CHILD DEATH REVIEW CHECKLIST
(Attach to the front of the file)
Please check the following to ensure all materials have been obtained and requirements met for this child’s death review:
1. ______ Law Enforcement Report of Incident and any supplemental
reports added by detectives
2. ______ Criminal Records of All Subjects in Report/Juveniles Records
3. ______ Law Enforcement calls to the home
4. ______ Medical Examiner’s Autopsy Report
5. ______ Birth Certificate
6. ______ Death Certificate
7. ______ CPT Report
8. ______ Medical/Hospital Records
9. ______ Fire Department/EMS Report, Records (If Applicable)
10. ______ Current CSA Completed; Reviewed by Zone Specialist Prior
to Closure
11. ______ Prior CSA, FAHIS, and HSn Case Information on Each
Subject in the Report
12. ______ Information From the Prior Investigative File and/or Services
file when applicable (may need to request the file)
13. ______ Report and/or contact information from Licensing on
Institutional Reports
14. ______ DCF Death Review Form for DOH When Applicable
(Death Review Coordinator will provide to the CPI)
15. ______ Obtain the SS Number on the child and input into HSn
16. ______ Enter the Date of Death into the child’s general information in
HSn, Demographics section
17. ______ Contact with SAO, verbal and written memo
18. ______ Include in HSn (recommended in the Implication for
Maltreatment section) a listing and/or summary of all
current/past service providers working with the family
Child Protective Investigator:___________________________________________
Phone: ________________________________________________________
Child Protective Supervisor:_____________________________________________
Phone: _________________________________________________________
Program Administrator:_________________________________________________
Phone: __________________________________________________________
Death Review Coordinator:
Jody Blinn
SC 841-2192; 723-2192
(Original: Death Review Coordinator File; Copies to: CPI, CPIS, POA)
Attachment to Checklist
1. Follow district guidelines for reporting child deaths. When completing the incident form, make sure to include any media involvement, prior investigations/services with findings, law enforcement information that is known and any other pertinent information.
2. Add the Death Review Coordinator as a secondary worker to all death reports.
3. Ensure the IDS is detailed and fluent:
Implication Boxes: Criminal Records – list each arrest, arrest date, and disposition for each subject on the report. Then add what the impact on child safety is as a result of the arrest history.
Prior Reports: List each prior report number, victims/perpetrator, findings of the investigation, any services offered/completed if known. Include any services history with Protective Supervision or foster care; if Intensive Crisis Counseling Program or Family Builders were offered, try to obtain information to see if the family completed the service. When we have priors, we may need to request the files from closed records. Then add what the impact on child safety is as a result of the priors.
Family Strengths/Concerns: Include who was living in the home, family support available, financial information, any past hx of abuse/neglect by the adults or problems overall with mental illness/substance/etc… Then add what the impact on child safety is as a result of these strengths/concerns.
4. Ensure that Each Maltreatment has a SEPARATE SUMMARY OF FINDING to include: Names/source of evidence and what was found to support that maltreatment; interview information from persons providing the evidence; reference photos or other physical evidence when applicable; include law enforcement names and report numbers as well as criminal findings; include SAO notification (memo as well as who you spoke with at the SAO office); CPT findings (include who saw child, findings, recommendations); name of ME conducting the autopsy when known and report findings (indicate preliminary findings when we don’t’ have the report). ***This is the most detailed and important section of the IDS. Please consult your allegation matrix to determine what evidence is required to determine findings.
5. Implication for Findings of Maltreatment is not the same as the Summary (don’t copy/paste summary into this section.). Address safety risks based on your findings and what was done to alleviate risk to surviving siblings when applicable.
6. The CSA should have been reviewed thoroughly by the CPI, Supervisor, and POA/Specialist prior to requesting review for closure.
7. Please do not use the wording; “risk is low because child is dead or deceased”. Complete the risk assessment as it relates to the surviving children or any other children in this person’s care (risk in general). Please Remember these reports can be released to the public, including the Media. Please be cognizant of what your final report contains as well as the format.
I am available at your convenience to assist with any matters regarding these type cases.
Office: (904) 723-2192