Multi-Agency Identification and Investigation of Severe and Fatal Child Injury:

Guidelines for Networking, Communication and Collaboration

View the Current Draft of the Cal EMA guidelines at: CalEMA Guidelines.pdf

For the current state of ICAN's Severe Injury Program, check out the ICAN California Hospital Network.

Poster ArtScenario: Baby Valerie is hospitalized in intensive care for head trauma with a history of falling when held by a six year old sibling. The hospital does not report suspected child abuse. Although there are agencies with experts and separate pieces of relevant history who regularly meet to talk about such cases, unfortunately, little Valerie must die before she comes to the attention of such a group…the Child Death Review Team.

We can do better.

Through a grant from the California Emergency Management Agency (Cal EMA), and with the help of professional experts in many fields, ICAN/NCFR is in the process of drafting guidelines for Fatal Severe/Non-fatal Investigation.

Multi-disciplinary guidelines for the investigation of Severe Non-fatal Child Maltreatment will help agencies understand, communicate, coordinate and collaborate with each other. The Child Death Review Teams will provide part of the model. In fact, ultimately, it may be the Child Death Review Team (CDRT) that actually reviews these cases. As in CDRT, responses from involved agencies will benefit from the critical information, opinions and recommendations of other professions. Coordination will improve for city, county and state jurisdictions that follow the same investigative guidelines and procedures.

The source of Severe Non-fatal Injury cases will shift from the coroner (who initiates cases for Child Death Review) to the pediatric hospital with a focus the Pediatric Intensive Care Unit (PICU). Medical records and medical systems will become more important. Early studies suggest that the total number of suspicious cases could easily more than double the number of suspicious child deaths.

These new Guidelines will address minimum standards for components and we will define how the separate pieces might fit together. For a suspicious child death, for example, we will determine a minimum measure for best practices of a death scene investigation and address the need and methods for specialized interviews and record searches. We will also address the questions of multi-agency records, the potential value of collecting local and state records, and the need for communication across county and state lines.

Hospitals’ inpatient services already report child abuse and work with other agencies. One of the major tasks for this grant will be to help hospitals develop more efficient and predictable responses. Some hospitals have Suspected Child Abuse and Neglect (SCAN) Teams. Some have formally integrated their PICUs, birth units, burn services and other programs with their SCAN Teams. Many, perhaps most, have more informal connections. Many avoid reporting family violence, at least for their private patients.

Multi-Agency Investigation of Fatal and Severe Child Injuries Graphic

Please contact Lidia Escobar at or Michael Durfee if you would like to take part in the drafting of the guidelines or have information on existing severe injury teams or guidelines.


"Funding for this Child Maltreatment Investigations Guidelines Grant was made available by a grant from the California Emergency Management Agency (Grant #FS07021617) through a federal Children's Justice Act grant. The opinions, findings, and conclusions in this publication are those of the authors and not necessarily those of Cal EMA. Cal EMA reserves a royalty-free, non-exclusive, and irrevocable license to reproduce, publish, and use this material and to authorize others to do so."