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Document Sample
2007 PREVENT Institute Team Project Planning Guide
Appendix B
Team Project Final Report
PREVENT Institute 2007
Team Members: June 27, 2007
Bill Baney Debby Kernan
Julie Goodrich Cindy Thompson
Lisa Hansell
Please note: These sections are in text boxes and can expand to fit the amount of content you have. Also,
please double space in size 12 font.
Executive Summary: this section should be a ½-¾-page overview of the entire report. This section
should include your final goals, objectives and action steps. (For each action step, state whether it is
“future,” “currently underway,” or “already completed.” For objectives, state whether they are
“achieved” or “still to be achieved” in the future. ) It should also include a brief description of the
assessment you did leading into the project, what you planned to do, what you actually did and a
summary of the results.
The Portland, Oregon PREVENT Team’s five-year goal is to support safe and healthy families and
reduce child maltreatment in Multnomah County. The eight-month project goal was to collect and
analyze formative data to shape the development of an effective child maltreatment primary
prevention awareness campaign.
Based on our individual and collective professional experiences, we applied to participate in the
PREVENT Institute on the premise that primary child maltreatment prevention has not been a
public health priority in Multnomah County. Our plan at that time was to create a community
campaign targeting the community at large, focusing on protecting children from harm and
promoting safe and healthy families.
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2007 PREVENT Institute Team Project Planning Guide
However, as a result of our comprehensive training and dynamic teamwork at the PREVENT
Institute in January, we determined that, to succeed long range, we needed to do more formative
groundwork. Consequently, we took a step back and set out to develop an understanding of
current conditions; document existing data, clarify our definition of primary prevention, identify
existing prevention resources, and collect baseline data on attitudes and awareness related to child
maltreatment and primary prevention. Our next steps will include identification of existing data
sources (and/or need for new data sources) measuring risks and protective factors, as well as the
development and implementation of a child maltreatment prevention campaign.
Objective 1: Document existing rates of child maltreatment in Multnomah County. Achieved.
Action Steps:
A. Compile child maltreatment rates for Multnomah County for the past ten years
(l996 – 2005). Already completed.
B. Develop graph/tables showing trends. Already completed.
C. Distribute and discuss data with PREVENT team. Already completed.
D. Use rates and trends to inform focus group questions and process. Already
completed.
Objective 2: Adopt an agreed upon definition of primary prevention of child maltreatment.
Achieved.
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2007 PREVENT Institute Team Project Planning Guide
Action Steps:
A. Review literature on child maltreatment primary prevention. Already completed.
B. Team to discuss several definitions. Already completed.
C. Develop consensus on definition to be used to drive project efforts. Already
completed.
Objective 3: Inventory existing child maltreatment prevention resources (including programs,
services, policies and funding) in Multnomah County. Achieved.
Action Steps:
A. Review draft inventory (created by the Safe Child Task Force), identify gaps in data,
collect missing information and finalize inventory. Already completed.
B. Identify existing governmental policies that support and/or mandate primary
prevention. Already completed.
C. Generate list of service providers/stakeholders. Already completed.
Objective 4: Establish baseline information regarding family and community attitudes and
awareness toward child maltreatment and primary prevention. Still to be achieved.
Action Steps:
A. Create assessment tools for specific audiences (i.e. parents, policy makers, service
providers, funders). Currently underway.
B. Conduct interviews, surveys, focus groups and forums. Currently underway.
C. Summarize data. Future.
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2007 PREVENT Institute Team Project Planning Guide
D. Develop educational materials for discussions with policy makers and funders.
Future.
Objective 5: Identify existing data sources and/or the need for new data sources measuring risks
for child maltreatment and protective factors preventing child maltreatment. Still to be achieved.
Action Steps:
A. Form a data team. Currently underway.
B. From literature review and focus group findings, identify risk
and protective factors. Currently underway.
C. Identify existing data sources and new data sources needed to measure risk and
protective factors. Currently underway.
D. Secure funding needed for the development of any new data sources needed.
Future.
E. Collect baseline data. Future.
F. Analyze and summarize data. Future.
Objective 6: Develop a child maltreatment prevention campaign. Still to be achieved.
Action Steps:
A. Use findings from focus groups, quantitative data on risk and protective factors
and literature to draft primary prevention messages. Future.
B. Test messages and format with a pilot group. Future.
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2007 PREVENT Institute Team Project Planning Guide
C. Modify messaging based on pilot feedback. Future.
D. Secure funding for large-scale implementation. Future.
E. Implement campaign. Future.
F. Evaluate the possible influence of campaign on risk and protective factors and
ultimately on the reduction of Child maltreatment. Future.
See Appendix A for Project Plan Grid and Logic Model.
Using Data: this section should include data sources you’ve used, you’ve collected and those
you’ve created.
Using Data:
Problem statement: Rates of child abuse continue to rise and primary prevention of child
maltreatment has not yet become a priority in Multnomah County.
Our January 2007 PREVENT Institute trainings on data and evidence-based interventions by Dr.
Mel Kohn, Dr. Andres Villaveces and Dr. Des Runyan, and our subsequent April interview of Dr.
Kohn in Portland all guided us to review an evidence-based primary prevention program and an
evidence-based primary prevention product, and to establish formative, baseline data on child
maltreatment in Multnomah County.
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2007 PREVENT Institute Team Project Planning Guide
Evidence-based Primary Prevention:
David Olds’ Nurse-Family Partnership
Summary:
Nurse-Family Partnership (NFP) provides first-time, low-income mothers with home visitation
services from public health nurses. NFP nurses work intensively with these mothers to improve
maternal, prenatal, and early childhood health and well being with the expectation that this
intervention will help achieve long-term improvements in the lives of at-risk families. It focuses
on developing therapeutic relationships with the family and is designed to improve five broad
domains of family functioning:
Health (physical and mental)
Home and neighborhood environment
Family and friend support
Parental roles
Major life events (e.g. pregnancy planning, education, employment)
Starting with expectant mothers, the program addresses substance abuse and other behaviors
that contribute to family poverty, subsequent pregnancies, poor maternal and infant outcomes,
suboptimal childcare, and a lack of opportunities for the children.
Based on extensive research of the NFP over the last three decades, consistent program effects
are: improved prenatal health, fewer childhood injuries, fewer subsequent pregnancies,
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2007 PREVENT Institute Team Project Planning Guide
increased intervals between births, increased maternal employment, and improved school
readiness.
Team applications: We narrowed our initial PREVENT project focus to learn more about our local
Nurse-Family Partnership. Our focus group with Multnomah County nurses explored the
following issues:
1. In your opinion, how often do your clients, when they enter the program, believe that
they have the knowledge, skills and resources to be healthy, nurturing, and protective
parents?
2. What do parents feel they lack (to be healthy parents)? And what do you (nurse) feel they
lack?
3. What strengths do parents identify in themselves? What strengths do you (nurse)
identify?
4. How do the knowledge, skills and resources your clients lack affect their likelihood of
mistreating or neglecting their children? In your opinion, how would your clients
answer this?
5. What specific interventions in your practice do you believe influence your client’s
confidence level, attitudes and behaviors about parenting? What is the influence? How
do you know?
6. What have you found that is a successful motivator for behavior change in your clients?
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2007 PREVENT Institute Team Project Planning Guide
We also conducted a focus group with parents affiliated with FACT (Family Advocate
Community Team) who responded to the following questions:
1) What are the places in the community that are welcoming and comfortable for families
and what makes them that way? What are the places that aren’t welcoming and
comfortable and why not? How could they change?
2) Who/where do families go to when they need help with parenting? How does it feel to
ask for help? What/who would be available to parents in an ideal situation? What
would be the best place/way to get information out?
3) What did you learn about parenting that you wish you knew before you had children?
4) What kind of situations put a child at risk for abuse or neglect? What do you see as the
strengths of parents you know in protecting their children from abuse/neglect? What
kind of supports do parents need to prevent abuse and neglect?
5) Think about a child that you worry or have worried about. How comfortable is it to
respond? Does it depend on how well you know the family?
“Does Infant Carrying Promote Attachment? An Experimental Study of the Effects of
Increased Physical Contact on the Development of Attachment” article in 1990 Child
Development by Anisfeld, Casper, Nozyce and Cunningham
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2007 PREVENT Institute Team Project Planning Guide
Summary:
This study was designed to test the hypothesis that increased physical contact, experimentally
induced, would promote greater maternal responsiveness and more secure attachment between
infant and mother. Researchers inferred from the study results that for low-income, inner-city
mothers, there may be a causal relation between increased physical contact, achieved through
early carrying in a soft baby carrier, and subsequent security of attachment between infant and
mother.
Team application:
We have shared this study with the lead nurse educator for Legacy Health System’s
“Fourth Trimester Survival Skills” discharge class for parents of newborns and the “Baby and
Me” classes. More of those parents are now carrying their babies close to their bodies in soft
infant carriers rather than transporting them at arms length in the hard shell carriers.
Review of Existing Data Sources:
New Directions for North Carolina (www.preventchildabusenc.org/taskforce)
Florida Resiliency Mapping Project, CEED, The Lawton and Rhea Chiles Center for Healthy
Mothers and Babies, June 2004.
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2007 PREVENT Institute Team Project Planning Guide
CARES Northwest’s “Child Maltreatment Risk and Protective Factors” by Leila Keltner, MD
(www.caresnw.org)
“Seven Deadly Sins of Childhood: Advising Parents about Difficult Developmental Phases”
article by Barton Schmitt in Child Abuse and Neglect: The International Journal, v11, n3, p421-
32, 1987.
Department of Human Services’ Status of Children in Multnomah County -- Source:
Portland/Multnomah Progress Board.
Centers for Disease Control and Prevention’s Positive Parenting for Developmental Milestones
(www.cdc.gov/ncbddd/child/earlyadolescence.htm)
Focus Group training by Allan Steckler, PhD, 2/19/03, Professor at University of North
Carolina, Chapel Hill. (Email: steckler@email.unc.edu)
Readiness to Learn Inventory Survey Narrative June 2005 by Multnomah County Commission
on Children, Families and Community
(www.portlandonline.com/shared/cfm/image.cfm?id=14872)
Reframing Child Abuse and Neglect: A Practical Toolkit by Prevent Child Abuse America and
FRIENDS National Resource Center for Community Based Child Abuse Prevention
(www.friendsnrc.org/reframing/index1.htm)
University of Oregon’s Community Planning Workshop’s Summary of Online Survey Results
(www.uoregon.edu/~cpw/text/csc/tcsc.htm)
1993 Oregon House Bill 2004 (Creating State Commission on Children and Families) Oregon
Revised Statutes Chapter 676 Relating to children; creating new provisions; amending ORS
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2007 PREVENT Institute Team Project Planning Guide
169.090, 184.007, 326.615, 326.795, 336.168, 336.435, 339.195, 339.505, 417.315, 417.700, 418.653,
418.657, 418.658, 418.660 and 420.017 and section 44, chapter 33, Oregon Laws 1993 (Enrolled
Senate Bill 257); repealing ORS 409.210, 409.620, 409.630, 417.330, 417.335, 417.364, 417.400,
417.405, 417.410, 417.415, 417.420, 417.425, 417.430, 417.435, 417.440, 417.445, 417.455, 417.475,
417.480, 417.485, 417.490, 417.500, 417.510 and 417.672 and sections 1 and 2, chapter 611, Oregon
Laws 1993 (Enrolled Senate Bill 93); appropriating money; and declaring an emergency.
1999 Oregon Senate Bill 555 (Establishing state policy for serving children and families) Oregon
Revised Statutes Chapter 1053 Relating to juveniles; creating new provisions; amending ORS
137.656, 329.155, 329.237, 417.300, 417.305, 417.705, 417.710, 417.730, 417.735, 417.747, 417.750,
417.755, 417.760, 417.765, 417.775, 417.780, 417.785, 417.787, 417.795, 418.191, 418.193, 430.250,
430.255 and 430.257; repealing ORS 417.310, 417.315, 417.320 and 417.325 and sections 41 and 54,
chapter 1084, Oregon Laws 1999 (Enrolled Senate Bill 1127); appropriating money; and declaring
and emergency.
The Bill of Rights for the Children and Youth of the City of Portland and Multnomah County
(www.portlandonline.com/mayor/index.cfm?=eaaaha)
"The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead"
2002 article by Vincent J. Felitti, MD (www.acestudy.org/docs/GoldintoLead.pdf)
"Adult Health Problems Linked to Traumatic Childhood Experiences," 1998 article by Centers
for Disease Control and Prevention Media Relations
(www.cdc.gov/od/oc/media/pressrel/r980514.htm)
The ACE Study web site, (www.acestudy.org)
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2007 PREVENT Institute Team Project Planning Guide
Team’s Completion of Draft Data Source:
Safe Child Task Force Inventory of Child Maltreatment Prevention Resources in Multnomah
County
Team’s Development of New Data Sources:
Questions for “Roots and Wings, Celebrating Families and Community” event for Child Abuse
Prevention Month to increase awareness of child abuse prevention and to engage as many
families as possible in protecting the health and well-being of our community’s children.
Sponsors include: Multnomah County Commission on Children, Families and Community;
Multnomah County; Children’s Trust Fund of Oregon; Department of Human Services; CARES
Northwest; Legacy Emanuel Children’s Hospital; Portland Police Bureau; LifeWorks;
Multnomah County Library; Providence Health System; Foresters; Children’s Relief Nursery;
Listen to Kids; Morrison Child and Family Services; OnPoint; Verisonwireless; Portland
Children’s Investment Fund; Oregon Commission on Children and Families; and Witham &
Dickey.
Questions for Nurse-Family Partnership Focus Group
Questions for Family Advocate Community Team (FACT) Focus Group
Team Interviews with Data Experts:
Diane Yatchmenoff, PhD, Regional Research Institute for Human Services on 3/26/07. The
Regional Research Institute for Human Services is the research component of the Graduate
School of Social Work at Portland State University, Portland, Oregon. Their aim is to improve
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2007 PREVENT Institute Team Project Planning Guide
the manner in which social services and service delivery systems are designed, managed and
evaluated. (www.rri.pdx.edu)
Mel Kohn, MD, Oregon State Epidemiologist on 4/6/07
Identification of Potential Data Sources:
Multnomah Child Fatality Review Team data
Behavioral Risk Factor Surveillance System (BRFSS) surveys
Pregnancy Risk Assessment Monitoring Systems (PRAMS)
Professional peers in the field of child abuse prevention and intervention
Our project’s own Data Team (Dr. Mel Kohn, Lisa Millet, Kathryn Bradley, etc.)
Teleconferences:
PREVENT Topic Call with Ron Barr, MD on 2/14/07 regarding Shaken Baby Syndrome
prevention
Prevent Child Abuse America Research Call on 3/1/07 with Isaac Prilleltensky and Geoffrey
Nelson, “Shifting the Paradigm to Promote Child Well-Being”
PREVENT Leadership Call on 6/5/07 - “The Discipline of Collaboration” by Russ Linde
National Conference:
16th National Conference on Child Abuse and Neglect: Protecting Children, Promoting Healthy
Families and Preserving Communities 4/16/07 - 4/21/07 in Portland, Oregon. National
sponsors: Office on Child Abuse and Neglect; Children’s Bureau; Administration of Children,
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2007 PREVENT Institute Team Project Planning Guide
Youth and Families; Administration for Children and Families; and U.S. Department of Health
and Human Services.
Program Planning and Evaluation
Child maltreatment is a devastating problem affecting too many children in Multnomah County. In
2004, approximately 2100 of Multnomah County’s children (13.4 per 1,000) were abused and
neglected. This rate was up almost 32%, from 1591 children abused and neglected in 2003 (10.3 per
1,000). Statewide, 49.2% of victims of reported abuse/neglect are under age 6. The cost of
intervention in these child abuse and neglect cases places an enormous weight on our Child
Protective Services, educational, juvenile, and mental health systems. There is a need to shift the
balance of resources and focus “upstream”, so we can better protect children and ultimately reduce
the need for intervention.
Another compelling reason to make primary prevention of child maltreatment a priority is the
Adverse Childhood Experiences (ACE) study, conducted by the Kaiser Permanente Medical Care
Program in San Diego, the Centers for Disease Control and Prevention (CDC), Emory University in
Atlanta, and the University of Arizona Health Sciences Center in Tucson. Results of this
groundbreaking study suggest that childhood abuse and household dysfunction lead to chronic
diseases and common causes of death and disability later in life. In fact, the more adverse
experiences one has as a child, the more likely one will suffer multiple health risk behaviors and
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2007 PREVENT Institute Team Project Planning Guide
organic diseases as an adult. According to Dr. Vincent Felitti, principal investigator of the ACE
study,
“Clearly, we have shown that adverse childhood experiences are common, destructive,
and have an effect that often lasts for a lifetime. They are the most important
determinant of the health and well-being of our nation.”
In response to the escalating child abuse rates, a strategic partnership of: Multnomah County
Commission on Children, Families and Community, Children’s Trust Fund of Oregon, CARES
(Child Abuse Response and Evaluation Services) Northwest, Multnomah County Health
Department, and the Portland State University’s Center for Healthy and Inclusive Parenting was
formed to apply to become a PREVENT Institute team to prevent child maltreatment before it
occurs.
This collaboration resulted in the creation of the Portland Oregon PREVENT team. The PREVENT
Team’s five-year goal is to support safe and healthy families and reduce child maltreatment in
Multnomah County. The team’s eight- month project was to collect and analyze formative data to
shape the development of an effective child maltreatment primary prevention community
awareness and education campaign.
The project proposed in our application was to create a community campaign focused on protecting
children and promoting safe and healthy families. While attending the PREVENT Institute in
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2007 PREVENT Institute Team Project Planning Guide
January 2007, we quickly realized the need to take a step back; we weren’t ready to develop a
campaign. One of the primary goals of the campaign will be to change community attitudes. We
recognized that in order to be successful in changing attitudes, we needed to develop an
understanding of current attitudes and conditions. The team brainstormed questions that needed to
be explored to inform the development of an effective campaign.
1. What do we know about child maltreatment in Multnomah County?
2. What do we mean when we say primary prevention?
3. What are the resources that currently exist in the community and who are the stakeholders?
4. What are the current attitudes and opinions related to child maltreatment and prevention?
5. What do we know about risk factors and protective factors?
These questions guided the team in developing goals and objectives and methods of evaluating
progress in meeting the objectives. The next section describes the Objectives, Action Steps, Progress
to Date and Next Steps.
Objective 1 – Document existing rates of child maltreatment in Multnomah County.
Action Steps:
A. Compile child maltreatment rates for Multnomah County for the past ten years (1996-2005).
B. Develop graph/tables showing trends.
C. Distribute and discuss data with PREVENT team.
D. Use rates and trends to inform focus group questions and process.
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2007 PREVENT Institute Team Project Planning Guide
Progress to Date:
The Oregon Department of Human Services (DHS) publishes The Status of Children in Oregon's
Child Protection System, the annual report of abuse and neglect statistics. Victim rates in
Multnomah County have fluctuated over the past ten years, ranging from a low of 9.0 (2002) to a
high of 16.2 (1998).
Child Abuse and Neglect Rates Multnomah County compared to Oregon
1996-2005
Multnomah
County Oregon
Year Rate/1000 Rate/1000
1996 12.0 10.2
1997 13.7 11.8
1998 16.2 12.3
1999 14.9 13.5
2000 11.3 12.2
2001 8.9 9.6
2002 9.0 9.7
2003 10.3 10.8
2004 13.4 12.0
2005 14.3 13.0
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2007 PREVENT Institute Team Project Planning Guide
Victim Rate per 1000 children Multnomah County
compared to State
18
16
14
12
10 Mult. Co
8 OR
6
4
2
0
96
97
98
99
00
01
02
03
04
05
ar
Ye
19
19
19
19
20
20
20
20
20
20
According to the DHS report, in federal fiscal year 2005, the incidents (in Oregon) of mental injury,
sexual abuse and physical abuse declined, while incidents of threat of harm and neglect increased
from the previous year.
Mental Injury 24.9 percent
Sexual Abuse 6.2 percent
Physical Abuse 3.1 percent
Threat of Harm 5.4 percent
Neglect 21.1 percent
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2007 PREVENT Institute Team Project Planning Guide
Next Steps:
PREVENT team to further analyze and understand the data; exploring questions such as:
*What factors have lead to the negative change in the victimization rate trend (rates were
decreasing between 1999 and 2002; since 2003 the rate have been rising steadily)?
*Is the increase due to more abuse and neglect, better reporting, a combination of factors?
*Does this variation have anything to do with reporting differences?
*Is there a way to break out statistics by types of abuse or neglect, or by severity at the county level?
Data will be utilized to educate and inform community members, service providers, policy makers
and funders.
Objective 2 – Adopt an agreed upon definition of primary prevention of child maltreatment.
Action Steps:
A. Review literature on child maltreatment primary prevention.
B. Team to discuss several definitions.
C. Develop consensus on definition to be used to drive project efforts.
Progress to Date:
Myriad sources informed the creation of the PREVENT Team’s definition of primary prevention,
including:
January Pre-Work for the 2007 PREVENT Institute, including the
“Orientation to Violence Prevention: Part 1 – Moving Upstream: The
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2007 PREVENT Institute Team Project Planning Guide
Story of Prevention, Part 2 – Public Health Approach to Violence
Prevention, and Part 3 – Socio Ecological Model: A Pathway to Prevention.”
Participation in the 2007 PREVENT Institute, including Dr. Carol Runyan’s presentation,
“Preventing Violence Before It Starts.”
Centers for Disease Control and Prevention website, including the CDC Bulletin on Child
Maltreatment, “Preventing Child Maltreatment in the United States: Literature Update
2005.”
Prevent Child Abuse America’s White Paper #1, “Reframing Child Abuse and Neglect for
Increased Understanding and Engagement: Defining the Need for Strategic Reframing”
by Kevin T. Kirkpatrick, 2003.
Children’s Trust Fund of Oregon’s website, including the grant application guidelines for
primary prevention programs. (www.ctfo.org)
Our PREVENT Team’s collective expertise in the field of primary prevention.
Feedback from Mark Johnson, our PREVENT Institute coach.
The PREVENT Team adopted the following definition of primary prevention because it crystallizes
our understanding of and commitment to the overarching project goal.
Primary prevention of child maltreatment includes activities, strategies, programs or policies to
reduce risk factors and increase protective factors influencing the safety and well being of
children. These efforts, designed to increase the capacity of parents, caretakers and community
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2007 PREVENT Institute Team Project Planning Guide
to protect, nurture and promote the healthy development of children, are directed at the general
population with the goal of stopping the occurrence of maltreatment before it ever happens.
This definition formed the foundation for the team’s project fact sheet entitled,
“What will it take to prioritize safe and healthy families in our community? Your Multnomah
County PREVENT Team wants to know,” which is shared with others affiliated with the project,
so there is a common understanding of the goals and objectives (See Attachment 1).
Next Steps:
This definition will continue to drive the work of this project. For example, it will be included in the
information packets that are created for policy makers and funders (see Objective 4).
Objective 3 – Inventory existing child maltreatment prevention resources (including programs,
services, policies and funding) in Multnomah County.
Action Steps:
A. Review draft inventory (created by the Safe Child Task Force), identify gaps in data, collect
missing information and finalize inventory.
B. Identify existing governmental policies that support and/or mandate primary prevention.
C. Generate list of service providers/stakeholders.
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2007 PREVENT Institute Team Project Planning Guide
Progress to Date:
PREVENT team members have reviewed the draft inventory (created by the Commission on
Children and Families for the Safe Child Task Force). Data from the Department of Human Services
(DHS) regarding numbers served is forthcoming. Final changes in formatting are in process. A list
of the service providers/stakeholders has been created and will be part of the inventory.
Overall Inventory Findings:
Sixty-three (63) programs responded to the survey. Of those 63, 11 programs were categorized as
primary prevention, 21 programs as risk-focused prevention, 6 programs as early intervention, and
25 as intensive intervention programs. Based on the data collected, $121,046,318 is spent annually,
in Multnomah County, on child abuse prevention and intervention services.
Individual Component Findings:
Primary Prevention – Basic services that are needed by all and are broadly available; programs that
support the healthy growth and development of all children and youth; $2,699,006 spent annually
(34% City of Portland; 31% Other; 25% Federal; 6% County; 4% State); 10,883 people were served
through primary prevention efforts.
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2007 PREVENT Institute Team Project Planning Guide
Risk-focused Prevention – Services focused on specific groups of children, youth and families that
are determined to be “at-risk”; annual spending of $24,874,892 (42% Federal; 34% County; 10%
State; 9% Other; 5% City); 41,934 people risk-focused prevention services.
Early Intervention - Services that respond to individual children, youth or families who show
beginning signs of social, emotional or behavioral difficulties; $1,476,102 (33% County; 27% Federal;
26% State; 9% City; 5% Other), is spent annually, serving 1,565 people.
Intensive Intervention – Services for specific children, youth or families who are experiencing
difficulties, typically requiring multiple interventions; $91,996,318 is spent on this level of service;
serving 7,368 people (not including those served through DHS child welfare – figures not yet
available); state, federal and county government provide the vast majority of funding for intensive
intervention services.
Analysis
The cost of intensive intervention strategies for Multnomah County is approximately three times
that of the other categories combined. The data also indicates that we spend almost ten times as
much on a client once indicated services are needed to address child abuse after it has occurred
versus investing in universal strategies to prevent child abuse. While a cost benefit analysis has not
been done as part of this project, a growing body of research provides overwhelming evidence
validating that funding child abuse prevention efforts is a good investment. Research indicates that
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2007 PREVENT Institute Team Project Planning Guide
for every dollar spent on child abuse prevention a community can save between $3 and $7 in future
costs. (Brookings Institute).
In addition to the inventory review, the team researched existing governmental policies that
support and/or mandate primary prevention. The team located the following:
State Statutes: We found no state statute (or Governor’s Order) mandating prevention resources as
state policy in Oregon. In the statutes there is reference to prevention programs under the statutes
governing the Commission for Children and Families, but it was not a mandate for prevention.
Local Ordinances/Public Policies: There are no local laws/policies at the city or county level
mandating prevention programs in Multnomah County. There have been study groups about the
subject, but no official law/policy resulted.
Next Steps:
The Commission on Children, Families and Community will finalize and distribute the inventory.
Information will be utilized to inform and educate funders and policy makers.
Objective 4 – Establish baseline information regarding family and community attitudes and
awareness toward child maltreatment and primary prevention.
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2007 PREVENT Institute Team Project Planning Guide
Action Steps:
A. Create assessment tools for specific audiences (i.e. parents, policy makers, service providers,
funders).
B. Conduct interviews, surveys, focus groups and forums.
C. Summarize data.
D. Develop educational materials for discussions with policy makers and funders.
Progress to Date:
Representatives from the team met with Mel Kohn, Oregon State Health Department
Epidemiologist, to discuss the project. He recommended that the team narrow its focus for the
initial phase of the PREVENT project. He suggested a focus on the David Olds Visiting Home
Nurses model (only proven effective model) and investigating attitudes and social norms created
through this process (e.g. self respect, modeling effective parenting behaviors, providing social
support, being attended to by a medical professional, etc.) Mel advised asking the public
health nurses using the Olds model about attitudes and practices they believe change as a result of
their interactions with new parents. He encouraged the team to ask the nurses about the roles of
fathers in attitude and practice changes.
Building on this advice, the team worked with Chris Sorvari, Multnomah County Health
Department Research/Evaluation Analyst to develop a focus group interview tool to be used with
the Multnomah County Nurse Family Partnership (NFP) Team (OLDS model). Thirteen nurses
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2007 PREVENT Institute Team Project Planning Guide
working with the Multnomah County Health Department, Nurse Family Partnership program
participated in the focus group. Nurse experience in providing home visitation services to families
ranged from 6 months to 20 years. Their opinions about the attitudes and practices of the families
they work with will serve as a resource, in designing our community awareness campaign.
In addition to the focus group with the nurses, the team considered talking with parents as another
important initial step. The team worked with Yvonne Recchia, Portland State University Social
Work Intern, to develop focus group questions for the Family Advocate Community Team
(F.A.C.T.), a group of parents who have previously received community supports and services.
Yvonne facilitated the focus group discussion with the parents. 10 people participated in the focus
group, 7 females (ages ranging from 30-56) and 3 males (ages ranging from 36-41). Nine
participants were Caucasian and one was African American. All members were parents, with
children ranging in age from 1-30. Monthly income of participants ranged from $150 – 1,720;
household sizes ranged from one to four. Two of the parents shared that they had spent a
significant amount of time in prison.
Both groups provided perspectives and insights that will help shape future exploration of
community attitudes (Focus Group Notes – FNP See Attachment 1; FACT See Attachment 2). The
following themes regarding social attitudes and norms emerged from the focus groups with Nurse
Family Partnership and the FACT parent group.
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1. Social Isolation:
a. Both the nurses and FACT group identified social isolation as a problem for families.
b. Parents, both men and women, lack friend or peer networks, extended family
supports, and connection to the greater community.
c. There may be something to learn from other cultures about how to encourage and
support social connection. Nurses have observed that newly immigrated families
initially have supportive connections. Once they become acculturated, those
connections diminish or are lost.
d. Parents talked about more danger and less safe places for families to bring their
children, compared to when they were children.
e. Nurses and parents both said that parents need a break from their kids and kids need
a break from their parents.
f. Nurses said that the most important factor in the FNP program is personal
relationships.
2. Fear of Disapproval/ Judgment or Negative Consequences of asking for help:
a. Nurses reported that parents sometimes hide information from them if the parent
thinks the nurse would disapprove. Nurses said that their own personal values
sometimes conflict with those of the families. Nurses recognize that they must refrain
from judgment in order to help families.
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2007 PREVENT Institute Team Project Planning Guide
b. FACT parents (mothers and fathers) shared that it is difficult for them to ask for help.
They are embarrassed and are afraid of having their children removed by DHS for
asking for or needing help. Families do not trust the system.
c. Parents talked about wanting a safe place to go to get support. They wanted
opportunities to ask for help anonymously. Just talking to someone, without being
judged, about his or her struggles helps. (This relates closely with theme #1).
3. Connections with Resources to meet needs:
a. Nurses talked about families needing connections with basic resources before they can
address larger issues. Parents also identified lack of economic resources as a barrier to
keeping children healthy and safe.
b. Parents discussed wanting help, but not knowing where to go to get help.
4. Parents love their children and want to be good parents.
a. The nurses said that sometimes the only strength a parent can identify is the love for
their babies.
b. Parents said that even in the worst time of their lives (ex. Heavy drug use/criminal
involvement), being a good parent to their children was still the most important thing
to them.
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2007 PREVENT Institute Team Project Planning Guide
In addition to gathering information through the focus groups, the team received input from
attendees at the Roots & Wings Child Abuse Prevention Month event sponsored by the Multnomah
County Commission on Children, Families and Community. . The Health Department had a booth
at the event and asked people to complete anonymous questionnaires. Questions and common
responses are summarized below:
1. Who do you turn to for help raising your family?
Multnomah County, family and friends, church, playgroups.
2. Where do you go for support or advice for your children?
Counseling, God, friends and family, books, internet, co workers.
3. Where do you go for support or advice for yourself?
God, counseling, friends, service agencies.
4. What do you consider to be child abuse?
Neglecting them, physical abuse, verbal abuse, mean verbal, uncontrolled physical, anything that hurts a
child, anything damaging to the child.
5. How would your community know if you needed help?
Poverty and Depression, I would tell them, ASK….
6. What can your community do to help you with your children?
Child care, respite, parenting lessons, food for the poor, guidance when I need help
7. What are the barriers to keeping a safe, healthy family?
Lack of time, money and support.
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Additionally, the Commission on Children, Families and Community distributed a survey to
participants at the Roots and Wings event. One question asked was “What are some things the
community can do to better support families and children?” Common responses included:
1. More free events for children and families, combining resource information and fun activities
for families to enjoy together.
2. Families need to know about the programs and services that are available and how to access
them. Outreach needs to be done in multiple languages and in a variety of ways.
3. A variety of services need to be available, including quality child care, services for families
experiencing domestic violence, respite care, mental health services,
community/neighborhood centers, services for teens, early education services for low-
income families. Services need to be available in a variety of languages.
4. Assure parent education and support groups are available to all parents (new parents, single
parents, teen parents, parents of teens, etc.).
5. Everyone needs to do what they can to support children and families – advocate for children
and families, make children a priority, volunteer in the community, be friendly to families,
learn more about what they can do to help.
Next Steps:
Through additional focus groups, interviews and surveys, build upon and further explore the
themes that emerged from the discussions with the FNP team and FACT parents.
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How do extended families stay connected?
What environmental/cultural factors cause social isolation and what can our community
do to change these factors?
How can we educate and support parents without making them feel judged or
threatened?
What are the most effective ways of distributing resource information to families?
How can we build upon the parents’ strength of “loving their children” to enhance
protective capacity?
Additional groups to connect with include culturally specific communities (African American,
Native American, Latino, Asian and Russian), newly immigrated families, teen parents, new
parents, low-income parents, neighborhood associations, service providers and non-parents. After
learning from the community, develop informational materials for policy makers and funders.
Conduct interviews with key funders and policy makers.
Objective 5 – Identify existing data sources and/or the need for new data sources measuring risks
for child maltreatment and protective factors preventing child maltreatment.
Action Steps:
A. Form a data team.
B. From literature review and focus group findings identify risk and protective factors.
C. Identify existing data sources and new data sources needed to measure risk and protective
factors.
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2007 PREVENT Institute Team Project Planning Guide
D. Secure funding needed for the development of any new data sources needed.
E. Collect baseline data.
F. Analyze and summarize data.
Progress to Date:
Team members met with Mel Kohn, Oregon State Health Department Epidemiologist, for a data
discussion.
What are the existing sources of data regarding child maltreatment in Oregon?
1. Child Fatality Review data (www.oregon.gov/DHS/ph/ipe/fatalrpt/index.shtml)
2. BFRSS (Behavioral Risk Factor Surveillance System) surveys – currently does not include
questions related to child maltreatment (www.cdc.gov.brfss)
3. PRAMS (Pregnancy Risk Assessment Monitoring System) – currently does not include
questions related to child maltreatment (www.cdc.gov/prams/)
4. Child Protective Services data (www.oregon.gov/DHS/children/abuse)
5. Child Maltreatment Surveillance project – not yet started (Oregon State Health Department)
Regarding the formal data team, Mel recommended that the PREVENT team check the web
(www.oregon.gov/DHS/ph/ipe/98rpt/cfrteams.shtml) for Multnomah County Child Fatality
Review Team data and case reports. He also recommended that we observe a county Child Fatality
Review Team meeting to observe the caseworkers, DAs, medical professionals, public health
representatives and law enforcement working together to "move upstream" in primary prevention.
This is a model for changing attitudes.
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2007 PREVENT Institute Team Project Planning Guide
It was also suggested that the team explore attitudes of community partners regarding child
maltreatment and prevention. For example, there are lots of factors around neglect and stereotypes
about neglectful parents. Attitudes and perceptions are very hard to change.
In addition to the data meeting, a literature review has been done regarding risk and protective
factors. Leila Keltner, Medical Director for CARES Northwest, developed a chart of these factors, as
part of the Safe Child Task Force effort (See Attachment 3.)
Next Steps:
Follow-up on the recommendations made by Mel Kohn and connect with the contacts he provided.
Identify ways to mobilize professionals in the child welfare field to focus on primary prevention.
Explore additional sources of data providing information about protective factors and risk factors.
Form a data team to establish baseline data that can be used to evaluate the possible influence of the
community education campaign on risk and protective factors and ultimately on the reduction of
child maltreatment.
Objective 6 – Develop a child maltreatment prevention campaign.
Action Steps:
A. Use findings from focus groups, quantitative data on risk and protective factors and
literature to draft primary prevention messages.
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2007 PREVENT Institute Team Project Planning Guide
B. Test messages and format with a pilot group.
C. Modify messaging based on pilot feedback.
D. Secure funding for large-scale implementation.
E. Implement campaign.
F. Evaluate the possible influence of campaign on risk and protective factors (see Objective 5)
and ultimately on the reduction of child maltreatment.
Progress to Date:
This phase of the project has not yet been initiated.
Next Steps:
Initiate the action steps as described above
Leading for Sustainable Social Change
Our team, with the involvement and participation of multiple stakeholders, expects to begin to
create a social context in our community that does not tolerate child abuse--one that values the
widespread availability and accessibility of child protection and family support resources to
prevent child maltreatment. Child maltreatment cannot be eliminated one person at a time. In
addition to offering services and supports for individual families, it’s imperative to focus on the
larger social and community environment. Engaging community members is fundamental to
fostering the lasting social change needed to keep families and communities safe and strong. We
recognize that community attitudes, social norms and public policies need to change to better
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2007 PREVENT Institute Team Project Planning Guide
support the safe and healthy development of children and families. Specific outcomes of the long-
term project to address community attitudes and social norms include:
1. increased community understanding of the characteristics of safe and healthy families;
2. increased responsibility and commitment in the community to protect children from
maltreatment; and
3. Strengthened community networks where families can confidently seek support.
The first step in changing community norms is to understand current conditions. By reviewing
data, developing an inventory of current services and talking with a group of parents and
community health nurses, the team has developed a preliminary understanding of current attitudes
regarding child maltreatment and primary prevention. Through our work, it is clear that the
engagement of the broader community is a critical component of a comprehensive approach to
preventing child maltreatment.
During this initial project phase, the team has reflected on the impacts thus far on the team,
organizations, partnerships and the community. Through this project, team members have
developed a deeper understanding of the public health approach to preventing violence before it
occurs. Through our collective association, our networks have been brought closer together and our
connections and access to resources have been expanded. Individual team members have
experienced paradigm shifts and as a result have changed practices. Each team member’s
organization has benefited by receiving current information regarding violence prevention best
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2007 PREVENT Institute Team Project Planning Guide
practices and research. Through this project, one member reported that her agency has increased its
commitment to primary prevention. Through the connections of team members, several community
partnerships have been informed of this project. The team has begun to discuss long-term project
sustainability through the involvement of a variety of community partners. The team has noticed an
increased level of community interest and discussion around primary prevention strategies.
Conclusions
What are two or three important lessons that your team learned as a result of this action learning
project, and Institute, about what “good” planner and leaders should do to conduct and lead violence
prevention work?
In the action learning model of moving the field of prevention forward, we tried to deeply
understand a real problem, take wise actions and reflect on what we learned. We
experienced first hand that action learning occurs in groups so members can learn from one
another and collaborate, and we were called to commit and re-commit to the processes of
questioning and reflection, to taking action, and to learning from the results. Repeatedly
applying what we learned from experts in the field to our team project of elevating the
commitment to primary prevention of child maltreatment in our county.
Focus on the end result, but be flexible about the means used to accomplish that goal.
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2007 PREVENT Institute Team Project Planning Guide
“It’s as much about the process as it is about the product” and “You go slow to go
fast.”
Mel Kohn’s statement, “You will get people to move when you show them the data.”
How did what you learned at the Institute express itself, or show up, in the implementation of your
project?
Dr. Carol Runyan’s model of Effective Participation: Listen carefully, translate and ask for
clarification when necessary; help each other understand; and rely on evidence to solve
problems.
What were the challenges you faced that may have affected your progress in reaching your project
objectives?
Carving out time in our (core team’s) already overfull professional and personal lives to
communicate clearly and frequently, to meet all the PREVENT requirements, to move our
project forward, and to articulate together what we have accomplished. Re-establishing project
momentum after three major shifts in methods to achieve our objectives: l) during the January
PREVENT Institute, 2) after receiving input from Dr. Mel Kohn, and 3) after receiving input
from Chris Sorvari.
What people or strategies helped you reach your project objectives, or at least make progress?
People:
o Diane Yatchmenoff, PhD, Regional Research Institute
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2007 PREVENT Institute Team Project Planning Guide
o Mel Kohn, MD, State Epidemiologist for Oregon
o Yvonne Recchia, MSW, Intern with Multnomah County Commission on Children,
Families and Communities
o Christine Sorvari, Research/Evaluation Analyst, Multnomah County Health Department
Strategies:
o Practice patience and flexibility.
o Focus on the greater good and the ultimate goal.
o Positive regard and respect for our core team members’ unique perspectives, styles,
strengths and limitations.
o The healing power of humor.
Future Plans
The Oregon PREVENT Team’s five-year goal to support safe and healthy families, and reduce child
maltreatment in Multnomah County continues to drive all efforts and future plans. As outlined,
the initial phase of the project focused on collecting and analyzing formative data to ensure the
strategies implemented would be relevant to the target groups. Prior to initiating a community
outreach and data collection strategy, it was imperative that the group establish an agreed upon
definition of primary prevention in relation to child maltreatment. This definition drives the focus
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2007 PREVENT Institute Team Project Planning Guide
and direction of all Oregon PREVENT Team efforts. Feedback from community stakeholders
ensures the definition is not only appropriate, but also relevant and applicable.
Primary prevention of child maltreatment includes activities, strategies, programs or policies
to reduce risk factors and increase protective factors influencing the safety and well being of
children. These efforts, designed to increase the capacity of parents, caretakers and community
to protect, nurture and promote the healthy development of children, are directed at the general
population with the goal of stopping the occurrence of maltreatment before it ever happens.
Over the past eight months, the Oregon PREVENT Team established a strong foundation from
which to build. Future plans include:
Integration into Existing Networks
Oregon PREVENT Team members currently participate with a wide range of local, state, regional
and national networks that interface and/or support children, family and/or communities. Over
the past year, a number of these networks have participated in discussions around primary
prevention strategies. The PREVENT Institute provided the necessary structure and guidance to
ensure such discussions are truly focused on primary prevention versus secondary and tertiary
intervention. Oregon Team members will continue to participate with formal and informal
networks that address the various systems for support: private sector, public policy, service
provider, community stakeholder and family. The PREVENT Team is committed to meet on a
quarterly basis to ensure effective communication, support and guidance is provided among, and
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2007 PREVENT Institute Team Project Planning Guide
between, all members. Additionally, identified individuals will be integrated into the PREVENT
Team as the process evolves.
PROJECT: Wraparound Oregon
A number of organizations in the Oregon are involved in an initiative to build a
coordinated system of services for children and youth with complex mental health
needs and their families. PREVENT Team members currently participating in the
project are actively creating of a system o f support that includes strategies to address
core risk and protective factors from a primary prevention perspective. The following
is a brief overview of the project purpose:
Children and youth who have complex mental health needs currently
receive costly, fragmented care, leaving families frustrated and
disappointed. To improve the quality of life for these young people and
their families, Wraparound Oregon seeks change in the management of
child welfare, education, mental health, and juvenile justice t o allow
agencies to share governance and resources. Enhanced coordination will
offer the flexibility to create innovative, child -specific interventions to help
children and families in their own communities.
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2007 PREVENT Institute Team Project Planning Guide
PROJECT: Embrace Children, Support Families, Build Communities
Multnomah County Commission on Children, Families and Communities (CCFC) and Multnomah
Education Service District (MESD) have committed to an outreach and education campaign within
various communities in Multnomah County with a focus on family wellness. Specifically, the goal
of the outreach and education campaign is to create a social context in our community that (1)
celebrates and affirms healthy families and communities, and (2) values the availability and
accessibility of proactive, prevention based child and family support resources. The infrastructure
and focus of the project titled, Embrace Children, Support Families, Build Communities, ties in with the
goals and objectives of the Oregon PREVENT Team. Additionally, establishing a safe and trusting
relationship among, and between, families and community stakeholders will lead to increased
accessibility to, and equity of, primary prevention strategies around child maltreatment.
Specifically, the project is broken into Three Phases:
Phase One Community Outreach Meetings (COM) will draw upon the insight and knowledge of
formal and informal leaders within identified communities to raise awareness and discuss
proposed objectives of the project. In that these communities have been underrepresented and/or
misrepresented in the past, it is imperative to methodically and deliberately develop a trusting
rapport among families, community stakeholders and policy makers. Phase One COMs will build
upon existing communication vehicles within community, and explore additional forums to draw
upon formal and informal leaders.
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2007 PREVENT Institute Team Project Planning Guide
Desired participants will include families, with special efforts to recruit families from multiple
communities (e.g., Hispanic, Vietnamese, Russian, African American and Native American).
Participants will also include service providers and community leaders. The purpose of these
meetings will be to:
o Provide information regarding prevention and intervention based resources and
supports for children and families
o Identify opportunities to build upon community and family assets specific to target area
o Identify effective individual and community responses to enhance and ensure family
wellness
o Identify leaders to serve as advocates to promote healthy family prevention strategies
among different communities in Multnomah County
o Obtain feedback from participants regarding family wellness prevention strategies
Phase Two will engage leaders and invested stakeholders to explore untapped resources within the
community. Untapped assets may include, but not be limited to, individuals, groups,
organizations, businesses and resources. Indigenous leaders from communities will facilitate
discussions among invested stakeholders to identify effective outreach strategies. A Leadership
Summit with representation from identified communities will provide the vehicle to strengthen
leadership skills, explore sustainable strategies and share insight for growth and development.
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2007 PREVENT Institute Team Project Planning Guide
Phase Three will implement, track and evaluate outreach strategies that have been identified through
the COMs, Leadership Summit and community forums. Mid-course corrections will be
implemented based on assessment and evaluation of identified outcomes.
The Embrace Children, Support Families, Build Communities Project will identify, affirm, support and
cultivate leadership and representation throughout Multnomah County that can be integrated into
existing formal/informal systems of support for children, families and communities. Information
and data gleaned from the project will feed into the Multnomah County’s Commission on Children,
Families and Community: Community Plan.
State and Local Policy Makers
PREVENT Team members participate on the Multnomah County’s Safe Child Task Force. Their
participation provides local policy makers, service providers and community stakeholders’ insight
and guidance as to how to strategically implement and support a primary prevention service
delivery model. The following is an overview of the Task Force.
Multnomah County’s Safe Child Task Force
Local and state leaders working together to strengthen the child maltreatment prevention and
response service system in Multnomah County for children 0 -18. “Child safety is non-negotiable”.
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2007 PREVENT Institute Team Project Planning Guide
Description
The Safe Child Task Force was created in response to escalating child abuse rates in Multnomah
County (2,212 children were the victims of abuse or neglect in Multnomah County in 2005,
reflecting a 5% rise over 2004 and a staggering 39% increase since 2003). The Local Public Safety
Coordinating Council and the Multnomah Commission on Children, Families and Community co-
sponsored the Safe Child Task Force; co-chaired by Commissioner Lisa Naito and City of Gresham
Chief of Police Carla Piluso. The goal of the Task Force was to develop recommendations ensuring
children and youth are safe in Multnomah County, with a focus on preventing maltreatment before
it occurs. Outcomes include a plan for reducing the incidence of child abuse and neglect in
Multnomah County (indicators: child abuse rate, number of children entering foster care, child
deaths caused by maltreatment) and increasing positive outcomes for children in protective custody
(i.e. educational outcomes).” The charge of the Safe Child Task Force was to prepare an inventory
of services, identify best practices, outline a comprehensive vision and a set of very specific
recommendations for preventing child maltreatment before it occurs, and assure appropriate
services are available to respond to incidents of child maltreatment.
Process
The task force convened once a month starting in September 2006 through January 2007. In
October, the group diverged into three focus areas, each with a corresponding work group. These
subgroups were 1) advocacy, 2) best practices and 3) prevention/intervention. The group then
reconvened and shared work group recommendations.
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2007 PREVENT Institute Team Project Planning Guide
Task Force Recommendation and Next Steps
1. Advocacy: making child and family safety as a funding and policy priority. Join with other
groups to promote initiatives that prevent maltreatment and support intervention programs.
2. Create a local, universal parent education system.
3. Changing community attitudes and norms around the shared responsibility for safe and healthy
children and families.
4. A written report is produced, by the end of January, which includes:
Inventory of child abuse prevention/intervention services, and
Review of Safe Child Task Force and its work.
Review
The group will reconvene the Safe Child Task Force for a meeting to summarize legislative and
other activity, outcomes and next steps in September of 2007.
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2007 PREVENT Institute Team Project Planning Guide
Professional Development
Over the past few year’s, the Children’s Trust Fund of Oregon has coordinated a training summit
for professional organizations throughout the state that interface with families and communities
around child abuse prevention. The upcoming training event will be linked to the Community
Child Neglect Summit presented by the Multnomah County CAPTA Panel and Portland city
Commissioner Dan Saltzman. The focus of the training component will be primary prevention –
what it means to children, families and communities, examples of effective programming and how
to integrate a primary prevention focus into a service delivery model. A number of organizations
throughout the region have expressed a desire to provide primary prevention strategies; however,
many of the service delivery programs, policy makers, private foundations and community
stakeholders are unaware of how to systemically implement primary prevention within existing
service delivery models.
Data Team
The PREVENT Team members met with Mel Kohn, Oregon State Epidemiologist, and Diane
Yatchmenoff, PhD, Regional Research Institute, to assess and evaluate the integrity and outcomes of
the project. Both Mel and Diane suggested specific individuals to participate on the data team.
Additionally, Team members met with representatives from the Multnomah County Health
Department to secure data and request feedback regarding the integrity of project assessment tools.
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2007 PREVENT Institute Team Project Planning Guide
Chris Sorvari, Multnomah County Health Department Research and Evaluation Analyst, has
expressed a desire to remain actively involved in the project. As the community identifies specific
areas of primary prevention focus through the formal and informal community meetings, network
discussions and assessments, key individuals with relevant skills and experience will be invited to
join the data collection team.
Insight gleaned as a result of participation the PREVENT Institute has been integrated into a
number of regional, state and local projects. For instance, efforts are currently under way to
conduct a regional conference for family service providers focused on primary prevention
strategies. Additionally, a number of Oregon Team members participate on state and local
Advisory Boards. In turn, primary prevention strategies have been explored and, very often,
adopted by local governing bodies around social issues including health disparities for African
American men, teen pregnancy and family wellness. Individual and organizational networks
created as a result of participation in the PREVENT Institute have strengthened existing
relationships and/or broadened the scope of collaborative efforts throughout the region.
To effectively move the project forward it is imperative to secure leadership and investment from
legislative officials in the area. Though a number of community and state task forces have been
convened over the years to address child abuse, neglect and maltreatment, efforts often lose focus
to immediate political issues deemed more pressing. To ensure primary prevention strategies are
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2007 PREVENT Institute Team Project Planning Guide
effectively integrated into the fabric of the community, area and state, it is vital to utilize a
multifaceted systemic approach for outreach, awareness and action. Additionally, efforts should be
concurrent as opposed to isolated in delivery and design. Current and relevant empirical data
supporting and affirming positive outcomes of primary prevention strategies will address the need
for sustained funding. Adequate funding will provide the necessary support for staffing, services
and evaluation.
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Attachment 1
What will it take to prioritize safe and healthy families in our community?
Your Multnomah County PREVENT Team wants to know.
A strategic partnership of Multnomah County Commission on Children, Families and Community,
Children’s Trust Fund of Oregon, CARES Northwest, Multnomah County Health Department and
Portland State University’s Center for Healthy Inclusive Parenting was chosen to participate in the
“PREVENT Institute: Developing Leaders in Violence Prevention.” Our overarching goals in this
project, hosted by The University of North Carolina Injury Prevention Research Center, are to
reduce child maltreatment and increase primary prevention services in Multnomah County.
Our first task was that of adopting a clear definition of primary prevention:
Primary prevention of child maltreatment includes activities, strategies, programs or policies to reduce risk
factors and increase protective factors influencing the safety and well-being of children. These efforts,
designed to increase the capacity of parents, caretakers and community to protect, nurture and promote the
healthy development of children, are directed at the general population with the goal of stopping the
occurrence of maltreatment before it ever happens.
Within the next six months, our PREVENT Team will:
Identify existing primary prevention resources in Multnomah County
Survey and analyze families’ and community members’ awareness of and attitudes toward
primary prevention
Establish baseline data (risk and protective factors) for child and family safety
The results of this foundational work will guide our PREVENT Team in identifying steps necessary
to achieve the project’s intermediate goals:
Increasing families’ skills and knowledge
Changing families’ and communities’ attitudes toward primary prevention
Increase skills and knowledge of communications
Increase capacity for primary prevention services in Multnomah County
Thank you for supporting this vital work,
Lisa Hansell Bill Baney
Multnomah County Commission Portland State University’s
on Children, Families & Community Center for Healthy Inclusive Parenting
Cindy Thompson Julie Goodrich
Children’s Trust Fund of Oregon Multnomah County Health Department
Debby Kernan
CARES Northwest
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Attachment 2
FACT Focus Group –DRAFT Summary
Thursday May 10, 6:00 PM – 7:30 PM
Lead Facilitator: Yvonne Recchia
Co-Facilitator: Lisa Hansell
6:00 – 6:10
Introductions
Prevent Institute history and objectives – Lisa
a. Partnership of CCFC, Children’s Trust Fund, CARES NW, MCHD, and PSU
b. Goal is to reduce child maltreatment and increase prevention services to families.
Expectations and Confidentiality
c. Goal of today’s group: to hear you, our experts on parenting, about attitudes, norms and
values are regarding child abuse prevention are in our community.
d. Confidentiality – No names or identifying info will be used. We will take notes &
record meeting. Other Prevent team members will have access to all notes and
recordings of this meeting.
e. We are mandatory reporters.
f. Ground rules:
i. We all have different perspectives and experiences.
ii. Everyone’s opinion is equally important and we want to hear from everyone
iii. Raise your hand if you wish to speak, lets talk one at a time
iv. We may interrupt if we need to move on or hear from other people – this is a
pre-apology for interrupting but we want to make sure everyone is heard and
no one person dominates the conversation.
6:10 – 7:20 PM
Questions:
1. What are the places in the community that are welcoming and comfortable for families & what
makes them that way? What are the places that aren’t welcoming and comfortable & why not?
How could they change?
2.
Comfortable Places
Parenting Inside Out (program in the prisons) – great program
YWCA transitional housing – safe, structured, control who comes into the facility
Loaves & Fishes
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2007 PREVENT Institute Team Project Planning Guide
Some parks – Blue Lake; 32nd & Ainsworth park are safe; Blue Lake Park is nice because it is
set up for kids, play area, swimming area; something for lots of people; downside is you
have to pay; “everything is about money”
PAL Youth League – 172nd and Mt. Tabor and Mt. Scott; program for 8-18 year olds – hang
out; programs
Libraries are safe
Boys and Girls clubs (not as safe anymore) – teen nights; monitor who picks up child
Not so Comfortable/Lacking
Skating rinks used to be safe (when I was a kid); not now, fighting
Lots of gang activities happening; kids can find acceptance in gangs
Lack of safe places for teens (to hang out)
There are fewer safe places than there used to be
People get in their comfort zone and pay less attention to what is happening around them =
less safety
Changes
Need more marketing about programs; don’t know where things are or what is happening
3. Who/where do families go to when they need help with parenting? How does it feel to ask for
help? What/who would be available to parents in an ideal situation?
Go to their parents; don’t want to go outside of family because of fear of children being taken
away
Parents want help but fear of getting blamed stops them from asking for help
Ask friends for help
Sometimes it’s easier to ask friends for help than it is to ask family
Parents ask programs/networking (if they know about the resource)
Males feel they can’t ask anyone; embarrassed to ask; moms feel embarrassed too
Parents Anonymous; support lines; easier to ask when its anonymous; non-judgmental
Big Brother/Big Sister (program)
What would be the best place/way to get information out?
MAX & Bus ads (i.e. Hotline phone #)
Booklet that includes family activities
Parenting magazines (i.e. Metro Parent, Family) – get out in more places; they are just
downtown and few select places
Books for self growth
Billboards
AFS bulletin boards
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2007 PREVENT Institute Team Project Planning Guide
4. What did you learn about parenting that you wish you knew before you had children?
How smart they (kids) are; they are always thinking; manipulate; control
Kids know about computers, parents don’t
A 2-7 year olds brain is hardwiring; child learns more during this time period than any other
time during life
Wish I knew more about the teenage years
Impact of watching too much TV
Having kids is a life experience, “roll with it”
5. What kind of situations put a child at risk for abuse or neglect? What do you see as the strengths
of parents you know in protecting their children from abuse/neglect? What kinds of supports
do parents need to prevent abuse and neglect?
Puts kids at risk
Dysfunctional family – drugs; cycle of anger and abuse
Child’s low self-esteem
Peer pressure
Finances create stress and anger
Stress at work
Single parent, having to do it all alone
Lack of stability when a family member (bread winner) goes to jail
Strengths
Education
Support group
Advocate for my kids; push for what they need
Supports Needed:
Supportive adult other than parent (for child)
Parents need support too (mentor for parent)
Support groups for parents of teenagers (potential slogan “Connect with your Teen”)
Someone to talk to
Peer group/support system; most don’t have it
Need (parenting) ideas
“Kids get taken away out of the blue”
6. Think about a child that you worry or have worried about. How comfortable is it to respond?
Does it depend on how well you know the family?
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Talk to the child; talk to mom before making a report; worry about mom’s feelings and how
it will effect the mom/daughter relationship and what the outcome might be
There are no right or wrong answers of talking to child or parent; response depends on
where each is developmentally; counselors can assist; barriers arise when kids and parents
are not approached considering individual development; a big problem is that there are not
adequate mental health professionals (example given about advise from counselor “bite
back” resulting in child being removed from home; counselor did not admit to giving that
advise)
I’d go to the mom; if she didn’t respond I would have to report
Talk to the parent; try to lead by example; would NOT report
Confrontation is important; parents are often oblivious (to what their children are involved
in)
Attitudes/Beliefs/Experiences
Counselors ask child about parent, don’t focus on the child
It’s hard to trust the system
People don’t care about each other; they used to – no more
There used to be Block Homes (safe places for kids to go if they needed help); not any more
(if they had them now they’d probably be pedophiles)
Morals have changed; internet and TV garbage; old saying “it takes a village to raise a child”;
now no one cares; used to have extended family to talk to; people stereotype too much
Lots of single parents do a good job
Parenting is not easy
Parenting is not a job that is valued
Lifestyle 20 years ago has lead to the problems now; lots of gang involvement now; if a
teenager doesn’t feel accepted he/she will find acceptance in a gang
Don’t know who to warn my kids about (the people you think are safe turn out not to be
safe)
I was sheltered growing up, was naïve and blind to what my daughter got into
If you share too much, reports are made and kids are taken away; this permanently damages
the relationship with the child
Spanking used to be ok, now told it is against the law; it’s hard to control kids; time out
doesn’t work for teenagers; taking away possessions only works so far
What’s needed?
Need an anonymous way to get assistance
Offer cognitive classes in hospitals, out in community; universal as family oriented program
Offer free classes; close to where people live
My kids always came first; is saw help (when I was using) offered and felt I needed help,
would have done it
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2007 PREVENT Institute Team Project Planning Guide
Teddy Bear to fathers (in prison program); for 90 days care for bear as a child; name the bear
after child; at the end of the program, the bear is sent to child
Take care of an egg (in school)
Have a radio forum – talk to each other anonymously; safe forum; regular time each week
Parents need more opportunities to talk about family issues
They need a chance to vent in a safe environment
7:20 – 7:30
Final thoughts and questions for facilitators.
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2007 PREVENT Institute Team Project Planning Guide
Focus Group Survey – Summary of Responses
10 people participated in the focus group
7 females, ages ranging from 30-56; average age = 36
3 males, ages ranging from 36-41; average age = 39
Race/Ethnicity: 1 Black/African American, 9 White
Household size: range from 1-4
Children range in age from 1 – 30
Monthly Income: ranges from $150 - $1,720; average = $1,169
What other groups in the community do you think we should make sure to talk to about child
abuse prevention?
Welfare parents
Everywhere/Anywhere you possibly can
Providence Hospital “Teen Talk” program
Parents Anonymous Groups, schools
Welfare parents, low-income families
At risk teens, young unwed mothers and/or fathers
Any other comments about your experience today:
It was very informational
It was good to realize I was not alone in this world as a parent trying to figure out “just what
are the answers?”
I thought it was great community info
Thank you and God bless
It’s been nice to be able to vent and let out a lot of steam and tension
Thanks for coming
Very informative chance to vent in safe environment
Addiction groups, AA, NA, Allinon, etc.
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2007 PREVENT Institute Team Project Planning Guide
Attachment 3
Nurse Focus Group Responses
5/8/07
1. In your opinion, how often do your clients, when they enter the program, believe that they
have the knowledge, skills, and resources to be healthy, nurturing, and protective parents?
Do you agree or disagree with their assessment typically? (Cover all three: knowledge, skills, and
resources.)
a. Probe: Are there differences between women and men?
2) In your opinion, what do parents’ feel they lack in knowledge, skills and resources in being
healthy, nurturing, and protective parents? What do they think their strengths are? (Cover all
three: knowledge, skills, and resources.)
a. Probe: Are there differences between women and men?
3) What do you think your clients lack in knowledge, skills and resources in being healthy,
nurturing, and protective parents? What do you think their strengths are? (Cover all three:
knowledge, skills, and resources.)
a. Probe: Are there differences between women and men?
Focus Group Response to questions 1, 2 & 3:
Caucasian or acculturated families seem the least equipped – lack of extended family support
and good examples. These families are generally aware that they need help being good parents.
Hispanic or newly immigrated families tend to have better innate skills, for example: can read
babies cues more easily. They generally need help accessing basic needs resources – food,
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2007 PREVENT Institute Team Project Planning Guide
housing, jobs etc. They generally have extended family support. “Our culture shatters extended
families” so over time and generations, these families have less support. New immigrants tend
to seek connection with the greater society.
Acculturated families have neither resources nor knowledge and ability.
Acculturated families tend to rely on “experts”, often ignoring their own instincts. This is
apparent at any socio/economic level.
Sometimes, they think everything is fine. Particularly when it comes to domineering or abusive
male partners. They think this is a norm. They say that everything is fine, when in my opinion;
the reality is it is not fine. “It is not up to me to instill reality”.
There is a “parallel” process that happens in families. If they experienced abuse or neglect at a
certain age, they will re-experience the anger and hurt of their own experience when they were
their child’s age. Sometimes parents can’t handle that.
Parents might try to hide from you when they think they are doing things you would
disapprove of. It is important not to show judgment at this time when working with families.
The language of what the nurses do is important to the family. They will introduce the nurse as
“the babies nurse” or “the nutritionist” or “my worker”. In Spanish speaking families it is “el
doctoro”.
The program is geared toward mothers and babies. Nurses believe that father involvement is
critical. They worry when the father doesn’t participate. They mostly do not participate. The
nurses feel that the men’s needs are often greater than the mothers. The fathers that do
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participate “get hooked”. Many fathers don’t have any example of being a father due to the
absence of their own father figure.
A disturbing trend in our culture is of isolation. Both parents, men and women, lack friend or
peer networks, larger family units, a connection to the greater community. One of the important
things nurses to do is to encourage connection.
Many parents lack confidence in their ability to accomplish even simple tasks – scheduling
doctor appointments etc. They need to have a level of success.
The first thing to address with families is connections with resources to meet their basic needs –
their financial needs can overshadow other needs. Many parents don’t realize they are lacking
in other parenting skills because they are too busy trying to meet the basic needs of their family.
Until those needs are met, it is hard to move to the next level.
A nurse working with Asian and Latino families said that one barrier is when they say of certain
parenting practices presented to them: “that is not my culture.” Young parents with whom
English is not a first language she calls the “lost generation”. They may speak their native
language, but they don’t learn to write in their native language. Because English is not their first
language and schools don’t do a good enough job teaching them, they are not proficient in
English either. The end result is that they are not satisfactorily proficient in any language which
is a big disconnect in society for them.
Some Strengths:
a. Some clients have family support that is healthy.
b. Amazing resiliency and ability to rise above adversity.
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2007 PREVENT Institute Team Project Planning Guide
c. Grand parent support
d. A strong desire to be good parents
e. They are open to new relationships and ideas
f. They have hope for the future – some have no hope – if they see no future (I am going
to die by age 30), it is hard to instill hope.
g. Religious faith
h. Clients have a hard time identifying their own strengths.
i. One they all can identify is “I love my baby.”
4) How do the knowledge, skills and resources your clients lack affect their likelihood of
mistreating or neglecting their children? In your opinion, how would your clients answer
this? (Cover all three: knowledge, skills, and resources.)
a. Probe: Are there differences between women and men?
b. Probe: Do your clients know the risks for mistreatment and neglect?
Answer to question 4:
Daycare can be a problem – babies can be in different place everyday – there is a potential for
abuse when provider is unstable etc.
Worry about a parent who doesn’t recognize clues. Example: baby teething and crying all night
“Don’t pick her up, you’ll spoil her”, “she’s just crying to manipulate me.” “If I give the baby
Tylenol she’ll sleep all night and that is good” (No! Babies shouldn’t sleep all night). Etc.
Lack in social support and money cause stress which increases possibility of shaken baby other
kinds of physical abuse. Also, when parent is frazzled, less patience, more screaming etc.
Parents and kids need a break from each other.
When parents lack access to A&D services and mental health – change of child abuse increases.
Postpartum is more common than most people realize.
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2007 PREVENT Institute Team Project Planning Guide
Women who rely on controlling men and/or non-related men for financial support put children
at great risk.
People living in a crowded, cramped environment with no personal space is a risk factor.
Parents need continued support over time. As children age, their needs change and challenges
are different.
Sometimes parents are unable to get unstuck due to financial circumstances or societal/cultural
barriers. (live in a bad foster home, can’t get job training for living wage job).
Sometimes teenagers have more support than young or older adults – live with parents, peer
access at school etc.
Part II of question 4:
Some parents who have been abused are hyper vigilant about risk factors.
They are aware of the risks but not aware of all the factors.
5) What specific interventions in your practice do you believe influence your clients’ confidence
levels, attitudes and behaviors about parenting? What is the influence? How do you know?
(Make sure responses cover confidence levels, attitudes and behaviors separately. (Get at least five
attitudes and corresponding practices)
a. Probe: Are there differences between women and men?
b. Probe: Do you see any influence that could prevent maltreatment and neglect?
Question 5:
Interventions that are most effective in preventing abuse:
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2007 PREVENT Institute Team Project Planning Guide
The main intervention is the relationship that includes modeling, consistency and frequent
contact, compassion, trust, non-judgmental, being present, unconditional relationship and time.
Client needs an opportunity to be competent at something (ex. Knitting)
Life calendar is a good tool – shows parent where they encountered struggles as a child and
helps them make a plan for their child’s life calendar so they can be successful.
6) What have you found that is a successful motivator for behavior change in your clients?
How do you know?
a. Probe: Give examples of the changes. Were these long-term or short term changes?
b. Probe: Are there differences between women and men?
Question 6:
Working with the clients at the right time – starting with pregnancy – they are vulnerable.
The baby is the biggest motivator – you and your kid will be healthier, sleep better etc.
Being introduced to opportunity to change and hope that things can change with a consistent
presence and encouragement.
Being connected with actual “stuff”, food, jobs, clothing, housing, etc.
Finding a way to cultivate happiness through relationships
Providing families with a mother figure to help them reach their goals and letting them own
their successes.
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2007 PREVENT Institute Team Project Planning Guide
Kaiser Permanente
Legacy Emanuel Children’s Hospital
OHSU – Doernbecher Children’s Hospital
Attachment 4
Child Maltreatment:
Risk Factors and Protective Factors
Risk Factors Protective Factors
Under 36 months of age (highest risk Easy temperament
for physical maltreatment, neglect, High cognitive ability
homicide) Competence in normative roles
Pubescent (highest risk for sexual
abuse reporting)
Female (higher risk for sexual abuse)
Conduct problems
Difficult temperament
Disabilities ((physical handicaps,
Child
developmental disabilities, birth
complications)
Single parenting Psychological health and maturity
Low education levels Social competence
Teen parenting Good self-esteem and self-efficacy
Low-income, low socioeconomic status Childhood experiences
Past perpetrators of maltreatment Family history of nurturing,
History of maltreatment as a child stimulation, and appropriate care
Inadequate knowledge of child
development
Inappropriate beliefs about child
rearing
Negative affect in parent-child
relationship
Alcohol or substance abuse problems
Depression
Loneliness
Cognitive distortions
Parental
Lack of empathy
Poor social skills
Deviant sexual interests
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2007 PREVENT Institute Team Project Planning Guide
Risk Factors Protective Factors
Lack of resources Supportive relationships with family,
Four or more children friends, neighbors
Closely spaced pregnancies Regular, consistent household routines
Current stressors (financial, job, health, Shared parent-child activities
loss of loved ones) Respectful and trusting communication
Marital conflict or violence Appropriate monitoring, supervision
Social Isolation and involvement
History of maltreatment in family Parent-child warmth and
members supportiveness
Inadequate monitoring by other family Good quality relationship between
members parents
Disruption, separation and divorce Extracurricular school activities
Family
Children living with mother and non- Involvement in religious and volunteer
biological father activities
Risk Factors Protective Factors
Community/Neighborhood
High mobility Access to adequate healthcare
Unemployment Quality education
Poverty Employment services
Lack of monitoring and connectedness Friendship among neighbors
Military presence in community Watchfulness for other families
Natural disasters/crises Physical safety
Inadequate financing or coordination of Common knowledge of community
human services resources
Sense of “belonging”
Corporal punishment legally allowed Violence discouraged
Norm to spank or victimize children Basic family needs supported
Cultural/Societal
Poor legal status of children/viewed as Physical punishment discouraged
possessions
Weak understanding of child
development
Media portrayal of violence common
Source Material:
Florida Resiliency Mapping Project, CEED, The Lawton and Rhea Chiles Center for Healthy
Mothers and Babies, June 2004.
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