By: Dr. Eric Yazel

When the Indiana Department of Health (IDOH) was selected for a national demonstration initiative known as Child Safety Forward, aimed at reducing serious injuries and fatalities to children caused by abuse or neglect, they turned to the Clark County Child Fatality Review team (CFR) and the Clark County Community Action Team (CAT) to kick-start their implementation phase.

The Child Safety Forward initiative was launched in October 2019 by the Department of Justice’s Office for Victims of Crime.  IDOH was one of five sites selected the demonstration initiative and technical assistance to develop and execute implementation plans to address child maltreatment injuries and fatalities. 

With the third highest rate of child abuse and neglect in the nation, IDOH efforts began with a retrospective review of data over the past five years in four target counties: Clark, Delaware, Madison and Grant counties. These four counties all had rates of external injury deaths among children that were higher than the state average rate during that period. 

Working with the Indiana University (IU) School of Social Work, the IDOH team assisted the county level CFR teams with their retrospective review of cases to determine risk factors. Those reviews revealed that unsafe sleep-related deaths were the leading cause of death due to external cause for children ages 0-18 years old, when excluding medically expected fatalities. Based on this data, the IDOH team decided to focus efforts on assisting the county level teams with standardizing child fatality reviews and implementing safe sleep policies that go beyond education to include a public health approach.

In Clark County, our Community Action Team had been established two years earlier. This team was well-positioned to take the recommendations that were generated from our Child Fatality Review team and begin to implement safe sleep strategies to address at risk infants as well as other injury and fatality prevention initiatives. 

The data from the retrospective review was synthesized and presented to the Community Action Team.  From this data, we created the Clark County Cradle project, a multi-faceted initiative where the Public Health Educator links with expectant mothers at several milestone events: the 32-week prenatal visit, 1-2 weeks after hospital discharge, 1 month and 6-month well-checks, as well as many other touch points. We will also be partnering with another community organization to support child-parent psychotherapy visits, using the ACEs model to provide lasting change in our community.

As with many other community initiatives, COVID-19 was a major roadblock as we had to learn how to move forward in that challenging environment.  One of the first things we did was move some of our trainings to a virtual environment.  We have held infant CPR and Safe Sleep education classes monthly and were able to develop an online module to continue to provide training.   

In May of 2021, we organized our first drive-through baby shower. Mothers all over Southern Indiana were able to receive information and resources from dozens of community partners, all in a COVID-safe environment.    

In addition to the focus on safe sleep, the retrospective and current fatality review process revealed a number of unintentional firearm deaths. In response, our Community Action Team is developing a firearm education program in the community and working with a local State Representative to develop a smart gun pilot project.   

This public health approach can perhaps one day provide evidence-based data on what works to reduce these deaths and ensure the safety of our children. Our hope is that these initiatives, implemented at the community level, will help inform state and eventually national policy and practice to help other jurisdictions utilize fatality reviews to develop implementation strategies that can reduce and even prevent infant and child fatalities. 

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Eric Yazel, MD, is the coordinator of the Clark County Community Action Team, the Clark County Health officer, and a member of the Child Fatality Review team.

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 Laura Pinsoneault, founder and CEO of Evaluation Plus, a TA provider for the Child Safety Forward initiative

The Child Safety Forward initiative was launched in October of 2019 with a goal of reducing child abuse and neglect fatalities and injuries through a collaborative, community-based approach. 

Funded by the Department of Justice’s Office for Victims of Crime (OVC) and supported by a technical assistance (TA) team led by the Alliance for Strong Families and Communities and Council on Accreditation (Alliance-COA), Child Safety Forward is a demonstration initiative taking place across five sites. The five sites include: Cook County Health in Illinois; Indiana Department of Health; Michigan Department of Health and Human Services; St. Francis Hospital in Hartford, Connecticut; and Sacramento County, California’s Child Abuse Prevention Council. 

Child Safety Forward just released a brief highlighting the evaluation results of its initial planning year, which was originally scheduled to close out in October 2020 but was extended through December 2020 to allow sites to adapt to the COVID-19 pandemic.

Evaluation Plus, the TA provider and evaluator, utilized a Developmental Evaluation (DE) approach to support the Alliance-COA in planning for and adapting the TA, learning community, and communication strategy. DE is defined as an approach that is often used in complex systems challenges. It includes real-time feedback to program staff that simulates research and development to enable continuous adaptation and adjustment.

This approach allowed the Alliance-COA to stay nimble as it deployed early TA and coordinated the learning exchange in the planning year. 

The planning year evaluation was organized around five learning cycles: 

• Developing an initiative level theory of change 
• Building a robust TA model that is responsive to capacities and needs of demonstration sites 
• Understanding the value of a learning exchange for demonstration sites and its potential for the broader field 
• Exploring and understanding how COVID-19 influenced Child Safety Forward 
• Reflecting on how various decisions made during the planning year contributed to the development of demonstration sites’ implementation plans

Our learning around each of these cycles was aided by action learning activities (e.g., facilitated discussion around a framework, after-action reviews) with the demonstration sites and TA team, survey data collection, observation, and by prototyping different strategies for delivering technical assistance and learning opportunities and getting feedback and data on how successfully those strategies were in advancing our goals. 

Key takeaways from the evaluation highlighted changes needed in our systems if we want to accelerate progress toward a child and family wellbeing system:

• Using a public health approach that relies on ongoing assessment of need and rapid testing and evaluation to design and address strategy creates a cross-sector approach that is responsive and adaptable to community priorities. 
• Capacities and policies and practices for how to shift power dynamics between systems and families, address racism and disparate outcomes in child welfare, and engage in a higher-level dialogue about to support families across systems are underdeveloped.
• We need focus on learning by crediting multiple sources of data and information.
• Capacities to design, experiment with and participate in learning collaboratives to sustain effective strategies for child maltreatment are not engrained in our systems yet, and technical assistance and shared learning are needed.

By the end of the planning year, the demonstration sites presented comprehensive implementation plans focused on a variety of strategies and systems-level outcomes rooted in their data collection activities. 

“Each of the implementation strategies identified by the five sites are unique and specific to their communities, honoring the data they collected over the past year to identify community-led solutions that support resilient families and keep children safe in their homes,” commented Amy Templeman, director of the Within Our Reach Office at the Alliance-COA. “They share one common trait – they are predicated on demonstrating a public health approach to child and family well-being called for by the federal Commission to Eliminate Child Abuse and Neglect Fatalities. With a focus on increasing equity in systems that serve families, elevating families into relationships of equal power, building protective factors, and supporting families who are having trouble weathering one or more of the storms impacting our country right now, each of the demonstration sites are hoping to create a body of knowledge about what works to reduce child fatalities. And, over time, we will share these findings broadly across the field to inform policy and practice at a local, state and national level.”

As we work toward creating this body of knowledge, evaluation will continue to play an important role in helping the sites adapt to the challenges that emerge and better address the complex systems change that needs to occur to shift our current child welfare system into a child and family well-being system.

Review Brief

Laura Pinsoneault is founder and CEO of Evaluation Plus, a TA provider for the Child Safety Forward initiative. Through her leadership of Evaluation Plus, Laura brings extensive expertise in helping partners translate complex change ideas into meaningful results.

Disclaimer: This product was supported Casey Family Programs and  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 Amy Templeman, director of the Within Our Reach Office

April is Child Abuse Prevention Month, a time for communities to come together to build caring connections, supportive environments, and positive experiences for all children. This year’s theme is “Every day, we help positive childhood experience take root!” 

Science shows us that positive childhood experiences in nurturing environments provide fertile ground for physical and mental health, learning, and social skills to flourish.  Enabling these positive childhood experiences requires that we reimagine child welfare and focus instead on child well-being with upstream resources that can prevent child abuse and neglect before it occurs.

The Family First Prevention Services Act, which was signed into law as part of the Bipartisan Budget Act on February 9, 2018, was an important step toward realizing this goal. By emphasizing prevention, early intervention and evidence-based practices for children and families, Family First is helping shape the future of child and family well-being systems based on a public health approach.

What do policies to build a child and family-well being system look like in practice? Answering that question is the impetus behind a new national demonstration initiative to address child fatalities and injuries from maltreatment launched by the Department of Justice’s Office for Victims of Crime. The initiative features five sites selected across the nation, including Cook County Health in Illinois; Indiana Department of Health; Michigan Department of Health and Human Services; St. Francis Hospital in Hartford, Connecticut; and Sacramento County, California’s Child Abuse Prevention Council.  

The project launched a year ago with each site conducting retrospective reviews of at least five years of fatality review data to identify families who could benefit most from supportive services. Based on that data and informed by a community needs assessment to identify areas of opportunity for improved services and response, each site has developed an implementation plan targeted to a specific focus.

The following summarizes the implementation focus for each site:

• Cook County Health in Illinois – Based on a data review of Cook, Peoria and Vermillion counties, as well as data released in the annual Office of the Inspector General report, they will focus on community awareness programs targeting unsafe sleep practices and coping with infant crying. They will also work to improve They will also work to improve systems and training to support earlier detection of families in need of support. Their efforts will help to normalize and destigmatize parents seeking help and foster collaboration among community leaders by opening new opportunities to work together to strengthen multidisciplinary teams.  
• Indiana Department of Health – Based on research conducted over the past year in four target counties, Clark, Delaware, Grant and Madison, unsafe sleep-related deaths were the leading cause of death due to external cause for children ages 0-18 years old, when excluding medically expected fatalities. Based on this data, they will focus on local safe sleep interventions. Child Fatality Review teams and community stakeholders will have the opportunity to engage with training in such areas as trauma-informed care, social determinants of health, inter-state record sharing, and death investigation training. They will also focus efforts on a one-year research plan to increase knowledge around unsafe sleep behaviors in the state of Indiana. 
• Michigan Department of Health and Human Services – With input from an advisory panel, they will employ a collective impact approach to enhance the level of services for families in need of support and improve safety planning across Michigan’s child protection system. To improve the level of services for families, they will examine outcomes of current policies and practices related to families with low or moderate risk for child maltreatment to identify change recommendations. They will also partner with statewide or regional outreach efforts that focus on protective factors and work to promote these services to families. Finally, they will review current safety planning practices, assess the perceived needs, barriers, and facilitators to safety planning among child protective services (CPS) workers and other professionals, and assess the perceptions of safety plans among persons with lived experience. Collectively, this information will be used to identify areas for practice change and inform the development of educational resources and supports to reinforce safety plan best practices. 
• St. Francis Hospital in Hartford, Connecticut – They have established a stakeholder group, composed mostly of community- based organizations and community leaders, who will work with leadership of State and municipal agencies, elected officials, medical and other service providers to improve systems and practices to support healthy families and children.  This model is unique among the demonstration sites because the lead agency is a community-based organization. They are working to integrate community leaders with decision-making agencies such as CPS, law enforcement, the courts, etc. As part of their sustainability plan, St. Francis Hospital has committed to support the project for ten years with a focus on establishing a more standardized data collection and analysis system; improving cooperation between community members and agencies responsible for child protection; and, ultimately, significantly decreasing repeated child maltreatment and injury.
• Sacramento County, California’s Child Abuse Prevention Council – Based on a 10-year analysis of data, they identified several common risk factors across families, including poverty, parental crime and drug history, sibling child welfare history, and certain child and parental characteristics such as child age, age of mother at birth, child welfare history, and substantiated abuse/neglect history. Based on this data, the Sacramento County Prevention Cabinet has developed a model for a coordinated response using collaborative partnerships and data to inform and implement a strategic plan to eliminate child abuse and neglect deaths and critical injuries in Sacramento County by 2030. Strategies and corresponding actions will focus on building community partnerships through continued data collection and analysis of risk and protective factors; supporting trauma informed systems and practices through the expansion of collection, analysis, and review of data regarding risk and protective factors; promoting community, parent, and youth voice by engaging members of the community with lived experience; embedding equity into all aspects of the implementation plan; and advancing work on community resource education and cross-referrals to ensure strengthening of the referral process.

Each site is working with a collaborative body of stakeholders and partners, including those with lived experience, to guide the work. All sites are reviewing short and long term goals through an equity and diversity lens. The sites are supported in their efforts by a broad range of technical assistance providers led by the Within Our Reach office at the Alliance for Strong Families and Communities and Council on Accreditation.

“We know from the work of the federal Commission to Eliminate Child Abuse and Neglect Fatalities that child abuse is not inevitable,” noted Stacy Phillips, DSW, and a program specialist with the Office of Victims of Crime. “We also know that child protection agencies cannot do this work alone. Through this initiative we hope to examine what works and help build a knowledge base about the impact of a multidisciplinary approach to child and family well-being that engages a broad range of stakeholders working jointly to strengthen families and ensure the well-being of all children.”

As we celebrate National Child Abuse Prevention Month, let us not forget that addressing community needs by giving families support prevents traumatic events from happening, has much more impact, and costs much less, than attempting to address the consequences of adversity after a child has grown up. We all have a stake in our kids’ future. Let’s plant those seeds today.

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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.

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 Amy Templeman, director of the Within Our Reach Office at the Alliance/COA and Julie Sweetland, sociolinguist and senior advisor at the FrameWorks Institute

With the final deadline for implementation of the Family First Prevention Services Act coming in October, child welfare policymakers and practitioners are looking to how best to utilize title IV-E funding for a range of prevention services, including mental health, substance abuse, and in-home parent skill-based programs for children or youth who are candidates for foster care.

When communicating prevention policies to the public, to media and to stakeholders, challenges emerge. They are notoriously hard to communicate since the results are abstract. How do you quantify, for example, abuse or other problems that didn’t occur? 

Framing scientists are seeking to answer that challenge by changing the way we talk about child welfare. 

In 2004, Prevent Child Abuse America commissioned the first framing study on child abuse and neglect, in part because the strategy of using emotionally evocative stories of abuse and neglect had run its course. Today there is a need for a new framing around prevention as we look to remodel “child welfare” systems into “child and family well-being” systems. We are also reckoning with the evidence of systemic racism in child protective services – such as the harsh reality that children of color are more likely than white children to be removed from their families and placed in foster care – and we are working with communities to design approaches and systems that live up to the ideal of racial justice. 

To make the case for strategies that ensure that every child grows up in safe and nurturing environments, we must widen the lens to depict the factors that shape those environments.
This includes acknowledging that all families face adversity from time to time, as the current pandemic has so exemplified. It means being clear that financial stability is an essential part of weathering any of life’s storms – and that many in our country struggle to keep themselves afloat as income inequality only widens. 

It involves lifting up policy solutions like the proposed new expansion of the child tax credit, expanded childcare subsidies, and family-friendly workplace policies, such as consistent and flexible work schedules and paid family leave. It asks us to become more fluent and more forward in talking about how many child welfare interactions are symptoms of a flawed economy and a lack of conditions that support families, not evidence of a flawed family.  

Focusing on economic issues can’t be a substitute, however, for speaking directly to issues of racial justice. The two are related, but they shouldn’t be conflated. To do so would risk missing issues like implicit bias or the disparate racial impact of child welfare policies. In “centering race,” it’s not enough to merely point out disparities, as it leaves room for audiences to assume that the problem lies somehow with people of color. It means explaining the links between a history of injustice, contemporary systems and practices, and the effects on children and families. Framing science shows that when advocates make these connections clear, it increases and broadens support for policies aimed squarely at eliminating racial disparities.

In addition to widening the lens, we need to bring prevention into crisper focus, using that clarity to disrupt the assumption that child abuse and neglect – or its worst outcomes – are bound to happen. As Dr. David Sanders, chairman of the federal Commission to Eliminate Child Abuse and Neglect Fatalities noted in his forward to the Commission’s seminal 2016 report: “Child protection is perhaps the only field where some child deaths are assumed to be inevitable, no matter how hard we work to stop them. This is certainly not true in the airline industry, where safety is paramount and commercial airline crashes are never seen as inevitable.” 

We need ways to reframe child abuse and maltreatment fatalities as a preventable public issue, and, most importantly, a solvable one.

We can increase support for prevention by emphasizing the connection between now and later – and by giving concrete, realistic examples of what prevention looks like in action. It is equally important to emphasize that solutions exist and to champion programs that work. The body of evidence-based practices is still growing, however, there are resources that currently exist to help support families in times of need. These include community-based child abuse prevention programs, such as home visiting programs and Family Resource Centers .

Most of all, we need a common commitment to aspirational, solutions-oriented storytelling that moves mindsets beyond narrow conceptions of “problems children experience” to an expansive vision of how to do right by kids. To build a broader constituency for those approaches, the story we tell must spark a sense of collective responsibility and offer a sense of realistic hope.

One of the most challenging aspects of communicating a solutions-oriented, preventive message around child welfare is the way in which media outlets cover this topic. Many media outlets cover child welfare primarily through a crime lens that focuses on the consequences of harm after it occurs. Since the start of the COVID-19 pandemic, we have seen increasingly hyperbolic stories about the dangers to children who are out of the public eye, most of which speculate on what to make of the fact that calls to child abuse hotlines are down substantially . 

These stories fit neatly with the larger cultural narrative of vulnerable children, but they are misleading. Experts know that reduced referrals do not tell us the whole story, nor is it fair to say that children are necessarily at higher risk while they are home with their families. In fact, research by Mathematica shows that it is mostly the low-risk referrals that have decreased during the pandemic; the high-risk referrals are still coming through.

As child welfare advocates, we must work to educate and guide journalists on covering child welfare stories from a preventative, public health perspective that highlights resources and solutions that will benefit families in need of support. 

If our field can successfully embrace a common narrative – one that emphasizes that we all have a stake and a role in addressing this issue – we will continue to build critical public support for the momentous shift from child welfare systems to child and family well-being systems that can enable all families to thrive.

Access the Reframing Childhood Adversity: Promoting Upstream Approaches webinar. This webinar will delve into newly released guidance from the FrameWorks Institute for building the public understanding and political will needed to effectively prevent, identify, and address childhood adversity.

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Julie Sweetland, PhD is a sociolinguist and senior advisor at the FrameWorks Institute. 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 previously appeared in The Imprint on March 16, 2021.

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.
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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.