Child Death Review Team (CDRT)

March 19, 2014

Press Release

For questions please contact Diane Nelson, Public Health Program Manager at 920-674-7186 or

Jefferson County Child Death Review Team

By Abigail Tanner, UW Whitewater Student Intern and Diane Nelson, Public Health Program Manager Jefferson -

In October of 2011, the Health Department convened a group to create a Jefferson County Child Death Review (CDR) team with the support of the Wisconsin Department of Health Services and the Children’s Health Alliance of Wisconsin. There are currently 54 out of 72 counties in Wisconsin that have CDR teams.

The CDR team is a multidisciplinary team consisting of wide variety of agencies including the County Coroner, local law enforcement and EMS, child protective services, community mental health, District Attorney’s office, local Public Health, Fort HealthCare and UW Health Partners Watertown Regional Medical Center Emergency Room and Obstetrical staff, Fort HealthCare pediatrician, People Against Domestic Violence (PADA) and local school representatives. The CDR receives ongoing technical assistance from the Children’s Health Alliance of Wisconsin. The review of child deaths by the team is a professional and respectful process aimed at understanding the risk factors and circumstances surrounding the death of a child. Strict confidentiality is maintained by all team members.

The goal of the local CDR team is to improve understanding of how and why children die and to improve child health, safety and protection. A second goal is to educate policy makers on policies and programs needed with the intended outcome of preventing other children’s deaths.

Jefferson’s CDR team meets quarterly to review deaths of children and young adults up to the age of 25. Diane Nelson, Jefferson County Health Department Public Health Program Manager and CDR team chair stated, "from the death certificate records we have statistics on the number of child deaths and causes, but we know very little at state or local levels about circumstances, such as who, what, when, where, why and how. A CDR team can help identify preventable risk factors contributing to a child’s demise."

Early in the process, 4 cases of unsafe sleep related deaths were reviewed. In 2013 the team worked on strategies to prevent these untimely deaths with consistent messaging to and from medical providers, nurses, daycares, baby sitters and prenatal clients. One strategy was the investigation of a community agency that could provide a safer sleep environment when an unsafe situation was encountered.

This resulted in the start of a "Cribs for Kids" program at the Jefferson County Health Department. "Cribs for Kids" supplies education on safe sleep along with a Pack N Play for a safer place for infants to sleep. "In just a little over a year, the Public Health Nurses have distributed over 40 Pack N Play cribs and we are always in need of more. At the present time we are looking for donations or a sponsor to assist us in purchasing the Pack N

Plays as the Public Health Nurses continue to find families in need. Our goal is to prevent another precious child from dying from a preventable cause," stated Gail Scott, Director of Jefferson County Health Department.

In 2014 the team decided to continue emphasizing safety and injury prevention by working on child passenger safety. Motor vehicle crashes continues to be one of the top causes of child deaths, many due to improper car seat restraints. The team decided to emphasize proper installation of car safety seats as a prevention strategy. Many of the agencies around the table did not know what the community resources were for car seat inspections. A list was compiled of currently certified car seat technicians and distributed to local police departments (Call the Health Department at 920-674-7275 or access the Jefferson County Health Department website at if you would like a list).

The team is currently working with the local police departments and certified technicians to develop a "Fix it or Ticket" program where, in lieu of a citation for not having your child properly restrained, you can go to a technician, learn to properly install the car seat and safely restrain your child and have your car seat citation withdrawn. This program is being done in partnership with the Jefferson County Health Department Car Safety Seat Program where certified technicians educate parents or others on how to properly install a car safety seat. Car safety seats are available free of charge to those in need for children of all ages.

"By understanding how and why children die, our communities can take action to prevent similar deaths. CDR teams are catalysts for community action. The local team looks forward to partnering and linking with community agencies such as local law enforcement to reduce the risk of untimely child deaths," stated Nelson. For more information contact Diane Nelson at the Jefferson County Health Department at 920-674-7186.