Guests Verleaner Lane and Daniel Riggins: Using data to prevent deaths from child abuse and neglect

The nation's child welfare systems have long been structured in a way that responds to incidents of child abuse and neglect after harm has occurred. There is a new movement in child welfare to change this and devote more resources to using data to identify those children most at risk. Based on what the data shows, front-end resources and services can then be brought to bear in support of families before abuse or neglect occurs.

A good example of this can be found in the Child Safety Forward initiative. Funded through a grant from the U.S. Department of Justice, Child Safety Forward is a demonstration initiative to develop multidisciplinary strategies and a public health response to address fatalities or near-death injuries as a result of child abuse, neglect or unsafe practices. The initiative takes place across five sites, including Cook County Health in Illinois.

Cook County Health established Project CHILD in 2019 to better understand and address infant-specific deaths due to maltreatment.

Our strategy includes bringing together a diverse group of community stakeholders who work with most-affected families in a variety of different settings, including health care and mental health providers, community health workers, maternal infant health providers, faith leaders, educators and social service providers. Our work has been focused in three Illinois counties: Cook, Peoria and Vermilion, with a goal of identifying the highest-risk geographic areas and targeting resources at these communities.

We began our efforts by using a data collection process that had been established earlier by Cook County Health in partnership with the Cook County Medical Examiner. The process automates data exchange between these two Cook County agencies allowing for the linkage of clinical data to mortality events among specific populations as determined by the medical examiner. Data sharing across these agencies is automated to identify risk factors for mortality among individuals experiencing homelessness, those impacted by the opioid epidemic, those with justice involvement and the intersection of these experiences.

For Cook County, we reviewed approximately 300 sudden unexpected infant deaths over the past five years likely related to unsafe sleep conditions. We identified specific neighborhoods that had a higher rate of sudden unexpected infant death.

Based on these findings, we are now able to appropriately target resources and educational interventions to protect families from these catastrophic events. We are currently working with pediatricians and community organizations to develop safe sleep messaging and interventions targeted to these high-risk neighborhoods.

Child Safety Forward is an example of what can be accomplished through a data-informed, place-based approach that facilitates community engagement and targets interventions to families that need them the most. It reflects a growing trend in child welfare to shift from a reactive to a proactive approach and to highlight the importance of data sharing and collaboration when addressing complex problems like child safety.

By working across agencies and directing resources upstream, we can continue to support a shift from child welfare systems to child well-being systems that better serve all families.

• Verleaner Lane is project director for Project CHILD of Cook County Health. Daniel P. Riggins, M.D., is with Cook County Health. This commentary is provided in memoriam of Dr. Majorie Fujara, former pediatrician at Cook County Health, who served as the principal investigator for Project CHILD and a tireless advocate for the welfare of children.