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.

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

DOWNLOAD AGENDA

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:

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:

  1. Despite research studies such as the one presented by Dr. Sege and research from Chapin Hall and others on the benefits of economic and concrete supports for families, prevention remains under-prioritized as a public policy. Only 15% of child welfare spending is to support parents and keep children safely in their homes, compared to 45% of spending on out-of-home placements (the other 40% is divided between CPS/investigations, adoption, and guardianship)
  2. Three federal programs are due for re-authorization by Congress this year and can help to make community-based prevention more of a priority. They are 1) the Child Abuse Prevention and Treatment Act (CAPTA), 2) Title IV-B of the Social Security Act, and 3) the Maternal Infant and Early Childhood Home Visiting (MIECHV) program. A modest investment in families allows parents to care for their children the way they want to. Other critical supports to families are the expanded Child Tax Credit, paid family and medical leave, and quality childcare with improved access. Access to behavioral health services is another critical component to supporting families during difficult times, as multiple studies have shown an increased need during the pandemic.
  3. Solutions to improve child and family well-being must address equity and racial justice. Most families come to the attention of CPS for allegations of neglect, which are often related to economic insecurity. These families need economic and family support much more than child protection involvement. In fact, CPS often doesn’t have the resources to provide these types of economic and family support services and doesn’t do a good job of connecting families to resources. The policy solution is to disentangle economic hardship from neglect, showing how they are different, and offloading economic stressors experienced by families. We also need to better understand the results of mandatory reporting policies and look to reshape them as mandatory supporting policies. More than half of all Black children and more than ⅓ of all children in the U.S. are a subject of a child abuse or neglect investigation by the age of 18. This type of mandatory reporting structure does not encourage reporters to connect families with help from supportive programs before harm occurs and before families become involved with CPS, and it is a racial justice issue that requires immediate attention.
  4. Social Current is the national technical assistance provider to five demonstration sites for a federal demonstration initiative funded by the Department of Justice called Child Safety Forward. This national initiative is working to reduce child abuse and neglect fatalities and injuries through a collaborative, community-based approach. One of the five sites, the Michigan Department of Health and Human Services, is putting equitable solutions into practice as they expand Family Resource Centers across the state and improve safety planning to better address serious injuries and child fatalities from abuse and neglect. Through a collaborative approach to systems change, they are looking to respond differently to neglect allegations by focusing on protective factors and working to promote supportive services to families.
  5. As the federal Commission to Eliminate Child Abuse and Neglect Fatalities stated in its 2016 report “Within Our Reach,” child welfare agencies cannot do this work alone. Media can help to improve outcomes for children and families by covering child welfare more thoroughly, beyond the tragedies that occur, and increase public attention to prevention programs that work. In a national survey of parents with young children, even before the pandemic, 48% of parents report not receiving the help or support they need. Together, we can illustrate that a community-wide, public health approach to child and family well-being is required so that all parents are supported, and all families can thrive.

Panel handouts from the event:

A series of three evaluation briefs recently released by Child Safety Forward, a national initiative to reduce child abuse and neglect fatalities and injuries through a collaborative, community-based approach. This demonstration initiative, for which Social Current is the technical assistance provider, works to develop and test multidisciplinary strategies in five different demonstration sites over three years. These briefs were created as part of the initiative’s developmental evaluation approach.

“The developmental evaluation approach is critical to the success of the initiative and demonstration sites because it allows us to work collaboratively to uncover insight and use what we’re learning to adjust our efforts accordingly,” says Laura Pinsoneault, founder and CEO of Evaluation Plus, evaluator for Child Safety Forward.

During year one, the planning year, those participating in the initiative built a theory of change and implementation plans that would lead to a strengthened child and family well-being system. This approach elevated learning from across the sites and the technical assistance team as well as through the demonstration sites’ local data collection process.

In year two, while focused on implementation, the initiative refined the theory of change to include greater intentionality around three core conditions they believe are necessary to having this impact:

Each brief in this series takes a deeper look at one of these conditions. They highlight how Child Safety Forward is defining the condition, the strategies and approaches it believes will advance this condition, and the intermediate outcomes from those strategies. In addition, based on early learning during the first year of Child Safety Forward, it outlines a roadmap for this strategy. These roadmaps will be further refined through the implementation study conducted at the end of the second year of implementation and will contribute to each’s sites plans for sustainability.

Download the briefs online.

April is Child Abuse Prevention Month. In recognition, resources to support organizations in communicating about childhood adversity are now available at: BuildingBetterChildhoods.org.

These easy-to-use tools were developed through a partnership between Social Current and Prevent Child Abuse America and grounded in recent research from the FrameWorks Institute.

They are intended to support practitioners and professionals at human services organizations in describing how childhood adversity is a public, preventable, and solvable issue. The Building Better Childhoods website provides important guidance on how to talk about child abuse prevention in a way that resonates with a broad range of audiences. The tools can be used when communicating with media, funders, policymakers, and the general public.

The toolkit includes:

This Child Abuse Prevention Month and beyond—we hope you will join us in this movement to effectively frame childhood adversity and communicate about the benefits of prevention and upstream resources.

Visit BuildingBetterChildhoods.org to download the toolkit.

About the Reframing Research

Building Better Childhoods is based on recent research from the FrameWorks Institute, which was shared in the 2021 framing brief Reframing Childhood Adversity: Promoting Upstream Approaches.

The communications guidance is designed to be highly accessible and actionable. In addition, it takes recent science and current communications contexts into account, speaks to racial and social justice, and aligns with efforts to reimagine child welfare systems into child well-being systems.

Download the reframing brief online and view our on-demand webinar for a guided tour of the recommendations.

By Verleaner Lane and Daniel P. Riggins of Cook County Health

The nation’s child welfare systems have long been structured in a way that responds to incidents of child abuse and neglect after harm has occurred. There is a new movement in child welfare to change this and devote more resources to using data to identify those children most at risk. Based on what the data shows, front end resources and services can then be brought to bear in support of families before abuse or neglect occurs.

A good example of this can be found in the Child Safety Forward initiative. Funded through a grant from the U.S. Department of Justice, Child Safety Forward is a demonstration initiative to develop multidisciplinary strategies and a public health response to address fatalities or near-death injuries as a result of child abuse, neglect, or unsafe practices. The initiative takes place across five sites, including Cook County Health in Illinois.

Cook County Health established Project CHILD in 2019 to better understand and address infant-specific deaths due to maltreatment.

Our strategy includes bringing together a diverse group of community stakeholders that work with most affected families in a variety of different settings, including healthcare and mental health providers, community health workers, maternal infant health providers, faith leaders, educators and social service providers. Our work has been focused in three Illinois counties: Cook, Peoria, and Vermilion, with a goal of identifying the highest-risk geographic areas and targeting resources at 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 findings, we are now able to appropriately target resources and educational interventions to protect families from these catastrophic events. We are currently working with pediatricians and community organizations to develop safe sleep messaging and interventions targeted to these high-risk neighborhoods.

Child Safety Forward is an example of what can be accomplished through a data-informed, place-based approach that facilitates community engagement and targets interventions to families that need them the most. It reflects a growing trend in child welfare to shift from a reactive to a proactive approach and to highlight the importance of data sharing and collaboration when addressing complex problems like child safety.

By working across agencies and directing resources upstream, we can continue to support a shift from child welfare systems to child wellbeing systems that better serve all families.

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A version of this oped was previously published in The Daily Herald on March 31, 2022.

Verleaner Lane is the project director for Project CHILD of Cook County Health. Daniel P. Riggins, MD is with Cook County Health. This commentary is provided in memoriam of Dr. Majorie Fujara, former pediatrician at Cook County Health, who served as the principal investigator for Project CHILD and a tireless advocate for the welfare of children.

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.

Child welfare systems have traditionally focused on responding to allegations and incidents of child abuse and neglect, stepping in once warning signs or problems are already visible. What would it look like to have a system dedicated to engaging with parents and shoring up families all along the way so that problems are prevented before they occur?

This is the idea behind new federal policies, including the Family First Prevention Services Act, the Child Abuse Prevention and Treatment Act, and a national demonstration initiative funded by the Department of Justice called Child Safety Forward. What these all share is an effort to devote more resources to front end, upstream services that support families before abuse or neglect occurs and to remodel child welfare systems into “child and family wellbeing” systems that extend beyond child protection to all systems that help bolster child and family wellbeing.

These shifts are long overdue. Children’s early experiences get built into the brain’s architecture, so ensuring healthy, nurturing environments for infants and toddlers leads to healthy, thriving children and adolescents who are equipped to learn and fulfill their potential.

A stronger emphasis on promoting family wellbeing is also an important part of addressing racial injustices in the child welfare system – like the troubling fact that a disproportionate number of children who are removed from their families and placed in foster care are children of color. In fact, a February 2021 report from the Connecticut Department of Children and Families noted “African American and Hispanic/Latinx children are more likely to be substantiated for maltreatment, removed from their homes, and remain in care longer than White children.”

We all have a stake and a role in addressing this issue. We also have a responsibility to speak up in support of policies that put good jobs, safe neighborhoods, consistent health care, and great schools within reach for every family. Policies like the Child Tax Credit, which experts have noted has the potential to cut childhood poverty by half, and the recent research from Chapin Hall that shows that providing families with concrete supports like food, cash, and housing both strengthens communities and families.

Addressing disproportionality in the child welfare system is one of the key goals of the Child Safety Forward initiative. Funded through a grant from the U.S. Department of Justice, Child Safety Forward is a demonstration initiative to develop multidisciplinary strategies and a public health response to address fatalities or near-death injuries as a result of child abuse and neglect. The initiative takes place across five sites, and the Saint Francis site is primarily focused across the Hartford, Connecticut region.

In Hartford, the team faced socioeconomic conditions across the region, including poverty, racially segregated communities, and inadequacies in data collection and reporting that have led to limited opportunities for a proactive, preventative approach to addressing child safety. Central to this effort is the data-driven collaborative approach that engages parents alongside grassroots neighborhood organizations, caregivers, health professionals, researchers, foundations, state agencies, and others, with a goal of better equipping those with lived experience in the tools and resources they need to help their communities and families thrive.

Armed with data showing a higher-than-average number of unsafe sleep deaths among African American infants, the Hartford Child Safety Forward site was able to work with parents to develop and disseminate culturally appropriate safe sleep messages for their communities.

Parents are full members of the Hartford site’s stakeholder group, working in partnership with Child Protective Services (CPS) officials, pediatricians, community-based organizations, and other service providers. Community organizing and leadership development are among the methods used to build parent confidence and skills to assert the value of their lived experiences. The project helps prepare them to not only “speak truth to power” but to see themselves as powerful. One outcome of this process is that parents created a list of topics on which they want to be educated so that they can create a comprehensive, pro-active “Child Safety” curriculum that will be accessible to parents before CPS or law enforcement reports result in being mandated to classes.

By engaging parents as part of the solution and providing them with the tools and resources they need to improve their lives and their families’ lives, we can continue to support a shift from child welfare systems to child wellbeing systems that better serve all families. Child protection systems are important but represent only one aspect of a larger network of systems that can promote child and family wellbeing and unlock children’s full potential.

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A version of this op-ed previously appeared in The Hartford Courant on February 24, 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.

By: Katie Albright and Jody Levison-Johnson

Children thrive on positive and nurturing relationships with caregivers and other adults in their lives.

This means supporting a child starts with supporting their parents and caregivers, and too many are overloaded right now. COVID-19 has created immense burdens for people who are caring for children, and they are trying their best to stay afloat — from financial strains caused by job loss, to child care shortages, to the mental stress of keeping their families healthy. Too often, parents do not know where to turn for assistance when they need it. Even before the pandemic, a national survey of parents with young children found 48% did not receive the help they needed, with 8% saying they get no support at all.

We can relieve some of this stress and improve the well-being of children by providing support to families who may be struggling. Sixty percent of children who come to the attention of child protection systems do so because of concerns related to neglect, which can often result from living in poverty. If we want to prevent neglect, we need to address the root causes and ensure families are financially stable. By investing in preventive resources, public health approaches, and financial support for children and their families, we can implement effective long-term solutions that keep families together and ultimately keep young people safe.

We cannot afford to be solely reactive and only pay attention after a crisis occurs. Research shows that by working proactively to address immediate needs with concrete financial support, we can prevent families from needing child welfare involvement. Entities like Family Resource Centers and nurse home visiting programs are two best-in-class examples of how providing concrete supports — housing, income, and food — can alleviate the need to place children in the foster care system and separate them from their home, communities, and culture.

Fortunately, child protection in our country is changing for the better — from a system that responds only after a child has been harmed — to one that is more focused on the needs of children and families from the start. As representatives of organizations that work across the child protection spectrum from prevention to placement to reunification, we welcome this change. We have seen what works, and what does not.

Some may argue that removing children from their families, rather than finding ways to proactively support the family, is the right approach. Science, however, shows that further harm may occur when children and youth are taken from their support systems. Our focus should be on minimizing this trauma, especially for the majority of families who do not require removing a child from their home.

When parents are unable to care for their children, placing children with other family members can be the next best option. Studies have shown that child welfare policies that prioritize placing a child with their relatives or other guardians have significant benefits for the child. By investing in kinship care, we can help minimize a child’s trauma, increase stability and permanency, improve mental and behavioral health outcomes, and create an easier transition for these youth as they age into adulthood.

Further, our solutions must reckon with racism that is deeply embedded within the very system intended to protect children. Our children pay the price when we ignore this ugly reality. The structural flaws of the child protection system have a disproportionately negative impact on Black and Indigenous children compared to their white peers. Because of systemic and structural inequities, the child protection system is more likely to separate children of color from their parents and place them in foster care; place them with multiple families or in group homes; and reunite them less frequently with their birth families or establish a permanent home. All of this creates conditions under which children of color are less likely to attain equal social, behavioral, and educational outcomes.

Taken together, this paints a clear picture: We need to reimagine the child protection system. By funding programs that support housing infrastructure, child care assistance, and medical care, we can relieve significant stress for families — stress that we know has negative downstream effects on children. When we support parents and caregivers with the resources they need, everyone benefits. We all want what’s best for kids. Let’s start with their parents.

Katie Albright is an attorney and president & CEO of Safe & Sound, a San Francisco-based children’s advocacy organization dedicated to strengthening families and ending child abuse through evidenced-informed services, education, partnerships, and policy. Safe & Sound is part of a national network of family resource centers that partner with families each day to promote positive outcomes for children, caregivers, and communities.

Jody Levison-Johnson is a licensed clinical social worker with nearly 30 years of human service experience and the president and CEO of Social Current, a Washington, D.C.-based organization formed from the Alliance for Strong Families and Communities and the Council on Accreditation joining forces. Social Current creates and nurtures relationships among social sector organizations and drives the future of the sector through policy, advocacy, knowledge exchange, certification, and accreditation.

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. 

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.