Mandatory child death review program gets fraction of requested funding as counties struggle

The Pennsylvania Department of Health received $242,000 in this year’s budget to help county teams review the deaths of children, a state mandate many have struggled to keep up with.

The allocation is a fraction of the $2.5 million that Gov. Josh Shapiro proposed earlier this year for the Child Death Review program, and some advocates say it won’t be enough to make major changes to the failing system.

The program requires counties to maintain a board of local officials to analyze the circumstances surrounding every death of a person under 21 to inform prevention efforts. However, just half of all cases have been reviewed by local teams since 2020, and county officials say they are overwhelmed by the time-consuming, complicated state mandate.

The Shapiro administration said it was disappointed by the funding. It sought to revamp counties’ efforts with new state-level staff, grant opportunities, and a public education campaign. Much of that plan appears unachievable, given the limited funding available.

Still, the Department of Health said in a statement after the budget became law that even the more modest funding will “provide much needed resources to support this important, yet underfunded, public health initiative.”

The agency will use the money to “explore additional staff members” and “increase our capacity” to help county review teams improve data collection and analysis, and develop prevention recommendations that local officials can act on.

Advocates pursuing improvements to the Child Death Review program are disappointed that Shapiro’s full pitch didn’t make it into the final budget.

Cathleen Palm, founder of the Center for Children’s Justice, said the $242,000 is “an insulting number” and that state policymakers need to step back and figure out their real plan to prevent child deaths. She has been skeptical for months that lawmakers would prioritize Shapiro’s proposed funding for the program.

“The reality is that we’re continuing to ask local teams to do things that the state itself has not created its own infrastructure” to implement, Palm said. “This is about the humanity of children and how we learn and live, and work to protect them and keep them alive.”

County Child Death Review teams consist of local healthcare professionals, law enforcement, child protective service providers, and a coroner or medical examiner. Most of these officials volunteer their time alongside their regular paid positions. The state mandate requires these teams to synthesize data to identify trends and turn that information into concrete death prevention recommendations — a tall order.

Local members of the review teams and advocates for improving the system told Spotlight PA that state funding and coordination of data collection would be extremely helpful. Shapiro’s proposal offered a potential solution, and there appeared to be some support for fully funding it.

Shapiro’s father, a pediatrician, sits on a local review team and told Spotlight PA he was in conversations with his son’s administration about improving the program. And the Republican state senator who authored legislation that initially created the review mandate, Lisa Baker of Luzerne County, said she was open to reevaluating the system.

But lawmakers this year did not address tough policy decisions as part of the budget process, opting instead to pass a simple plan that avoids the most partisan debates in the Capitol. They maintained Pennsylvania’s structural deficit and did not approve any new revenue generators, using accounting tricks to avoid tapping into the state’s rainy day fund.

Christina Phillips, a retired Department of Health employee who organized the Child Death Review program, told Spotlight PA that the state needs to focus the limited resources that made it into the budget on two aspects of supporting counties: acquiring victims’ difficult-to-obtain medical records, and synthesizing that information into usable data for prevention.

“A review is only as good as the information that you have at the table,” Phillips said.

Rosie Lapowsky, Shapiro’s spokesperson, noted there previously was no funding available for the program, and the new money is “the result of compromise and reflects the reality of working with a divided government.”

“The Governor will continue to make investments that keep Pennsylvania’s children safe and looks forward to working with the General Assembly to further improve PA’s child death review program,” Lapowsky said in a statement.

Further changes to Child Death Review appear possible in the near future.

State Senate Majority Leader Joe Pittman (R., Indiana) told Spotlight PA in a statement that looking closer at improving the program “makes sense.”

“Any increases to the Department of Health to further support this program would require accountability that tax dollars are being used efficiently and effectively to better protect children,” Pittman said.

State House Majority Leader Matt Bradford (D., Montgomery) did not respond to a request for comment on Child Death Review.

Policymakers have known about the program’s shortcomings since at least 2024, when an East Stroudsburg University evaluation deemed the program “an unfunded mandate” for counties because there is little-to-no state-level support. The Department of Health commissioned that study after Phillips said she raised concerns about the program to her supervisors.

East Stroudsburg researchers identified 20 rural counties that should at least consider organizing under regional offices to maximize their resources, and 22 counties — 6 urban and 16 rural — that must regroup because although they experienced “sufficient deaths to justify a local team,” they saw inconsistent participation from members.

Only 15 counties’ teams were found to be “strong” in their current form.

The new funding for Child Death Review is the only increase included under the total $5.2 million for the Department of Health’s Health Promotion and Disease Prevention line item, according to the agency. Currently, one full-time position — vacant, but with a new candidate beginning on Aug. 10 — is funded using federal grant money to review sudden unexpected infant deaths, while the department says there are three part-time staff members assigned to aid data support and management of the death review program.

The Department of Health did not answer a question about how many employees, if any, it plans to hire with the new funding.

Pennsylvania lawmakers created the Child Death Review mandate in 2008, one of several policies it adopted in the wake of the murder of Berks County toddler Maxwell Fisher in 1996. Another was Act 33 of 2008, which requires county-level investigations when a child younger than 18 dies or nearly dies due to suspected abuse or neglect.

Palm has also criticized Act 33’s effectiveness and the lack of transparency she says she’s seen from local teams, and argues that the two related laws “don’t have good interplay between them.” She said she would like to see lawmakers take a comprehensive look at the state’s entire approach to preventing child deaths that combines Child Death Review, Act 33, and other related prevention efforts.

“It just feels like we’re at a moment where we need to take a step back and be like, ‘What is it we want to do as it relates to when children die? What do we want to do in response to those deaths in terms of learning from them and working to prevent them?’” Palm said.