Overview and Findings of the Ontario Paediatric Death Review

[Jayne Morrish]

If you have any questions or comments regarding this series please post them here.

August 11th, 2009
10:00 am-11:00 am EST
Faculty: Karen Bridgman-Acker, MSW, RSW – Child Welfare Specialist, Paediatric Death Review Committee, Deaths Under 5 Committee, Office of the Chief Coroner of Ontario


Session Title: Overview and Findings of the Ontario Paediatric Death Review Committees, 2009

Brief Overview of Presentation:

The Paediatric Death Review Committee is a multidisciplinary expert committee of The Office of the Chief Coroner that reviews the deaths of children age 0-18 in the province of Ontario. The Deaths Under 5 Committee reviews the deaths of children under the age of 5 to assist the investigating coroner to establish cause and manner of death. The primary goal of both committees is to identify trends, themes and issues and to make recommendations for the prevention of future deaths in similar circumstances.

This presentation will provide an overview of these committees, trends and themes identified and data collected on children’s deaths as reported in the committees’ 2009 Annual Report. Case examples and recommendations made for changes or enhancement in best practice, policy and service will be offered. The identified themes to be focused on include infants in unsafe sleeping environments, adolescent suicide, and residential fire deaths.

About the Presenter: Karen Bridgman-Acker is a social worker and child welfare specialist who works at the Office of Chief Coroner for Ontario. She co-coordinates the case reviews for the Paediatric Death Review Committee and the Deaths under 5 Committee and is the liaison for child welfare agencies and the coroners’ offices. She is a co-author of the committees’ Annual Report which is produced and distributed publicly in June of each year.

Learning Objectives: By the end of this session, participants will:

-Have a better understanding of the Paediatric Death Review Committee and Deaths under 5 Committee and the death reporting and review process in Ontario for children’s deaths.
- Will have learned about the trends, themes and statistics related to paediatric deaths in Ontario.
-Have been introduced to case examples and recommendations made to assist in future death prevention of children in Ontario.

Resource List:

Annual Report of the Paediatric Death Review Committee and Deaths Under 5 Committee, Office of the Chief Coroner Ontario, 2009

[4tlc2]

Thanks so much for the informative overview of the trends of causes of death in children. It is always a challenge to get access to this type of information to inform our practice. First I wanted to say how much I appreciated the slide Preventable Deaths A does not equal B. I see this as an important issue to address, often when talking about preventable injuries and deaths comes a lot of blame, finger wagging and tsk tsk you should have known better. I think this point deserves a lot of emphasis and repetition. The second and related thing I wanted to say was how important I think it is to not emphasize just the individual in each of these cases, but rather emphasize their environment as well, in this way we can be sure to take into consideration the whole story and not just the poor decisions of the parent, so we don't get overly focused on those poor choices. When trying to prevent these future avoidable deaths it is so important that we are all looking at the entire picture. How many of these deaths could be prevented if poverty were no longer an issue, or all children had the same opportunities for growth and learning so that when they become parents they will be better prepared to do be parents? We have to make sure we aren't just blaming the drug addicted parent for the death, but figure out why that parent was or is drug addicted and how we can help keep that from happening. We must start at the beginning, not at the end result in order to prevent these most horrible results.

Thanks again for the presentation, I learned a lot.
Tanya

[Jayne Morrish]

Thanks for the interest Tanya!

Those are all very important things to consider, especially in future prevention measures.

I will forward your post over to Karen.

If anyone has any further questions for her you can reach her via e-mail at Karen.Bridgman.Acker@Ontario.ca.

The report that she spoke to is available online through the following link: http://www.oacas.org/pubs/external/PDRC ... 9June1.pdf