Keywords

Overview

A great deal has been learned about child maltreatment over the past 50 years. Much of this new learning, however, simply underscores how much more we need to learn. Today, child maltreatment is perceived as more complex than first described in terms of its interaction with other forms of risk and trauma; in terms of how best to design and implement strategies to address it; and in terms of how to tailor these strategies across different populations and contexts. Facing this reality should generate a certain degree of humility in all who work in this field.

Looking across the chapters in this book, several common themes surfaced regarding how the problem is currently being defined and how programs and policies are being crafted and implemented. As a group, the chapter authors underscored the importance of adopting a developmental framework in understanding the continuous, and often different, impacts of maltreatment. They called for a more inclusive definition of culture and its application in understanding the definition, roots, and consequences of maltreatment and efforts to prevent it. They spoke of the importance of recognizing that child maltreatment is often one of multiple adversities experienced by children and the parents who mistreat them. The authors recommend that an interdisciplinary, multilayered response be fostered, in which all aspects of the social ecology are considered both a source of the problem and potential opportunity for prevention.

The purpose of this chapter is to expand on these themes and note areas in which they collectively deepen our understanding of the problem and how we assess our interventions. The chapter also discusses how these themes offer important opportunities to reconnect the field’s treatment and prevention functions. Noting the need to build a more interdisciplinary and cross-sector workforce, the chapter discusses the development strategies required to build a pool of professionals deeply committed to interdisciplinary practice and capable of sustaining diverse and generative learning. The chapter concludes with a set of promising strategies for building on the lessons presented in this volume and continuing the field’s long tradition of integrating research and practice.

The Nature of the Problem

All (or most) social dilemmas operate within a broader context. Rarely do they occur in isolation from other adverse events nor are they triggered by a narrow range of circumstances limited to a single ecological level. At a minimum, a child’s safety and ultimate well-being is a function of her parents’ capacity to meet her basic needs, the other adverse conditions she and her family have experienced or may experience, the resources available within her local community, and the normative standards that determine appropriate and inappropriate parent–child interactions. Despite this obvious integration with other familial and contextual conditions, child maltreatment has historically been viewed as a separate, stand-alone social problem requiring a unique public policy response. More recently, however, child maltreatment has been viewed as a behavior so deeply influenced by other issues (such as poverty, inequality, and violence) that sustaining progress in addressing its incidence and consequences can only occur from a more integrated platform.

The contributing authors, while recognizing the relationship between child maltreatment and these broader issues, endorse a set of policy and practice reforms that would retain child maltreatment as a unique topic of study and field of practice. Their perspective, however, is tempered by intentionality in recognizing points of interaction between child maltreatment and myriad other issues that facilitate or hinder progress in defining and confronting it. While supporting a research and policy agenda that centers on child maltreatment, the contributing authors fully understand that this type of single-issue focus will be insufficient to achieve a meaningful reduction in incidence rates. As noted by Atul Gawande, “We always hope for the easy fix: the simple one change that will erase a problem in a stroke. But few things in life work in this way. Instead, success requires making a hundred small steps go right—one after the other, no slip ups, no goofs, everyone pitching in” (Gawande 2008, p. 21). Strategies suggested by the contributing authors to create a rich, multifaceted lens through which to view the problem include embracing the perspectives of multiple disciplines in conceptualizing the problem; casting a broad, inclusive net in defining what constitutes abuse or neglect; and simultaneously seeking to both reduce risk and enhance protective factors.

Engage a Broad Array of Disciplines

The complexity of child maltreatment accentuates the importance of applying the perspectives of multiple disciplines to all aspects of the problem—from incidence and prevalence through intervention and prevention. This theme, evident in nearly every chapter, suggests that truly understanding child maltreatment requires the active participation of those operating with research and theoretical frameworks representing diverse areas of study, including (but likely not limited to): anthropology, biology, business, computer science, economics, education, engineering, family and consumer science, gender and sexuality studies, genetics, law, medicine (emergency medicine, pediatrics, psychiatry, etc.), neuroscience, philosophy (ethics), psychology, public administration, public health, social work, sociology, statistics, and systems science. (These areas are listed alphabetically to avoid assigning primacy to a single discipline.) It will also need to include experts from a variety of fields that are not necessarily discipline specific, such as scholars from the fields of implementation and prevention science (Institute of Medicine and National Research Council 2013).

The productive use of an interdisciplinary platform demands authentic, joint planning and integrated thinking. As described by Rosenfield (1992), a taxonomy of cross-disciplinary research (and practice) suggests that these relationships develop over time and move through specific stages. At the basic level, multidisciplinary approaches involve researchers working in parallel or sequentially from their own disciplinary-specific base to address a common problem. An example of this would be the early multidisciplinary teams established to review reported child abuse cases and fatalities. In interdisciplinary work, researchers work collaboratively, but retain their specific disciplinary base, as reflected in the relationships commonly found on public task forces and interdisciplinary study teams established to examine a specific program or complex social issue. In the final stage of collaborative work, transdisciplinary approaches, researchers “work jointly using shared conceptual framework drawing together disciplinary-specific theories, concepts, and approaches”, a qualitatively different way of interaction (Rosenfield 1992, p. 1351). Rather than simply representing a combination of ideas, this new level of collaboration is capable of birthing a new identity and potentially generating innovative approaches. Indeed, Johnson, in his book Where Good Ideas Come From: The Natural History of Innovation (2010), notes that one of the factors that often underlies innovation is the availability of “loosely formed multidisciplinary teams that work on the edges of new ideas and by virtue of their proximity and specialization generate new ideas” (as cited in Hogwood et al. 2014, p. 154).

Addressing and untangling the complexity of child maltreatment through transdisciplinary research will not be possible without a great deal of patience, respect, trust, and institutional support from universities, funders, foundations, governmental agencies, and other stakeholders. On the academic side, it may also require recalibrating metrics for promotion and tenure so that they reflect the value of academic and community collaboration. Despite the challenges, the contributing authors are optimistic about the promise cross-discipline collaboration and partnerships present for advancing the field.

Broaden the Concept of Child Maltreatment

The specific behaviors and conditions which constitute maltreatment are far reaching and not simply limited to the way in which adults treat children. From the onset, researchers and practitioners have recognized that social conditions not only contribute to the likelihood that parents or caretakers may mistreat their own children but that conditions such as poverty, inequalities in how resources are allocated across populations and communities, community violence, and social norms around gender and race can have a direct, cumulative effect on the lives of young children and their overall well-being. While guidelines for reporting and substantiating child maltreatment have expanded over the years, the official behaviors that trigger a formal report of child abuse or neglect, or are perceived by the public as child maltreatment, remain narrowly focused on the behaviors individuals perpetrate against children.

Those examining the issue of child maltreatment, including the authors contributing to this volume, are now seeking ways to explicitly expand the discussion about which behaviors and conditions might be considered abusive and neglectful and how this broader range of issues might enhance our understanding of the problem. Moving forward, child maltreatment “perpetrators” might come to include not only individuals—most often parents, guardians or caretakers—but also the families, institutions, culture, and environment (e.g., the society) in which children are reared. This multilayered view of maltreatment reinforces the notion that while historically maltreatment has been defined as a collection of discrete actions or inactions (e.g., physical abuse at the hands of a parent), victims of maltreatment are often exposed to multiple forms of abuse and trauma at one time or over time. This layering of so many different traumas has cumulative effects on a child’s well-being and life course development. The more adversity a child experiences, the stronger the effects. While not every act of commission or omission constitutes a reportable act of child abuse or neglect, all of these actions reflect society’s inability to fulfill its collective responsibility to care for its children and create a context in which children are safe and nurtured. Recognizing this collective responsibility allows for a more effective and purposeful integration of the child maltreatment concept within the social fabric and opens up new prevention opportunities.

Establish a Dual Focus on Risk and Protective Factors

As highlighted in several chapters, efforts are being made at the local, state, and federal levels to improve utilization of prevention and treatment frameworks that focus on building upon individual and family strengths. Strengths commonly cited as reducing the likelihood for maltreatment and assisting parents in overcoming adversity include parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children. However, the field continues to depend largely on risk assessment and abatement strategies when working with or studying families. While it is not a viable option to abandon any discussion of risk, researchers, practitioners, and policymakers are making strides in better balancing their focus between risk and resilience.

Promulgating this dual perspective in the public discourse around child maltreatment not only impacts how practitioners and policymakers perceive the issue but also may alter how families perceive and respond to interventions addressing the problem. Effectively recruiting and engaging families are ongoing challenges for all voluntary interventions. Increasing the focus on strengths building as a critical goal of preventive services may improve the ability to attract, enroll, and retain potential participants. Programs that are built around building resilience and enhancing parental capacity create a more inclusive and welcoming window for families concerned about their ability to meet their child’s needs but who are not comfortable defining these concerns as an indicator of a potential risk to abuse or neglect them. A protective factors or strengths-based framework creates a more inclusive intervention, one which may be more acceptable to a higher proportion of families across income, family structure, culture, and social stratification.

While those contributing to this volume acknowledge that there are factors present at the individual, family, and community level that may stand to protect against maltreatment, they also agree that more research is needed in several areas to provide practitioners with the information they need to develop or modify programs to reflect this reality. Community-level protective factors are not well understood—both in terms of how those factors influence the actions of individual families as well as how they effectively increase community or collective efficacy. When examining the transmission of violence across generations, the field needs to focus efforts on identifying which protective factors have the greatest likelihood to help individuals break the cycle of violence. Once identified, the field needs to develop programmatic and policy innovations to more explicitly nurture these conditions among current victims, to increase their resilience and help them avoid maltreating their own children. In addition, greater understanding is needed of the role culture and gender identity may play in the differential impacts of these factors and how to accommodate these differences when working with victims.

The Nature of the Response

As noted in Chap. 1, the policy and programmatic response to child maltreatment has grown exponentially over the past 50 years. Every state has a child welfare system to investigate all child maltreatment reports and to respond in an appropriate manner when maltreatment has occurred or is at high risk of occurring. Outside of the formal child welfare system, most (if not all) communities have some number of therapeutic and support services available to victims and their families as well as a range of preventive services to strengthen parental capacity, promote healthy child development, and address immediate needs. This system is not perfect and often inadequate to meet total demand; its depth and breadth, however, is increasingly robust.

While recognizing this progress, the contributing authors envision a response system that does more and does it in a more efficient and effective manner. Specifically, in several chapters the authors discuss the importance of building a strong continuum of interventions and public policies that support children and their families from birth through the child’s transition to adulthood. Authors utilize a range of diverse research designs and methods to document the implementation and impacts of these interventions and create a “learning culture” in which data is used to inform program development and interagency collaboration. Underlying all of these pathways to improvement is the realization that the most effective response system will indeed be one which is diverse and one which avoids creating a hierarchy of what is “best.” One of the major themes surfacing throughout these chapters is the importance of always considering context when determining what interventions will be used, what research methods will be employed, and how data can best inform a given policy or practice.

Develop an Integrated Response Across the Lifespan

Confronting child maltreatment has, for decades, involved the development and implementation of diverse services provided by a range of public and private agencies. As noted in Chap. 1, most recently the prevention field has placed particular emphasis on investing in early intervention services and those programs targeting newborns and their parents. Reflecting on this reality, several of the authors make a compelling case for not allowing concern with one developmental stage to minimize the importance of supporting a child’s development at every stage, utilizing a developmental lens to create a comprehensive array of mutually reinforcing supports. As Isabell Sawhill and her colleagues at the Brookings Institute have demonstrated, interventions offered at multiple points during a child’s development produce a level of additive value unable to be achieved through a singular offer of assistance, even when that assistance begins early in a child’s development (Sawhill and Karpilow 2014). While investment in early childhood interventions makes solid programmatic and financial sense, such investments will never yield the anticipated level of returns unless high-quality clinical interventions and prevention services are offered throughout the life span, including adolescence and young adulthood. And, as cited earlier, such efforts need to target not only individuals but also the context in which these individuals live and the systems and institutions that shape these contexts.

Future public policies targeting child maltreatment will need to embrace multiple programs provided through multiple institutions. These policies will also need to build in an intentional focus on addressing the factors associated with an elevated risk of maltreatment at every stage of a child’s development. Collectively, the contributing authors believe the programmatic response to maltreatment needs to be deeper, broader, and more fluid. Allocating prevention resources more equitably across all populations at risk rather than focusing so heavily on early childhood—which is certainly what has occurred in the child maltreatment prevention field—will be required to maximize impacts over time. It is becoming increasingly difficult to justify investing in the one thing you think is most promising. What is needed are investments in multiple strategies operating at varying levels of the social ecology.

Embrace Methodological Pluralism

A new balance is needed between effectiveness and efficacy studies when investing in program research. When promising programs are taken to scale, the limitations of relying on randomized clinical trials in determining “what works” becomes more evident. As noted in several of the chapters, improving the quality and replicability of interventions requires greater investment in research studies built around implementation science. At a minimum, improving practice will require a more detailed and nuanced documentation of how programs operate and their key levers of change, the organizational and contextual factors that facilitate or hinder successful program replication, and the “meaning” participants ascribe to the interventions they receive. Obtaining these data and effectively using them to guide practice reform and policy innovation requires the development and implementation of a new research framework. Addressing this need, Lisbeth Schorr and her colleagues have called for an expanded definition of what constitutes “useful and usable” evidence. The core operational elements of their framework, the majority of which mirror recommendations made in several chapters, include the incorporation of multiple sources of evidence, goal-oriented networks to accelerate knowledge development and dissemination, multiple evaluation methods suitable for diverse purposes, and a strong infrastructure to support continuous learning over time (Schorr and Farrow 2014).

The range of issues addressed in this book further speaks to the need for the field of child maltreatment prevention to employ a diverse set of research methods and analytic approaches. This is directly related to the need to engage various disciplines; no one method or approach to analysis will be sufficient for all situations. For example, randomized controlled trials are not always feasible, because they need both design alternatives (Brown et al. 2009) and analytic methods that can approximate the conditions of a randomized controlled trial (e.g., propensity score matching). Chapter 6 deals with this most explicitly. Other chapters also suggest the need for quantitative, qualitative, and mixed methods research approaches. Mixed methods approaches are particularly attractive. These approaches address the need to demonstrate the impact of interventions in a rigorous way. They also foster a better understanding of the processes and mechanisms by which they exert their effects and the subjective experience of relevant stakeholders who are involved in providing or receiving the intervention. Economic evaluation is another underutilized methodology that deserves greater attention. Finally, systems science has promise for capturing, explaining, and intervening in the complex pathways that lead to child maltreatment (Office of Behavioral and Social Science Research 2014).

Promote Greater Data Use and Sharing Within and Across Programs

Creating a more diversified body of evidence is one challenge. Equally important is improving the capacity of policymakers, agency managers, and practitioners to access these data in a timely and appropriate manner and to make sure that they know what to do with the data once they access it. In several chapters, authors underscore the need to create methods in which direct service providers can document what they do and how participants are responding in a seamless manner. In addition, providers must view such data collection is as an integral part of the service delivery process, not an added burden. These data can then inform the supervisory process as well as guide agency decisions regarding appropriate target populations, methods of participant engagement, dosage levels, and service duration. When data is collected as a matter of practice and the information fed back to staff in a timely manner, practice and resource decisions are well-served. Choices regarding resource allocations, modifications to an existing protocol, and opportunities for interagency planning are guided by current reality and the best available information.

Great progress has been made toward accomplishing the ideals of open access to research findings and the sharing of data. The contributing authors are optimistic that a commitment to increased data sharing will continue. With respect to interagency data sharing, a growing number of state agencies are encouraging policy innovations and methods that will allow for cross-referencing the experiences of families across various institutions as well as tracking performance over time. These “integrated data systems” are allowing state child welfare directors, for example, to better understand the long-term developmental and educational outcomes of children in foster care and to examine the characteristics of those children in care who are at highest risk for poor outcomes (Wulczyn et al. 2005). Similarly, those interested in documenting the potential savings of early intervention services are investigating ways to use administrative data to track future expenditures as well as performance (Aos et al. 2011). This ability to be more intentional and creative in using the data currently available regarding service use and expenditures has strong potential to improve the public policy debate regarding alternative strategies and, more importantly, to enhance participant outcomes (Haskins and Margolis 2014).

In addition to the more effective use of administrative data, researchers are seeking ways to share their data and build on each other’s findings in a more efficient and time-sensitive manner. In the area of child maltreatment research, the federal Children’s Bureau has supported the National Data Archive on Child Abuse and Neglect at Cornell University since 1988. The goal of the Data Archive is to make available to researchers and doctoral students all of the studies that have been funded by the federal government regarding this topic, as well as several other large national studies that have examined the issue. (The Data Archive can be accessed at www.ndacan.cornell.edu.) Similarly, all publications from taxpayer-funded research in the United States are required to be made freely available after one year’s delay (http://blogs.nature.com/news/2013/02/us-white-house-announces-open-access-policy.html). There are also increasing numbers of open access journals available (see the website for the Directory of Open Access Journals at http://doaj.org). Data sharing may also soon be incentivized, if not required. A recent editorial in the Journal of the American Medical Association advocated for the value of scholars’ research being evaluated on a specified list of criteria, one of which was the sharing of data and other resources as indicated by the proportion of publications that share data, materials, or protocols (Ioannidis and Khoury 2014). These and other efforts suggest that, going forward, researchers examining child maltreatment and related issues cited by the authors in this volume will have more direct access to each other’s work.

Building and Sustaining a Unified Approach to Child Maltreatment

Practitioners, policymakers, researchers, and advocates need to learn from and inform each other’s decisions. Those focusing on developing treatment and preventive services need to identify shared challenges and opportunities for joint learning. Reflecting on their own experiences and interests moving forward, the authors identified at least three areas where all of those contributing to the child maltreatment response can find common ground regardless of their specific target of interest: the application of neurobiological research findings in identifying new pathways for understanding and confronting child maltreatment; better designed program evaluations and implementation studies to inform the design and quality of both treatment and prevention programs; and examining the ways in which community context can be altered to better support participant engagement in services and reinforce the gains such programs are able to achieve for the families they serve.

Neurobiological Research

The application of neurobiological research offers a unique and robust opportunity to identify both the consequences of abuse as well as the possible interventions to pursue in remediating or preventing these consequences. As this line of research refines and clarifies how behavior and context influences early brain development, program planners and policy advocates are developing a clearer understanding of how exposure to ongoing stress, economic deprivation, and violence can alter a child’s cognitive and neurological development. The use of physiological measures to assess outcomes (e.g., saliva cortisol to measure neuroendocrine levels) provide new, more consistent ways to assess constructs, such as emotional dysregulation, that cannot be directly observed but can now be inferred by measuring neuroendocrine levels. Such information can inform both the treatment and prevention planning process by documenting the impacts of maltreatment and other trauma on child well-being and more effectively monitoring the impact interventions have on these constructs. While capturing only one aspect of trauma, this line of research offers a common source of new knowledge equally useful to those focusing on new treatment interventions and those seeking ways to design more effective prevention services.

Neurobiological research also furthers our understanding of the developmental challenges facing children who are born into families affected by intergenerational maltreatment. These children face not only the adverse consequences resulting from direct environmental stress, such as maternal drug use, mental illness, or intimate partner violence, but also may be born primed to respond to stress much differently as a result of their genetic makeup. As with an increased risk for cancer, diabetes, and heart disease, it is now hypothesized that trauma, including trauma resulting from abuse or chronic neglect, can be passed down generation to generation through genetic patterns. While far from a fully understood process, this line of research will most certainly influence the next generation of researchers and provide a rich context for joint discussions at both ends of the intervention continuum.

Implementation Research

Just like other fields, such as health, behavioral health, and social services, the field of child maltreatment prevention has been hampered by the slow translation of research into practice; effective prevention and treatment programs have been developed but they are seldom implemented widely or with a high degree of fidelity (see Chaps. 7 and 8). Implementation research is fundamentally about bridging the gap from research to practice by developing and testing strategies to change the behavior of individuals, families, teams, organizations, and systems. Implementation research also enables greater understanding of the contextual factors that influence those behaviors (Eccles and Mittman 2006). Further, it is increasingly recognized as a necessary element for improving the response to child maltreatment (Institute of Medicine and National Research Council 2013; Paulsell et al. 2014).

Implementation science has the potential to serve as a strong, generative platform to promote a shared purpose across all stages of the child maltreatment research and service continuum. First, implementation research can bridge multiple phases of research. While we sometimes think of the progression from efficacy studies to effectiveness studies to dissemination and implementation studies as linear, all of these stages of work inform one another in an iterative fashion (Institute of Medicine 2009). At the early stages of intervention development, there is utility in “designing for dissemination” by taking into account the characteristics of interventions that may render them easier to implement in the real world (Brownson et al. 2013; Klesges et al. 2005). Similarly, learning about how these interventions are actually implemented and adapted in community settings (see Chap. 8) will inform future efforts to develop and test any intervention regardless of its focus in efficacy and effectiveness trials.

Second, the field of implementation science does not belong to a single discipline, so it has the advantage of facilitating the type of interdisciplinary and transdisciplinary research needed to advance the field as discussed earlier. There are also ample opportunities to apply the lessons learned about the implementation of complex interventions in health, behavioral health, and other settings that may or may not focus specifically on child maltreatment.

Finally, implementation research inherently requires partners (Chambers and Azrin 2013; Kirchner et al. 2014); thus, it demands that a wide range of stakeholders be brought to the table to address the challenges of child maltreatment prevention. The traditional siloed approach to research will not suffice. The contributing authors believe that the work of researchers and program developers are enhanced when they partner with children and families, community organizations, treatment providers, and other key stakeholders to develop effective and culturally informed prevention and treatment programs.

Community Context Research

Understanding the role context plays in determining both the potential and feasibility of evidence-based interventions and public policy to succeed is increasingly salient to those now entering the field. Although the development of model programs and interventions grounded in a solid theory of change is of high importance, as discussed in Chap. 6, the chapter authors are keenly aware of the influence context and culture will have in how potential participants view these models and how these models adapt to diverse settings. Understanding these processes are of equal importance and interest to practitioners and researchers formulating both treatment and prevention services. The fundamental question of what can be accomplished through interventions targeting individuals in the absence of adjustments to community context is equally important across all interventions. All interventions, even those highly specified, will need to make some adjustments and adaptations in going to scale. Given the complexity in the causal factors contributing to the likelihood of maltreatment and the diversity of needs presented by families who have either experienced maltreatment or are trying to avoid it, any intervention’s long-term success is inherently dependent upon how context supports or contradicts its mission. Rather than addressing these issues on their own, the next generation of program developers and those who evaluate these models will need to work in partnership—sharing ideas, formulating a common message, and advocating for similar changes in the institutional response to the problem and in the normative context in which parents care for their children.

Building and Sustaining New Leadership

Throughout this book, the authors have highlighted their interest in working more intentionally across disciplines, subject areas, funding streams, and agencies. Despite these good intentions, experience suggests that collaborative problem solving and true transdisciplinary inquiry will not happen in the absence of intentional and sustained efforts—it is simply easier to continue doing things the way they have always been done. Fortunately, the next generation of leaders, as represented by the chapter authors, appears willing to take on the challenge of change and are defining their work and research questions in ways conducive to a more collaborative and integrative planning process. The structure and implementation of the Doris Duke Fellowship, and efforts underway in many academic institutions across the country, suggest at least three strategies will be important in supporting the next generation of researchers:

  • Nurturing transdisciplinary practice: In the coming decade, the child maltreatment field will require “renaissance researchers” or individuals who are comfortable working in diverse settings as well as across diverse disciplines. The Doris Duke Fellowship fosters this type of scholar through a variety of strategies, including organizing the fellows into small groups that are intentionally multidisciplinary yet loosely focused on a particular line of research (e.g., early childhood, adolescents, child welfare, parenting, etc.). Fellows are required to complete a collaborative project within that group, increasing their exposure to actually working jointly with colleagues from other disciplines. These joint projects, along with the development of this manuscript, have required the fellows to accommodate diverse perspectives as they grappled with how to frame and prioritize an integrated response to a common problem.

  • Introducing young scholars to the policy world: As public policy adopts a more intentional focus on using research to guide decisions and determine the allocation of programmatic resources, researchers face increasing pressure to insure that their research questions and findings are in line with the questions of high interest to those making these decisions. To this end, the Doris Duke Fellowship explicitly emphasizes the link between research and public policy, both in its selection methods and mentoring structure. As part of the application process, all candidates are required to address the practice and policy implications of their dissertation. Candidates also are required to identify a policy or practice mentor who is committed to working with them and participating in fellowship activities should they be selected. These mentors are typically senior-level professionals in nonprofit organizations, state or federal agencies, or university-based policy centers. The policy mentor’s role is to assist the fellow in understanding the policy challenges facing their agency or service delivery process and the way in which data is integrated (or not) into their decision making process. Expectations for the policy mentor during the fellowship period include engaging in regular communication with the fellow, establishing goals for the relationship, providing feedback on the dissertation to sharpen its policy or practice focus, assisting the fellow in improving her ability to communicate research findings to a nonacademic audience, and facilitating networking with colleagues.

  • Enriching the pipeline: Traditionally, a doctoral student works directly—and often in isolation—with a faculty member at his university. The student may or (more likely) may not have substantive exposure to other researchers within his department; only rarely is a doctoral student substantively engaged in working with researchers in other contexts or from other disciplines. Yet experts continue to call for scholars to be willing and able to work jointly with scholars from other disciplines, utilizing different funding streams and targeting their findings to diverse audiences in order to maximize their learning (Walker et al. 2007). The Doris Duke Fellowship is built upon the idea that in order to become leaders in the child abuse and neglect prevention field, it is imperative that students have meaningful interactions with others from different disciplines who represent different professional perspectives (i.e., policymaker, practitioner, program developer, funder). Opportunities for these types of substantive interactions are built into the fellowship through small group collaborative projects, mentorship from individuals engaged directly in creating policy or implementing programs, and multiple opportunities to learn from experts and other students.

In the end, the primary lesson from all of this work may lie less in the merits of a specific strategy and more in the need to create multiple opportunities for emerging scholars to interact with those in other disciplines and to commit to working jointly on projects that involve coauthorship. Such opportunities can be created through a specific fellowship program or embedded within organized research centers that draw together different academic departments from within a specific institution or between a university and local or state agencies. Professional associations that focus on a substantive area of study rather than a single discipline also offer opportunities for cross-discipline learning and joint relationships between research and practice. Such associations often have specific strategies for engaging students and early career professionals. Some examples include the Society for Prevention Research’s Early Career Preventionists Network (ECPN) and the American Professional Society on the Abuse of Children’s Prevention Committee and Early Career Sub-Committee. Where these opportunities exist is far less important than ensuring that emerging scholars have multiple opportunities to “look over the fence” and learn from other disciplines and theoretical frameworks.

Conclusion

The authors who contributed the central content of this book challenge all concerned with child maltreatment to think anew about the problem and the public policy response. They have articulated a set of issues, big and small, that will influence their work and the direction of the field. These authors collectively recognize the complexities of child maltreatment as a societal and a human problem; it is not a singular phenomenon but rather multiple, often overlapping ones. Within this context they acknowledge that there is no “silver bullet” for addressing the issue and that building and sustaining an effective response requires a thoughtful and nuanced approach. No research portfolio, no matter how inclusive or sophisticated, will produce a singular and lasting resolution to the problem. Each study adds to the knowledge base and while some insights are robust and enduring most have a limited shelf life, or must share “the shelf” with hundreds of other possible solutions. That said, each finding or promising intervention offers an important building block for advancing our thinking and stimulating innovation, particularly when considered in tandem with other results.

Drawing on the lessons learned and recommendations articulated by the chapter authors, several operational pillars emerge as being important to this group of leaders as they think about their future work. The most salient of these features include:

  • Implementation science: Examine programs not simply from the perspective of outcomes but also with an eye toward more fully understanding the implementation process and the factors that contribute to successful replication.

  • Data integration: Find ways to share information on program participants across institutions and across the life span for purposes of better understanding who is being reached and who is most successfully served. Equally important is using administrative data to identify promising pathways for prevention—better understanding how families come to require remedial services can offer critical insights into how to find them before such assistance is needed.

  • Continuous quality improvement: Raise the performance bar and set the expectation that researchers and practitioners alike have a responsibility to find ways to do better, even when they believe they are doing a great job.

  • Family and participant voice: Listen to those you intend to help and incorporate their thoughts and perspectives into planning and implementation.

  • Policy integration: Do not implement policy reforms alone when it can be done in partnership with others. This principle applies to work across agencies as well as across sectors (public, private, and nonprofit).

Making progress in understanding and resolving social dilemmas requires a balance of generating innovative ideas and rediscovering the potential of old ideas when applied to a new context. The next generation of scholars is well-positioned to lead the field in ways their predecessors could not have imagined. This fact alone suggests great promise for the field and great hope for the well-being of all children.