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While reducing trauma, healthy outcomes, and more efficient government are all good, the silo-and-turf approach is not helpful to child victims. Public health facilitates access to services. The ability to take this model to scale and replicate it exists. If more of a public health focus is placed on the how, maybe the direct service providers will not have to fight the battle again and again. The focus on children's healthy development must be as important as the focus on making money in this country.

Dollars follow priorities. Ways must be found to bridge practice, policy, and research and ensure that research gets to the community level. Osofsky noted that some people involved in research and policy are also service providers. There is a need for cross training of child protective services, law enforcement, the judicial branch, early intervention, mental health, and others.

Cherna's program provides a good example of cross training. The model is good; it includes communicating across systems and giving children and parents a voice. Can this work in other areas?

Cherna said that it is possible to transfer the model elsewhere if one has the will and continuity. But building community trust and institutionalizing the model take time and are not easy. He clarified that his program does not do a lot of cross training, but it does do a lot of cross communicating.

The issue is difficult due to staff turnover. Alexander clarified some statistics, noting that 2, deaths per year is not a complete count. He encouraged participants not to use numbers as gospel. There are three to four times as many cases that are not captured. There is a need to be careful because the numbers are wrong; however, they are the best that are available.

There also is a need to be careful about which type of abuse they are talking about. He said that he was not aware that child sexual abuse is related to poverty, as other types of abuse are. Robert Bob Johnson, M. He suggested that it would be easier to do what participants had been discussing if there were no "system. This must be done in communities at the local level.

A Web participant, Nancy Duncan, St. Louis Children's Hospital, asked: How can interventions cause harm? Maxine Stein, Stop it Now! Work must be done through collaboration. One gets at true prevention via primary prevention. Berkowitz noted that the American Academy of Pediatrics is concerned about the increase in domestic violence in the sector of troops returning from combat to civil life.

This is a risk group that needs to be included in this discussion. Knell commented that the Sesame Workshop is about to launch an outreach effort targeting these families. Harris noted that money alone will not solve the problem. There are many serious issues to grapple with, such as poverty; yet people cannot continue to deny that child maltreatment is a huge issue.

The need for resources that exists must be acknowledged. Money will not do it alone, but there is a need for the money. Knell said that money follows ideas, and money follows the narrative. The political reality is that this issue has not yet been properly "sold.

Shay Bilchik, J. Cherna noted that in addition to the county's hard work and efforts to gain public will, the county integrated all financial assistance into five program offices. It integrated data systems and public information systems as well. While there was initial resistance at the state level, the secretary is now fully supportive.

Marilyn Peterson, M. John Holton, Ph. The Surgeon General should figure out how to maximize time from this meeting. There are several services models, including Healthy Families America. Prinz noted that the role of prevention is to take stress off of formal systems. There are strategies that do not have to boil up from within one system. One example of this is the Wyoming Parenting Initiative. This initiative is funded by Department of Family Services, but it is open to all systems in which parents are involved.

It is possible to have public health population-level approaches that destigmatize parenting improvement. Diana English, Ph. There is a need to address specific age groups; adolescents are the next parents. She suggested discussing strategies that can help set a direction in the immediate future while building a base for long-term evidence. When one asks families what they want, they indicate they want different services from what they are offered not that they do not want services.

Patricia Sullivan, Ph. Covington said that there are not many good primary prevention systems. Public health systems know little about social services. She stated that the foundation of their efforts must be to determine a way to make state public health and social services systems work together. Help building models for primary prevention is needed as well. Knell commented on the need to focus on getting America to own this issue and stated that a powerful coalition can be built on behalf of children who do not have the political clout in this country.

Kessel asked participants to pull their thoughts together and distill their ideas. While problem identification is the first priority, one homogenous solution will not work. Catherine Nolan, M. A community resource packet was distributed to communities in February both in English and Spanish. Charles Wilson, M. Wilson summarized the themes of the day and noted that participants must remember the children, the stories, and what motivates them. He remembered the moment in in Florida when he decided to do something about child abuse.

It was after viewing a television advertisement showing babies crawling toward him and a voiceover that said: "Who Would Hurt a Little Child?

Child abuse reporting in Florida skyrocketed after the placement of this ad. Wilson also shared a personal story, noting communication from his daughter's school about paddling. He said that children cannot comprehend that adults would hurt kids. Wilson said that an underappreciated crisis exists. It is a public health crisis, the full scale of which is masked by secrecy and denial.

It also is a social welfare crisis, a criminal justice crisis, an educational crisis. No one system or discipline has the answers.

But there is synergy in our collective wisdom. It is necessary to learn from the public health model and the public health framework, and to look at what has been done before. It is necessary to first measure the problem. There is a need to create environments that reduce toxicity for children; programs must be accountable and measure outcomes. Targeted programs must be based on sound theory and a conceptual model.

They must include adequate dosage and be culturally and developmentally appropriate. How can maltreatment be prevented? One way is to invest in research to develop the knowledge base; there must be widespread adoption of evidence-based practices.

There also is a need to identify related supports, such as funding, community resources, and organizational change. He commented on the need to engage clients, institutionalize processes over time, think about strategies that impact on all systems, and create the public will to demand change at the national level.

For example, participants must speak with one voice and build a narrative; they must expand "collaboration and coordination"; there is a need for authentic voices that will empower adults to break the silence; they need shared leadership; and they must create a social movement that will demand change.

Wilson also discussed the need to find the right message-the words "child abuse" make people uncomfortable. How can the message be framed in a new way? It is necessary to make child abuse socially unacceptable. There is a need to take the long view: things that seem impossible do change in the blink of an eye. There are many problems in the system, but one cannot just turn off the system. There are children who are dependent upon the system, and there is a need to fix it.

It may be worth revisiting past activities that have worked. Wilson concluded that financing best practices and investing on the front end require money-and there is little of it. It is possible to invest public funds in programs that have evidentiary support, but it is necessary to be aware of unintended consequences. A good idea should not be applied in the real world in a way that makes no sense. Moving to an evidence-supported practice world is complicated. Wilson asked for comments that inform action planning by the government.

Prinz said that it is necessary to define the guiding principles of prevention. Barbara Bonner, M. Runyan said that public health has largely ignored child abuse and neglect, as well as injury. Public health agencies must be encouraged to be part of the discussion.

Chadwick commented that a major change and immediate role at a low cost could be achieved by having the public health sector move into the measurement area for child maltreatment and measure health harms. Marge said that guidance from the Surgeon General is needed on the level of prevention to focus on. In terms of a plan, are participants considering recommendations within the context of constraints imposed by resources?

Or are they looking at something more ideal, such as what is right for the country? Gottlieb commented on the need to describe what family wellness is and redefine it with true cultural norms. Osofsky remarked that from a public health perspective, generally the focus would be on primary prevention.

But there is a compelling reason to focus on secondary and tertiary as well in an effort to stop the intergenerational cycle of violence. To prevent abuse and violence, it is necessary to stop the intergenerational cycle.

Halfon suggested moving beyond primary, secondary, and tertiary models to think more broadly. He said that Federal agencies' rules often make it impossible to have meshed services due primarily to cost accounting principles. He suggested looking at what is going on in England, Canada, and Australia for models of children's agendas.

Participants can learn from what they are doing instead of reinventing the wheel. Mark Chaffin, Ph. Ramey suggested collecting innovative and creative ideas. She noted that there is public evidence of other groups making inroads i. The city of Seattle has an innovative program to reach families by providing information through grocery stores. Hayes said that the Surgeon General could use the bully pulpit to underscore what communities can do.

The measurement piece is the most important contribution that public health can make. The Department of Public Health in Washington State documented that children were dying and polled the public about their views. There is a need to clarify more accurately what people will react to. County commissioners are the decisionmakers in many communities, and it is clear that many local communities are not yet ready to move forward.

They must be motivated to want to act. The child maltreatment message must be balanced with that of optimal healthy child development. Wilson stated that the fundamental issue is that this is a public health crisis, and there is a need to learn from past public health experiences. Kessel commented that the real sign of a good meeting is that it does not end on time because people are sharing ideas and thoughts.

Moritsugu concluded the first day of the workshop by noting that the sign of a good meeting is when time runs out before the ideas do. He summarized that the focus of Day One was on data, evidence, and the human face.

Some participants raised questions about guidance from the Surgeon General. The Surgeon General and the Office of Surgeon General staff were present to listen and learn, but not to react or respond. In highlighting the gap areas, he asked participants to keep in mind that this workshop is not the end of a process but part of a process. He asked for participants' best recommendations to the Surgeon General and asked them to think about how to parse and prioritize resources. Kessel opened the second day of the meeting by highlighting the issues discussed during Day One of the workshop.

He reported that presentations and discussions focused on data and the proper collection of information; creating and disseminating messages; adding specificity to clarify dimensions of the problem; the importance of primary, secondary, and tertiary prevention; the opportunity to create the next third revolution in public health health promotion ; the need for systems integration; the importance of resources along with the realization that it is possible to do some things with the resources that are available; the importance of education across the continuum; the impact of cross training; differentiating notions of "at risk" versus "high risk" versus "no risk" related to interventions to enhance the well-being of families and children; the importance of screening, follow-up, and follow-through; and system touch-points.

He reminded participants of the importance of the community and household levels in addition to county, state, and national levels. Most important, participants discussed making sure their focus stays family- and child-centric.

Kessel stressed that the goal of Day Two was to look at what participants need to do next. What are the key elements for successful implementation? Who must be on board, and how can they accomplish key next steps?

He showed participants an image of the Stop Family Violence stamp known as a "semi-postal" and pointed out that the stamp is not selling well. Kessel said that in his view, the stamp captures hope. Funds from the stamps will support programs such as the Safe and Bright Futures Program designed to stop the cycle of violence from children's exposure to domestic violence.

Kessel concluded by noting that the Surgeon General believes in action-he wants to focus on this issue and implement effective actions. Kessel introduced Katherine Gottlieb, M.

Moderator: Katherine Gottlieb, M. Gottlieb related that domestic violence, child abuse, and child neglect occur in the whole population in Alaska. The Family Wellness Warriors Initiative involves men to address these issues. Through this project, Alaskans are breaking the silence and telling their stories publicly. Expositeur: Cindy Lederman, J. Judge Lederman discussed how juvenile courts can play a role in prevention efforts. By the time juveniles come into the system, if the courts cannot help them, no one can.

Juvenile court is a place where cumulative disadvantage, impoverishment, and deprivation are everywhere. To be successful, it is necessary to modify human behavior. There needs to be a marriage of law and science in juvenile courts across America. If the courts understood the research, they would know better how to intervene. Judge Lederman said that one could define what the juvenile courts do as doing clinical work in a legal setting. This is why that work has to be interdisciplinary.

One way the Miami court system has chosen to engage in prevention is to start with the youngest children in the child welfare system.

Judge Lederman said that the courts try to bring infants and toddlers to the forefront, changing the culture from being ignored to being the focus. The hope is that if they can intervene successfully, they can help children be ready to learn by the time they go to school instead of the children going to school, acting out, having problems, and finally having someone at the school diagnose those undetected problems.

The difficult part is stopping the intergenerational transmission of abuse. Judge Lederman added that parenting classes in this country are ineffective and do not deal with the level of parents' problems. With the help of Dr.

Osofsky, Judge Lederman's court developed a week dyadic therapy program for mothers and babies. After 4 years of data, the program has been able to demonstrate promising improvements in the relationship between parents and babies. Expositeur: Terry Cross, M. Cross said that it is important to have tribal leaders at the table for discussion of this topic. Due to limited funding, child abuse prevention efforts are nonexistent in Indian Country.

Of the tribes across the country, all provide some form of child welfare services; most have their own tribal courts, their own child abuse codes, and their own child welfare programs.

Most are doing child protection services. The study revealed that less than 1 percent of tribes had any ongoing prevention efforts at that time. Last year, a follow-up study found that just one of those tribes that had been providing prevention services in was able to continue doing so in Cross noted that data show that child abuse rates among Indians have increased it is unclear whether the increase is an actual figure or due to increasing numbers of tribes providing their own services, resulting in a higher count.

No funding has been appropriated for implementation of the law. He discussed various funding streams, such as entitlement funds and block grant funds, that do not reach tribal communities. Cross discussed the cultural strengths model, which focuses on tapping into the strength of a culture to find its resiliency factors.

He noted that a project is under way to gather information on resilience to isolate the items that represent cultural strengths. This work is being funded by the Children's Bureau through a grant that helps examine how to develop a better system for tribal communities to report child abuse and neglect data into the National Child Abuse and Neglect Data System database.

He concluded with a cautionary note about evidence-based practices, stating that no methodology has been able to reduce societal issues and complex human behavior associated with this issue. He noted that evidence-based practice is becoming the next wave of oppression-imposed outside solutions derived from Western models and Western thinking. Expositeur: Robert Clyman, M. Clyman discussed new opportunities to improve outcomes for maltreated children. He explained that there is growing evidence of the importance of genes in influencing outcomes and treatment.

The risk for maltreating children may be genetically influenced. Nearly half of all children entering foster care are under age 3. This gap in age between age 3 and adolescence represents the best opportunity to make a difference. In partnership with the Denver Department of Human Services, his program reaches out and enrolls every baby under age 6 months who goes into foster care in Denver.

Empirical information is one way to potentially help improve major child welfare practice and policy. Clyman called for three items to move forward on child maltreatment prevention efforts: 1 leadership that stands up and makes this a national priority; 2 grassroots support; and 3 scientific advances to innovate, test, and implement in the next generation of interventions.

Is there any legal recourse? Judge Lederman responded that the answer is yes, but it falls on us to take responsibility for this and to complain. Litigation is costly.

Many states are on the verge of privatization. Berkowitz asked about Judge Lederman's view of the adversarial relationship in juvenile court. Judge Lederman replied that this is troubling; it is necessary to work as a team. Being adversarial just to be adversarial will not help anyone.

In addition, with the Adoption and Safe Families Act, there is a very short time to deal with these families, and there is a need to work on solving the problem rather than legal maneuvering. Nicholson noted that in Colorado, there is a movement by legislators toward a mandatory requirement of termination of parental rights at time of birth if there is any evidence in the baby of substance abuse by a parent.

This is drastic and provides no leeway for judges. Judge Lederman pointed out that this is an example of the legislature intervening in the judicial role based on politics, not science, which is a major problem. There is a need to understand the research and have respect for it to help craft laws that make sense. Ramey noted a program in Washington State-WAMI Washington, Alaska, Montana, Idaho in which Washington State provides medical education as a way to engage individuals from rural states where there is no state medical school.

She echoed Mr. Cross' point about the Positive Indian Parenting Program and other local initiatives that are culturally grounded and accepted, and in which people see first-hand benefits-these programs do not get studied. Ramey called for more efforts to connect to scientific evaluations. Gottlieb noted that there are foundations such as Robert Wood Johnson that fund measurement efforts. Hsi said that the emphasis on toxicology screens has become overemphasized.

He asked how communities are looking at that and wondered what potential community and legal responses might be. Marge noted that Florida has an effective advocate for disabled persons, so that when situations reach the court, there is no adversarial relationship. Prinz asked whether any of the parent and family innovations have been applied to the population level.

If not, is there a specific model or recommendations about how to do that? Clyman responded that the answer depends on the population. He was not aware that it is going on at the full population level. Cross commented that there is a growing movement in tribal communities to define issues and prevention strategies culturally, but there are no resources to support this. Brooke McClintic Griese, Ph.

Hospital-based linkages to technology could be used, such as DVDs, to provide media that teach basic skills; schools could get out information to students. Wilson noted that legitimate criticism is that this field does not have a tradition of applying good science to what it does. He encouraged the Surgeon General to focus efforts on building the science base and to test some child welfare prevention efforts to help sort out the "pearls of practice.

Judith Becker, Ph. There is a need to advocate for more evaluation of the effectiveness of a number of policies, particularly some of the mandated probation policies. Marge asked Mr. Cross responded that he approached them and received some funding and offers of collaboration and support.

But he said that the Federal Government is falling far short. This provision also has been included in the Welfare Reform Bill that recently came out of the Senate Finance Committee. This administration must step forward and say that it is time to pass that provision.

Cherna agreed that it is unconscionable that Indian tribes do not get Title 4-E funds. That is something the Surgeon General should hear and advocate for. Osofsky said that in terms of the adversarial relationship in the courts, communication and partnerships are important so the judges recognize not only where expert witnesses are coming from, but also the experts recognize how much judges really value the expertise that helps them make better decisions related to the children.

She added that cultural sensitivity is extremely important in trying to build strength within families and communities. Chadwick commented that total information usually informs public policy, but it does not have to be this way. He described the continuous quality improvement CQI model. Randy Alexander asked how the genetics angle might be used for interventions.

Clyman remarked that it is still early, but it is possible that the way psychosocial interventions are targeted will completely change based on genetic research. Birch suggested that participants recommend to the Surgeon General that the Public Health Service aggressively promote prenatal care to underserved populations and communities all over the country. Dubowitz stated that one strong, clear recommendation he would like to see is a commitment to building the knowledge base.

Ann Burgess, Boston College School of Nursing, commented on a study of abused children in which researchers looked at more than children between the ages of 5 and 16 who were reported as sexually reactive children.

The issue of multiple foster homes or multiple caregivers was found to be important. Olds noted that collaboration and deep commitment are necessary to move the field forward. He noted that participants have an ethical responsibility to test and do their work more effectively. Bair-Merritt added that participants must think about interventions and challenge themselves to ensure that they do not harm families.

Kessel introduced the session by noting an article in the Washington Post Metro section on March 31, , that highlighted the Sesame Street character Elmo and the Surgeon General talking about parenting. Chief Bueermann discussed the roles and responsibilities of law enforcement, pointing out that most police activity is reactive. His discussion focused on prevention efforts. There is a movement today from primarily reactive orientation to community problem solving.

There is a need to expand the knowledge base regarding how to better serve communities. Out in the field, it is the cops who have an opportunity to make a difference in the lives of families. This new model is called "risk-focused policing," and its genesis is in health care see Hawkins and Catalano, University of Washington. Chief Bueermann presented maps related to risk-focused policing.

He indicated that in individual neighborhood risk profiles, the darker the color, the higher the concentration of risk. He explained that where children live has something to do with the notion of risk. There is a need to look at a variety of connections like this in forming policy. Expositeur: Maxine Hayes, M. Hayes stated that a clear articulation of the public health approach is needed.

There is a need to promote optimal child health and use it as a construct. Hayes detailed the three core functions of public health via the 10 essential services of public health. Every grant proposal submitted to CDC and other Federal agencies needs to include these elements. She commented on the need for policy and environmental changes that can create conditions in which it is optimally possible to promote child health. Hayes noted the need for surveillance systems that can provide a full picture.

Community-based child death review teams are extremely helpful in providing information that can lead to systems change. Achieving the public health approach will not be possible unless data are pulled together across systems such as law enforcement, juvenile justice, the courts, clinics, hospital rooms, emergency rooms, mental health, drug abuse, and alcohol.

One of the fundamental flaws is that information sharing across systems is difficult due to privacy and confidentiality. Once this problem is addressed, there is a need to standardize early intervention and early warning protocols around what to do when one discovers an issue. Pierce discussed the idea of community. If communities are an opportunity for intervention, it is necessary to reestablish communities and what they mean for people. Isler explained that the work of his organization is grounded in child development philosophy.

The framework is based on working with the community. He noted that that Dr. Osofsky's work and research are used in all projects. Isler spoke about Family Communications products and initiatives that help people who work with young children. For example, the "Mad Feelings" project, a series of anger management programs and posters, is an initiative that was very well received in the community. Another workshop on relationship-based discipline targets parents and others who work with young children.

The Safe Havens training program helps people working with children deal with the violence they see in their lives. The focus is on partners in crisis, communication, and helping children who are in trouble. Isler reminded participants that they must carefully choose words and messages.

Finally, he detailed the "One Kind Word" project, which helps parents diffuse situations with their children. Much of the training is done by DVD. Chaffin asked which elements in Dr. Hayes' presentation on the public health system she thought were the most important.

Hayes responded that key elements include assessing the size and magnitude of the problem, and getting to the data without barriers. No one system captured all mortality and morbidity. It was found that they did a better job when they merged data systems. A report on this is coming out soon. The neglect categories were the ones missed. Patricia Trish Sullivan, Ph. Children have developed disabilities as a result of child abuse and neglect.

There is a tendency to let parents off the hook sometimes, especially in relation to adolescents. In Nebraska, children go back and forth from the mental health system to the criminal justice system. There is a need to look at those pathways. Cunningham stated that it is critical to support parents who have environmental stressors. This is especially true for parents whose basic needs are not met.

Schools are critical-how can participants help them play a major role in what many in society think of as a private issue? Christian noted the need for data and added that this is an enormous problem. One-third of all children are not doing well.

The public thinks that it is an urban, rural, or minority problem; it is necessary to get the public to embrace this as a serious public health problem. This can be done by highlighting the impact on adults and stressing how much money is required to address related issues.

A focus group may be needed to look at how the issue resonates with the public. Edgerton commented on the need for community participatory research to bring partners to the table and keep the focus on messaging. Children's Advocacy Center, stated that a lot is learned from child death reviews and wondered how to get systems to implement recommendations coming out of those reviews.

What about confidentially issues or getting community buy-in? Hayes said that funding has been reduced, and there is a need for resources for this. There are structural barriers to information sharing, and these barriers could be addressed in some cases without money. Hayes said that she did not know the role of the Federal Government because there is a lot of resistance to disclosing information. Katherine Beckman, HHS Emerging Leader, suggested that participants look to partners they do not usually think of such as childcare providers.

The American Academy of Pediatrics is working on a plan to form linkages between childcare providers, parents, and children. The National Center for Birth Defects also is working on this issue. The California Children and Families Commission uses tobacco money to develop New Parent Toolkits that include videos on child development and safety, and offers home visiting to talk about child well treatment.

She urged participants to think of the media as a potential partner in public health. Isler said that everything is based on partnerships. Schools must share in the responsibility, and it is important not to give up on the media. The social messaging concept is slowly emerging from corporations.

There is a need for participants to follow up on initiatives that work in their own communities. Hsi noted a disconnect around funding issues. He pointed out that government agencies play a game of funding projects in short cycles, limiting the funding, then saying the project is not a priority and eliminating it.

Olds explored the issue of how much the public is aware of child abuse and neglect. Prevent Child Abuse America has shown that the public is aware. He said that the public is aware but feels helpless and does not believe the government can do anything. He commented on the need to develop and test effective programs and share these with the public.

John Lutzker, Ph. This survey, for the first time ever, will allow formal and full cost-benefit analyses. Lithco commented that it is important for participants to realize what they are communicating and to whom they are communicating.

He concluded with a question to all the parents: When dealing with your child, how much of what you do is evidence-based practice? Ramey remarked that parents are vital but warned against focusing on parents alone. Others perpetrate abuse and neglect: childcare providers, healthcare providers, boyfriends, and extended kin. The public is more likely to accept a national campaign if the focus is not all on parents. Nicholson said that she has not experienced that people do not want to hear the message.

The Surgeon General should develop a comprehensive strategy for how to address the press, fraternal organizations, and the clergy. There is a need to develop models or protocols that are not necessarily evidence based.

Chief Bueermann suggested engaging police departments in this debate, noting that 99 percent of police chiefs are parents themselves. Kessel concluded the session by noting that the neighborhood policing concept is important. He commented that things that used to be important seem not to be included in the schools anymore e.

Dinnin shared a story about young girls asking for money on the streets and how no one in the community wanted to take responsibility for this problem. He said that the United States has a fabric that many countries do not have. Our fabric might be like gauze-with holes throughout-but there is a need just to tighten it up a bit.

Expositeur: Ed Schor, M. Schor said that families have been changing over the past decades. It is necessary to ensure that families do well to achieve better outcomes for children. Relationships are the key to early development as discussed in From Neurons to Neighborhoods. Yet family relationships are strained.

He did not think that child development should be taught in high school but said that positive skills can be reinforced via relationship education. Early brain development research shows that parents play a big role in shaping development, but they do not know how to do it very well. We do not know all the answers, and we do not know what we do not know. Public health needs to place more emphasis on promoting families' early development.

He called for a system of universal parent education in this country. Child abuse is a reflection of families being unable to cope. Surveys of parents indicate a lot of stress. There is a need to help parents get the resources they need to cope. A model initiative is "Help Me Grow" in Connecticut, which provides a number for doctors or parents to call if they have a concern.

Calls come in to short-term care organizers who link people to services. The project is not expensive because it piggybacks on existing numbers. Public health could partner with private medicine. And public health needs to help people in communities build supportive relationships. Schor mentioned a book titled Better Together that discusses the notion of social capital.

Expositeur: Calvin Johnson, M. Johnson's first job in public health was in New York City. He said that he could not remember his first experiences dealing with child abuse as a professional because there have been far too many and such a wide range of them. In Pennsylvania, 36 children died of abuse in Johnson discussed taking "AIM" at child maltreatment. Johnson discussed the state perspective and stated that there is no national standard for defining and collecting data.

The Pennsylvania Child Death Review program needs to be implemented elsewhere. The program operates in 48 of 67 counties and will be extended to all counties.

There is a need to understand more and coordinate better to solve this issue. There also is need for a broader standard curriculum for healthcare workers to train them to recognize and deal with child abuse and neglect issues. There also is a need to target parents. The Nurse-Family Partnership Program is an example of a good home visitation program. It is necessary to show a return on investment for programs when requesting money. Ellen Wartella, Ph. Wartella discussed historical change in the use of media in public health campaigns.

She noted that adaptation of commercial marketing technologies and social marketing has swept through public health campaigns. Campaigns have a customer-driven focus on desired behavior e. Mass media are not good at impacting individual behavior. Community-levels programs are a little more effective, but are dwarfed by other messages e.

The institution level is where there is a need to galvanize public will. Approaches include media advocacy and entertainment education. Larry Wallick has developed kits on the media advocacy approach. Entertainment education puts public health messages into mainstream shows, including the use of dramatic portrayals. Wartella recommended that participants use the media advocacy toolkits to galvanize local media.

She suggested establishing a coalition of groups to set up an organization that will constantly keep the issue in front of the media. She stated that the Surgeon General should serve as a spokesperson around a summit for the media on this issue. Groups that are engaged in trying to create good programming for children, such as Sesame Workshop, Nickelodeon channel, Disney channel, ABC Family channel, could be pulled together to discuss ways to bring these messages into their programming.

In terms of entertainment education, specific issues could be written into television shows Sonny Cox holds an annual workshop on this topic. Schor reflected that a fair number of children are being raised by grandparents, but that group has not been studied much. Charlie LaVallee, Highmark Caring Foundation, Pittsburgh, commented on the need to quantify financial impacts and argue the case from a financial perspective.

Participants must take the data to the media. Nancy Siegel, M. Wartella suggested bringing public relations experts in social marketing together to analyze where people are on this issue. The Surgeon General or another highly placed official could bring together media groups for discussions. Bettina Richardson, Bexar County District Attorney's Office, stated that family is the best place to reach out to children.

She noted that there are currently 15 family justice centers being established throughout the nation under the same prototype as the Children's Advocacy Centers. It is difficult to reach out and establish connections. Government agencies are part of the solution, not the problem. Many states have implemented alternative responses so that every family does not get the same response. The child welfare system would welcome any level of prevention.

In terms of the CQI concept mentioned earlier, every agency in the child family service review process is required to have a quality assurance system in place.

She added that the public system needs help, support, and partners to make the effort on child abuse prevention successful. Egeland noted the need for somebody like the Surgeon General to speak out and say that this is a national crisis.

He cited a Federal Reserve member in Minneapolis who accomplished a lot on the issue of early childhood development with just one speech. Prinz commented on the need for positive parenting programs that model positive parenting and are evidence-based.

Christian called on participants to work behind the scenes; there is need for a spokesperson and a message that resonate with the American public. Lithco stated that it would be helpful if there were a mechanism to continue commenting on this issue.

Lauren Raskin Ramos, M. Calvin Johnson responded that when a person feels ownership of a problem, he or she is more likely to do something about it.

One constituent can cause a ripple effect by getting the attention of a legislator. Data and information matter. Growth and development and health are what drive an economy. The economic message has not been effective. There are many competing issues and agendas. Dinnin noted that last year Texas eliminated prevention programs, but the public was able to get them restored.

He wondered if participants would be interested in an effort to do national polling of the public to get the messaging right. Do not leave any fields blank. If an employee is listed, but no contribution is being made, enter zero for all contribution amounts. Log into the secure email system Attached the file to an email containing your name and employer location and send via secure email to: HSAbillingfiles highmark.

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Thanks again for thinking of us and taking the time to show us your system. We look forward to working with you on the next opportunity that presents itself as a good fit. Your team took excellent care of this order from start to finish, and I truly appreciate it. Thank you so much for the support during the entire experience and for having Jeff on site during installation.

It was a great process, and I look forward to working together again in the future. Learn why Highmark is the leader in modular event structures, offering cost-effective design and construction versatility for any size event or exhibit.

Call Now. Explore our products to learn more. Learn More About Us. Indoor Products Superior indoor structures that are flexible, light-weight, reusable, and easily installed. Outdoor Products Ultra-mobile pop-up solutions, versatile kiosks, and large-scale multi-level outdoor environments. Case Study Merlo Moves the Earth!

Read More. Case Study Qualcomm Introduces the latest innovations for cars While other exhibitors focused on their new phones, Qualcomm engaged CES attendees with automotive technology that promises to change the Learn More About EventMax. Learn More About ExpoDeck. Learn More Max Multi-Wall. Learn More About Modulbox - Mobile.

Exhibit : Ces "Highmark is a Best in Class strategic partner to the exhibit industry. Exhibit : Ces "I have been in this business for the good part of 35 years, and I have never worked with a deck system as well thought out and as easy to use as the ExpoDeck product from Highmark.

Exhibit : Ces "Thank you again for a very informative presentation. Exhibit : Ces "I wanted to thank you for a fantastic experience. Speak to a Highmark Specialist Learn why Highmark is the leader in modular event structures, offering cost-effective design and construction versatility for any size event or exhibit.

Learn why Highmark is the leader in modular event structures, offering cost-effective design and construction versatility for any size event or exhibit. Call Now. Explore our products to learn more. Learn More About Us. Indoor Products Superior indoor structures that are flexible, light-weight, reusable, and easily installed.

Outdoor Products Ultra-mobile pop-up solutions, versatile kiosks, and large-scale multi-level outdoor environments. Case Study Merlo Moves the Earth! Read More. Case Study Qualcomm Introduces the latest innovations for cars While other exhibitors focused on their new phones, Qualcomm engaged CES attendees with automotive technology that promises to change the Learn More About EventMax.

Learn More About ExpoDeck. Learn More Max Multi-Wall. Learn More About Modulbox - Mobile. Exhibit : Ces "Highmark is a Best in Class strategic partner to the exhibit industry. Exhibit : Ces "I have been in this business for the good part of 35 years, and I have never worked with a deck system as well thought out and as easy to use as the ExpoDeck product from Highmark. Exhibit : Ces "Thank you again for a very informative presentation.

Exhibit : Ces "I wanted to thank you for a fantastic experience. Speak to a Highmark Specialist Learn why Highmark is the leader in modular event structures, offering cost-effective design and construction versatility for any size event or exhibit. Contact Us. Invoice Payment. Please provide your name and email to download this resource.

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