About, History, and FAQs

About Colorado's Child Fatality Prevention System

The Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes) establishes the Colorado Child Fatality Prevention System (CFPS), a statewide, multidisciplinary, multi-agency effort to prevent child deaths. CFPS is housed at the Colorado Department of Public Health and Environment (CDPHE) in the Violence and Injury Prevention - Mental Health Promotion Branch of the Prevention Services Division. The CFPS is based on a public health approach to the  prevention of injury and violence related fatalities of children ages 0-17 that occur in the state of Colorado.. Through individual case-specific reviews of these deaths, specific risk and protective factors are identified that can be mitigated or enhanced through best practices and evidence-based interventions to prevent infant, child and youth deaths. State and local partners implement and evaluate these interventions to prevent future fatalities from occurring in Colorado. 

Currently, county or district public health agencies coordinate 43 multidisciplinary, local child fatality prevention review teams (local teams) representing every county in Colorado. Local teams review deaths assigned to them by the CFPS State Support Team at CDPHE, who uses death certificates provided by CDPHE’s Vital Statistics Program to assign cases based on coroner jurisdiction. Teams are responsible for conducting individual, case-specific reviews of deaths of infants, children and youth meeting the Child Fatality Prevention Act statutory criteria. Reviewable deaths result from one or more of the following causes: undetermined causes, unintentional injury, violence, motor vehicle/transport-related, child maltreatment, SUID and suicide. On an annual basis, the CFPS State Support Team aggregates local team prevention recommendations and facilitates a process for members of the CFPS State Review Team and local teams to generate system-wide recommendations based on the annual statewide data. The CFPS State Review Team, local teams and content experts vote on final prevention strategies for inclusion in  the annual legislative report, which is mandated per the statute and shared with the Colorado General Assembly and Governor’s Office.

Structural Inequity
CDPHE acknowledges that generations-long social, economic and environmental inequities result in adverse health outcomes. They affect communities differently and have a greater influence on health outcomes than either individual choices or one’s ability to access health care. Some families lose infants, children and youth to the types of deaths reviewed by CFPS not as the result of the actions or behaviors of those who died, or their parents or caregivers. Social factors such as where they live, how much money or education they have and how they are treated because of their racial or ethnic backgrounds can also contribute to a child’s death. When reviewing individual cases and interpreting the data, it is critical not to lose sight of these systemic, avoidable and unjust factors. These factors perpetuate the inequities that we observe in infant, child and youth deaths deaths across populations in Colorado. It is critical that data systems like CFPS identify and understand the life-long inequities that persist across groups in order to eradicate them. Reducing health disparities through policies, practices and organizational systems can help improve opportunities for all Coloradans.

History of Colorado's Child Fatality Prevention System
The Colorado Department of Public Health and Environment has conducted child fatality reviews at the state level since 1989. The Child Fatality Prevention System (CFPS) was codified in statute in 2005 (Article 20.5 of Title 25, Colorado Revised Statutes) as a multidisciplinary, statewide team with staff support housed at CDPHE in the Prevention Services Division’s Violence and Injury Prevention--Mental Health Promotion (VIP-MHP) Branch.

The 2005 statute required a State Review Team to review all preventable fatalities of children ages 0-17 years that occur in the state of Colorado. This public health review process is different from human service fatality reviews, which focus only on child abuse and neglect cases known to the county human service system. Public health reviews are conducted to identify trends across a variety of child fatality causes and make prevention recommendations for the future. 

In 2009, the State Review Team began using the National Center for Fatality Review and Prevention's data collection website. This system currently contains complete data on child deaths reviewed from 2004-2014. 

The statute did not receive an appropriation until Senate Bill-255 passed during the 2013 legislative session. With these changes, all comprehensive reviews shifted from the State Review Team to the local level. This statute requires local public health agencies to establish or arrange for the establishment of a local, multidisciplinary child fatality review team. Currently, there are 48 teams covering all 64 Colorado counties. CDPHE provides coordination, oversight, funding, and comprehensive technical assistance to both the State Review Team and local (or regional) child fatality review teams. 


Colorado Child Fatality Prevention System (CFPS) Frequently Asked Questions will provide information about:

  • Colorado Child Fatality Prevention System (CFPS) Overview
  • Prevention of Child Deaths
  • State-Level Role
  • Training and Technical Assistance
  • Local Child Fatality Review Team Structure
  • Local Child Fatality Review Team Roles, and Responsibilities
  • Funding
  • Child Death Case Identification
  • Confidentiality and Record Storage
  • Child Fatality Review Process
  • Data and the National Center for Fatality Review and Prevention Case Reporting System
  • Legal
  • Colorado Department of Human Services (CDHS) Child Fatality Review Team (CFRT)

If you cannot find the answer to your question, please contact the CFPS support staff.