Virginia’s Adult Fatality Review Team Process Virginia Powell, Ph.D. Office of the Chief Medical Examiner Virginia Coalition for the Prevention of Elder Abuse Annual Conference May 27, 2015
Overview of fatality review as theory and practice
Virginia law establishing local and regional adult fatality review team
Getting started: early steps
Overview of Fatality Review: Theory and Practice
In Virginia, a public health emphasis … understand circumstances of death provide information to change agents: legislators, policymakers, and prevention programs make recommendations for prevention and intervention make something good come from violence and destruction of human life by improving safety net for vulnerable population
Who Benefits? Deaths
Injuries The At-Risk Population The Population
Fatality Review What? So what? Now what?
How It Works Collect records - from death investigation backwards in time Convene a multidisciplinary group of stakeholders Create timeline of events to understand risk factors, circumstances, system contacts Identify what can be done to save this life
Fatality Review Identify places where decedent touches the system: who met this decedent along the way? What might they have done to prevent the abuse, the injury, the death? What do they need – law, policy, practice, standard of care – to support protective efforts? How were systems prevented from intervening?
What Fatality Review is Not A blame game. A gotcha. Second guessing the past. About the dead.
Team Review Governed by these Values Public health approach Multidisciplinary review Retrospective review Consensus decision-making Emphasis on interventions and preventability
Why adult/elder abuse fatality review? Why now?
The Time to Act is Now Aging of the population. Increase in institutionalized adults. 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 yet underway.
Virginia Law Permitting Local and Regional Teams
Virginia’s Statute – § 32.1-283.6 July 1, 2015 To review …. … the death of any adult, as defined in § 63.2-1603 (i) the subject of an adult protective services or law enforcement investigation, (ii) death was due to abuse or neglect or acts suggesting abuse or neglect, or (iii)death came under the jurisdiction of or was investigated by the Office of the Chief Medical Examiner.
Team Members: Suggested Representatives from the Community
Medical examiner Local APS official Local DSS official Public Health Local area agency on aging or comparable professional Law enforcement Commonwealth’s Attorneys Mental Health
Team Members: Other Potential Representative
Funeral services providers Physicians Emergency medical services Geriatric nurses and psychiatrists Long term care providers AARP Ombudsman Advocates for the disabled or older citizens
Team Review is Confidential Broad authority to discuss information and records with protection for the Team members
Getting A Team Underway
Establishing a Team (1) Team Organizer, Lead, Champion Identify Key Stakeholders Convene Early Meetings Capacity to Identify Cases
Core Group Planning and Implementation Team Establishes Policies and Procedures Identifies Other Team Members
Establishing a Team (2) Full Team
Diverse Multidisciplinary Seasoned Professionals Knowledge of Policy and Procedure
Establishing a Team (3) The “Ins” and “Outs” of Team Membership
Commit to meeting times Not defensive Experience on the front line Relay team findings back to agency and community
Establishing a Team (4) Local or Regional Effort?
Size and location of community Resources Number of death cases of be reviewed Degree of overlap in service provision
Establishing a Team (5) Tools Letters of Invitation Memorandum of Agreement Interagency Cooperation/Confidentiality Agreement
Establishing a Team (6) Mission Statement Clarifies Team Purpose Communicates Purpose to Others Helps to Allay Fears
Establishing a Team (7) Governmental Endorsement After Core Group and Mission Statement City Council or Board of Supervisors A resolution that the team is important and should proceed with review Assists in recruiting additional team members and agencies
Establishing a Team (8) Tools Letter of Support from Governmental Official City Council Agenda Item Summary Sample Endorsements/Resolutions
Establishing a Team (9) Create Policies and Procedures, a Team Protocol Guidelines for Case Review Team Functioning
Establishing a Team (10) Elements of a Protocol
Roles and Titles Membership Rules and Responsibilities Building Team Capacity for Review Protecting Confidentiality Reviewing Fatalities Developing Findings and Recommendations Preparing Team Reports
Establishing a Team (11) Resources Sample Team Protocols Sample Confidentiality Agreements Sample Agreement to Maintain Confidentiality
Stay Tuned …. …. A website with materials will be available after July 1, 2015 at the URL provided below. Look for a link to Adult Fatality Review. http://www.vdh.virginia.gov/medExam/Fat alityReviewSurveillance.htm
Contact Information Virginia Powell, Ph.D. Office of the Chief Medical Examiner 737 North 5th Street, Suite 301 Richmond, VA 23219 Phone: 804.205.3856 Fax: 804.786.1877 Email: [email protected]