Fetal-Infant Mortality Review (FIMR)

The overall goal of fetal and infant mortality review is to enhance the health and well being of women, infants and families by improving the community resources and service delivery systems available to them. Through FIMR, key members of the community come together to review information from individual fetal and infant deaths. The purposes of these reviews are to identify the factors associated with these deaths; and determine if the factors represent system problems that require change, develop recommendations for change and assist in the implementation of the change.

The overall FIMR objectives are to:

• Identify both positive and negative social, economic, cultural, safety and health factors associated with fetal and infant mortality as well as factors associated with neighborhoods and community groups with higher mortality through review of individual cases
• Work with the community to plan a series of targeted and cultural competent interventions and policies that address the negative factors related to fetal and infant deaths and improve the service systems and community resources
• Participate in the implementation of these community-designed interventions and policies
• Assess the progress of the interventions and work to maintain the positive aspects of the systems serving families

Many sources provide information for FIMR reviews. These may include records from physicians and hospitals along with those from home visits, the Women, Infant and Children (WIC) and, perhaps, additional social service records. Information is obtained in an interview with the family, usually the mother. All identifying information (i.e., names of families, providers and institutions) is removed. A summary of the case is prepared and presented to the case review team (CRT).

Members of the CRT represent a broad range of professional organizations and public and private agencies (health, welfare, education and advocacy) that provide services and resources for women, infants and families. The CRT will ask questions as it examines each case.

For example:

• What can this case tell us about how families can use the existing local public health care systems?
• What community infrastructure resources support local families?
• Where are the gaps in services and resources?
• What added barriers do culturally diverse families face?
• What culturally competent resources are available to them?

The answers to these questions help the CRT to identify barriers to care and trends in service delivery and suggest ideas to improve policies that affect families.

Typically, the case review team presents their recommendations to a second team of individuals referred to as the community action team (CAT). The CAT is composed of two types of members: those with the political power, fiscal resources and responsibility to create large-scale system change and those who can define a community perspective on how best to create the desired change. The CAT translates the case review team recommendations into action. They also participate in implementing interventions designed to address the problems that have been identified.

Feedback is critical to the FIMR process. The ongoing review of new cases identifies consistent trends in mortality and serves as a built-in feedback mechanism that reveals the change or lack thereof in the service system and community resources. Teams may also develop other ways to stay informed about the progress of interventions.

As problems are resolved and the health care, physical and social environment for families improves, communities that implement FIMR change for the better. The FIMR process not only improves services and resources for women, infants and families, FIMR can also generate a sense of energy and hope for the future in a community because the community is, indeed, successfully addressing local issues.