ACOG Community-Driven National Fetal and Infant Mortality Review Program

The FIMR program was a collaborative effort between ACOG and the Maternal and Child Health Bureau (MCHB) established in 1990 to address the rate of infant and fetal deaths. The creation of the National FIMR Resource Center was the result of a presidential initiative from ACOG Past President Ezra Davidson, MD, who promoted this promising public health approach.  In addition to infant and fetal deaths, the FIMR process identifies system gaps for elimination of mother to child HIV transmission, congenital syphilis, and maternal morbidity/mortality with seasonal influenza, and to examine homeless deaths in Indianapolis.

Fetal and Infant Mortality Review (FIMR) is a community-based and action-oriented process used to improve service systems and resources for women, infants, and families. This evidence-based method examines fetal and infant deaths, determines preventability, and engages communities to take action. 

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Fetal and Infant Mortality Review Process

A multi-disciplinary team (Case Review Team) first reviews case summaries from de-identified infant and fetal deaths. These case summaries include interviews with mothers for their perspective on why the death occurred. The team then makes recommendations for system changes, and a team of community leaders (Community Action Team) is assembled to take action. The Community Action Team works with at-risk families and other partner agencies in the region to develop and implement street-level outreach activities. The goal is not to assign blame, but rather examine the circumstances surrounding an infant or fetal death to identify what went wrong and prevent deaths in the future.

The National FIMR program is no longer funded by MCHB, but publications, guides, and technical materials to support and sustain FIMR programs are listed here.

Listen to ACOG Fellows talk about the FIMR Process for Physicians:

Dr. Charlene CollierDr. Washington HillDr. Christine Curry

 

 

 

 

 

Dr. Charlene Collier       Dr. Washington Hill        Dr. Christine Curry 

Resources

Incorporating Life Course Theory into the Fetal & Infant Mortality Review: Strategies From Local FIMR Programs

FIMR Programs Improve Community Systems: Survey Results From Local Programs

FIMR Takes Action in their Communities


 

Guides, Manuals, and Tools Archive

Maternal and Family Interview Module
An overview of the Maternal Interview process with tips to help local programs increase their maternal interviews. Listen to maternal interviewers comment on their strategies to connect with families.

Sustaining The FIMR Program: A Toolkit
This document provides an overview of strategies to sustain a FIMR program.

FIMR Process Overview for New Team Members
This publication provides an overview of the FIMR process, role of CRT and CAT members, and suggested team members.

FIMR for Title V directors
Fetal and Infant Mortality Review (FIMR) is a valuable tool that can enhance your Title V Needs Assessment.

FIMR for Healthy Start Programs
New to FIMR? Looking to strengthen collaboration between your local FIMR and Healthy Start site? Here are some tools and resources to help you get started.

  • This handy one page document provides an overview of FIMR and explains the process. 
  • This two page publication provides an overview of the FIMR process, role of CRT and CAT members, and suggested team members. 
  • FIMR and Healthy Start have had a collaboration spanning years. An evaluation of NFIMR conducted by Johns Hopkins University found that local health departments were two times more likely to report progress in meeting goals and objectives for pregnant women if they had either a FIMR or another perinatal initiative (PI). And, if both FIMR and a PI, such as Healthy Start, worked together, they were nine times more likely to report progress. This remarkable synergistic relationship can be a major benefit to Healthy Start communities.

Healing Unresolved Grief: Embracing Your Journey
Healing Unresolved Grief: Embracing Your Journey is a seven week support group curriculum for empowering mothers who have experienced a pregnancy loss, stillbirth or infant death less than one year of age.  A professional storyteller developed it in collaboration with the Douglas County Health Department, Omaha, Nebraska. Special thanks to Carol Isaac RN, BSN, MA, Health Promotion & Omaha FIMR, Douglas County Health Department for making this curriculum available.

Healing Unresolved Grief- Now in Spanish
These materials are now available in Spanish, with slight modifications. 

Description of FIMR
This one page overview of NFIMR is a great tool for describing and sharing the FIMR process as well as NFIMR contact information.

Voices from the Community- Cross Cultural Expressions of Grief
This document summarizes panel presentations from four National Fetal-Infant Mortality Review (NFIMR) conferences around cross cultural experiences of bereavement and grief.

Fetal and Infant Mortality Review Manual: A Guide for Communities (2nd Edition)
This manual is the "go to" reference for new and existing FIMR projects.

FIMR: A Decade of Lessons Learned
In order to understand some of the common elements that contribute to successful, long-term FIMR operation, we interviewed a sample of nine well-established programs from different parts of the country. We also chose programs with different start-up funding sources and a variety of lead agency sponsors.

Fetal and Infant Mortality Review: A Guide for Home Interviewers
The Fetal and Infant Mortality Review: A Guide for Home Interviewers provides FIMR home interviewers with technical skills and best practices necessary to conduct maternal interviews.

Thinking Creatively: What FIMR Team Members Need to Know to Foster Community Buy-in
This document adapts concepts that underpin the development of community support for the FIMR methodology and provides insights that will help FIMR team members foster community buy-in.

Social Marketing: A Strategy to Take FIMR Recommendations to Action
Social Marketing: A Strategy to Take FIMR Recommendations to Action highlights social marketing strategies and includes steps to planning a social marketing campaign.

Entrevista Domiciliaria
This document is a Spanish translation of the maternal interview questions. 

NFIMR Data Abstraction Forms
August 20, 2015 — NFIMR Data Abstraction Forms are available at no charge to FIMR programs, state Title V programs, local health departments, and ACOG Fellows.

Physician FAQs
This document answers common questions physicians have about participating in the FIMR Process. 

The Fetal and Infant Mortality Review Process: The HIPAA Privacy Regulations
This document is designed to help local and state FIMR programs understand HIPAA regulations. 

Making a Difference in the Community
This brochure describes the FIMR process.

The Cultural and Linguistic Competence Organizational Assessment Instrument for Fetal and Infant Mortality Review Programs
The Cultural and Linguistic Competence Organizational Assessment Instrument for Fetal and Infant Mortality Review Programs (CLCOA-FIMR) was developed by the National Center for Cultural Competence in collaboration with the National Fetal and Infant Mortality Review Program with guidance from a national workgroup of state and local FIMR representatives. 

2015 Annotated Bereavement Bibliography
These annotated references are from 2010-1014 published literature. PubMed, CINAHL Plus, and PsycINFO were searched using the terms: grief, bereavement, perinatal loss, infant death, and culture. Articles are cited as research articles, practice recommendations, or systematic/ research reviews. The previous NFIMR bereavement bibliography contains earlier publications. 

Fetal and Infant Mortality Review and Child Fatality Review: Opportunities for Collaboration
This bulletin describes FIMR and CFR and compares and contrasts the two methods. It also provides helpful ideas, lessons learned, and suggestions for local collaboration.

When an Infant Dies: Cross Cultural Expressions of Grief and Loss IV
This bulletin explores the cultural traditions of African Americans, Iranians, Somalis, and hard of hearing families grieving the loss of an infant. 

When an Infant Dies: Cross Cultural Expressions of Grief and Loss III
This bulletin summarizes a panel presentation from the National Fetal and Infant Mortality Review Program’s Fifth National Conference, held August 12–14, 2004 in Washington, D.C. 


 

More Publications

Transferring Components of FIMR to Maternal Mortality Review and Child Fatality Review
 
Executive Summary of the Invitational Meeting on CFR, FIMR, and SIDS convened by HRSA's Maternal and Child Health Bureau: Preliminary Recommendations (1997)

The Role and Responsibilities of State FIMR Coordinators (1997)

The Role of State Title V Programs in Maternal and Child Mortality Review Programs (1998)

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