n a presentation to professionals in the fields of social work, law, the judiciary, and advocacy, Dr. Jerry Milner, Associate Director of The Children’s Bureau and Acting Commissioner of the US. Government’s Administration for Children, Youth and Families proposes what is for the group a new, radical view of child welfare. He proposes that we start with primary prevention as the core of our efforts.[i] For us the suggestion is not new and not radical – it is just what there is to do to make the difference we want to make.
So why would what he is suggesting be considered a “new” or “radical” approach and what is “primary prevention” anyway? Dr. Milner’s comments also give us some insight into why it is so difficult to get people in both the professional community and the general population to listen to what we have to say about the need to shift the paradigm.
Most people know that there are several types of prevention programs. Primary prevention programs address the environments, circumstances, and situations that give rise to the likelihood of abuse and are designed to intervene to stop abuse from ever happening in the first place. Secondary prevention programs address abusive situations in order stop the abuse immediately and reduce the likelihood that abuse reoccurs. Tertiary prevention programs are those that focus on victims and seek to reduce or eliminate the harm resulting from abuse that already happened.[ii]
In the area of child abuse and child sexual abuse prevention the emphasis for over 35 years has been on secondary and tertiary prevention programs. For adults the emphasis has been on secondary prevention. Researchers, program developers, and other professionals in the field have focused their attention on stopping abuse when it is discovered. Programs teach adults how to recognize children who might have already been abused, how to deal with disclosures in a way that intervenes and stops the abuse, and how to report suspected abuse to authorities.
Keeping Them Safe is distinctly different in that it approaches the issue from a primary prevention perspective. These programs focus on educating adults about the grooming process as the place to intervene and interrupt the sequence of events that the predator intends will lead to a sexual encounter with a child. Even now there are only two programs available to the community that are truly “primary prevention,” Keeping Them Safe and Protecting All Children, a program from NCS.
The emphasis on secondary and tertiary prevention is deeply ingrained in the child abuse and child sexual abuse professional community. In his presentation, the voice of child welfare for the nation is calling for a new perspective and a new approach – and he talks openly about the major obstacles to fulfilling on that objective. The resistance professionals have are indicative of the resistance Dr. Milner is addressing in his presentation. Understanding the source of the resistance can help us help others to see what we have to offer as a unique opportunity to stop child sexual abuse before any child is harmed.
In this 18 minute video, Dr. Milner articulates the challenges that face our current child welfare system and the need for primary prevention as a focus. He also clearly identifies the barriers to primary prevention programs in the existing child welfare system structures. His description of how it works today can be enlightening and helpful to us as we continue to promote primary prevention as the key to a future free from child sexual abuse.
Among the key points of his presentation are:
· When faced with difficult social and public health issues we first look for ways to stop them from continuing (secondary prevention) and then look for how to prevent them from happening in the future (primary prevention). As a result, we vaccinate children all over the world to “prevent” polio from infecting anyone or mandate safety features on cars today to “prevent” accidents. No one is suggesting that we should have had our sights on more effective ways to deal with the consequences of polio in order to prevent it or buy and stockpile seat belts to install if there is a problem down the road. However, that is exactly what is expected of us where child maltreatment is concerned. We promote and seek funding for more foster homes, shelters, therapy, etc. rather than investing in broad based primary prevention efforts with a goal toward stopping the abuse before it happens.
· When primary prevention is recommended, everyone smiles and nods and seems to be on board with the plan. However, the enthusiasm fades when that same group of people is confronted with what it actually takes to accomplish primary prevention. Dr. Milner likened the response to that of his four dogs that, even though they are all asleep on the floor around him, are at once awake enthusiastic, and excited if he just says the word “walk.” The excitement lasts until the leashes are on and they go out the front door and are suddenly confronted with the 100 degree weather and the humidity. They promptly sit down and refuse to go further. They just want to return to the comfort of their air conditioned home. Child welfare professionals do the same thing. They know that primary prevention is the answer but the demand for foster care keeps growing, there are limited resources, someone has to lose something for the refocus to be implemented – so back into the comfort of doing it the way it has always been done they/we go.
· Primary prevention prevents the initial event from happening. The way the system is designed now (which PGCA has pointed out for over 20 years) is to prevent a reoccurrence of the abuse. Concentrating on primary prevention requires BOLD action and a total re-imagination of the child welfare system and how we in this country go about working to prevent child maltreatment of all kinds – including child sexual abuse.
Dr. Milner’s presentation on this subject was in December of 2018. His voice is the voice of the US Government Agency that is responsible for dealing with this issue. He is lending himself to the message we have been promoting for almost 20 years. At times it is difficult for us to see that anything is making a difference. However, there is something happening in the professional community that is opening a door to what we do as the future of prevention in all our systems. WE CAN’T STOP NOW!!!! WE ARE JUST STARTING TO GET SOMEWHERE!!!