Child Fatality Prevention System

The Child Fatality Prevention System is a statewide network that focuses on preventing child deaths. Administered through CDPHE, Colorado’s Child Fatality Prevention System consists of local review teams covering all 64 counties in Colorado, a State Review Team, and the state support team at CDPHE. Local teams include community members and field experts. These teams complete case reviews of infant, child, and youth deaths in Colorado due to undetermined causes, unintentional injury, violence, motor vehicle and other transportation, child maltreatment, sudden unexpected infant death, and suicide. These case reviews show trends and patterns in these deaths, and help identify strategies to prevent future deaths. The State Review Team develops recommendations for how to prevent child deaths in an annual legislative report. The leading causes of death among infants, children, and youth under age 18 reviewed by the Child Fatality Prevention System for the years 2017-2021 were suicide, motor vehicle and other transportation deaths, sudden unexpected infant death, child maltreatment, and firearm deaths. The Child Fatality Prevention System also maintains a Data Dashboard.

Maternal Mortality Prevention Program

The Maternal Mortality Prevention Program is in the process of developing a legislatively-mandated report that covers 2016-2020 maternal deaths to be published in July 2023. This report includes 13 overarching recommendations generated by the Maternal Mortality Review Committee addressing the following: equity, bias, and discrimination, community-based solutions and engagement, clinical quality, screening and follow-up, care coordination and transitions, overdose prevention, firearm violence prevention, capacity and access, workforce diversification and expansion, provider training, education and public awareness, reproductive autonomy, and equitable reimbursement and insurance coverage. Quantitative data in the report addresses racial inequities and discrimination, causes of death, the role of mental health and substance use, and additional demographic data. Data from 2016-2020 show that American Indian/Alaska Native pregnant and postpartum people were 2.9 times more likely to die during pregnancy or within one year postpartum than the overall population of people giving birth, and Black pregnant and postpartum people were 2.1 times more likely to die of pregnancy-related causes than the overall population in Colorado. The leading causes of pregnancy-associated deaths continue to be suicide, unintentional drug overdose, and obstetric complications. In addition to the Maternal Mortality Review Committee legislative report, the Maternal Mortality Prevention Program also completed a legislatively-mandated report to assess the state’s gaps in maternal health data.

Pregnancy Risk Assessment Monitoring System

CDPHE has been collecting data on postpartum people two to four months after delivery via the Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) since 1997. PRAMS collects data on maternal behaviors and experiences before, during, and immediately after pregnancy. Colorado has annual weighted data sets through 2021. That year, 1,261 postpartum people completed the survey, which was administered by mail and telephone, for a weighted response rate of 60%. The Phase 8 questionnaire was fielded for the last year in 2022 along with the twelve question social determinants of health supplement. The weighted 2022 dataset should be available around the end of 2023. The new Phase 9 questionnaire was finalized in early 2023 and fielded in June 2023. CDC PRAMS delayed the start of Phase 9 data collection by two months to accommodate the final stages of programming and testing of the new questionnaire. In addition to the Phase 9 questionnaire, 2023 data collection also marks the implementation of the web-survey module for Colorado. With each mailing, the sampled postpartum person is provided a QR code, web address, user ID and passcode to access the web version of the questionnaire. Now there are three options to complete PRAMS - mail, web, or phone. PRAMS data are provided to CDPHE programs and partners for planning, policy and programming, evaluation, and research. The MCH Epidemiologist coordinates the Pregnancy Risk Assessment Monitoring System for Colorado and MCH contributes funding to support PRAMS data collection each year.

Health eMoms/Baby & You

Health eMoms and Baby & You are online, longitudinal survey programs that CDPHE created to collect novel perinatal and early childhood data. State MCH staff were critical in the development and oversight of both programs.

Health eMoms operated from 2018-2021, drawing a monthly simple random sample of 200 Colorado-resident postpartum people from live birth certificates and recruiting these people by mail to join an online survey platform. Enrolled participants received four to six, 10-minute online surveys by email and text from shortly after birth up until their baby’s third birthday. In January 2021, an additional survey was sent to the full enrolled cohort in order to provide understanding of the impacts of the pandemic on families. All surveys were developed in collaboration with CDPHE programs and partners.

Health eMoms sunsetted in August 2021 due to funding instability, and data collection ceased in January 2022. Prior to the sunset, Health eMoms collected data via six surveys from the 2018 birth cohort, four surveys from the 2019 birth cohort, two surveys from the 2020 birth cohort, and one survey for half of the 2021 birth cohort. Enrollment rates ranged from 45-47%, resulting in enrollment and first survey sample sizes of 1000-1100 postpartum people annually. Response rates for subsequent surveys (2-6) ranged from 75-80% with sample sizes of 800-880. The COVID-19 survey had 1844 respondents. Survey responses were weighted to represent the eligible birth population for each birth cohort. The results for all surveys and birth cohorts were shared broadly with partners and can be viewed on CDPHE’s Center for Health and Environmental Data’s website.

As a testament to Health eMoms’ value to partners, the Colorado Children’s Campaign and other stakeholders advocated to integrate the survey into HB22-1289. The legislation passed in May 2022, codifying the program into state statute and funding it with state General Funds. The new program, rebranded as Baby & You to be more gender inclusive, is tasked with collecting data to inform programs and policies that advance health equity for birthing people. To this end, the program is required to conduct an oversample of groups that make up a small percentage of the population and that disproportionately experience health inequities, including African Americans and Native Americans. In order to balance the sample across all groups, Baby & You will also oversample Asian Americans/Pacific Islanders.

Baby & You will begin collecting data in June 2023 and will sample 3,400 people annually. Due to the shift towards harder to reach populations, we anticipate 1,200-1,300 respondents on the first survey annually. Participants will receive four surveys over the first three years postpartum (at 3-6 months, 1 year, 2 years, and 3 years). Baby & You is in the process of redesigning its advisory structure to balance community and professional partners. MCH staff remain an integral part of the Baby & You Steering Committee and Advisory Board.

National Survey of Children’s Health Oversample

MCH funded the first NSCH sub-state oversample in 2020, with a goal of 1,200 completes among children ages 0-17 years from eight regions of the state. The first year (2020) of oversample exceeded that goal with 1,609 completed interviews. The second year (2021) of the oversample also exceeded that goal with 1,737 completed interviews. The third year (2022) of the oversample will be released in October 2023. Data collection for the fourth year (2023) of the oversample commenced in June 2023. The MCH Epidemiologist worked with the Rocky Mountain Research Data Center to gain approval of a proposal to the U.S. Census Bureau to access the sub-state variables for regional analysis. Once the proposal was approved, two researchers from Colorado secured special sworn status to access the Research Data Center. Upon receiving access, the researchers analyzed regional data for several MCH indicators. Two indicators were submitted for disclosure avoidance review, which was granted in May 2023. The MCH Epidemiologist presented on Colorado’s NSCH oversample journey, including accessing the Research Data Center, at the 2023 Association of Maternal and Child Health Programs Annual Conference in May 2023. Upon consultation with the MCHB Senior Epidemiologist who reviewed the first set of regional estimates, Colorado decided to include a third year of the oversample before releasing regional estimates. Additional analysis will be completed after the release of the 2022 oversample dataset. Since this is a federal surveillance system, states are not currently allowed to add state-specific questions of interest, which is a drawback for some programs that previously relied heavily on Colorado’s Child Health Survey, which was customizable. The MCH Epidemiologist coordinates the contract for the oversample with the U.S. Census Bureau plus data access and analysis for the NSCH oversample and MCH continues to fund the NSCH oversample each year.

Healthy Kids Colorado Survey

The Healthy Kids Colorado Survey is Colorado's most comprehensive survey focussed on the health and well-being of middle school and high school students in Colorado. It's aligned with the CDC's Youth Risk Behavior Survey and is conducted on a biannual basis in the fall of odd years. The purpose of the survey is to better understand youth health and which factors support youth to make healthy choices. The survey covers numerous topics such as substance use, alcohol, tobacco, mental health, suicide, physical activity, nutrition, sexual health, safety, and other risk/protective factors, in order to develop interventions and supports to keep Colorado’s youth healthy and safe. Statewide and regional survey data are compiled and disseminated after each survey. Colorado’s 2021 Healthy Kids Colorado Survey had responses from 106,799 students (38,518 middle school students and 68,281 high school students). A total of 340 schools participated in the 2021 survey (161 middle schools and 179 high schools), with data released in June 2022. The next survey will be administered beginning in the fall of 2023, with data available in 2024.

Colorado has received representative results for the CDC’s Youth Risk Behavior Survey six times in 30 years (2005, 2009, 2011, 2017, 2019, and 2021) of participation. In order to focus on the administration of the Healthy Kids Colorado Survey and to reduce local burden on schools who are invited to participate in both surveys, CDPHE has decided to pause participation in the CDC’s Youth Risk Behavior Survey. An additional factor is that the Youth Risk Behavior Survey only yields statewide results, while the Healthy Kids Colorado Survey yields school, district, regional, and statewide results. Colorado remains committed to collaborating with the CDC to enhance national youth surveillance efforts and share innovations.

Data Products

In addition to ensuring access to various population-based data sets, the MCH data team created data products to support the 2021-2025 MCH priority work. The MCH Data Inventory organizes surveillance questions and indicators by MCH priority for the following data sources: birth certificate, PRAMS, Health eMoms, NSCH, HKCS, and a few other surveys that are focused on adults. The NOM, SOM, NPM, ESM, SPM Trends 2021-2025 is an internal tracking sheet that includes trend indicators and annual objectives for each of the core measures. The data in this tracking sheet link to data figures in the MCH program’s quarterly reporting document and to the annual evaluation summaries. The MCH Snapshot was updated this year and will be included in the data to action packages (see section III.C. Needs Assessment Summary Update). A Council of State and Territorial Epidemiologists Applied Epidemiology Fellow led the development of six Health eMoms areas of wellbeing reports released in summer 2022. These reports showcase Health eMoms data in the areas of access to care, behavioral health, nutrition security, economic mobility, and child and youth development. A summary, the sixth report, connects the five other reports. MCH has a specific tab on the Colorado Health Information Dataset website to direct users to various online MCH data sources. The first MCH data brief was completed this year and the rest will be finished by the end of 2023.