Coroners from Saline and Lonoke County, and officers with the Benton Police Department, have a common goal – to severely diminish, if not completely end, infant deaths. Arkansas has one of the highest infant mortality rates in the country, but Saline County Coroner Kevin Cleghorn believes education is the key to meeting their goal.
“It’s real and it’s a real monster to deal with, and it’s simply because of a lack of education I think,” he said. “It’s hard for a mom to hear that their child died because of being in an unsafe sleeping environment, but learning that now may save another child in the future. Because, unfortunately, we’ve had cases in Arkansas where families had multiple children die unexpectedly.”
Cleghorn, along with Faulkner County Coroner Patrick Moore (and President of the Arkansas Coroner’s Association), recently held the first Sudden Unexpected Infant Death (SUID) training program for law enforcement officers at the Benton Police Department. Chief Kirk Lane said supervisors, Criminal Investigation Division detectives, and select patrol officers attended the training “to enhance our abilities in that area of investigation.”
So what is SUID? Cleghorn explained when an officer and coroner arrive on the scene of an infant death, they begin the SUID investigation. Investigators are taught how to use a doll to reenact how the infant was positioned while he or she was alive, and to reenact the position of the infant when he or she was found deceased. Cleghorn said the Sudden Unexpected Infant Death is “pre-autopsy,” which is not to be confused with Sudden Unexplained Infant Death which is a term used post-autopsy. He said if there’s no medical reasons for the infant’s death, the death will normally be labeled as Sudden Unexplained Infant Death “with contributing factors such as co-sleeping, unsafe sleeping environment or wedging (such as the infant wedged between a mattress and bed frame, blocking their airway).”
“The most important thing in the officers’ training is to make sure they get all the data that might be involved with the infant death,” Moore said. “It’s very important for the officers to conduct a doll reenactment so that the pathologist at autopsy can see how the doll was placed when the infant was laid down to go to sleep, and how the infant was found. Someone can tell you how it was, but until they reenact it and actually show you, you don’t really know.”
Cleghorn added, “Out of all the courses I have taken in my 27-years of being a paramedic and then into the Saline County Coroner’s Office since 2007, this is probably the best program I’ve been to in my life. It changed the way I look at things which is a reason I became an instructor of this program as well. I’m that passionate about it.”
Though it is not an overly difficult training session, the state remains high on the infant mortality rates, and Cleghorn again points to the lack of education across the state. He said the issue isn’t severe in Saline County due to having a large number of local officers and investigators from the Arkansas State Police Crimes Against Children Division, along with trained coroner assistants, trained as SUID investigators.
“They’ve been through this course, the doll reenactment, plus they’ve got multiple years of medical experience and/or investigative training, so we are very blessed in Saline County,” Cleghorn said. “When I go to a scene, they’re all there. The vast majority of Arkansas, however, doesn’t have what we have.”
Cleghorn recalled an investigator once telling him a case where a respected community member’s child died and they told that person the child died of Sudden Infant Death Syndrome, but didn’t mention the contributing factor in order to protect the feelings of that person. Years later, that same person death had a second child die in the same manner.
“That investigator told me he wanted to kick himself because if he’d just been honest in the beginning, he could have possibly prevented that second child’s death,” Cleghorn said. “That’s another reason why this program is so important and why I’m so passionate about it.”
Cleghorn is also the director of the South Central Arkansas Infant and Child Death Review Team, which covers 12 counties in Arkansas. The purpose of the review team is to improve the response to infant and child fatalities, provide accurate information on how and why Arkansas children are dying, and ultimately reduce the number of preventable infant and child deaths by establishing an effective review and standardized data collection system for all unexpected infant and child deaths.
“I get case reports in and it just amazes me the lack of investigation that’s done from multiple sources (coroners, law enforcement officers, DHS investigators, and hospital staff),” Cleghorn said. “It baffles me that people don’t have more answers to the questions about these kid’s deaths. That’s really what these classes are all about, educating the communities, such as at hospital’s labor and delivery units.”
This was also the first time they incorporated a Vicarious Trauma course with the SUID course, which was presented by Dr. Pamela Tabor, DNP-Forensics, Director of Arkansas Infant and Child Death Review Program.
“We included the Vicarious Trauma course because of the nature of what we’re dealing with in the SUID investigations,” Cleghorn said. “Officers see the worst of the worst cases on a day to day basis that I nor the public see. When they go into a scene that involves an infant or child, those are hard to deal with cases. When you start talking about the death of a child, there’s a lot of emotional trauma.”
Tabor said that understanding the concept of vicarious traumatization is essential for person’s working with victims of violence and trauma in order to educate and intervene when necessary. She said the term describes the negative changes experienced by the care provider when dealing with survivors. Tabor said the cumulative effects of vicarious trauma include changes in psychological and emotional needs, trust and dependence, control, intimacy, self-esteem, beliefs and cognition, and changes in a sense of safety that parallels those experienced by people suffering from PTSD.
“Negative coping strategies can involve alcohol, drugs, disengagement, and denial,” she said. “Positive coping strategies can include: expression of feelings, emotional support, humor, good physical health, hobbies, seeks peer support, and spiritual activities.”
Tabor said there is currently no proven prevention for vicarious trauma, but the overall plan should be to educate and increase awareness, implement early identification and recognition, and to combat and eradicate vicarious trauma. She said education, research and outreach have been found to help mitigate the effects of vicarious trauma.
“When I go out there to work, I don’t just look at a case, I look at those with me and we have to take care of each other,” Cleghorn said. “Suicide rates among law enforcement, EMS, and military personnel is way too high, and a lot of that starts with cases like we are talking about. And if we aren’t there backing each other and taking care of each other, and having a way out from all of this trauma we are seeing, it doesn’t do anyone any good.”
“This class teaches us to take care of each other. The overall goal of the entire course is to learn how to handle this [trauma],” he added.
The SUIDI Training, which is recommended by the Center for Disease Control and Prevention, teaches attendees infant growth and development; differentiation between the types of SUID (including asphyxiation, entrapment, wedging, occlusion of upper airway, etc.). Sudden Infant Death Syndrome (SIDS); interviewing psychology; conducting witness interviews, scene investigations, doll reenactment; and pre- and post-autopsy reporting. Proper death scene investigation assists in accurately identifying the cause and manner of death in order to increase accuracy of reporting, guide research and influence the development of interventions. Proper DSI will assist the family by providing an accurate explanation for their loss, and will allow for appropriate referrals and counseling.