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Public health frame and approach to the prevention of child maltreatment
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Public health frame and approach to the prevention of child maltreatment


Presentation by Sally Fogerty of Children's Safety Network (www.ChildrensSafetyNetwork.org) at Building Communities of Hope Event Oct. 23, 2012 in Springfield, Mass.

Presentation by Sally Fogerty of Children's Safety Network (www.ChildrensSafetyNetwork.org) at Building Communities of Hope Event Oct. 23, 2012 in Springfield, Mass.

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  • 1. The  Public  Health   Frame  and  Approach  to     Learning the  Preven7on  of    Child  EDC transforms lives. Maltreatment   Sally  Fogerty   October  23,  2012  
  • 2. “Children’s health is the extent to whichindividual children or groups of children are able orenabled to (a) develop and realize their potential,(b) satisfy their needs, and (c ) develop thecapacities that allow them to interact successfullywith their biological, physical, and socialenvironments.”From Children’s Health, the Nation’s Wealth, National AcademiesPress, 2004 2
  • 3. It is in the national interest to have healthy children. Healthy children are …more likely to becomehealthy adults who will contribute as a productive citizenry and workforce to the continued vitality of society. National Academy of Sciences, 2004 Childrens Health, the Nations Wealth: Assessing and Improving Child Health
  • 4. 4
  • 5. Adverse  Childhood  Experience   (ACE)  Study   q Maltreatment §  Emotional, physical, and sexual abuse §  Emotional and physical neglect q Family Dysfunction §  Family Substance Abuse §  Family Mental Illness §  Intimate Partner Violence §  Parental Divorce/Separation §  Incarcerated Family Member –  Almost two-thirds had at least one ACE –  More than one in five had 3 or more ACEsAdverse Childhood Experiences (ACEs) fact sheet. www.cdc.gov/nccdphp/ace
  • 6. Linked  to  Broad  Array  of  Problems   Depression Liver disease Suicide Heart disease Current smoking Unintended pregnancy Teenage pregnancy STDs Teenage paternity Memory deficits Work Absenteeism Illicit drug use IPV Perpetration Early alcohol use Slide courtesy of Valerie Edwards, PhD. Div. of Adult and Community Health. CDC
  • 7. ACE Score and Alcoholism 18 ACE    SCORE   16 Percent With Health Problem 0 1 2 3 4 or more 14 12 10 (%) 8 6 4 2 0 Problem w/alcohol or Began drinking <=14 years consider self alcoholicSlide courtesy of Valerie Edwards, PhD. Div. of Adult and Community Health. CDC
  • 8. Why it matters? 8
  • 9. Individual  Health  Influenced  by:   ž Biological – individual attributes ž Environmental - family, community ž Social Influences – population experience 9
  • 10. On-­‐going  Stressors  Influence  Individual   Health  ž  Livingin poverty Activatež  Financial strain Stressž  Lack of social Pathways support Blood pressure Heart rate Altered reflexes 10
  • 11. Physical Cognitive Health and Functioning Development GeneticsEnvironment Emotional/ Social Behavioral Functioning Functioning 11
  • 12.   Social  ‘Determinants  of  Health    ž  Circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.ž  Circumstances shaped by: economics, social policies, and politics. Could someone help me with these? I’m late for math class CSMHA - NASBHC MHET 12
  • 13. Social-­‐Ecological  Model   Life Course Individual Family/Peer Community Social/Cultural Environment
  • 14. Our Health Outcomesare Multi-Factorial Educa7on   Health   Family/Peer   Neighborhood  Services   Child   Policy   Community   Family   Support   Social   Welfare   Graphic  Concept  Adapted  from  Neal  Halfon,  UCLA   14
  • 15. Child  abuse  and  neglect  is  result  of  complex  transac7ons  between  mul7ple  risk  factors  and  ecologies.  It  is  …   Preventable Multifaceted Requiring Multilevel and Multidisciplinary solutions Collaborations & partnerships which are cross-agency, disciplines and community- based 15
  • 16. Reframing What We Do andHow We Do It. De-scaling What Doesn’t Work, Scaling Up What Does Work Measure Outcomes not just Services 16
  • 17. We are standing on the bank ofthe river, rescuing people whoare drowning. We have notgone to the head of the river tokeep them from falling in. Gloria Steinem, 2002 17
  • 18. Risk  Factors,  Protec7ve   Factors  and  Resiliency    Risk factors: something shown to be associated with   ahigher incidence when populations exposed to factor.Protective factors: something present increases healthand well-being of children and families.Resilience: set of skills & behaviors which appear toprevent more serious effects due to trauma, illness andother life events 18
  • 19. Risk Factors Protective FactorsGraphic  Concept  Adapted  from  Neal  Halfon,  UCLA   19
  • 20. Safe, Stable, NurturingRelationships (SSNRs) Safety. Safety refers to the extent to which a child is free from fear and secure from physical or psychological harm within his or her social and physical environment. Stability. This refers to the degree of predictability and consistency in a childs environment. Families that are stable and have regular routines provide children with the consistency needed to lessen the impact of stressful experiences. Nurturing. Nurturing refers to the extent to which a parent or caregiver is available and able to sensitively respond to and meet the needs of their child 20
  • 21. The  Public  Health  Approach  to   Ensure WidespreadPreven7on   Adoption Develop and Test Prevention Strategies Identify Risk and Protective Factors Define the Problem 21
  • 22. Data ActionResearch “Real World”Silos SystemsTreatment Ecological ModelRelationships Results 22
  • 23. Strengthening  Families:    Aligning  Results  for  Families   23
  • 24. Do  Something  at  Each   Level  of  Preven7on   Influencing Changing Organizational Policy & Practices Legislation Fostering Coalitions & Networks Educating ProvidersPromoting Community Education Strengthening Individual Knowledge & Skills Prevention Institute 24
  • 25. LowestImpact (1) Equity     Education & 1 Counseling Framework   2 Clinical Interventions 3 Long Lasting Protection Health Interventions Highest Changing the Context HealthyImpact (5) 4 Choices as Default Options Social and Environmental 5 Determinants of Health This pyramid is adapted from Thomas Frieden, MD, MPH, presented at the Weight of the Nation conference in Washington, DC, July 27, 2009
  • 26. Child’s  Health  &  Well-­‐being  Depend  on:   A GOOD START GOOD FUTURE GOOD CARE GOOD SUPPORT 26
  • 27. Contact Information Sally Fogerty Children’s Safety NetworkEducation Development Center, Inc. 43 Foundry Ave Waltham, MA 02453 www.ChildrensSafetyNetwork.org 1-617-618-2918 27