Child Death Overview Processes:
Since April 1st 2008, Local Safeguarding Children’s Boards in England have had a statutory responsibility for child death review processes. The relevant legislature is enshrined within the Children’s Act, 2004, and applies to all young people under the age of 18 years.. The processes to be followed when a child dies are outlined within Working Together to Safeguard Children: Child Death Review Process – Every Child Matters
Very useful guidance has also been published by the Royal College of Paediatrics and Child Health: Child Death Review Processes – RCPCH
The overall purpose of the child death review processes is to understand why children die, put in place interventions to protect other children, and to prevent future deaths. It is intended that these processes will:
- Document and accurately establish causation of death in an individual child.
- Identify patterns of death in a community so that preventable factors can be recognised and reduced.
- Contribute to the improved collection of forensic evidence in the small proportion of deaths where there may have been an act of maltreatment.
‘Working Together (2006)’ outlines 2 inter-related processes:
1. A Rapid Response where a group of key professionals come together for the purpose of evaluating the cause of death in an individual child, where the death of that individual child is unexpected. ‘Unexpected’ in this context is defined as a ‘’Death not anticipated as a significant possibility 24 hours before the death, or where there was a similarly unexpected collapse leading to or precipitating the events that led to the death’’
2. A Child Death Overview Panel (CDOP) that comes together to undertake an overview of all child deaths under the age of 18 years in a defined LSCB area(s)
Rapid Response Process
The rapid response process is divided into 3 phases: an immediate, early and late response.
Immediate response (4-6 hours). This involves the transfer of the child’s body to the hospital, appropriate management in the Emergency Department, the taking of initial history and examination of the body, notification of the coroner and the West of England Child Death Enquiry office, and an initial multi-agency strategy discussion.
Early response (24-48 hours). This involves amore comprehensive milt-agency planning meeting, leading to a home (or scene of death) visit, an initial report to the coroner and to the pathologist, the post mortem, and ensuring ongoing support to the family.
Late response (2–3 months). This involves a final child death review meeting, at which all the key professionals are present, with the intention of scrutinising all the factors intrinsic to the death of the child and completing national data forms. Eventually, a final report is produced that is circulated to the Coroner, and arrangements made to give feedback to the family.
In many cases, Health will be the lead agency and, in the West of England, the Community Paediatrician is the designated professional for overseeing the process. In some cases, however, Police and Social Services may be the Lead Agencies and will take charge of the investigation. The sequence of events outlined above should follow any unexpected death, be it in the community or in hospital. Clinical common sense is often required to ensure a proportional response is triggered, and this will mostly be facilitated by an early multiprofessional strategy discussion in the early stages by senior professionals from all the relevant agencies.
Finally, professionals need to be mindful of their relevant organisation’s Critical Incident reporting practise. Such investigations should run in parallel to the Child Death Review Process and will inform any final judgement on the relative factors intrinsic to the child’s death.
