A team leader is identified who is responsible to assign cases to the team each month. Cases are selected based on a preliminary review of each unnatural childhood death and on input from team members regarding any cases that they are personally concerned about.

Prior to the forming of the team, the team leader contacts representatives from the emergency community, fire, police, ambulance, hospital, nurses, physicians, injury prevention and mental health. Representatives from Child Protective Services and the coroner’s office are essential, and a member of the community is also included. Other members can be included as deemed necessary and appropriate. A document is distributed outlining the laws pertaining to the team and the responsibilities of every member. A confidentiality statement is signed by each member and kept on file.

The first meeting of the team establishes the membership, the scheduling of meetings, what constitutes an unnatural death, and a review of the laws under which the team is established. There is usually considerable concern about legal responsibilities of the members and about the confidentiality laws that govern the team. These concerns are addressed and when everyone is satisfied with their roles and responsibilities, the team is formed. Alternates for some of the team members may be established at this time.

Cases that are to be brought for review are sent to each team member a week before the meeting in a confidential envelope. Each member gathers information pertinent to each case from his or her files as available. Copies of all the records pertaining to the cases are brought to the monthly meeting.

The case review begins with the team leader presenting an overview of the case, identity of the deceased, time and date of death, reported cause of death, and any relevant known facts. Then members of the team who have information briefly present their findings. A discussion follows the presentations.

The discussion centers on issues that should have warned the agencies involved that the child was endangered, failures to communicate those signals, inadequate follow up, and systems problems that may have prevented adequate protections for the child. Also investigated are any relevant facts that may lead to a reopening of the case by authorities and anything that may indicate a hazard in the community. Some teams also choose to investigate third-trimester fatalities.

The value of these multidisciplinary teams is that they bring together all of the protective community in order to investigate, document and correct any flaws in the system. By having members from each agency discussing these cases together in a non-threatening forum, many complications between agencies become known and can be addressed directly thus avoiding similar problems in the future. Also, by having access to all the facts at once, new information sometimes emerges that leads to effective injury prevention efforts. Yearly reports from the CDRT go to the County Board of Supervisors with recommendations for correcting issues that endanger children.

If your community does not have a CDRT in place, I urge you to go to the CDRT links in this document and gather information on the state and local requirements that pertain to your region. As a member of the Humboldt County CDRT at its inception in the early 1990’s, I strongly believe that they are essential.

Our team found a number of serious policy issues that decreased cooperation and information sharing between public safety agencies. These issues were then easily and painlessly addressed by the team. This resulted in increased cooperation and improved communications. In addition some injury prevention issues came to light that would not otherwise have surfaced. In particular, the Coroner of that time advised the team that it’s a common practice for coroners to avoid "suicide" as a cause of death, and also to use "SIDS" more frequently than necessary as a means of "protecting the families". If these practices are widespread, which seems likely, SIDS is being over reported and suicide under reported by an unknown but significant amount.

For protecting children, the two hours I spent at a regular lunch meeting of the Humboldt County CDRT was the most profitable time I spent each month. For an example of a working CDRT and the data that results go to the link below on the World Wide Web.