Why Child Maltreatment Should be Viewed as a Public Health Issue, Not an Unsolvable Problem

6/1/2020

Why Child Maltreatment Should be Viewed as a Public Health Issue, Not an Unsolvable Problem

By Kim Dvorchak and Amy Templeman

In several recent Washington Post articles, reporters have put a spotlight on the drop in calls to child abuse hotlines during the COVID-19 pandemic and have surmised that this drop reflects a potential rise in child abuse cases. Their argument suggests that fewer calls are the result of fewer eyes on children.

As advocates for children and families, we are glad to see the increased media attention on child safety and family well-being during the pandemic. However, we share a concern that this type of coverage can be misleading when it implies the only answer to these concerns is increased reporting. 

While it is important to raise these issues, as the Post has done consistently across this pandemic, it is equally important to share solutions. Just as journalists would not highlight stories of suicide without offering mental health hotlines, it is vital to provide families experiencing stress with support options that can help prevent child abuse and neglect. 

Child maltreatment is a public health issue and is preventable. When the federal Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) issued its groundbreaking report in 2016, Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities, they envisioned a 21st century child welfare system that was realigned toward prevention and a public health approach to reducing maltreatment and fatalities. This approach is even more critical today in the midst of a pandemic that is highlighting financial, health, and mental health challenges for all families.

Noticably absent in the aforementioned articles in the Post and other news outlets reporting on this issue was any mention of prevention generally, or specific prevention programs, that might help families safely manage the stresses of the pandemic. Research has demonstrated a range of protective factors that can help families weather this storm safely, together. These include enhanced social connections, quality childcare, access to health insurance, engagement with services that reduce stress, and economic benefits that provide for basic human needs. 

There are a number of existing prevention programs that could have been described in these articles. Home visiting programs, such as the Nurse Family Partnership (which has served more than 300,000 families across 40 states) and Family Resource Centers (which include 3,000 centers available in 30 states and the District of Columbia) are just two examples of thousands of prevention-focused programs available to families that can help address family stressors and lower the risk of child maltreatment and entry into foster care. 

The Alliance for Strong Families and Communities and the National Association of Counsel for Children support efforts to increase funding for these and other evidence-based best practices, and to include promotion of telehealth to support families during this pandemic. In a letter to Congress, our organizations joined a national home visiting coalition requesting a one-time $100 million appropriation for the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV) to train home visitors to deliver services through telehealth and to provide for the tangible needs of families during the pandemic. We have also requested that virtual visits be considered the same as home visits through the end of the calendar year to meet funding requirements and safely preserve valuable relationships.

We applaud the Post and other news outlets for reporting on the importance of keeping children safe, now and in the future, but we also encourage them, along with the nation’s media, to stress the solutions that exist and offer families the vital resources they need to overcome the challenges all families are facing during this pandemic.

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Kim Dvorchak, JD, is Executive Director of the National Association of Counsel for Children. Amy Templeman is Director of Within Our Reach at the Alliance for Strong Families and Communities.

Things We Can All Do to Strengthen Families and Why It Matters

4/13/2020

By Amy Templeman, Alliance director of safety and resilience, Within Our Reach Office

In the last few weeks, we have observed communities coming together in remarkable ways, despite our physical separation. People in cities around the world open their windows and applaud first responders at sunset or shift change, high school and college choirs record musical zoomcasts that bring tears to our eyes, people sew cotton face masks for friends and neighbors, and a large group of nurses from Atlanta, GA travel together to help patients in New York City, where they are needed the most. In my northeast Washington, DC neighborhood, a newly married couple who canceled their wedding reception drive around the block in a decorated car to cheers and well wishes from people on the sidewalk who they have never met before. We all seem to be sending and craving the message: You are not alone. We can do this. And we will need each other to get through it.

During this moment when we are widening our circles, take time to notice the powerful and positive effects neighbors can have on one another. In many ways, we are well-equipped to help each other weather this storm of stress and fear brought on or exacerbated by COVID-19. We can help to build protective factors to keep each other strong. Protective factors are things that can increase the health and well-being of all people – children, adults, families, and communities. For parents, these factors include social connections, quality childcare, and access to services that reduce stress. Helping parents strengthen their foundation of protective factors, especially during this unpredictable time, will make them more likely to withstand and recover from the pressures of the pandemic. Protective factors are particularly important during this crisis, when we have seen increases in calls to national hotlines for parent support and child maltreatment, because these factors help to decrease the risk of harm. 

During the month of April, which is National Child Abuse Prevention Month, and in the weeks and months to come as we navigate this public health crisis, many local resources are available to help communities stay strong. Here are some concrete things that you can do to promote health and well-being in your community, adapted from this excellent guide from Futures Without Violence:

1. Keep in touch with your neighbors. Send a text or drop a card in the mailbox of a family member or neighbor who seems socially isolated during this time. Add your phone number and encourage them to contact you if they need someone to talk to.

2. Offer to drop off groceries or other basic necessities. At a time when access to these items is limited, especially for working parents with young children at home, this type of help can lower stress in the household and protect parents from feeling overloaded.

3. Find out what local resources are available right now in your town to stabilize families and prevent a crisis from occurring. For example, Family Resource Centers can help to lower the risk of child maltreatment and entry into foster care. There are more than 3,000 centers available nationwide in 29 states and the District of Columbia. 

4. Contact a crisis counselor for information and referrals to help you support the people you care about. If you are worried about child abuse or neglect, you can call or text the 24/7 national child abuse hotline at 1-800-422-4423 or chat at childhelphotline.org . If you or someone you know needs support, call the national parent helpline at 1-855-427-2736. If you are concerned about domestic violence, contact the national domestic violence hotline at 1-800-799-7233 or by chat at thehotline.org . If you or someone you love is experiencing anxiety or panic attacks call the mentalhelp.net hotline.

5. Address your own mental and emotional health, and advocate for your employer to do the same for its employees. For tips and techniques to ensure your own well-being, join webinars on self-care hosted by the Change in Mind Institute at the Alliance for Strong Families and Communities. They will run every Friday at 11:30am CT and last about 30  minutes through June 26, 2020. Click here to register. 

Your help can make a difference, even for people who find themselves in very challenging situations during this crisis. One mother in Sacramento, California was recently connected through a hotline to a family engagement liaison who helped to connect her to much-needed resources. The woman was three-months pregnant and parenting two school-age children while also experiencing homelessness. She was unable to find a shelter that had space for her family due to COVID-19 and could not obtain hotel vouchers. The liaison listened to the woman’s story and acted quickly to contact a supervisor within a government agency to complete an application over the phone and approve the family for a 14-day hotel voucher plus future rental assistance. The liaison was also able to enroll the mom in a new home visiting program, provide safe sleep education, and find the family a crib for the baby. 

Stories like this one, where families are strengthened and the worst outcomes are prevented, are not told often enough. They are useful stories as they help to illustrate how prevention services are much more useful than services that are provided after harm occurs. Research shows that investments in prevention are more cost-effective than services that need to happen after a crisis. Research has shown that child maltreatment costs the U.S. $428 billion per year. For every $1 invested in prevention services, we save anywhere from $1.79 to more than $20 on the cost of responding to child maltreatment, according to data from Casey Family Programs. Given the high economic burden of child maltreatment, the benefits of prevention programs are undeniable.

Beyond the economic argument, preventing child abuse and neglect is simply the right thing to do. We all share the responsibility to make sure families have what they need, regardless of their situation, and especially if they are under more stress during this pandemic than usual. A National Imperative: Joining Forces to Strengthen Human Services in America , a report released by the Alliance for Strong Families and Communities and the American Public Human Services Association (APHSA) in 2019, illustrated how community-based human services organizations help to strengthen individuals, families, and communities by building well-being and providing critical assistance, both preventative and in times of crisis, which enables people to lead healthier and more productive lives. Please do what you can and call upon the resources offered by your local community-based organizations – they were built for this moment.

Child Safety Forward: Informing Strategies to Reduce Child Abuse and Neglect Fatalities

4/7/2020

By Amy Templeman and Laura Pinsoneault

According to the latest data, children in the U.S. are healthier and safer than ever before, and medical advances in treating childhood diseases have made enormous strides over the last few decades. The U.S. child mortality rate has also improved over time. Despite these advances, the number of child deaths due to abuse and neglect has remained steady or even increased, according to the Annie E. Casey Foundation’s annual Kids Count Data Project. Just as we can prevent childhood illnesses, child maltreatment can be prevented, and the associated risk factors can be treated. Child maltreatment deaths are not inevitable.

Within Our Reach and the Alliance for Strong Families and Communities are working with the U.S. Department of Justice’s Office for Victims of Crime on a demonstration initiative at five sites to develop multidisciplinary strategies and responses to address serious or near-death injuries as a result of child abuse or neglect and identify ways to reduce them.

The strategies that each site are developing will be informed, in part, by the recommendations and work of the federal Commission to Eliminate Child Abuse and Neglect Fatalities, which released its groundbreaking report in March 2016.

The five participating sites include St. Francis Hospital in Hartford, Connecticut; Cook County Health, Illinois; Indiana State Department of Health; Michigan Department of Health and Human Services; and Sacramento County’s Child Abuse Prevention Council. 

A fundamental element of the strategic planning effort will be technical assistance provided by a team of national experts focusing on improved data collection and analysis using a safety science approach, development of strong community collaboratives, engagement of persons with lived experiences, and developmental evaluation. 

Over the course of the project, we will be sharing key guidance from each of our technical assistance team members, starting with the training and resources provided by Dr. Laura Pinsoneault, president and CEO of Evaluation Plus.

An expert and practitioner in the use of evaluation tools that can help support large scale and complex systems change, Dr. Pinsoneault is helping our team understand the importance of using developmental evaluation (DE) when dealing with more complex issues where both environments and outcomes can be unpredictable. 

As systems undergo change, they evolve. DE offers evaluation tools that are able to support strategic decision-making, helping systems be more responsive and adaptive.

Developmental evaluation helps us make decisions about the best possible approaches for success. It helps us be more adaptive working on challenging issues in increasingly complex environments.

Development evaluation can be contrasted with the more common formative and summative evaluation processes by using the analogy of a recipe. With formative and summative evaluation, you know what you want the outcome to look like; you have a recipe you are pretty sure works; you know what all the ingredients are; and you are pretty sure that the people who are going to eat it will like it.  With DE, it is like being told to make something nourishing but not everybody agrees on what that is or what should go into it.

For example, building on the recipe analogy, a DE approach acknowledges that there are a lot of items to choose from in the pantry, but perhaps not the exact ingredients needed. Perhaps it is not the right time of year to find a particular fresh ingredient, and that might require variations to the recipe. These variations in turn may change the type of pan you use or the temperature at which you prepare your recipe. And finally, your end goal may not be the creation of a specific dish, but rather a successful meal that everyone enjoys.

Most of all, a DE approach requires evaluators to have a comfort level with ambiguity, understanding of systems, willingness to make errors, a willingness to challenge existing assumptions and change course, and the capacity to bring data to the table to help make decisions.

Ultimately, using all of the evaluation tools in the toolbox is critical to driving meaningful change at a systems level that can achieve the goal of ensuring the safety and well-being of children.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Keeping Our Children and Families Strong During This Pandemic

4/7/2020

Blog by Susan N. Dreyfus, Alliance president and CEO

All Americans want the same things – we want our children to be safe and healthy, our neighborhoods to be secure, our economy to be strong, and our friends and families to unite and lift each other up in this time of crisis. 

Congress and the White House are moving quickly to provide economic relief for families as well as for essential industries as the COVID-19 pandemic spreads. This must also include support for community-based human services organizations that are typically hit hardest by economic downturns, particularly when their services are needed more than ever. 

One area that deserves our attention is our nation’s child welfare system, which has the critical responsibility of keeping our families strong and intact so that parents can care for their children safely at home. On a normal day, child welfare caseworkers interact with thousands of families across the country that are experiencing stressors, adversity, and other issues that put their children at risk for maltreatment. Research shows that increased financial and emotional stress during a crisis, such as a natural disaster or today’s pandemic, increase the likelihood that children will experience physical abuse or neglect.  

Our systems must be nimble, flexible, and innovative. Caseworker visits, essential to the safety of children known to the child welfare system, need to continue despite facing a virus that is spread by people-to-people contact. Fortunately, the U.S. Department of Health and Human Services recently issued guidance allowing for caseworker visits via videoconference. 

Many of the families involved in the child welfare system are dealing with complex issues, such as substance use disorders, mental health issues, and domestic violence. As the number of coronavirus infections rise, reduced access to medical care will also be a significant concern for children and families who have come to rely upon the much-needed treatment and services they were receiving. We must ensure through telehealth and videoconferencing that families can continue to access mental health counseling and substance use disorder treatment. 

We currently face a shortage of foster homes in this country.  A large number of children in foster care are placed with relatives, typically with grandparents, who are at increased risk for the virus. We must identify back-up homes for these kinship caregivers, put more resources into our foster parent recruitment and retention efforts, encourage virtual foster parent training, and do everything we can do to ensure we have enough safe and qualified homes should we witness a spike in need.  

As a former child welfare director and current head of a national strategic network of community-based human services organizations, I think it is absolutely crucial that state and county child welfare agencies work alongside and in partnership with our community-based organizations. Because community-based organizations are closely connected to the communities we serve, we are indeed essential to emergency responses in crisis like what we are experiencing today. 

We applaud New York’s Mayor Bill de Blasio for his executive order naming all 40,000 community-based human services employees as essential city personnel. All governors, mayors and county executives should follow suit quickly or they will find that the organizations they are dependent upon will face disastrous financial challenges they are not equipped to meet alone.  

We are working in partnership with child welfare advocacy leaders calling on Congress to provide new funds to state and local communities, programs, and services that support vulnerable children and families through prevention and intervention of child abuse and neglect during this public health emergency. The requests include more support for kinship care providers, domestic violence programs, and critical supports for older foster youth, especially those who have to leave college with nowhere to go. 

This should be a loud wake-up call for all of us who work in or support our nation’s child welfare system. As we all scramble to ensure we are meeting our obligations and responsibilities to our families, communities, and staff, we should take a moment to take note of all that we are learning here, and all that we should put in place before the next crisis comes our way. We should also find opportunities to identify ways that the child welfare system can be more flexible, more efficient, and with fewer regulations that just do not make sense in this day and time.  

We can rise to this challenge. We have done hard things before. We need to remain united as a field and across sectors in ensuring every child, every family, and every community remains strong and healthy and can come through this pandemic able to move forward in their lives. 

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This article appeared in The Hill Congress Daily blog on March 23, 2020.

Transforming the Vision of a 21st Century Child Welfare System into Practice

2/28/2020

By Amy Templeman, Alliance director of safety and resilience, Within Our Reach Office

Child abuse and neglect fatalities are preventable, not inevitable. This was the bold vision laid out by the federal Commission to Eliminate Child Abuse and Neglect Fatalities when it issued its report in March 2016, reimagining a 21st century child welfare system. 

Commissioners called for a public health approach to transforming child welfare systems guided by greater leadership and accountability, decisions grounded in better data and research and a multidisciplinary approach to ensuring child safety.

Based on the Commission’s findings, the U.S. Department of Justice’s Office for Victims of Crime announced earlier this year funding for a demonstration initiative to develop multidisciplinary strategies and responses to address serious or near-death injuries as a result of child abuse or neglect. Through a competitive grant process, they selected five sites that are receiving national technical assistance for a three-year period from a team of national experts. The sites were selected based on their ability to support a collaborative, community-based approach to reducing child maltreatment fatalities and serious injuries. 

This effort will provide what has been sorely lacking in previous attempts to reduce child fatalities – the identification and evaluation of evidence-based practices. Coupled with the federal government’s focus on prevention services and requirement of fatality prevention plans in the Family First Prevention Services Act, these actions will add up to a new knowledge base on best practices and what works to reduce and prevent these tragedies.

The five selected sites include St. Francis Hospital in Hartford, Connecticut; Cook County Health, Illinois; Indiana State Department of Health; Michigan Department of Health and Human Services; and Sacramento County’s Child Abuse Prevention Council.

Technical assistance will support sites in improved data collection and analysis using a safety science approach, development of strong community collaboratives, engagement of persons with lived experiences, better communications strategies, and developmental evaluation. This assistance is geared toward helping sites plan and implement an all-systems approach and coordinated strategic planning to respond to and reduce their child maltreatment fatalities and child crime victimization.

Each site will conduct their own data-driven needs assessment to identify children most at risk, as well as the strategies most likely to prevent future tragedies.

For example:

  • The Michigan Department of Health and Human Services will use data and input from partners to create a fatality/injury risk identification tool, which will be used by child protective services. They are also focused on expanding the efforts of the Michigan Child Death State Advisory Team and Citizen Review Panel on Child Fatalities. Serving as a state advisory committee for the project, the panel will create a forum for sharing information and innovations related to preventing child maltreatment deaths and injuries.
  • The Child Abuse Prevention Council of Sacramento will develop a model for a coordinated response to effectively identify and address recurring child injuries and fatalities using collaborative partnerships. Sacramento County will utilize a county-wide cross-disciplinary, public and private Prevention Cabinet to expand analysis of child fatality, near-fatality and injury data; gather social determinants of health data for neighborhoods most at-risk; review current screening and investigative policies; and use this information to inform and implement a strategic plan to eliminate child abuse and neglect fatalities in Sacramento County.
  • Cook County Health in Illinois, working in partnership with the Chicago Children’s Advocacy Center, will bring together other critical stakeholders to form the Collaboration of Helpers Lowering Deaths of Children (Project CHILD). Using a public health model, the Project CHILD collaborative will address the problem through parenting education, a home visiting nurse program, and family referrals. Additional strategies include use of a simulation laboratory, regional unit-based multidisciplinary teams and telehealth technology to improve the assessment of information gathered during investigations.
  • St. Francis Hospital in Hartford, Connecticut will utilize the funding to work with diverse stakeholders, including state agencies, policy makers, affected community members, first responders, educators, researchers and providers, in order to develop a standardized, data-driven systemic approach to documenting and tracking child maltreatment. They will focus on cities and towns under the judicial district GA-14, including Avon, Bloomfield, Canton, Farmington, Hartford, and West Hartford. 
  • The Indiana State Department of health will conduct a two-phase project in three target counties (Clark, Delaware and Grant counties) whose child fatality rate is higher than the state average. They will undergo a 5-year retrospective review to identify risk factors for child injuries and deaths and will work in partnership with the Community Partners for Child Safety program to develop prevention strategies for schools, social services agencies, health care providers, public health, hospitals, child care providers, community mental health agencies, local DCS office, child abuse prevention agencies, Youth Services bureaus, Child Advocacy Centers, the faith-based community and Twelve Step programs to create and implement a collaborative prevention network.

All sites will establish learning exchange teams and communications strategies to share findings both regionally and nationally.

In the words of the Commission’s final report: “In the Commission’s two years of hearings, deliberations, and meetings with stakeholder groups, we found little in the way of evidence-based programs to end child maltreatment deaths. We found no state that had developed a sufficiently comprehensive plan to address the problem. But we found hope and urgency for building the steps to a 21st century child welfare system that can prevent deaths of the 3,000 children who will die from abuse or neglect next year if the status quo remains in place.…We must build a more comprehensive child welfare system that goes beyond CPS agencies and uses a public health approach to develop community capacity to help families and prevent abuse and neglect before problems turn into tragedy.”

It is hoped that this innovative initiative will fulfill the mission of the Commission by taking the first step to inform an ongoing nationwide effort to reduce child abuse and neglect tragedies.

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Amy Templeman is project coordinator for the cooperative agreement and director of the Within Our Reach office at the Alliance for Strong Families and Communities. Previously, she served as the Executive Director for the Commission to Eliminate Child Abuse and Neglect Fatalities. This article previously appeared in The Hill.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

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About this Blog

The goal of the Within Our Reach blog is to provide actionable advice for child welfare practitioners; a place to discuss policy trends and ideas for policy makers at all levels; and to provide leading commentary for any stakeholders involved in preventing child fatalities due to abuse and neglect.

As a space for conversation, the Within Our Reach Office at the Alliance for Strong Families and Communities welcomes guest submissions from service providers and policymakers.

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