Abstract
BackgroundIn many countries there are now detailed Child Death Review (CDR) processes following unexpected child deaths. CDR can lead to a fuller understanding of the causes for each child’s death but this potentially intrusive process may increase the distress of bereaved families. In England, a joint agency approach (JAA) is used where police, healthcare and social services investigate sudden child deaths together and a key part of this is the joint home visit (JHV) where specialist police and paediatricians visit the home with the parents to view the scene of death. This study aimed to learn of bereaved parents’ experiences of JAA investigation following Sudden Unexpected Death in Infancy (SUDI).MethodsThis was a qualitative study of joint agency investigation of SUDI by specialist police, healthcare and social services including case note analysis, parental questionnaires, and in-depth interviews with parents and professionals. Families were recruited at the conclusion of the JAA. Data were analysed using a Framework Approach.Results21/113 eligible families and 26 professionals participated giving theoretical saturation of data. There was an inherent conflict for professionals trying to both investigate deaths thoroughly as well as support families. Bereaved parents appreciated the JAA especially for the information it provided about the cause of death but were frustrated with long delays waiting to obtain this. Many parents wanted more emotional support to be routinely provided. Most parents found the JHV helpful but a small minority of mothers found this intensely distressing. In comparison to JHVs, when police visited death scenes without paediatricians, information was missed and parents found these visits more upsetting. There were issues with uniformed non-specialist police traumatising parents by starting criminal investigations and preventing parents from accessing their home or collecting vital possessions.ConclusionsOverall most parents feel supported by professionals during the JAA; however there is scope for improvement. Paediatricians should ensure that parents are kept updated with the progress of the investigations. Some parents require more emotional support and professionals should assist them in accessing this.
Highlights
In many countries there are detailed Child Death Review (CDR) processes following unexpected child deaths
We used the Income Deprivation Affecting Children Index (IDACI) [8] to compare social deprivation between recruited and non-recruited cases and there was no significant difference between these two groups of cases; these are shown in Tables 1 and 2
Our results provide reassurance to professionals that detailed child death investigations are acceptable to bereaved parents and provide them with valuable information as to why their child died
Summary
In many countries there are detailed Child Death Review (CDR) processes following unexpected child deaths. In England, a joint agency approach (JAA) is used where police, healthcare and social services investigate sudden child deaths together and a key part of this is the joint home visit (JHV) where specialist police and paediatricians visit the home with the parents to view the scene of death. CDR may involve prospective investigation of unexpected deaths; this might include physicians obtaining detailed medical histories from parents, analysis of death scenes by police and health care professionals, and multi-agency case reviews [3]. Key elements include taking the deceased infant to an Emergency Department, a paediatrician (possibly accompanied by the police) taking a detailed medical history from the parents, a joint examination of the scene of death by police and paediatrician, and follow-up for the parents. The practice of joint police and paediatric examination of the scene of death is variable and often police examine death scenes alone; these cases are still considered to have had a JAA if there is inter-agency communication throughout the investigation
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