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The Heart of Texas CFRT was formed in June 2008 to review child fatalities within the HOTRAC Region (Bosque, Falls, Hill, Limestone, and McLennan Counties). At this time, the McLennan County CFRT merged with the Heart of Texas CFRT to form one regional effort.
The Heart of Texas CFRT's goal is to improve the response to child fatalities, provide accurate information on how and why children are dying in our Region, and ultimately reduce the number of preventable deaths by establishing an effective review and standardized data collection system for all child fatalities.
The Heart of Texas CFRT membership is made up of local and regional representatives in the areas of pre-hospital care, hospital care, law enforcement, public health, child advocacy, mental health, CPS, physicans, fire, victim services, and education.
The Heart of Texas CFRT meets on a monthly basis. All CFRT meetings are closed to the public and are by invitation only. Any questions should be directed to the Heart of Texas CFRT Coordinator.
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Presiding Officer: Lori Boyett, RN, BSN
CFRT Coordinator: Stephanie Alvey
For information on the State of Texas CFRT, click here.
Helpful Websites
National MCH Center for Child Death Review
ICAN National Center on Child Fatality Review
CDC Sudden, Unexplained Infant Death Initiative (SUIDI)
Department of Family and Protective Services, Keeping Children Safe
National Clearinghouse of Child Abuse and Neglect Information
Shaken Baby Alliance
SIDS Network
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What Are Child Fatality Review Teams (CFRTs)?
CFRTs are multidisciplinary, multiagency working groups that review child deaths on a local level from a public health perspective. By reviewing circumstances surrounding child deaths, teams identify prevention strategies that will decrease the incidence of preventable child deaths by:
- Providing assistance, direction, and coordination to investigations of child deaths;
- Promoting cooperation, communication, and coordination among agencies involved in responding to child fatalities;
- Developing an understanding of the causes and incidence of child deaths in the county or counties in which the team is located;
- Recommending changes to agencies, through the agency's representative member, that will reduce the number of preventable child deaths; and
- Advising the State Committee on changes to law, policy, or practice that will assist the team and the agencies represented on the team in fulfilling their duties.
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The Roles of Team Members
Each member provides the team with information from their records, serves as a liaison to their professional counterparts, provides definitions of their profession's terminology, interprets the procedures and policies of their agency, and explains the legal responsibilities or limitations of their profession. They also assist in making referrals for services or providing direct aid to surviving family members. All team members must have a clear understanding of their own and other professional's and agencies' roles and responsibilities in response to child fatalities. Additionally, members need to be aware of and respect the expertise and resources offered by each profession and agency. The integration of these roles is the key to a community having a well coordinated child fatality response system.
Medical Examiner and/or Justice of the Peace
All information regarding suspicious or unnatural child deaths is received by medical examiners or justices of the peace. However, all child deaths under age 6, regardless of the cause must be reported to the medical examiner or justice of the peace according to Chapter 264 of the Family Code. If a county has a medical examiner (ME) system, justices of the peace (JP) are not involved in child deaths, and medical examiners make the determination of cause of death. Justices of the peace have the authority of a medical examiner in counties without a medical examiner. There are usually several justices of the peace in a county, but only one medical examiner for several adjacent counties. Guided by state law requirements, justices of the peace routinely request medical examiners to perform an autopsy to aid them in making cause of death rulings. When reviewing suspicious or unnatural deaths, the medical examiner or justice of the peace provides the team with information regarding how the determination of cause of death was reached. If an autopsy was performed, a summary of the report is included. They educate team members in areas relating to cause of death rulings. The medical examiner or justice of the peace also assists the team because of their access to records from the other investigating agencies and because of their ongoing working relationship with law enforcement, EMS, hospitals, and CPS.
Law Enforcement
Law enforcement members provide information on criminal investigations of child deaths reviewed by the team. They also check the criminal histories of the child and/or family members and suspects in the child death cases. To ensure sufficient representation, both the sheriff's department and the police department in the largest jurisdiction are needed as team members. The law enforcement team members act as liaisons between the team and other local law enforcement departments. They assist with persuading officers from other agencies to participate in reviews when there is a death in that jurisdiction. Law enforcement officers are usually the best trained team members on scene investigations and interrogations, essential skills required in determining how a child died. Their expertise provides useful information and training to other members.
Child Protective Services (CPS)
The CPS member has the legal authority and responsibility to investigate and provide protection to siblings that might be at risk. As a team member, they provide detailed information on the family and the worker's investigation into the child?s death. CPS members also have prior agency contact information including 1) reports of neglect or abuse on that child or siblings and 2) CPS services previously or currently being provided to the family. They may be able to provide the team with information regarding the family's history and the psychosocial factors that influence family dynamics such as unemployment, divorce, previous deaths, history of domestic violence, history of drug abuse, and previous abuse of children. When reviews indicate the need, CPS may provide services to the surviving family members. Their knowledge on issues related to child abuse and neglect cases is essential to an effective team.
Prosecutor
Prosecutors educate the team on criminal law and provide information about criminal and civil actions taken against those involved in the child deaths reviewed. They also provide the team with explanations regarding when a case can or cannot be pursued and information about previous contacts with family members and criminal prosecutions of suspects in a child death.
Public Health
Public health agencies facilitate and coordinate preventive services needed to assist the community with education and community awareness programs. Public health members provide the team with vital records, epidemiological profiles of families for early risk detection and prevention of child deaths, and help educate members on the public health services available in the county. Public health doctors or nurses help identify public health issues that arise in child deaths and also provide medical explanations to the team. If the child was treated in a local public health facility, they can provide medical histories and explanations of previous treatments.
Pediatrician; Family Practice and/or General Practice Physicians
The pediatrician provides the team with medical explanations and the perspective of having knowledge gained from routinely examining children who present with a variety of medical conditions. They can access medical records at hospitals and from other doctors. It is preferable if a physician team member has experience in treating victims of child abuse and neglect.
Mental Health
The mental health representative provides information and insight regarding psychological issues related to the child, the family, the perpetrator, and the event that caused the child?s death. They make suggestions when counseling or other mental health service referrals may be appropriate.
EMS, Air Medical and/or Fire Fighter
These professionals can provide much information. Fire can provide information about investigations of fire - related deaths and education regarding preventing these deaths. EMS is frequently first at the scene and observes critical information regarding the scene and circumstances of a child?s death, including the behavior of witnesses. The EMS report can also be useful in determining the position of the body at death and other scene elements that may have changed before an investigator arrived.
Child Advocate
Child advocates represent a variety of local child advocacy programs. These individuals offer the team organizational ability, excellent communication and negotiation skills, and understand the role of each of the team members and participating agencies.
Juvenile Probation
The juvenile probation officer provides information regarding crimes involving older children. A large number of teenagers die from gunshot or stab wounds inflicted by other adolescents. Gang related shootings are frequent in some communities, along with drug and alcohol related deaths of teenagers. Teenage suicide numbers increase each year. Records from juvenile workers assist in the reviews of these deaths.
Sudden Infant Death Syndrome (SIDS) Family Service Provider
SIDS account for a large number of infant deaths. Sudden infant death syndrome family service providers educate the team on various issues related to SIDS deaths. The counseling of surviving family members in a SIDS death is a much needed component of the community child death response. What contributes to these deaths and, therefore, how to prevent them continues to puzzle the professionals handling these cases. As team members, SIDS family service providers offer the most up-to-date information and assistance available regarding this issue.
Child Educator
The child educator provides the team with information from school records regarding child ren and families. School records include academic performance, participation in school and extra-curricular activities, absenteeism, and other indicators of a child?s well-being. As educators, these team members offer the perspective of professionals who regularly observe child health, growth and development.
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Membership
Core Team Membership -- Core members are representatives from the agencies responsible for child death investigations, death certification, or any resulting legal action.
Additional Members -- Additional members are determined depending on community resources and needs. Other members may be determined as reviews reveal gaps in information that indicate a need for additional team representation.
Auxiliary Members -- To facilitate completing reviews in a timely manner, teams may designate auxiliary members. These team members are not permanent members and therefore, do not regularly receive team notices. They attend meetings only when 1) they were directly involved in a death scheduled for review or, 2) to provide information on team related activities. Auxiliary members provide valuable information to the team without increasing the number of permanent team members.
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