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Healthy communities start with our children

A Q&A with Ann Trebesch and Mollie Harris

Child abuse is a problem in the United States—in 2017, the last year that statistics are available, around 674,000 kids were determined to be victims of neglect, physical abuse, or sexual abuse. Why is violence towards children so prevalent? What are we doing to stop it? What challenges stand in the way of reducing this type of violence?

We asked Ann Trebesch, Vice President of Operations/Mission at CHI St. Francis, and Mollie Harris, Violence Prevention Coordinator at CHI Saint Joseph London, about their efforts to stop child abuse and improve their communities’ health.

“Ann, can you give us some background on your program?”

A: “Sure. We’re located in Breckenridge, MN, and our program is called Family Footprints. Our main goal is to decrease the incidence of child abuse and neglect in the two counties in our primary service area through evidence-based education in parental skills. We utilize the Parents As Teachers curriculum, which we are able to customize to each family’s needs.”

“And Mollie, is your program fairly similar?”

M: “Yes, our program at Saint Joseph London is called the Nurturing Children Program. We also provide an evidence-based parenting program to parents, with a focus on reducing child abuse and neglect amongst families who are pregnant or have children ages 0–4. We utilize the Nurturing Parenting curriculum, and we are also able to customize to meet the needs of the family.

“Does this program just happen in the hospital?”

M: “Nope, it’s community-wide. Our obstetrics department is involved, but we also partner with the Department for Community Based Services and local OB/GYN offices, self-referrals and court appointed referrals to make sure this is a community-wide effort.

I’d also mention that the program curriculum is very different than your typical “parenting” classes. We work on issues surrounding empathy, communication and discipline, and offer creative tools to bond with children such as infant massage. The education can be provided in home, office, and group settings, as well as in the local correctional facility.”

“Ann, how long has your program been active?”

A: “We began seeing parents in January of 2012 with an acceptance rate of 90% for the first 6 months of the program. In 2018, our 7th year of operation, we had a record 418 visits to parents, with a 100% acceptance rate for those born at St. Francis. What we are seeing is a change in the program due to the limited number of OB providers in the community. Because they receive their prenatal care in Fargo, many are opting to travel there for the birth of their child.  So we have fewer direct visits at St. Francis.

However, our outside referrals have increased immensely.  We now receive referrals from both Wilkin County Social Services, Richland County Social Services, area mental health providers, and other early childhood resources. In addition, we have experienced our first court-appointed referral.”

“So, it sounds like getting parents in the community to learn about the program has become somewhat of a challenge?”

A: “Well, I think the biggest challenge we have faced is the increase in number of parents with substance use issues, as well an increase in the number who have learning disabilities. This has affected our success rate with decreasing the child abuse and neglect reports.

Our coordinator has training in special education and has been able to use those skills when adapting the education materials for those with learning disabilities. She’s also presented education to county social workers on how to communicate more effectively with this population.

Another challenge we have had is getting our parent mentorship program going. Our goal is to develop a resource of parents with proven skills who can be matched with young families who do not have adequate support.  We have experienced a reluctance for our parents to transfer from the Family Footprints coordinator visits to another person. They have a limited circle of trust, and are often unwilling to open up to another person.  We continue to try new ways to improve the acceptance rate.

One other concern is future funding. We serve two counties in two different states, so it will take a collaborative effort to fund the program when we no longer have grant funding. Currently we are tracking the number of families who either come off the county social services case load, or who are never enrolled due to early intervention by the Family Footprints program.”

“Mollie, what about you—what challenges has your program faced?”

M: “We’ve also faced barriers related to substance abuse. Opioid abuse in Southeastern Kentucky is a big issue right now, however methamphetamines are also a problem and are often overlooked. This has been challenging because drug use can result in an increase in child abuse/neglect, but we can also help the parents deal with their substance abuse problems, so it’s a challenge we really want to take on. We’ve recently had additional training to offer classes specific to substance abuse.

Another challenge unique to our community is educating parents on the dangers of SUID (sudden unexpected infant death). In years past, our community has had a high number of child fatalities related to co-sleeping with newborns/infants.”

“And what kind of success have you seen with your program?”

M: “We used data to establish a baseline of 488 calls and 106 substantiations in 2010. Our goal was to achieve a 15% reduction in the reported and substantiated number of abuse cases for infants and children.

In 2015–2016, we reduced reported calls by 17.65% for children ages 0–18, with a 10% reduction for children under the age of 4. We also saw a 4.69% reduction in the number of children substantiated in abuse and neglect cases. Within the families we’ve had successfully graduate from our program, we’ve seen a 93% decrease in recidivism acts of child abuse and neglect.

On top of those statistics, we’ve also expanded the reach of our program to help increase awareness. Throughout the month of March and April, we provided education in local schools on educating children on how to identify the 4 different types of abuse, as well as how to report abuse/neglect. We will be training over 500 elementary aged students this month.

We also partner with our local Department for Community Based Services-Child Protective Services and host a child abuse awareness event at Saint Joseph London. Our event this year was a success, with about 600 attendees (last year we had approximately 250 in attendance), and 27 community vendors.

“Wonderful! Ann, have you seen a similar focus on expanding awareness?”

A: “Yes! While we have not seen a decrease in the rate of child abuse and neglect, we have seen an increased awareness regarding the importance of good parental skills. We have seen a steady increase in the number of prenatal referrals received, so that the coordinator has time to develop a relationship and begin teaching before the baby arrives. We’ve also built credibility with the other early childhood resources in our community. Referrals back and forth are made as needs are identified.

In addition to those measures of success, we also measure the skills and knowledge level of the parents who have multiple births in our program to see if there is any growth from birth to birth. The latest stats show that 91% of the families are able to demonstrate increased knowledge and skills when assessed during the next referral.

One particular success story that would illustrate the growth of this program occurred this past year. A young high school student became pregnant during her senior year. In order to help support this student, she was referred to the Family Footprints program. The school set up an area for the student and coordinator to meet on a regular basis. In fact, the school is giving this student class credit for the time she meets with the program coordinator. This young woman who was ready to drop out of school has now been inspired to remain in school and will graduate this year. She has grown in her knowledge regarding parenting through this experience.”

“Have either of you gotten any feedback from the community?”

M: “Yes, we receive feedback from community partners as well as families that have completed the program. Overall, it’s been very positive.”

A: “We’ve gotten feedback from our partners that the increase in referrals, especially prenatal ones, is very valuable to them. The improvements that parents in our program show with each successive birth, and the number of families who no longer need social services, are also indicators of how we’re making a difference.”

“Thank you so much for taking the time to share about your work.”

A: “Thank you!”

M: “Yes, thanks so much.”

For more information on child abuse and neglect, please visit:


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