Establishing an Adult Fatality Review Team in (City/County/Region)

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Resource 7: Sample Power Point Presentation on Adult Fatality Review Teams

Adult Fatality Review in Virginia: Team Protocol and Resource Manual

What is Fatality Review?

• Goal: To understand how and why Virginians die, and prevent future fatalities by improving community response to violence and other public health issues

• Principles:– Participatory– Multidisciplinary– Local– Retrospective– Consensus decision-making– Confidential– No blame, no shame

What is Fatality Review?

• Process: A Public Health Exercise1. Review circumstances of fatal event2. Analyze strengths and weaknesses in community

response3. Provide information to change agents (legislators,

policymakers, and prevention programs)4. Make recommendations for prevention and

intervention5. Make something good come from violence and

destruction of human life by improving safety net services for elder and vulnerable populations

What is Fatality Review?

• How it works:1. Collect or arrange for team members to bring

records (starting with death investigation and working backwards in time)

2. Convene a multidisciplinary group of stakeholders

3. Create timeline of events to understand risk factors, circumstances and system contacts

4. Identify what could be done to change the outcome

What is Fatality Review?

• Assessing community response:1. Identify where the decedent interacted with the

system: Who met this person along the way?2. What might these system agents have done to

prevent or mitigate risks? What is needed to support that response (e.g., changes to law, policy, practice, standards of care)?

3. How were system agents prevented from intervening before the death?

What is Fatality Review?

• Benefits of fatality review:– Demonstrates your community’s commitment to

preventing premature death.– Provides enhanced understanding of these deaths.– Creates improved awareness of the policies, procedures

and roles of all community service providers.– Enhances cooperation and collaboration among

community service providers.– Supports public health, safety and protection through

case-specific recommendations for system improvement.

What Fatality Review is NOT

• A blame game.• A “gotcha”.• Second guessing or reinvestigating the past.• About the dead.

Local and Regional Adult Fatality Review Teams in Virginia

• Permitted by the Code of Virginia July 1, 2015:“…local or regional adult fatality review teams may be established for the purpose of conducting contemporaneous reviews of local adult deaths in order to develop interventions and strategies for prevention specific to the locality or region.” (§32.1-283.6)

• Allows for the review of the death of any adult 60 years or older, or any incapacitated adult age 18 or older who:– Was the subject of an adult protective services or law-enforcement

investigation; or– Whose death was due to abuse, neglect or exploitation or acts suggesting

abuse, neglect, or exploitation; or– Whose death came under the jurisdiction of or was investigated by the Office

of the Chief Medical Examiner as occurring in any suspicious, unusual, or unnatural manner.

Why Review Adult Deaths in Virginia?

• Aging of the population.• Increase in adults living in institutions.• National consensus that elder abuse is both

common and underreported.• Successful efforts in child, maternal, and

domestic violence fatality review.• No routine examination of response system is

yet underway.

Adult Abuse and Neglect in Virginia

In 2014, Adult Protective Services programs reported:

• 9,140 substantiated reports of abuse, neglect, or exploitation.

• 75% of victims are >59 years of age and 25% are vulnerable adults between ages of 18 and 59.

• Victims are most commonly women and white.

Adult Abuse and Neglect in Virginia

In 2014, Adult Protective Services programs reported:

• Most victims are abused in their own homes• Most common forms of abuse were self-

neglect (55%) and neglect (19%). • Financial exploitation (10%) and physical

abuse (7%) reported less often.

Adult Abuse and Neglect in (insert your community name)

Add information from your local law enforcement, adult protective services, or Commonwealth’s attorney here. What do you know about deaths suspicious for abuse, neglect and exploitation in your community?

Adult Abuse and Neglect Fatalities

• While we are beginning to understand the scope of adult abuse and neglect, we don’t know how many people die from the abuse. Such deaths are often not reported and therefore undercounted.

• The National Center on Elder Abuse estimates that victims of elder abuse are at 300% higher risk of death compared with non-abused peers.

• Vulnerable adults are at-risk by virtue of their disability or compromised capacity.

• Fatality review helps communities to identify and understand problems of adult abuse, neglect and exploitation, and to identify needs and opportunities for improved response.

Establishing a TeamStatutory Requirements (Code of Virginia §32.1-283.6):• Each team shall establish rules and procedures prior to first

case review.• Review shall be delayed until any criminal investigations or

prosecutions connected with the death are completed, or earlier with permission from the Commonwealth.

• All information and records concerning the victim and the family shall be returned to the originating agency or destroyed after team review.

• Findings of the team are disclosed or published in statistical or other form which shall not identify individuals.

• All members and participants shall execute a sworn statement to honor the confidentiality of the information, records, discussions and opinions disclosed during any closed meeting to review a specific death.

Establishing a Team

Statutory Protections• Team records are exempt from the Virginia Freedom of Information

Act, and cannot otherwise be disclosed or subpoenaed. • No member or participant shall be required to make any statement

as to what transpired during the review or what information was collected during the review.

• Portions of meetings in which individual cases are discussed by the team shall be closed.

• Members and participants providing information, as well as their agents and employees, are immune from civil liability for any act or omission made in connection with participation in a family violence fatality review, unless such act or omission was the result of gross negligence or willful misconduct.

Establishing a Team

• Team Organizer– Initiates establishment of team, takes the lead in identifying

and contacting potential core group members.• Core Group or Steering Committee

– A smaller, committed group of stakeholders that identifies potential members and moves process forward.

• Full Team– Multidisciplinary group that can commit to regular meetings.

Team Organizer

Core Group Full Team

Next Steps

1. Identify team members

2. Write a team mission statement

3. Solicit buy-in and endorsement

4. Establish team roles and structure

5. Conduct meetings

6. Follow-through on findings

1. Identify Team Members

• Recommended representation:– Commonwealth’s Attorneys

– Law enforcement

– Local APS official

– Local area agency on aging or comparable professional

– Local DSS official

– Medical examiner

– Mental Health

– Public Health

• Other potential team members:– AARP

– Advocates for the disabled or older citizens

– Emergency medical services

– Funeral services providers

– Geriatric nurses and psychiatrists

– Long term care providers

– Ombudsman

– Physicians

Virginia does not mandate AFRT membership, so team makeup will vary depending on community characteristics and the goals of the team.

1. Identify Team Members (Cont’d)

• Team characteristics:– Diverse– Multidisciplinary– Seasoned Professionals– Knowledgeable about local policy and procedures

• Member characteristics:– Will commit to meeting attendance– Non-defensive, open-minded– Experienced on the front lines– Able to influence agency policy

2. Write a Team Mission Statement

• Clarifies team’s purpose, including jurisdiction• Communicates that purpose to outside agencies

and organizations• Serves as the foundation for government

endorsement

Vet draft statement with stakeholders or government officials

Revisit and revise periodically

3. Solicit Buy-In From Stakeholders…from prospective team members• Letter of invitation• Meeting of prospective members– Mission statement, draft policies and procedures

if available– Formal Memoranda of Agreement (MOA)

• Agency endorsement of the team• Designation of agency representative(s)• Agreement to attend meetings, provide case

information• Understanding of rights and responsibilities around

confidentiality

3. Solicit Buy-In (Continued)

…from local governmental• Strategies for building support for government

endorsement:– Letter of support from an influential government official or

agency– Educational presentations

• Sample process:1. Make contact with city or county manager2. Submit agenda item for discussion and action at

governmental meeting3. Vet draft resolution with stakeholders

4. Establish Team Roles and Structure

Team Protocol: Policies and procedures• Guidelines for case review• E.g., Case selection criteria, meeting frequency

• Overall team functioning• E.g., Membership roles & responsibilities

•Can be drafted early on by the Core Group•Don’t let the process drag!• Create a sub-committee• Consult sample protocols from existing teams• Review and re-evaluate periodically

5. Conduct Meetings• Regular (monthly, quarterly, etc.), or• Activated as needed for case review

6. Follow Through on FindingsIdentify and agree upon themes, trends and community risk

factorsFormulate recommendationsShare findings with the communityCatalyze implementation

Aspects of Case Review

• Case Identification

• Notification

• Collecting and Organizing Data

• Discussion andAnalysis

Case Identification

• Most common source: Local Commonwealth’s Attorney, Law Enforcement, Adult Protective Services, Medical Examiner– Consult to identify pending investigations or prosecution

• Additional considerations:– How many?– How far to go back?– How long to spend on each case?

• Notification of case:– By writing or in person– Provide case identifiers to allow identification of relevant

information or records for review

Collecting & Organizing Case Facts• Compiling collected records and

information: Before meeting or during

– Case summary

– Case timeline

– Relationship tree

– Data collection

Date Agency Event(s) Comments

4/4/07 Police 911 call from residence

(completed during review)

4/21/07 APS Anonymous call received

4/27/07 Hospital Admitted to ER

Discussion/Analysis

• Equally important to the gathering of case facts from multiple sources is the bringing together of a wide range of disciplines from the community to create the most complete picture possible of the life and death of an abuse or neglect victim.

• The sharing of multidisciplinary information and perspectives is critical to the case review process.

• Each team member brings the ability to contextualize information relevant to their agency, such as policies and procedures, professional guidelines, and resource limitations.

Resources

• OCME website: www.vdh.virginia.gov/medexam/FatalityReviewSurveillance.htm – More information and background on AFR in Virginia– Links to Protocol Manual and other resources

• American Bar Association’s Replication Manual for Elder Abuse Fatality Review Teams

• Gone Without A Case: Elder Deaths Rarely Investigated (ProPublica and PBS Frontline)

Questions or Comments?

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