Preventing child abuse through partnerships, programs, policies
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* Kim Krisberg

In 2015, about 683,000 U.S. children were victims of abuse or neglect, with nearly 1,700 children dying as a result. From a public health perspective, preventing such abuse not only protects children in the present, but puts them on a trajectory toward better health and well-being.

In the late 1990s, the Adverse Childhood Experiences Study, a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente and one of the largest investigations of its kind, found an association between abuse and adverse experiences in childhood and later health problems.

Study results, published in 1998 in the *American Journal of Preventive Medicine,* found that people who reported multiple adverse exposures during childhood — such as abuse, witnessing violence against a parent or living with someone struggling with addiction — had a four- to 12-fold increase in the risk for alcoholism, drug abuse, depression and suicide attempt. To get at the root of such experiences and help prevent them from occurring in the first place, CDC takes a decidedly public health-based approach that targets the social conditions that exacerbate the risk of child maltreatment and engages multiple sectors across a community.

The agency’s 2014 report on “Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments” focuses on raising community awareness and commitment and on using policies and programs to create environments in which children and parents can more easily thrive.

The report highlights a number of programs that help prevent child maltreatment, such as coaching programs that work directly with child-parent pairs, nurse home-visiting programs that help first-time mothers, and hospital-based programs that educate new parents on how to safely handle and soothe a crying baby. Examples of supportive policies include safety net programs that help buffer families against the impacts of poverty and reduce parental stress, a known risk factor in child maltreatment.

Last year, CDC also released “Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm and Programmatic Activities,” which provides evidence-based strategies to help prevent child abuse and neglect.

“Imagine if we had this seamless, coordinated network of care, where individuals and families are nurtured from the beginning to end because they understand the full compliment of services available to them,” said Wendy Ellis, project director of the Building Community Resilience collaborative at the George Washington University Milken Institute School of Public Health. “It’s about working smarter together.”

Ellis, an APHA member, describes the adverse childhood experience with the image of a tree: The branches represent the visible manifestations of social stresses — such as maternal depression, substance abuse, neglect and homelessness — that effect the risk of child maltreatment. The roots represent the social conditions that lead to those manifestations — such as poverty, discrimination, lack economic mobility and poor housing.

Ellis oversees the Building Community Resilience collaborative, an innovative project launched in 2016 to create integrated, coordinated and community-level networks that link up public and private systems with local, grassroots organizations. The overarching goal of the effort, which now has test sites in Ohio, Texas, Oregon, Delaware and Washington, D.C., is to address the root causes of childhood adversity. For example, the team in Portland, Oregon — a team that includes a local university, an insurer, a behavioral health services provider and a public health nonprofit — is working with a school of kindergarteners through eighth-graders where more than 90 percent of students receive free or reduced lunch and half of are homeless or have unstable housing.

The collaborative is also partnering with the National Association of County and City Health Officials to adapt NACCHO’s Mobilizing for Action through Planning and Partnerships framework to address childhood adversity.

“It’s not about asking what’s wrong with you, but what’s happening to you that really gets at the root of adversity,” Ellis said. “For public health, this is right in our wheelhouse. We are the guardians of the community’s health.”

For resources on preventing child maltreatment, visit [bit.ly/childabuseresources](http://bit.ly/childabuseresources).

*   Copyright The Nation’s Health, American Public Health Association