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February 2019Vol. 20, No. 1Let's Enhance the Well-Being of All Children by Building Vibrant and Healthy Communities Together

Written by Frank L. Alexander, director, Boulder County Department of Housing and Human Services, Boulder, Colorado

It is time for us to lift our eyes from the consuming confines of our individual agency work and aim higher—much higher. We have been working for decades to reach the moment that we have before us, an opportunity to truly transform our historically isolated child protection agencies (CPAs) into component parts within integrated systems of care that build vibrant communities and enhance the well-being of all children. We all know this must be done, we know it is not impossible, and, yet, we can't quite see the path forward. That should only further encourage us to sit together with determination and urgency and get to work. When answers are not easily seen, and when fear of failure arises, we need to be thoughtful in how we approach the work we must do. Carl Jung stated, "in sterquiliniis invenitur", meaning that which we most need to find will be found where we least want to look. 

Last year, CPAs received 4.1 million referrals involving 7.4 million children. Every day across the United States, we receive referrals on more than 20,000 children. Our child protection systems are overloaded responding to the needs of families with children aged 0 to 5 years that should be met much earlier in our communities. Nationally, between 1,750 and 5,250 children die as a result of maltreatment; 84 percent of child maltreatment fatalities occur in children between the ages of 0 and 5 years, and 50 percent of those occur before the age of 1; 62 percent of all child fatalities occur before the age of 1; the rate of child maltreatment is highest among children under the age of 1, at 24.8 per 1,000, and 50 percent of all child maltreatment occurs before the age of 5; and of the 700,000 children that spent time in care last year, a full 40 percent (280,000) were under the age of 5. The highest rate of fatalities, near fatalities, egregious incidents, out-of-home placements, and child victimization are experienced by children under the age of 1, followed closely by children under age 5. We know that 75 percent of founded instances of child maltreatment are neglect. We know that rates of child abuse and neglect are five times higher for children in families with low socioeconomic status. With all of that being said, we still illogically define child safety as the absence of repeat maltreatment, not the freedom from maltreatment. It is time that we establish a collective national goal to prevent child maltreatment and eliminate child fatalities among our youngest children ages 0 to 5 by positively and proactively supporting strong and healthy families. 

We do not have a problem that should be or can be owned by the child protection system, we have a public health problem that requires a much more comprehensive solution. The social and economic costs of child maltreatment rival every major public health issue, including diabetes, cancer, stroke, obesity, and chronic heart disease. For children, there are physical, psychological, and behavioral outcomes that negatively impact lifelong health and social vitality. For society, the annual cost associated with child maltreatment is $80 billion, and the estimated lifetime economic burden resulting from new cases of child maltreatment each year is $124 billion. Significant public health issues require coordinated policy and practice solutions across sectors.

To prevent maltreatment and eliminate fatalities, we need a new foundation. The cornerstone of this foundation is built on strengthening our national alignment among critical federal health and human agencies; private foundations; state and local child protection, human services, and public health agencies; and community agencies serving children and families. By combining direct services for children and families with population-level strategies, we can support the building of vibrant and healthy communities and advance the necessary work of deconstructing the siloes that still largely operate among the health-care, public health, housing, education, and human services systems. The child well-being system needs strengthening and better coordination. Only by activating broad cross-sector coalitions far beyond the child protection agency will we improve child well-being and address the community drivers of health. 

Together, we know much of what needs to be done. A broad swath of well-documented studies outline the need to advance child abuse and neglect prevention strategies within broad community efforts around strengthening economic supports for families, supporting parents, providing quality care and education early in life, promoting healthy child development, and developing interventions that lessen harm and prevent future risk. Child well-being is cultivated within vibrant and healthy communities. It is time for us to aim higher—much higher. Let's name child maltreatment the public health problem that it is, roll up our sleeves, and build the public will and national alignment necessary to end it.