The agency in charge of keeping Georgias children safe has issued its first-ever yearly report on deaths among the children it has involvement with. The report covers the death of every child who received some kind of service from the Division of Family and Children Services -- even if only assistance with food or day care -- during the previous five years.
The state agency identified 152 of these deaths in 2012, although only 48 of those children had open DFCS cases at the time. Thirteen were in foster care, and 84 had been the subject of a prior investigation for abuse or neglect.
The report analyzed the causes of the deaths -- including many unrelated to abuse or neglect -- and identified ways that DFCS could improve both its prevention and responses to deaths.
I think because its so hard to talk about child deaths, we may not have talked about it as much in the past, said Susan Boatwright, the DFCS communications director. Now were trying to intentionally create the opportunity, even though its difficult, even though theres still a tendency to look at what DFCS did wrong.
According to the report, the children who died in foster care mostly died before leaving the hospital, or they died of medical problems caused by maltreatment before entering the foster system. Only one case involved suspected maltreatment at the time of death.
Forty-one percent of the child deaths -- children 17 and younger -- happened in just four regions. They include the one that covers Bibb County, counties that surround it, and Putnam, Baldwin and Wilkinson counties.
The other regions with the highest number of deaths of children cover Columbus, Atlanta and southwest Georgia.
Boatwright called the number of deaths in Middle Georgia and southwest Georgia regions unusually high relative to their populations.
We are certainly looking at those numbers and saying, Hmm. I wonder whats going on, she said. Were looking very carefully to see if this is an anomaly or this is a trend.
Statewide, 33 percent of the deaths were deemed natural, mostly caused by a pre-existing medical condition or disease. Accidents, such as fires and drownings, accounted for 23 percent of the deaths. Murders caused 18 deaths, or 12 percent of the total. Six deaths were suicides.
Ravae Graham, deputy communications director for the state Department of Human Services, said 11 of the 18 murders were committed by a caregiver. Some of these families had no record of abuse or neglect, having received only support services from DFCS.
In the remaining deaths statewide, the cause of death couldnt be determined, or a determination is still pending.
Dangers of co-sleeping
All the 10 pending cases from the fourth quarter of 2012 relate to infants who died in their sleep.
Sleeping with parents, sleeping in a location besides a crib or sleeping with blankets or pillows in a crib played the greatest role in accidental deaths -- with 13 caused by sleep-related suffocation -- and deaths from Sudden Unexpected Infant Death Syndrome, a label for any death whose cause isnt apparent before further investigation.
A total of 17 children died while sleeping with an adult, according to the DFCS report.
As a result, the agency stepped up its public education efforts about the dangers of co-sleeping.
Weve narrowed it down to three things we really like to talk to families about: Babies should sleep alone, on their backs and in a crib, Boatwright said.
DFCS will help a obtain a crib if caseworkers discover the family doesnt have one, Graham said.
Bibb County Coroner Leon Jones said he has spoken as often as he can to community groups about the risks of sleeping in the same bed with a child, and he says he has seen the number of co-sleeping deaths in the county drop.
I cant remember when I had a co-sleeping death in Bibb County, he said.
But Ryan Sanford, deputy director of the Georgia Office of the Child Advocate, said at the state level, One thing we have noticed in the past few years is a pretty high incidence of sleep-related deaths with DFCS.
He said his office has been trying to stress the importance of caseworkers not just handing out a pamphlet about safe sleep habits, but asking parents to show them where and how their baby is put to bed.
Every time DFCS is in the home, its an opportunity to catch things like that, Sanford said.
He acknowledged that the rate of sleep-related deaths in the DFCS report is fairly representative of the problem statewide.
Sanfords office is responsible for assisting the state Child Fatality Review Panel, a group that submits an annual report to the governor and various legislative leaders about trends and factors in child deaths.
The most recent report compiled by the panel, which covered 2011, found almost 30 percent of deaths reviewed were labeled SUIDS. Ninety-one percent of the time, those deaths turned out to be caused by sleep-related smothering, often caused by co-sleeping.
Nancy Scott Malcor, a Bibb prosecutor who until recently was chairwoman of Bibb Countys Child Fatality Review committee, said co-sleeping was the most frequent recurring cause of child deaths in Bibb County during her tenure.
How many children have to die before people stop sleeping with their children? she asked.
Child deaths in Bibb County
The state Child Fatality Review Panel gets its information from county committees such as the one on which Malcor served, which review unexpected or unexplained child deaths referred by the coroner or medical examiner.
Those committees required members to include a representative from the local DFCS office, as well as law enforcement, public health and others. Its one way DFCS is supposed to learn about the deaths of children it might have served.
But the role of DFCS is really to provide case histories that could help the committee analyze some deaths, just as law enforcement provides details about the scene of the death.
According to the state Child Fatality Review Panel, 26 of the 495 children whose deaths were reviewed in 2011 had an open case with DFCS. In a little more than half of the 495 deaths, some public agency -- DFCS, mental health providers, police, Juvenile Court or others -- had contact with the child or the family before the death.
Although the state panel wants county committees to review all eligible child deaths, in 2011 counties had reviewed only 495 of the 557 eligible cases. Middle Georgia counties had a good track record, according to the report.
Malcor said Bibbs committee reviewed 11 child deaths in 2011 and 13 deaths, including two that were ruled homicides, in 2012.
She said all committee members, including the DFCS representative, attend the monthly or bi-monthly meetings.
Room for improvement
Boatwright said county DFCS offices always tracked and responded to child deaths, but not uniformly.
Federal law requires the state to report the number of child deaths related to abuse or neglect. (For example, in fiscal 2011 there were 65 such deaths in Georgia, according to DFCS.)
But the tracking of all children who die while receiving DFCS services -- including deaths caused by accidents, suicides and other causes -- wasnt centralized, Graham said. The state does not know how many children with open cases died in previous years, she said.
Dee Simms, a Bibb attorney who was formerly the director of the state Office of the Child Advocate, said the state DFCS office should have this information if it was participating in county Child Fatality Review committees.
Boatwright said although the state did have a system for collecting information about child deaths, it wasnt as consistent or defined in the past. The new approach to reporting and analysis was initiated by the department not because there was a problem but because we wanted to do better, she said.
What were trying to learn is the circumstances around a childs death so we can get better at identifying risks, Boatwright said. For example, the analysis found that children younger than 11 months old are the most vulnerable.
The report identified ways DFCS could improve its approach. For example, it recommends that case managers meet in person with medically fragile children, who are at greater risk for abuse and neglect. Caseworkers also need to verify their medical progress with doctors and outside agencies, the report states.
The report refers repeatedly to the need to share information with community agencies and law enforcement.
Sanford said communication between DFCS and police varies by county, but he has not seen any statewide problem. Jones, Malcor and Simms say DFCS and law enforcement work well together in Bibb County.
But Simms said sharing information with partner agencies has always been a problem with DFCS and has a lot to do with how they view their obligation with confidentiality.
Simms represents children and families in Family Court. She said sometimes even when she wants to talk with a child she represents, DFCS doesnt want to tell her where the child is. This seems to be a bigger problem in some other Middle Georgia counties than in Bibb, she said.
The report also included recommendations about emergency placement of children whose home situation is unsafe.
An immediate placement with family or friends provides a temporary, alternative placement for a child -- and should not be automatically thought of as a long-term placement so the case can be closed, the report states.
It goes on to emphasize the importance of criminal history and DFCS checks for these temporary caregivers.
Simms said she has seen this problem repeatedly. Sometimes the place theyre sending the kid is worse than the place theyre taking them from.
Caseworkers frequently place a child in the temporary setting without supervision, which basically closes the case, she said.
They need to at least provide some avenue for the parent to create a plan to be able to get the child back, Simms said. Its just left out there in this legal limbo. And thats not good.
Judicial oversight might also provide an extra safety net for the child in these cases, the report suggests.
Boatwright explained that the state rarely goes to court to establish temporary custody when a child is removed from a dangerous home situation. But sometimes a Juvenile Court judge might clarify what is expected of both the parents and temporary caregivers.
DFCS already began making changes last year as it compiled an earlier report covering the first three quarters of 2012. Perhaps the most significant is a 24-hour staffing protocol when a child with a DFCS history dies after apparent mistreatment.
Local caseworkers were already investigating immediately when such a death happened, Boatwright said. But the process varied by county and was often complicated by the emotional response of DFCS employees.
The new approach provides a central group of partners to guide the process.
Plus, a state-level response to each death enables DFCS to better recognize patterns.
Learning has been broadened to where we all see that (for example) sleep-related deaths are an issue, Boatwright said. Not having a gun locked away from a child is an issue. So we know case managers need to be looking for these things.
To contact writer S. Heather Duncan, call 744-4225.