By: Verleaner R. Lane

April has long been recognized as Child Abuse Prevention Month. This year, the conversation around prevention has broadened to include family strengthening, in recognition of the importance of families and communities having access to resources that can lessen family stressors and prevent child abuse and neglect before it occurs.

Science shows us that children are more likely to thrive when their families have the economic and social supports that they need. Enabling these positive childhood experiences requires that we reimagine child welfare and focus instead on child and family well-being with upstream resources that can prevent child abuse and neglect before it occurs.

Federal and state policies that connect families to economic support services, such as Temporary Assistance for Needy Families (TANF), housing assistance, and nutritional supplements have been shown to strengthen families and reduce child welfare interactions.

By shifting to a preventative child and family well-being system that offers upstream resources for families, the goal is to provide families with more services rather than more surveillance.

Federal policy is supporting this shift by authorizing more funding and more flexible funding for family-strengthening services through the Family First Prevention Services Act and the proposed reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA).

What does a family-strengthening approach to child safety look like in practice? Answering that question is the impetus behind a national demonstration initiative launched by the Department of Justice’s Office for Victims of Crime in 2019.

The project, Child Safety Forward, engaged five sites across the United States in a multi-year focus that included research, planning, and implementation around strategies aimed at reducing child injury and fatality from abuse and neglect. The sites selected are Cook County Health in Illinois; Indiana Department of Health; Michigan Department of Health and Human Services; Saint Francis Hospital in Hartford, Connecticut; and Sacramento County, California’s Child Abuse Prevention Council. 

Each site is developing strategies that are unique and specific to their communities, honoring and reflecting the data they collected in the first year to identify community-led solutions that support resilient families and keep children safe in their homes. Each site is also working with a collaborative body of stakeholders and partners, including those with lived experience, to guide the work and is reviewing short- and long-term goals through an equity and diversity lens.

Our strategy includes bringing together a diverse group of community stakeholders that work with the most affected families in a variety of different settings. Our work has been focused on three Illinois counties: Cook, Peoria, and Vermilion, to identify the highest-risk geographic areas and target resources in these communities.

We began our efforts by using a data collection process that had been established earlier by Cook County Health in partnership with the Cook County Medical Examiner. The process automates data exchange between these two Cook County agencies allowing for the linkage of clinical data to mortality events among specific populations as determined by the medical examiner. Data sharing across these agencies is automated to identify risk factors for mortality among individuals experiencing homelessness, those impacted by the opioid epidemic, those with justice involvement, and the intersection of these experiences.

For Cook County, we reviewed approximately 300 sudden unexpected infant deaths over the past five years likely related to unsafe sleep conditions. We identified specific neighborhoods that had a higher rate of sudden unexpected infant death.

Based on these lessons learned, we are now able to appropriately target resources and educational interventions to protect families from these catastrophic events by creating the Safety for Children 0-5 self-paced educational curriculum and adding scenarios to the Simulation Labs and the MDT Training. We worked with pediatricians and community organizations to develop safe sleep messaging and interventions targeted to these high-risk neighborhoods. The program, led by 12 government and community agencies, including Project CHILD, aims to address sudden unexpected infant death (SUID), one of the leading causes of infant mortality.

Illinois Safe Sleep Support will focus on outreach and education to expand the community-based promotion of safe sleep practices, promote resources to improve safe sleep environments, identify SUID disparities, and address opportunities for improvement. The investments of this year-long campaign will continue to position Illinois as a leading state for children, families, and the early childhood workforce that supports them.

All of the strategies across the five Child Safety Forward sites 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 parents 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 is working to create a body of knowledge about what works to reduce child fatalities.

As we celebrate Child Abuse Prevention, 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 removing children from families and/or attempting to address the consequences of adversity after a child has grown up. 

We all have a stake in our kids’ future and shifting our focus from child welfare to child and family well-being will help us create a future where every child can thrive and reach their full potential.

Verleaner R. Lane, MA. is the Project Director for Project Child as a Visiting Project Specialist contracted employee within the Institute for Legal, Legislative, and Policy Studies (ILLAPS) at the University of Illinois at Springfield. Cook County Health established Project CHILD in 2019 to better understand and address infant deaths due to unsafe sleep conditions, or from abuse or neglect.

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 and Chavon Campbell

When Saint Francis Hospital in Hartford, Conn. was chosen by the U.S. Department of Justice for a demonstration initiative to develop strategies and responses to address child fatalities from abuse or neglect, we didn’t expect the transformative nature of this project.

We began our efforts on the Child Safety Forward initiative three years ago with research and data analysis that showed that Hartford was an outlier when compared to Conn. and national child maltreatment rates. From 2015-2017 Hartford averaged 17.6 substantiated cases of child maltreatment per 1,000 children, nearly double the state and national rates during the same period. This and other disparities evident in the data demonstrated the need for a greater understanding of the underlying causes of disparities and risks for child maltreatment, particularly around prevention messaging for communities of color.

With a guiding principle of “those closest to the problem are closest to the solution,” we sought to bring parents together to form a Parent Engagement Work Group that would work closely with a multidisciplinary team of stakeholders composed of state agencies and community-based organizations to better understand the underlying issues.

 We recruited parents from existing relationships in the community, with the Greater Hartford Family Advocacy Center at Saint Francis Hospital, and with members of the Hartford Parent University (HPU), a grassroots organizing agency that trains and supports parents to advocate for quality education. We met with state agency leaders, child abuse pediatricians, and community agency directors to review the data and better understand the risks for child maltreatment that contributed to injuries and fatalities.

Perhaps the greatest area of learning on this topic was the parents’ perceptions of risks. Early in the formation of the Parent Engagement Work Group, parents made it clear that they wanted to address issues beyond child abuse and neglect by caregivers, noting that there are many environmental, systemic, and other types of threats to the safety of children. Examples included non-caregiver abuse and exploitation, drugs, suicide, and community violence, in short, all threats to child safety and well-being.

This led parents to focus on the ways in which they receive child safety education, which in most cases, was only mandated by child protection agencies after an allegation of abuse or neglect, leading parents to view child safety education as reactive and punitive. They wondered if other communities or families had better access to comprehensive and preventative child safety education.

The biggest impact came when the parents were presented with the data that showed that the death rate of Black children due to abuse and neglect was two times that of white children.

They asked how people who were not members of their communities (not just racially/ethnically but socio-economically and culturally) knew more about their collective reality than they themselves and made plans for them without communicating with those directly affected.

And while child fatality data is released publicly by state agencies, for a variety of reasons, including a lack of trust between families and state agencies, that data rarely reaches the populations who need it most.

Parents asked if and how they could be more involved in planning and carrying out research on their own communities and then using that data to plan improvements for child, family, and community well-being.

Based on their findings, the parents came together to develop a comprehensive educational guide to teach parents about multiple topics related to child well-being. Entitled “From Pain to Parenting,” the guide outlines a series of training workshops, led by parents, on a range of topics related to child well-being, including unsafe sleep, domestic violence, sexual abuse and assault, mental health, firearm safety and gun violence, and disabilities.

The Child Safety Forward Hartford initiative will serve as a springboard for establishing ongoing planning and action on preventing child maltreatment fatality and near fatality. The project will transfer from Saint Francis Hospital to the Institute for Community Research (ICR) as the lead agency, with Voices of Women of Color and Hartford Parent University as partners. ICR will train a group of parents to design and implement their own research and will conduct sessions to help parents understand data and advocate for data-sharing with communities. 

Hartford Parent University will provide ongoing training on topics identified by parents as they relate to Hartford Public Schools, especially regarding children with disabilities and children belonging to other marginalized communities. Voices of Women of Color will provide training in community organizing and advocacy and will lead the recruitment of a parent engagement group for each of Hartford’s thirteen neighborhoods.

The Hartford Child Safety Forward site was unique among the other demonstration sites in focusing on parent and community organizing and the purposeful shifting of power to those most affected. By combining the disciplines of research, community organizing, and prevention education, we were able to engage parents in a meaningful dialogue about the things that matter to them most – the safety and well-being of their children.

By elevating their voices and experiences and authentically shifting power to these parents, we ultimately learned far more from them about how to prevent abuse and neglect and build a Child and Family Well-being System that can strengthen families and enable all children to thrive. Our field will be all the richer for it.

Regina S. Dyton, MSW, served as principal investigator and project manager for the Child Safety Forward Project in Hartford. Chavon Campbell, MBA, is director of compliance for Hartford Communities That Care and project manager for the Pain to Parenting Project.

 This commentary was supported by cooperative agreement number 2019-V3-GX-K005 Reducing Child Fatalities and Recurring Injuries Caused by Crime Victimization, 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 are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Social Current was pleased to be included at the in-person event to recognize the fifth anniversary of the Family First Prevention Services Act (FFPSA), hosted by the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) in Washington, DC. To mark the occasion, on March 1, 2023, HHS and ACF leadership gathered stakeholders, delivered remarks, and brought together panels of legislators, national experts, and state and tribal leaders. The event featured videos from families with lived expertise in the child welfare system. The conversations reflected a rich understanding of why the legislation was created, what it has accomplished, its challenges, and where we go from here to better support families. The recording for this event is available here.

Five years ago, FFPSA was enacted to enhance upstream and supportive services for families to help children remain safely at home with their caregivers, reduce the unnecessary use of congregate care, and build the capacity of communities to support children and families. At the anniversary event, Social Current observed five takeaways that will help to shape future opportunities to support thriving families and communities.

• Create community pathways to family success outside of child welfare. All families need help sometimes, and we must create pathways for families to receive that help from trusted community-based organizations. Child and family well-being is a shared responsibility across communities, as we all benefit from strengthening families.  This responsibility includes child protection but is not limited to it, as it extends to all systems that help to bolster child and family well-being. More and more public systems are recognizing that families are best served in the community. These community pathways will require systems change that normalizes and de-stigmatizes help-seeking behaviors.

• Reduce child welfare’s footprint. As these community pathways are established, child welfare can safely reduce its footprint and effectively serve a smaller population of families. Shifting more resources toward upstream prevention in the community, rather than reacting by the child welfare system, does not mean that we give up our responsibility to keep children safe. Shifting our focus to support families before they are known to child welfare will ultimately mean that fewer children require protection because their families are better supported, safe, and healthy.

• Bring Medicaid and SAMHSA to the table. FFPSA authorized new optional title IV–E funding for time-limited prevention services for mental health, substance use disorders, and in-home parent skill-based programs for children or youth who are candidates for foster care, pregnant or parenting youth in foster care, and the parents or kin caregivers of those children and youth. To move further upstream and support more families outside of the child welfare system, Medicaid can be utilized and accessed for services that can reduce the involvement of child welfare. Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. This collaboration can be informed by the science generated through the Substance Abuse and Mental Health Service Administration (SAMHSA), demonstrating that addressing behavioral health keeps families strong and together.

• Build the evidence base for cultural adaptation of programs. There is a lack of research models that build the evidence base for cultural adaptation of programs and services, coupled with an awareness that there is disparity across child welfare systems that too often results in more children of color coming to the attention of child welfare. These research models need to be community-engaged and community-designed. The Title IV-E Prevention Services Clearinghouse should prioritize populations and problems that are underserved by the current array of programs. This should encompass communities of color, including Tribal communities. It should also include programs that address domestic violence, economic supports to reduce poverty, and peer/parent mentoring programs. 

• See all ACF and other family-support programs as preventative. Our goal should be to invest prevention dollars, including those spent on concrete and economic supports, in more children than the number of children we are removing from their homes and families. To accomplish this, we need to see all family-support programs sponsored by ACF and others as preventative. The human and social services sector is at the forefront of an evolutionary change, one that aims to realign social services to be more preventative with greater upstream resources that focus more directly on addressing the social determinants of health (SDoH) to achieve better outcomes. The potential to improve health outcomes and more fully address SDoH through a public health and a system of care approach with greater investments in human services could transform a range of systems, including health, education, welfare, and criminal justice systems and ultimately result in greater well-being for all families.

Achieving these reforms will require a tremendous shift in resources, both at the federal funding level to redirect funding to more front-end resources, through policies that adapt to a more preventative approach, and in the way that place-based services are delivered by community-based organizations. Passage of FFPSA is a first step in that journey for child welfare. Too many of our social systems were structured to respond only after harm occurs – by realigning our nation’s social service delivery systems and reimagining the power and impact of the social sector, we can deliver on the promise of equitable access to health and well-being for all people.

The Department of Justice, Office for Victims of Crime, and Social Current are offering free training and technical assistance to law enforcement agencies looking to improve workforce retention and officer well-being. This 18-month initiative has 12 spots for law enforcement agencies to join. All types of agencies are welcome, including but not limited to:

• Municipal police
• Sheriff’s departments
• Tribal agencies
• School district police departments
• Juvenile and youth corrections
• Corrections officers
• Transit police agencies

During this initiative, agencies will learn and grow together. Social Current’s technical assistance team will introduce hope-centered and trauma-informed frameworks and principles related to equity, diversity, and inclusion that will help the agencies better address trauma and adversity to improve their workforce.

View this detailed letter about the initiative and register for our virtual open house on March 14 or March 20 from Noon-1 p.m. PT.

Direct any questions to Romero Davis, senior program manager at Social Current.

Strategic organizations are transformative organizations. They look beyond current experience to anticipate future trends and opportunities. They ask, “Why?” and evaluate answers within a future-oriented context. They expect to change.

Trendspotting and trend analysis can be powerful for strategic planning by creating credible illustrations of what the future might look like. Based on that, community-based organizations and their cross-sector partners can align community priorities and resources to help all people reach their full potential.

Incorporating a diversity of trends topics is particularly useful for creating a strategy where the end product is a long-term plan to be implemented over multiple years. Such plans aren’t just about identifying broad goals to be realized, but also key strategies for how the organization will meet those goals. 

Designing Useful Trend Inquiry

Core to trendspotting is research, and two types of research—primary and secondary—are best for identifying data that can inform activities like strategic planning, risk assessment, and opportunity mapping.

Primary research is firsthand research using methods like interviews with consumers and program participants, employees, community leaders and advocates, academic subject matter experts, regulators, policymakers, funders, and other stakeholders.

Secondary research uses available data and information found in reports and databases from diverse industries, which can be used as sources for trend determination. Examples can include demographics and other census tract information, local asset mapping, state and federal data (e.g., Adoption and Foster Care Analysis and Reporting System [AFCARS]), and more.

The essential process of trend investigation is about asking the right questions about the right things. These can roughly be divided into three areas, with examples of questions below:

• Identification of trends. What are the trends we should follow? Are there any associated systems and disciplines we need to understand better before determining trend relevance?
• Analysis of the effects and possible projections.In which directions can a trend lead? What impact can a trend have on our strengths and weaknesses? Can we expect more or less support from partners and collaborators?
• Analysis of the implications.What do these trends mean for our community? How will child and family well-being change as a result? Do we have adequate organizational capacity in relation to this trend?

Getting the Most Out of Scenario Planning

Since no one can tell the future with 100% certainty all the time, developing robust scenarios can help bridge present circumstances with future requirements. The range and value of organizational opportunities based on trend analysis depend on scenarios that should include most of these criteria:

• Plausible. Logical, consistent, and believable
• Relevant. Highlighting key challenges and dynamics of the future
• Divergent. Different from each other in strategically significant ways
• Challenging. Questioning fundamental beliefs and assumptions

By evaluating relevant trends compiled through primary and secondary research and using the analysis to explore governance and operational scenarios, the ability to optimize programs and services and create achievable pathways to child and family well-being is strengthened.

Harnessing Trends

The Social Current Knowledge and Insights Center, available through our Impact Partnerships, helps professionals in human/social services to learn, improve, and innovate by providing timely, useful, and relevant information and resources. This is done by:

• Employing an evidence-first approach to evaluate and scan the knowledge base of an area of inquiry, especially scope, relevance, and utility
• Reviewing and evaluating information sources for credibility and thoroughness
• Working closely with subject matter experts to define specific questions to be answered, problems to be solved, or opportunities to uncover
• Systematizing the information in a way that users can quickly and easily understand

Professional librarians in the Knowledge and Insights Center routinely gather trends data on a variety of organizational topics, such as workforce resilience and service innovation, as well as meta trends that encompass demographics, systemic and environmental factors, technology, and more.

Hot Topics from 2022

Below are some of the key topics that have been monitored in 2022, with an insight summary, brief source examples, and related resources and offerings from Social Current:

Integration of Workforce Resilience as a Key Organizational Sustainability Strategy

Resilience is a buzzword and seen as necessary for workplaces. But can organizations improve employee resilience? Some think yes, others think no. “A resilience-oriented workforce spans many disciplines and training programs will need to reflect that. It requires a collaborative organizational model that promotes information sharing structures.”

Sources:

• What Leaders Get Wrong About Resilience
• Beyond Disaster Preparedness: Building a Resilience-Oriented Workforce for the Future

See Also:

• Partner with Staff to Build a Resilient Workforce
• Keeping Our Trauma Therapists Healthy with Vicarious Resilience
• Workforce Resilience Consulting

Providers Increasingly Incorporating Social Determinants of Health in Service Delivery  

Social determinants of health (SDOH) and adverse childhood experiences (ACEs) profoundly impact lives of individuals. Both SDOH and ACEs are risk factors for childhood mental health disorders, health, and social outcomes. These factors include housing instability, food insecurity, poverty, community violence, and discrimination. There are ways to help address these risk factors, and this includes things like quality education, safe neighborhoods, and positive parent-child relationships.

Sources:  

• Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response

See Also:

• Social Determinants of Health Issue Brief
• Screening for Social Need and the Social Determinants of Health
• Health and Mental Well-Being SPARK Exchange

Biggest Public Health Threats to Teens Are Mental Health Disorders

Teenage pregnancy, smoking, binge drinking, drunken driving and smoking are no longer the biggest public health threats to teens. It is now rising rates of mental health disorders. With up to one in five children having a mental, emotional, development, or behavioral disorder, and rising rates of mental health visits in emergency rooms and depression symptoms rising during the pandemic, it is critical to pay attention to the mental health crisis in young people today.

Sources:  

• Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory
• Mental Health–Related Emergency Dept. Visits Among Children <18 Years During COVID-19 Pandemic
• “It’s Life or Death”: The Mental Health Crisis Among U.S. Teens

See Also:

• Tackling the Silent Epidemic of Childhood Grief
• Mental Health in the Spotlight (Federal Update)

Post-Pandemic Mental Health Crises Driving Change to Suicide Prevention Strategies   

With rising rates of depression and anxiety compared to prior to the pandemic, the new U.S. suicide hotline 988 comes at a critical time. Suicide is a leading cause of death for people ages 10-34 years old, and 90% of those who died by suicide had a “diagnosable mental health condition at the time of their death.”

Sources:  

• Depression and Anxiety Escalate During COVID
• 988 Key Messages; American Foundation for Suicide Prevention

See Also:

• The Promise of 988: Accelerating Community Response to Suicide Crisis

Successful Mental Health Interventions Are More Dependent on Cultural Responsiveness     

Cultural competencies and cultural responsiveness for mental health providers is now seen as critical, even “a matter of life and death.”

Source:  

• Why is Cultural Competence Important in Mental Health Care

See Also:

• Mapping Adolescents’ Community Histories
• See Why Incorporating Community Voices Achieves Equitable Solutions

Integrated Community and Systems Response Counteract School-to-Prison Pipeline  

The school-to-prison pipeline is a “disturbing national trend wherein youth are funneled out of public schools and into the juvenile and criminal legal systems. Many of these youth are Black or Brown, have disabilities, or histories of poverty, abuse, or neglect, and would benefit from additional supports and resources. Instead, they are isolated, punished, and pushed out.” 

Source:  

• School-to-Prison Pipeline: What’s at Stake

See Also:

• Federal Public Policy Agenda: Policy Principles
• Advancing Equity SPARK Exchange
• Education Success SPARK Exchange

Other top trends recently updated by the Knowledge and Insights Center:

• Children in Poverty
• Adoption and Foster Care
• Substance Abuse
• LGBTQ Youth and Mental Health/Suicide

How to Access Our Specialized Researchers & Tools

As you plan for 2023 and beyond, make sure you’re utilizing all the tools in your toolbox. Join our Dec. 7 webinar for an in-depth overview of the Knowledge and Insights Center. For more information on the resources portal, including the Ask-a-Librarian reference request service, visit the Social Current Hub or contact the Knowledge and Insights Center.

About the Knowledge and Insights Center

The Knowledge and Insights Center offers a robust resources portal through the Social Current Hub, which includes a digital library with over 22,000 records; aggregated research and business databases; diverse topic collections and library guides; original content summarizing complex information; and coaching that helps users maximize these resources. Our team includes professional librarians with wide-ranging skillsets and extensive experience in collection development specific to the nonprofit social services sector.

By: Susana Mariscal and Bryan Victor

There is a shift taking place across the nation regarding child abuse and neglect fatalities. These heartbreaking tragedies make headlines across every community, with a focus on why systems failed our children and how these children fell through the cracks.

As the U.S. Commission to Eliminate Child Abuse and Neglect Fatalities notes, child welfare systems have historically been focused on addressing harm only after it has occurred. Fortunately, federal and state agencies along with local nonprofits and community leaders are beginning to work collaboratively and create a multi-system service continuum to provide the resources that families need beforehand, preventing abuse and neglect before it occurs. We can see evidence of that shift, with demonstration projects across the U.S., including Indiana, that are identifying risk factors (e.g., contributing factors) for child fatalities, moving resources upstream to support families, and building on protective factors with an emphasis on prevention.

The Indiana Department of Health (IDOH) is one of five sites nationwide participating in a Department of Justice demonstration initiative known as Child Safety Forward (CSF). With support from technical assistance providers and multidisciplinary child fatality review teams, IDOH has conducted research focusing on Clark, Delaware, Grant, and Madison counties that identified unsafe sleep-related deaths as the leading cause of death due to external causes (e.g., sleep-related, drowning) for children ages 0-18 years old, excluding medical reasons. The findings from IDOH – based on a 5-year retrospective review – highlighted that Black infants are at a heightened risk for sleep-related deaths (55.9%t; 19 of 34 deaths) and that sleep-related deaths have been underreported throughout the state due to inconsistent and incomplete documentation of Sudden Unexpected Infant Deaths (SUIDs). High quality, accurate fatality data enables jurisdictions to better understand and address risk factors, improving the effectiveness and actionability of recommendations.

Based on these findings, IDOH took several steps to expand the state’s ability to prevent child fatalities. They developed Community Action Teams to implement prevention initiatives, and are working collaboratively with Prevent Child Abuse Indiana chapters and Family Resource Centers run by the Strengthening Indiana Families project to educate the public about safe sleep practices. Family Resource Centers are a one-stop-shop for families, providing tailored resources to address their needs and build on their strengths. IDOH has also developed videos providing safe sleep information and stories of parents who lost a child in unsafe sleep environments. (For more information on safe sleep, visit the IDOH website.)

Informed by findings from the CSF initiative, Indiana legislators passed House Enrolled Act 1169 — which went into effect on July 1, 2022 — establishing consistent standards for SUID investigations and data collection, aligning with the Centers for Disease Control and Prevention best practices, including pathology and toxicology.

It is important to note that, in 2020, in 95 of 168 cases identified (56.5 percent), children were unknown to Child Protective Services before the fatality, indicating that government agencies like the Indiana Department of Child Services alone cannot prevent these deaths. The work of fatality prevention lies with all of us: neighbors, community members, and the full range of professionals that serve children and families. To increase our effectiveness at preventing these fatalities and reducing racial disparities, the multiple systems that serve families must collaborate and share information to provide coordinated, holistic services. Communities also need to increase their formal and informal supports for families, so that all parents in the community have equitable access to the resources they need to be connected and safe. Every parent needs help at some point and -as the Family Resource Centers’ motto says- “Kids don’t come with instructions. We’re here to help.” Let’s all join in the nationwide shift toward prevention by supporting families in our communities so that children can develop their full potential. Imagine what a difference we all can make in the lives of children in our community when we work together proactively to keep the most vulnerable among us safe.

A version of this article appeared previously in the Indianapolis Star on October 6, 2022.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005 Reducing Child Fatalities and Recurring Injuries Caused by Crime Victimization, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice and by the Children’s Bureau, Administration for Children, Youth and Families, Administration for Children and Families, USDHHS, under grant 90CA1864. 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 and the Children’s Bureau.

By Amy Templeman, director of Within Our Reach at Social Current

There is a shift taking place across the nation regarding child abuse and neglect fatalities. These tragedies, long considered inevitable, make headlines across every community and jurisdiction, with a focus on why systems failed our children and how these children fell through the cracks.

One finding points to the fact that child welfare systems have historically been focused on addressing harm only after it has occurred. Now imagine a system that works collaboratively across multiple agencies to provide the resources and supports that families need to prevent abuse and neglect before it can occur. That is the shift taking place today, with demonstration projects taking place across the United States, including Indiana, that are identifying risk factors and moving resources upstream to address the stressors that families face and with an emphasis on prevention.

The Indiana Department of Health (IDOH) is one of five sites nationwide participating in a Department of Justice demonstration initiative known as Child Safety Forward. With support from a broad range of technical assistance providers, IDOH has conducted research that identifies unsafe sleep-related deaths as the leading cause of death due to external causes for children ages 0-18 years old, when excluding medically expected fatalities.

Their findings, which focused on Clark, Grant, Delaware, and Madison Counties, highlighted the fact that infants are at a heightened risk for sleep-related deaths and that those deaths were being underreported throughout the state based on inconsistent and incomplete child fatality reviews. Furthermore, they found that inconsistent and incomplete documentation of Sudden Unexpected Infant Deaths (SUIDs) had the potential to limit knowledge of the true rates of SUIDs and the risk factors. High quality, accurate fatality data enables jurisdictions to better understand and address risk factors, promoting the effectiveness and actionability of recommendations.

It is important to note that, in 107 of 140 of the cases identified, children were unknown to Child Protective Services (CPS) before the fatality, pointing to the fact that CPS alone cannot address these deaths and supporting the need for a public health approach to child maltreatment-related fatalities.

Based on these findings, IDOH took several important steps. They developed Community Action Teams in each of the four counties to create avenues for distribution of safe sleep information and resources through pediatricians, vaccination sites, and other channels. They connected with Family Resource Centers and Prevent Child Abuse chapters to share information and identify resources for families.

They also shared their data with government leaders and policymakers, which helped lead to improved SUID policies in Governor Holcomb’s 2022 Next Level Agenda. On July 1, 2022, House Enrolled Act 1169 went into effect, establishing consistent standards for investigations into SUIDs, aligning with the Centers for Disease Control and Prevention best practices. This alignment will ensure that coroner investigations into deaths among healthy children who die suddenly and unexpectedly are handled consistently across the state and include imaging, pathology, and toxicology.

Child abuse and neglect fatalities, including unsafe sleep deaths, are not inevitable. They are preventable, solvable and an issue that we all have a stake in addressing. For more information on safe sleep guidelines, visit the Indiana Department of Child Services website on Safe Sleep.

A version of this article previously appeared in the Indiana Herald Bulletin on September 15, 2022.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005 Reducing Child Fatalities and Recurring Injuries Caused by Crime Victimization, 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.

If there is to be significant change, there needs to be significant research.

In 2020, the Annie E. Casey Foundation, Casey Family Programs, and the William T. Grant Foundation came together to address the gaps they saw in child welfare research. With their overarching goal to reduce inequality within the system, they identified research gaps that spanned community-based family supports, child protective services, out-of-home care, and post-permanency services. They partnered with 50 individuals representing an array of experts, stakeholders, and people with lived experience to identify these gaps. With information from those conversations, they outlined the most urgent needs in the report, Building a 21st-Century Research Agenda. This initiative continues to conduct research to address these identified gaps and answer key questions, as well as increase the use of this research in decision-making.

In partnership with these three leading organizations, Social Current is hosting a five-part webinar series that digs into the research agenda. These sessions highlight different areas of focus within the agenda.

• Cutting through the Chaos by Reframing Childhood Adversity | Oct. 11
• How Monthly Cash Gifts Are Fostering Infant Brain Development | Oct. 13
• Supporting Safe and Effective Investigations through Training Labs | Nov. 29
• Building Protective Factors through Family Resource Centers | Dec. 1
• An Anti-Racist Approach to Child Neglect Investigations | Dec. 6

Together, we can move toward a child welfare system that prioritizes equity and dignity and drives change with greater power and pace.

Read this recent blog by the William T. Grant Foundation to learn more about the initiative.

Hear more from initiative participants in this video.

By: Dr. Daniel P. Hall Riggins and Verleaner Lane

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. Despite this progress, national public health efforts to prevent Sudden Unexpected Infant Death (SUID) have hit a standstill, prompting the American Academy of Pediatrics (AAP) to update its guidance on safe sleep practices.

When the Back to Sleep Campaign was first launched by AAP in the 1990s, our nation saw unprecedented decreases in infant death based on initial recommendations that babies are safer if placed on their backs to sleep. That progress stalled, however, by the early 2000s, with infant mortality rates remaining stagnant at around 85-100 deaths per 100,000 births each year. Part of this was because educational campaigns were not effective across all segments of the population. Today, dramatic racial disparities persist with American Indian/Alaska Native and Non-Hispanic Black infants suffering rates more than twice those of Non-Hispanic White infants. The reasons for these disparities, including the impact of structural racism and poverty, have largely been left out of the conversation.

Cook County SUID trends contrast from national ones in important ways. From 2015 to 2019, the county experienced great strides in reducing infant mortality, decreasing the overall yearly incidence from 291 to 203 deaths per 100,000 births. Despite those positive trends, the county’s rate is still twice the national rate. Although most of the improvement in Cook County is due to a reduction in SUID among black infants, the residual disparities remain starker than those seen nationally. In 2019, the Cook County incidence of SUID in Non-Hispanic Black people was over 10 times higher compared to Non-Hispanic White infants.

With a focus on reducing disparities, including those that are racially-based, the AAP updated its safe sleep guidance in a new policy statement released on June 21, 2022. It focuses on contextualizing safe sleep behavior within broader societal and cultural factors. In addition to reiterating the “ABCs” that babies should sleep Alone on their Back in a Crib, the AAP makes the following updates:

• Along with using a firm surface as in a crib or bassinet, the AAP adds that the surface should be flat. The most important implication is that parents should carefully watch their infant when placed in a stroller, car seat, or swing and transfer baby to a flat surface when they fall asleep.
• The AAP continues to support breastfeeding for all infants less than 6 months because of its association with decreased risk of death. Now they highlight how breastfeeding particularly benefits pre-term and low-birth-weight infants.
• Co-sleeping with an infant is especially risky when done with specific other behaviors. Now the AAP breaks down that list of behaviors into groups of relatively similar risk. For example, the following are associated with over a 10-fold increase in the risk of death when co-sleeping:
• Impaired by fatigue or sedating drugs
• Having recently smoked
• Using a soft surface
• The AAP still endorses keeping the sleep surface bare of extra cushions or blankets that could accidentally suffocate baby. Now they add additional nuances such as using layers of clothing rather than blankets, not using hats, and not using any sort of weighted cloth.
• In addition to recommending against smoking, the AAP now discourages any kind of nicotine exposure, which would include vaping products.
• The AAP strengthens its wording to explicitly discourage use of home heart/lung monitors under the rationale that these products are not adequately regulated by the Food and Drug Administration (FDA) for a life-preserving context and might falsely lull families into a sense of complacency.
• In a substantial revision to earlier guidance, the AAP calls for funding of research on the social determinants of health, health care delivery system inequalities, and the impact of structural racism.

Pediatricians have long faced limitations when working with families to implement safe sleep practices. Placing the burden on parents without a larger understanding of the health care disparities and limitations in access to quality care also affects how families address safe sleep. That is why community-based collaborations are so important to conveying guidance within cultural contexts.

That is the goal of Cook County Health’s participation in the Child Safety Forward initiative, one of five sites that was selected for a Department of Justice-funded grant to reduce child abuse and neglect fatalities and injuries through a collaborative, community-based approach. As part of the initiative, Cook County Health has convened a multi-disciplinary group of stakeholders and has deployed an innovative simulation training at the Child Protection Training Academy of the University of Illinois Springfield to help identify risk factors for communities that can lead to unsafe sleep practices.

The collaboration of several organizations, including Project CHILD, Be Strong Families and EverThrive Illinois has led to the development of a comprehensive education curriculum that draws on these new recommendations from the AAP. The curriculum and online training, Safe Sleep, Safety 101, will be available to communities across Illinois in the Fall of 2022.

Using a public health approach based on the AAP’s guidelines, we are working with a collaborative body of stakeholders to build a body of knowledge and share timely information. Educating specifically through an equity and diversity lens will more effectively achieve our goal of helping all families implement safe sleep practices to reduce child fatalities.

Daniel P. Riggins, MD is a pediatrician with Cook County Health. Verleaner Lane is the project director for Project CHILD of Cook County Health, one of five Child Safety Forward sites.

A version of this piece appeared in the Chicago Sun-Times as a letter to the editor on August 22, 2022.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005 Reducing Child Fatalities and Recurring Injuries Caused by Crime Victimization, 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.

Social Current was proud to sponsor a national press panel held by Chapin Hall at the University of Chicago on May 31. Ruby Goyal-Carkeek, senior vice president at Social Current joined a panel of parents from the Alliance National Parent Partnership Council (ANPPC) along with child welfare professionals, and medical experts including Robert Sege, MD, PhD. The focus of the panel was to help members of the press better frame future stories that touch on child welfare and child protection with a pro-family lens. There were approximately 70 participants including reporters from The Boston Globe and Washington Times in attendance.

During the panel, Ruby Goyal-Carkeek highlighted several key insights to improve child and family well-being including work that Social Current has undertaken:

Panel handouts from the event:

• Press Panelists’ Biographies
• Chapin Hall–Economic Concrete Supports Deck
• Sege R, Stephens A. Child Physical Abuse Did Not Increase During the Pandemic. JAMA Pediatrics. 2022;176(4):338–340.
• About HOPE