Research-based policies, practices and programs

Provide high level administrative and legislative support for North Carolina’s ongoing implementation of the federal child maltreatment prevention framework, Essentials for Childhood.

The Essentials for Childhood framework was created by the Centers for Disease Control and Prevention.¹ It views child maltreatment as a public health problem and seeks to create the safe, stable, and nurturing relationships and environments that are essential for promoting the healthy development of all children.

The framework has four goals:

• Raise public awareness and commitment to nurturing safe relationships
• Use data to inform action
• Change norms to focus on healthy children and families
• Make policy change to improve child and family well-being and reduce the likelihood of child maltreatment²

This public health prevention approach is also advocated by the federal child welfare agency on its Child Welfare Information Gateway, which includes many resources for states.³ Additional recommendations included in the child welfare guidance include:

• Use evidence-based interventions
• Evaluate programs to ensure fidelity to standards and measure outcomes
• Ensure sustainability at the local level

North Carolina is engaged in a collective impact process to implement the Essentials for Childhood framework.⁴ The North Carolina Essentials for Childhood implementation involves:

• Coordinating and managing existing and new child abuse and neglect prevention efforts
• Aligning strategies across sectors
• Monitoring, documenting, and reporting on state-level child abuse prevention efforts⁵

North Carolina’s First 2,000 Days initiative, hosted by the North Carolina Early Childhood Foundation, is included in the Essentials implementation plan. First 2,000 Days seeks to increase public awareness about the impact of early childhood experiences on later learning, health, and success.⁶

Strengthening Families™ is a research-informed approach to increase family strengths, enhance child development, and reduce the likelihood of child abuse and neglect. It engages families and the community to build on five research-informed protective factors:  

• Parental resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Social and emotional competence of children¹

This approach is intended for children over the age of five.

More than 30 states, including North Carolina, are working to embed the Strengthening Families approach across child- and family-serving systems, from early childhood education to child welfare.²

The North Carolina Department of Social Services is partnering with the Center for the Study of Social Policy to implement the Protective Factors Framework in child welfare policy and practice. Parents and other state and local agencies are part of the process.³ The five goals of this effort are to:

• Integrate the protective factors framework into child maltreatment prevention funding sources
• Develop a set of outcomes and indicators that measure the impact of the child welfare system’s work
• Increase the capacity of those who provide child maltreatment prevention services in the state to embed the protective factors approach into their service provision work
• Coordinate the prevention work of the multiple child- and family-serving systems in the state
• Integrate the protective factors approach into state and local child welfare practice

Circle of Parents is an example of a preventive service in North Carolina that is anchored in the protective factors framework. It is a process where parents provide support and help to each other. Evaluation results have found that the program results in significant increases in parent resilience, social-emotional support, concrete support, and parental nurturing and attachment.⁴ Prevent Child Abuse North Carolina (PCANC)⁵ provides the infrastructure support necessary for quality implementation of the program, including access to coaching, technical assistance, training, and evaluation assistance.

Ensure that families living with low income have access to economic supports that have been shown to reduce child maltreatment.

Living with low income increases the risk of child abuse and neglect. Policies that strengthen families’ financial security improve parents’ ability to meet children’s basic needs, including food, housing, medical care, child care, and mental health.¹ To combat child maltreatment, the Centers for Disease Control and Prevention recommends policies that improve families’ income, including:²

• Expanding refundable tax credits for families with children
• Improving access to federal nutritional benefits through streamlined application processes
• Using federal housing funds to help families secure safe, stable housing
• Providing families with subsidies for high quality child care
• Establishing flexible work supports for low-income families with young children, including flexible and predictable work hours
• Modifying how Temporary Assistance for Needy Families (TANF) benefits are affected by child support payments. In many states, the child support payments are used by the state to reimburse itself, but states may also elect to allow some or all of the child support payment to be passed on to the custodial parent and child without any reduction in the TANF benefits.

Invest in North Carolina community agencies receiving child welfare Differential Response clients in order to address family and community maltreatment risks and promote well-being.

Differential Response (DR) in the child welfare system is a model of responding to child maltreatment that works with families to address needs and issues that impact children’s safety. Compared to traditional child welfare approaches, DR is:

• More flexible
• Less punitive
• More focused on understanding root causes
• More focused on engaging with families around their needs.

The goal of DR is to avoid more serious maltreatment and future contact with the child welfare system.¹ DR systems can:

• Help community organizations learn what interventions work for specific and diverse, child welfare populations
• Ensure that families are referred to the most effective and cost-efficient community services
• Support government agencies in evaluating child welfare practices and outcomes for low- to moderate-risk families²

DR, implemented at the state and county levels across the nation,³ has been identified by the California Evidence-Based Clearinghouse as a promising practice.

North Carolina’s DR system is called the Multiple Response System (MRS). MRS and similar systems across the country have been found to reduce confrontational relationships with families and increase their use of voluntary support services, without putting children in danger.⁴ 

DR triages cases, with more serious cases being handled in-house and low- and moderate-risk families being served by other community resources. To be successful, DR systems must be supported by sufficient community-based services to handle referrals of DR clients.⁵

Offer services and supports for which families are eligible as a bundle, rather than requiring families to apply individually for each service, work with different caseworkers, and renew their eligibility at different times of year. Integrating services and supports can:

• Improve cost-efficiency
• Improve family economic outcomes
• Reduce stress on low-income families

High levels of parent stress can increase the risk of child maltreatment, including harsh discipline practices and low levels of parent warmth and nurturing behavior.¹ Parent stress is linked to the challenges of living in poverty without the benefits of supportive services, including housing and mental health treatment.²

A package of work supports that provides modest improvements across many aspects of a family’s life is most effective. Examples include:³

• Improving parents’ education levels
• Improving parental health and mental health
• Raising family incomes

Expand the use of child sexual abuse screening in community organizations, schools, and programs such as summer camps and afterschool programs. Agencies implementing training for employees on developmentally appropriate screening have achieved reductions of up to 50% in rates of child sexual abuse.  ¹

The following programs have been rated by either Essentials for Childhood or the California Evidence-Based Clearinghouse for Child Welfare (CEBCCW) as having significant evidence of a positive impact on child maltreatment, or with sufficient evidence to be rated a promising program for child welfare impact. See our Programs webpage for program descriptions.

• Attachment and Biobehavioral Catch Up (ABC) 
• Child First 
• Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT) 
• Early Pathways Program (EPP) 
• Homebuilders 
• Incredible Years 
• Multi-Systemic Therapy for Child Abuse and Neglect (MST-CAN) 
• Nurse Family Partnership 
• Parent-Child Interaction Therapy (PCIT) 
• Project Connect 
• Positive Parenting Program – Triple P
• Promoting First Relationships (PFR) 
• Safe Babies Court Team 
• Safe Environments for Every Kid (SEEK) 
• Strengthening Families 
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)