Frequently when a death or other situation with extreme circumstances occurs involving a child/family who is known to Child Protective Services, the media or legislators contact the State offices for comments or information. These contacts generally occur in recognition of the fact that the Department has supervising responsibility over county departments. In order to respond in an appropriate fashion, but subject to all appropriate confidentiality requirements, it is important for us to know when these situations occur. In virtually all cases, our response would be to refer the legislator or media representative to the affected county. We are asking that you notify us when there is a death or near-death of a child. Near-death is defined as bodily injury which creates a substantial risk of death. Also please notify us if you have a situation with egregious circumstances which may trigger or has triggered media or legislative attention.
In order to facilitate this process to the extent possible, we have developed a checklist/form (attached). Counties may either use this form or create their own form which includes the same information or they may call Linda Hisgen at (608) 266-6799 and speak with her directly or leave this information on her voice mail. If a form is used, it would be Faxed to Carol Vaughn, Division of Children and Family Services, (608) 264-6750. In any case, the information should be provided within 24 hours following the county being made aware of a situation which meets any of the criteria specified on the form.
If the child involved is in a foster home or treatment home licensed by a private agency, the information should be provided by the county agency which has legal responsibility for the child. The central office staff will be responsible for forwarding the information to the appropriate regional staff.
To obtain additional copies of this form, send a Forms/Publications Requisition DMT-25 to the Division of Children and Family Services Forms Manager at P. O. Box 8916, Madison, WI 53708-8916.
Child's Death/Near-Death or Egregious Incident Notification Form