Big Changes Coming to North Carolina’s Child Fatality Prevention System

Tragically, 1,474 North Carolina children under the age of 18 died in 2022. According to the North Carolina Child Fatality Task Force’s 2024 Annual Report, the rate of child deaths in 2022 was 64.2 per 100,000 children—the highest rate recorded in the state since 2009. North Carolina will soon undergo a substantial restructuring of its statewide child fatality prevention system, including changes to how child fatalities and active child protective services cases are reviewed at the local level. The statutory changes to the system’s structure, many of which will become effective on July 1, 2025, were part of the 2023 Appropriations Act (S.L. 2023-134), as later amended by S.L. 2024-1 and S.L. 2024-57. The goal of these changes was to “eliminate the silos and redundancy that exist within the current system,” while also seeking to strengthen the system’s effectiveness in preventing child abuse, neglect, and death. Read on to learn more about the new system. State-Level Changes S.L. 2023-134 requires the North Carolina Department of Health and Human Services (NCDHHS) to create and staff a new State Office of Child Fatality Prevention (“State Office”) within the Division of Public Health, which must be prepared to begin carrying out its statutory duties by July 1, 2025. The new State Office is responsible for coordinating state-level support for the entire North Carolina child fatality prevention system, including creating and implementing tools, guidelines, resources, and training for local multidisciplinary child death review teams and providing technical assistance for those teams. The State Office is also responsible for implementing and managing a centralized data and information system capable of gathering, analyzing, and reporting aggregate information from child death review teams, with appropriate protocols for sharing information and protecting confidentiality. A full list of the new State Office’s powers and duties may be found at G.S. 143B-150.27. S.L. 2023-134 also made some structural changes to the North Carolina Child Fatality Task Force (“Task Force”), a legislative study commission that studies the incidences and causes of child deaths in North Carolina, as well as examining and recommending evidence-driven strategies for preventing child death, abuse, and neglect. You can read the Task Force’s most recent report on child fatalities in North Carolina here. G.S. 7B-1402.5 now requires the Task Force to carry out its duties (as specified in G.S. 7B-1403) through the work of three committees: (1) a Perinatal Health Committee to address healthy pregnancies, births, and infants; (2) an Unintentional Death Prevention Committee to address the prevention of deaths resulting from unintentional causes such as motor vehicle or bicycle accidents, poisoning, burning, or drowning; and (3) an Intentional Death Prevention Committee to address the prevention of deaths resulting from intentional causes (such as homicide, suicide, abuse, or neglect) and the prevention of child abuse and neglect. Background on Child Fatality Reviews at the Local Level Starting in 1991 in response to Executive Order 142, North Carolina counties were required to form Community Child Protection Teams (each, a “CCPT”) to review cases of child abuse and neglect, including child fatalities, at the local level. The duties and composition of these teams were formally established by statute beginning in July 1993 (see S.L. 1993-321). CCPTs review selected active cases in which children are being served by child protective services. CCPTs also review all cases in which a child died as a result of suspected abuse or neglect and (i) a report of abuse or neglect has been made about the deceased child or the child’s family to the county department of social services (DSS) within the previous 12 months, or (ii) the deceased child or the child’s family was a recipient of child protective services within the previous 12 months. G.S. 7B-1406. Starting in 1993, state law required counties to establish multidisciplinary teams to review all other child deaths in the county (i.e., those that did not have DSS involvement to qualify for review by the CCPT). Counties could choose to meet this requirement in two different ways:

• by having the CCPT review all child deaths in the county (not just those with DSS involvement), or
• by establishing a separate Child Fatality Prevention Team (CFPT) to review all other child deaths in the county (i.e. those that did not qualify for CCPT review due to lack of involvement with DSS).

In many North Carolina counties, these teams eventually merged, so that a single team was carrying out all the duties of both a CCPT and a CFPT. Each county is required by statute to have certain representatives of public and nonpublic agencies serving on the team(s), which vary depending on whether the teams are merged or separate. Upcoming Changes at the Local Level Effective July 1, 2025, the current model of CCPTs and CFPTs is ending. Instead, each county will be required to either (1) have its own single local multidisciplinary child death review team; or (2) join with other counties to form a multicounty multidisciplinary child death review team (collectively, “Local Teams”). Mandatory Reviews of Certain Child Fatalities: Local Teams are responsible for reviewing all child deaths of resident children under age 18 in the county or counties comprising the Local Team that fall under one of the following categories (G.S. 7B‑1406.5(c)):

• undetermined causes;
• unintentional injury;
• violence;
• motor vehicle incidents;
• deaths related to child maltreatment or child deaths involving a child or child’s family who was reported or known to child protective services (that meet criteria set forth in S. 7B-1407.5(a));
• sudden unexpected infant deaths;
• suicide;
• deaths not expected in the next six months;
• and additional infant deaths, based on criteria established by the State Office under S. 7B-1407.6.

For deaths related to child maltreatment or involving a child or child’s family who was reported or known to child protective services, the State Office is charged with developing policies, procedures, and tools for Local Teams to utilize when reviewing this category of child deaths, as well as providing technical assistance to Local Teams, such as coordinating the review, gathering information, determining necessary participants, establishing meeting procedures, developing recommendations, and drafting reports. See G.S. 7B‑1407.5(b). Permissive Reviews of Other Child Fatalities and Active Child Protective Services Cases: Each Local Team may also choose (but is not required) to review other child deaths that fall outside the required categories (G.S. 7B‑1406.5(d)). If requested by a county DSS director, a Local Team may also review an active case in which a child or children are being served by child protective services. (G.S. 7B‑1406.5(e)). The Local Team is not required to make findings or create reports based on discretionary reviews of active child protective services cases but may make recommendations to the board(s) of county commissioners based on these reviews. Participation in a Single County Versus Multicounty Local Team Each board of county commissioners (BOCC) must evaluate and determine whether the county will have its own single county Local Team or be part of a multicounty Local Team (G.S. 7B‑1406.5(b)). The commissioners must make this decision by consulting with the director of the local health department and the director of the local DSS (or if applicable, the consolidated human services director). The BOCC must also consult guidance that will be created by the State Office, addressing the formation and implementation of a single versus multicounty Local Team. The State Office guidance will also provide a model agreement to be used by the counties who agree to be part of a multicounty team. Required Local Team Membership Per G.S. 7B-1407, each Local Team must meet at least twice a year and must consist of:

1. The director of the county DSS or the director of the consolidated human services agency and a member of the director’s staff;
2. A local law enforcement officer, appointed by the BOCC;
3. An attorney from the district attorney’s office, appointed by the district attorney;
4. The executive director of the local community action agency, as defined by NCDHHS, or the executive director’s designee;
5. The superintendent of each local school administrative unit located in the county, or the superintendent’s designee;
6. A member of the county board of social services, appointed by the chair of that board;
7. A local mental health professional, appointed by the director of the area authority established under G.S. Chapter 122C;
8. The local guardian ad litem coordinator, or the coordinator’s designee;
9. The director of the local health department;
10. A local health care provider, appointed by the local board of health;
11. An emergency medical services provider or firefighter, appointed by the BOCC;
12. A district court judge, appointed by the chief district court judge in that judicial district;
13. A county medical examiner, appointed by the Chief Medical Examiner;
14. A representative of a local child care facility or Head Start program, appointed by the director of the county DSS; and
15. A parent of a child who died before reaching the child’s eighteenth birthday, to be appointed by the BOCC.

The chair of the Local Team may invite up to five additional individuals to participate on the Local Team on an ad hoc basis for a specific review if the chair believes the individual’s subject matter expertise or position within an organization will enhance the ability of the Local Team to conduct an effective review. These ad hoc members may be from outside of the county or counties served by the Local Team. One or more members of the State Office staff may also serve as ex officio members of any Local Team. Right of Access to Records G.S. 7B-1413 gives the Local Teams, the Task Force, and State Office staff (when providing technical assistance with a review to a Local Team) access to all medical records, hospital records, and records maintained by any state, county, or local agency that the Local Teams, the Task Force, or the State Office deems necessary to carry out their case reviews and reporting. This includes police investigations data, medical examiner investigative data, health records, mental health records, and social services records. Local CCPTs/CFPTs and the Task Force had this right of access under the prior law and structure, but S.L. 2023-134 has now amended the statute to clarify that such access to records “is subject to and limited by all relevant federal and State laws whenever applicable.” In the context of a Local Team meeting, a Local Team member is also permitted to share information available to that member with the rest of the Local Team if it is necessary to carry out the Local Team’s duties (G.S. 7B-1413(a)). In the course of their case reviews, Local Teams, the Task Force, and the State Office staff are prohibited from contacting, questioning, or interviewing the child, the parent of the child, or any other family member of the child whose record is being reviewed. (G.S. 7B-1413(a)). Another new addition to the law allows a Local Team, the Task Force, or the State Office to apply for a court order to compel disclosure of the information relevant to a case review, if the requesting entity has not received the requested information within 30 days (G.S. 7B-1413(a1)). The application for a court order must state factors supporting the need for an order compelling disclosure and must be filed in the district court of the county where the review is being conducted. District courts, which have jurisdiction to issue these orders compelling disclosure, must schedule these actions for immediate hearing, and the appellate courts must give priority to appeal proceedings in these actions. Confidentiality of Records and Information All information and records that are acquired or created by the Local Teams, the Task Force, and the State Office in the exercise of their duties and are otherwise confidential under federal or State law:

• are confidential and not public records (as defined by G.S. 132-1);
• are not subject to discovery or introduction into evidence in any proceedings; and
• may only be disclosed as necessary to carry out the purposes of the Local Teams, the Task Force, and the State Office, or as otherwise required by law (S. 7B-1413(c)).

However, Local Teams may disclose certain information as required by federal law or as required by G.S. 7B‑2902 in cases of fatalities or near fatalities arising from abuse, neglect, or maltreatment (see my blog post on that here). The State Office is also charged with developing a procedure for Local Teams to create and release reports that address recommendations for improving local and state coordination, resulting from reviews of child deaths involving child abuse or neglect or a history of involvement with child protective services (G.S. 7B‑1407.5(b)(3)). No person who attends a Local Team meeting (including a Local Team member) may testify in any proceeding about what transpired at the meeting, about information presented at the meeting, or about opinions formed by that person as a result of the meeting (G.S. 7B-1413(c)). This law does not, however, prohibit a person from testifying about matters within that person’s independent knowledge that were learned outside the context of a Local Team meeting. Each member of a Local Team must sign a statement indicating that they understand and will adhere to confidentiality requirements, including the possible civil or criminal consequences of any breach of confidentiality (G.S. 7B-1413(d)). Each ad hoc member of a Local Team must sign the same confidentiality statement and is also subject to the provisions of G.S. 7B-1413 (see G.S. 7B-1407(c)). Participation in the National Fatality Review Case Reporting System One significant change effectuated by S.L. 2023-134 is that North Carolina will soon begin participating in the National Fatality Review Case Reporting System (NFR-CRS), a web-based standardized case reporting tool available to states. By January 1, 2026, Local Teams, the State Office, and medical examiner child fatality staff must start using the NFR-CRS for case reporting (G.S. 7B-1413.5). For each mandatory review of a child’s death, information about the case, including circumstances surrounding the death and the Local Team’s findings, must be entered into the NFR-CRS (G.S. 7B-1407.10). For each permissive review of a child’s death (those outside the required categories), the Local Team may—but is not required to—enter case review information into the NFR‑CRS. The State Office is required to provide guidance and training to all Local Teams addressing their participation in the NFR-CRS, including (i) appropriate information protection and sharing that complies with federal and state law, (ii) who is authorized to access the NFR‑CRS, and (iii) requirements for accessing the NFR‑CRS. For each child death reviewed, G.S. 7B-1407.10(a) requires a Local Team to make findings addressing at least: (1) significant challenges faced by the child or family, the systems with which they interacted, and the response to the incident; (2) notable positive elements in the case that may have promoted resiliency in the child or family, the systems with which they interacted, and the response to the incident; (3) recommendations and initiatives that could be implemented at the state or local level to prevent deaths from similar causes or circumstances in the future; and (4) whether the cause or a contributing cause of the death was related to child abuse or neglect (as defined by G.S. 7B‑101(1) and (15)). All Local Teams are also required to annually submit a report to the board(s) of county commissioners that includes recommendations, if any, for systemic improvements and needed resources to address identified gaps and deficiencies in the existing system (G.S. 7B-1407.10(d)). Each Local Team must also provide a copy of this annual report to the State Office. And There’s More…. As part of restructuring the statewide child fatality prevention system, S.L. 2023-134 also made another significant change: the establishment of citizen review panels to evaluate the extent to which the state is fulfilling its child protection responsibilities in accordance with federal law. I will discuss the new citizen review panels and how they intersect with child fatality reviews in an upcoming blog post.