October 2020Vol. 21, No. 7Public Health's Role in Creating Child and Family Well-Being
Written by James A. Mercy and Phyllis Holditch Niolon, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention*
The creation of a child protection system that works proactively to promote child and family well-being, rather than one that simply reacts to violence and adversity, has great potential to improve the health of children, families, and entire communities. As such, we see public health, at the national, state, and local levels, as a key partner in the transformative effort, Thriving Families, Safer Children: A National Commitment to Well-Being, sponsored by the U.S. Children's Bureau, Casey Family Programs, the Annie E. Casey Foundation, and Prevent Child Abuse America. The primary goal of this effort is to "move from traditional, reactive child protection systems to those designed to support child and family well-being and prevent child maltreatment and unnecessary family separations (Children's Bureau, Casey Family Programs, Annie E. Casey Foundation, & Prevent Child Abuse America, 2020)." Public health aligns with the goals of this initiative and brings unique and important perspectives to this multisectoral partnership. First and foremost, public health brings a focus on prevention, rather than response, and puts prevention at the forefront of its efforts (Mercy et al., 1993). Second, public health makes science integral to identifying and developing effective policies and programs. And consistent with the intent of this initiative, public health brings a tradition of integrating the efforts of diverse scientific disciplines, organizations, and communities in applying and scaling up effective solutions.
The challenges to the well-being of children and families are myriad, but exposure to violence and other forms of adversity is a particularly formidable barrier to their well-being for several reasons. First, over half of children in the United States experience or witness violence every year (Finkelhor et al., 2015). Most of these victims rarely encounter police, child welfare, or other social services but may be helped through preventative actions (Afifi et al., 2015). Second, the more violence and adversity a child is exposed to the greater the likelihood that she or he will experience mental health problems, chronic and infectious disease, and economic challenges during her or his lifetime (Merrick et al., 2019). Many of these health consequences do not become apparent until years after exposure (National Scientific Council on the Developing Child, 2020). Moreover, exposure to violence and adversity during childhood can be rooted in underlying social determinants of health, such as poverty and racism, that are difficult to change (Mercy and DeGue, 2013). A focus on promoting the well-being of all families and children that acknowledges and addresses these social determinants of health has the potential to prevent exposure to adversity for all children, not just those who might have otherwise come into contact with the child welfare system. The current model of child protective services is not designed to prevent children's exposure to violence or neglect. Rather, it is designed to react and intervene once they have occurred and are recognized and reported. However, creating a system that applies the public health principle of prevention, and proactively supports families in ways that promote the well-being of parents and their children, has the potential to reduce their exposure to violence and other forms of adversity in the first place, thereby substantially reducing their risk of experiencing the broad range of physical, mental, and behavioral health problems linked to early exposure to violence and adversity (Centers for Disease Control and Prevention, 2019; Merrick et al. 2019).
This transformative effort holds the promise of ensuring that children and their families are supported and healthy and, thereby, will contribute to setting the conditions for shared well-being. We know a lot about the types of programs and policies that can create well-being for children by ensuring they are raised in safe, stable, and nurturing relationships and environments (Centers for Disease Control and Prevention, 2019). Included among the strategies are those that seek to strengthen economic supports to families and strengthen social norms that protect against violence and adversity. Other strategies being implemented by communities seeking to protect children and adolescents from violence include parent training, connecting children to caring adults and activities, and helping children and adolescents acquire protective social-emotional skills. Early interventions, such as home visiting and high-quality child care, that serve to ensure a strong start for children and their families are being implemented on a much broader scale across the country than has previously been the case (Adirim and Supplee, 2013). The importance of providing social and psychological services that aim to lessen the immediate and long-term harms when children experience violence and adversity are also gaining greater traction as efforts to create trauma-informed organizations and communities take hold.
Much of the violence and adversity that children experience is hidden from those who have the potential to help until it is much too late. Thriving Families, Safer Children: A National Commitment to Well-Being offers an innovative model for truly protecting children by supporting and promoting the well-being of their families, thereby preventing their exposure to harm and adversity before it happens. This approach and the partnership that supports it will also serve to elevate the priority we give to preventing the trauma that threatens the well-being of children and families everywhere. Victor Hugo famously said, "The invasion of armies can be stopped, but not an idea whose time has come." Bringing together child welfare agencies, public health, and other key sectors to build a stronger foundation for family health and well-being is an idea whose time has come.
References
Adirim, T. & Supplee, L. (2013). Overview of the federal home visiting program. Pediatrics, 132, Suppl. 2, S59-S64. doi: 10.1542/peds.2013-1021C
Afifi, T. O., MacMillan, H. L., Taillieu, T., Cheung, K., Turner, S., Tonmyr, L., et al. (2015). Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey. Child Abuse & Neglect, 46, 198-206 doi: 10.1016/j.chiabu.2015.05.001
Centers for Disease Control and Prevention (2019). Preventing adverse childhood experiences: Leveraging the best available evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Children's Bureau, Casey Family Programs, Annie E. Casey Foundation, & Prevent Child Abuse America (2020). Press release: First-of-its-kind national partnership aims to redesign child welfare into child- and family-well-being systems. https://preventchildabuse.org/latest-activity/press-release-thriving-families/
Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the National Survey of Children's Exposure to Violence. JAMA Pediatrics, 169(8), 746-754. doi: 10.1001/jamapediatrics.2015.0676
Mercy, J. & DeGue, S. (2019). Violence. In Levy, B. S. (Ed.), Social injustice and public health. Oxford: Oxford University Press.
Mercy, J. A., Rosenberg, M. L., Powell, K. E., Broome, C. V., Roper, W.L. (1993). Public health policy for preventing violence. Health Affairs, 12(4), 7-29. doi: 10.1377/hlthaff.12.4.7
Merrick, M. T., Ford, D. C., Ports, K. A., Guinn, A. S., Chen, J., Klevens, J., et al. (2019). Vital signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention-25 states, 2015-2017. MMWR. Morbidity and Mortality Weekly Report, 68(44), 999-1005. doi: 10.15585/mmwr.mm6844e1
National Scientific Council on the Developing Child. (2020). Connecting the brain to the rest of the body: Early child¬hood development and lifelong health are deeply intertwined. Working paper no. 15. www.developingchild.harvard.edu
*The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
