Faith Vos Winkel, MSW
Assistant Child Advocate
Office of the Child Advocate
18-20 Trinity Street
Hartford, CT 06106
The Connecticut Child Fatality Review Panel (CFRP) was established in 1995 by statute (§§ 46a-13l(b) and (c ), The impetus for the creation of a child fatality review process came about as a result of a high profile infant death (Baby Emily). The Governor convened two multi-disciplinary panels to provide a series of recommendations related to the tragic death of Emily; one such recommendation was the creation of the Child Advocate Office and within the OCA statue is the mandate for a child fatality review process.
Child fatality reviews began shortly after the enabling legislation was passed. Currently, the program is housed out of the Office of the Child Advocate. The program’s annual budget is $150,000 which comes from the State of Connecticut. There is one full-time and one part-time staff person that devotes primary attention to child fatality review and related issues.
Connecticut, like most of New England, has a State Child Fatality Review Panel (CFRP) and no local teams. Initially, the CFRP was given the mandate of reviewing the circumstances involved in the death of a child who received service from a state department or agency addressing child welfare, social or human services or juvenile justice. In October 1999, the Governor and Legislature authorized the panel to review all unexpected or unexplained deaths.
There is established a child fatality review panel composed of thirteen permanent members as follows: The Child Advocate, or a designee; the Commissioners of Children and Families, Public Health and Public Safety, or their designees; the Chief Medical Examiner, or a designee; the Chief State’s Attorney, or a designee; a pediatrician, appointed by the Governor; a representative of law enforcement, appointed by the president pro tempore of the Senate; an attorney, appointed by the majority leader of the Senate; a social work professional, appointed by the minority leader of the Senate; a representative of a community service group appointed by the speaker of the House of Representatives; a psychologist, appointed by the majority leader of the House of Representatives; and an injury prevention representative, appointed by the minority leader of the House of Representatives. A majority of the panel may select not more than three additional temporary members with particular expertise or interest to serve on the panel. Such temporary members shall have the same duties and powers as the permanent members of the panel. The chairperson shall be elected from among the panel’s permanent members. The panel shall, to the greatest extent possible, reflect the ethnic, cultural and geographic diversity of the state.
The panel shall review the circumstances of the death of a child placed in out- of-home care or whose death was due to unexpected or unexplained causes to facilitate development of prevention strategies to address identified trends and patterns of risk and to improve coordination of services for children and families in the state. Members of the panel shall not be compensated for their services, but may be reimbursed for necessary expenses incurred in the performance of their duties.
On or before January 1, 2000, and annually thereafter, the panel shall issue an annual report which shall include its findings and recommendations to the Governor and the General Assembly on its review of child fatalities for the preceding year.
Upon request of two-thirds of the members of the panel and within available appropriations, the Governor, the General Assembly or at the Child Advocate’s discretion, the Child Advocate shall conduct an in-depth investigation and review and issue a report with recommendations on the death or critical incident of a child. The report shall be submitted to the Governor, the General Assembly and the commissioner of any state agency cited in the report and shall be made available to the general public.
The Office of the Chief Medical Examiner shall provide timely notice to the Child Advocate and to the chairperson of the child fatality review panel of the death of any child that is to be investigated pursuant to section 19a-406.
Any agency having responsibility for the custody or care of children shall provide timely notice to the Child Advocate and the chairperson of the child fatality review panel of the death of a child or a critical incident involving a child in its custody or care.
The Office of the Chief Medical Examiner primarily identifies the deaths for the Panel to review. However, statute allows the Panel to review any death that occurs in the state. There is a particular emphasis on children placed in out-of-home care or known to state systems. Cases are reviewed regarding children that are less than 18 years old. The Panel reviews about 120+ deaths per year, about half (60) are child deaths from unintentional and intentional injuries. The Child Advocate can subpoena records and witnesses for the review process if they choose. Some child death reviews will become full fatality investigations that result in a public report.
The main purpose of the Connecticut CFRP process is to facilitate the development of prevention strategies to address identified trends and patterns of risk and to improve coordination of services to prevent child deaths. The panel’s purpose is to save lives by learning from lives lost.
Standardized data forms are completed for all cases reviewed. Connecticut is also part of the National Child Fatality Data System.
Connecticut produces an annual report on trends and patterns of child fatalities. The annual report is a section in the Child Advocate annual report. Connecticut also produces trend reports in child death; both a 10 year review and a 5 year review, combining 15 years of trend data. Connecticut produces many major investigative reports and public health alerts related to child fatalities, all of which are made available to the public.
The Panel will focus on policy and systemic issues related to children’s deaths. Examples include tightening up the graduated drivers licensing law, suicide prevention initiatives and partnering with other prevention entities to support systemic change related to child safety and well-being. Other examples of outreach include training on how children die, utilizing the panel’s data to support and inform various community initiatives including shaken baby/abusive head trauma and infant safe sleep. The Panel also publishes public health alerts related to child fatalities.
The child fatality coordinator provides training to community and other stakeholders on the child death review process and critical issues confronting children in the State of Connecticut.
Last Updated: January 2019