October 2020Vol. 21, No. 7Print issueThriving Families, Safer Children

Issue Spotlight

• Bring Up Nebraska: Community-Led Prevention Is Making a Difference

  Bring Up Nebraska: Community-Led Prevention Is Making a Difference

  Written by Stephanie L. Beasley, M.S.W., director, Division of Children and Family Services, Nebraska Department of Health and Human Services, and Jennifer Skala, M.Sc., senior vice president, Nebraska Children and Families Foundation
  
  Nebraska will always prioritize the protection of children. But when is that protection necessary? It is important to understand that children can be best protected when systems and communities prioritize the well-being of children and families, long before there is a concern for a child's safety. The majority of maltreatment toward children in Nebraska is termed as neglect, and through investigations of neglect we have the ability to understand what leads to a child being removed from their home and into the child welfare system. This learning can help Nebraska mitigate the factors leading to removals early on, before neglect occurs.

  Jerry Milner and David Kelly of the Children's Bureau recently published, "The role that poverty plays in child welfare decision-making is a topic that has yet to be meaningfully confronted and addressed. Poverty is a risk factor for neglect, but poverty does not equate to neglect. The presence of poverty alone does not mean a child is unsafe, unloved, or that a parent lacks the capacity to care for his or her child. Poverty can make it more challenging for parents to meet their children's needs. We must be resoundingly clear that a child should never be removed from his or her family due to poverty alone."

  The critical work laid before child welfare leaders involves making evident the differences between poverty and neglect. While poverty may create barriers for families to meet the needs of their children, we must recognize unintended biases that often lead children and families into system involvement. It is necessary to establish a focus on the well-being of children and families led by those most impacted and in the communities where families can flourish. It is in collaboration with youth, families, and communities that we will establish a clear vision for child and family well-being.

  In Nebraska, we have already begun this important work. Local communities are creating well-being systems with collaboration, data, evidence-informed practices, and innovation. Bring Up Nebraska is based on the belief that everyone faces challenges and providing support early, before challenges turn to crises, improves outcomes for children, adults, and communities. Local communities are best situated to provide supports to build protective factors and resilience and are primed to determine strategies to protect and promote child and family well-being.

  Nebraska has an opportunity to help families early, long before the family comes to the attention of the child welfare agency. For example, Barb, a single mom, was being evicted but found support through a local community response navigator, a strategy born out of Bring Up Nebraska. She risked homelessness and her children living elsewhere, but instead this support ensured her children remained with her in stable housing. A temporary boost, such as rental assistance, can help families get through a difficult situation.

  In 2017, First Lady Susanne Shore recognized potential within existing community prevention efforts. Her leadership galvanized state and local partners to align under the Bring Up Nebraska umbrella. This partnership allows state agencies to collaborate with community-based efforts to understand the strengths and needs of each community and support the development of community-based approaches to prevention. There are currently 22 collaboratives covering 81 counties, each working to identify unique priorities and resources to strengthen children and families.

  The Bring Up Nebraska approach to community well-being has received national recognition as a promising, transformative solution to the complex social problems faced by our most marginalized and economically challenged populations, including those in rural and tribal communities as well as in the underresourced, racially and ethnically rich neighborhoods of our metropolitan areas.
  
  This collective impact-framed infrastructure and has emerged over 20 years of practice in the following:

  • Community capacity building
  • Data collection and long-term tracking of well-being indicators across multiple sectors
  • Evaluation of evidence-informed and evidence-based programs and policies
  • Infusion of public and private funds to meet the needs of young people and families before challenges necessitate higher-end system involvement
  • Engagement of stakeholders across the provision and beneficiary spectrum

  
  All Bring Up Nebraska collaboratives have a community response (CR) program of formal and informal supports (e.g., churches, public health, child care, schools) committed to keeping children, young adults, and families safely in their homes and out of public systems. CR relies on youth and family engagement and practices such as central navigation, coaching, and flexible funding to provide tailored services acceptable to each family or individual. The array of resources is accessed through collaborative partners who formally pledge to support families first, no matter the barriers (e.g., funding, eligibility).
  
  Bring Up Nebraska's bright spots are many and include the following:

  • Since 2007, Nebraska has realized a 50 percent reduction of substantiated rates of abuse and neglect. This transformation is attributed in part to prevention supports, increased protective factors, and new practices authentically involving communities and persons with lived experience.
  • During the 2018-2019 program year, collaboratives directly served more than 2,000 families and more than 5,000 children, with 91 percent of the families served at risk due to poverty and 49 percent identifying as Hispanic, Black, Native American, or multiracial.
  • Multigenerational emphases, practices, and policy changes are addressing whole family well-being.
  • A robust data collection and evaluation mechanism is in place. Since 2007, over 300 stakeholders have worked to identify 12 key indicators of well-being. Every Nebraskan can see local indicators in Nebraska Community Opportunity Map, created in partnership with Casey Family Programs.
  • Tribal communities, as well as predominantly Latin and Hispanic communities and metropolitan centers comprising neighborhoods where majority Black, African American, African, and Asian refugee and immigrant populations reside because of historical segregation, are all active Bring Up Nebraska locations.

  Nebraska has made progress, but more is needed. We must continue to bring in more elected officials, businesses, community members, and more representation from those disproportionately impacted by state systems. That's why Thriving Families, Safer Children: A National Commitment to Well-Being will be such a positive boost to our work. Children and families need engaged stakeholders creating pathways for communities to address systemic challenges and transforming those systems.
  
  Learn more about how Bring Up Nebraska is a call to action here.  
  
   

• Moving Upstream: The Urgency of Transforming Systems

  Moving Upstream: The Urgency of Transforming Systems

  Written by Michael D. Warren, M.D., M.P.H., F.A.A.P., associate administrator, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
  
  A public health fable: Imagine that you are walking alongside a peaceful river on a beautiful fall afternoon. As you continue your walk, the tranquility is interrupted by the sounds of splashing and cries for help. You look out and notice that someone is drowning in the river. So you immediately jump in, swim to them, and help them to shore. As you are helping them up on the bank to safety, you hear more screaming and splashing. You turn around and see someone else struggling in the river. So, you swim back out, grab them, and bring them back to the riverbank. By this point, as you're feeling a bit weary, you hear more splashing and cries for help. And—you've guessed it—there's another person struggling in the river that needs your help. About this same time, you see someone jogging along the riverbank. You call out to them, "Can you help me?" The jogger keeps going along. You call out again, "Hey, why won't you stop and help me?" The jogger looks at you and says, "I'm going upstream to find out why these people are falling into the river in the first place."

  For those of us who work with children and families—whether it be in the context of child welfare, public health, pediatric primary care, or early childhood education—we can often feel like we spend the bulk of our days pulling people out of the river. We see the impact of adverse childhood experiences, acute and chronic stressors on families, and longstanding community inequities manifest in myriad ways: inattention or acting-out behaviors, chronic physical and behavioral health problems, and child abuse and maltreatment. So, we've built our system to respond to this—to diagnose and treat those maladies. And that's okay, if we want to spend our days pulling people from the river when it's nearly too late. But it doesn't have to be that way. A focus on primary prevention helps to prevent disease and harm before it ever happens, to move upstream to prevent people from falling into the river in the first place.

  At the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB), we have incorporated this primary prevention approach into many of our programs. We are thrilled that our partners at the Children's Bureau are now embarking on the exciting new Thriving Families, Safer Children: A National Commitment to Well-Being initiative. This effort will radically transform the child welfare system as we know it—from one that is largely reactive, responding when someone makes a report of suspected abuse or neglect, to one that is focused more upstream on supporting communities and families to thrive and achieve their fullest potential.

  Fortunately, we already know many of the key ingredients needed to support healthy child development and prevent child maltreatment. Children develop best in the context of safe and nurturing relationships, in which they are engaged and supported through "serve-and-return" interactions. Families thrive when they are surrounded by a range of "protective factors" that can reduce sources of stress, build resilience, connect them to social supports and needed resources, and enhance their skills to guide their children's development. There are already many parenting programs, evidence-based home visiting models, and behavioral health supports that have proven effective in promoting healthy development and preventing child maltreatment. Despite their effectiveness, these programs are often not available to families or, contrary to a preventive approach, are available or accessed only after problems emerge.

  HRSA's MCHB is committed to partnering with the Children's Bureau and community partners in implementing this new initiative by taking all that we know and translating it into priorities and programs that create a unified primary prevention system that reduces child maltreatment by promoting well-being from the start. One way MCHB can support this initiative is through our Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, which supports pregnant women and families to develop necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn. The program builds upon decades of scientific research showing that home visits by a trained professional during pregnancy and early childhood help to prevent child abuse and neglect, support positive parenting, improve maternal and child health, and promote child development and school readiness.

  Another way MCHB will advance the Children's Bureau's initiative is through our Infant-Toddler Court Program. Using a cross-sector approach, this program not only provides intensive individualized support to court-involved families with infants and toddlers but also brings together service providers, family members, community representatives, and other experts to make systems work better for families. The program seeks to change the knowledge, culture, and practices of the court system and community partners to advance two-generation, trauma-informed approaches to strengthen families and prevent future maltreatment. We must continue to look even further upstream. Ideally, we shouldn't wait until a family interacts with the child welfare or judicial systems to marshal the necessary resources and support to keep them well.

  Further, MCHB's Early Childhood Comprehensive Systems (ECCS) build comprehensive systems of care at state and community levels to effectively support young children and their families to reach their full potential. ECCS ensures families can access resources for basic needs, such as food and diapers; improves connections to quality child care or mental health services; and identifies and addresses parental depression early. No matter which "door" a family enters for help, ECCS puts families at the center to build bright futures. 

  Working together and reenvisioning our systems in these ways is not always easy, but the urgency and complexity of the current moment requires that we do so. It will take all of us. MCHB is excited to partner with the Children's Bureau, and we stand ready to expand our reach and advance a public health approach to accelerate our pace of change, move upstream, and together realize a transformed child welfare system for the benefit of all children and families.
  
   

• Vision as an Action Word

  Vision as an Action Word

  Written by Jerry Milner and David Kelly
  
  A vision without action is just a bunch of words. There can be art and poetry in those words. Words can express values and stir emotion, and history tells us that vision is necessary to inspire action and provoke meaningful change. History also tells us that vision alone, without action, cannot achieve or sustain a transformation of great proportions. Transformation requires more. It requires comfort with discomfort, thinking, and acting differently. It requires owning one's contributions to the problem and letting go of what is not serving those we serve. It requires fidelity to a clear purpose of doing and being better.

  Successful social transformations do not take pause to convince the skeptics or wait for all the support they may need to solidify. Rather, acting on a clear vision, they set out to demonstrate what can be done, and when this occurs, transformation is possible. Successful social transformations are not about disruption for disruption's sake or destruction. They are about creating with purposeful intention, divestment in what is not working and more investment in a just alternative that is inclusive of antecedent value but exceeds it. They are about striving to achieve a vastly different and better state—a new state, something that is doable if we work hard and smart enough in a unified fashion.

  Transformation is possible when we, collectively, are compassionate enough to go after conditions as opposed to people, when we realize that our efforts to "fix people" after they have experienced trauma will never be enough to overcome history and ameliorate systems and structures that perpetuate poverty, disparity, and harmful cycles of family instability. We must, instead, see inherent value in preventing trauma—and aggressively prosecute its root causes. Failure to do so is to endorse and enable suffering. We can create the conditions for strong and thriving families where children are free from harm. We can demonstrate that children are safer when families thrive. We can and will show the power of community in supporting families and keeping them healthy and well. We can make a national commitment to well-being, grounded in thriving families and safer children.

  We recognize that no one agency, organization, or system can create the conditions families and communities deserve, the conditions that make clear the inherent worth and dignity both possess and nurture that worth and dignity. To do so, we are committing more boldly, transparently, and collaboratively than ever before to do right by families. The core partnership we have entered into with Casey Family Programs, the Annie E. Casey Foundation, and Prevent Child Abuse America is an invitation for public accountability. We invite all to watch and keep each partner honest and focused on this essential work. We cannot afford to fall into familiar patterns of distraction or allow the effort to become diluted. Staying true to our intention is integral to our success.

  Success will not foreclose our need or dedication to being as effective at healing as we possibly can be at all times; however, it does require a commitment to well-being as the best and most compassionate strategy for lessening the occurrence of trauma and the ensuing need for healing.

  Results will not be immediate, but learning will be and has already begun. The work is unlikely to be flashy or sensational—we may not grab the headlines. We are not beginning with large, new investments or miraculous cures in mind or hand.

  Our greatest tool is humility.

  Humility grounds us in the understanding that we are not the sole, or best, proprietors of knowledge about what families and communities need. In fact, humility provides us with awareness that the wisdom we need to be most helpful can only be found in families and communities. Humility leads us to measure what matters to families and communities—and captures strengths and resiliency instead of deficits alone, measures that harness what it means to thrive. To be sure, we will offer, adapt, and align the resources and learning we do have in unprecedented ways, and we will continuously push for more support to do what is right.

  We will create evidence in partnership with families and communities as opposed to imposing it on them. When we share and shift power in such fundamental ways we will create fundamentally different conditions and achieve more equitable and humane experiences and outcomes.

  Transformation is possible if we make vision an action word.
  
   

• Colorado Solutions Lie in Listening to Families

  Colorado Solutions Lie in Listening to Families

  Written by Heather Hicks and Fikile Ryder, members of the leadership team for the Colorado Partnership for Thriving Families
  
  As parents, we are at the center of a societal transformation in Colorado. We are striving for systemic change within all communities, emphasizing shifts to support all families across our great state by utilizing a shared responsibility model with no one system carrying the weight of child maltreatment prevention. This metamorphosis is being driven by members of the Colorado Partnership for Thriving Families (the Partnership), an improvement collaborative working to create the conditions for strong families and communities where children are healthy, valued, and thriving. Parents don't just have one seat at the table guiding this work, we are true partners and our voices are driving a sense of urgency to strengthen families right now.  

  Our experiences as families navigating systems safely to access resources for our children are guiding conversations. Our stories advocating for programs that supported our families in those critical early years are illustrating what too many families are missing out on in too many communities. As immigrants, we have shared our fears about gaining access to and navigating the system. As mothers, we have shared stories of the most difficult moments in our lives during pregnancy and throughout the first 5 years of our children's lives, hoping to shed some light on how the health-care system is not working for us. As fathers, more and more, we are opening up about our frustrations about parenting and expressing interest to learn more about child development only to find too few spaces for us. No one parent's experience is guiding this work. We are taking the time to understand what families are experiencing and how they are feeling in order to assist them in reaching their full potential individually and as a whole family unit. 

  We are proud that Colorado is one of four states chosen by the U.S. Children's Bureau, Casey Family Programs, the Annie E. Casey Foundation and Prevent Child Abuse America to participate in a national effort to prove it is possible to fundamentally rethink child welfare by creating the conditions for strong, thriving families where children are free from harm. The technical assistance and resources that national partners are investing in us will enable Colorado to approach this work differently, as a county-administered human services system, by embracing local and creative solutions to prevent abuse or neglect of children before it ever occurs. Using the socioecological model to stress a shared responsibility within local and state systems—well beyond child welfare to include public health, economic development, and health-care systems—our new system shares responsibility for the prevention of child maltreatment and the well-being of children and families.

  Our work in Colorado is unique because there are so many differing perspectives on how to accomplish the same goal: reducing child fatalities and child maltreatment for all children aged 0 to 5. A wide variety of community leaders, state and county partnerships, and family voices from across the state are aiming to strengthen our neighborhoods and society as a whole.

  It is exciting to be a part of this work because we know we can prove that families and children will prosper living in a society that believes in fundamental equality and access to adequate health care, resources, and positive community connections. The placed emphasis on empowering families of all colors and creeds to be a part of identifying the changes that need to be made is also driving a greater insistence on equal quality care for all and need to better equip individuals with the tools they need in order to thrive. Nothing is designed for us, without us.

  Together, we are focused on three key priority areas:

  • Aligning funding streams, programs, and outcomes within state and county human services, public health, and health care systems
  • Strengthening services and support throughout pregnancy and the first year of parenting
  • Changing community norms to increase social connections and community support for families

  These priorities are important to us because they will reshape and redefine what it means to be a part of and live within a thriving village in Colorado. A village that relies on healthy policies, focuses on breaking down barriers, and transforming communities through empathy and understanding of the real experiences of families trying to raise children. A future where our village reaches out to us to decrease social isolation, where the services we need are known to us and easy to access, and where mothers of color can trust that they will get the health care they need so having a baby isn't life or death.

  The pandemic highlighted to the world our preconception that prenatal and family systems are unstable. Our dialogue on what it means to seek and receive care, guidance, and assistance—not only during vulnerable times but also during the stable and secure moments—needs to change.

  Every aspect of our present well-being is due to the lack of work spent on creating a collaborative system that we can all benefit from:

  • Colorado has one of the highest rates of low-birth-weight births in the country, at about 9 percent but as high as 26 percent in some counties.
  • A total of 27.3 percent of women felt down, depressed, or hopeless since their baby was born sometimes, often, or frequently.
  • An estimated 54,000 parents in Colorado reported that they felt aggravation from parenting usually or always in the past month. On the 2017-2018 National Survey of Children's Health, over 10,000 Colorado parents admitted that they didn't think they were handling the day-to-day demands of raising children well, and 1 in 5 parents stated they did not have anyone to turn to for day-to-day emotional support with raising children.
  • Colorado has seen a 12 percent increase in the number of children that were victims of first-time child maltreatment in the past 5 years.
  • Of Colorado child maltreatment fatalities in state fiscal year 2017-2018, 52.9 percent of children were under the age of 1 year, and 82.4 percent were under the age of 5 years.

  
  Children's development does not have a pause button. We, too, cannot wait until this pandemic is over to change. Families need improved access to health care, social connections, mental/emotional support, therapy, affordable housing, reliable transportation, parent education, and, most importantly, positive encouragement now. Look for Colorado to shine a light on how to get everyone in the community involved in building a village in which we can all thrive by transforming our current systems and connecting with each other to create a new system that proactively supports child and family well-being.
   

• Because Childhood Lasts a Lifetime

  Because Childhood Lasts a Lifetime

  Written by Melissa T. Merrick, Ph.D., president and chief executive officer, Prevent Child Abuse America
  
  When I reflect on the last 20 years of science in the field of child abuse and neglect and other early adversity, I am struck by the confluence of neurobiological, psychosocial, and economic research that all find that the seeds of lifelong and even intergenerational health, well-being, and prosperity are founded in our earliest years. Yet, this same field in practice has developed overwhelmingly as one that is reactionary and rooted in the belief that early identification and trauma-informed responses are the gold standard. Our systems, policies, and appropriations have largely been designed to strengthen and support children and families only after they have found themselves in crisis. Indeed, the dominant narrative in this country has been that a "bad parent" maltreats their children and that children must be rescued from such "bad parents." However, science also tells us time and again that children are generally safer with their families than from their families, particularly when their families are strengthened and supported before they find themselves in crisis.

  Children experience their world through their relationships. It is how we grow, learn, adapt, and succeed. We want these relationships to be as safe, stable, and nurturing as possible. Yet, we must always remember that relationships develop within a sociopolitical context that is either supportive or not of these healthy relationships. 

  Child abuse and neglect is not inevitable; it can absolutely be prevented. Science also shows us that. 

  When systems and stakeholders in communities and across sectors partner in purpose to keep families strong by reducing parental stress, thereby helping keep parents emotionally regulated, children do better because their relationships can be more regulated too. Put in even simpler terms, when parents and families do better, children do better! We know that most Americans want every child to grow up feeling secure and being safe to explore and access the many opportunities in their worlds. As such, the collective shift to a child and family well-being system underscores that we all have a role to play in ensuring that children and families thrive. 

  Thriving Families, Safer Children allows the Children's Bureau, the Annie E. Casey Foundation, Casey Family Programs, and us in the Prevent Child Abuse America family the great fortune of partnering with communities to create the conditions for strong families where children are free from harm. It allows us to continue to strive for a future in which children grow up happy, healthy, and prepared to succeed by focusing on a comprehensive public health approach with equity at its core. Together, we can and must actively dismantle the root causes of stress and anxiety, the inequities, that can lead to child abuse, neglect, and other adversity and trauma in the first place so that all children can meet their full health and life potential.

  A coming together across child welfare, health, philanthropy, and other sectors can model at the national level what we know has been increasingly effective in communities for prevention and will necessarily create more positive outcomes for children. When we collectively call for and create conditions for health and health equity, through expansion of evidence-based home visitation programs like Healthy Families America, through family-friendly policies such as paid family and sick leave, and through providing concrete supports to families, for example, families and entire communities are strengthened and more resilient. 

  Parenting is always challenging. But parenting during a global pandemic, acute racial and civil unrest, and increasing natural (and unnatural) disasters can be excruciatingly difficult! We need each other more than ever. We need each other in ways we never have before, or at least in ways that we didn't know we needed each other before. We need to act with empathy and kindness, propelled by science to transform the ways we are there for children and families.

  Together, we can prevent child abuse, America, because childhood lasts a lifetime!
  
   

• The Time Is Now for a New Path Forward

  The Time Is Now for a New Path Forward

  Written by David Sanders, Ph.D., executive vice president of Systems Improvement, Casey Family Programs

  Now is the time for those of us in the field of child welfare to challenge the status quo of policies, practices, and funding that have for decades limited our horizons and too often failed to achieve the basic goals of safety and healthy life outcomes that all children and families deserve.

  The sudden and unprecedented health and economic challenges wrought by COVID-19 have brought into sharp relief the long-standing and inequitable challenges far too many children and families must overcome every day in underserved and marginalized communities. The police killing of George Floyd in Minnesota and the death of 16-year-old Cornelius Fredericks in a residential youth facility in Michigan have led to a long-overdue reckoning of the role that systemic and institutionalized racism plays not only in holding back those same children and families from sharing in the promise of our nation but whether they are even allowed to survive at all.  

  We can no longer rely on the old way of doing business when it comes to the health and safety of our children and families. We must seize this moment in our history to support communities in designing and building new, inclusive, equitable, and more effective networks and partnerships that will prevent the trauma of maltreatment before it occurs and ensure that all children and families have access to the opportunities and supports they need to thrive.

  This is why Casey Family Programs is partnering with the Children's Bureau, Prevent Child Abuse America, and the Annie E. Casey Foundation to launch Thriving Families, Safer Children: A National Commitment to Well-Being.

  We are committed to combining the experience, knowledge, and resources of the many national, tribal, state, and local partners working to improve child and family well-being with the wisdom and perspectives of those who have experienced child protection systems firsthand. Thriving Families, Safer Children will help communities in forging the partnerships, policies, and practices necessary for primary prevention strategies that reduce child abuse and neglect from occurring in the first place while creating the supports and opportunities that all families need to reach their full potential.

  Child protection systems should be proud of progress already made, such as safely reducing the number of children and youth in foster care, including congregate care. However, what we know works does not consistently align with what we do.

  Too often, we see children separated from their families; placed in multiple foster or group homes; left to languish in state office buildings while workers search for foster families; abused while in care; and aged out of the system without a high school diploma, permanent family, or place to live. Yet, most children who leave foster care return safely to their families. We need to ask ourselves much earlier whether government intervention will actually be better for children and modify the decisions that separate families based on whether the government has something better to offer.

  We need to acknowledge that child and family well-being is not solely the responsibility of the child protection agency. Public systems' responsibilities include public health, mental health, early childhood, substance use treatment, housing, and education. Child protection is only one of the public systems responsible for child well-being, and in each community the community-based supports are also significant contributors.

  Those with lived experience and expertise are essential partners in developing this new path forward. With this necessary perspective as an equal voice, equity and community health and well-being will be prioritized. This effort, led by community members themselves, will feel, look, and be very different. Yet it will lead to a system that is truly focused on well-being and strengthening families before they come to the attention of child protection agencies.

  Thriving Families, Safer Children provides a space and intention to cultivate those partnerships across government, community, constituencies, and other sectors. Alongside that, the Family First Prevention Services Act and the related Family First Transition Act are important tools for prevention and creating a new child and family well-being system.

  To see how communities are already responding in new and innovative ways to today's challenges, I encourage you to read our just-published special report, Building Communities of Hope: Creating a Better Future for Children and Families in a Time of Crisis. The stories show that change is not only possible, but it is already taking place.

  The urgent need to overcome the barriers to systemic and long-lasting change are personal for me. Prior to joining Casey Family Programs, I led child welfare systems that include the cities of Minneapolis and Los Angeles. I have watched with sadness, pain, and horror the events of the last several months and recognized the same underlying problems that I and many others struggled to address.

  Today, it is clearer than ever to me that we must fundamentally change how we work—and with whom we work—to achieve our shared goal of child and family well-being. I believe we have within our grasp the knowledge; experience; and, most importantly, commitment across the public, private, philanthropic, and nonprofit and faith-based sectors to help community members develop truly effective and sustainable solutions to ensure that every child is safe and every family thrives.

  Please join us in building this new path forward. Now, more than ever, we have no time to lose.  
   

• Transforming South Carolina's Approach to Child Welfare

  Transforming South Carolina's Approach to Child Welfare

  Written by the South Carolina Department of Social Services and The Children's Trust of South Carolina

  The concept is simple. South Carolina can keep families together and children out of the child welfare system if it makes sure the state's families have the resources, skills, and abilities to provide nurturing home environments.

  The reality, however, is more complex, and it will require innovative shifts in how South Carolina approaches child welfare. The focus must be on a preventative system that boosts family well-being and supportive communities rather than one that is reactive to individual cases of trauma and violence.

  South Carolina is one of four jurisdictions participating in Thriving Families, Safer Children: A National Commitment to Well-Being, a national program to redesign child welfare. The program is being developed by the U.S. Children's Bureau, Casey Family Programs, the Annie E. Casey Foundation, and Prevent Child Abuse America to create more just and equitable systems to break harmful multigenerational cycles of trauma and poverty to benefit all children and families. 

  It takes all of us working together to prevent child abuse, and this project puts those words into action. 

  The success of families and children is dependent upon nurturing environments. For South Carolina to make this transformation to a more proactive approach, it must increase the protective factors around families and ensure resources are available within communities and that those resources are truly accessible to families regardless of race or socioeconomic status. It will incorporate a holistic view of child development and family well-being, while preventing child maltreatment and unnecessary family separation. 

  South Carolina partners are eager to be part of this cutting-edge national program, especially as the COVID-19 pandemic has brought about increased stressors to families and made them more fragile. The partnership in South Carolina is being led by the South Carolina Department of Social Services (SC DSS), with Children's Trust of South Carolina as a primary partner. Additional partners include the Department of Children's Advocacy, South Carolina Department of Alcohol and Other Drug Abuse Services, and other state agencies and organizations.

  SC DSS director Michael Leach has been a strong advocate for strengthening families and creating a system that promotes true prevention since taking over leadership of the agency in 2019. "Having South Carolina chosen as one of the four demonstration sites in the entire country shows that SC DSS is making progress in serving our state's children and families. There is no better time than right now to move our state from a reactive child welfare system to a system that enables greater, more fluid interagency coordination and collaboration in serving families," Leach said.  
  
  As the South Carolina lead for the Maternal, Infant and Early Childhood Home Visiting program and the Strengthening Families Program, Children's Trust leads much of the evidence-based prevention work in the state. "Our focus on discrete programs that use two-generation strategies to work with individual children and their families has been very effective in South Carolina," Children's Trust chief executive officer Sue Williams said. "However, they have been available to only a fraction of the families who could benefit from them. Now is the time to build upon what we know prevents abuse and neglect and scale our impact."  With support from state and national partners, this is a long-term project and will work up and down the socioecological model to significantly expand efforts and impact. "This is a marathon and not a sprint. We will be at this for a number of years before we see sustainable change at the family and community levels," Williams added. 

  The effort will also assess the economic and social conditions that influence the health of families and engage a wide variety of stakeholders across public, private and philanthropic sectors. The ultimate goal will be that all families, regardless of race/ethnicity or socioeconomic status, can readily access help when and where they need it.

  Key elements of the work will include the following:   

  • Partnering with diverse groups of nonprofits and community-based organizations to ensure a robust array of services are available and ready for families
  • Removing the stigma parents experience when seeking assistance and shift the mindset to one that normalizes help-seeking behaviors 
  • Engaging parents so that the work is informed by those who have direct experience with the system 
  • Establishing family resources centers in communities across the state to ensure communities are networked to support families seeking help 
  • Providing more services that meet families where they are, including in their homes and with early intervention programs 
  • Fostering a greater understanding of adverse childhood experiences to increase the understanding of how important it is to address potential trauma before it can occur and create positive childhood experiences that build resilience for children and their families

  
  Department of Children's advocacy director and state child advocate Amanda Whittle sees this national initiative as a great opportunity for South Carolina. "Thriving Families provides continued momentum for South Carolina's efforts to improve outcomes for children and families," Whittle said. "Child welfare practitioners, parents, community partners, volunteers, and other caring and supportive adults can help transform South Carolina to a child and family well-being system that is grounded in urgency, empathy and sustainability with this new endeavor."
  
  
   

• Public Health's Role in Creating Child and Family Well-Being

  Public 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.
   

• Upending the Status Quo

  Upending the Status Quo

  Written by Bobby D. Cagle, M.S.W., director, Los Angeles County Department of Children and Family Services
  
  In January, as the first reports of a global health crisis made headlines, few of us could have imagined then the extent to which the coronavirus pandemic would disrupt our everyday lives and illuminate the inequities and dysfunctions of our systems.

  The pandemic served as a magnifying glass on long-overlooked issues of poverty and racism and, ultimately, set the scene for a series of national protests where thousands gathered, unified by deep pain and outrage, to denounce the unjustified police killings of African American men and women.

  During this time, the Los Angeles County Department of Children and Family Services (DCFS) experienced its share of civil unrest. On a weekday morning in July, a single man stood outside of DCFS headquarters with a large banner that read, "DCFS Terrorizes Black Families." That same day, our offices in Lancaster and Palmdale, areas impacted by high-profile child deaths, also had small public demonstrations where protestors rebuked our organization for systemic deficiencies that disproportionately affect children and families of color.

  This critique is not unique to Los Angeles County. Over the years, child welfare jurisdictions across the country have experienced this type of opposition from families, child welfare advocates, and other community stakeholders.

  For those of us who have dedicated our lives to the well-being of communities, it is evident that we have reached a tipping point, and, frankly, I am all for it. As much as it pains me for DCFS to be the subject of criticism, I empathize with those who feel wronged, and, like them, I also desire meaningful change.

  There could, therefore, not be a more opportune time for the Thriving Families, Safer Children initiative. I am simultaneously humbled and thrilled to be among the jurisdictions, including Denver, Nebraska, and South Carolina, selected to participate in this national effort intended to revolutionize child welfare systems.

  For me, social work is a calling, an indelible part of my identity. I entered the system as an infant and was fortunate to be adopted by two loving parents. The child welfare system worked for me, and I've dedicated my life to supporting that system so that other children could have the same opportunities.

  As the leader of one of the largest child welfare agencies in the United States, with nearly 8,800 employees and 36,000 children in our care, I am proud to say that our workforce is wholeheartedly invested. Our nearly 4,200 children's social workers across 20 regional offices engage daily in painstaking "heart work" because they, too, believe that through a full continuum of prevention services we can strengthen families and change lives.

  The best path forward, according to the architects of Thriving Families—the U.S. Children's Bureau, Casey Family Programs, the Annie E. Casey Foundation, and Prevent Child Abuse America—is to unite the public, private, and philanthropic sectors with families to redesign child welfare systems and create organizations that advance justice and equity.

  I couldn't agree more. The timing of Thriving Families coincides with DCFS' roll out of Invest LA, an organizational framework that prioritizes superior service delivery, workforce excellence, and community and cross-sector partnerships. Its foundational pillars are prevention and after care services, brain science, a shared core practice model, and a culture of safety and equity.

  Within DCFS, our executive team has exceeded my expectations in its commitment to Invest LA. Similarly, we have received invaluable support from community partners like the Los Angeles County Board of Supervisors, the Office of Child Protection, and the Department of Mental Health.

  Like Thriving Families, Invest LA promotes the idea that child well-being is a shared responsibility. Among Invest LA's most important components is its human-centered design, a problem-solving framework that incorporates diverse perspectives, including those of children and families.

  In the coming months, we will be hosting community forums for key stakeholders, including parents, relative caregivers, resource families, faith-based groups, and community-based service providers. The forums are meant to elicit feedback about how our department should move forward in today's changing child welfare landscape and how we can achieve our ultimate goal of establishing a child well-being system wherein protection is a component of a broader family wellness plan.

  I'd like to note that this year has been the most challenging of my career. The coronavirus pandemic has posed unforeseeable difficulties that have pushed our workforce to its limits. Yet despite the serious risks posed by this deadly virus, DCFS has had record-low employee call-out rates, and our social workers have remained on the frontline throughout the pandemic making home visits to check on vulnerable youth and families.

  That level of commitment cannot be faked. Through their extraordinary work ethic and purposeful actions, our social workers demonstrate daily that they have, at times, been unfairly mischaracterized by media as disengaged and jaded. Their commitment to the well-being of families as well as their enthusiasm for the opportunity to cocreate our child welfare system speaks to the true character and heart of most social workers.

  As I look toward the future, I am energized and optimistic about this long-overdue paradigm shift. As children's social workers, most of us have spent our entire careers working to cultivate a child well-being community where families connect, heal, and become whole. While I never could have imagined that I would see it in my lifetime, the time is upon us and I am here to tell you that DCFS is fully committed to upending the status quo.
  
   
   

• Creating the Child and Youth Well-Being System We Believe In

  Creating the Child and Youth Well-Being System We Believe In

  Written by Sandra Gasca-Gonzalez, vice president of the Center for Systems Innovation at the Annie E. Casey Foundation   
  
  Every few days, I ask myself, colleagues, and others around me, "Are we creating the world we believe in, or the world we are used to?"

  This was a central question a speaker recently put to attendees at the Annie E. Casey Foundation's Activating Youth Engagement Summit. Teams of creative and committed teens and young adults, over 100 strong, both currently in the child welfare system and affected by the system at some point in their lives, met virtually for 2 days. Through all of their meetings and ideas about how to improve outcomes for children and families, it became clear that the answer was literally right in front of us: We can do better by young people and families by listening to them, believing in them, working with them, and investing in the resources they need to support each other.

  In short, we need to flip the way we've been investing our resources and put families, children, and young people at the center and align our efforts to help keep them together, strong and healthy, in their communities.

  That's why the Annie E. Casey Foundation is joining the U.S. Children's Bureau, Casey Family Programs, and Prevent Child Abuse America in a national effort to prove it is possible to fundamentally rethink child welfare. This first-of-its-kind effort—Thriving Families, Safer Children: A National Commitment to Well-Being—will work across the public, private, and philanthropic sectors to help develop more just and equitable systems that benefit all children and families and break harmful intergenerational cycles of trauma and poverty. Beginning with four select jurisdictions, Thriving Families will help these jurisdictions move from systems that are reactionary to systems designed to provide proactive support that keeps families together and prevent child maltreatment and unnecessary family separation.

  The Annie E. Casey Foundation brings a long history of working with systems to this effort because we believe that if we target solutions to those who are experiencing some of the greatest inequities and challenges, we will likely find solutions that improve outcomes for everyone. We also understand that the child welfare system was never really designed for the young people who find themselves in it as teenagers, especially young people of color. As a result, these young people are likely to spend their very first night in the child welfare system in a group placement, far from the experience of growing up with a family, which research shows is central to well-being.

  Over and over, young leaders are demanding a say in the decision-making processes that most affect their lives. The promise in our work lies in sharing power with parents, young people, and communities to build an equitable child and family well-being system. Leaders working in child welfare collectively need to get comfortable with shifting power to families, young people, and communities to create a way forward that allows the people we serve to get what they most need—not just what we have to offer.

  Creating new systems based on prevention and support services, along with needed cultural and structural changes, will take more than changing a mission statement or name from child WELfare to child WELL-being.

  Over these many years, we have spoken to thousands of young people, particularly those facing significant obstacles to success, about what would help them achieve the future they would like to see and could believe in. What we heard from them does not point to one program, resource, system, or policy. Their needs are holistic and require comprehensive solutions for them and their parents early on at the front end before any trauma or crisis condition develops.

  We need to ask young people, "What does primary prevention look like for them?" Youth leaders are telling us that preventing abuse, neglect, and unnecessary out-of-home placements are critical for a child welfare system. But child and youth well-being systems need to be as comprehensive as their mission suggests. They need to focus on opportunities and equity that fuel what all families and young people deserve—the ability to thrive in their communities—while incorporating a broad array of primary prevention strategies to make sure young people graduate from high school; put off parenting until they are ready; and avoid the harms of drug addiction, gun violence, police brutality, and homelessness. A true child and youth well-being system faces racism head on and works actively to dismantle it.

  As we reinvent and redesign, we need to redistribute power in ways that enable young people to determine the future of child, youth, and family well-being systems along with the power to determine their future by being in control of important life decisions.

  There is one good thing about the pandemic we are living with today—it has changed the world we are used to and upended our notions of what is possible. It's time to create the world we believe in.