In this case study, we have summarized how we established a cross-sector partnership, agreed on a shared vision of all Kansas children living in safe, stable, nurturing relationships and environments, a shared commitment to reduce the number of children exposed to 3+ ACEs (Adverse Childhood Experiences) to under 10% by 2020, identified six strategies for accomplishing this commitment and organized two workgroups to implement these strategies. As a result, we saw increased dissemination of information on ACEs and use of consistent messaging, changes in partners’ organizations, and increased funding for evidence-based programs. With limited resources but considerable enthusiasm, Kansas has made great strides towards changing mindsets about safe, stable, nurturing, relationships and environments and creating a platform for supporting family-friendly policy change.
Kansas is considered America’s breadbasket because it produces the most wheat in the US. In addition to wheat, Kansas has cattle, corn, and soybeans for a robust agricultural economy spread across its plains and prairies.
However, our population is increasingly urban (67%) and concentrated in the cities of Wichita, Topeka, and Kansas City. Kansas is also increasingly racially and ethnically diverse. In 2013, 68% of children were White, 18% were Latino, and 6% were Black.
In 2013, 5.4% of Kansas children were reported to Child Protective Services, 3% were confirmed as “cases”. In addition, 23% of our children had experienced two or more other kinds of adverse childhood experiences (ACEs)
such as financial hardship (28%), living with someone who was mentally ill (10%) or had problems with substance abuse (10%), or witnessing partner violence (8%) or neighborhood violence (8%; National Survey of Children’s Health 2011/2012). At the time, our efforts to prevent child maltreatment and other ACEs in Kansas were focused on individual-level work (e.g., home visitation and parent training). In 2008, we created the Wichita Coalition for Child Abuse Prevention as a community response to a cluster of eight child abuse fatalities. This Coalition accomplished important work such as:
creating a network with service providers to improve the prevention service delivery system and remove barriers to services in the Wichita area;
designing a Strengthening Families Resource Map for health care providers and others;
implementing an evidence-informed program to educate new parents of the frustrating features of increased crying in normal infants that can lead to shaking or abuse;
establishing Crisis Nursery Program, which provided short-term care services for children when parents are experiencing a crisis or extreme stress and case management services connecting families to resources needed to improve parent/child functioning;
starting REAL Support for Families, a group that distributes resource booklets and diapers, wipes, and formula in the Wichita zip code areas with the highest child abuse and neglect and child abuse fatalities.
creating the Greater Wichita Fatherhood Coalition to help local agencies become more father-friendly and to host activities for fathers and their children; and
organizing the Research and Education Team to educate the medical community on abusive head trauma.
However, there were no efforts to partner with those using public health strategies to prevent child maltreatment.
When we saw the Essentials funding announcement, we identified an opportunity to learn public health strategies to prevent child maltreatment. Kansas Department of Health and Environment, Injury and Violence Prevention Program, reached out to the Prevent Child Abuse Kansas chapter at The Kansas Children's Service League, among others to write our application. In our application, we proposed partnering with the business sector and community organizations to promote safe, stable, nurturing relationships and environments. Unfortunately, we were unable to get the necessary approvals to submit the application. However, we were thrilled when CDC invited us to participate without funding and scrambled to find a way to get to CDC’s convening of funded and self-supported states for that first meeting in Atlanta in January 2014. This paper summarizes our story of what happened as a result.
To compile our story, we relied on meeting agendas and notes, evaluation reports, and notes from conference calls. We also interviewed five of our partners. We shared the story with our partners to check for inaccuracies or differing perspectives.
To communicate our goal of creating positive community change, we called our initiative Kansas Power of the Positive (KPOP). To implement the initiative, we were able to secure several gifts that together totaled more than $100,000 per year for five years. The donors included Christie Development Associates, Health Care Foundation of Greater Kansas City, Junior League Wichita, REACH Health Care Foundation, and an anonymous family foundation.
As a result of our writing the application for Essentials for Childhood funding, it was natural to have Kansas Department of Health and Environment (KDHE) Bureau of Health Promotion Injury and Violence Prevention as one of the three backbone organizations (the others were Kansas Children’s Service League and Wichita State University Community Engagement Institute) for this collective impact project. The three organizations meet six times a year to review data, plan steering committee meetings, and work on funders’ reports. Both Kansas Children’s Service League and Wichita State University had worked together on several projects using a collective impact approach since 2008 so we had some experience in this process. Several of us even had formal training in collective impact through the Kansas Health Foundation.
To create a steering committee, we reached out to individuals who worked at the director level or higher in over 50 organizations/agencies. In addition to the three backbone organizations, we were able to bring together 40 agencies that included:
the government (Kansas Children’s Cabinet and Trust Fund; State Attorney General’s Office; Departments for Aging and Disability Services , Children and Families, Corrections, and Education; and the court system),
academia (University of Kansas School of Medicine, and Center for Public Partnerships and Research; Kansas State Extension Office; Washburn University School of Social Welfare),
non-profits (Kansas Chapters of the Academy of Pediatrics, Circle of Parents, and Prevent Child Abuse America; Kansas Child Advocacy Centers; Kansas Alliance for Childhood Education; Child Care Aware of Kansas; Children’s Alliance of Kansas; Kansas Head Start Association; Kansas Action for Children; Kansas Parent Leadership Advisory Council; Kansas City and Wichita Coalitions for Child Abuse Prevention; Kansas Coalition Against Sexual & Domestic Violence),
philanthropy (Health Care Foundation of Greater Kansas City, REACH Health Care Foundation, Wyandotte Health Foundation, and the Business Alliance for Childhood Education),
faith-based organizations (St. Francis Community Services, United Methodist Health Ministries Fund), and
the business sector (Business Alliance for Childhood Education, two city hospitals and Westar Energy). This steering committee meets quarterly.
During each year of the initiative, we have convened a meeting of statewide healthcare organizations and community organizations to learn more about Essentials (safe, stable, nurturing relationships and environments) and the Kansas ACEs data. Describing these experiences, one of our partners noted:
As people who never knew each other before this project work together, I’m starting to see they all had ties to building safe, stable, nurturing relationships and environments in Kansas. Significant things are happening while these partners develop trust and learn more about one another.
KDHE played a key role in the development of the KPoP strategic vision, commitments, strategies and principles. It took two meetings to agree on our vision that “All Kansas children live in safe, stable, nurturing relationships and environments.” We committed “To improve the well-being of all Kansans by creating safe, stable, nurturing relationships and environments thereby addressing the consequences of adverse childhood experiences (ACEs) and reducing the number of children exposed to 3+ ACEs to under 10% by 2020.”
It took three steering committee meetings to agree on strategies to achieve this commitment but we had to form a smaller subcommittee to actually get this done. We finally agreed to:
employ a multi-generational approach to mitigate and prevent Adverse Childhood Experiences;
advance systems connections through multi-sectorial collaboration and build upon mutually reinforcing activities;
engage communities in collaborative efforts in order to empower local level impact;
develop a network for information and data sharing;
change mindsets about safe, stable, nurturing, relationships and environments to create norms change; and
create a platform for supporting family-friendly policy change.
Our evaluator, Wichita State University Community Engagement Institute, recorded meeting agreements to hold partners accountable for progress. KDHE hosts the KPoP webpage on their website (http://www.kansaspowerofthepositive.org/) to maintain continuous communication with our partners. Our legislative champions have included Kansas Children’s Service League’s CEO, Board of Directors, Foundation Trustees and Lobbyist; Kansas Action for Children; several parent leaders; key legislators and their spouses; our Steering Committee and Leadership Team and our funders.
We created two workgroups, a Raising Awareness Work Group and Kids Are Good Business Policy Work Group. Each had about 15 members to implement the strategies identified previously. Steering Committee members participated in the work groups and this facilitated making decisions at this level.
Participants in the Awareness Work Group represented health, education, social services, child care, university, business, and philanthropic sectors. They developed a toolkit with slides, videos, and talking points for steering committee members to use in creating awareness about Essentials and adverse childhood experiences within their spheres of influence such as staff, partners, and clients (http://www.kansaspowerofthepositive.org/presentation_tips_tools.htm). Kansas Department of Health and Environment epidemiologists helped analyze data on ACEs and created state and county-level reports which have been disseminated through our website (http://www.kansaspowerofthepositive.org/ACE_Reports.htm) and through presentations in many different forums. They also shared their PowerPoint so others could present this information to different audiences.
Participants in the Kids Are Good Business Policy Work Group also came from different sectors. This group is chaired by someone who works in the business sector and leads a business sector coalition. He provided comment as the CDC was finalizing its Supplement guide for business. This group engaged their own organizations and reached out to other employers to encourage them to look at their workplace policies and consider making changes that will promote safe, stable, nurturing relationships and environments for families. This work group developed a description of workplace policies that would be good for families. The description was the basis for the creation of a survey intended to help employers understand how families are impacted by different policies and practices, prioritize opportunities for improvement, and access resources to facilitate that improvement. The survey was pilot-tested with employers and their feedback led to finalizing a package that will be shared with other employers statewide. This work group is using the “Boost Your Competitive Edge: Actions for a Productive Workforce” CDC Supplement (2017) to inform its work.
Wichita State University helps us track our progress markers by using outcome mapping (i.e., documenting behavior change within organizations or systems) and plotting these on a customized version of the Kansas University Center for Community Health and Development Community Check Box Evaluation System (https://ctb.ku.edu/en/community-check-box-evaluation-system). A first big win was getting private funding to add the ACEs module to the Kansas BRFSS in 2014. We were also successful in negotiating to keep the module in the 2015 BRFSS, which allowed for some county-level data collection. Multiple ACE reports have subsequently been released.
Another accomplishment was seeing meaningful change in our partner organizations. For example, after viewing The Raising of America, the CEO of a large social service agency in Kansas City got the executive leadership team of his agency to review its policies regarding paid sick and medical leave and recommended changes to the Board of Directors. The Board approved changes that enable employees to accrue sick and medical leave faster. A full-time employee can accrue 12 weeks of paid medical leave in 18 months instead of 4 years, and employees can take this paid leave for anything covered by the Family Medical Leave Act, including maternity and paternity leave. In response to a request from the Chairman of another of our partners, an inmate-run self-help program at the Lansing Correctional Facility created a four-week course for all Kansas Correctional Facilities that includes ACEs information. Another partner shared,
Participating in Essentials opened my eyes to the public health way of approaching problems. It just helped me see so many new levers we could use. Now I look for the systems that are pushing families away from success. It is my role as a convener to spread that view to the people who can make the changes.
Other accomplishments include:
securing private funding to purchase baseline data from the awareness, commitment and norms survey conducted by YouGov among representative sample of 800 Kansans; our evaluator was able to analyze these data and compare Kansas to the national data and the funded states;
our partner, Wichita State University Community Engagement Institute integrated ACE information and 2014 ACE data into a full day training for community service providers connected to Kansas Department for Aging and Disability Services;
our partner, the Kansas Children’s Service League presented Adverse Childhood Experiences, the importance of safe, stable, nurturing relationships and environments to approximately 5000 people in Kansas;
in 2015, the co-chairs of the Senate Appropriations and the House Ways and Means Committee were from Kansas. A Leadership Team member met with Kansas Congressional members in 2015 and 2017 and used CDC messaging to convey why this matters and what we can do about it; five of the six congress members voted in favor of the Maternal Infant and Early Child Home Visitation legislation both years;
members of the Coalition worked with Kansas Action for Children to protect $63 million a year of tobacco settlement funding designated for early childhood services from securitization. After Kansas Children’s Service League and Kansas Department of Health and Environment’s Bureau of Health Promotion Injury and Violence Prevention presented our PowerPoint to different committees of the Legislature, legislators worked to re-direct TANF funding to evidence-based home visitation programs ($3 million) and pre-K programs ($4.2 million) during the 2017 session and an additional $4.2 million for pre-K programs from tobacco settlement dollars in the 2018 session;
wichita Coalition for Child Abuse Prevention testified for the National Commission to Eliminate Child Abuse and Neglect Fatalities using CDC’s recommended messaging and was one of four stories featured in the final report;
pittsburgh, PA ABC Affiliate filmed a documentary on their Cluster of Child Abuse Fatalities, which features two-days of interviews in Wichita, KS in which we also used CDC messaging;
a Leadership Team member chaired the Family Work Group of the KS School Readiness Task Force for the Kansas State Dept. of Education School Readiness Plan and utilized the Essentials for Childhood framework of safe, stable, nurturing relationships and environments;
another Leadership Team member authored the Kansas Children’s Cabinet and Trust Fund’s Blueprint for Early Childhood and utilized the Essentials for Childhood framework of safe, stable, nurturing relationships and environments;
the Kansas State Dept. of Education has sent out Essentials for Childhood information to its entire Early Childhood email distribution list;
increases in the percent of Community-Based Child Abuse Prevention dollars invested in evidence-based programs increased from 30% (in 2013) to 44% (in 2014) and 47% (in 2015);
While the positive branding of the initiative (“Power of the Positive”) helped to engage partners, keeping them engaged has been challenging. Meetings are not enough to keep members engaged. To foster engagement, we give members a role to play, including making a short “setting the stage” presentation before work groups, making a panel presentation before the steering committee, or leading table discussions. We think that giving people a role creates more investment. Also, the continual focus on data resonates with people and gets their attention.
Another challenge has been staff turnover, especially in 2014. Although, agencies continue to support the Essentials work, we now do conference call orientations before each steering committee meeting to get new participants up to speed.
Several partners mentioned the group’s reactions to learning about ACEs as a challenge. “When people learn about ACEs they want to ask everyone their ACE score. I was afraid it would re-traumatize some people. Everyone doesn’t need to know. Policy-makers need to know but you need to give them concrete steps to take.”
Another stated, “We went down a whole lot of rabbit holes we didn’t need to go down like screening everyone.”
In this case study, we have summarized how we established a cross-sector partnership, agreed on a shared vision of all Kansas children living in safe, stable, nurturing relationships and environments, a shared commitment to reduce the number of children exposed to 3+ ACEs to under 10% by 2020, identified six strategies for accomplishing this commitment and organized two workgroups to implement these strategies. As a result, we saw increased dissemination of information on ACEs and use of consistent messaging, changes in partners’ organizations, and increased funding for evidence-based programs.
We learned many lessons. For example, to stimulate participation and prevent turnover, we recommend creating Web options for participation, providing telephone orientation to new participants, and assigning specific roles (e.g., participation in panel discussions) to partners to keep them engaged. To ensure common understanding among partners, it is important to define key terms in scopes of work and to undertake face-to-face discussions to correct misunderstandings. Connections with compatible efforts already underway can facilitate collaboration.
We cultivated our private donors by sending VIP invitations to our meetings and sharing annual reports. However, donors' engagement may still be short-term, so that backup plans for continuity should be an ongoing elements of community initiatives.
Knowing what we know now, we would probably choose different metrics. While “reducing the percent of children exposed to 3+ ACES to under 10% by 2020” accurately explains the common aspiration of the coalition, it fails to create a barometer for measuring the success of the activities along the way. Moving forward, the Leadership team will ask the Coalition to identify measures that are more sensitive to change and provide needed feedback about the effectiveness of the efforts of our workgroups.
We plan to focus on family-friendly work policies and social norms change for our future next steps. A partner described the strategy: “We asked ourselves, what group stands between us and our goal? We landed on employers. Then we asked, if we were successful, what would X Company be doing differently? And we came up with a list of 19 conditions for a family-friendly work environment. We’ve created an employee survey which we hope to automate so that employers can identify what they can do to make their business family-friendly. Then they’ll work with employees to prioritize what issues they will work on. We want them to use the data so employers can see themselves in the solution. Once business buys in, they’ll start bringing policy makers along.” This strategy makes the most sense for Kansas’ current political environment.
In sum, with limited resources but a lot of energy, Kansas has made great strides towards changing mindsets about safe, stable, nurturing, relationships and environments and creating a platform for supporting family-friendly policy change.
Centers for Disease Control and Prevention, National Center for Injury Control and Prevention, Division of Violence Prevention. (2017) Boost Your Competitive Edge: Actions for a productive workforce. Retrieved June 7, 2018 from https://www.cdc.gov/violenceprevention/pdf/Essentials_Sup_3_Employer-Role.pdf.
National Survey of Children's Health. NSCH. (2011/12). Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. Retrieved April 11, 2018 from www.childhealthdata.org.
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Roper, V.B., Haskett, L., Maack, A. et al. Kansas Power of the Positive. Int. Journal on Child Malt. 1, 195–204 (2019). https://doi.org/10.1007/s42448-018-0010-2
- Adverse childhood experiences (ACEs)
- Community collaboration
- Essentials for Childhood
- Family-friendly work environments