Report on Arkansas child deaths shows improvements, concerns

Posted: November 2, 2017 at 4:30 a.m.

Fewer infants died in their sleep and more children are being adopted this year, but other figures -- like the doubling of firearm fatalities -- prove that efforts to improve child health in Arkansas must continue, officials told lawmakers Wednesday.

Medical conditions, injuries and unsafe sleep were the top causes of child fatalities in the past two years, according to an annual report released by the Child Death and Near Fatality Multidisciplinary Review Committee.

The legislatively created panel looked at fatal and near-death cases of children younger than 18 that either were reported through the state's Child Abuse Hotline or where there had been contact with the Children and Family Services Division in the previous two years -- 86 cases in fiscal 2016 and 95 cases the following year.

The report said Arkansas lacked data and key information in certain areas regarding child fatalities and near deaths, a concern also shared by members of the Legislature's committees focused on children and youth during Wednesday's meeting.

"How do we go to the prevention side?" Rep. Mickey Gates, R-Hot Springs, asked. "You don't know what you don't know. A lot of kids can be saved if we could find trends."

For instance, statutes do not require unexpected child death cases to go to the state medical examiner's office; only line-of-duty deaths involving certain first-responders are mandated.

In an interview after the meeting, Arkansas Coroners' Association president Kevin Cleghorn said that coroners are told it is "best practice" to send child-death cases to a medical examiner.

"I'm sure it's not always happening, even though it needs to be," Cleghorn said. "It slips through the cracks sometimes and nothing is done. It's not acceptable."

The report also concluded that the panel's "death reviews did not reveal a pattern of agency fault or egregious missteps by a provider, but rather an increased need for education and awareness."

Suggested policy changes included:

• Educating parents about complex childhood medical conditions, substance abuse and sleep, firearm and water safety.

• Upholding child abuse reporting requirements.

• Increasing substance abuse treatment access.

• Closing gaps in fatality data and information.

• Mandating that all unexpected child deaths go to a medical examiner for autopsy.

The report contained only percentages of child deaths by category. The Department of Human Services was unable to provide specific counts immediately after the meeting.

Infant deaths related to "unsafe sleep environments" decreased from 21 to 12 percent between fiscal 2016 and 2017, the report said. The authors of the report counted those deaths separately from sudden unexplained infant death.

As of December 2016, Arkansas still ranked second-highest in the nation on Sudden Unexplained Infant Death, according to federal health records. A majority of these deaths were attributed to unsafe sleeping conditions, such as co-sleeping in adult beds or sleeping alone in baby beds with pillows or other unsafe bedding, a special report by the Arkansas Democrat-Gazette in January found.

Gun-related fatalities jumped from 5 percent to 10 percent in the same two-year period reviewed by the committee.

State agency leaders said it was unclear whether these deaths were homicides or accidents or whether an adult or child pulled the trigger. Arkansas is second only to South Carolina in the number of gun accidents involving minors, statistics from Moms Demand Action, a national advocacy group, and news reports show.

Suicides and drownings also increased.

Human Services Department officials vowed to make changes last year that would better protect children and support families.

A key change is bolstered funding, and lawmakers approved a nearly $27 million budget increase, drawn from surplus funds, that went into effect this July. Caseworkers' minimum annual salary increased from $30,713 to $36,155.

In November 2016, agency officials projected its staff would grow from 5,040 to 5,800. They said they also are expected to hire 228 additional employees by fiscal 2019. As of this September, the division plateaued at 5,035 employees.

Adoption numbers are up and caseload figures have begun to improve, officials told lawmakers Wednesday.

There were at least 929 adoptions in fiscal 2017, which ended June 30, up from 678 the previous year, according to Children and Family Services quarterly performance review reports.

The agency's caseload report also indicated that the average individual caseload is "trending downwards" -- from 28 to 22. The national standard is 15. About 81 percent of child maltreatment investigations were completed "on time" -- within 45 days a case is initiated.

Children and Family Services assistant director Leslie Sebren said the agency aimed to increase monthly interactions with families -- and "to make sure those are quality home visits.

'The division recently developed a "structured coaching model" and hired a child protective services program manager to lead new training that helps child welfare investigators, Sebren said.

A Section on 11/02/2017