The Role of Fatality Review in Understanding how Systems Changed During the COVID-19 Pandemic

Full Description: As a result of the COVID-19 pandemic, children and families had to change the way that they live, work, play, learn, and worship. The nimble response needed to address the pandemic shifted the way the systems functioned, and families navigated the community. The number of children who die because of the COVID-19 pandemic may never be known. Deaths directly associated with the COVID-19 virus may be easier to identify than deaths indirectly related to the pandemic. To fully understand the impact of the COVID-19 pandemic on children who died, it is imperative that these deaths be reviewed in a comprehensive manner to understand how to prevent future deaths when systems are required to shift due to pressing public health crises.
Child death review (CDR) teams offer a unique view into how systems function during the pandemic by convening a multidisciplinary group of community professionals who seek to identify key risk and protective factors surrounding the death of a child. Common members include representatives from child welfare, pediatrics, public health, mental health, and public safety. CDR teams collect extensive data about the deceased child, family, circumstances, systems, and person(s) responsible (when applicable). Additionally, CDR teams collect data on the stressors experienced by the family such as racism, poverty, food insecurity, bullying, and transitions into or out of foster care.
Data from CDR teams that has been entered into the National Fatality Review-Case Reporting System (NFR-CRS) was analyzed to gain a more complete understanding of the circumstances surrounding child deaths. A total of 13,209 cases have been entered for deaths occurring in 2020-21 in 41 states. Section I8 of NFR-CRS asks questions related to the impacts of COVID-19. Despite a high proportion of missing data for these questions (67-79%), they provide important insights into how systems and families were affected by the pandemic. Of these deaths, 343 had a relationship with COVID-19 noted in Section I8 of NFR-CRS. Almost two-thirds of COVID-19 impacted deaths were listed as indirectly related to COVID-19. Furthermore 50% of indirect deaths had a manner of death listed as suicide. COVID impacted deaths were known to child welfare at a higher percentage when compared to all deaths from the same time. Due to the high percentage of suicides listed as indirectly related to COVID-19, life stressor data in the NFR-CRS was also analyzed. Across all deaths for 2020-2021, the average number of life stressors was 1.5. For all deaths impacted by COVID-19, the average number of life stressors was 3.2. For COVID-impacted suicides, the average was 4.5.
As a result of CDR teams, communities can understand how their systems reacted to the pandemic, how families were impacted, and make important adjustments in how they continue to deliver essential services.

Abbreviated Description: The number of children who die because of the COVID-19 pandemic may never be known. However, child death review (CDR) teams provide communities with a unique opportunity to view how systems responded during the pandemic. Data from CDR teams entered into the National Fatality Review-Case Reporting System (NFR-CRS) was analyzed to gain a more complete understanding of the circumstances surrounding COVID-19. A total of 13,209 cases have been entered for deaths occurring in 2020-21. Of these deaths, 343 had a relationship with COVID-19. Almost 2/3 of COVID-19 impacted deaths were listed as indirectly related to COVID-19. Furthermore 50% of indirect deaths had a manner of death listed as suicide. This session will focus on how CDR teams can inform systems change during public health crises.