To provide guidance on the methods and procedures by which:
notifications of child deaths are managed, and
information and reports in relation to child death notifications are exchanged with the Office of the State Coroner (the Coroner) and the Ombudsman Western Australia (the Ombudsman).
Refer to Chapter 2.1.5 Responding to concerns for children in care – critical incidents and the following legislation:
Note: CEO refers to the Chief Executive Officer of the Department of Communities (the Department).
The Coroner forwards a Coronial Notification with details about the death to the SCPU.
The SCPU searches our client record systems and completes a Response to Coronial Notification identifying the nature and extent of the Department's contact with the subject child and/or family. The search is conducted on the subject child, the parents and any significant others, such as siblings.
The SCPU distributes the Response to Coronial Notification and original Coronial Notification, by email to:
external stakeholders including the Coroner, Coronial Investigation Squad, the Ombudsman and the State Solicitors Office, and
internal stakeholders including the relevant District Director (DD), Executive Director (ED), Director Executive Services, Assistant Director General (ADG), Regional Executive Director, and Service and Operational Improvement. Other stakeholders may be included as relevant to the nature of the Department's involvement.
Refer to the Child Death and Family and Domestic Violence FDV Fatality Notification Flowchart for further information.
You and/or your TL must assess the information received in the Response to Coronial Notification and determine further action, such as:
recording the date of the child's death in our information systems
assessing the safety and wellbeing of remaining siblings, which may include determining whether a CSI is necessary
assessing supports/services that may be required, or
the provision of financial or other assistance.
The minimum action required is that Department staff are aware of the death if the family seek financial or other types of assistance.
If the notification is in relation to an open case, you must record the date of death on our information systems.
The SCPU will coordinate the preparation of any further information requested by the Coroner and/or Ombudsman.
If the Coroner (or WA Police officers on behalf of the Coroner) need to make an after-hours notification of death and/or require information, the Coroner will notify the Statewide Referral and Response Service (SRRS) directly.
The SRRS will respond directly to urgent information requests and will assess and respond to the safety needs of surviving children in consultation with the relevant district.
The SRRS advise the relevant ADG, ED and SCPU Director of the child's death within one business day.
The ED advises other officers, such as the DD or Corporate Communications, as per standard critical incident requirements.
As directed in Chapter 2.1 Responding to concerns for children in care - critical incidents, you must immediately notify a TL, ADD and the SPCU.
The SCPU Director must be notified by phone or via email centralreviewteamDL@cpfs.wa.gov.au.
The SCPU will advise the Coroner of the death.
Coroner and/or WA Police
The Coroner notifies the Department of the reportable death of any child under the age of 18 years. A reportable death is defined under the Coroner's Act 1996 (Coroner's Act) and includes any child who is in the CEO's care at the time of his or her death. It also includes any child whose death "appears to have been unexpected, unnatural or violent, or to have resulted directly or indirectly from injury".
The Department may seek details about the circumstances of the death of a child where it is believed that these may indicate risk or harm to another child. Requests for such information, including post-mortem information, should be made via the SCPU, who forward the request to the manager at the Coroner. The request should include the reasons the information is being requested. The information is confidential and is only to be used for promoting the safety of children believed to be at risk.
The Coroner's Act enables the Coroner to obtain information from any source to assist in the investigation and determination of a person's death. The Department, via the SCPU, provides this information.
The Coroner is responsible for investigating the circumstances of a reportable death and to determine the cause of that person's death. They obtain information through two processes:
Coronial inquiry – an inquiry occurs when the Coroner examines information to determine a person's death.
Coronial inquest – an inquest occurs when the Coroner's Court examines information to determine a person's death or group of deaths. Where a child was in the CEO's care at, or immediately before the time of death, the Coroner must hold a mandated inquest.
The Coroner (Coronial Investigation Squad) may request a report on the Department's history of contact with a child and their family. The Coroner, or WA Police Officer with investigative responsibility acting on behalf of the Coroner, formally submits the written report request to the SCPU.
Situations may arise where WA Police officers attending a death, or those with investigative responsibility, may directly request information about a child and their family from Department staff. Where this occurs, you must refer the request to the SCPU.
For further information refer to the Reciprocal Child Protection Procedures – State Coroner of Western Australia (and in related resources).
The Ombudsman reviews investigable child deaths including the circumstances in which they occur. An investigable death is defined in the Parliamentary Commissioner Amendment Act 2009.
The Ombudsman also identifies patterns or trends in relation to child deaths and may make recommendations about ways to prevent or reduce deaths.
The SCPU notifies the Ombudsman of all reportable deaths with a copy of the Coronial Notification and the Response to Coronial Notification documents.
The Ombudsman assesses the notifications to determine whether cases meet the criteria for investigable child death reviews. If the death meets the criteria it must be reviewed. If the death does not meet the criteria it can be reviewed at the Ombudsman's discretion.
If contacted directly by staff from the Office of the Ombudsman in relation to a child death, staff are required to assist with inquiries including telephone and interviews. The SCPU should be advised of any request for information by the Ombudsman.
The death of a child is a traumatic, painful and difficult time for a parent. Parents (particularly those whose child was in the CEO's care) may have many questions about the circumstances and causes of their child's death. Staff are requested to refer all enquiries received from parents or persons acting on behalf of parents to the counselling staff at the Coroner.
The Coronial Counselling Service has been established to facilitate communication between the next of kin and all other parties and to provide counselling and support at this difficult time.
The counselling service can be contacted on:
08 9425 2900 or 1800 671 994.
You should advise the SCPU of any request for information about the death of a child from an external source, including parents or persons acting on their behalf.