Prevention Program
Recommendations and Considerations
Child Abuse and Neglect Prevention Strategies
- Reduces stigma around help-seeking [1][3]
- Enhances connectedness to build resiliency in the face of adversity [1][3]
- Fosters healthy and positive norms around gender, masculinity, and violence to protect against violence towards intimate partners, children, and peers [1][4][5]
- Promotes safe and effective discipline [1][3]
- Supports ACEs awareness [1][3][4]
- Child development [2][6]
- Expectations for child behavior [1][6][7]
- Behavior management [6][7][8][9][10]
- Anger management skills [2][6][7][9]
- Problem-solving skills [2][6][7][9][10]
- Discipline techniques not involving physical punishment [2][6][7]
- Safe supervision [2][6][7][9]
- Ensuring early childhood home visitation programs meet demand needs [2][11][12][13][14][15][16][17][18]
- Licensed and accredited child care facilities are available where needed [2]
- Availability of preschool enrichment with family engagement programs that provide parents social support, educational opportunities, and access to community resources. [2][19][20][21][22][23][24]
- Subsidized child care [2][25]
- State and federal earned income tax credit [2][26]
- Section 8 housing [2][27]
- SNAP benefits [2][28][29]
- Livable wages [30]
- Paid leave [31][32][33][34]
- Flexible and consistent schedules [2]
New Programs for Consideration
Upstream USA
Upstream partners with states to provide health centers with patient-centered, evidence-based training and technical assistance that eliminate barriers to offering the full range of contraception.
Cure Violence
Cure Violence stops the spread of violence by using the methods and strategies associated with disease control: detecting and interrupting conflicts, identifying and treating the highest risk individuals, changing social norms. It is a successful evidence-based program with multiple studies showing reductions in violence.
Darkness to Light
Stewards of Children is an evidence-informed, award-winning two-hour training that teaches adults to prevent, recognize, and react responsibly to child sexual abuse. Through interviews with child sexual abuse survivors, experts, and treatment providers, Stewards of Children teaches adults practical actions to reduce instances of child sexual abuse in their organizations, families, and communities.
No Hit Zone
A No Hit Zone is a comprehensive program that includes multiple strategies to effectively influence attitudes, norms, and behaviors. Anyone can become a No Hit Zone! Family homes, schools, hospitals, religious institutions, communities, and many more can join the movement to address the most prevalent risk factor of child abuse-social norms around corporal punishment.
CDC: Essentials for Parenting Toddlers and Preschoolers
Essentials for Parenting Toddlers and Preschoolers is a free, online resource developed by the Centers for Disease Control and Prevention (CDC). Designed for parents of 2 to 4-year-olds,
Jewish Women International
Jewish Women International offers domestic violence prevention training opportunities that empower clergy, social workers, teachers, parents, lawyers, advocates, mental health professionals – everyone positioned to touch a child, teen, adult, or family at risk.
Coaching Boys Into Men
CBIM trains and motivates high school coaches to teach young male athletes healthy relationship skills and that violence never equals strength. A study found that athletes who participated in the program were significantly more likely to intervene when witnessing abusive or disrespectful behaviors among their peers and were also more likely to report less abuse perpetration.
CDC VetoViolence
VetoViolence exists to empower you and your community to prevent violence and implement evidence-based prevention strategies in your community. Tools, trainings, and resources are designed to empower you and your partners to help reduce risks for violence and to increase what protects people and communities from it.
Zero Abuse Project
Programs are designed to provide cross-disciplinary education and training, advocacy for systemic legal change, guidance for survivor support, and leadership on emerging technologies. We take a holistic approach by also recognizing and addressing the intersecting forms of child maltreatment in connection with child sexual abuse.
Existing New Hampshire Community Resources to Explore for Alignment
Alcohol / Opioid Abuse
Neonatal Abstinence Syndrome (NAS)
- Hope on Haven Hill
- Dartmouth-Hitchcock
- Memorial Hospital Maine Health
- JSI New Hampshire
- The Partnership
- Families in Transition
- Harbor Care
Asthma or COPD
Lead Exposure in Children
- Lead Safe Manchester
- CDC’s Childhood Lead Poisoning Prevention Program
- DPHS: Healthy Homes and Lead Poisoning Prevention Program
Domestic Violence
- New Hampshire Coalition Against Domestic & Sexual Violence
- Voices Against Violence
- YWCA Crisis Service: Emily's Place in Manchester
- New Horizons for New Hampshire
Assault / Community Violence
Prevention Concepts and Initiatives
In addition to specific recommendations, a population’s concentrated exposure to adverse experiences, including child abuse and neglect, is directly related to negative outcomes; prevention must be a cross-sector, collaborative effort.
The negative outcomes shown in the chart below are also risk factors for ongoing adverse experiences.
CLICK TO ENLARGE
Hundreds of scientific studies have established these connections, so attempts to address just one negative outcome in isolation are unlikely to be successful.
Therefore, focused efforts to prevent child abuse and neglect must occur in the context of reducing a population’s overall exposure to adverse experiences.
Prevention Possibilities for Further Discussion
Concepts Related to Community-Level Prevention
Although exposure to multiple ACEs generally results in the outcomes listed in the chart above, some people and communities do not display these outcomes because of differing adaptations to their environments and thereby change their outcomes for the better. Since this form of community wisdom could be learned and replicated in other parts of the community, geospatial machine learning taught with such outcome data would help in identifying these types of positive deviance.
The response of medical, first responder, and social work professionals play important roles in ACEs exposure. When addressing outcomes/risk factors, does a professional response serve to increase ACEs for families? For example, in cases of domestic violence, are policies in place to prosecute violent offenders without requiring victims’ cooperation? If animal cruelty is recognized, are child maltreatment and elder abuse also addressed? When women and girls who are of childbearing age but who do not plan on becoming pregnant within the next year are in a medical setting, are long-acting reversible contraceptives made immediately available as the best-in-class pregnancy-prevention option? Are police well trained in de-escalation techniques to avoid incarceration of nonviolent offenders? Are medical, dental, first responder, and child care personnel taught sentinel-injury recognition and subsequent reporting procedures?
Community leaders shape social norms and so, when speaking from a position of authority, can influence what is considered acceptable behavior, thereby influencing a community’s
exposure to ACEs. For example, does the faith community take a no-tolerance stance with respect to domestic
violence? Does the within-school response to sexual abuse of children and teenagers prioritize a child’s stated
experience, which is almost always true? In the case of rampant child physical abuse, is physical punishment
of children in the home or school setting encouraged?
Some buildings and places tend to support specific types of criminal behavior. Predictive risk modeling can identify specific areas where risk of child abuse and neglect is particularly high and which buildings and places have significantly more crime events relative to a city as a whole. Safety in these areas can be improved by enforcing code, addressing code violations, implementing Crime Prevention through Environmental Design, replacing abandoned or unsafe buildings with community spaces, and making crime-attracting places less attractive.
Multiple organizations, coalitions, teams, and programs working in the same places with the same people provides an incredible opportunity to deploy impactful prevention messaging. Moreover, any approach to behavioral change follows similar steps, from marketing of designer clothing brands to influencing voting behaviors. Within a prevention context, are the local organizations, coalitions, teams, and programs working together to ensure consistency and lack of conflict in prevention messaging? Are common risk factors addressed collaboratively to increase the number of times target audiences see or hear prevention messaging? Are all organizations held to an evidence-based standard that does not spread misinformation harmful to communities?
Many coalitions, organizations, teams, and programs
interface with the same people from the same places, and
most conduct surveys and attempt to engage the same
target populations. Working in silos, this approach can
create an administrative burden in communities in need
of services and supports. So, instead of conducting new
surveys, new focus groups, new asset-mapping exercises
and asking new questions about what the community thinks
its problems and their solutions are, how can
organizations work together to use the information that
has already been gathered in moving toward instituting
tactical action? In addition to conserving resources,
this approach places less of a burden on community
members, most likely improving community engagement.
The most qualified professional to obtain specific data
should be the one collecting that data, and the most
reliable data source should be used as the source of
that data. For example, if medical data are being
collected, it should be by a skilled medical
professional. If crime data are being collected, it
should be from the police department. Self-reported and
survey data can be utilized, but only if those answers
can be objectively verified. Answers that can’t be
objectively verified and represent major risk factors
for child maltreatment should not be used in assessing
risk.
The ideals of implementation programs can face
significant challenges in breaking down existing
silos. Often, “collective impact” type initiatives
splinter into sub-groups that mirror previously existing
committees and task forces and suffer from the same
barriers to change. Thus, whenever possible,
cross-sector collaboration aims to simplify,
standardize, and automate to maximize impact and
resource utilization, with the “backbone”
organization(s) “owning” the most protected data and
driving continuous quality improvement based on that
data.
Funders set expectations and requirements for what
outcomes can and should be measured. But do funders
require objective, verifiable outcomes for the ongoing
allocation of resources? Are outcomes expectations
linked for programs intended to address problems with
similar risk factors and target populations? Government,
philanthropic, and industry funders are probably in the
most powerful position to define success in prevention
interventions and encourage adherence to the findings of
data-driven continuous quality improvement cycles.
Child Abuse and Neglect Prevention Initiatives
Period of PURPLE Crying provides training to all new parents
to help them understand their child’s development from about 2 weeks of age to 3 to 4 months, focusing particularly on safe caregiver responses to inconsolable crying.
Community-wide campaigns promoting positive parenting techniques which do not include physical punishment of children, a proven precursor to physical abuse and physical abuse fatalities, is another relevant initiative. One option, the No Hit Zone program, provides resources for family homes, organizations, and communities including multiple strategies to effectively influence attitudes, norms, and behaviors around interpersonal violence.
Early recognition and an effective response to sentinel injuries in a health care setting can prevent severe or fatal injury. Professional training, such as the TRAIN Collaborative , has quadrupled the frequency with which children are identified as having a sentinel injury in participating institutions.
Court and legal professionals, medical examiners, journalists, and pediatric physicians, who may be called to testify in a criminal proceeding for a case of abusive head trauma, should be aware of the findings in professional society consensus statements, such as the Consensus statement on abusive head trauma in infants and young children, which provide an evidence-base for the evaluation of AHT. This knowledge is important for prevention because misinformation, perpetuated by paid defense experts, can result in legal proceedings which allow a single male perpetrator to be involved in the abusive deaths of multiple unrelated children from different mothers over time in a single community.
Postpartum depression and psychosis
awareness, screening, and treatment supports, such as are available from Postpartum Support International
ACEs awareness programs, such as ACE Interface, are designed to support rapid dissemination of ACE and resilience science, and promote understanding and application of the
science to improve health and wellbeing across the lifespan.
Evidence-based home visitation and parenting programs, such as Nurse Family Partnership and Triple P Parenting
Housing availability for formerly incarcerated people with violent criminal histories that does not include responsibility to care for infants or toddlers.
Specific to High-Needs Areas
Availability of high-quality child care for single working mothers that is cost appropriate, easily accessible, open for the duration of typical working hours, and has the capacity to care for infants and children with special needs. Child care is important for prevention so that mothers don’t have to rely upon unrelated adults to care for their infants and children while they are at work. Optimal placement of new child care centers can be extrapolated from Predict and Align findings.
Mothers or caregivers of infants and toddlers should be
aware of risk factors influencing the safety of their children while being cared for by unbonded adults.
Violence spreads like a contagious disease, and can be prevented by reducing exposure. One option, Cure Violence, is an effective community-based violence prevention program which has demonstrated significant reductions in violence in communities all over the world. Violence prevention is critical because unsafe communities are isolated communities, and resilience is built on community connections and relationships.
Family justice centers, such as One Safe Place, bring together resources for victims of domestic violence, and often include child care, pet care, and emergency housing. Domestic violence is the most predictive risk feature for child maltreatment in Richmond, and is also one of the most important causes of homelessness for women and children nationally.
Community Engagement and Communication Strategy Development
Recommendations for Optimizing Community Engagement Based on the Manchester Psychographic Analysis Findings
Capitalize on audience insights at most meaningful touchpoints
- High usage in social media: Partner with new mothers’ Facebook groups for events or education to raise awareness amongst the most critical target. Encourage mothers as the group that cares the most about children to stay vigilant and help each other.
- Have little interest in parenting: Partner with clinics to ensure access to long-acting reversible contraception (LARC) is available.
- Careful spenders who only buy essentials / shop at low-end retailers: consider partnering with these retailers as a possible communication channel.
- Low income, economically unstable: Improve financial security by providing well-publicized and easily accessible education and assistance surrounding economic supports such as Section 8 housing, SNAP benefits, WIC, Children’s Medicaid, and CDB child care assistance.
- Smokers who are uninterested in health/exercise, cooking: Partner with CVS/Walgreens/Walmart or other stores that have in-store clinics to introduce healthy options and programs. Create a campaign to increase EBT/SNAP usage at Fresh Food Farms to promote healthy eating.
- Medicaid recipient, medical insurance from a union: Review in high-needs areas which insurances are accepted and if new patients are welcome.
- Unlikely to have dental insurance: Partner with dental clinics to offer discount / low-cost options.
- Eleven to fifteen-year-olds present in household: Educate early partnering with middle and high schools to foster healthy and positive norms around gender, masculinity, and violence to protect against violence towards intimate partners, children, and peers.
- Passionate about music, frequently listening to the radio and free music streaming sites: Prioritize communicating on those channels with educational messaging and promoting social norms conveying community shared responsibility for the well-being of all children. Form partnerships with venues that have live music or sponsor an outdoor concert and share messaging at these events.
Developing a core message: key questions to address
- What are the values and priorities of the audience?
- What is the audience’s current level of awareness about the issue?
- Does our message address the problem, strategy, and call to action?
- While determining the creative development and approach of our messaging, are we keeping in mind real-life stories are preferable to shock tactics and avoiding shaming or finger-pointing?
- Are we choosing media channels such as digital, social, public relations, traditional, etc., based upon analytical research and balancing constraints versus intended results?
Build media advocacy
- Develop relationships with local media: write letters to editors and press releases, focused on the issue and messaging needed for change.
- Share media advisories and media statements that will be introduced by the press, which can create a new or different way of thinking for your audience.
Measuring Communication Effectiveness
As we work towards solidifying our communication strategy, we will create an analytical basis to measure the effectiveness of our efforts.
Communication strategy development will include identifying key performance indicators unique to each approach with measurement solutions that allow for active management so course adjustments can be made effectively to reach our goals.
We will look to develop measurement solutions that:
- Provide objective evidence of progress towards achieving our prevention results
- Offer a comparison that gauges the degree of change of the action or behavior over time
- Measure what is intended to be measured to help inform active decision making
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