A Public Health Approach to Create a 21st Century Child Welfare System

8/19/2020

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: 

  1. Define and monitor the problem. 
  2. Identify risk and protective factors. 
  3. Develop and test prevention strategies. 
  4. 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.

Children’s Bureau Joins Alliance Members for Conversation on the Future of Child Welfare

8/10/2020

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. 

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

6/1/2020

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.

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.

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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.

For questions or more information about guest submissions for this blog, contact us