• February 2019
  • Vol. 20, No. 1

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Prevention Is Well-Being Work

Written by Melissa T. Merrick, Ph.D., senior epidemiologist, detailee, Office of the Commissioner, Administration for Children and Families, Children's Bureau

As I reflect on my 20 years working with and for children and families, I'll never forget the day I was confronted with the reality that I was not in the business of preventing child abuse and neglect.

In walked a young couple with a 9 month old child, the same age as my daughter at the time. The baby presented with patterned bruising on her torso, and the parents described just needing her to stop crying. As tears streamed down all of our faces, they continued, "We just didn't know what to do!" The father had been spending most of his days looking for work, but there were few jobs for someone with his level of education and nonexistent job training that would actually pay the family's bills. The mother was also unemployed and was struggling to comfort her difficult-to-soothe infant. She did not have access to the mental health services she knew she required to help her cope with her own unresolved trauma. They had no family or social support in their neighborhood, having just moved. They spoke only Spanish and asked whether all Americans regarded Spanish speakers as "less than."

"Ok," I thought for a split second, "maybe I am just crying because I am postpartum and emotional." No. I was crying because the situation was very sad. It was sad that we, as a field, were not in the business of prevention.  We, as a field and as a society, were actually in the business of blaming parents, particularly young parents, single parents, and parents of color for their challenges and circumstances. We were in the business of saving children from their big, bad, terrible parents, rather than responsibly assuming the roles we must all play to prevent child abuse and neglect and to build, bolster, and strengthen families and communities.

This same day, I realized that I yearned to be in the business of prevention for children and families—and, frankly, for my own mental health—I joined the Centers for Disease Control and Prevention shortly thereafter.

A public health approach requires that we assure the conditions for lifelong health and well-being before parental stress becomes unbearable and crisis mode is fully engaged. It requires that we implement policies and practices that stop early adversity like child abuse and neglect before it begins, thereby stemming the flow of children and families who encounter the child protection agency in the first place. It requires that we identify and address the structural, contextual, and historical barriers to thriving communities, families, and children. Given the multigenerational impacts of trauma and adversity and the systemic inequities that accompany such, a multigenerational prevention solution that improves the conditions within which parents are caring for their children is imperative.

We know that children and families will reap more of the benefits of treatment and clinical services if the conditions within which they are living and developing improve. Not to mention, they will be able to make it into treatment and services in the first place if their basic necessities are met and they have access and means to access services and preventive interventions.

Prevention is possible if we are willing to work in a different, collaborative, and, dare I say, empathetic way. We must work across systems, across silos, and across disciplines to call for a new narrative for all children and families. My now 10-year-old daughter, and all of our sons and daughters, are more likely to thrive if all children are thriving. Please join me in the actual business of prevention. 

 

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