States grappling to ensure continuity of services amid the COVID-19 pandemic highlight a stark reality: the welfare of our nation’s children falls short of our collective aim to eradicate structural inequities among communities of color and low-income families. Swift action from public health and human services leaders to advance a collective vision that encompasses a prevention focused child welfare model is a critical opportunity for collaboration between public health and human service partnerships.
The window of opportunity toward shifting the public discourse and understanding to a collective vision rests on building a foundational family well-being roadmap based on known protective factors, strength-based approaches, and necessary universal supports for all families. In this blog post, Tracy Wareing Evans, President and CEO of the American Public Human Services Association (APHSA), discusses the perspective of human services and child welfare, and Michael Fraser, the CEO at the Association of State and Territorial Health Officials (ASTHO), discusses the public health perspective of transforming child welfare.
Public health has always emphasized primary prevention for child health and well-being. From your perspective, can you share your thoughts about why public health and child welfare haven’t worked together more closely in the past?
Wareing Evans: From my time leading Arizona’s human services agency, I wish had better understood what it truly means to keep families at the center in systems. While we used family decisioning-making tools, they were tools we or other child welfare experts had designed. Rarely, if ever, did we co-design solutions directly with and through the families.
I know I didn’t fully appreciate the ways in which systems and social constructs are intertwined, and shape a community, and impact the ability of people who live in it to be healthy and well. Local context matters -- it must be more relevant in the way we approach complex social issues like preventing child maltreatment.
Fraser: The individual disciplines of public health and child welfare are about improving child and family well-being, but often don’t work together despite sharing the same goals. We have worked on programs – like home visiting and supporting mothers and babies – aimed at helping families and outcomes for children. What we’re talking about now is having both public health and child welfare create a new way of doing “business as usual” by placing a stronger emphasis on investing in upstream approaches.
Public health and child welfare do share similar approaches to improve health in children and families. Child welfare drives population level campaigns to reduce trauma and ACES; public health supports individual care and support services for families in need of support. Many public health programs are also funded by federal dollars for very specific outcomes related to a disease or a condition. This creates siloed thinking that is hard to change without leadership support and support from funders.
APHSA and ASTHO are now in partnership to support transformation of the child welfare system through a prevention first model. In many ways, this will be transformational in how public health and child welfare agencies will work together. What are some of the ways APHSA and ASTHO work with their members to develop transformational leaders?
Wareing-Evans: Moving our systems upstream to help prevent issues before they happen is one of our core focus areas, along with advancing social and economic mobility for families and building the capacity of public sector agencies to optimize their data and support their workforce.
We use our platforms and network to provide opportunities for peer exchange and for shared learning. Our network includes cabinet level heads of human services agencies at both state and local levels as well as directors of child welfare agencies. We also partner across sectors, including academia/research, private industry, philanthropy, and community-based organizations, and we partner across multiple systems, including public health, health, education, housing, justice, transportation, and more.
Fraser: ASTHO works directly with the chief health officials in all 59 states and territories to support them in formulating sound public health policy and ensuring excellence in state-based public health practice. All that takes strong and consistent leadership, which is one of ASTHO’s strategic goals.
ASTHO has for several years been working with members on Boundary Spanning Leadership, a model framework to develop strong cross-sectoral alliances for change. We emphasize in this training, developed by the Center for Creative Leadership, that working across sectors may take time and involve elements of compromise to achieve a shared vision.
The evidence is clear that primary prevention will help to create stronger families and to reduce child trauma. How are some ways APHSA and ASTHO can work together to create a national conversation that mobilizes state and local partnerships to address upstream approaches? What is the role of family voice and communities in this work?
Wareing Evans: Together through our network we can help activate a prevention mindset by:
- Providing a shared learning agenda - bringing together what we know about child development and adverse child experiences (ACEs), neuroscience, trauma-informed practice, family to family engagement, maternal and paternal health, and population health approaches. We can bring leaders from both systems together through common language and frameworks that help translate across public health and child welfare.
- Developing and sharing practice models that link universal population-health models with effective family led models.
- Helping build and share practical tools to align, link, and leverage funding streams and services across public health, child welfare, and broader human and social services.
- Showcasing what is already working in communities and lifting up promising practices.
Fraser: First, we must approach our work together with a strong emphasis on achieving equity and engaging communities. We must both strive to ensure that families, and especially Black and Brown families, are assessed using a new equity lens free from bias, bigotry, and suppositions. Structural and systemic policy practices regarding how to assess neglect must be addressed to ensure that children are safe, but not unnecessarily removed from their families.
Engagement in partnerships and families with lived experience combined with a financial investment will lead to structural and programmatic changes. ASTHO and APHSA have committed to a partnership, and while that makes for a strong foundation, we also need to find ways to more fully engage families with lived experience to ensure our front-line leaders have clear and thoughtful direction.
As we know, primary prevention decreases ACEs. On the financial side, what does a commitment to investment in prevention services cost in the long-term?
Fraser: The monetary cost of ACEs is growing. We can study specific economic costs but are now grasping the generational impact that trauma has on a person’s life course. Generational poverty, poor housing and resulting stress in families contributes to ACES and its outcomes. We should work harder to quantify the return on investment gained from addressing the determinants of health and longstanding inequities in relation to ACEs. This information is invaluable to policy makers with concerns about rising health care costs.
Wareing Evans: Population-level prevention programs cost, on average, five times less than individual interventions. The earlier interventions are made, more savings can be made by decreasing the frequency and duration of future necessary services and interventions. Starting and maintaining
prevention programs is an
investment in community health 20
years down the line—it might take a
little while to see the financial benefits
of investing in prevention programs
but the impact to child and family
well-being can be felt immediately.
Any other thoughts or advice that you would like to share as we launch this work?
Wareing Evans: I would challenge all of us committed to this partnership and this work to ask ourselves: Are we curious enough? Are we asking the right questions? How might we break open new pathways? In what ways can our cross-system work accelerate change?
We have to co-build “system resilience” - co-designing metrics that help us capture what it means for everyone to thrive in a community. We need to focus on what those thriving metrics should be - and measure to them. These include metrics that tell us how families are doing. How do we know we are moving upstream and helping prevent issues before they happen? Are we enabling the conditions that meet families where they are and address root causes?
Fraser: When we put families at the center of our shared work, I think we can do amazing things. That transcends silos and turf and allows staff to make connections based on needs. The more flexibility leadership grants to teams to work together and innovate, the better our solutions will be. Even amid a global pandemic, we can imagine a better future for children and families that includes both of our memberships.