Through case reviews, the PDRC – Child Welfare collects information that, when tracked over time, may identify emerging trends. This knowledge can help contribute to understanding how services may be enhanced to better ensure the safety of children who come into contact with the child welfare system. Definitions which describe the criteria for these factors can be found in Appendix B.

In addition to the factors identified by the PDRC – Child Welfare as part of the case review process, Societies report on vulnerability factors associated with the child, youth or their family as part of their submission of the Child Fatality Case Summary Report. These vulnerability factors have similarities to the factors tracked by the PDRC – Child Welfare. Neither the vulnerability factors nor the factors that are tracked through PDRC case review are necessarily predictive of death, however; both sets of data are collected and help evaluate trends over time.

In the future, the OCC hopes to align the approach to tracking both sets of information.

Chart 28A: Top ten factors identified in PDRC- Child Welfare case reviews (2016)

  • Chart 28A illustrates the top ten factors that were most frequently identified in the PDRC – Child Welfare case reviews conducted in 2016. The top ten risk factors identified were substance abuse (66%), mental health (63%), domestic violence (47%), high risk subject child (41%), neglect/inadequate supervision (41%), 3 or more Society referrals (41%), physical abuse (34%), caregivers’ level of cooperation (28%), 3 or more Society openings (28%) and other, which include childhood history with a Society (25%) and criminal activity (25%).  

Chart 28B: Top ten factors identified in PDRC- Child Welfare case reviews (2017)

  • Chart 28B illustrates the top risk factors for the cases reviewed by the PDRC in 2017, which were substance abuse (69%), sexual abuse (62%), mental health (62%), neglect/inadequate supervision (54%), 3 or more Society openings (38%), domestic violence (38%), 3 or more Society referrals (31%), caregivers’ level of cooperation (15%), caregiver capacity concerns (15%) and other factors (24%), which includes criminal activity (8%), childhood history with a Society (8%) and a high risk subject youth that has special needs or is less than one year of age (8%).  The top two factors identified in cases reviewed by the PDRC – Child Welfare have been consistent over the last three years, while the top ten factors vary from year to year.

As in previous years, the findings highlight the prevalence of multiple factors in cases reviewed by the PDRC:

  • 41% (13 out of 32) of the cases reviewed by the PDRC – Child Welfare in 2016 had five or more of the ten most frequently identified factors present while 38% (5 out of 13) of the cases had these same factors present in 2017. 

In 13% (4) of cases, all of the five most frequently identified factors were present (i.e. substance abuse, three or more Society referrals, neglect/inadequate supervision, domestic violence and mental health) in 2016. One case reviewed in 2017 (8%) had all five of the most frequently identified factors present (i.e. substance abuse, neglect/inadequate supervision, physical abuse, sexual abuse and mental health).

  • In 9% (3) of cases in 2016, all ten of the most frequently identified factors were present; and in one case (3%), eight of the most frequently identified factors were present.

In 2017, one case (8%) had seven of the most frequently identified factors present.

The prevalence of these factors in cases reviewed by the PDRC – Child Welfare may warrant additional investigation to determine whether or not these factors speak to an increased risk of death.