C H I LD D E ATH I N V E ST I G ATI O N T R A I NI N G RE P O RT 2005-2009
PREPARED BY LISA MAYHEW, MS CHILD DEATH INVESTIGATOR/TRAINER
Child Death Investigation Training Report 2005-2009 ABOUT THE CHILD DEATH INVESTIGATION TRAINING PROGRAM
Initiated in 2001, the Child Death Investigation Training Program is a comprehensive medicolegal course specifically aimed at the investigation of deaths of children falling under the jurisdiction of the medical examiner system. Interdisciplinary by design, the course encompasses the roles of a variety of professionals responsible for the investigation of child fatalities across North Carolina. All manners and mechanisms of death are addressed, as well as investigative needs of the medicolegal investigation, and investigative strategies utilized to obtain the necessary details for these cases. While oriented to the law enforcement community, any professional having even a peripheral role in child fatalities is encouraged to attend. Students over the years have included prosecutors, social workers, nurses, physicians, school personnel, paramedics, defense investigators, and judges. The curriculum is continuously updated and has expanded to now include advanced training. Specialized instruction or presentations on specific areas such as Sudden Infant Death Syndrome, Child Abuse Homicides, and Scene Reconstruction is also available. In conjunction with the North Carolina Justice Academy, our courses provide credit to law enforcement personnel enrolled in the Criminal Investigator Certificate Program. Our exceptional relationship with the academy has allowed us the flexibility to provide the trainings locally to requesting agencies while still providing participants with academy credit, providing more opportunities to train and reach more students. To date, more than 2600 professionals have participated in our training program in 155 classes over an eight year period. DESCRIPTION OF COURSES
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CHILD DEATH INVESTIGATION o
o
This course is the basic two day investigation course. It is the most comprehensive and covers all manners and mechanisms of death falling under the jurisdiction of the medical examiner system. In addition, it addresses scene investigation, particular obstacles or challenges that child deaths present, interviewing families, case examples, and prosecutorial issues. Most importantly it specifically addresses the varying agencies that become involved in these cases, their roles and responsibilities in an investigation, and their mandates as they relate to child deaths. While NCJA courses are attended primarily by law enforcement, locally requested trainings require attendance by representatives from any or all vested agencies. With an emphasis on interdisciplinary collaboration, having everyone in the same room for training brings communication to the forefront.
ADVANCED CHILD DEATH INVESTIGATION o
Evaluations from the two day course consistently commented on the desire for additional training, making the course longer, or including
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more cases. In response, in 2007 we developed the Advanced Child Death Investigation course in conjunction with the Conference of District Attorneys. The co-instructor for the course is the Child Abuse Resource Prosecutor, Laura Parker. She provides an excellent overview and application of the statutes pertaining to child abuse and murder. The original plan for the course was to vary the mechanism of death annually; however, the original topic of abusive head trauma has been so well received and utilized that we have decided not to change topics at this time. Participants receive a brief overview on homicides by the OCME, review and application of statutes by CDA, and in groups analyze three cases and present a detailed argument for charges as if they were presenting to their own district attorney. o
INFANT DEATH SCENE RECONSTRUCTION o
In 2006, representatives from OCME, DSS, Greensboro Police Department, and NC State University attended the SUIDI (Sudden Unexpected Infant Death Investigation) Academy in Atlanta, Georgia. This academy was a national training initiative on infant death scene reconstructions. Following the academy, a curriculum was developed specifically for training law enforcement investigators on properly conducting scene reconstructions in cases of deaths of infants under one year of age. In 2007 the course was offered to all law enforcement agencies across North Carolina as a one day course. This effort was tremendously successful (see proceeding section). In 2008, this curriculum was absorbed into the two day course. It can still be provided as an individual training at the local level.
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C O U R S E S TA T I S T I C S
Course evaluation forms were analyzed from 2005-2009. The reconstruction course was only conducted in 2007 and the advanced course began in 2007 but was only offered a limited number of times per year. Only qualitative evaluations were available for the advanced course. NCJA recently changed their evaluation forms so data will be collected for that course beginning 2010. CHILD DEATH 2005 INVESTIGATIONS
2006
2007
2008
2009
TOTALS
No. of classes taught
7
10
10
7
5
39
No. of participants
119
147
138
114
78
596
INFANT DEATH SCENE RECONSTRUCTION
ADVANCED CHILD DEATH INVESTIGATION
Total number of participants = 1208
42
42
531
531
1
3
1
5
24
40
17
81
Total number of classes = 86
Clearly 2007 was an exceptional year for training. With 53 classes conducted in over 42 counties totaling over 10,000 travel miles, it is no surprise that 2008 and 2009 appear drastically different. The reason is twofold. First, the time away from the office in 2007 meant more time in the office in 2008. Second, there were travel restrictions instituted in 2009 which hampered our ability to teach locally. To date, and to our knowledge, North Carolina has the highest training numbers for scene reconstruction of any of the states participating in the SUIDI Academy. The numbers for the advanced course are slightly smaller than the two day course because we did limit the number of participants in each class. Due to the nature of the course, and the intensive case studies done in groups, we prefer to have less than 20 students per class. Of note, the two day course is a prerequisite for the advanced course. The majority of the professionals attending the courses were law enforcement (89%). Other disciplines (11%) attending courses included prosecutors, social workers, Abuse/Neglect Consultants with the Division of Child Development, defense investigators, guardian ad litem representatives, medical fields (nurses, physicians, EMS), and school personnel. The reconstruction course and advanced course were limited to law enforcement representatives. Individualized trainings have been provided to a variety of other professionals as well.
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The map represents all of the counties where trainings were conducted from 2005-2009. Those counties in black represent where only the two day Child Death Investigation course was conducted. Light gray counties represent where only the scene reconstruction course was conducted. The dark gray (or purple) counties represent where multiple courses were conducted. So those counties received training in two or more areas. The advanced courses are captured by dark gray since the two day course is a prerequisite. Overall, 76 counties have received training in areas of child death investigations, with only 24 receiving none during this five year period. See Appendix A for a detailed list of counties and courses.
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E VA L UA T I O N S
Evaluations sheets and demographic forms are collected at the conclusion of each class. That allows us to collect information on the level of experience of participants, which agencies they work for, and how many child deaths they have investigated. The evaluation forms contain ten items rated on a scale from Excellent (5) to Poor (1). Additional qualitative questions are asked regarding suggestions for improvements to the course and most valuable aspects. The following chart contains the ten evaluation items and average ratings from 2005-2009 and overall ratings. ITEMS COURSE 1. The course as a whole was: 2. The course content was: 3. Case examples and videos were: 4. Applicability to my professional functions: 5. Expansion of my professional knowledge: INSTRUCTOR 6. The instructor’s effectiveness in teaching was: 7. Organization: 8. Demonstration of knowledge and skills: 9. Providing direction and feedback: 10. Establishing and maintaining rapport with the group:
2005
2006
2007
2008
2009
OVERALL
4.92
4.86
4.85
4.89
4.93
4.89
4.86 4.86
4.85 4.73
4.84 4.74
4.89 4.84
4.95 4.89
4.88 4.81
4.78
4.82
4.8
4.84
4.93
4.83
4.87
4.85
4.85
4.94
4.95
4.89
4.93
4.9
4.93
4.96
4.96
4.93
4.94 4.97
4.91 4.97
4.91 4.95
4.93 4.96
4.95 4.97
4.93 4.96
4.93
4.93
4.93
4.93
4.96
4.94
4.92
4.95
4.94
4.94
4.97
4.94
The qualitative responses from the Advanced Child Death Investigation course have been overwhelmingly positive. Both courses have continuous waiting lists with the academy. We are working on adding dates for the remainder of 2010 and into 2011 to accommodate those waiting to attend.
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C H I L D D E A T H I N V E S T I G A T I O N P ROT O C O L
The North Carolina Child Death Investigation Protocol was developed in 2006. The means by which to implement the protocol statewide has been a topic of discussion since that time. A pilot was initiated, but unfortunately was suspended in order to address training and investigative priorities at the time. After much consideration, a new proposal has been developed. A 16 month plan will begin in September of 2010. Counties will be divided into regions based on State Bureau of Investigation Districts for simplicity. Each region of counties will be provided two dates to attend training on the protocol provided by Lisa Mayhew with the OCME and NC CFPT. Trainings will be offered during the first and third weeks of the months of September through December. The following chart illustrates the training schedule. Month September October November December
Four Month Follow-Up January February March April
Six Month Follow-Up March April May June
Final Post Assessment September October November December
Local child fatality teams will receive written notification and information packets on the trainings for distribution to local agencies. While there are no requirements for the representatives, it is recommended they be from professions specifically addressed in the protocol itself. Those professions include law enforcement, social services, hospitals/medical, emergency medical services, and medical examiners. The training will be in a half day format and be provided at a local site within each region. This way expenses can be minimized as much as possible. Representatives will be responsible for taking the information back to their local agencies and implementing the policies as set forth by the protocol. All training materials will be provided. An evaluation process will be developed and will include a pre-assessment provided to each local team prior to training. A four month technical assistance follow-up will be conducted by Lisa Mayhew to assist with any implementation issues or questions local agencies may have. The first post assessment will be conducted at the six month follow-up and a final post assessment will be conducted at one year. This should allow ample time for counties to have experienced child deaths in their jurisdiction and utilized the policies. Memorandums of Agreement will be collected from each local team and maintained at the Office of the Chief Medical Examiner’s office. Participation is voluntary, though records will be kept indicating any counties not participating.
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S U M M A RY
Training in the area of child death investigations is a continuously evolving process. We strive to maintain the highest standards and best practices. Every attempt is made to continue our own training and stay abreast of the national issues, polices and procedures, and medicolegal investigative trends. The cases themselves guide us in new directions as the level of complexity increases with every year. Our methods for gathering and analyzing information must evolve in the same directions. As with any profession, turn-over within local agencies is a constant. Our training program is requested repeatedly in many counties to off-set staff changes and growth. We have seen vast improvements in the investigative information gathered in child death investigations over the last ten years. The appreciation for what these cases require has also shifted for many professionals. Shedding preconceived notions and assumptions and seeing the individuality of the cases is evident in the participants that come through our courses. The level of detail received by the OCME has greatly enhanced our abilities to make the most appropriate and accurate determinations of cause and manner of death. We will continue to expand the comfort zones of new investigators and enhance the existing knowledge of seasoned detectives. Never satisfied with par, there is always room for improvement.
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APPENDIX A
COUNTY Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Greene Guilford Halifax Harnett
CDI
ADV
RECON 18
24 1
1 1 1 4 8 37 9 8 2 3 10
3 9
2 16 11 16
2
11 9 5
1 2 1
8 16 2 53 2 7 3 3 3 13
1
21 1 13
2
9 1
6
1* 2
7
12 18
10 2 3
1
19
2 2
8 10
1
28
28
3
8
9
Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrrell Union Vance
8 12
1 3
8
2
14 2 3
3
7 15 13
1 5
1
5 11
5 1
8
3 15
33
1 17
1
14
16
3
9
10 5
1 1
14
2 3
1
3 3 2 4 17 12 12 3 6 5 5 4 3 3 1 5
1
8 1 1 1 2 2 1 1 4 3
1 14 9 12 13
4 2 15
1 6 13
10
Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey
41
5
74
2 6 2 4
1
9 15 13 1
1 3
* Represents EMS Shaded areas represent counties where no training has occurred during the 2005-2009 time period. The table represents the actual number of participants in the courses over the same time period per county.
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