By Alyssa Banks, Senior Program Analyst, Injury and Violence Prevention, NACCHO

In April 2014, President Obama announced that April is National Child Abuse Prevention Month. As public health practitioners, we are reminded that millions of children and adolescents are exposed to violence and experience maltreatment early in life. Exposure to violence and maltreatment is a significant problem, as it can cause serious physical, mental, and emotional health problems and lead to injuries and death.

According to the National Survey of Children Exposed to Violence, an estimated 46 million of the 76 million children currently residing in the United States are exposed to violence, crime, and abuse each year.¹ In 2013, there were an estimated 678,932 cases of child abuse or neglect in the United States.² Even more concerning is that our youngest and most vulnerable population of children under the age of one continue to have the highest rate of victimization, at 23.1 per 1,000 children nationally. The same year, states reported 1,484 child fatalities due to child abuse and neglect.² We should be appalled.

Child maltreatment is linked to factors that increase the risk for long-term health problems. Children who are abused or exposed to other adversities are more likely to smoke,^{3, 4} be physically inactive or obese,⁵ and engage in risky sexual behavior.^{6, 7} Children who are maltreated are at increased risk to experience other serious issues such as academic problems, delinquency, and involvement in the child welfare and juvenile justice systems.^8–10

Children’s exposure to violence and maltreatment is a preventable problem. Healthy People 2020 aims to reduce children’s exposure to violence from 60.6 percent in 2008 to 54.5 percent in 2020. Addressing and preventing children’s exposure to violence and maltreatment requires specialized expertise and comprehensive interdisciplinary approaches.

Local health departments (LHDs) are well positioned to provide leadership, capacity-building, and support in local communities to prevent and reduce children’s exposure to violence and maltreatment. LHDs play an important role in local systems that serve children to reduce rates of abuse and neglect, both as direct service providers and as coordinating agencies.

LHDs can provide critical services and programs that provide support to families and promote safe, stable, and nurturing environments for children through nurse-home visitation programs such as Nurse Family Partnership; therapeutic interventions such as cognitive behavioral therapy and family strengthening; and evidenced-based parenting education programs such as the Positive Parenting Program (Triple P). Triple P is one of the most effective evidence-based parenting programs in the world, supported by more than 30 years of ongoing research.

Triple P gives parents simple and practical strategies to help them confidently manage their children’s behavior, prevent emerging problems, and build strong, healthy relationships. Triple P is currently used in over 25 countries and has been shown to work across cultures and socio-economic groups and in all kinds of family structures. NACCHO has helped study the ways in which LHDs have implemented Triple P and developed tools and resources for incorporating parenting education and skills-building programs into local public health services (see resources below).

This April, NACCHO encourages LHDs to observe National Child Abuse Prevention Month by implementing policies, programs, and strategies that help prevent child maltreatment and exposure to violence and provide for children’s physical, emotional, and developmental needs. Every young person deserves the right to grow up safe, healthy, and free from violence.

Resources

• NACCHO Podcast Interview with Triple P Developer Professor Matt Sanders (2015)
• Webinar Recording: Implementing Triple P – Positive Parenting Program at the Local Level (2014)
• Conversations with Local Health Departments: Parenting Education and Skills-Building Program Implementation Capacity (2014)
• Staying Resilient in Hard Times: Local Collaboration for Women, Children, Youth, and Families (2013)
• Stories From the Field: Parents Need Support to Prevent Youth Violence (2013)
• Compendium of Local Health Department Home Visitation Program Case Studies [PDF] (2010)

References

1. Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of pediatrics & adolescent medicine, 164(3), 238-242.
2. S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2013). Child Maltreatment 2013. Available from http://www.acf.hhs.gov/sites/default/files/cb/cm2013.pdf
3. Anda, R. F, Croft, J., Felitti, V., Nordenberg, D., Giles, W., Williamson, D., et al. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652-1658.
4. Edwards, V. J., Anda, R. F., Gu, D., Dube, S. R., & Felitti V. J. (2007). Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness. Permanente Journal; 11:5-7.
5. Williamson, D. F., Thompson, T. J., Anda, R. F., Dietz, W. H., & Felitti, V. (2002). Body weight and obesity in adults and self-reported abuse in childhood. International journal of obesity.
6. Hillis, S., Anda, R., Dube, S., Felitti, V., Marchbanks, P., & Marks, J. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences and fetal death. Pediatrics, 113, 320-327.
7. Hillis, S., Anda, R., Felitti, V., Nordenberg, D., & Marchbanks, P. (2000). Adverse childhood experiences and sexually transmitted diseases in men and women: A retrospective study. Pediatrics, 106, E11.
8. Margolin, G., & Elana B. G. (2004). Children’s exposure to violence in the family and community. Current Directions in Psychological Science, 13, (4), 152-155. Available from http://www.jstor.org/stable/pdfplus/20182938.pdf
9. Duke, N. N., Pettingell, S. L., McMorris, B. J., & Borowsky, I. W. (2010). Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences. Pediatrics, 124 (4), e778-e786.
10. Finkelhor, D., Turner, H. A., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. U.S. Department of Justice. Available from http://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf