Social Current looking for a consultant with expertise in curriculum design to support our Recruiting and Developing Peer Recovery Coaches initiative. The consultant will guide the project team in developing a workforce curriculum and train-the-trainer model and process for the sub-awardee organizations supported through this initiative. They will write content, as needed, for the curriculum.

The completed curriculum will include core content, activities, handouts, videos, and other interactive strategies. The consultant will also co-lead a curriculum working group including other initiative partners. In addition to expertise in curriculum development, we prefer that the consultant has subject matter expertise in two or more of the following areas: Substance use peer recovery, family-centered care, trauma-informed approaches, equity, diversity and inclusion, and workforce resilience.

The expected term of engagement is six months and will require approximately 35 hours per month.

If interested, please send your cover letter and resume to Karen Johnson, senior director of Change in Mind at Social Current.

On May 22, 2024, the Senate Finance Committee convened the hearing, “The Family First Prevention Services Act: Successes, Roadblocks, and Opportunities for Improvement.” This session was part of Foster Care Awareness Month, reflecting the ongoing commitment to enhancing child welfare in the U.S. The hearing brought together experts, policymakers, and stakeholders to discuss the progress and challenges of the Family First Prevention Services Act (FFPSA) since its enactment in 2018. The discussions highlighted both the successes achieved under the act and the obstacles that continue to impede its full implementation.

Social Current submitted this written testimony, which incorporates feedback from our network.

Key Statements

Senator Mike Crapo’s Opening Remarks
Senator Crapo, the committee’s ranking member, emphasized the bipartisan nature of FFPSA and its role in transforming the child welfare system to prioritize prevention and family preservation. He highlighted the importance of front-end interventions, such as mental health and substance use disorder treatment, to keep families intact and reduce reliance on foster care. Crapo also noted the recent regulation to reduce bureaucratic barriers for family members to become licensed foster parents, which he believes will further support children living with trusted caregivers.

Chairman Ron Wyden’s Remarks
Chairman Wyden underlined the necessity of federal funding to empower kinship caregivers and the importance of prevention services to address issues like mental health and substance use disorders. He called for removing bureaucratic barriers that prevent states from fully utilizing available prevention funds and stressed the need for more comprehensive support systems to keep families together. Wyden also expressed concern over the government’s disproportionate spending on traditional foster care compared to prevention services, urging for better allocation of resources.

Expert Testimonies

JooYeun Chang, Doris Duke Foundation
Chang highlighted the significant impact of FFPSA in shifting the child welfare paradigm toward prevention. Despite its promise, she noted that many families still face barriers to accessing the necessary services. Chang recommended structural changes to broaden eligibility for prevention services and include support for addressing domestic violence and economic hardships. She emphasized the importance of community-based support systems and the need for data-driven approaches to effectively identify and serve at-risk populations.

David Reed, Indiana Department of Child Services
Reed provided insights into Indiana’s implementation of FFPSA, showcasing the state’s success in reducing the number of children in foster care by over 50%. He emphasized the importance of flexible, comprehensive service models like Indiana’s Family Preservation Services, which address various family needs, including economic support to prevent unnecessary foster care placements. Reed shared specific examples of how targeted interventions, such as providing concrete support like transportation, have kept families together and reduced racial disparities in child removals.

Rebecca Jones Gaston, Administration for Children and Families
Commissioner Gaston discussed the broader implementation of FFPSA across various states and tribes. She underscored the importance of cultural responsiveness in prevention programs and highlighted regulatory actions to strengthen kinship care and provide legal representation for families in the child welfare system. Gaston also pointed out the challenges of workforce shortages and the need for better collaboration across service systems. She emphasized the role of federal support in overcoming these challenges and the importance of continuous evaluation and data collection to measure the effectiveness of prevention programs.

Key Takeaways

Conclusion

The hearing underscored the ongoing commitment to improving child welfare through the FFPSA. While significant progress has been made, roadblocks remain to be addressed. Policymakers, advocates, and stakeholders must continue working together to refine and expand the reach of prevention services, ensuring that all children can grow up in safe, stable, and loving environments. The continued collaboration between federal and state agencies and community partners is essential to realize the full potential of the FFPSA and create a child welfare system that genuinely supports and strengthens families.

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April is National Child Abuse Prevention Month. Since 1983, when Child Abuse Prevention Month was first established, this national recognition has coalesced efforts to bring communities together to serve children and their families in meaningful, impactful ways that provide families what they need to thrive through both calm and challenging times.

Child abuse prevention efforts have evolved over the years. For example, when the Commission to Eliminate Child Abuse and Neglect Fatalities released its final report in 2016, it was intended to equip policymakers, practitioners, and advocates with the tools needed to fundamentally reform child welfare. It outlined a vision for a 21st-century child welfare system predicated on a proactive public health approach that was framed by greater leadership and accountability, decisions grounded in better data and research, and multidisciplinary support for families.

In October 2019, the Department of Justice, Office for Victims of Crime launched the Child Safety Forward initiative, with technical assistance provided by Social Current, to test strategies based on the commission’s report for a public health approach to reducing child abuse and neglect fatalities. We issued our final evaluation report on the initiative last year, and in that report, identified three very important themes that  emerged across this work.

First, many organizations and jurisdictions began their work with a focus on risk factors among children. However, because these initiatives took place during the COVID-19 pandemic, we gained greater insights into the impact of concrete, economic supports for families during times of crisis. This real-time learning inspired a shift from focusing solely on risk factors to an approach that more heavily identified and addressed protective factors.

Protective factors are conditions or attributes that mitigate or eliminate risk and can increase the health and well-being of children and families. They provide parents with the tools they need to parent effectively even under stress. Major protective factors include knowledge of parenting, knowledge of child development, parental resilience, social connections, and concrete supports.

That shift in focus led to strategies that promote strengthening families and identifying supports that help children stay with their families and prevent them from entering the child welfare system, a finding that is supported by a range of recent research. In fact, April has more recently also been designated as Family Strengthening Month in response to the growing body of knowledge in support of the importance and impact of family strengthening approaches.

Secondly, it has become more evident than ever that child welfare must acknowledge and address the impact of disproportionality and racial bias across child welfare decision-making. This is a system-wide issue and will require systemic changes to address it.

And finally, what has been missing for too long in the conversation about keeping children safe is the voice of the community and those with lived experience. Parents are key to keeping their children safe and resilient. While parents have historically been placed in antagonistic roles in child welfare systems, it is critical that parents are positioned as strong partners and leaders in our efforts.

To achieve this vision, though, we must shift from a child welfare system that responds after harm has occurred to a family strengthening approach that invests in upstream preventive resources that respond to the needs and challenges of families. The challenge we face in achieving this, though, is that the framework of our child welfare system is not set up to respond unless a child has come to the attention of the system because of harm occurring or through a report from a mandatory reporter or hotline call.

Achieving a more preventive system means moving away from the idea that it is solely the function of child protective services (CPS) to keep kids safe. Instead, CPS is one component in a shared, community-wide responsibility for child and family well-being with an emphasis on prevention and a public health approach that addresses the social determinants of health.  

A public health approach to child safety and prevention of fatalities looks for the maximum benefit for the largest number of people, promoting the healthy development and well-being of all children. It works not only at the family level, but also at the community and societal level by bringing the public and private sectors together to align, leverage, and coordinate existing resources to provide support to children and families and to address risks and promote resilience before there is a crisis. Importantly, CPS remains a critical downstream component, but the goal is for fewer families to require CPS involvement.

Because communication is so vital to this shift, an additional resource for child welfare professionals is the Building Better Childhoods website and toolkit. It is based on the framing brief, “Reframing Childhood Adversity: Promoting Upstream Approaches,” developed by the FrameWorks Institute in partnership with Prevent Child Abuse America and Social Current, and provides tools and resources that can help child welfare professionals talk about the shift to a more preventative, family-strengthening system. We know this transition from a CPS-focused child welfare system to a much broader child and family well-being system is not an easy shift to make, but it is one we hope everyone can embrace as we prioritize the tools and resources needed to keep families safe, strong, and together.

We have long been aware of the impact of adverse childhood experiences (ACEs) on our long-term health and well-being. Because toxic stress from ACEs can change brain development and how the body responds to stress, their occurrence in childhood has a direct correlation to increases in substance abuse, mental illnesses, and poor health outcomes.

The Journal of the American Medical Association (JAMA) recently published a new study that puts a staggering dollar figure on that impact. Researchers found that ACEs cost our nation $14.1 trillion annually because of related adult health conditions, including direct medical spending and lost productivity.

However, the study is limited, in that it doesn’t identify the disparities in the number of ACEs impacting children and families of color, and the exponentially higher costs for this segment of our population. In fact, a recent Child Trends report indicates that 61% of Black children in the U.S. have experienced at least one ACE, as compared with 40% of white children and 23% of Asian children.

Researchers have long identified ACEs based on the Felitti scale, which identifies 10 items under two categories:

What’s missing is the impact of generational and historical trauma, especially racism.

Impact of Generational Trauma and Systemic Racism

Racism has a direct and measurable impact on children’s health. More families of color live in poverty than white families, which can lead to food insecurity, lack of safe housing, and reduced access to health care and education. All of these increase chronic stress in children and can have long-term health consequences, with African Americans at a higher risk for heart disease, stroke, cancer, asthma, influenza, diabetes, and HIV/AIDS. This disproportionality also is evident in incarceration rates, child welfare system involvement, and educational outcomes for African American youth, and disparities are often linked to systemic biases.

Research backs this up. A study from Princeton University sociologist Devah Pager showed that young Black men with similar education and no criminal record were much less likely to be offered a job than similar white men. It went on to show that white men with criminal records had an equal or better chance of being hired than Black men with no record. We see the same biases in housing discrimination, child separation rates in child welfare, and more.

There has been some progress in expanding the ACEs scale to reflect the toxic stress that bias and racism impart on children. For example, the team at RYSE Youth Center in Oakland expanded the original ACEs pyramid from the CDC, adding layers of collective and multigenerational thinking, layers of historical, cultural, and social context, to highlight the deeper roots of trauma and explore why these traumatic experiences occur in the first place. The CDC has since adopted the more complete picture offered by this pyramid.

For those of us who work in health and human services, it is critical that we expand our understanding of trauma and adversity beyond the 10 ACEs questions, and work to integrate both trauma-informed and antiracist efforts across the systems we support.

Embracing a Trauma-Informed Approach

One example can be found in Zero to Three’s Safe Babies Court Team™ (SBCT) approach, which focuses on minimizing trauma and its impact on early development by improving how the courts, child welfare agencies, and related child-serving organizations come together to partner with families to support their young children. This approach recognizes that some families experience great stress while raising their children due to environmental conditions—community violence, systemic racism, trauma, or health issues—that make it difficult to provide safety and stability. The Safe Babies Court Team approach does not promote a “one-size-fits-all” solution to the challenges faced by families within the child welfare system or by the system itself. By addressing the needs of each family, through housing, work opportunities, job training, transportation, substance use counseling, and more, Safe Babies Courts are showing that their children are reaching permanency three times faster than infants and toddlers in the general foster care population. Almost two-thirds of babies and toddlers are reunified or find permanent homes with members of their families.

This approach calls for practitioners to ensure all equity efforts include knowledge and practices that embed brain science concepts, including understanding the areas of our nervous system that are activated when we discuss, experience, or perpetrate racism, and how that activation creates barriers for connection.

A core concept of the trauma-informed approach is, “healing happens in relationships.” The development of safe, stable, and nurturing relationships can help build greater resilience in individuals. In its July 2021 policy statement, the Academy of Pediatrics emphasized the need to shift from toxic stress to building relational health. As Dr. Andrew Garner with the American Academy of Pediatrics notes: “The concept of drawing on positive relationships as a shield against the toxic stress caused by adverse experiences has never been more relevant. Over the past few years, we’ve experienced a socially isolating pandemic and reckoned with centuries of structural racism. We must take steps to help kids form close, healthy, and nurturing bonds, whether it is within family, school, or community.”

Policymakers have a role to play as well, by promoting concrete, economic supports and family strengthening policies, such as expanded family medical leave, child tax credits, access to safe and affordable housing, access to early childhood education and mental health services, and more. Research from Chapin Hall at the University of Chicago has demonstrated that connecting families to a well-resourced, community-driven prevention system can meaningfully address the root causes of adverse experiences, including racism, child abuse and neglect and trauma. 

Despite the terrible cost of ACEs, both in economic dollars and lifelong negative impacts, the latest research has demonstrated the potential for safe, stable, and nurturing relationships to act as a protective buffer against the harm of toxic stress on children. When we expand our view of ACEs to include the impact of generational racism, and lift up community efforts focused on building relationships and an understanding that our diversity as a nation is our strength, we have a better roadmap to addressing disparities and incorporating trauma-informed approaches that can help provide all children with a foundation for building resilience that leads to safer, healthier outcomes throughout their life.

By: Susana Mariscal and Bryan Victor 

One of the most challenging and complex responsibilities of the child welfare system is understanding and investigating the death of a child. As difficult as they are, these investigations are an essential part of a public health process that helps explain why child deaths occur and the strategies that can prevent future deaths.  

Child Fatality Review (CFR) teams are assigned the hard task of reviewing all deaths of children under the age of 18 that are sudden, unexpected, or unexplained, including children known to child protective services, and deaths that are determined to be the result of homicide, suicide, accident, or are undetermined. While many local CFR teams are comprised of individuals who are committed to protecting children and families in their local communities, for some states, including Indiana, CFR teams are volunteer positions and members are not compensated for their participation.  

When the Indiana Department of Health (IDOH) was selected in 2019 by the Department of Justice Office for Victims of Crime as one of five sites in the nation to participate in a demonstration initiative to apply a public health approach to reducing child abuse and neglect fatalities and injuries, a focal area was the CFR process. The initiative, known as Child Safety Forward, gave us the opportunity to apply support from a national technical assistance team to our long-term aim of ensuring that processes, such as fatality review, are used consistently and effectively to generate data-informed recommendations to support prevention.  

For the first phase of Child Safety Forward Indiana, CFR teams undertook a five-year retrospective review of data corresponding to child deaths in four counties that experienced the highest number of child fatalities in the state, along comparison counties. We also conducted interviews with parents and child-serving professionals involved with CFR, such as child welfare, public health, education, mental health, criminal justice, and others to learn about barriers and facilitators related to identification and prevention. The findings were significant, both in what they revealed about causes of child death, and in what they revealed about gaps in the system. 

One of the findings identified inconsistencies around the implementation and operation of CFR teams around the state. For instance, instead of focusing on determining factors that could help identify prevention strategies, local review teams were often oriented toward assigning responsibility for death in individual cases—which reinforced the notion that CFR is a punitive process. To improve policy, IDOH developed data-driven recommendations that informed two state legislative changes. The first proposed policy change was to eliminate restrictions on who could initiate a CFR team, opening the door to a broader set of practitioners and community members to take the lead. The second proposed policy change was to mandate certain types of evidence and data to be collected during a death scene investigation in Sudden Unexpected Infant Death (SUID) cases–often related to unsafe sleep conditions. 

Since the passage of these bills, the Child Safety Forward Indiana team has continued to implement several other changes that strengthened the CFR infrastructure across the state. The biggest change is the increase in the number of CFR teams, which for the first time in the history of the program, now cover all 92 counties in the state. The Department of Child Services (DCS) has taken on the responsibility of initiating teams in many of these areas. With this rapid expansion, training and resources for teams were needed, and Child Safety Forward Indiana has created a hub and toolkit for this purpose, along with coordinators to provide support at the regional level. 

Over the course of the initiative, the improvement in the quality of the CFR process was one aspect of a multi-dimensional effort, including multidisciplinary team training.  The team also worked to improve cross-system collaboration in partnership with Strengthening Indiana Families (SIF), a primary child maltreatment project that is implementing Family Resource Centers in central Indiana to provide support and build on families’ protective factors through community collaboration. SIF also convened a Parent Advisory Group to emphasize the voices and representation of parents in shaping prevention programs, advancing racial equity and inclusion, and improving children and family outcomes.  

Community Action Teams, consisting of a group of stakeholders, were established to implement CFR team recommendations. IDOH also developed and launched a data-informed statewide infant safe sleep campaign, including videos which have garnered over 1.5 million views. 

While no direct causal inferences can be made, all of these and other prevention efforts have had a meaningful collective impact in the four target counties, which has seen decreases in SUID rates and in the rates of child fatalities due to external injury.  

These efforts demonstrate that, while difficult, the work of those who conduct child fatality reviews are a vital and necessary tool in a public health approach that is geared toward providing the resources and knowledge that can prevent future tragedies, so that all children fulfill their promise. 

______________________ 

Susana Mariscal is an associate professor at the Indiana University School of Social Work. She is the lead evaluator of Child Safety Forward Indiana and project director of Strengthening Indiana Families, a strengths-based primary child maltreatment prevention program funded by the U.S. Children’s Bureau. Mariscal is a community-engaged scholar focused on violence prevention and resilience promotion among children and families. 

Bryan Victor is an assistant professor at Wayne State University School of Social Work. His research examines community-based approaches to violence prevention with a particular focus on child maltreatment. Victor is a co-investigator on the Child Safety Forward Indiana evaluation team and co-leads the Strengthening Indiana Families project with Dr. Susana Mariscal. 

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.  

By: Sheila Boxley  

When the federal Commission to Eliminate Child Abuse and Neglect Fatalities released its groundbreaking report in 2018, one of the key concepts that informed its recommendations was the need for multi-disciplinary support for families. In other words, keeping children safe is a job that child welfare systems and child protective services (CPS) cannot do alone. 

On the heels of the release of the Commission’s report, the U.S. Department of Justice funded a demonstration initiative to develop and test multidisciplinary strategies and responses to address fatalities or near-death injuries as a result of child abuse and neglect. Known as Child Safety Forward, the initiative has spent the subsequent four years developing strategies to support a public health approach to reducing abuse and neglect fatalities. 

The Child Abuse Prevention Council of Sacramento (CAPC) was one of five demonstration sites in the nation chosen for this grant. Systems partners across Sacramento County began the work with an understanding that child safety and well-being was not solely a “child welfare responsibility,” and recognized the need for all child- and family-serving agencies and organizations to partner together. While collaboration across systems in Sacramento County was already strong, the initiative furthered a sense of shared responsibility and accountability for child safety to fully implement a public health approach to prevent child maltreatment through systems change.  

Through the development of a Prevention Cabinet comprised of local system and community leaders, the Sacramento Child Safety Forward team leaned into  the collective impact approach, which is often utilized to support and engage multi-disciplinary players to work together to solve complex problems. 

What is collective impact? Practitioners define it as “a network of community members, organizations, and institutions that advance equity by learning together, aligning, and integrating their actions to achieve population and systems-level change.” It involves a structured process that integrates the following: a common agenda; shared measurement; mutually reinforcing activities; continuous communication; and a backbone team.  

Engaging community and centering equity are essential elements to the success of collective impact. The Sacramento team approached the work by elevating families into relationships of equal power in the development of a strategic plan with the goal of aligning with community needs.  

They achieved this by appointing Community Representatives to infuse the initiative with the stories, voices, and life experiences of those who have had contact with any child- and family- serving system or agency in Sacramento County. Seven community listening sessions, developed in partnership with the Community Representatives, provided additional community feedback. 

Shifting the way people think and understand the connection between prevention and child safety takes time. It requires moving decision makers and practitioners from focusing on how to work within the constraints of their current system to envisioning a new way for the system to operate. There were core elements of the Child Safety Forward design that helped accelerate some of the necessary transformations. These included: 

Child Safety Forward enabled Sacramento County to create a robust governing structure through its Prevention Cabinet for this work. This entity now consists of more than 30 cross-systems leaders from public systems, private nonprofits, and the community who have come together to co-create a strategic plan focused on systems change that promotes positive outcomes for children and families. 

The demonstration initiative has afforded Sacramento County the opportunity to participate in peer-to-peer learning and connect with subject-matter experts to support planning and implementation of a cross-systems strategic plan using a public health 21st century child welfare system approach. This has included the development of strategic ten-year plan to eliminate child abuse and neglect fatalities by 2030 that the team will be presenting to the Sacramento County Board of Supervisors. 

Child Safety Forward Sacramento’s Prevention Cabinet has become the advisory body and collaborative partner for other child safety initiatives in the county. Because the Prevention Cabinet has such a widespread reach across county agencies and organizations, the Prevention Cabinet has been selected as the governing body of the county’s efforts to implement the Family First Sacramento Comprehensive Prevention Plan.   

This approach to collective impact is uniting cross-sector and community leaders under a common cause and will ultimately help leaders engage and collaborate across systems that touch families with a common goal and collective responsibility for keeping children safe.  

___________________ 

Sheila Boxley is the President & CEO of the Child Abuse Prevention Center, a local and state organization which provides services, training, research, and advocacy and serves as the association for the 500 family resource centers in California. 

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.  

Reports highlight findings in multi-year effort to develop strategies to reduce child abuse and neglect.

WASHINGTON, DC – Child Safety Forward (CSF) today released the final evaluation report of its four-year demonstration initiative funded by the Department of Justice (DOJ) with technical assistance led by Social Current. CSF, which was launched in October 2019 by the DOJ’s Office for Victims of Crime, engaged five sites across the U.S. in the demonstration initiative, which included research, planning and implementation around strategies aimed at reducing child injury and fatality from abuse and neglect.

The CSF demonstration sites include: The Indiana Department of Health; St. Francis Hospital in Hartford, Connecticut; Cook County Health in Illinois; the Michigan Department of Health and Human Services; and the Sacramento County Child Abuse Prevention Council. Final reports from the sites are available here.

Through CSF, the five demonstration sites received technical assistance from a team of national experts to help plan and implement an all-systems approach to respond to and reduce child maltreatment fatalities and child crime victimization. Technical assistance focused on collecting and analyzing data using a safety science approach; developing strong community collaboratives; engaging persons with lived experience; developing and implementing a communications strategy; addressing systemic bias, racism, and issues of power; and using a developmental evaluation approach.

“Each of the strategies identified and implemented by the five sites were unique and specific to their communities,” commented Amy Templeman, director of Within Our Reach and senior director of child and family well-being at Social Current. “However, they all shared a common trait – they all pivoted away from an approach that only took into account risk factors and broadened their focus to protective factors, which is ultimately at the heart of a public health approach that engages voices of those with lived experience as experts in finding the solutions that will make all lives better.”

Demonstration sites conducted retrospective reviews of child fatality data and/or collected additional community-level and system-level data to inform their implementation plans. The following summarizes the key strategies and learnings from each site:

Some of the key lessons learned and takeaways from the initiative include:

Parent engagement strategies often end up being transactional and unidirectional. To address this, we must unlearn, test new infrastructures and ways to building partnerships with parents, and relearn as a system how to effectively address the existing power imbalance that makes it difficult for the system and parents to be united in their commitment to keeping children safe and at home.

“Child Safety Forward’s ability to evolve over time is one of the keys to its success,” noted Stacy Phillips, Victim Justice Program Specialist with the Office for Victims of Crime (OVC) within the U.S. Department of Justice. “The technical assistance team worked to create a culture of learning around the many strategies developed by the sites and were able to support sites in building flexibility into their approach. OVC was proud to support this work and contribute toward an extensive community of learning across the field with regard to reducing child maltreatment and fatalities.”

About the Within Our Reach Office 

Within Our Reach is an office established within Social Current to further the recommendations of the federal Commission to Eliminate Child Abuse and Neglect Fatalities. The goal of Within Our Reach is to equip policymakers, practitioners, and advocates with the tools they need to fundamentally reform child welfare. Based on the commission’s national strategy, desired reform includes a proactive public health approach—a shared family and community responsibility to keep children safe. Within Our Reach is made possible through collaboration with Casey Family Programs, whose mission is to provide, improve, and prevent the need for foster care.   

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice. 

By: Dr. Daniel P. Hall Riggins and Verleaner Lane

According to the Center for Disease Control and Prevention, each year, there are nearly 3,500 sudden unexpected infant deaths (SUID) in the United States. In 2020, 27% of those deaths occurred in infants under the age of one due to an unsafe sleep environment.

The American Academy of Pediatrics understood the dangers of unsafe sleep nearly three decades ago, resulting in the launch of their Safe to Sleep, (formerly Back to Sleep) campaign in partnership with the National Institute of Child Health and Human Development. The campaign advocated for parents to place children on their backs to sleep and to remove loose bedding. As a result, child death rates from SUIDs dropped precipitously, but in the early 2000s those advances stalled, with infant mortality rates remaining stagnant at around 85-100 deaths per 100,000 births each year.

Since then, researchers have recognized that rates of infant death remain high in American Indian/Alaska Native and Black communities, leading child health experts to examine the role that race may play in these health disparities.

AAP updated its safe sleep guidance last year, with a focus on addressing disparities by contextualizing safe sleep behavior within broader societal and cultural factors, including the impact of poverty, lack of access to prenatal and well-childcare, and lack of culturally appropriate messaging around safe sleep. As a result, communities nationwide are taking a fresh look at sleep-related infant deaths through the lens of a population health approach.

That was one of the goals of Cook County Health Project CHILD’s participation in the Child Safety Forward initiative — one of five sites that was selected for a Department of Justice-funded grant to reduce child abuse and neglect fatalities and injuries through a collaborative, community-based approach.

An initial data review showed that Cook County’s SUID rate is twice the national rate and the Cook County incidence of SUID in Black infants was over 10 times higher compared to Non-Hispanic White infants, based on data from 2019.

Project CHILD began its efforts by using geospatial risk analysis mapping to demonstrate neighborhood “hot spots” of SUIDs. We discovered noted clusters of deaths on the Westside of Chicago in neighborhoods like Garfield Park, Humboldt Park, and North Lawndale; on the Southside in neighborhoods like Englewood, Pullman, and Woodlawn; and in Southern suburbs like Chicago Heights, Harvey, Hazel Crest, Olympia Fields, and Park Forest.

Project CHILD also approached the issue with an understanding that child welfare cannot do this work alone. In fact, data indicates that 50 percent of infants and children who die from fatal injuries caused by maltreatment, including unsafe sleep practices, are unknown to the child welfare system. This led to Project CHILD convening a multi-disciplinary group of stakeholders comprised of healthcare providers, community health workers, maternal infant health providers, educators, social service providers, and law enforcement – all those who come into contact with children and families.

We then partnered with the Child Protection Training Academy, (CPTA) located on the University of Illinois campus, which had created a simulation training model for DCFS Child Protection Investigators. The simulation was structured around training to recognize elements of unsafe sleep practices based on a fictional family with numerous underlying conditions including domestic violence, mental health concerns, substance use disorder and suspicions of sexual & physical abuse.

The simulation developed a home that was designed to draw attention to unsafe sleep practices, with the environment staged with a pack and play that was cluttered with clothing, bedding, and other objects. The simulation’s life-like doll was placed on a soft couch, to draw attention to other risk factors for unsafe sleep. Though the training was conducted on Zoom the teams were able to “investigate” the environment through the use of the “proxy” who walked through the home with a camera enabling the participants to see the home and its contents. Team members could ask for close up examination of particular items in order to determine what questions they might need to ask to gather additional evidence. Additional risk factors were added within the house, such as a premature infant and evidence of smoking.

What the simulation training revealed was that safe sleep issues were often not the primary concerns of members of the MDT as they observed the family’s home. Law enforcement, for example, is often called to homes for other reasons but are rarely trained to look for unsafe sleep practices.

It’s also important for members of the MDT to hear from families and parents with lived experience about the other factors that can influence sleep practices. Project CHILD met with families and heard from them about conflicting messaging coming from older generations who are respected for their wisdom, beliefs about the importance of skin-to-skin bonding, and, in communities where violence is prevalent, thoughts on family beds as perhaps one of the safer places for infants. We also heard loud and clear that families often do not trust public agencies and that the child safety messaging they do receive appears punitive and reactive.

Based on the insights from our geospatial mapping, simulation training and parent insights, we hope to create more advanced safe sleep trainings and guides for all stakeholders, not just those across the child welfare system. This information can also be used to assist in planning targeted messaging to hot spot communities, and the implementation of services and greater awareness, education and outreach to those communities.

Ultimately, we hope that, through the collaboration with key partners, such as Be Strong Families, EverThrive Illinois and the MDT teams, we can apply these learnings in new ways to enhance community understanding and action around safe sleep practices to reduce child fatalities.

Daniel P. Riggins, MD is a pediatrician with Cook County Health. Verleaner Lane is the project director for Project CHILD of Cook County Health, one of five Child Safety Forward sites.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005 Reducing Child Fatalities and Recurring Injuries Caused by Crime Victimization, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Child Safety Forward is a national demonstration initiative funded by the Department of Justice, Office for Victims of Crime (OVC) to reduce child abuse and neglect fatalities and injuries through a collaborative, community-based approach. Social Current’s Within Our Reach office is the lead technical assistance provider for the initiative, which is wrapping up its final year. Along with final reports from the five sites, Child Safety Forward is releasing two new briefs with funding from Casey Family Programs.

The first brief, A Reflection Guide to Shape Provider Conversations about Infant Sleep, focuses on Safe Sleep conversations. This is offered to providers as a tool based on the learnings from the sites on how bias shows up at the individual, relational, and institutional levels. The brief reflects strategies adapted by the sites to prioritize conversations and listening to community to better understand how together we can shape environments for children that support health and well-being.

Based on initiative findings and learnings, the second brief on Sustainability focuses on how to overcome resource interruptions and other challenges that stand in the way of producing lasting and effective change. This brief learning memo examines how Child Safety Forward was set up to encourage demonstration sites to apply a more comprehensive definition of sustainability during implementation. It also presents our recommendations for how funders and technical assistance teams can support sustainability.

Download Safe Sleep Brief Download Sustainability Brief

By: Verleaner R. Lane

April has long been recognized as Child Abuse Prevention Month. This year, the conversation around prevention has broadened to include family strengthening, in recognition of the importance of families and communities having access to resources that can lessen family stressors and prevent child abuse and neglect before it occurs.

Science shows us that children are more likely to thrive when their families have the economic and social supports that they need. Enabling these positive childhood experiences requires that we reimagine child welfare and focus instead on child and family well-being with upstream resources that can prevent child abuse and neglect before it occurs.

Federal and state policies that connect families to economic support services, such as Temporary Assistance for Needy Families (TANF), housing assistance, and nutritional supplements have been shown to strengthen families and reduce child welfare interactions.

By shifting to a preventative child and family well-being system that offers upstream resources for families, the goal is to provide families with more services rather than more surveillance.

Federal policy is supporting this shift by authorizing more funding and more flexible funding for family-strengthening services through the Family First Prevention Services Act and the proposed reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA).

What does a family-strengthening approach to child safety look like in practice? Answering that question is the impetus behind a national demonstration initiative launched by the Department of Justice’s Office for Victims of Crime in 2019.

The project, Child Safety Forward, engaged five sites across the United States in a multi-year focus that included research, planning, and implementation around strategies aimed at reducing child injury and fatality from abuse and neglect. The sites selected are Cook County Health in Illinois; Indiana Department of Health; Michigan Department of Health and Human Services; Saint Francis Hospital in Hartford, Connecticut; and Sacramento County, California’s Child Abuse Prevention Council. 

Each site is developing strategies that are unique and specific to their communities, honoring and reflecting the data they collected in the first year to identify community-led solutions that support resilient families and keep children safe in their homes. Each site is also working with a collaborative body of stakeholders and partners, including those with lived experience, to guide the work and is reviewing short- and long-term goals through an equity and diversity lens.

Our strategy includes bringing together a diverse group of community stakeholders that work with the most affected families in a variety of different settings. Our work has been focused on three Illinois counties: Cook, Peoria, and Vermilion, to identify the highest-risk geographic areas and target resources in these communities.

We began our efforts by using a data collection process that had been established earlier by Cook County Health in partnership with the Cook County Medical Examiner. The process automates data exchange between these two Cook County agencies allowing for the linkage of clinical data to mortality events among specific populations as determined by the medical examiner. Data sharing across these agencies is automated to identify risk factors for mortality among individuals experiencing homelessness, those impacted by the opioid epidemic, those with justice involvement, and the intersection of these experiences.

For Cook County, we reviewed approximately 300 sudden unexpected infant deaths over the past five years likely related to unsafe sleep conditions. We identified specific neighborhoods that had a higher rate of sudden unexpected infant death.

Based on these lessons learned, we are now able to appropriately target resources and educational interventions to protect families from these catastrophic events by creating the Safety for Children 0-5 self-paced educational curriculum and adding scenarios to the Simulation Labs and the MDT Training. We worked with pediatricians and community organizations to develop safe sleep messaging and interventions targeted to these high-risk neighborhoods. The program, led by 12 government and community agencies, including Project CHILD, aims to address sudden unexpected infant death (SUID), one of the leading causes of infant mortality.

Illinois Safe Sleep Support will focus on outreach and education to expand the community-based promotion of safe sleep practices, promote resources to improve safe sleep environments, identify SUID disparities, and address opportunities for improvement. The investments of this year-long campaign will continue to position Illinois as a leading state for children, families, and the early childhood workforce that supports them.

All of the strategies across the five Child Safety Forward sites share one common trait – they are predicated on demonstrating a public health approach to child and family well-being called for by the federal Commission to Eliminate Child Abuse and Neglect Fatalities. With a focus on increasing equity in systems that serve families, elevating parents into relationships of equal power, building protective factors, and supporting families who are having trouble weathering one or more of the storms impacting our country right now, each of the demonstration sites is working to create a body of knowledge about what works to reduce child fatalities.

As we celebrate Child Abuse Prevention, let us not forget that addressing community needs by giving families support prevents traumatic events from happening, has much more impact, and costs much less, than removing children from families and/or attempting to address the consequences of adversity after a child has grown up. 

We all have a stake in our kids’ future and shifting our focus from child welfare to child and family well-being will help us create a future where every child can thrive and reach their full potential.

Verleaner R. Lane, MA. is the Project Director for Project Child as a Visiting Project Specialist contracted employee within the Institute for Legal, Legislative, and Policy Studies (ILLAPS) at the University of Illinois at Springfield. Cook County Health established Project CHILD in 2019 to better understand and address infant deaths due to unsafe sleep conditions, or from abuse or neglect.

Disclaimer: This product was supported by cooperative agreement number 2019-V3-GX-K005, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.