parent helpline

it's 1:00 and i'm welcoming youto our 22nd public round at cdc. i do want to mention as alwaysfor those who may be new to these events that you can see usboth internally through the cdc web page or externally throughthe link here and also you can also watch us on youtube. in my family i'm now the mostpopular person on youtube, because my kids don't doanything fun that would get them to youtube. i would like to mention that weare just a couple of topics that

are coming in july and august,electronic health records and new born screening and then thatwe are transitioning from a third thursday, going to come asshock to a lot of people to a third tuesday in a month. we hope to be able to keep thesame time slot and i will make sure we share that informationwidely. and the first topic in the newtime day is going to be traumatic brain injury. i must disappoint some of youwho stopped me in the elevator

after each one of these sessionsand say that, you know, a small part of the reason why theyenjoy these sessions is how i make fun of the speakers andshow them in all kinds of compromising positions. this time i'm not going to dothat. i thought that the topic itselfis so serious that perhaps we could stay away from being toofunny, at least i wanted to stay away from being too funy. we have four outstandingindividuals, in many ways with

whom i have worked over the pastseveral week very closely and i'm sure there's going to be awithdrawal symptoms here this weekend. we have some colleagues fromcdc. jim merce around janet saul andthen we have two colleagues from outside cdc, shieri turner fromflorida and patrick from nekc foundation. one thing that i would like toleave you with is the fact that there are hundreds of thousandsof children who endure

treatments every year and ifeach event actually a single event and you will hear from ourspeakers that it's not a single event. it's not something that happensonce as a rule, this would be the speed, the speed of thesechildren's photos appearing on the screen, is the rate withwhich a child mull treatment occurs in the country. cases every year that translatesto 20,6 hrn 00 a day. 858 and hour, 14 a minute and4.3 in, one in every 4.3

seconds. so i wanted you to really beshocked with those numbers as i think some of us who don't workin this arena are shocked, because we're so used to hearingabout so many other things, but not necessarily about somethingthat has to be close to everybody. because everybody has a child intheir family, and you don't have to be a parent to appreciatethat. and with that i am going to askour colleagues in the studio to

put a short welcoming comment byour director and then we will immediately begin with ourpresentations. child abuse is a crime, tragedyand significant public health problem. in this country about one infive children have experienced some form of maltreatment,either physical, sexual or other abuse. child maltreatment flaumts morethan 1,700 deaths each year, but the negative health effects ofchild maltreatment reach well

beyond these fatalities. in addition to physicalinjuries, maltreatment interferes with braindevelopment. children who are maltreated areat greater risk for adult health problems, such as alcoholism,smoking, depression, drug abuse, obesity, high rist behaviors,suicide and certain chronic diseases. this session of public healthrounds will focus on the epidemiology and costs of childmaltreatment and recommended

actions to both learn more anddo more to combat this urgent and tragic public health issue. >> good afternoon. i'm dr. jim merce around i'mgoing to begin by provide an overview of child maltreatment. you know, child maltreatment wasone of the initial ires for cred kr's interests just over 30years ago. one of cdc's first violentinvestigation was a study's a series of 22 murders thatoccurred in atlanta between 1979

and 1981. cdc's work on prevention hasexpanded since thor 1980s especially with congress'appropriations over the past decade. our annual preparation for childmaltreatment was just under $7 million in fiscal year 2011. but the importance of childmaltreatment is a public health problem as become clearer asfull consequences in costs have come to light over these pastthree decades.

let's begin by defining childmaltreatment. child maltreatment can either bean act of co-mission, omission, by any type of caregiver to aperson under the age of 18. four types. physical abuse such as hitting,kicking, shaking or burning. sexual abuse that includesbehavior such as rape or fondling. psychological abuse such asterrorizing or intimidating a child, and neglect, which is thefailure to meet a child's bake

needs forbasic needs for things like nutrition, shelter and medicalcare. it is beyond tragic that almost1,800 children by from maltreatment at the hands oftheir parents or caregivers in 2009. this is the equivalent of fivechildren dying every day or 71 classrooms of children a year. the great majority of thesechildren are under age 4 and abusive head trauma from beingshaken the most important cause

of these deaths. even more tragically, thesedeaths represent only the tip of the iceberg. in 2009, state child protectiveservice agencies received about 6 million reports of allegedmaltreatment of children. based on investigations thesereports confirmed 7,200 cases of child maltreatment. these confirmed cases representonly a fraction of the true magnitude of the problem becausemost cases are never reported.

survey data provide a morecomplete picture of this problem based on self-reports fromchildren and parents in a nationally representative surveyin 2008, about one in ten, or 7.5 million children, say charonhave been maltreated in the past year and one in five at somepoint in their childhood. self-report data indicates theoverall risk for maltreatment increases with age withemotional abuse being the most common form followed by physicalabuse, net then sexual abuse. very young children, however,are at greatest risk for most

severe injuries and death frommaltreatment and we know children with special needs,those with learning, mental or physical disabilities are atincreased risk of maltreatment. child protective service data isthe primary source of data for monitoring child maltreatment inthe u.s. while this data source is veryvaluable for monitoring the active tis of the child welfaresystem, it is well-recognized that it underestimates themagnitude of child maltreatment and distorts its epidemiology.

for example, child protectivesurvey data suggests young children are at greatest risk ofchild maltreatment. self-report data indicates therick is greatest among adolescents. new methods are needed lessaffected by the likelihood of cases coming to the attention ofauthorities. surveys of children and parentsis one very promising method as well as making better use ofhospital discharge and emergency department data.

those who maltreat children thatas perpetrators are influenced by a variety of individualfamily and community characteristics, largely relatedto social and economic disadvantage. individual characteristicsassociated with perpetration include factors that may impairjudgment, place caregivers under stress, or those associated withlimited parent knowledge and skills. family factors include thosethat produce stress or isolation

from support. community factors are generallyfeatures of neighborhoods that undermine safetiy, stability,support and even trust. child maltreatment influenceshealth across the life span. maltreatment and other adverseexposures contribute to social and emotional and cognitiveimpairments that in turn may lead to behaviors and diseaseinjury and disabilities. these series of consequencessuggest maltreatment in early life may trigary xwengs ofevents leading to premature

mortality. the health consequences of childmaltreatment are broad and varied ranging from riskbehavior such as smoking, the leading cause of death, such asheart disease. the evidence of theseassociations is based on a huge lit dhaer spans decades. the bottom line is that whilethe contribution of child maltreatment to any one of thesehealth conditions may be relatively small, the cumulativeimpact of child maltreatment on

health across these variedoutcomes may be huge. the most prominent studydocumenting the relationship between child maltreatment andother early xpoeshs to held, the study conducted by cdc andkaiser per mendte in san diego and began in the 1990s. a sfudy of over 17,000participants in which adult members self-report theiradverse childhood experiences and health status. adverse experienceses includephysical, sexual and emotional

abuse as well as risk factorsfrom maltreatment such as sexual abuse and mental illness. in this study an a score iscreated by summing the number of experiences exposures todifferent types of adverse experiences that occurred to arespondent as a child. here is an example of therelationship between the ascore and mental health, in this case,lifetime depression. the greatest odds of depressionand the number of adverse experiences.

those respondents whoexperienced five or more aces were at five times the risk ofsuffering depression than those with no aces. this association is especiallyimportant given that 9% of the adult population is estimated tobe currently depressed. it's not just mental healththat's affected also physical health. the odds of experiencingcardiovascular disease increases with the number of adverseexperiences as well, even after

adjusting for traditional riskfactors. these trends also appear fordiabetes, hypertension, obesity and cancer. even risks for infectiousdisease, in this case, hiv, are affected by child maltreatment. again what we see a consistentgraded relationship with increasing number adverseexperiences being associated with the greater odds of iv druguse, sexual promiscuity and having an std.

what mechanism could explainthis relationship between child maltreatment and such a broadrange of health outcomes? an ever-expanding scientificliterature shows the architecture of the brain ischanged by the impact of excessive and repeated stress. this stress causes the releaseof chemicals that impair normal cell growth and alter basicstructures in the brain making child maltreatment victims morevulnerable to health problems throughout their life span.

cdc recently estimated theeconomic total of child maltreatment. the total lifetime economicburden resulting from new cases of fatal and non-fatal childmaltreatment in the u.s. in 2008 is estimated to exceed 121billion dollars. about 20% of this estimate isattributable to health care costs, 69% to productivitylosses and the rest of the cost of child welfare, criminaljustice and special education. this cost estimate is based onconfirmed reports of child

maltreatment to child protectiveservice agencies. this is our most conservedestimate of the magnitude of if one uses a survey these costsballooned to over half a trillion dollars. productivity losses in annualearnings are greater for child maltreatment than for smoking,obesity and teen pregnancy combined. this isn't surprising given thebroad impact of child maltreatment on mental andphysical health as well as

cognitive development. we face several significantchallenges in reducing child for one, the significance ofchild maltreatment on health is underappreciated. we also lack ongoing datasystems for monitoring the full spectrum of child maltreatment. as a society, we have notprioritized primary prevention but rather invested primarily inresponse to the child welfare system.

finally, public health is notwell integrated into a coordinated prevention systemfor child maltreatment. cdc is committed to reducingchild maltreatment by moving the field towards driven preventionstrategies in several key ways. first, by raising thevisabilities of the consequences and costs of child maltreatment. second, by developing datasystems to better track the problem. third, by helping the field movetowards policies and programs

that impact a broad environmentwith child maltreatment occurring. we need interventions that canbe scaled up and have population impact at reasonable cost. finally, we must mobilize thepublic health system to take leadership on this issue andfully engage in child maltreatment prevention. the following speakers willaddress many of these priorities, particularly as theyrelate to prevention policies

and public health capacity. child maltreatment is at once acritical social and public health issue. anything that undermines thehealthy development of children as does maltreatment hasprofound implications for society. public health must joint childwelfare, criminal justice and other sectors to work togetherto ensure that every child has a healthy start in life.

our next speaker is janice saul. given jim's comments on theprevalence and consequences of child maltreatment it's easy tofeel overwhelmed, but we believe there is hope throughprevention. let's start with what we'recurrently doing to stop the tragedy of child maltreatment. you just heard from sdwlamjimthat one of our challenges we haven'tprioritized prevention. here's a picture of thatchallenge.

not that we're ignoring theproblem. there are many organizationswhose work revolves around the issue of childnallmaltreatment's pt ma jortdy of resources go toresponding to it after it's already occurred. clearly, this response iscritical. in the federal arena otheragencies have this mandate. most of the response efforts arehoused in the administration for children and families often ofchild abuse and neglect.

the federal agencies also workon child maltreatment preventions including cdc. we focus our efforts on thebottom two sections of this triangle nap is, preventingchild maltreatment before it occurs. we need a more balanced approachto addressing child maltreatment and an approach where we put atleast as much emphasis on prevention as on response. cdc's vision for preventingchild maltreatment is to ensure

that all children grow up withsafe, stable and nurturing relationships in their lives. we call them ssnrs for short. we're not just talking aboutparents when we talk about ssnrs. we're also talking about othercare gavors and important adults in a child's life. and we also focus onenvironments that are conducive to providing ssnrs, because if afamily lives in a chaotic,

high-stress environment, it'smuch more difficult for parents to provide ssnrs. the focus on ssnrs is based onscientific evidence. the literature tells us thathealthy development depends on the quality and reliability ofchildren's relationships. positive interactions buildhealthy brain architecture and that also provides a strongfoundation for learning positive behavior and held. and health.

how do we go about buildingssnrs and preventing child maltreatment? in child maltreatment preventionwe're fortunate to have evidence that some prevention strategiesdo work, and i'm going to give some examples ever those. of those. one general type of strategycalled home distags in which trained practitioners, nurses orparent educators, visit parents in their homes to provideinformation, training and

support on a variety of topicsincluding child development, childcare and parenting skills. the community guide recommendshome visitation for preventing child maltreatment but it alsofound that not all home visitation models are equallyeffective. the affordable care act createdthe maternal infant and early childhood home visitationprogram led by hers in collaboration with acf and otherfederal agencies including cdc. funding is provided as states,territories and tribes to

implement evidence based homevisitation models. the governor of each stateappoints a lead agency in over 30 states the agency is in thepublic health department. because this program is in theinitial stages, we actually don't know yet how many familiesacross the nation will benefit. however, this funding is a majormilestone for prevention. in that it is a national programand it will result in nationwide implementation of strategiesthat have the potential to prevent child maltreatment.

one specific home visitationmodel is called nurse family partnership or nfp. in this program registerednurses make home visits to first-time moms and theirbabies. this program has been rigorouslyevaluated multiple times. in one study, 46% fewer cases ofchild maltreatment than families that did not get the program. importantly, this homevisitation model is cost beneficial providing around $6in benefits for every $1 spent.

another evidence-based programis called the positive parenting program or triple ppp developedin australia by a clinical psychologist who after spendingyears working with families in crisis decided that he wanted toprevent families from needing to seek therapeutic services. pp spchlt made up a collectionof intervention. ppp. you can see from this graphic,the frequency of what gets tliverred depends on the needsof the family.

in the outer most ring everyonegets the media message. in the center of, only familiesin crisis get the intensive one-on-one counseling. ideally, everyone in thecommunity has access to some level of ppp. ppp has been rigorouslyevaluated for many outcomes pap cdc funded multicounty trial insouth carolina was the first study of ppp to measure impacton child maltreatment. our study provided evidence thatppp can impact child

maltreatment estimating that forevery 100,000 children in a community, we can preventapproximately 306 cases of child maltreatment, 188 out of homeplacements and 60 injuries seen in hospitals either through ervisits or hospitalizations. ppp is available to anycommunity that wishes to implement it. communities purchase programmaterials and training for professionals from ppp america. through a partnership with afoundation, cdc foundation and

hrsa, cdc is currently fundingtwo sites in michigan and north carolina to implement pppthrough health centers. the cost, just under $13 perchild with the community and also cost beneficial providingapproximately $47 in benefits for every $1 spent. another area in childmaltreatment where we have an evidenced-based program isabusive head trauma prevention. this programs give parents ofnewborns information about the serious adverse effects ofshaking and offer guidance on

how to handle a trying infoontavoid shiking. one such program was developedand evaluated in new york by a pediatric neurosurgeon who dealtwith the travesty of abusive head trauma after the fact. delivered in hospital maternitywards before patients and their babies were discharged. this evaluation showed a 47%reduction in abusive head trauma cases. these findings influenced 14states to pass legislation

mandating some form of abusivehead trauma prevention. currently, cdc's funding twostatewide demonstrations of abusive head trauma prevention. hour goal is to evaluate themfor their impact on abusive head trauma and determine if there'sa cost benefit. first, expansion of the programtested in new york and the second is an evaluation in northcarolina of the period of purple crying. a program developed by thenational center on shaken baby

syndrome. jim mentioned the need tostrengthen national and state-level prevention systems. we are doing just that with ourpublic health leadership initiative. its purpose is to strengthenpublic health capacity to lead child maltreatment prevention instates. why this focus on public healthagencies? first and foremost, as you haveheard today, child maltreatment

is a public health problem. also, public health has a longhistory of working on complex problems that are not solvableby any one discipline, knowledge base or value system. we have assessed the currentpublic health role at the state level and found a greater degreeof engagement than expected but it's still not where it needs tobe. doctor turner will provide anin-depth look at what florida is doing.

even though the evidence we haveisn't perfect, we need act on it. we have effective individual andfamily-based programs. we need to simultaneously fillin the gaps in our knowledge. it's especially important thatwe understand how to change community and societal factorsthat contribute to putting parents and families at risk. dr. mccarthy will focus hiscomments on policies that have the potential to prevent childmaltreatment.

conducting policy evaluationswould be a smart investment for our field at this time. public health is a good deliverysystem for acting on what we know and standing at the readyto incorporate any new discoveries. only through this type ofcoordinated interactive system will we reach our goal ofimproving the lives of children by ensuring that they all havesafe, stable and nurturing relationships, and by stoppingchild maltreatment.

thank you. i am dr. shieri turner and fromthe florida department of i appreciate the opportunity tobe here today to discuss florida's effort in the area ofchild maltreatment prevention. i will present some specificdata on florida's current child maltreatment burden and somedata about longer term consequences similar to what youheard from jim at the national level. then i will provide some contextfor how child maltreatment

prevention and child protectionis address in florida. followed by more detailedinformation on the role of public health in preventingchild maltreatment. florida has over 4 millionchildren. there were over 45,000 confirmedcases of child maltreatment in the majority of confirmed cases,53%, were neglect. with about 11% confirmed forphysical abuse, and about 5% confirmed as sexual abuse. florida rate of 11.3 per 1,000cases are similar to the

national average of 9.3 per1,000. as for the nation, our numbersare likely just the tip of the iceberg. certain types of maltreatmentare less likely to be reported, and other cases are morechallenging to validate. but even with limited data, thisresult in a significant societal and public health problem forthe state. because it is very importantthat have good data, in 2008, florida added a subset ofquestions mirroring the adverse

childhood experiences study tothe behavioral risk factor surveillance system. jim already explained what acesare, so here is just a reminder. among the 8,821 respondents inflorida, only 13% had zero ace risk factors and 28.1% had fouror more. this group reported two to threetimes more physical, mental health and social concerns thanthose with zero to two ace factors. at the state level, the economicburden of child maltreatment is

large. the estimated cost to florida isover $9 billion per year. to put that in perspective, theflorida legislature just passed a $67 billion budget. this, then, represents over 13%of the en's tire state budget. now that you have a glimpse ofthe burden of child maltreatment in the florida, let's explorewhat child maltreatment prevention efforts occur inflorida. as elsewhere, traditionally thefocus in florida has been on

responding to reported cases ofchild abuse and neglect with the majority of resources allocatedto focusing on the children in the top of that triangle thatjanet mentioned. in florida, the lead agencyresponsible for investigation of child maltreatment is thedepartment of children and families. they also handle child welfare,mental health and substance abuse just to name a fewservices. they are ultimately responsiblefor the disposition of the child

in a reported abuse case. the department of health has aleadership role in providing several kinds of preventionservices to families to deter child maltreatment foreignminister occurring in the first place, and i will speak moreabout this later in this talk. public health has had a growingrole in preventioning child maltreatment in florida. starting with the passing of theflorida prevention plan, focused and improving the status ofyoung children.

in 2007, legislation mandatedclearly public health's role in child maltreatment and socodified the department of health's official role in childmaltreatment prevention and helped to make this worksustainable. the governor's office ofadoption and child protection was established as well as thechildren and youth cabinet. the list of members on thiscabinet shown here is impressive. also, a new child abuseprevention and permanency

advisory council was kweengsed,edqueen convened and in charge of thestate-wide plan on prevention and permanency. while a number of piece was inplace for some time, the changes in 2007 have led to moresystemic and integrated thinking about the prevention system. division for the plan was thatchildren are raised in healthy, safe, stable and nurturingfamily. you are right.

this is very similar to thessnrs that you heard about from janet. the plan highlights a number ofimportant strategies, such as, infusing protective factors intosystems that serve both parents and children. and providing information onways to ensure children are safe and nurtured and live in stableenvironments that promote well-being. for example in a tricounty area,clay, duvall and nassau

counties, the local communitybased care lead agency for child welfare, a public-privatepartnership hire add nurse to work with their familiesincluding helping them build the five protective factors. statewide are medicaid, childhelp checkup programs incorporating into literatureand outreach efforts that go to pediatricians, nurses andfamilies. information about the fiveprotective factors, they're importance and how to buildthem.

please note that monitoring andevaluation of the plan implementation are alsoincluded. here are just some key floridaactivities that create a network for the prevention of childmaltreatment. let me point out a few. the healthy start program has anassessment tool called tell us about yourself that incorporatespersonal and family history and has recently incorporatedcomponents of the ace scoring tool.

it is used to help focusinterventions in the prenatal and early childhood periods. the teen parent program, floridaparent helpline and the florida circle of parents provideparent-to-parent support while speak up, be safe, is anelementary school child abuse prevention curriculum beingintroduced into florida's schools. the child protection teams withthe department of health play an important role in conjunctionwith the department of children

and families. they are medically directed,multidisciplinary community-based programs thatscamming potential child abuse or neglect and provide variousservices listed on this slide. they supplement the childprotective investigations of the department of children andfamilies or the designated sheriff's offices. experts in the field includespecially trained pediatricians, nurses, clinical capecoordinators, psychologists and

attorneys. the health care servicesproviders are especially trained and qualified to notice thesmallest physical or behavioral changes in a child, which canlead to early detection and reporting potential abuse cases. in florida, over 250,000 reportsof possible child maltreatment are made annually to the floridachild abuse hot line. in 2009, these teams reviewedover 190,000 reports, and then provided services to 29,000children.

16,000 were found to haveexperienced child maltreatment. another critical component tochild maltreatment prevention is the child abuse death reviewcommittee established in 1999 as an independent entityadministratively housed with the department of health. it reviews the facts and thecircumstances of all deaths of children from birth through age18 which occur at a result of verified child abuse or neglect. the purpose of the review is toidentifydent deficiencies or

problemsprovided to the familiened by public and private agencies. the findings and recommendationsare used to aid in future prevention efforts by informingchanges in legislation or policies and helping to developpracticed standards that support healthy children and reducepreventible child abuse deaths. the staff includes those fromthe department of health and seven other state agencies aswell as 11 members appointed by the state's surgeon general.

in 2009, there were 197 reviews,predominantly young families. although this is a last step inaddressing child maltreatment and some would say these are thechildren that the system has failed, much information can begathered that will potentially save the lives of otherchildren. in conclusion, florida continuesto make strides in our child maltreatment prevention effortby having a state statute and infrastructure in place tosupport public health participation, particularlyaround prevention approaches.

this allows for the work to besustainable and provides clarity on the role of each agency. for the department of healthbeing at the table at the strategic planning stage isimportant. in order to be fully engaged andpart of the long-term solution. this ensures that preventionapproaches are prioritized rather than relying solely onresponse in emergency situations. public health bring as greatdeal to the table.

primarily by looking at theissue through a broader framework and providingopportunities to interact with families in a non-threateningmanner. also importantly, public healthcan serve to convene this multisector approach by bringingother diverse partners and stakeholders together. our final speaker now is dr. patrick mccarthy. i'm patrick mccarthy.

i'm the president of thefoundation and i'm going to describe some of the policyoptions for reducing child focusing especially on thefactors that contribute to risk. poverty, family dysfunction andthe breakdown of community norms and supports. the casey foundation's missionis to foster public policy, human service reforms andcommunity supports that effectively meet the needs oftoday's vulnerable kids and we advocate for policies thatcan support the scaling up of

evidence-based programs such asthe kind that janet walked us through, that build strongerfamilies. policy approaches have limits. compared to some of the programswe heard about, for example, there are no single evenmultiple child maltreatment prevention policials which ofsuccess, but if you're a policymaker and want to reducethe risk of child maltreatment, the evidence suggests you wouldenact policies that number one, reduce poverty.

number two, reduce theconcentration of poverty in certain places, increaseeffective family strengthening interventions and promotepositive parenting norms. now, i'm going to focusprimarily on the poverty issues and the scaling up ofevidence-based prevention activities. reducing poverty, the datasuggests that reduced poverty, three things that a young personneeds to do. number one, complete highschool.

number two, delay parenthood. number three, achieve an earlyattachment to the workforce. national and state policy canhelp with all three of these. on the education front, federaland state policy can help reduce poverty by investing in highquality early learning and literacy as well as providingopportunities for youth who need to find a way back to theeducational opportunities if they've gone off track. in the area of delayingparenthood, policies can promote

community-bashaned pregnancyprevention and in early workforce attachment, policy, ofcourse, can provide support for summer jobs and supported workopportunities for young people. however, investing in theparents of that young person is also critical. requiring policies that ensurethat work pays well enough to lift the family out of poverty,if necessary, supplemented by additional income supports likethe earned income tax credit, it's child tax credit.

policies can also make itpossible for parents to work. making work pay and there'smaking work work. in order for parents to workthey need health coverage, child care, paid leave and adequateunemployment benefits when we hit the kind of recession we'rein the midst of right now. in the area of building andprotecting assets policies can help families protect assetsthat can secure they're economic success such as individualdevelopment accounts thatmatic savings, financial coaching andpractices that strip well from

poor families and communities. for example, home ownership canbe an effective means to build wealth. while the net worth of a typicallow income household is about $7,9s 00, low income householdsthat own a home have incomes six times that. $50,000. big question, though. can we actually reduce poverty?

there's some evidence that wecan. if you look at the stimulusbill, the american recovery and reinvestment act we see thatmitigated the effects on children by temporarilyexpanding supplemental nutrition assistance program benefits,snap or the food stamp program, creating a temporary tax creditfor working families and expanding the earned income taxcredit and the child tax credit. these benefits help familiesmeet needs at home while pumping money into the economy.

it's projected 6 million 100,000families were lifted out of poverty in the 36 states anddistrict of columbia for which we have data and that overallthe impact of the recession on poor folks reached a total ofalmost 33 million families. an example from oversea, thepoverty, the child poverty rate in great britain has been cut inhalf since 1994. using some of the same basicpolicy tools we have available to us, but haven't fully used. by contrast, the u.s. childpoverty raid trended upwards

since the year 2,000 andchildren proved economically vulnerable to increasedunemployment. some of the policies in greatbrit than led to these extraordinary results wereincreases in the national minimum wage. in comparable dollars about$9.70. in britain. about $7.25 in the u.s. tax incentives to encouragesingle parents to move into paid

employment increased publicbenefits for parents, universal preschool and regulations makeit easier for parents of young children to request flexiblework schedules. again, poverty is one of manyfactors that increase the risk of child maltreatment yet itappears to be the single largest risk factor. let's be clear. most poor folks don't abusetheir kids. however, being in povertygreatly increase yourself risk.

we have to respond more toallegations of child maltreatment when they hit ourpublic child welfare systems. federal policy can increase ournational investment in research and evaluation of the kinds ofpromising interventions janet talked about. making they're they're deliveredwith fidelity and at scale. we have a number of promisingareas we ought to invest in including providing universalexact and screening at birth at age 3, at school entry and atthe third, 6th, 9th and 11th

grade and investing inevidence-based prevention programs as described earlier. just one community levelexample -- sorry. just one community level examplefrom -- let me go back leer. study strongly indicate thechirn who attended chick's child-parent preschool programsin the highest poverty neighborhoods experiencedsubstantially lower rates of child maltreatment bip the ageof 17.

for every dollar invested in thepreschool programs the return to society at large was $7.14 andreduced costs of things like a medial education, justice systemex-xpentd chers et cetera. states need to make thesecommitments to implement evidence based prevention earlyintervention and treatment tied to cost benefit analysis. this requires changes in howprograms are financed, how states ensure fidelity to theseproven practices, workforce changes, contracting changes,and community engagement.

another critical policy elementis how systems respond to allegations. for example, differentialresponse systems focus on the -- which focus on the well-being ofthe whole family are grounded in the premise that a one sizeresponse to child maltreatment events simply doesn't work. at present, over 30 childwelfare jurisdictions completely or partially integrateddifferent responses into their systems.

depending on 0 state implementsthis, reductions in child maltreatment ranging from 20% toalmost 70%. also we must shift funds fromineffective deep end programs to prevention and earlyintervention. for example, the caseyfoundation worked with new york's administration forchildren's services on the goal of decommissioning 600 con graget care beds. very kbesive deep end beds. this goal surpassioned with anumber of con gra get care

getsbedsreduced from 1,474 in 2002 down to 2,191 in 2008, a 47%decrease. the importance of that, thatyields a savings of $41 million, a portion reinvested insupportive and aftercare services. policies that reduce povertythat deconcentrate poverty and attempt to change norms wouldall contribute to a decrease in more direct vee rao spoenssrequire scaling up of programs with best evidence.

our response require ascommitment at the national, state and local level, all havea role to play. our challenge is to build on themost promising examples and to persuade policymakers that theseexamples can be the norm rather than the exception. given the cost of failure, thehuman consequences and the investment, we will ultimatelymake if we choose to ignore this, the choice is simple. sound policy approaches thatreduce poverty and scale up

in sum, my fellow panelists haveshared the startling statistics and discussed the long-termconsequences of child maltreatment in today'spresentation. as startling at these may be, weall must work together knowing that child maltreatment can beprevented through the promotion of safe, stable and nurturingrelationships, and evidence-based that address thebroader community versus just looking at individual change. as a nation, we have theopportunity to invest in proven

policy and other interventionsthat can make our communities and our children safer,healthier and more able to contribute to our futurestrength. [ applause ]>> thank you very much to all the speakers. we now have about, a little overten minutes for questions. the floor is now open forquestions. we ask that you state your nameand limit yourself to one question.

while we're waiting for peopleto come to the microphone, let me ask dr. mccarthy a question. you know, i was reallyinterested in the great britain example of cutting the chartpoverty, child poverty rate in half. what can we learn about othercountries about policies that have potential to prevent childmaltreatment? >> thering -- [ inaudible ] inthe current area -- also, it's a question that -- [ inaudible ][ inaudible ].

>> for example -- in, there's --[ inaudible ] the intervention program, but -- a lot to --developing the programs we're getting them replicated andevidence behind them at the program level, but we haven'treally mastered the public will to take these to a scale largeenough that you see changes of the population level. and the uk, they're saying,we'll take a lot of your good ideas and we'll figure how toscale them up so we actually move the entire needle.

they did that with poverty issueand now start doing to it in things like child maltreatment. >> please? >> thank you. for a very good presentation. i have a question that youtalked about -- [ inaudible ] in children in the -- interested alittle more in what we know about the brain damage, if it'spermanent brain damage, does it, similar to sort of if you stopsmoking, certain you know -- you

can kind of restore some of thedamage done. what do we know about childmaltreatment, brain damage and over time? >> uh-huh. well, there is evidence, ithink, that the changes aren't necessarily permanent. i mean, one of the -- one of thekey ways that the brain is affected is by potentiallyaffecting the stress regulation and you can think of the stressregulation system as a

thermostat in your home. that has a normal set point. and if you're exposed torepeated and excessive stress, that may be altered such thatit's perhaps much lower. and in a house where you turnthe thermostat down, your heaters come into -- come onmuch more frequently. and in the same way, thoseheaters will burn out faster if your system is activated morefrequently. so it's also important to notethat the brain is vulnerable to

these types of stresses through,some people say early adulthood. different parts of the brain isaffected. you can still be affected bythis excessive and repeated stress as an adolescent. those are two aspects of theaffect on the brain that are important to remember. >>ie. mime name's alison amoroso. i was wondering if differentmembers of the panel could speak

about earnings for a tax creditnear georgia, one of the group states that still don't have alot of media at the health department level, a cdc leveland i know the foundation has a little, or maybe a lot of work,i don't know. i'd be interested in see you howthat particular strategy could influence the child -->> so is the question, how do you build a campaign with astate in order to get a state-level earned income taxcredit? of course, there's a nationalearned income tax credit.

>> right, because if i -- i seethe data that states don't have that have higher rates ofpofbty. >> absolutely. we made a big bet in themid-90s. what we said was that, if you'regoing it find a answer to poverty it's not through thetransfer of public benefits alone. there's got to be a path towardswork. it was a deal.

you work full time you ought notbe poor. in today's economy if you don'thave higher levels of education, you're going to have to havethat income supplemented in some way, and going back to ronaldreagan, by the way, a huge supporter of the itc, we'vetried to supplement incomes at the national level. what states have started tofigure out, if they want to deal with poverty at the state level,in a fairly straightforward way they can give a percentage ofthat eitc on top of it and

thereby incentivize work moreeffectively. the challenge in this particularmoment in time, of course, is that we're fighting a lot ofbattles to preserve state-level eitcs across the country,because of the deficits the states are facing. this is the worst deficitsituation for states since the depression by far. no comparison to otherrecessions. so this is probably the -- notthe time to mount a major

campaign around eitcs, rather toprepare in -- in georgia -- rather to prepare the ground sopeople start to see it not as a giveaway but a path towardsopportunities, incentive towards work, which we've made the betthat's the best path out of poverty. and just a matter of a lot ofcoalitions. you need have business at thetable. the advocacy community united. there are -- one of the mosteffective approaches we've used

is using one of the granteesfrom brookings. they do a geographic analysisand look at congressional districts and state senatedistricts and assembly districts and say, in your district, ifyou had an eitc and a greater use of the federal eitc, morefolks signing up for it, this is the amount of money that wouldcome into your district. that's real economic investment. pragmatically, that's anargument that works a lot better than, gee, lift this poor familyout of poverty.

it works a lot better to saythis is actually good for your economy. i don't know if that's helpful,but that's been our experience. >> next questioner? >> i'm susan katz. thank you for your great work. i have a question about the costbenefit figures that were mentioned. i was wondering if you had moreinformation here about how they

were calculated, and inparticular i'm wondering if sometimes the benefit is not tothe same group or the part of government that pays the costs,and how do you handle that policy wise? can you hear me? the second part? >> where you said -->> sometimes the benefit may not be too the same group that showsthe cost savings, or vice versa. >> well, what i'm going to sayis i wish our health economists

who calculated those was hereright now, but i do know that the, one of the things that theydid, the cost to society number that jim presented, the $121billion, that was derived by looking at costs, long-termcosts due to child maltreatment like mental health and delinkkwaes, getting involved in the juvenile justice system. education. not graduating from high school. as well as short-term costs likecost of the child welfare system

and involved in medical becauseof the child maltreatment. one of the things they did istook the -- they took those costs of child maltreatment andthen the costs of the program and then they looked at how muchcost -- i'm sorry. how much child maltreatment wasprevented. those are the factors they usedin getting it and actually in the audience, maybe afterwardshe could explain that to you a little bit more, because he'sone of the health economists who helped to derive not just thenational costs but also the cost

benefit numbers. >> do you have anymore -->> i hi that's accurate, but as you can see from ourpresentations, the costs of child maltreatment spread acrosssociety. and i think the estimates thatwere derived, that factored into the cost benefit analysesreflect a broad range of costs over a variety of sectors ofsociety. >> grant? >> oh, there's someone overhere.

>> i'm sorry. >> hi. my name's mary mcdonald. thank you for yourpresentations. one of the things that most ofyou alluded to is the epidemic nature of childhood sexual abuseand yet there weren't a lot of specifics talked about in termsof intervention, and i'm wondering, if you do saysomething about that. since oftentimes as response tochild abuse, child sexual abuse

will simply put the child in asituation where they have new potential abusers and i'mwondering if something like adding child sexual abuseawareness to what the person learns while they're learningnot to shake the baby might be a good idea. i welcome your thoughts. >> there's a lot that people doacross the country around child sexual abuse prevention. many efforts-of-perm safetyprograms in school ps those have

been evaluated to a certainextent. they've been avaluated to lookat whether children heard the message, whether they understoodit, whether they -- whether they disclosed child sexual abuseafter hearing about the, you know, what to do if someoneapproaches you. there hasn't been any that havelooked at whether or not being exposed to a program like thatactually prevents child sexual abuse from occurring. we don't really know theeffectiveness of that for the

ultimate outcome. so whether or not that could beadded to something like abusive head trauma prevention, i thinkthat, you know -- i mean, that's an interesting idea. one of the things that we'recurrently doing right now that i'll mention is working with dr. kim miller, who works in theglobal aids program, and he's developed a great parentingprogram calmed parents matter here and families matter that'sgoing into some other countries

internationally, and what we'redoing there is trying to add a module on child sexual abuseprevention to a parenting program. but that's -- it's just inthe -- that's in the development stage, but that's another placewhere i think specific information and conversationaround child sexual abuse could be plugged into parentingprograms. >> last question. grant?

>> yeah. grant, my question is for dr. turner. i wonder if you could speak tohow you got the governor's commitment to child maltreatmentprevention and the public health role, because i think the realmodel i think other states need to adapt. there had been many years in themaking of working behind the scenes on the part of staff atthe department of health and the

department of children andfamilies. with the previousadministration, governor crist. those with his administrationwere supportive. it was the stars aligning, ithink, at that point in time, where the legislation was ready,the interest was there. you had, the agency hadappointed who were willing to take on the charge, and moveforward with it. so it was -- people who werewaiting for the right opportunity to infuse thelanguage, infuse the commitment

and a governor willing to takeon the charge for children. >> i want to thank the speakersagain. i thank the audience for theirinterest and attention. >> we'll see you in four weeks.thank you.