Background:Child maltreatment is a complex problem requiring interdisciplinary collaborative research to generate innovative solutions. The Doris Duke Fellowships for the Promotion of Child Well-Being were designed to identify and nurture emerging scholars committed to child maltreatment prevention and create a supportive interdisciplinary learning network. Objective:This paper examines connectivity within the collaborative network created by the fellowships program using longitudinal social network data. Participants and Setting:Participants were 120 individuals selected as Doris Duke Fellows during their doctoral training at universities in the United States. Methods:Fellows completed annual, voluntary web-based surveys to assess their interactions with other fellows during the past year. Social network analysis methods were used to assess the strength and quality of the learning network over a four-year period. Results:Across four years of data, there were increases in the number of connections, proportion of cross-cohort connections, and proportion of interdisciplinary connections. Network analyses showed a highly connected network consisting of primarily medium- and high-quality connections between fellows from different disciplines. The number of scientific journal articles authored by two or more fellows grew substantially over time. Conclusions:Findings indicate the collaborative network created by the fellowships program is growing and strengthening over time. The new Child Well-Being Research Network extends the fellowships network to a broader group of scholars and professionals to advance diversity, equity, inclusion, and justice in the field of child well-being research.

Public and media understandings of statutory child welfare services tend to be more focused on child protection rather than support and prevention services. The aim of the public awareness package was to consider how the public can be made more aware of support, prevention and partnership services within Tusla. The chapter provides an overview of the research process engaged in and provides sample findings relating to the public awareness package. Three literature sources that informed the study are summarised: help-seeking, public awareness campaigns and literature relating to the media and child welfare. The authors then report a sample of results from the published findings and discuss how these findings impacted public awareness activities during the study period. They demonstrate the complexity of undertaking moment-in-time, in-process, research where so many of the factors are beyond the control of the parties involved. The chapter gives a sense of 'real-world' research where one has to expect a constant process of change and review. The discussion includes reflections on three core themes arising from the work: the need for critical reflection on public understanding of child protection and family support; the value of having a partnership process; and the importance of learning to inform how child welfare agencies can better engage the public and the media to normalise pathways to help-seeking behaviours for children and families.

Background States, territories, non-profits, and tribes are eligible to obtain federal funding to implement federally endorsed evidence-based home visiting programs. This represents a massive success in translational science, with $400 million a year allocated to these implementation efforts. This legislation also requires that 3% of this annual funding be allocated to tribal entities implementing home visiting in their communities. However, implementing stakeholders face challenges with selecting which program is best for their desired outcomes and context. Moreover, recent reviews have indicated that when implemented in practice and delivered at scale, many evidence-based home visiting programs fail to replicate the retention rates and effects achieved during clinical trials. To inform program implementers and better identify the active ingredients in home visiting programs that drive significant impacts, we aimed to develop an expert derived consensus taxonomy on the elements used in home visiting practice that are essential to priority outcome domains. Methods We convened a panel of 16 experts representing researchers, model representatives, and program implementers using a Delphi approach. We first elicited standard practice elements (SPEs) using open-ended inquiry, then compared these elements to behavior change techniques (BCTs) given their general importance in the field of home visiting; and finally rated their importance to 10 outcome domains. Results Our process identified 48 SPEs derived from the panel, with 83 additional BCTs added based on the literature. Six SPEs, mostly related to home visitor characteristics and skills, were rated essential across all outcome domains. Fifty-three of the 83 BCTs were rated unnecessary across all outcome domains. Conclusions This work represents the first step in a consensus-grounded taxonomy of techniques and strategies necessary for home visiting programs and provides a framework for future hypothesis testing and replication studies.

Background The US is scaling up evidence-based home visiting to promote health equity in expectant families and families with young children. Persistently small average effects for full models argue for a new research paradigm to understand what interventions within models work best, for which families, in which contexts, why, and how. Historically, the complexity and proprietary nature of most evidence-based models have been barriers to such research. To address this, stakeholders are building the Precision Paradigm, a common framework and language to define and test interventions and their mediators and moderators. This observational study used portions of an early version of the Precision Paradigm to describe models' intended behavioral pathways to good birth outcomes and their stance on home visitors' use of specific intervention technique categories to promote families' progress along intended pathways. Methods Five evidence-based home visiting models participated. Model representatives independently completed three structured surveys focused on 41 potential behavioral pathways to good birth outcomes, and 23 behavior change technique categories. Survey data were used to describe and compare models' intended behavioral pathways, explicit endorsement of behavior change technique categories, expectations for home visitors' relative emphasis in using endorsed technique categories, and consistency in endorsing technique categories across intended pathways. Results Models differed substantially in nearly all respects: their intended pathways to good birth outcomes (range 16-41); the number of technique categories they endorsed in any intended pathway (range 12-23); the mean number of technique categories they endorsed per intended pathway (range 1.5-20.0); and their consistency in endorsing technique categories across intended pathways (22%-100% consistency). Models were similar in rating nearly all behavior change technique categories as at least compatible with their model, even if not explicitly endorsed. Conclusions Models successfully used components of the Precision Paradigm to define and differentiate their intended behavioral pathways and their expectations for home visitors' use of specific technique categories to promote family progress on intended pathways. Use of the Precision Paradigm can accelerate innovative cross-model research to describe current models and to learn which interventions within home visiting work best for which families, in which contexts, why and how.

Child maltreatment prevention efforts continuously evolve as developers learn from past efforts and adjust to current realities. For many years, changes in context and family circumstances has been gradual, requiring prevention planners to make relatively modest changes in their strategies and overall approach. Today, the COVID-19 pandemic presents significant challenges to those utilizing prevention services as well as those charged with developing them. The purpose of this chapter is to take stock of where the prevention field is at and to identify those areas that offer the richest opportunities for doing better in these times of great uncertainty. Beginning with a prevention history, the chapter examines the various stages through which the field has evolved and the gains each stage has produced. The chapter highlights primary accomplishments in four areas – concentrating prevention efforts on strengthening early parent-child relationships and early child development; investing in evidence-based program models with demonstrated success in achieving targeted outcomes; expanding implementation research that focuses on program replication; and creating effective service delivery systems capable of sustaining and extending prevention's reach. The chapter concludes with a discussion of COVID's programmatic and policy challenges and how the field might use these challenges to identify new opportunities.

Universal Approaches to Promoting Healthy Development:Introducing the Issue Deborah Daro (bio), Kenneth A. Dodge (bio), and Ron Haskins (bio) How can society best support parents, beginning early in their children's lives? That's the most basic question we ask in this issue of Future of Children. The articles that follow describe several ways that local communities have tried to provide such support, by implementing new interventions, reforming existing systems of care, and improving the coordination and planning of services. The primary assumption underlying these efforts is that unless we can develop programs and strategies with universal reach to help parents at all levels of need, we will fight a never-ending battle to deal with families and children exhibiting individual problems that affect child development and child safety. Perhaps even more important, the efforts we highlight in this issue are showing scholars and policymakers how programs that help all or nearly all families in a community might be developed, tested and used as a platform to employ existing resources more efficiently. The most important point of all is the growing realization that parents rarely succeed entirely on their own, and that providing support from community resources to families in need is a worthy goal of public policy. Before we turn to briefly summarizing the content of each article, it's useful to consider why the program innovations described in these articles are widely seen as the next step in evidence-based policymaking. Those concerned with children's welfare and safety can no longer be content to support individual families deemed to need assistance only after they have demonstrated serious problems or substantial risk. Our approach must be organized around offering assistance to all or nearly all families in a given community early in children's lives, and trying to bring supports and services at the moment family problems and vulnerabilities are identified or shortly thereafter. We contrast this broader preventive approach with strategies that confront family issues only after serious problems such as abuse or neglect have arisen and seem to pose an immediate or potential risk of harm to children. If we saw children in a canoe heading for a waterfall, we wouldn't be content to wait at the bottom and mend their wounds [End Page 3] after they crash; instead, we would climb to the top of the falls and try to stop them from going over the edge in the first place. Similarly, we must begin earlier in children's lives and come equipped to identify family needs and offer assistance in a timely fashion before problems surface. Yet this issue of the journal is not merely about prevention versus treatment—it's about universal approaches that can reduce the population rate of adverse outcomes. Many questions remain about the appropriate design, implementation and funding of universal strategies. Still, the programs described in this issue suggest that building the infrastructure to support a universal approach involves three important steps. The first is a mechanism that allows all families in a community to be assessed and to receive advice from qualified professionals about how to ensure the healthy development of their children. Second, when giving advice, these professionals must recommend specific prevention or treatment services that are available and accessible in the local community—and, often, help parents gain access to and pay for the services. Third, programs need a way to track families' developmental and other issues, the services they seek and receive, and the results of those services. The various strategies reviewed here illustrate not just how all three steps can be accomplished, but also the advantages of this approach to serving families. A few words are in order about how child protection currently operates in the United States. Over the past few decades, child protection has been governed largely by the accepted belief that parents should make most of the decisions regarding their children's care and wellbeing. Laws overriding parental preferences are generally limited to cases in which a child has experienced physical harm or neglect, or is at imminent risk. And usually, public concern is triggered only after a parent fails. Unfortunately for parents who have limited access to family...

Summary:In the United States, two approaches have developed to exercise collective influence on how parents raise their children. One is mandatory public intervention in families who have placed their children at risk, exemplified by the child welfare system. The other is voluntary offers of assistance, for example, child abuse prevention services that place responsibility on parents to determine whether they'll accept the advice they receive and change their behavior.In this article, Deborah Daro traces a shift in emphasis from a Progressive-Era policy that offered common supports to all new parents to a more bifurcated prevention system that emphasizes public investments primarily for those parents and children at highest risk. Moreover, she writes, for the past 50 years, voluntary and mandatory parental assistance have operated independently, with minimal shared agenda setting and planning. She contrasts this to the health care system, where early assessment and diagnosis mean that people receive a continuum of care, based on their level of need. Early medical treatment isn't viewed as intrusive; it's seen as an important first step in protecting health and avoiding more complex and costly therapy.Unfortunately, Daro argues, the policy response to parental shortcomings isn't comparable. There's no adequate early assessment when people become parents, and child welfare agencies typically offer assistance only after a child is harmed. She suggests that the time is right for a universal approach that reaches out to all new parents, offering each family a level of assistance commensurate with their needs. Ideally, she writes, "Seeking out and accepting formal public services to help meet parenting demands should be as acceptable as using preventive health care."

Ecological or multidimensional theories are commonly used to explain the causal pathways that contribute to complex social problems. While it is generally understood that context matters for improving and strengthening parental capacity and positive child development, it is less well recognized that context also matters for the capacity of interventions, even those that are well specified and researched, to realize their full potential. Indeed, the attention being given to directing public investments to “evidence-based models” suggests that a program, once proven to work, can be successfully transplanted in a range of communities and that positive outcomes can be replicated at scale. However, rarely do these so-called proven programs replicate their impacts when taken to scale. Maximizing the impacts and viability of evidence-based programs, in many ways, depends upon the ability of local communities to facilitate collaboration across sectors and target investment around a shared mission and set of core outcomes. The purpose of this commentary is to articulate why focusing on both program and context offers policymakers a more promising pathway for achieving meaningful and sustainable improvements in a child’s well-being and healthy development.

OBJECTIVE:Evaluate the effect of a community-based, experiential cooking and nutrition education program on consumption of fruits and vegetables and associated intermediate outcomes in students from low-income families. DESIGN:Quasi-experimental program evaluation by pre-post survey of participating students and their parents. SETTING:Underserved elementary and middle schools in Chicago. PARTICIPANTS:Students (n = 271; 65% girls, 44% Hispanic, 32% African American; 94% eligible for free/reduced price lunch) in grades 3-8 selected by school staff to participate by variable inclusion criteria. 59% of students who applied returned both pre- and post-surveys. INTERVENTION(S):Ten-week (2 h/wk) chef-instructor-led program held in cafeteria kitchens after school. MAIN OUTCOME MEASURE(S):Changes in student nutrition knowledge, cooking self-efficacy, fruit and vegetable liking and consumption, and communication to family about healthy eating. ANALYSIS:Changes from beginning to end of program were analyzed with paired t test. Results were considered significant at P < .05. RESULTS:Increased nutrition knowledge score from 0.6 to 0.8, cooking self-efficacy score from 3.2 to 3.6, and vegetable consumption score from 2.2 to 2.4 (all P < .05). Increased score for communication about healthy eating (4.1 to 4.4; P < .05) 6 months after the end of the course. CONCLUSIONS AND IMPLICATIONS:Experiential cooking and nutrition education programs led by chef-instructors may be effective ways to improve nutrition in low-income communities.

Much of the fabric in today's society is at odds with planning a robust and generative public health response to child maltreatment prevention. A critical component of this problem is the absence of a public policy framework and related infrastructure that can create common ownership of the problem while recognizing the vast differences in individual willingness and capacity to alter their parenting behaviors. To address this challenge, it seems prudent to begin building a universal system of assessment and support that will touch all children and all families at multiple points in the developmental process. Such a system would not simply identify those at highest risk. Rather this system would be built on the premise that all parents have issues and concerns and differ only in the extent to which they have the capacity to address these issues. This commentary outlines the key elements of such a system and its benefits in strengthening both the impacts of interventions and the collective will to support all children.

A great deal has been learned about child maltreatment over the past 50 years. The problem is perceived as more complex in terms of how best to design and implement strategies to address it and how to tailor those strategies across different populations and contexts. This chapter builds upon the Doris Duke fellows’ work and describes emergent themes related to the nature of the problem (engaging multiple disciplines, broadening the concept of maltreatment, focusing on risk and protective factors), the nature of the response (integrating the response across the lifespan, embracing methodological pluralism, promoting data use and data sharing), building a unified response to child maltreatment (integrating neurobiological, implementation, and contextually sensitive research approaches), and building and sustaining new leadership for the field (nurturing transdisciplinary practice, introducing scholars to the policy world, enriching the pipeline of qualified scholars). The chapter concludes by articulating operational pillars that will undergird the fellows’ future work.