Lawmakers adopt review urging written procedures and better data access for Kentucky Child Fatality Panel

The Legislative Oversight and Investigations Committee adopted a staff evaluation on Wednesday that recommended the Kentucky Child Fatality and Near Fatality External Review Panel formalize written procedures and secure access to child-welfare data systems.

“Per statute, the panel is required to conduct comprehensive reviews of child fatalities and near fatalities,” said Jacob Levens, an analyst with the committee, as he summarized five finding areas and two recommendations. The report noted the panel’s 2025 annual report contained 21 recommendations forwarded to responsible agencies and credited improved agency responses in 2025 for meeting statutory content requirements.

The evaluation highlighted two operational priorities. First, staff recommended panel personnel request timely access to the Department for Community Based Services’ child-welfare information systems (Twist and I-Twist) and any necessary training so reviews are not hampered by missing records. Second, LOIC reissued a prior recommendation that the panel develop formal written standard operating procedures documenting how cases are obtained, stored, reviewed and turned into annual findings.

Steve Shannon, a panel member who represents mental-health centers, told lawmakers the work is emotionally taxing and that panel members deliberately delayed establishing permanent procedures until a new case-management system was in place. "We are hoping to have both of those completed by the end of this year," Shannon said, adding the panel is optimistic about gaining the needed Twist access.

LOIC staff also described the panel’s technical transition: the panel is consolidating existing SharePoint and REDCap uses into a single case-management platform being developed with the Commonwealth Office of Technology. Panel staff said initial testing is complete, they returned implementation concerns to COOT, and they are hopeful a second testing phase will allow an operational deployment by early September.

The committee hearing included questions about trends and causes in the panel’s cases. Staff reported 248 reviewed cases in 2025 — a substantially higher total than in earlier years — and said that increase likely reflects a mix of higher reporting and changing incidence, particularly in areas tied to substance use. Shannon noted recurring issues including pediatric ingestions (noting that THC/CBD gummies are often indistinguishable from ordinary candy) and unsafe firearm storage in households.

LOIC’s report also raised a matter for legislative consideration: when agencies decline recommendations, the General Assembly may wish to request agency testimony to determine whether refusals stem from legitimate legal or funding constraints or whether statutory changes are warranted.

The committee held a roll-call vote to adopt the staff evaluation; members recorded affirmative responses and the report was adopted. The committee directed that the report and its recommendations be transmitted consistent with statute.

The committee will monitor the panel’s progress on Twist access, COOT’s implementation of the new case-management platform, and the development of formal written procedures.