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Creating a 21st Century Child Well-Being System

Here’s how we can change the fabric of support for families striving to raise our future workers and citizens.

This is excerpted from a three-part blog series exploring the mental health needs of very young children. Click here for the full article originally published in the Huffington Post.


As National Child Abuse Prevention Month draws to a close, we take time to reflect on how we protect young children and make new plans to move forward. The final report of the Commission to Eliminate Child Abuse and Neglect Fatalities seems a fitting, though sorrowful, place to start.

According to the Commission’s report, between 1,500 and 3,000 children—three quarters of them babies and preschool-age children—become fatalities each year as a result of maltreatment, ending short lives that never had a chance to blossom. In fact, more than 700,000 children experienced substantiated maltreatment in 2014, including 192,000 infants and toddlers who face long developmental odds because of this experience.

Encouragingly, the report calls for a new 21st Century Child Welfare System. We absolutely need such a system to replace the current dysfunctional one that fails to get to the heart of families’ problems and children’s well-being, but we shouldn’t stop there. We need a 21st Century Child Well-Being System—a system that includes child welfare and also offers a comprehensive and integrated system of services designed to proactively support families with young children to help them thrive. By addressing the needs of families before there is a crisis, we can work toward the goal of ultimately reducing the number of families that become involved with Child Protective Services.

The stresses on families today are serious. The cumulative impacts of these stress factors on their children are significant and lasting—ranging from emotional and cognitive harm that hampers success in school to adverse health consequences as adults. To promote children’s well-being, we must face the daily realities for many families with young children: extensive poverty, unstable neighborhoods, low-wage jobs, lack of affordable housing or child care, and food insecurity. We also must confront the conditions of many parents that escalate risk—their own trauma histories, substance abuse or mental illness, their own cognitive disabilities—and sometimes undermine their children’s brain development and even lead to life-threatening harm.

Overall, the service systems for the needs of vulnerable children and families who haven’t come to the attention of the child welfare system are inadequately integrated, underfunded and over stressed. This leaves families struggling on their own until challenges escalate and spiral downward. In some cases, this downward plunge results in a tragic death of a child. But in the vast majority of cases where children do not come to such grave harm, they often still face very serious long-term developmental consequences. This vulnerability begins a new cycle of difficulties that can prove detrimental for children and families for years to come, including social-emotional and cognitive delays, challenging behaviors, and lack of school and workforce-readiness.

To truly create the 21st Century Child Well-Being system, we need to look at strategies that help build strong community systems oriented around positive early development and strengthening parents’ ability to cope with their own needs. Proven approaches include home visiting, comprehensive early care and learning programs, intensive parenting and mental health support. Financing comprehensive approaches widespread enough to make a difference is always a challenge.

The Commission report recommends financing home visiting through Medicaid, which would be a step in the right direction. Here are some ideas for broader approaches:

  • Support innovative ways to serve families that meet their individual needs while advancing systemic change. The Safe Babies Court Team™ approach uses teams of community service providers, led by judges, to change policy and practice for babies in the child welfare system. The team provides individual children and families with closely monitored services and supports tailored to their individual situations. They organize services and review progress every month in a holistic approach that wraps around the family—a far cry from the usual three- to six-month case reviews. At the systems level, the teams collaborate to identify and fill service gaps and change the way the community works with families. Research has found young children who are part of a Safe Babies Court Team leave foster care faster and are more likely to live permanently with a member of their biological family. Additionally, more than 99 percent were protected from further maltreatment.
  • Start in the pediatrician’s office, where young children are most often seen, and use the universal experience of well-child visits to identify and support young children and families with risk factors. Healthy Steps integrates child development specialists into pediatric practices to provide parenting support and child guidance, often through home visits. The specialist gauges child development and family risk/protective factors, and connects families with community services. Evaluations of families engaged in the program found reduced parental use of harsh punishment and greater identification of risks for depression, violence and substance abuse.
  • Provide comprehensive services for pregnant women, infants, toddlers and families through an early care and learning platform. Early Head Start provides a holistic approach to supporting early development by increasing parenting strengths and supporting child development. Mental health consultation and community service connections are built into the program. While not part of the Early Head Start mission, follow up research has found fewer contacts with the child welfare system for participating families as their children grow up.
  • Forge community-wide connections starting at birth. Durham Connects, now being scaled up as Family Connects, reaches out to all families with newborns and offers home visits to support parenting and child development as well as connections to other community services. A key to success has been the mapping of available community services and collaboration to fill gaps identified. The project has demonstrated community-wide impacts, including reductions in emergency room visits for children.

The ultimate goal should be to change the fabric of support for families striving to raise our future workers and citizens. However, the tragedy of abuse and neglect dictates that we start first, and immediately, with the child welfare system. While the perennially underfunded Child Protective Service agencies could undoubtedly use the billion-dollar “surge” in resources the Commission’s report calls for, it is not enough to change the odds for these children or their families. Increasing the surveillance and resources to corral more at-risk families into the same threadbare system is not going to change outcomes.

A successful 21st Century Child Well-Being System must be one that starts with valuing and making investments to support families, taking into account the whole family’s needs and employing a broader range of strategies beyond just those evaluated for fatality prevention. Change begins at home. Empowering parents with the resources necessary to address their own needs will positively impact the kind of parents they will be and ultimately influence the kind of parents their children will become.


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