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

Discussion Today 

Overview of fatality review as theory and practice

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Virginia law establishing local and regional adult fatality review team

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Getting started: early steps

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Mock review

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

Mock Review

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]