by Amy Templeman, director of the Alliance’s Within Our Reach Office
An essential resource for professionals in the child welfare field are the voices of those with lived experience who are willing to share their stories. Matthew Peiffer in Indiana is one of those heroes. Matthew’s resilience in the face of tremendous adversity has given him the passion and drive to speak out for system reforms even after facing some of the most challenging life circumstances.
Matthew Peiffer and his two sisters were adopted at a young age. Their adoptive parents abused them physically and sexually for almost thirteen years. When they were finally removed from their adoptive parents, they were placed into separate foster care homes and institutions. Matthew, who is now 23 years old, aged out of the foster care system. His younger sister Emily did not make it out. She died by suicide at age 18.
The experiences of Matthew and his sisters are horrific and tragic and are shared by too many children in the child welfare system. In its groundbreaking report released in 2016, the federal Commission to Eliminate Child Abuse and Neglect Fatalities noted that, on average, between 1,500 and 3,000 U.S. children die from maltreatment every year. These numbers have remained constant for years because for too long, our systems have been geared to addressing child abuse and neglect only after harm has occurred.
A new and innovative demonstration initiative is aiming to change that. Child Safety Forward, supported by the U.S. Department of Justice, includes five sites across the nation who are utilizing comprehensive and evidence-based strategies to identify those children most at risk and develop targeted steps to strengthen supports and address those risk factors.
A key element to the strategy is the integration of the voices and experiences of youth and families involved with child welfare.
As Jerry Milner, associate commissioner of the Children’s Bureau recently noted: "Young adults with lived experience are the experts in the child welfare system. Any meaningful change in the child welfare system must happen with youth and young adults as our partners.”
Matthew is one of the young adults helping provide that important perspective. He serves as a member of the Advisory Council for the Indiana Department of Health (IDOH), one of the five sites for the Child Safety Forward initiative. His experiences and perspective have been a valuable tool in the development of IDOH’s implementation plan to reduce child abuse and maltreatment.
For example, Matthew shared details of attempts that he and his sisters made to reach authorities to let them know of the abuse they were experiencing. As young children they were often locked in their rooms for hours and deprived of food. They were home schooled and rarely encountered other adults. Matthew would sometimes call 911 and hang up. He also managed to get out and vandalize his adopted parents’ car with the hope that the police would notice their plight and take them away. In both cases, law enforcement would show up but wouldn’t enter the house and would only talk to the children with the parents present, so there was no chance for the children to seek help.
In response, Matthew is providing training seminars for law enforcement today on what to look for when visiting a home where abuse might be suspected.
Matthew has also spoken out about the need for better data to address children at risk, a strategy which is receiving emphasis in Indiana’s plans for Child Safety Forward. As IDOH notes in its draft implementation plan, “The lack of standardization in investigation practices, including incomplete investigations, limits our understanding of the causes and circumstances related to child maltreatment related fatalities, Sudden Unexpected Infant Deaths (SUIDs), and youth suicide. It also leads to incomplete and inconsistent data. Quality and accurate data allow us to better understand and address risk factors.”
IDOH’s efforts to collect and analyze data, bring in the voices of those like Matthew with lived experience, and work collaboratively across the community to develop new models for addressing child fatalities and serious injuries from maltreatment will provide what has been sorely lacking in previous attempts – the identification and evaluation of evidence-based practices.
Coupled with the federal government’s focus on preventing foster care and requirement of statewide 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 tragedies like those experienced by Matthew and his sisters.
Amy Templeman is director of the Within Our Reach office at the Alliance for Strong Families and Communities. Within Our Reach is supported by Casey Family Programs. A version of this article appeared on February 3, 2021 in Youth Today.
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.
By Regina Dyton
Since the nation witnessed the murder of George Floyd at the hands of members of law enforcement, it has been hard to contain the sorrow and anger. As he called out for his deceased mother, he spoke to every mother across this nation who has struggled to keep her child safe. As a Black mother of an incarcerated son, I am tired and scared to stand witness to yet another generation of children and grandchildren who must learn to navigate the racial prejudices that infuse our systems.
And, while it is clear that this issue extends far beyond law enforcement, any dialogue about how we move forward must acknowledge the fact that systemic racism across all of our systems is interconnected and interwoven.
What child of an African American mother hasn’t heard the phrase: “I’m beating you now so the cops don’t kill you later.” Too many Black and brown parents believe that teaching our children compliance without question can save our sons from being taken from us by police through imprisonment, permanent injury, disability or outright murder, like the knee to the neck that took George Floyd. “That boy better learn to listen!”
It is with anguish and desperation that we seek to impart submission into our children early on. In doing so, we prepare our children for servitude while others prepare their children for leadership.
A 2015 Pew Research survey found that Black parents are more than twice as likely as white and Latino parents to use corporal punishment on a regular basis. Many believe it is a tradition that has its roots in slavery, with enslaved Black mothers and fathers preferring to beat their child rather than allow the slave owner and his overseers to beat them. I find it appalling, but understandable on some level, that descendants of one of the cruelest examples of slavery in world history would pass the beatings on.
This is clearly also one of the root causes for the disparities we see in the child welfare system. There is no question that racial bias exists in Child Protection Services. A parent of color is more likely to be reported for abuse or neglect, that report is more likely to be substantiated, and that child more likely to enter the foster care system.
In fact, according to The Imprint’s Foster Care Capacity website, while African Americans make up 9.8% of the population in Connecticut, they represent 22.5% of the population of youth in foster care.
Once in that system, that child is more likely to be exposed to situations and environments leading him to trouble with the juvenile justice system. The juvenile justice system is too often a road to the adult criminal justice system. Every step on that road is life threatening.
Challenging the negative definitions and images we have been given of ourselves and working to heal internalized racism is one critical step to reducing the number of children of color fed into child protective services.
That is one of the key goals of the St Francis Hospital and Medical Center/Trinity Health of New England’s participation in the Child Safety Forward initiative. Funded through a grant from the U.S. Department of Justice, Child Safety Forward is a demonstration initiative across five sites to develop multidisciplinary strategies and responses to address fatalities or near-death injuries as a result of child abuse and neglect. Our site is primarily focused across the Hartford, Connecticut, region.
The challenges we face include socioeconomic conditions across our region that include poverty, racially segregated communities, and inadequacies in data collection and reporting that have led to a reactionary rather than proactive approaches to child safety. Ultimately, we hope to utilize a population health approach to reduce the rate of repeated child injuries and fatalities in Hartford, which is currently two times the national average.
The effort will include a collaborative approach involving grassroots neighborhood organizations, caregivers, health professionals, researchers, foundations, state agencies and others to eliminate health disparities in communities served by St. Francis Hospital and Medical Center. And, it will include a conversation across communities about the systemic racism that impacts families of color and how we can engage all voices and all lived experiences to bridge the gaps and disparities that have resulted.
These issues may not be solved overnight. But I am encouraged that the dialogue is real, that the voices speaking out are loud are multi-cultural and united in the call for change.
For every Black mother of a newborn who, like me, whispered into my baby’s ear, “I will not lose you to the police, I will not lose you to prison, I will not lose you to the law enforcement system,” know you are heard.
Child abuse and neglect is not inevitable. It is our responsibility as a society to tackle these hard issues and ensure that all children have the opportunity to grow up in an America that represents equity, inclusion, diversity and most of all, hope.
Regina S. Dyton is director of community health and well-being for Trinity Health of New England and project director of the Child Safety Forward Initiative in Connecticut. This article originally appeared in The Imprint on Dec. 6, 2020.
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.