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Policies, programs aim to prevent 2,000 yearly deaths from child maltreatment

March 29, 2024

More than 7.5 million children were reported to child protective services (CPS) and more than 3 million received an investigation in 2022, according to the U.S. Department of Health and Human Services (HHS). Furthermore, investigations substantiated abuse or neglect in more than 550,000 children, and an estimated 1,990 children died from maltreatment.

Historically, much emphasis has been placed on the identification and system response to child maltreatment. However, awareness is growing among pediatricians, legislators, CPS agencies and community partners that the focus should shift to preventing child maltreatment and CPS involvement, both of which are important for child well-being and equity.

Recently, progress has been made in policy and programmatic efforts to prevent child maltreatment and CPS involvement.

Progress through policy

Pediatricians know the role that economic policies and material supports can play in reducing child maltreatment, particularly neglect. Policies that improve health care access and affordability (e.g., Medicaid), child tax credits, earned income tax credits, child and dependent care credits, the Supplemental Nutrition Assistance Program and other basic needs programs can help reduce CPS investigations, substantiations and/or foster care placements.

These policies may prevent child maltreatment in several ways. For example, they can reduce the harmful effects of poverty and material hardship for families. Medicaid also can connect caregivers to physical, mental and substance use care.

States play a large role in providing supports that can prevent maltreatment. Over the last five years, states that offer refundable child tax credits have increased from two to 11. Within the last three years, Idaho, Missouri, Nebraska, North Carolina, Oklahoma, South Dakota and Utah expanded Medicaid. Some states also gained approval for Section 1115 waivers to use Medicaid funds to address enrollees’ social determinants of health.

However, inaction in state legislatures and Congress continues to threaten adoption and preservation of these policies. For example, more families are experiencing financial hardships and gaps in health care insurance due to lapses in pandemic-era supports.

The AAP-championed Family First Prevention Services Act (FFPSA), which was signed into law in 2018, provides the legislative foundation for states to reorient their CPS agencies from prioritizing investigation to prevention.

In 2022, foster care services were provided to more than 145,000 children, according to HHS. FFPSA seeks to safely reduce the need for foster care and keep CPS-involved families together when possible by providing greater access to mental health services, substance use treatment and/or parenting skills courses.

FFPSA expanded Title IV-E to finance these prevention services. These funds allow states to implement evidence-based interventions approved by the Prevention Services Clearinghouse, which vets programs to ensure their efficacy.

Implementation of efforts funded under Title IV-E, however, remains in the early stages and has yet to be moved to scale.

Programmatic efforts

Targeted interventions, such as home-visiting and parent education programs, also have shown promise as evidence-based strategies to prevent child maltreatment.

Home visiting is a structured intervention to support parenting for pregnant women and/or families with young children (often under 5 years of age). Since 2010, the Maternal, Infant, and Early Childhood Home Visiting program has provided federal funds to states, territories and tribal entities to develop and implement evidence-based home-visiting services. Reduction in child maltreatment through home-visiting programs is well-documented (Avellar SA, Supplee LH. Pediatrics. 2013;132:S90-S99, https://bit.ly/3P7iKNo).

Primary care pediatricians also have a unique opportunity to promote safe, stable and nurturing relationships between children and their families by connecting them with parenting programs such as Triple P: Positive Parenting Program. Triple P is designed to enhance parental competence and prevent dysfunctional parenting practices. Research has shown the program can decrease substantiated maltreatment, out-of-home placements and child maltreatment injuries (Prinz RJ, et al. Prev Sci. 2009;10:1-12, https://bit.ly/49G3csd).

The Safe Environment for Every Kid (SEEK) model includes a parent questionnaire that primary care providers can use to identify and respond to maltreatment risk factors. A 2021 study showed implementing the SEEK model in pediatric primary care practices cost $305.58 to prevent one incident of child maltreatment (Lane WG, et al. Child Abuse Negl. 2021;111:104809, https://bit.ly/49QEa9A).

The challenges faced by pediatricians to implement screening and referral practices must be weighed against their sizable benefits in improving family well-being and children’s health and preventing child maltreatment.

What pediatricians can do

Pediatricians can advocate for the following to prevent child maltreatment and safely reduce foster care placements:

  • expansions of Medicaid coverage and services in their states to promote affordable health care for children and their caregivers;
  • Section 1115 waivers allowing the use of Medicaid funds to address social determinants of health for enrollees;
  • economic and material supports for families in general and for children within the child welfare system (i.e., Title IV-B and Title IV-E); and
  • increased funding for evidence-based home-visiting programs.

Pediatricians also can connect parents to evidence- and community-based programs and resources that support safe, stable, nurturing relationships for children at risk of maltreatment. In addition, they can work with state programs, like the Children’s Trust Fund, to advance programming aimed at child maltreatment prevention.

 Dr. Segal and Dr. Puls are members of the AAP Council on Child Abuse and Neglect.

 

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