuse If evidence of abuse prior to incident was found during the course of the investigation indicate from what source the evidence was found E9 CPS action taken because of death If CPS action was taken as a result of death select report screen out not investigation unsubstantiated inconclusive or substantiated Indicate services or actions that occurred These terms may vary by state E10 If death occurred in licensed setting indicat
177. sy performed Autopsy was performed on the child as stated on death certificate or other source Specify person who performed the autopsy e Forensic pathologist The forensic pathologist is a pathologist with a subspecialty in the examination of persons who die sudden unexpected or violent deaths The forensic pathologist is an expert in determining cause and manner of death The forensic pathologist is specially trained to perform autopsies to determine the presence or absence of disease injury or poisoning to evaluate historical and law enforcement investigative information relating to manner of death to collect medical evidence such as trace evidence and secretions to document sexual assault and to reconstruct how a person received injuries e Pediatric pathologist Pediatric pathology is a subspecialty of pathology concerned with the study and diagnosis of disease from conception through adolescence recognizing that diseases of early life are distinct from those of adulthood It is often at the forefront of advances in understanding and treatment of disorders of the fetus the newborn infant and the child e General pathologist A pathologist is a physician trained in the medical specialty of pathology Pathology is the branch of medicine that deals with the diagnosis of disease and causes of death by means of laboratory examination of body fluids clinical pathology cell samples cytology and tissues pathologic anatomy E4 Li
178. t abuse be sure to also answer question G9a G4c If strangulation object causing event For cases of strangulation indicate what object caused the compression of the child s neck If manual strangulation by an assailant be sure to also answer question G6q and Section I G4d If choking object causing event For cases of choking indicate what type of object blocked the child s airway G4e Was asphyxia an autoerotic event Autoerotic asphyxiation is defined as the practice of inducing cerebral anoxia usually by means of self applied ligatures or suffocating devices while the individual masturbates The most common practitioners are adolescent and young adult males Select U K if the team could not determine if the child was participating in an autoerotic event or intentionally killed him herself G4f Was child participating in choking game or pass out game Indicate whether asphyxial death was related to play known by many names most commonly as choking game or pass out game The goal of this game most often played by younger adolescents 9 14 year olds is to achieve a brief high or euphoric state by stopping the flow of oxygen containing blood to the brain Sometimes children choke each other until the person being choked passes out The pressure on the arteries is then released and blood flow to the brain resumes causing a rush as consciousness returns There are variations of this activity
179. t diarrhea and pneumonia For a child with a chronic illness but without any acute symptoms in the two weeks prior to death code as no Exacerbations of chronic illness may include a severe asthma attack or insulin shock A31 Are child s parents first generation immigrants The child s parents were born in a country other than the U S and were citizens of another country at the time they moved to the United States A32 If child over age 12 what was child s gender identity Gender identity is what a person considers their gender to be regardless if this gender is different from the sex that was assigned to them at birth This should only be answered if you have reliable documentation that the adolescent self reported their gender identity A33 If child over age 12 what was child s sexual orientation Sexual orientation is the pattern of a person s emotional physical sexual attraction and psychological attraction to someone of a particular sex This should only be answered if you have reliable documentation that the adolescent self identified their sexual orientation e Heterosexual Someone whose predominant physical or sexual attraction is to the opposite sex Straight e Gay Preferred term for homosexual Can apply to men and women mostly men e Lesbian Preferred term for homosexual woman Can only apply to women e Bisexual Someone who has a physical or sexual attraction to both sexes e Questioning Questioning refers
180. tandardized reports The purpose of this form is to collect comprehensive information from multiple agencies participating in a child death review It can be partially filled out before a meeting The form documents the circumstances involved in the death investigative actions services provided or needed key risk factors and actions recommended and or taken by the CDR team to prevent other deaths While this data collection form is an important part of the child death review process the form should not be the central focus of the review meeting Experienced users have found that it works best to assign a person to record data while the team discussions are occurring Persons should not attempt to answer every single question in a step by step manner as part of the team discussion It is not expected that teams will have answers to all of the questions related to a death However over time teams begin understanding the importance of data collection and bring necessary information to the meeting They find that the percentage of unknowns and unanswered questions decreases as the team becomes more familiar with the form The form contains three types of questions 1 Those that users should only select one response represented by a circle 2 Those in which users can select several responses represented by a square and 3 Those in which users enter text This last type is depicted by specify or describe Most questions have a selecti
181. te a local level or state level report Be sure to click on the hyperlink in the same row as the report that you are interested in Depending on the complexity of the report it may take up to a minute to generate so please be patient Infant Child Information 1 Demographics Ethnicity Race and Age Group by Sex Local State 2 Infant Death Information Local State 3 Manner and Cause of Death by Age Group Local State Incident Information 4 Investigation Information Local State The report opens in a new window so we recommend that you modify any pop up blocker software to always allow pop ups from our site https www cdrdata org If the new report window is still not visible check the Windows Task Bar at the very bottom of your screen to see if one of the open programs is the report The Report View Window When the Report View window opens it may only be displaying the first pre defined report page Many of the reports are multiple pages You can determine the report length from the toolbar at the top of the Report View window The example below shows that 20 you are on page of 3 The four arrows to the left of page number are your tools to navigate through the report pages From left to right the arrows are first page previous page next page and last page g Ss gt A 13 100 Every report has a header that displays information about the
182. te to the type of fire Fire extinguishers are classified for use on specific types of fires For example an extinguisher classified for Type A B or C fires can be used for ordinary combustible materials Type A flammable liquids Type B and electrical equipment Type C A Class D extinguisher would be used for flammable metals Many fire extinguishers sold today can be used for more than one type of fire A B C See the National Fire Protection Association Code 10 Portable Fire Extinguishers Chapter 5 which describes appropriate fire extinguishers http www nfpa org freecodes free_access_document asp G2o Was sprinkler system present A sprinkler system was present in building structure of fire at time of incident If yes indicate if it was working G2p Were smoke detectors present If smoke detectors were present in building structure at time of incident specify type with removable batteries with non removable batteries or hardwired For each type indicate if detectors were functioning properly If any were not functioning select No If not functioning properly select the reason they were not working missing batteries or another reason Indicate if there were an adequate number of detectors for the space Suggested guidelines for judging adequate coverage are based on codes from the National Fire Protection Association NFPA code 72 National Fire Alarm Code Chapter 11 e There should be a smoke alarm on every leve
183. ter is a group of three or more suicides that occur closer together in time and space than would be expected in a given community with suicides occurring later in the cluster being motivated by earlier suicides or having a common exposure that may be associated with increased risk of suicides A community can consist of a geographic area or a social network such as a youth group The perception of the child fatality review team that a cluster exists is sufficient to endorse this variable 129 For suicide was there a history of acute or cumulative personal crisis or events that may have contributed to the child s despondency Victim experienced a personal crisis leading up to the suicide in which it is believed the crisis was significant enough to the child to have contributed to their despondency and suicide e None known No known personal crisis at time of incident e Family discord Problems with a family member friend or associate other than an intimate partner e Parent s divorce separation Parents were recently separated or divorced or the victim was still experiencing the divorce or separation as an on going problem as documented in records e Argument with parents caregivers The child had had a major argument with his her parents caregivers Data Dictionary 60 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide e Argument with boyfriend girlfriend The child had had a major argument with
184. th care issues on part of child family or health care providers related to death specify issues Compliance with care is defined as recommended ways of caring for child as prescribed by a physician G11h options are defined in section A39 Data Dictionary 48 Section G11 Medical Condition Section G12 Other Cause Undetermined Cause or Unknown Cause Gl12a Cause Describe the cause and or circumstances involved in the child s death The following causes of death are included in this section e Other injury cause e Undetermined injury cause e Unknown injury cause e Unknown cause no information is available e Undetermined if injury or medical cause death was not classified as an injury or medical cause Data Dictionary 49 Section G12 Other Cause Undetermined Cause or Unknown Cause Section H Other Circumstances of Incident H1 Death Occurred While Child Sleeping or in a Sleeping Environment If yes answer the following questions Hla Incident sleep place Type of place child was sleeping in or on Playpen includes pack n play Select couch if the death occurred on a futon that was in the couch position If a futon was positioned horizontally so as to resemble a bed select adult bed as the sleep place H1b Child put to sleep Position child was put to sleep in H1c Child found Position child was found unresponsive H1d Usual sleep place Usual sleep place refers to the place the child slept a majo
185. time of incident e Unknown CDR team does not know the position of the child involved in the motor vehicle other transport incident Glc Causes of incident Causes of incident as determined by reporting law enforcement officer on motor vehicle crash report e Recklessness Level of intent of driver to operate vehicle in a unsafe manner not conducive to road weather and other traffic conditions e Driver distraction When a driver engages in a secondary task that is not necessary to perform the primary driving task i e talking to a passenger eating This includes distractions that occur outside of the vehicle as well If a cell phone was the distraction select Cell phone in use while driving e Driver inexperience Use the information available to the team to make this decision For example if the crash occurred during winter conditions was this the first time the child had driven on icy roads e Drugs or alcohol use This includes use by the driver of any vehicle pedestrian bicyclist or passenger that contributed to the incident Gld Collision type Indicate circumstances existing at time of incident causing injury of child Vehicle rollovers in which another vehicle or objects was not struck should be categorized in Other event Gle Driving conditions Environmental conditions effecting road surface conditions and driver s ability to drive vehicle safely as specified on law enforcement s motor vehicle crash repo
186. tives Resulting from Review Reports Report 30 Deaths by Manner and Cause by Preventability No Probably Could Not Determine Pneumonia Prematurity SIDS Other infection Other perinatal condition Other medical condition Undetermined medical cause Unknown Subtotal Accident unintentional Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Subtotal ooooo0oo0o0 00 eooon Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Undetermined Injury Other Injury Unknown Subtotal E E E E E E E E ooooooqco0oc9ce eooon eooon9n 55 Report 30 Deaths by Manner and Cause by Preventability Continued No Probably Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowning Asphyxia Weapon Animal Bite or Attack Fall or Crush Poisoning Overdose or Acute Intoxication Exposure Other Injury Undetermined Injury Unknown Subtotal oooocc ccf eooo9n Undetermined Any Medical Cause Motor Vehicle Fire Burn or Electrocution Drowni
187. tivities A cult is a religion regarded as unorthodox or spurious Members of a cult feel a great devotion to a person idea object or movement e Involvement in computer and video games There was evidence of the child s involvement with video or computer games that the team has evidence of contributing to child s mental health status and or suicide ideation e Involvement with the internet There was evidence that the child routinely accessed internet chat rooms or sites that were either age inappropriate e g sites with pornographic or excessively violent material or that may have contributed to the child s suicidal ideations e Other specify Specify other events or personal crisis that may have contributed to the victim s suicide Data Dictionary 62 Section Acts of Omission or Commission Including Child Abuse Neglect and Suicide Section J Services to Family and Community as a Result of the Death Jl Services Services are any type of supportive resource that the family and community were offered and or utilized as a direct result of a child s death In order to accommodate all types of services the categories listed are general To note a specific service select Other and write the service in the Specify text box Data Dictionary Section J Services to Family and Community as a Result of Death 63 Section K Prevention Initiatives Resulting from the Review Mark this case to edit add prevention acti
188. to include all pages in the report Adobe will automatically launch with the complete report In Adobe you can either save the report to your desktop or print it 21 Print a Report lt 4 Print the Report Microsoft Internet Explorer E oxi Page Range To Print 1 Inthe next dialog that appears select the Open this file option and click the OK button 2 Click the printer icon on the Acrobat Reader Menu rather than the print button on your internet browser Cancel The second button on the Report View window toolbar is Print lt 3 This will launch a new Print window The Print window defaults to print just the first page We recommend that you select All for the page range and click OK As stated at the bottom of the Print window you may see another window in which you should select Open this file and click OK Adobe will automatically launch with the complete report In Adobe you can either print the report or save it to your desktop 22 Section 6 Download Your Data Clicking on the Download Your Data option from the Welcome Page gives you the ability to download all of the cases you have entered into the Internet Child Death Review Case Reporting System Depending on your permission level set by your State Administrator you may or may not be able to access this section Local level users will only be able to download data for their county and or team State le
189. to questions about whether one is gay or a lesbian Select questioning is the child is experiencing conflict or is confused regarding their sexual orientation Data Dictionary 11 Section A Child Information e Unknown Select unknown if the team was not able to determine the child s sexual orientation given the information available A34 Gestational age If under one year gestational age in weeks as stated on birth certificate A35 Birth weight If under one year birth weight in grams OR pounds and ounces as stated on birth certificate A36 Multiple birth Pregnancy with more than one fetus at conception as stated on birth certificate A37 Number of prenatal visits Documented number of prenatal visits child s mother made to doctor during pregnancy as stated on birth certificate A38 Month of first prenatal visit Prenatal visit as stated on birth certificate is defined as pregnancy related medical care delivered by a doctor nurse or other health professional with the goal of monitoring the pregnancy providing education and increasing the likelihood of a positive maternal fetal outcome A39 During pregnancy did mother Indicate any health risk that mother experienced during pregnancy e Have medical complications infections Mother had documented medical complications pregnancy related or non pregnancy related or infections during pregnancy at anytime These categories are not mutually exclusive For example
190. to seek follow treatment specify Emotional neglect specify Abandonment specify U K Check only one per column and describe in narrative Caused Contributed OOO CO O00 00 6 For abusive head trauma were there retinal hemorrhages O No O Yes UK 7 For abusive head trauma was the child shaken O No Yes UK If yes was there impact O no O Yes O UK 10 Other negligence Vehicular Other specify O uk Caused Poor absent supervision go to 11 Child abuse go to 4 Child neglect go to 9 Other negligence go to 10 O Assault not child abuse go to 11 O Religious cultural practices go to 11 O Suicide go to 28 Medical misadventure specify and go to 12 Other specify and go to 11 UK goto 11 8 Events s triggering physical abuse check all that apply OOoOOHOOooOooO0Oo None Crying Toilet training Disobedience Feeding problems Domestic argument Other specify U K 11 Was act s of ommision commision Contributed Chronic with child Pattern in family or with perpetrator Isolated incident O UK Person s Responsible 12 Is person the caregiver or supervisor 13 Primary person responsible for action s that caused and or contributed to death in previous section Select no more than one person for caused and one person for contributed Caused Contributed O No O Yes caregiver one go to 25 Caused Contributed Caused Contribut
191. tored in hard copy only not in the electronic database If this is the case it is acceptable to leave these fields blank A2 Date of birth Date of child s birth as stated on birth or death certificate A3 Date of death Exact date of child s death as stated on death certificate Exact date of death is sometimes unknown as in an unwitnessed suicide or homicide If this is the case select unknown A4 Age Numerical age of child as stated on death certificate In some cases the child s exact age will not be known If age is provided within a five year age range or less choose the midpoint of the range round to the lower year if the midpoint calculation results in a half year If an age range of greater than five years is provided leave this field blank e Years Months Days Hours Minutes U K Type of unit used to report child s numerical age as stated on death certificate A5 Race Race of child as stated on death certificate These categories were issued by the Office of Management and Budget in order to promote comparability of data among federal data systems The standards for 1997 have five racial groups American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander and White For the CDR Case Reporting System American Indian Alaskan Native Native Hawaiian and Pacific Islander each have their own category A6 Hispanic or Latino origin This question refers to the child
192. ts or persons check all that apply On top of gt Adult s C1 Water bed mattress Clothing Under Child ren Unobstructed by person or object O Fully obstructed by person or object Air mattress Cord O Partially obstructed by person or object O uK Between Animal s Bumper pads Plastic bag Wedged into Blanket Crib rail Wall Fell or rolled onto Comforter Chair type Tangled in Mattress Car seat stroller U K O O O Pressed into Pillow O Couch Other specify O O O Other specify Pillow top mattress uK Stuffed toy 000000000 i Caregiver supervisor fell asleep while feeding child j Child sleeping on same surface with person s or animals s Check all that apply O No If yes type of feeding Bottle With adult s Number ___ Ol uK Adult obese Omno O Yes O UK O Yes O Breast With other children Number __ Cl UK Children s ages O uK O UK With animal s Number ___ Ol uK Type s of animal U K 2 WAS DEATH A CONSEQUENCE OF A PROBLEM WITH A CONSUMER PRODUCT No gotoH3 Yes UK go to H3 a Describe product and b Was product c Is a recall in place d Did product have e Was Consumer Product Safety circumstances used properly safety label Commission CPSC notified Ono Oye OuKIONo OvYes OuK ONo O yes O ux O No call 1 800 638 2772 to file report O Yes O UK 11 3 DID DEATH OCCUR DURING COMMISSION OF ANOTHER CRIME a Type of crime check all that apply
193. tting fires Indicate age of person that started fire G2h Did anyone attempt to put out fire Any person including victim caregiver supervisor or first responders that were reported to have tried to extinguish the fire G2i Did escape or rescue efforts worsen fire Indicate if attempts by child or family members to escape or anyone s attempts to rescue victims worsened the situation For example were windows opened or broken out doors opened etc thereby fueling the fire with oxygen and increasing the volume of smoke G2j Did any factors delay fire department arrival If factors delayed fire department arrival such as lack of communication environmental conditions etc specify factors G2k Were barriers preventing safe exit List any barriers that prevented the safe exit of child thus resulting in child s death such as objects blocking child s path of exit etc Data Dictionary 31 Section G2 Fire Burn or Electrocution G2l Was building a rental property Building structure that was on fire was a rental property not owned by occupants G2m Were building rental codes violated Existing state or local building rental codes were violated Answer if specific code violations were related to the fire incident for example if barriers were improperly installed code as yes G2n Were proper working fire extinguishers present A proper extinguisher refers to having a type of fire extinguisher appropria
194. u will be able to enter values for county if applicable team if applicable the year of review or sequence of review as your search parameters Some examples of useful searches include Enter all fields to locate a particular case Enter the county to list all cases for that county Enter the year of review to list all cases in a review year Enter the county and year of review to list all cases for that county in a review year State County Year Sequence Search for Date of Death You can search for all cases where the date of death occurred in a particular time period Some examples of useful searches include Enter 01 01 2005 in the start date and 12 31 2005 in the end date to list all deaths that occurred in 2005 Enter the same date in both fields to list all deaths that occurred on a particular day Enter just the start date to list all cases that occurred on that date and after Enter just the end date to list all cases that occurred on that date and before Cases returned by this search will be sorted chronologically by date of death starting with the earliest date Start Date MM DD YY YY End Date MM DD YY YY Search 15 Search for Manner of Death You can search for cases by the manner of death Only one selection may be made at a time This search parameter will also return those cases where manner of death was not answered Some examples of useful searches inclu
195. ual auditory and olfactory Examples include blindness and deafness B14 Caregiver s have prior child deaths Caregiver has a documented history of having a child anyone 17 years or under die while in his her care custody or control If yes indicate number of prior child deaths due to child abuse child neglect accidental suicide SIDS or other B15 Caregiver s have history of intimate partner violence Caregiver has a documented history of intimate partner violence IPV as either victim or perpetrator Documented refers to evidence from law enforcement medical or human services IPV is defined as actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse ex spouse current or former boyfriend or girlfriend or current or former dating partner Intimate partners may be heterosexual or of the same sex This may also include domestic disturbance complaints to which law enforcement responded B16 Caregiver s have delinquent or criminal history Caregiver has a documented history of delinquent or criminal behaviors or actions This includes any history with the juvenile justice system or the criminal justice system If yes specify type of delinquent or criminal history that is documented Delinquent behavior may include school disciplinary actions charges or convictions for misdemeanor offenses Criminal behavior includes charges or convictions for felony charges Data
196. ublic forum other education Education is any combination of learning experiences designed to facilitate voluntary adaptations of behavior conducive to health Public forum is an educational and or advocacy event for the broader community to address an issue of concern A community safety project is a prevention project that involves community or neighborhood in the planning design reach scope and or implementation e Agency New policy ies revised policy ies new program new services expanded services An institutional change could be made in an agency s formal or informal policies practices and or procedures that affect the way the agency does its business e Law New law ordinance amended law ordinance enforcement of law ordinance A proposal to enact a new or amend a current local state or national regulation ordinance or law by the appropriate governmental body or action taken to enforce an existing local state or national regulation ordinance or law by the appropriate enforcement body e Environment Modify a consumer product recall a consumer product modify a public space modify a private space A change could be made to a product or physical environment Physical environment refers to physical surroundings such as highway layout and construction and specific mechanisms for injury such as automobile design features Actions include adding isolation fence around pool reengineering a roadway intersection or notification
197. uding Child Abuse Neglect and SUICIGE setae et ire esate tea eve eee a eae tee tse et hele ol aah ERA 53 Section J Services to Family and Community as a Result of Death 63 Section K Prevention Initiatives Resulting from the Review eeceeeeeeeeees 64 Section L The Review Meeting Processis a cexusvyoxveveesesvy asi eoneas aay eseee neni ede e eves 66 Section M INarralivers 5 26 59 ick sheGsss sen Ea AE AA is Ga es pees secs sa ae a ARENA 68 Section N Form Completed BYy Jas ceesaaw eevee cn sacak vee na ee ee umaneep eeaeaes 69 Case Number Case Definition The first data entry page that appears on your screen is the Case Definition Page which corresponds to the Case Number section of the paper form This is where you create the unique identifier for the case you are entering The paper form allows for five levels of information to define a case State County Team Number Year of Review and Sequence of Review However depending on the profile that your state has established with the National Center you may not see all of these options State This identifier is automatically filled in for you and you cannot edit this field Every state has a unique identifier County States that have county level teams will have this identifier Local level users will have this identifier filled in automatically and will not be able to edit this field State level users will be able to select from amo
198. uestions Some questions have additional parts that become visible when a certain answer is given This can include questions that have a Specify following an Other answer as in the first example or those that have one or more questions that follow the initial question as in the second example 18 Child s health insurance No Follow Up Foll U o Follow I None No Follow up M Private I Medicaid I State Plan T Other I Unknown 18 Child s health insurance T None M Private I Medicaid I State Plan M Other Specify CSHCS T Unknown 9 b History of seizures No Follow Up No C Yes C Unknown Follow Up b History of seizures i C No p 0 Yes Number 2 ov Yes C Unknown aise nknown Ensuring Data Quality Skip Patterns While the paper Child Death Review Case Report Form appears daunting there are on average six pages of questions for each case that are not applicable and do not need to be completed The skip patterns written into the paper form are translated to the Internet by hiding all of the questions that are skipped according to the answers that are entered So you will never see a question on the Internet system that does not apply to the case being entered Some sections are more complex and require further explanation of how the skip patterns are translated to the Internet system In Section F Official Manner and Primary Cause of Death you are as
199. ug alcohol impaired at time of incident History of mental illness Had transgendered identity Was gayllesbian bisexual questioning Criminal history on delinquency Spent time in juvenile detention Open CPS case at time of death Investigation found evidence of prior abuse Child had history of maltreatment as victim Child placed outside of home History of intimate partner violence as victim History of intimate partner violence as perperator 53 Report 29 Acts of Omission Commission Suicide Information Continued Child left a note Child talked about suicide Prior suicide threats were made Prior attempts where made Suicide was completely unexpected Child had received prior mental health services Child was receiving mental health services at time of death Child was on medications for mental illness Issues prevented child from receiving mental health services Child had history of running away Child had history of self mutilation There is a history of family suicide Suicide was part of a murder suicide Suicide was part of a suicide pact Suicide was part of a suicide cluster Footnote Includes all cases where action of omission commission caused or contributed to the death was reported by team as Yes or Probable Section Question 1 in CDR Case Reporting System Child placed outside of home refers to placement in foster care including licensed and relative kinship foster homes 54 Prevention Initia
200. val gang member O uK O Razor O Hammer O Adoptive parent O Friend Stranger Hunting knife Rock O Stepparent O Acquaintance O Law enforcement O Scissors O Household item O Foster parent Child s boyfriend Other specify Other specify Other specify Mother s partner or girlfriend Father s partner O Classmate O uK O uK O UK What did person s body Did person using weapon have o Persons handling weapons at time of incident check all that apply p Sex of person s part do Check all that history of weapon related offenses Fatal and or Other weapon Fatal and or Other weapon handling weapon apply O No O Self oO C Friend m Beat kick or punch O Yes 0 Biological parent 0 O Acquaintance Fatal weapon Drop O uk Adoptive parent l Child s boyfriend or girlfriend O Male Push Stepparent O Classmate O Female Bite Does anyone in child s family have Foster parent Co worker O uK Shake a history of weapon offenses or Mother s partner Institutional staff Strangle die of weapons related causes Father s partner Neighbor Other weapon Drown D Yes describe circumstances Sibling Stranger O Female Burn Spouse Law enforcement officer O UK Other specify Other relative Other specify O E O E O O Throw O No Grandparent Rival gang member O Male Oo El O E U K U K Use of weapon at time check all that apply Self injury m Ar
201. vel users will be able to download data for all teams in their state Some states have legal restrictions on viewing case identifiers For these states and for the National Center for Child Death Review the downloads will not include the following HIPAA identifiable information e County and or team of review Child s name Date of birth Date of death only month and day of death removed Residential address street apartment city county and zip Birth certificate number Death certificate number Date and time of incident Incident county Narrative Form completed by Important While the above list of variables are removed from the National Center s view users are also cautioned to avoid entering identifying information in specify boxes for other questions This would primarily include names and county identifiers that could be used to recognize your team or the case For example when referring to local law enforcement use county sheriff rather than Columbia County sheriff Answers that identify the state are fine because the National Center already has access to that information Downloading Data When you download data from the Child Death Review Case Reporting System it is a snapshot of the all the data you have entered up until that point in time Any corrections changes made to the downloaded files will not be reflected in the Internet system You will need to login and make corrections changes directly to the d
202. w or by year of death The standardized reports also have the ability to filter cases based upon whether the cases have been marked complete for data entry This is the check box Data Entry Completed For This Case in Section N of the report If you would like to run a report for all cases reviewed between 2004 and 2007 select 2004 for the start review year in the drop down box and 2007 for the end review year in the drop down box see first example below If you would like to run a report that included all cases where the year of death was 2006 select 2006 for the start death year and 2006 for end death year see second example below You must select either All Cases or Cases marked complete for data entry Likewise you must select either Year of Review or Year of Death in the selection criteria If you select Year of Death as your selection criteria the reports will automatically exclude those cases that do not have a year of death entered into the data tool A statement will appear that advises you of the number of cases with missing year of death information You can select the case type that you would like included in your reports This is the question found on the Case Definition data entry page with the options of child death child near death event or not born alive The selection criterion also has the option to view all cases Selection Criteria All cases Cases marked
203. web application or prior to receiving an error message What problem occurred what error message came up Mail to National MCH Center for Child Death Review Fax 517 324 7365 2440 Woodlake Circle Suite 150 Okemos MI 48864 NATIONAL CENTER FOR CHILD DEATH REVIEW KEEPING KIDS ALIVE Child Death Review Reporting System Contact Information National Center for Child Death Review 2440 Woodlake Circle Suite 150 Okemos MI 48864 Phone 800 656 2434 Fax 517 324 7365 Email info childdeathreview org National Center for Child Death Review staff include Theresa Covington MPH Executive Director Email tcovingt mphi org Heather Dykstra MPA Data Analyst Email hdykstra mphi org Esther Shaw Data Analyst Email eshaw mphi org The Child Death Review Case Reporting System is supported in part by Grant No 1 U93 MC 00225 01 from the Maternal and Child Health Bureau Title V Social Security Act Health Resources and Services Administration Department of Health and Human Services NATIONAL CENTER FOR _ 1 800 656 2434 CHII D DEA TH REVIEW www childdeathreview org 7 Email info childdeathreview org el KEEPING KIDS ALIVE
204. wed Cases marked as complete for data entry Many reports also have a footer on the last page that provides more information about the data displayed in the body of the report Other functions on the toolbar are explained below While it is possible to print the Report View window through Internet Explorer we recommend that you use the Export or Print function to get it into an Adobe format first If you do not have Adobe Acrobat then you can download a free copy of Adobe Acrobat Reader at www adobe com Please check with your technology staff before downloading and installing any new software Save a Report The first button on the Report View MEE window toolbar is Save Export 4 File Format Adobe Acrobat PDF 7 This will launch a new Export window in which you can select the Micrasoft Excel 37 2000 XLS format that you would like the report ar el aaa to be saved We recommend Page Range eal ae a ik selecting Adobe Acrobat PDF and clicking OK The Export window defaults to include all pages in the report Adobe will automatically launch with the complete report In Adobe you can either save the report to your desktop or print it C Pages From 1 To 1 Print A Report B The second button on the Report View window toolbar is Print This will launch a new Print window The Print window defaults to print just the first page We recommend that you select All for the page range and click
205. wn Sub Total 0 a 0 a 0 0 0 a 0 0 0 a 0 a 0 a 0 0 0 0 0 0 0 0 0 0 0 a 0 a 0 a 0 a 0 0 0 0 0 0 a 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a 0 a 0 0 0 0 a 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36 Report 19 Sleep Related Death Demographics Continued American Indian Native Alaskan Multi racial All Races 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 1 Months 2 3 Months 45 Months 6 7 Months 8 11 Months 1 4 Years 5 Years and Up Unknown Sub Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 eoo0o0cc0cc 000 T i ecoco00c 005 Fi eoooooqceooao eoooocccco ad eoo0oo0c0cc 0 00 eoo0oo0oo0ccc 00 eooo0o0cc0c 0c gd i eocoo0ovccc 0c 00 eooo0o0 oo o 2 eocoo0cc0c0c 0co00 eoooq0o0oaqo a eocoo0oo0co0c 0c 00 fo i

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