It is now generally recognized that a community-wide approach to the prevention of child maltreatment is the most promising technique for reducing its incidence and prevalence. Since child maltreatment is such a multivariate phenomenon, the resources of many different professional disciplines, as well as the resources of neighborhoods and communities at large, must be enlisted in a coordinated fashion. Child abuse and neglect stem partially from broad socioeconomic difficulties, so a response is required by society in general. It is also a problem that is caused in part by psychosocial factors, which requires the intervention of many branches of the helping professions. The interactions between child, parent, and environmental factors in precipitating maltreatment further indicate the necessity of comprehensive approaches. In short, the most effective prevention and intervention strategies must be:
- Comprehensive, integrating the contributions of social service, legal, law enforcement, health, mental health and education professionals;
- Neighborhood-based, strengthening the neighborhood and community by encouraging and supporting local improvement efforts, including self-help programs, that make the environment more supportive of families and children;
- Child-centered, protecting the safety and personal integrity of children and giving primary attention to their best interests; and
- Family-focused, strengthening families, supporting and enhancing their functioning, providing intensive services when needed, and removing children when such action is appropriate (U.S. Advisory Board on Child Abuse and Neglect, 1993).
Some specific activities that characterize a comprehensive, ecologically-based model of prevention and intervention include:
Health Care Initiatives, such as prenatal and early childhood health care to improve pregnancy outcomes and health among new mothers and young children; home health visitors to provide support, education and community linkage for new parents; and support programs for parents of special-needs children to assist them with their unique problems.
Community-Based Initiatives, such as self-help and mutual aid groups like Parents Anonymous, which provide nonjudgmental support and assistance to troubled families; child care programs to reduce the stress for employed parents; programs that address the impact of lack of economic resources on children and families such as the lack of adequate shelter, nutrition and health care, and public education; and media campaigns to increase public knowledge and awareness about the importance of prevention of child abuse and neglect.
A good example of a community-based initiative founded on the principles of coordination and collaboration of related services is mandated by the Child Abuse Prevention and Treatment Act of 1996. Title II of the Act established the Community-Based Family Resource and Support Grants Program whose purpose is "to support State efforts to develop, operate, expand, and enhance a network of community-based, prevention-focused, family resource and support programs ... to foster an understanding, appreciation, and knowledge of diverse populations in order to be effective in preventing and treating child abuse and neglect."
Parent Education Programs,such as those geared toward young parents, first-time parents, and parents with young children, which provide training in developmental stages, behavioral expectations and alternative disciplinary techniques.
Workplace Initiatives, such as the provision of flexible work schedules to help families balance the demands of their work with parenthood; education and support programs on parenting; employer-supported child care; and liberal parental leave polices.
Family-Centered Welfare to Work Programs which provide family support services both pre- and post-employment.
Social Service Programs, such as parent aide programs to provide a supportive relationship for parents at risk of harming their children; crisis and emergency services to provide respite at times of crisis; alcohol, substance abuse and mental health treatment; treatment for abused children to prevent intergenerational abuse; comprehensive prevention programs to provide multi-disciplinary services and support to families at risk; and respite care for women experiencing domestic violence, or taking care of a disabled family member.
Prevention Programs in Schools, such as self-protection training for children; family life education to equip children and adolescents with skills for coping with family problems and to prepare them for their future roles as parents, and programs for children with special needs to help reduce the stress on families with a disabled child. These may also include child abuse/neglect prevention and intervention programs in the school or in other settings which specifically address the needs of children of substance abusing parents.
It is clear that while our understanding of the nature of child maltreatment has expanded greatly as a result of years of research, demonstration, and clinical observation, there is still much to be learned and determined about the etiology, prevention, and treatment of this complex problem. We have come to understand the extreme importance of a coordinated response to child maltreatment, one that incorporates a recognition of its relationship to a multiplicity of factors, both within and outside the family system. Substance abuse is certainly one of the most important of these factors.
As far back as 1989, Congress recognized the link between substance abuse and child maltreatment. That year the Child Abuse Prevention and Treatment Act was amended to establish the Emergency Child Abuse and Neglect Prevention Services Program. This legislation authorized the Secretary of the Department of Health and Human Services to establish "a grant program to make grants to eligible entities to enable such entities to provide services to children whose parents are substance abusers." No funds were authorized until fiscal year 1991, when approximately $18 million was made available for grants to prevent the maltreatment of the children of substance abusing parents through comprehensive, multi-disciplinary, coordinated services addressing the needs of these children and their families. Ninety-four grants were funded by the National Center on Child Abuse and Neglect in four sub-categories: comprehensive emergency services, public information and education, improvement of services to substance abuse-affected families, and multi-disciplinary/interdisciplinary training. Some excellent projects emerged from this effort, and many lessons affecting policy, planning and service delivery were learned. Results from these grants are discussed in Chapter 7. The program was later combined with several other discretionary grant programs into what has become the Community-Based Family Resource Program.