Putting Community Action at the Heart of Systems Change

When the Indiana Department of Health (IDOH) was selected for a national demonstration initiative known as Child Safety Forward, aimed at reducing serious injuries and fatalities to children caused by abuse or neglect, they turned to the Clark County Child Fatality Review team (CFR) and the Clark County Community Action Team (CAT) to kick-start their implementation phase.

The Child Safety Forward initiative was launched in October 2019 by the Department of Justice’s Office for Victims of Crime.  IDOH was one of five sites selected the demonstration initiative and technical assistance to develop and execute implementation plans to address child maltreatment injuries and fatalities. 

With the third highest rate of child abuse and neglect in the nation, IDOH efforts began with a retrospective review of data over the past five years in four target counties: Clark, Delaware, Madison and Grant counties. These four counties all had rates of external injury deaths among children that were higher than the state average rate during that period. 

Working with the Indiana University (IU) School of Social Work, the IDOH team assisted the county level CFR teams with their retrospective review of cases to determine risk factors. Those reviews revealed that unsafe sleep-related deaths were the leading cause of death due to external cause for children ages 0-18 years old, when excluding medically expected fatalities. Based on this data, the IDOH team decided to focus efforts on assisting the county level teams with standardizing child fatality reviews and implementing safe sleep policies that go beyond education to include a public health approach.

In Clark County, our Community Action Team had been established two years earlier. This team was well-positioned to take the recommendations that were generated from our Child Fatality Review team and begin to implement safe sleep strategies to address at risk infants as well as other injury and fatality prevention initiatives. 

The data from the retrospective review was synthesized and presented to the Community Action Team.  From this data, we created the Clark County Cradle project, a multi-faceted initiative where the Public Health Educator links with expectant mothers at several milestone events: the 32-week prenatal visit, 1-2 weeks after hospital discharge, 1 month and 6-month well-checks, as well as many other touch points. We will also be partnering with another community organization to support child-parent psychotherapy visits, using the ACEs model to provide lasting change in our community.

As with many other community initiatives, COVID-19 was a major roadblock as we had to learn how to move forward in that challenging environment.  One of the first things we did was move some of our trainings to a virtual environment.  We have held infant CPR and Safe Sleep education classes monthly and were able to develop an online module to continue to provide training.   

In May of 2021, we organized our first drive-through baby shower. Mothers all over Southern Indiana were able to receive information and resources from dozens of community partners, all in a COVID-safe environment.    

In addition to the focus on safe sleep, the retrospective and current fatality review process revealed a number of unintentional firearm deaths. In response, our Community Action Team is developing a firearm education program in the community and working with a local State Representative to develop a smart gun pilot project.   

This public health approach can perhaps one day provide evidence-based data on what works to reduce these deaths and ensure the safety of our children. Our hope is that these initiatives, implemented at the community level, will help inform state and eventually national policy and practice to help other jurisdictions utilize fatality reviews to develop implementation strategies that can reduce and even prevent infant and child fatalities. 

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.