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Recommendations for our Little Rock Program

Focusing on the six outcomes we determined, PAP will continue to partner with DCFS, our Align Coalition, and the Little Rock faith organizations to build a prevention strategy and campaign action plan while integrating the insights gained from our geospatial analysis, psychographic segmentation analysis, and community focus group research and recommendations.

We will work with DCFS to acquire the remaining services, death, and ACES data needed to support our program methodology, ensuring the greatest impact.

Recommended evidence-based prevention for the six outcomes

Child Abuse and Neglect

  • Reduces stigma around help-seeking
  • Enhances connectedness to build resiliency in the face of adversity
  • Fosters healthy and positive norms around gender, masculinity, and violence to protect against violence towards intimate partners, children, and peers
  • Promotes safe and effective discipline
  • Supports ACEs awareness
  • Child development
  • Expectations for child behavior
  • Behavior management
  • Anger management skills
  • Problem-solving skills
  • Discipline techniques not involving physical punishment
  • Appropriate supervision
  • Ensuring early childhood home visitation programs meet demand needs
  • Licensed and accredited child care facilities are available where needed
  • Availability of preschool enrichment with family engagement programs that provide parents social support, educational opportunities, and access to community resources.
  • Subsidized child care
  • State and federal earned income tax credit
  • Section 8 housing
  • SNAP benefits
  • Livable wages
  • Paid leave
  • Flexible and consistent schedules

Infant mortality

  • Provide childcare providers training in safe infant sleep practices
  • Create and ensure existing messages in media depict safe sleep practices that are consistent with the American Academy of Pediatrics recommendations
  • Expand parent education, training efforts, statewide regulations, mandates, and monitoring to decrease further risk of sudden infant death syndrome
  • Train healthcare professionals to share the importance of folic acid intake before and during pregnancy
  • Build public awareness around women of reproductive age needing 400 mcg of folic acid every day and how to ensure they receive enough in their diet

Suicide

  • Increase access to mental health providers in underserved areas by expanding the reach of health services through telephone, video, and web-based technologies
  • Create environments that address risk and protective factors where individuals live, work, and play include erecting barriers or limiting access to prevent jumping
  • Educate on safe storage practices of medications, firearms, and other household products
  • Encourage organizational policies and culture that promote protective environments such as prosocial behavior, skill-building, positive social norms, assessment, referral and access to helping services (e.g., mental health, substance abuse treatment, financial counseling) in places of employment, detention facilities, and other secured environments
  • Address community-based policies to reduce excessive alcohol use such as zoning to limit the location and density of alcohol outlets, taxes on alcohol, and bans on the sale of alcohol for individuals under the legal drinking age
  • Implement peer norm programs that seek to normalize protective factors for suicide such as help-seeking, reaching out to trusted adults, and promoting peer connectedness
  • Promote community engagement activities e.g., religious activities, community clean-up and greening activities, and group physical exercise
  • Train teachers, coaches, clergy, emergency responders, primary and urgent care providers, to identify people who may be at risk of suicide and to respond effectively

Teen Birth

  • Encourage teens not to have sex
  • Recognize long-acting reversible contraception (LARC) as a safe and effective first-line choice of birth control for teens
  • Provide teens with knowledge about LARC and explore funding options to cover costs
  • Offer a broad range of birth control options to teens, and discuss the pros and cons of each
  • Seek training in LARC insertion and removal, have supplies of LARC available, and explore funding options to cover costs
  • Remind teens that LARC by itself does not protect against sexually transmitted diseases and that condoms should also be used every time they have sex
  • Talk with their teens about sex, including encouraging them not to have sex
  • Encourage teens to use effective birth control to prevent pregnancy, along with condoms to protect against sexually transmitted diseases
  • Visit a health care provider with the teen to learn about various types of birth control, including LARC
  • Check with their health plan(s) about coverage of preventive services. Birth control and counseling may be available for teens at no out-of-pocket cost
  • Locate Title X-funded centers for possible financial help
  • Use educational campaigns to encourage teens not to have sex
  • Licensed and accredited child care facilities are available where needed
  • Availability of preschool enrichment with family engagement programs that provide parents social support, educational opportunities, and access to community resources.
  • Subsidized child care
  • State and federal earned income tax credit
  • Section 8 housing
  • SNAP benefits
  • Livable wages
  • Paid leave
  • Flexible and consistent schedules

Violent Crime

According to the Community Preventive Services Task Force, (CPSTF) primary prevention interventions to reduce perpetration of intimate partner violence and sexual violence among youth, may be implemented in schools (middle school, high school, or college), at home, in communities, or in a combination of settings.

They may target groups at high risk for violence or the general population, both of which may include youth who have already experienced intimate partner violence or sexual violence as a victim or perpetrator.

  • Teaching healthy relationship skills
  • Promoting social norms that protect against violence
  • Creating protective environments
  • Interventions that taught healthy relationship skills OR promoted social norms to protect against violence reported favorable and consistent decreases in perpetration.
  • Interventions that taught healthy relationship skills OR combined teaching healthy relationship skills with efforts to promote social norms that protect against violence, reported favorable and consistent decreases in victimization.
  • Interventions that used all three strategies in combination reported decreases in perpetration and victimization.

Interventions that promote social norms to protect against violence through bystander education and empowerment, engaging men and boys as allies in prevention, or both are also recommended.

Chronic absenteeism

  • Prioritize the development of early warning prevention and intervention systems that identify students who are, or are at risk of becoming, chronically absent before they miss enough school that it is nearly impossible for them to catch up
  • Focus on developing positive messages for youth and families as well as implementing supportive engagement strategies
  • Launch local initiatives to raise public awareness about the causes and effects of chronic absenteeism, including awareness among families and youth
  • Regularly communicate across sectors that chronic absenteeism is a problem that affects the whole community, not just those students who are chronically absent and their families
  • Community collaboration such as Integrated Student Supports programs
  • Parent / guardian engagement and home visits
  • Mentoring: pairing a caring adult or older student with an at-risk youth
  • Safe Passage Program: adult monitors are placed along the streets and paths around select schools
  • Extended Learning Programs/Summer Learning Program
  • Incentives including praise and public recognition or material / monetary rewards

Prevention Concepts
and Initiatives for Consideration

Since 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.



Hundreds of scientific studies have established these connections, and so attempts to address just one negative outcome in isolation is 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.

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-Risk 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.

Prevention
communication
strategy development

As we work to define what specific prevention goals are, we will use the psychographic segmentation analysis results to ensure intended audiences are reached and motivated to act.

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?

Approaches to Consider:

In high-risk areas

  • Partner with dentists to provide discounted dental services
  • Promote job training and low-cost financial planning
  • Educate on all Wal-Mart pharmacy services (flu shots and immunizations)
  • Offer promotions that incentivize healthy behaviors (e.g. Redbox coupons for attending a community nutrition class)
  • Share awareness messaging through radio, cable TV and bus stop shelter advertising to disseminate well defined behaviourally focused messages to large audiences repeatedly
  • Use email and social media channels for prevention awareness messaging and education

In low-risk areas

  • Increase awareness factors associated with high-risk areas.
  • Solicit assistance from individuals able and willing to offer needed services at a donated or discounted rate (e.g. dentists, financial planners, coding experts).

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.

Partner with your local university

Develop partnerships with your local university graduate programs to support campaign efforts. From creating materials to helping form community partnerships, Graduate students are an amazing resource and want to help their community.

A recommended
direct email approach

for Little Rock, focused on the prevention of child abuse and neglect in the highest risk areas

Acquire email addresses of the highest risk groups filtered by demographics for optimal targeting


We will use the risk maps as our resource

Send emails using a survey platform that opens with an incentivization offer such as an entry into a sweepstakes


We have identified that the highest risk groups enjoy sweepstakes and contests

Our topic: identify the signs of child abuse and what to do about it


Our target audience is most likely to be exposed to the 0-3 children at risk who are not seen by traditional reporters

Our campaign goal: to educate and empower community members to be the voice of the at-risk children while sharing how participants can report concerns anonymously


Avoid finger-pointing and conflict while addressing the community’s voice for the need of interconnectivity to alert others to potential maltreatment which was unanimously brought up in all focus groups

The interactive platform would begin with a knowledge pre-assessment

Baseline measurement of awareness


Followed by prevention awareness messaging

Using a positive approach without shock tactics


Concluding with a knowledge post-assessment


Providing comparison and reinforcement

Participants could then enter the sweepstakes and would be asked to join DCFS social media channels, providing future communication, and messaging opportunities

Using this methodology and our areas of focus, we suggest two additional direct email approaches to consider:

Suicide prevention: how to recognize early warning signs, what to say and do, and where to find help

Safe sleep practices: safe alternatives to co-sleeping

For added reach and reinforcement of the prevention messaging:

We recommend city bus advertising of a minimum of 10 buses per 4 week period to reach 25% of the daily population

For stronger impact still:

Radio prevention messaging of fifteen to thirty-second spots on local gospel and urban stations for 15 weeks

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

Click to Continue to the Ahead Section

References

  • Daley D., Bachmann M., Bachmann B.A., Pedigo C., Bui. M.T., & Coffman J. (2016). Risk terrain modeling predicts child maltreatment. Child Abuse Neglect. 62:29-38. doi:10.1016/j.chiabu.2016.09.014. https://www.sciencedirect.com/science/article/pii/S0145213416301922
  • Predict Align Prevent (2019). Richmond, Virginia Technical Report. https://b9157c41-5fbe-4e28-8784-ea36ffdbce2f.filesusr.com/ugd/fbb580_2f1dda2ff6b84f32856bc95d802d6629.pdf
Visit www.Predict-Align-Prevent.org

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