Child Death Reviews: Scottish Government Steering Group Report
The report of the Scottish Government Child Death Reviews Steering Group setting out recommendations for establishing a national child death review system in Scotland.
Annex 3
NOTIFICATION AND DATA COLLECTION FORMS
Data items for Child Death Review forms | Form 1 | Form 2 | Form 3 | |
---|---|---|---|---|
Data item | Coding structure/comments | Initial notification | Information gathering template | Summary review output data |
Child identifiers and demographics | ||||
CDR unique case reference number | √ | √ | ||
CHI number | √ | √ | √ | |
NRS death registration identifiers | √ | √ | ||
NRS registration district | √ | √ | ||
NRS registration year | √ | √ | ||
NRS entry number | √ | √ | ||
First forename | √ | √ | ||
Second forename | √ | √ | ||
Surname | √ | √ | ||
Previous forename | √ | √ | ||
Previous surname | √ | √ | ||
Date of birth | DD/MM/YYYY | √ | √ | √ |
Gender | M/F | √ | √ | √ |
Address of usual residence | √ | √ | ||
Postcode of usual residence | √ | √ | √ | |
Alternative postcode | Eg if child lives between two homes or has recently moved | √ | √ | √ |
Country of residence | √ | |||
Area of usual residence | NHS Ayrshire & Arran | √ | ||
NHS Borders | √ | |||
NHS Dumfries & Galloway | √ | |||
NHS Fife | √ | |||
NHS Forth Valley | √ | |||
NHS Grampian | √ | |||
NHS Greater Glasgow & Clyde | √ | |||
NHS Highland | √ | |||
NHS Lanarkshire | √ | |||
NHS Lothian | √ | |||
NHS Orkney | √ | |||
NHS Shetland | √ | |||
NHS Tayside | √ | |||
NHS Western Isles | √ | |||
Rest of UK | √ | |||
Outwith UK | √ | |||
Country of birth | √ | √ | √ | |
Length of time in Scotland prior to death | YY/MM | √ | √ | |
Ethnicity | See code list | √ | √ | √ |
At the time of death, was the child: | √ | √ | ||
Member of a travelling family | Y/N | √ | √ | |
Unaccompanied asylum seeker | Y/N | √ | √ | |
Member of asylum seeking family | Y/N | √ | √ | |
Recognised as homeless | Y/N | √ | √ | |
Looked after child | Y/N | √ | √ | |
On child protection register | Y/N | √ | √ | |
Respondent identifiers | √ | |||
Individual registering the death | √ | |||
Forename | √ | |||
Surname | √ | |||
Address | √ | |||
Postcode | √ | |||
Date of registration | DD/MM/YY | √ | ||
Doctor certifying the death | √ | |||
Forename | √ | |||
Surname | √ | |||
Business address | √ | |||
Business contact telephone number | √ | |||
Consultant responsible for deceased as a patient | √ | |||
Registered GP | √ | |||
Forename | √ | |||
Surname | √ | |||
Surgery address | √ | |||
Each individual completing information gathering template | √ | |||
Forename | √ | |||
Surname | √ | |||
Job title | √ | |||
Place of work | √ | |||
Address | √ | |||
Postcode | √ | |||
Tel | √ | |||
√ | ||||
Date of completion | DD/MM/YY | √ | ||
Circumstances of the death | ||||
Type of death | Neonatal death | √ | ||
May trigger additional type specific data collection forms. | Death of a child with a life limiting condition | √ | ||
SUDI | √ | |||
Road traffic accident | √ | |||
Drowning | √ | |||
Fire/burns | √ | |||
Poisoning | √ | |||
Other non-intentional injury | √ | |||
Substance misuse | √ | |||
Apparent homicide | √ | |||
Apparent suicide | √ | |||
Death expected ie death anticipated as a significant possibility in 24 hours before the death (or before the collapse that precipitated the events leading to death) | Y/N | √ | ||
Medical certificate of cause of death issued | Y/N | √ | √ | |
Registered cause of death | √ | √ | ||
Ia | √ | √ | ||
Ib | √ | √ | ||
Ic | √ | √ | ||
Id | √ | √ | ||
Ie | √ | √ | ||
Death referred to Procurator Fiscal? | Y/N | √ | √ | |
Post mortem intended or carried out? | Y/N | √ | √ | |
Post mortem carried out? | Y/N | √ | ||
Other reviews conducted on death (concluded/ongoing) | √ | |||
Critical incident review | Y/N | √ | ||
SUDI review | Y/N | √ | ||
Significant case review | Y/N | √ | ||
Fatal accident inquiry | Y/N | √ | ||
Other, eg Adverse Event Review, Medical certificate of cause of death (MCCD)? | √ | |||
Cause of death - provisional description | √ | |||
Circumstances of death - provisional description | √ | |||
Date of death | DD/MM/YYYY | √ | √ | |
Time of death | 00.00-24.00 | √ | √ | |
Age at death | YY/MM | √ | √ | |
Place of death - address | √ | √ | ||
Place of death - postcode | √ | √ | ||
Place of death - type | Neonatal unit | √ | ||
A&E | √ | |||
Paediatric ward | √ | |||
ICU/HDU | √ | |||
Psychiatric hospital/unit | √ | |||
Hospice | √ | |||
Family home | √ | |||
Other private residence | √ | |||
Residential care setting | √ | |||
School/nursery | √ | |||
Public place | √ | |||
Outwith Scotland | √ | |||
Other | √ | |||
Not known | √ | |||
Date of event leading to death | √ | |||
Time of event leading to death | √ | |||
Place of event leading to death - address | If applicable eg onset of acute medical condition or injury that lead to the death | √ | ||
Place of event leading to death - postcode | √ | |||
Place of event leading to death - type | √ | |||
Child's medical history | √ | |||
Gestation at birth | WW (completed weeks) | √ | ||
Birthweight | In gms | √ | ||
Multiple birth | Singleton | √ | ||
Twin | √ | |||
Triplet or more | √ | |||
Perinatal issues | √ | |||
Developmental issues/disability | √ | |||
Physical health issues | √ | |||
Mental health issues | √ | |||
Child on medication at time of death | Free text | √ | ||
Alcohol or substance misuse | √ | |||
Summary of factors intrinsic to the child that are relevant to the death | Free text | √ | ||
Child's educational history | √ | |||
Child's education/occupation status | Not yet in education | √ | ||
Early education and childcare | √ | |||
School | √ | |||
Further/higher education | √ | |||
Left education - employed | √ | |||
Left education - unemployed | √ | |||
School/nursery attended | Name, address, postcode | √ | ||
Family/carers and household | √ | |||
Number of adults living in child's usual place of residence | √ | |||
For each adult | √ | |||
Date of birth/age | DD/MM/YY or YY | √ | ||
Gender | M/F | √ | ||
Relationship to child | √ | |||
Health or social issues? | Eg physical health, mental health, disability, alcohol or substance misuse | √ | ||
Number of children living in child's usual place of residence | √ | |||
For each child | √ | |||
Date of birth/age | DD/MM/YY or YY | √ | ||
Gender | M/F | √ | ||
Relationship to child | √ | |||
Health or social issues? | Eg physical health, mental health, disability, alcohol or substance misuse | √ | ||
Other carers living elsewhere | √ | |||
For each carer | √ | |||
Date of birth/age | DD/MM/YY or YY | √ | ||
Gender | M/F | √ | ||
Relationship to child | √ | |||
Health or social issues? | Eg physical health, mental health, disability, alcohol or substance misuse | √ | ||
Other siblings living elsewhere | √ | |||
For each sibling | √ | |||
Date of birth/age | DD/MM/YY or YY | √ | ||
Gender | M/F | √ | ||
Relationship to child | √ | |||
Health or social issues? | Eg physical health, mental health, disability, alcohol or substance misuse | √ | ||
Was the child ever looked after or on the child protection register? | Y/N | √ | ||
Have any siblings ever been looked after or on the child protection register? | Y/N | √ | ||
Summary of factors in the child's family, household, and wider social environment that are relevant to the death | Free text | √ | ||
Services involved with child | √ | |||
Were the following services involved with the child at the time of death (or during the final illness)? | Primary health care | √ | ||
Secondary health care | √ | |||
CAMHS | √ | |||
Hospice | √ | |||
Early education and childcare | √ | |||
Education | √ | |||
Social work | √ | |||
Scottish Children's Reporter Administration | √ | |||
Other | √ | |||
Summary of factors relating to the services being provided to the child/family that are relevant to the death | Free text | √ | ||
Delivery of review | ||||
Date of CDR | DD/MM/YYYY | √ | ||
Duration | H, MM | √ | ||
Agencies/specialties represented at review meeting | Primary health care | √ | ||
Neonatology | √ | |||
Paediatrics | √ | |||
Child and adolescent mental health | √ | |||
Public health | √ | |||
Ambulance service | √ | |||
Other healthcare | √ | |||
Police | √ | |||
Fire service | √ | |||
Procurator Fiscal | √ | |||
Social work | √ | |||
Early education and childcare | √ | |||
Education | √ | |||
Family representative | √ | |||
Other | √ | |||
Family involvement in review | Submitted written information | √ | ||
Review findings to be provided to family in written format | √ | |||
Review findings to be discussed with family | √ | |||
Information gathering template available from | Primary health care | √ | ||
Secondary health care | √ | |||
CAMHS | √ | |||
Hospice | √ | |||
Early education and childcare/Education | √ | |||
Social work | √ | |||
Other | √ | |||
Outcome of review | √ | |||
Cause of death - final description | Free text | √ | ||
Cause of death - classified | Deliberately inflicted injury, abuse or neglect | √ | ||
Suicide or deliberate self-inflicted harm | √ | |||
Trauma and other external factors | √ | |||
Malignancy | √ | |||
Acute medical or surgical conditions | √ | |||
Chronic medical condition | √ | |||
Chromosomal, genetic and congenital anomalies | √ | |||
Perinatal/neonatal event | √ | |||
Infection | √ | |||
Sudden unexpected, unexplained death | √ | |||
Factors that may have contributed to the child's death | Categorise each specific category marked 0-3 as | |||
0 No information available | ||||
1 No factors likely to have contributed to death | ||||
2 Factors identified that may have contributed to death | ||||
3 Factors identified that provide a complete and sufficient explanation for the death | ||||
Intrinsic to child | ||||
Summary | Free text - include strengths and difficulties | √ | ||
Perinatal issues | Free text / 0-3 | √ | ||
Acute physical illness | Free text / 0-3 | √ | ||
Chronic physical illness | Free text / 0-3 | √ | ||
Emotional / behavioural / mental health condition | Free text / 0-3 | √ | ||
Developmental problem or disability | Free text / 0-3 | √ | ||
Alcohol or substance misuse | Free text / 0-3 | √ | ||
Child's Family and social environment | √ | |||
Summary | Free text - include strengths and difficulties | √ | ||
Poor parenting / supervision | Free text / 0-3 | √ | ||
Child abuse / neglect | Free text / 0-3 | √ | ||
Physical health of parent / carer | Free text / 0-3 | √ | ||
Mental health of parent / carer | Free text / 0-3 | √ | ||
Alcohol or substance misuse by parent / carer | Free text / 0-3 | √ | ||
Domestic violence in home | Free text / 0-3 | √ | ||
Family breakdown | Free text / 0-3 | √ | ||
Family finances | Free text / 0-3 | √ | ||
Child's wider/physical environment | √ | |||
Summary | Free text - include strengths and difficulties | √ | ||
Home safety | Free text / 0-3 | √ | ||
Other physical environment safety issue | Free text / 0-3 | √ | ||
Bullying | Free text / 0-3 | √ | ||
Gang culture | Free text / 0-3 | √ | ||
Wider social and policy environment | Free text / 0-3 | √ | ||
Service provision/delivery | √ | |||
Summary | Free text - include strengths and difficulties | √ | ||
Recognition of sick child | Free text / 0-3 | √ | ||
Team working/coordination of care and support | Free text / 0-3 | √ | ||
Access to/availability of services | Free text / 0-3 | √ | ||
Summary and actions | √ | |||
Case summary | Free text | √ | ||
Issues relating to the delivery of the review | Free text eg agencies not represented information not submitted to panel | √ | ||
Modifiable factors identified? | The panel has identified one or more factors which may have contributed to the death and which, by means of locally or nationally achievable interventions, could be modified to reduce the risk of future child deaths - Y/N | √ | ||
Modifiable factors identified - description | Free text | √ | ||
Learning points | Free text | √ | ||
Recommendations | Action | √ | ||
Relevant agency | √ | |||
Level (local/regional/national) | √ | |||
Refer death to another agency | Police | √ | ||
Procurator fiscal | √ | |||
Health and Safety Executive | √ | |||
Serious Case Review panel | √ | |||
Other? | √ | |||
Follow up plans for the family | Free text | √ |
Code list for ethnicity
Group A - White
1A - Scottish
1B - Other British
1C - Irish
1K - Gypsy/Traveller
1L - Polish
1Z - Other white ethnic group
Group B - Mixed or multiple ethnic groups
2A - Any mixed or multiple ethnic groups
Group C - Asian, Asian Scottish or Asian British
3F - Pakistani, Pakistani Scottish or Pakistani British
3G - Indian, Indian Scottish or Indian British
3H - Bangladeshi, Bangladeshi Scottish or Bangladeshi British
3J - Chinese, Chinese Scottish or Chinese British
3Z - Other Asian, Asian Scottish or Asian British
Group D - African
4D - African, African Scottish or African British
4Y - Other African
Group E - Caribbean or Black
5C - Caribbean, Caribbean Scottish or Caribbean British
5D - Black, Black Scottish or Black British
5Y - Other Caribbean or Black
Group F - Other ethnic group
6A - Arab, Arab Scottish or Arab British
6Z - Other ethnic group
Group G - Refused/Not provided by patient
98 - Refused/Not provided by patient
Group H - Not Known
List for place of event leading to death and place of death
Acute hospital Family home
Neonatal unit Foster home
A&E Other private residence
ICU/HDU Residential care setting
Psychiatric hospital/unit School/nursery
Paediatric ward Public place
Hospice
Outwith Scotland
Other
Not Known
Contact
Email: Mary Sloan
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