Within Our Reach released a new report today entitled “Transforming Child Welfare Systems to a 21st Century Model that Strengthens and Supports Families and Communities: Innovations from the Field,” authored by Teri Covington, former director of the Within Our Reach office and funded through support from Casey Family Programs (CFP).
Within Our Reach is an office of the Alliance for Strong Families and Communities that was established to further the recommendations of the federal Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF). In a 2016 report, the commission called for fundamental reforms in the child welfare system including: “A comprehensive public health approach premised on the importance of strong, integrated, and collective responsibility and coordinated action and measurement across agencies and states and within our communities.”
Significant progress has been made in the four years since the commission’s report toward transforming child welfare into 21st century child and family well-being systems that focus on preventing child abuse and neglect and strengthening families.
Over the past several years, a number of convenings have taken place featuring transformational leaders across the child welfare ecosystem. Organized by CFP, in partnership with the U.S. Administration on Children, Youth, and Families (ACYF), the Centers for Disease Control (CDC), the Association for State and Territorial Health Officials (ASTHO) and American Public Human Services Association (APHSA), these convenings have helped coalesce leaders around a common vision and an improved understanding of a public health approach to child welfare.
This recently released report provides a framework and description of a prevention-aligned, public health approach to child welfare and provides some examples of innovations states and communities are implementing in their efforts to become a 21st century model of child welfare. Many of these innovations are based on the recommendations of CECANF and the frameworks being developed through the CFP convenings.
Some of the examples of community and state efforts towards a more family-supportive, public health approach to child welfare include: 1) Establishment of a network of Family Resource Centers (FRCs) in San Francisco, CA that provide a community-based resource hub for families needing to access formal and informal supports that promote health and well-being; 2) A Maricopa County, AZ effort to establish the Safe Babies Court Team™ approach first developed by the national organization, Zero to Three, that transforms child welfare into the practice of child “well-being” by using the science of early childhood development; 3) The Housing Opportunities Made to Enhance Stability (HOMES) initiative in Milwaukee, WI, which promotes stable, healthy, and affordable homes that provide a foundation for well-being and prosperity for children, families and communities.
Click here for more information and to access the full report.
By Dr. Michael Cull, associate professor in the Department of Health Management and Policy at the University of Kentucky and associate director for workplace health and safety in the Center for Innovation in Population Health
COVID-19 has changed the way we do work but it hasn’t changed the nature of the work. Our goals are the same. We want to get up everyday and do our best to help children and families. But “everyday” doesn’t look the same as it did before February. And we may need a new set of habits to ensure safety, reliability, and effectiveness.
Child welfare is not unlike the work done by professionals in a variety of high-risk, high-hazard, settings. In fact, like surgeons and pilots, child welfare professionals make complex and high-consequence, decisions all day long. And like flying a plane or operating on a heart, we can’t learn by failing. For these reasons, it makes sense to learn from other industries oriented around safety culture. It is likely that some of the same strategies that keep other professionals and those they serve safe might be effective for child welfare. But, strategies alone only get us part of the way there. We also need an organizational culture that supports our best laid plans.
Other safety critical settings seek to develop a very specific kind of organizational culture focused on safety. According to the Agency for Healthcare Research and Quality, organizations with a safety culture:
- acknowledge the high-risk nature of an organization's activities and the determination to achieve consistently safe operations;
- create a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment;
- encourage collaboration across ranks and disciplines to seek solutions to patient safety problems; and
- commit resources to address safety concerns.
In a safety culture, professionals must also feel psychologically safe. That is, they need to feel accepted, respected and a part of a team that speaks up, avoids blame, and uses errors as opportunities to learn. Psychological safety is the cornerstone of a safety culture. It allows for continuous learning in a setting where professionals are comfortable pointing out concerns.
An organization’s culture is formed by its habits and how it approaches problems. And culture defines the space we call work. Habits that promote safety are the building blocks of a safety culture. But developing new habits can be hard.
In 2012, Vanderbilt University Medical Center took an interesting approach to developing habits that addressed two important patient safety concerns; 1) handwashing and 2) staff psychological safety. It is the case that washing hands reduces infection rates in hospitals. It is also the case – big surprise – not all doctors and nurses always wash their hands. Vanderbilt’s approach to this problem was to train all of its staff to feel empowered to challenge another professional (even the most senior surgeon) who did not wash their hands. They also trained staff to know that the only appropriate response to a challenge was to say “thank you.”
Vanderbilt’s approach promoted hand washing while also promoting psychological safety – a broader organizational goal. Professionals need to be able to candidly speak up and give feedback independent of rank or status. And, importantly, the organization has to be able to support that behavior. If, for example, a nurse gives feedback to a physician and then the leadership fails to respond in support if/when that physician responds unprofessionally to the suggestion (yes this happens) psychological safety can be negatively impacted - making the system less safe. In Vanderbilt’s case, both handwashing and the organization’s culture change goals were improved by a new set of habits.
Vanderbilt’s story makes for an interesting and timely example. Handwashing as a habit has taken on new importance both in our personal and professional lives. And the need for it to become habitual may be fundamental to our ability as a culture to get control of the virus and thrive again. But we also have opportunities to improve child safety and well-being through strategies that help us develop habits to directly improve our culture.
A positive safety culture, whether in response to the pandemic or to preventing child abuse and maltreatment is a proven way to improve health, safety and to positively impact organizational goals. Fundamental to this approach are psychologically safe teams who challenge each other, feel confident raising concerns and promoting new ideas, and treat failures as opportunities to learn and grow. And just as it was not always comfortable for the nurse to take an interpersonal risk and challenge a physician’s decision, you can anticipate discomfort developing this new habit.
Psychological safety is not about comfort. In fact, it is often very uncomfortable to have the brave conversations that are needed. And we know people avoid these conversations for all kinds of understandable reasons. We generally want to be liked and want to get along in the workplace. We may be concerned that there could be retribution with a challenge to a colleague or supervisor. And we also just don’t want to be wrong. But to achieve the kind of safe, reliable, and effective practice we all hope for we need to learn from places that do it well. A safe cockpit is one where a co-pilot is confident taking risks and sharing concerns with the pilot. We have an obligation in child welfare to support this approach to move away from punitive approaches to managing professional behavior and toward approaches that support learning and improvement.
Dr. Michael Cull is an Associate Professor in the Department of Health Management and Policy at the University of Kentucky and Associate Director for Workplace Health and Safety in the Center for Innovation in Population Health. Mike has specific expertise in applying safety science to improve safety, reliability, and effectiveness in organizations. For more information, go to www.leadteamfirst.org.
This product was supported by cooperative agreement number 2019-V3-GX-K005, The OVC FY 2019 Reducing Child Fatalities and Recurring Child Injuries Caused by Crime Victimization demonstration initiative.
By Amy Templeman, director of the Alliance’s Within Our Reach Office
When the federal Commission to Eliminate Child Abuse and Neglect Fatalities issued its groundbreaking report in March 2016, it envisioned a reimagined 21st century child welfare system, one predicated on strategies to address child abuse and neglect before it occurs.
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 funding for a demonstration initiative known as Child Safety Forward 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 that draw upon a public health approach to addressing those at risk.
But what exactly does that mean?
In its report, Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities, the Commission defined a public health approach for child safety in the following way:
“A Public Health Approach is one that promotes the healthy development and well-being of children. It builds off of a public health model used to tackle complex social problems, a model with a focus on prevention and support for community change. The Surgeon General connected this model with child maltreatment in 2005, calling prevention of child maltreatment a national priority. The Centers for Disease Control and Prevention also championed a public health approach around reduction of child abuse and neglect. They define four steps in a public health model:
- Define and monitor the problem.
- Identify risk and protective factors.
- Develop and test prevention strategies.
- Ensure widespread adoption.
A public health approach to child safety and prevention of fatalities looks for the maximum benefit for the largest number of people, which means it works not only at the family level, but also at the community and societal level. Public and private sectors work together to align, leverage, and coordinate existing resources to provide support to children and families and to address risks and promote resilience before there is a crisis. The entire system becomes more preventive and responsive.
CPS remains a critical component of this approach in order to respond quickly when children are at risk of serious harm. But CPS is only one part of the picture. Other systems become key partners, including the courts, law enforcement, the medical community, mental health, public health, and education. Even neighbors who come into regular contact with young children and families are part of a public health approach. All have a role to play to ensure that help is available when families need it through services and supports such as prenatal care, mental health services, evidence-based home visiting programs, employment, education, parent partnerships, housing support, early childhood education, and parent skills training, as well as substance abuse, mental health, and domestic violence programs.
The CPS agency in the 21st century child welfare system will continue to respond to allegations of abuse or neglect and work to keep children safe. But the ultimate goal is that fewer families will need involvement with CPS. This will free up CPS agencies to respond with more in-depth support to every child who comes to their attention for abuse or neglect. As a result, CPS agencies will be stronger, and their case management teams will be more effective. They will have more multidisciplinary partners and better connections to professionals in the community to help families. Community- based partners will also be ready to step in with support for families when their CPS cases are closed.”
Rather than focusing exclusively on child protection, this new system places an emphasis on child well-being and provides the supports that help strengthen families that are at greatest risk.
There are challenges, of course, particularly in the face of the current COVID-19 pandemic. In an August 3, 2020 article in the Journal of American Medical Association Pediatrics, “Child Maltreatment in the Era of Coronavirus 2019,” author Dr. Christopher Spencer Greeley notes: “As COVID-19 has forced a reevaluation of the social contract between what communities, cities, and states are obligated to provide for their citizenries, there should be an emphasis on eliminating the systemic and structural injustices that exist in our communities already. This is not the first pandemic or natural disaster, nor will it be the last. With the current disruption from COVID-19, financial budgets will tighten and hard choices will have to be made. Now is the time to be thoughtful about the kinds of policies, practices, and resources that we will wish we had put in place when the next catastrophe occurs.”
Child Safety Forward and the five demonstration sites are seeking to broaden our existing knowledge base to help inform policies and practices that support a public health approach to child welfare. 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.
By Amy Templeman, director of the Alliance’s Within Our Reach Office
On July 14, Jerry Milner, associate commissioner of the Children’s Bureau and David Kelly, special assistant to the commissioner, joined members of the Alliance for Strong Families and Communities for a special webinar discussion on the future of child welfare. The wide-ranging conversation focused on the shift toward a more front-end, preventive child welfare system and the challenges that have emerged in the face of the COVID-19 pandemic and growing evidence of racial inequities in the child welfare system.
The recording of this webinar is available to members and nonmembers. Just log in with your Alliance account and register to access the recording. Anyone can create a login.
Milner spoke about the need to reach families sooner and build their protective capacities, instead of waiting for children to become at risk of coming into the foster care system. He noted, “The need for family support has never been greater. … We have a moment now. We have an incredible opportunity to build on what we have known and what we know more clearly from all the issues we are facing right now. Our priorities in the Children’s Bureau have been and continue to be primary prevention of child abuse and neglect and we know that primary prevention work has to occur in the community.”
He highlighted the importance of community-based organizations as, “core and essential components of the child welfare system,” but noted that the current child welfare system hasn’t adequately funded community-based programs. He spoke of the importance of shifting from an investment in foster care to an investment in family services geared toward helping families meet their basic needs, and the need for greater flexibility in funding streams to allow for state and county-wide innovation.
On the issue of racial disparities, he commented, “I believe the COVID-19 crisis and the current calls for social justice issues have highlighted and not necessarily created the weaknesses in our system that have long existed. We have known for decades that families, children, and young people of color are tremendously over-represented in the foster care system. … The current crisis makes that evident with families not having access to food, housing, employment, and other basic needs, putting them and their children at great risk of needing intervention. It tells us something about the confusion between poverty and neglect. … In many places, the child abuse hotline may be the only resource out there where a well-intended reporter can try to get some help to a family. We need to do better than that to create the kind of systems out there where there are places to go where a child or family might get the help that would prevent them from becoming part of the child welfare system.”
He added, “We want to make the very most of the moment we are in and what the root causes of these issues are so many of our families are experiencing. We need to be able at the federal level to give states, counties, and communities the opportunity to be creative and to serve families in ways that will benefit them not just for the short term but for the longer term.”
Special Assistant to the Commissioner David Kelly joined the conversation on racial equity and bias by noting, “For three years, we’ve been really explicit about saying that child welfare exists in the space where poverty, public health, and civil rights collide. … There are a number of things we need to take a really hard honest look at on a systems level including how we define neglect and the lack of consistency in neglect statutes across the states. We must ensure that there are clear ways to distinguish financial hardship and poverty from neglect and align around that. We also have a long and dark history in equating surveillance with services and we need to be clear that those types of practices are often the result of implicit if not explicit biases. We’ve seen this play out in countless media reports that are leaping to conclusions that when children are not seen by white and middle-class professionals, they are somehow more likely to be maltreated. We certainly know that risk factors are higher in families that are struggling but that is a dangerous proposition. … I think we are going to learn some lessons from this experience, especially in light of the fact that the vast majority of calls to hotlines are screened out under normal circumstances. And on the hopeful side, anecdotally, we are hearing from multiple sources that calls to community providers including family resource centers and support centers are on the rise in many places around the country.”
The Alliance and its Within Our Reach Office extend our gratitude to Milner and Kelly for their stewardship of the Children’s Bureau and their efforts to prioritize primary prevention and address racial justice and equity in the nation’s child welfare system. Investments in these issues help to ensure all children and families have the same opportunities to thrive.
Log in to watch the recording of the conversation.
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.
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.