Washington University

Ending U.S. Child Abuse and Neglect: Launching a national strategy Highly Ranked

Abuse prevention

Washington University physicians, scientists, colleagues in prevention research, and leaders of three U.S. health care systems committed to new strategies addressing the child abuse epidemic.

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Lead Organization

Washington University

St. Louis, Missouri, United States


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Project Summary

Imagine a world where every child is healthy, nurtured, and protected from harm. In this world, a quarter of all mental illness, crime, and lost productivity are eliminated. Today, one in six U.S. children suffers from child maltreatment, but there are only fragmented arrays of services delivering disjointed responses to this silent epidemic. It is a scientific fact that most child abuse can be predicted and prevented. We can no longer wait for a knock-on-the-door by Child Protective Services, only to move the most severely-abused children to the Courts. To protect a society from child abuse and its consequences, the solution must start early in life—when the enduring impact of prevention is highest—and integrate proven methods of risk surveillance with evidence-based intervention. Here we propose to accomplish this with a nationally-scalable, sustainable deployment of existing health and social service resources that will connect families-in-need with effective preventive intervention.

Problem Statement

Child maltreatment, which includes physical, emotional, sexual abuse and neglect, is the single most preventable cause of lifetime mental health impairment in the U.S., approaching 25% or more of the population-attributable risk. It most commonly first occurs in infancy, particularly when adult caregivers are too stressed, uneducated, preoccupied, or mentally incapacitated to attend to the needs of the child under their care. The consequences range from the inability to provide the minimum requirements for normal development (food, hygiene, human interaction) to overt physical assaults that result in chronic traumatic stress syndromes, permanent brain injury or death. The long-term cost for each yearly cohort of children abused in the U.S. exceeds $125 billion dollars. Despite remarkable advances in our ability to predict child maltreatment, the child welfare system is not designed for prediction or prevention. Previous attempts to prevent child abuse have relied primarily on singular interventions for which at-risk families are typically eligible (home visitation, intensive case management, parenting education, parental mental health care, reproductive health planning), yet no intervention alone covers the multiplicity of risks that precipitate child maltreatment. Fragmentation across health agencies, state departments, and local bureaucracies, together with a lack of ownership of systematic risk surveillance, all but ensure that no family-at-risk ever receives a comprehensive set of supports. The end result is that child maltreatment is perpetrated at epidemic proportions. In high income countries like the U.S., conservative estimates of prevalence based on official records is that 1 out of every 6 children is a victim.

Solution Overview

We propose a sustainable (ultimately zero-added-cost) nationally-scalable, integrated re-deployment of existing health, educational, social service, and economic interventions to predict and prevent child maltreatment before it occurs, leveraging (and coordinated by) the infrastructures of U.S. health systems. We focus on early childhood, when maltreatment is most common, risk is most straightforwardly ascertained, and life-impact of prevention is highest. Health-related expenditures on young families are typically fragmented and not focused on identifying families-at-risk or connecting them with the full constellation of health system and community services that offset risk for maltreatment. We’re in the process of deploying and refining a restructuring of screening, client management, and outreach to secure appropriate services for families in a U.S. NIH-funded clinical trial and plan to deploy this approach in three large health systems: BJCHealthCare (Missouri-Illinois, including metropolitan St. Louis), Geisinger Health System (rural Pennsylvania), and Envolve/PeopleCare a transformative health management subsidiary of Centene Corporation, that couples delivery of Medicaid-sponsored services to low-income families with robust community outreach in multiple U.S. states. The constellation of interventions that represent the complete “package” required — but rarely attained — by families-at-risk includes nurse home visitation, evidence-based parenting education, coordinated mental health service, reproductive health services for parents, access to effective court-based intervention in the setting of parental substance abuse, continuous needs- and risk-surveillance/response embedded in the course of medical follow-up, resolution of critical material needs (transportation and utilities) whenever necessary, a 2-1-1 crisis warm line, and the empowerment inherent in the opening of a child development account.

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Project Funders

  • National Institute of Child Health and Human Development 2018 - 2023
  • St. Louis County Children’s Service Fund

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