Prevention: Community-level Efforts

Question 1

What were the goals of the U.S. Advisory Board

Answer 1

• Evaluate nation’s progress in ensuring safety of children
• Develop vision for more effective protection

Question 2

How was the problem defined? (US Advisory Board)

Answer 2

• Declared a national emergency, due to:
• Epidemic scope of problem
• “The system the nation has devised… is failing… There is chronic and critical multiple organ failure.”
• Annual multi-billion-dollar cost of dealing with these failures

Question 3

What did the board determine?

Answer 3

• The Board made it clear that, even without these costs and even without demonstrable harm to children, it is a moral 
obligation to make 
big changes

Question 4

What were the problems identified? (US Advisory Board)

Answer 4

• Overemphasis on reporting and identification, rather than prevention and intervention
• Investigation as the primary “service” to families
• Focus on determining what happened, rather than what can be done to help
• “Checking off boxes” (U.S. ABCAN, 1993) detracts from effective plans to prevent initial and further harm

Question 5

What was the goal? US Advisory Board

Answer 5

“The principal goal of government involvement in child protection should be to facilitate comprehensive community efforts to ensure the safe and healthy development of children”

Question 6

What was the vision? US Advisory Board

Answer 6

“Neighborly” society, in which “All American adults… resolve to be good neighbors- to know, watch, and support their neighbors’ children and to offer help when needed to their neighbors’ families”

Question 7

What were some of the challenges to fulfilling the vision of the US Advisory Board?

Answer 7

• Understanding that fulfilling this vision would not be easy:
• Require reversal of powerful social trends
• Overcome isolation created - by societal demands/stressors (e.g., poverty)
• Create caring communities that support families and protect children

Question 8

What are some vulnerabilities/challenges in the exosystem?

Answer 8

• Community
• violence

• Crime in neighborhood

• Social isolation

• Impoverished community

• Lack of community
• resources


Question 9

What are some vulnerabilities/challenges in the macrosystem?

Answer 9

• Violent culture

• Parenting norms

• Racism

• Social acceptance of violence

• Recession

Question 10

What are the messages from the Research? about neighborhoods

Answer 10

• Poor neighborhood quality and sustained economic poverty are strong factors in the etiology of maltreatment
• Neighborhoods with insufficient resources are especially at risk
• Neighborhood characteristics can further influence outcomes, following maltreatment
• Personal/psychological etiological factors are closely tied to social and economic variables of neighborhoods

Question 11

What is the US ABCAN Board Strategy?

Answer 11

• Strengthening neighborhoods, both physically and socially, as environments for children
• Reorienting delivery of human services “so that it becomes as easy to provide services to prevention child maltreatment… as it is to place a child in foster care after the fact.”
• Improving the role of government in child protection (emphasize prevention and treatment)
• Reorient societal values that may contribute to maltreatment (e.g., acceptance of violence)
• Strengthen and broaden knowledge base about child maltreatment (e.g., evaluate prevention models)

Question 12

What are the US ABCAN Board Recommendations?

Answer 12

• Child protection system should be part of everyday life, and should give parents sense that they can make a difference in ensuring the well-being of their children and their neighborhoods
• Infusion of reciprocal help; “normalizing” assistance, and minimizing stigma
• Universal approach

Question 13

What is Strong Communities for Children?

Answer 13

• First large-scale initiative to address child abuse and neglect through research of community-based prevention and intervention
• Designed to change the norms of participating communities
• Aimed to develop an expectation that people will watch out for each other and each other’s children

Question 14

Who was the lead investigator for Strong Communities for Children?

Answer 14

Dr. Gary Melton (also lead author of the report from U.S. ABCAN)

Question 15

Where did Strong Communities for Children take place?

Answer 15

• Greenville, South Carolina
• Ethnically and economically diverse
• Urban area, suburban areas, small towns, rural areas
• Population 125,000
• 2002-2008

Question 16

What were the goals of Strong Communities for Children?

Answer 16

• Enhance sense of community
• Enhance sense of efficacy and action
• “… to ensure that every child and every parent would know that if they had a reason to celebrate, worry, or grieve, someone would notice, and someone would care” (Melton, 2014).
• “People shouldn’t have to ask.”

Question 17

What was Strong Communities for Children Theory of Change?

Answer 17

Once residents felt that their neighborhood was a place where families helped each other, and where it was expected both to ask for and offer help, they would be more likely to make wise decisions that enhance child well-being

Question 18

What were the 4 phases of Strong Communities for Children?

Answer 18

1. Raise awareness about child abuse as an important problem with opportunities for improvement
2. Mobilize the community to become engaged in planning and prevention maltreatment
3. Increase resources for families
4. Institutionalize resources in sustainable ways

Question 19

Who would implement Strong Communities for Children?

Answer 19

• Community outreach workers (~1 per community) who strove to organize community around 10 core principles
• Outreach workers sought to institutionalize neighborly activity that would enhance parents’ access to resources and their chances of being noticed

Question 20

Where would Strong Communities for Children be implemented?

Answer 20

Primary institutions (e.g., schools, churches, clinics)

Question 21

How would Strong Communities for Children be implemented?

Answer 21

• Spreading the word (e.g., to community leaders)
• Campaigns
• Pledges to learn the names of the children in 10 closest homes
• Special events
• Community festivals, religious observances
• Involvement of community members
  Firefighters knocked on doors to bring neighbors to community meetings, mentored children, etc
• Use of existing human resources
• Unpaid volunteer service and donated time
• Existing community facilities (e.g., churches, parks)
• Create sustainable programs that would enhance neighbor relationships (e.g., play groups)

Question 22

How did Strong Communities for Children increase community involvement?

Answer 22

• Increased community involvement
• Hundreds of organizations
• 5000+ volunteers (> 60,000 hours of volunteer service)
• This rate grew over course of initiative

Question 23

How did Strong Communities for Children increase family involvement?

Answer 23

• In first year, ~3000 families enrolled in Family Activity Centers (volunteer-managed centers in existing facilities)
• In first two years, at least 1300 activities

Question 24

What were the reports of children maltreatment for Strong Communities for Children?

Answer 24

• Fewer founded reports of child maltreatment
• Children 2 and under, 11% decrease in the service area (compared to 85% increase in comparison community)
• Children 4 and under, 41% decrease in the service area (compared to 49% increase in comparison community)

Question 25

What were the reports of emergency room visits and hospitalization for Strong Communities for Children?

Answer 25

• Fewer emergency room visits and hospitalizations for injuries to children For injuries related to neglect, 68% decrease in service area (compared to 19% decrease in comparison community)
• For maltreatment-related injuries of children 2 and under, 23% decrease in service area (compared to 6% decrease)
• For maltreatment-related injuries of children 4 and under, 38% decrease in service area (compared to 13% decrease)

Question 26

What were the reports of Teachers, parents, and children in elementary schools for Strong Communities for Children?

Answer 26

• Greater safety at school and in neighborhoods around school
• More welcoming responses to parents at the schools

Question 27

What were the reports of parents at home for Strong Communities for Children?

Answer 27

• Less parental stress, greater social support, more frequent help from others
• Greater sense of parental and collective efficacy
• More frequent positive parental behavior, more frequent use of household safety devices
• Less frequent disengaged (inattentive) parenting, less frequent neglect

Question 28

What was the cost for Strong Communities for Children?

Answer 28

• Salary of one outreach worker with appropriate training, supervision, and consultation may result in greater safety for thousands of children (ratio: 1 worker to 10,000 residents)
• Could supplement with other trained volunteers
• Support needed for faculty and senior professional staff to recruit communities, provide training/consultation, provide program evaluation and monitoring

Question 29

What were the conclusions from the study? Strong Communities for Children

Answer 29

• Changes at the level of the community can prevent maltreatment
• Community members can be the source of this change
  In fact, may be more effective than outsiders
• Community member investment may be more sustainable

Question 30

What is Triple P?

Answer 30

• Triple P = Positive Parenting Program
• Parenting and family support system, designed to prevent (as well as treat) behavioral and emotional problems in children
• Aims to equip parents with the skills they need to effectively parent
• Delivered to parents of children up to 12 years old

Question 31

What is Triple P Universal Level?

Answer 31

Communications strategy designed to reach population with positive parenting messages and information

Question 32

What is Triple P’s Stay Positive Campaign?

Answer 32

• Destigmatize and normalize process of seeking help
• Encourage parents to participate in parenting programs
• Increase visibility and access to programs
• Counter parent-blaming messages in the media
• Help parents become more confidence and self-sufficient

Question 33

What is the Evidence for Triple P?

Answer 33

• Results at the population level
• Fewer hospitalizations from child abuse injuries (17% lower)
• Fewer out-of-home placements (16% lower)
• Slowed growth of confirmed child abuse cases (22% lower)

Question 34

What is Triple P’s cost effectiveness?

Answer 34

• Cost of delivering Triple P universally would be recovered in a single year by reducing number of maltreatment cases by 10%
• Estimate of savings of $6 per $1 spent
• In Canada, using a birth cohort of 52,000, found that a 25% reduction in conduct disorder would result in saving $10.2 million in justice, mental health, education, and social services costs

Question 35

What are the challenges of a neighborhood-level approach?

Answer 35

• 4 critical challenges

1. Building relationships with communities
2. Working with culturally diverse communities
3. Barriers
4. Sustainability

Question 36

What are the recommendations for a community?

Answer 36

• Understand communities and their needs
• Work for holistic community change
• Make community members stakeholders
• Plan for sustainability from the beginning