The MO 886 3228 form serves as a crucial document for the Missouri Department of Social Services, specifically assisting in the Missouri Child Fatality Review Program's thorough investigation into the circumstances surrounding child fatalities. Designed to guide investigators through a comprehensive examination of the death scene, this detailed checklist is instrumental in determining the cause and manner of a child's death, especially in instances that are sudden, unexpected, or suspicious. For professionals involved in such sensitive investigations, completion of this form with as much detail as possible is vital, supporting pathologists and other authorities in their efforts to understand and prevent future tragedies.
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Understanding the importance of comprehensive investigation in cases of child fatalities, the Missouri Department of Social Services has developed a specialized tool, the MO 886 3228 form, also known as the Death Scene Investigative Checklist for Child Fatalities. This form is a critical component of the Missouri Child Fatality Review Program aiming to ensure that every child death is thoroughly investigated to determine its cause and manner. Conducted by professionals immediately following the tragic event, ideally within 24 hours, this complex checklist guides investigators through meticulous examination of the circumstances surrounding the child's demise. It anticipates the need to recreate the scene for accuracy, involves collection of vital information ranging from the victim's identifiers and pre-natal history to the minutiae of the environment and conditions at the death scene. It is designed to discern not only the medical facts but also to consider possible environmental and caregatorial influences, including the inspection of household, interview of witnesses, and rigorous documentation of any anomalies. Through detailed questions and the option to attach additional documentation, this form serves as an indispensable bridge linking initial on-scene observations to the definitive medical examination, thereby playing a pivotal role in uncovering the truth behind the unthinkable loss of young lives.
STAT
MISSOURI DEPARTMENT OF SOCIAL SERVICES MISSOURI CHILD FATALITY REVIEW PROGRAM
PO BOX 208
JEFFERSON CITY, MO 65102-0208 (573) 751-5980
DEATH SCENE INVESTIGATIVE CHECKLIST FOR CHILD FATALITIES
(800) 487-1626
INSTRUCTIONS
When a child dies suddenly and unexpectedly, or suspiciously, a thorough evaluation/investigation of the scene is necessary to accurately determine the cause and manner of death. The scene investigation should happen as soon as possible after the child’s death, optimally within 24 hours.
This checklist should be used as a guide to your investigation of the scene of a sudden and unexplained or suspicious death, especially to a child under the age of one. Completing all information appropriate to the fatality will help the pathologist determine how and why the child died. For assistance, call (800) 487- 1626.
The questions in the checklist will lead you through a thorough investigation. It is not expected that you will be able to answer all of the questions. You should attempt to interview witnesses, EMS and emergency room personnel, child care providers, law enforcement, and other persons from the scene.
In conducting the investigation, criminality or negligence should not be assumed, but the possibility should not be overlooked. An empathetic, non- confrontational approach is both appropriate and effective.
Complete as many sections as possible. If appropriate, attach this form to your investigation report. Submit a copy to the Medical Examiner’s Office prior to the autopsy.
Because the child will probably have already been transported to a hospital or other facility, it is important that, based on evidence and witness accounts, you try to recreate the scene to approximate actual events. This may include the use of dolls or silhouettes to reconstruct location and position of body. Attempt to acquire scene and reconstruction photographs as appropriate.
Contact your Prosecuting Attorney’s Office to ensure that all laws and regulations are followed in the search of the area, the interviewing of witnesses, and the collection of evidence. Only use procedures and forms approved by your agency and prosecutor. Sample forms are available from STAT.
VICTIM IDENTIFIERS AND PRE-NATAL HISTORY
1. CHILD’S NAME
2. SOCIAL SECURITY NUMBER
3. SCENE ADDRESS
4. DATE OF BIRTH
5. DATE OF DEATH
6. RACE OF CHILD
7. SEX
8. DECEDENT’S ADDRESS
9. MOTHER’S NAME
10. MOTHER’S ADDRESS
11. MOTHER’S TELEPHONE NUMBER
12. MOTHER’S DATE OF BIRTH
13. MOTHER’S SOCIAL SECURITY NUMBER
14. GESTATION IN WEEKS
15. BIRTH WEIGHT
16. KNOWN MATERNAL PRE-NATAL HEALTH PROBLEMS (DIABETES, HYPERTENSION, ETC.)?
NO
YES
UNKNOWN
IF YES, DESCRIBE
17. WAS MOTHER TAKING PRESCRIPTION MEDICATION FOR ABOVE MEDICAL CONDITION DURING PREGNANCY?
UNKNOWN If yes, what type of medication?
18. PRE-NATAL MATERNAL CIGARETTE, ALCOHOL OR DRUG USAGE?
IF YES,
Alcohol
Cigarettes
Cocaine
Heroin
Marijuana
Methamphetamine
Other
19. KNOWN COMPLICATIONS OF PREGNANCY OR DELIVERY?
UNKNOWN If yes, explain:
20.LOCATION OF BIRTH AND NAME OF FACILITY
21.ATTENDING MEDICAL PRACTITIONER
22.BIRTH DEFECTS OR OTHER ABNORMALITIES OF DECEDENT AT BIRTH, DESCRIBE:
MO 886-3228 (11-06)
23. ANY FAMILY HISTORY OF SIDS OR OTHER INFANT DEATH?
IF YES, DESCRIBE DETAILS INCLUDING DATE OF DEATH AND LOCATION OF OCCURRENCE:
EVENTS SURROUNDING DEATH
24. PLACE OF FATAL EVENT (E.G., IN CRIB, IN CAR)?
25. DEATH WITNESSED?
If yes, provide detail in narrative.
26. WHO FOUND CHILD?
TIME FOUND
27. STATUS OF CHILD WHEN FOUND
28. WHEN WAS CHILD LAST SEEN ALIVE (TIME, WHERE, BY WHOM)?
Dead
Unresponsive
In Distress
Unsure
29. DESCRIBE CONDITION OF CHILD WHEN LAST SEEN:
30. MEDICAL ASSISTANCE SUMMONED?
31. 911 CALL?
YES If yes, obtain tapes.
32. RESUSCITATION ATTEMPTED?
BY WHOM?
HISTORY OF PREVIOUS RESUSCITATION?
33. CONVEYED TO A MEDICAL FACILITY?
WHERE?
NAME AND ADDRESS OF FACILITY
34. WHO PRONOUNCED CHILD DEAD?
CONDITION OF CHILD
35. BODY TEMPERATURE (DEGREES)
TIME
METHOD
SWEATY?
36. LIVOR MORTIS
WHERE OBSERVED?
CONSISTENT WITH POSITION WHEN FOUND?
YES (See Question 44)
37. RIGOR MORTIS
38. HEMORRHAGE OF EYES, LIPS OR EARS?
39. CHILD APPEARS CLEAN, WELL NOURISHED AND CARED FOR
YES If no, explain in narrative.
40. CLOTHING CLEAN?
RIGHT SIZE?
CLOTHING REMOVED AFTER DEATH?
CLOTHING TYPE
41. DIAPERS USED? (COLLECT AS NECESSARY)
WET?
SOILED?
42. ARE THERE BIRTHMARKS OR INJURIES OF ANY TYPE, INCLUDING BRUISES, SCRAPES, CUTS, BURNS OR DIAPER RASH?
YES If yes, describe colors, shapes, sizes and locations in narrative. Ensure that necessary photos are taken if possible.
POSITION OF CHILD
43. SKETCH POSITION OF CHILD AND IDENTIFY WHERE IN CRIB, BED, OR OTHER PLACE
IF BABY IS NOT PRESENT, ENSURE THAT PHOTOS ARE TAKEN OF POSITIONED DOLL OR SILHOUETTE.
INDICATE DIRECTION OF CHILD’S HEAD (CHECK ONE):
N
W
E
S
44. WAS CHILD MOVED FROM ORIGINAL POSITION?
WHY?
45. POSITION WHEN DISCOVERED (REFER BACK TO QUESTION 43):
BODY
On Stomach
On Back
Seated Upright
Left Side
Right Side
BODY PINNED
Pinned Vertically
Pinned Horizontally
Other Wedging
Not Pinned
HEAD AND NECK
Face Directly Up
Face Directly Down
Face to Right
Face to Left
Neck Flexed to Chin
Neck Extended Back
USUAL SLEEPING POSITION
46. WAS AIRWAY OBSTRUCTED WHEN DISCOVERED?
Airway Not Obstructed
Right Nostril Blocked
Object Covering Mouth
Objects Near Face
Both Nostrils Blocked
Left Nostril Blocked
Object Covering Nose
47. DESCRIBE ANY OBJECTS COVERING NOSE, MOUTH OR FACE:
48. IF CHILD WAS FOUND FACE DOWN, IS THERE A VISIBLE CUP, POCKET OR DEPRESSION IN THE BEDDING?
Depth:
Diameter:
49. IS THERE A VISIBLE CREASE ON FACE, NECK OR HANDS FROM PILLOWS OR BEDDING?
50. MATERIAL FOUND IN NOSE OR MOUTH:
None
Formula
Bloody Froth
Blood Tinged Secretion
Mucous
Vomit
Dried Secretion
Food
Froth
Urine or Stool
51. SECRETION FOUND ON:
Blanket
Sheet
Clothing
Pillow
Other Item
52. WHAT TYPE OF SECRETION
Other Secretion
53. FACE IN CONTACT WITH WET MATERIALS
DESCRIBE:
54. IF FOUND WHILE SLEEPING, WAS CHILD SLEEPING ALONE?
If no, who was child sleeping with?
55. DESCRIBE BED AND/OR OTHER SLEEPING SURFACE.
56. LIST ALL MATERIALS AND OBJECTS NEAR CHILD WHEN FOUND, INCLUDING BED, SHEETS, PILLOWS, COVERS, TOYS, HOUSEHOLD OBJECTS, ETC.
57. COULD ANY OF THESE MATERIALS AND OBJECTS HAVE INFLUENCED THE DEATH?
Yes
If yes, describe in narrative.
58. IS THERE ANY POSSIBILITY OF OVERLYING? FOR EXAMPLE, TOO LITTLE ROOM FOR TOO MANY PEOPLE, RECENT ALCOHOL OR OTHER DRUG CONSUMPTION BY PERSON SLEEPING WITH CHILD.
If yes, explain in narrative.
59. IS THERE AN APNEA MONITOR IN THE HOME?
WAS CHILD ON MONITOR AT TIME OF DEATH?
Download information from monitor.
Collect monitor as evidence.
SOCIAL AND ENVIRONMENTAL CONDITIONS
60. WHO DOES CHILD LIVE WITH?
61. WHO HAD RESPONSIBILITY FOR CHILD AT TIME OF DEATH? IN NARRATIVE, DESCRIBE
ACTIVITIES OF CAREGIVERS DURING DAYS LEADING UP TO THE DEATH.
62. HAVE FAMILY MEMBERS OR CARETAKERS BEEN REPORTED FOR PAST ABUSE OR NEGLECT?
FOR DOMESTIC VIOLENCE?
Contact Hotline to obtain information. (800-392-3738)
63. LIST CHILD CARE PROVIDERS - LICENSED
UNLICENSED
64. DO SIBLINGS EVER WATCH CHILD UNATTENDED?
65. ARE THERE ANY CULTURAL PRACTICES THAT MAY HAVE INFLUENCED THE DEATH?
If yes, age:
If yes, explain fully in the narrative.
66. DESCRIPTION OF DWELLING:
67. CLEANLINESS OF DWELLING
BELOW AVERAGE
ABOVE AVERAGE
AVERAGE
68. NUMBER OF CHILDREN LIVING AT ADDRESS
NUMBER OF ADULTS
OVERCROWDED?
69. ARE THERE ANY ENVIRONMENTAL HAZARDS?
If yes, check all that apply.
Tobacco Smoke
High Room Temp
Recent Remodeling
Tobacco
Animals
Drugs or Alcohol
Low Room Temp
Toxic Gases
Lead
Medicines
Unusual Dampness
Toxic Products
Electrical
70. ROOM TEMPERATURE
OUTSIDE TEMPERATURE
HEATING/COOLING SOURCE
PROXIMITY OF CHILD TO HEAT/COOLING SOURCE
CHECKLIST FOR DISCRETIONARY COLLECTION OF EVIDENCE
Baby Bottles
Toys
Bedding
Drug Paraphernalia
Formula/Food
Equipment
Diapers
Folk Remedies
Honey, if fed within 30 days
TRACE EVIDENCE COLLECTED: LIST
LOCATION FOUND
DISPOSITION AND PRESENT LOCATION
PHOTOS TAKEN?
If yes, by whom?
ALL WITNESSES, RESPONDERS, AND OTHER PERSONS AT SCENE
List all persons at scene during time child died.
NAME
ADDRESS
RELATIONSHIP
NARRATIVE (USE ADDITIONAL PAGES AS NECESSARY)
71. DATE/TIME OF INVESTIGATION
72. CASE NUMBER
73. INVESTIGATOR’S NAME
74. AGENCY/DEPARTMENT
Once the unfortunate event of a child fatality occurs, especially under sudden, unexpected, or suspicious circumstances, a precise and thorough investigation of the scene is imperative. The MO 886 3228 form functions as a comprehensive guide to conducting such sensitive inquiries. Its proper completion ensures that the child's death is meticulously documented, facilitating a better understanding for the pathologist to determine the cause and manner of death. Here, detailed steps for accurately filling out this form are outlined, striving to assist in the methodical collection of all relevant information and evidence.
After completing the MO 886 3228 form, attach it to the investigation report and submit a copy to the Medical Examiner’s Office prior to the autopsy. Given the emotional and legal sensitivities involved, ensure all information is accurately recorded and procedural guidelines are followed meticulously. This task requires not only attention to detail but also a protocol-driven approach to gather evidence crucial for understanding the tragic death of a child.
The MO 886-3228 form is a critical document utilized by the Missouri Department of Social Services, specifically within the Missouri Child Fatality Review Program. Its primary purpose is to serve as a comprehensive death scene investigative checklist following the sudden, unexpected, or suspicious death of a child. This form guides investigators through a detailed examination of the scene to accurately determine the cause and manner of death, significantly aiding in the subsequent medical and legal processes.
This form is intended for use by professionals responsible for the investigation of a child's death scene. This includes members of law enforcement, emergency medical services (EMS) personnel, child care providers, and other suitable officials who arrive at the scene. These individuals are encouraged to fill out the checklist to the best of their abilities, providing essential information for the pathologist and contributing to a thorough investigation.
The checklist is designed to be used as soon as possible after the death of a child, optimally within the first 24 hours. Completing the investigation promptly is crucial for accurately determining the cause of death and preserving valuable evidence.
The form requests comprehensive information, including but not limited to:
Investigators are advised to conduct the scene examination with an empathetic, non-confrontational approach. Criminality or negligence should not be immediately assumed, but the possibility should not be overlooked. The investigation should include interviews with witnesses and the collection of physical evidence, with an effort to reconstruct the scene if the child has been moved prior to the investigation.
Once filled out, the form, along with any attached reports or additional documents, should be submitted to the Medical Examiner’s Office prior to the autopsy. It is also advised to coordinate with the local Prosecuting Attorney’s Office to ensure all procedures align with legal standards and regulations.
Yes, assistance is available. Investigators can call (800) 487-1626 for support in completing the form or navigating any part of the investigation process. This line can provide guidance on both the use of the checklist and general advice on conducting a child fatality scene investigation.
The form includes a section dedicated to the discretionary collection of evidence, which guides investigators on what types of items might be collected from the scene for further analysis. This could include anything from clothing and bedding to toys and medicines. Additionally, it instructs on the collection of trace evidence and the documentation of such, emphasizing the importance of photos and detailed notes for the complete reconstruction of the scene. Collaboration with law enforcement is crucial to ensure that evidence is collected and documented following legal protocols.
Filling out the Missouri Department of Social Services' MO 886-3228 Form, otherwise known as the Death Scene Investigative Checklist for Child Fatalities, is a critical task that requires attention to detail and thoroughness. However, individuals often encounter challenges during this process. Some common mistakes made include:
Besides these particular mistakes, there are several other areas where errors are commonly made:
By addressing these common mistakes, individuals tasked with completing the MO 886-3228 Form can ensure a more accurate and comprehensive investigative process, supporting the essential work of determining causes and contributing to the prevention of child fatalities.
When dealing with the complexities and emotional weight of child fatality cases, professionals often utilize a variety of forms and documents to ensure a thorough investigation and to care for the sensitivity of the situation. The MO 886-3228 form, focusing on death scene investigation for child fatalities, serves as a crucial tool in this process. Alongside this form, several other documents are integral in piecing together the narrative and facts surrounding such unfortunate events.
In gathering a complete picture of a child's passing, these documents and forms complement the MO 886-3228 checklist by enhancing understanding, guiding investigations, and ensuring compassionate interaction with affected families. Together, they form a comprehensive approach to addressing the multifaceted nature of child fatality investigations, balancing the need for thorough inquiry with the respect and care for those grieving.
The MO 886 3228 form is detailed and highly specialized, focusing specifically on the tragic circumstance of child fatalities. It bears similarities to other investigative forms used in sensitive cases, such as the Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) and the Child Abuse and Neglect Reporting Form (CANRF). These documents, though each serves a distinct purpose, overlap in their meticulous approach to gathering comprehensive details about incidents, emphasizing the investigative process, evidence collection, and witness interviews to ensure a thorough understanding of the circumstances surrounding a case.
The Sudden Unexplained Infant Death Investigation Reporting Form (SUIDIRF) is particularly comparable in its structure and intent. Like the MO 886 3228 form, it is utilized in the wake of an infant's unexpected death, guiding investigators through a comprehensive examination of the scene, the infant’s medical history, and circumstances leading up to the death. Both forms underscore the importance of capturing exhaustive details to aid in determining the cause of death. They stress the significance of scene recreation, witness interviews, and the collection of medical and environmental information. Where they converge is in their shared goal of piecing together a narrative that accurately reflects events surrounding the death, thereby illuminating potential causes.
Meanwhile, the Child Abuse and Neglect Reporting Form (CANRF) shares the MO 886 3228 form’s commitment to meticulous data collection in distressing circumstances. Although the CANRF focuses on cases of suspected abuse and neglect, parallel to the death scene investigative checklist’s focus on fatalities, both require detailed documentation of physical symptoms, environmental factors, and caregiver accounts. Each form represents a crucial component of a broader investigative process, where the primary objective is to safeguard vulnerable populations by ensuring that accurate, thoroughly researched information guides subsequent actions and interventions. Through careful documentation, both forms contribute significantly towards understanding and preventing future tragedies.
When filling out the MO 886-3228 form, which is utilized for the Missouri Child Fatality Review Program, attention to detail and thoroughness are paramount. Here are some key dos and don'ts to guide you through the process:
Understanding the MO 886 3228 form, used for child fatality scene investigations in Missouri, can sometimes be confusing. Here's clarifying some common misconceptions:
It's only for law enforcement use: While it's primarily used by professionals investigating child fatalities, the form is also intended for guidance to ensure a thorough scene investigation, which can include various agencies.
It determines the cause of death: The form is a tool for gathering evidence at the scene. Determining the cause of death is the job of medical professionals during the autopsy, though this form helps in that determination.
The form is optional: Completing the MO 886 3228 is a critical step in investigating child fatalities. Its use helps ensure all relevant details are considered and properly documented.
It's to be used for children of all ages: Specifically, it is designed primarily to guide investigations involving children under one year old or in cases of sudden, unexplained, or suspicious child deaths.
It’s for assessing parental responsibility: The focus of the form is to collect detailed information about the death scene, not to immediately assign blame or assess parental negligence.
Scene recreation is not mandatory: If the child has already been moved, recreating the scene as accurately as possible, including the use of dolls or silhouettes, is a crucial part of the investigation process.
The form is completed at the scene: While it's initiated at the scene, finishing it may require additional information from interviews, medical records, or autopsy findings.
All questions must be answered: It's understood that not all questions on the form will apply to every situation. The goal is to complete as much relevant information as possible.
You must personally perform all tasks listed: The form outlines a comprehensive investigative process, including interviews and evidence collection. While not all tasks may fall directly on the person completing the form, coordinating with other professionals is part of the process.
Submitting the form to the Medical Examiner's Office is the final step: In addition to submission, the investigator should ensure all procedures and laws have been followed and coordinate with the Prosecuting Attorney's Office as needed.
Correct understanding and application of the MO 886 3228 form is crucial in ensuring the careful and thorough investigation of child fatalities, ultimately helping to determine the cause and manner of death and potentially preventing future tragedies.
When facing the challenging task of investigating child fatalities, the MO 886 3228 form serves as an essential guide, designed to ensure a comprehensive analysis of the death scene. Here are ten key takeaways to consider while utilizing this form:
By adhering to these guidelines when completing the MO 886 3228 form, investigators can ensure a thorough and sensitive approach to the tragic event, aiding in the accurate determination of the cause and manner of death, and hopefully, contributing to the prevention of future tragedies.
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