HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Partnering to Prevent Child Maltreatment: Lessons and Outcomes

STEPHANIE BRYN: Thank you, everybody. I'm privileged today to join this great panel, and my job is going to be to describe to you what went on at the Surgeon General's conference on ‑‑ it was actually called the Workshop on Child Maltreatment.

And so the whole gist was that we were able to get the Surgeon General to focus in on child maltreatment and label it as a national priority. This is a real good quote, it's in your handout, and it's from the Surgeon General talking about the devastation of child maltreatment. And he was then privileged to oversee this two‑day conference and to talk about preventing child maltreatment and promoting child well treatment. And I know there are a couple of people in the room who attended that workshop. Isadora, I think you did. How many knew that the Surgeon General has looked at and is addressing child maltreatment? Okay. It's kind of a closely kept secret. One of the reasons it is that the proceedings aren't ready yet. So I'm actually giving you kind of a sneak preview of what was done and what were some of the themes and then you can look forward to seeing an upcoming proceedings from that workshop.

So the workshop ‑‑ and there's actually a little typo on this. This is the Year of the Healthy Child. And he wanted to do something that dealt with strengthening the body, mind and spirit of the growing child and adolescent and to discover the best ways to integrate and to prevent.

Now, at this workshop were people from academia, foundations, government people from all levels in the health and welfare sectors, advocacy groups, many, many professional organizations, faith‑based organizations, and survivors. And it was quite small. It was approximately 100 to 120 people who met together March 30, 31 of the year 2005.

Also attending were people with medicine as a focus, public health, child development, people who focused in on disabilities, Social Services, child welfare, education, law enforcement, juvenile justice, communications and media, mental health and substance abuse.

Now, two of the survivors said something quite profound. And I want to read them to you very quickly. A father of a child who had been shaken and who died talked about the frustration or rage, malice and ignorance, drugs or alcohol, whatever the explanation is for causing harm, any harm to a child, is not acceptable. There are no do‑overs after you shake a baby to death. And that was by George Lithgow, founder of the Skipper Initiative. So he kind of set the stage for us.

Then another person in the room who helped focus and put a face on child maltreatment was a survivor. C.C. Porter. She was a woman probably in her late 20s and she said, "The issues associated with child maltreatment evoke deep discomfort and are often highly charged. Yet, we must break that silence, create a world that is safe for everyone, victims and perpetrators alike, to tell the truth and to get help when they need help, and to stop this cycle of violence."

So that was great we had all these academicians, health professionals and every variety of person who works in this area, and then we had some people there to really help put a face and an emphasis on why we were together. Now, what we did was take the public health framework of assessment, policy development and assurance and take a look at, as we addressed the topics listed here on the screen. So we were talking about ‑‑ and this was a very give‑and‑take conversation back and forth, it was facilitated but the facilitators were really kind of there just to get the flow going. And there were no shy people in the room. It was very exciting. We talked about the integration of child health, human development and public health systems, how the influence of parents, family, community and society shaped human development. Operational and informative systems change, parenting and family innovations and opportunities for prevention, community and society innovations, opportunities and critical thinking for a new public health priority. And it got very real but it started out kind of very academic.

So now when we talk now about the discussion themes, and these are really the meat of what I want to share with you, because the proceedings of what you're going to read later on will fill you in. But we talked about how a comprehensive primary, secondary and tertiary prevention care system needed to be addressed, needed to be addressed.

The child well treatment education and early skills building for parents, critical. Critical. And the audience was quite clear that we don't do a very good job of doing this, and we needed to find the best ways to help educate and train parents and children and caretakers of children.

We talked a lot about the role of the media. This was something that frequently in workshops is left out. And this one was brought. We didn't really have a heavy dose of media, but we had reminders from people who represented communications with us. We talked about the human face of child maltreatment, and the importance that we needed to create a penetrating message that combines the tragic devastation of child maltreatment and the hopefulness. And so there was discussion about we needed a campaign. And there were a lot of people in the room who really wanted this to happen sooner than later.

Now, the primary and tertiary prevention care system was mentioned how we needed a comprehensive approach and we needed to prevent intergenerational systems of violence. And I think most of you in the room know this is something that's intergenerational. And it was a little bit difficult, because we all needed to talk and we needed to hear from everybody, and yet there was this kind of anxiousness in the room about, okay, so what are we going to do and what is the Surgeon General going to do?

The role of the media, to achieve ownership, it was suggested that there be a campaign, as I mentioned, and that we should encourage the public to take ownership, more ownership than they do. And I think we're all in this room probably quite interested in that.

We also needed to change some social norms. We needed to make it okay to ask for help. Our messages needed to learn from the anti‑smoking message. And I think that was brought up early today as well, and learn that ‑‑ and one person in the room said that people know that it takes a village to raise children. But they just don't know what the heck their role is. And I think there's a lot of frustration probably here today as well as that day of our meeting.

Some other discussion themes that I want to share are that we talked about the sustainability and the continuing programmatic efforts and this one was a little tough because there's not one single solution but rather it's multi‑factorial. There was really exciting talk about using technology much, much more than we do. And I think most of you who work on the ground in states in programs and in counties and communities know that we're just kind of scratching the surface of technology. And there were some really, I think, great people in the room who wanted to guide us more that way and that we should use all relevant information systems and reports and share between schools and emergency departments and faith‑based; and most of you who work in child abuse and child neglect know that, you know, some of us are doing that and we have a long way to go, or at least the group thought we had a long way to go.

They talked about systems integration and basic systems change. And CAPTA was brought up because there were numerous people from the Administration for Children and Families. So they were keeping us aware of the CAPTA, Child Abuse Prevention and Treatment Act. And I think you may be speaking about CAPTA later, or our audience might.

There was talk about to reassess the child welfare system, the health and human services system, the disability‑based organizations, the foster care system, and juvenile justice system, policing, public health systems. In other words, all the systems that we heard about earlier today and that we know and work in.

Cooperation among these organizations and disciplines, critical and important, and how local administration and evaluation was key and must not, we must not lose focus, and how the full availability and accessibility of the culturally competent evidence‑based prevention programming.

Okay. So then we went to what we thought the group that I just described thought, and we really thought that abuse by caretakers, and we needed to focus in on this, by parents and others, we needed to look at abuse by teachers, coaches, camp counselors, clergy and child care workers, take a look at the instances of abuse of head trauma. Formerly, we referred to that as shaken baby syndrome. A couple people talked about dentists and dental professionals might be key here because they work in the mouth and the face and could be early detectors. There was also discussion about people who see the child in any kind of health or social system needed to be educated and trained and alert.

We talked a little bit about neglect, trying to keep that on the table. And that, of course, is its own huge area of interest. Other areas that we wanted evidence‑based prevention programming to follow and to go towards would be the child maltreatment as it occurs with domestic violence. Many of you, how many of you work in areas of family or domestic violence?

How many of you work in the health side of the operation? And how about the Social Services/Welfare side? How about the other people? Some are from the Bureau.

We also talked about how that child maltreatment is taking place everywhere and so that there was no reason to focus in on rural over other areas in terms of location or environment; that we knew that child maltreatment takes place and neglect takes place in poor, middle and upper income settings. And in basically many, many families.

We talked a lot about child well treatment and trying to get that in people's vocabulary and trying to get it to be thought of and talked to as a strength and something to work towards. And about health promotion and injury prevention. And all the things to promote and to prevent injury and child maltreatment as well as to report it.

You can see that this was a full, full two days of discussion. We had some very articulate people to listen to and to learn from. And I can only tell you that the proceedings should be very, very rich reading. They will be many old ideas that we haven't done as well as we could or should, and quite a few new and exciting ones, including putting a face on child maltreatment, including campaigns, using the public, using oral health and dental health professionals, and not accepting child maltreatment but rather promoting child well treatment.

His last statement or one statement that we really listen to and agreed with was that in the past child maltreatment had been traditionally thought of as a criminal justice issue. And that is no longer acceptable to work in isolation and that it is very much a public health issue. And he talked about how the wrenching mental health and physical effects of child maltreatment continue long after the child has either grown out of or moved to a safer environment. And so it is his hope that together we will help shine a bright light on this problem and to help find ways to end this scourge. So I've really basically given you kind of the highlights of what went on at the conference, and now joining me today are two speakers who will tell you a lot more about child maltreatment as it works on the ground in states and I'd like to turn the podium over to Erin Lyons.