How did New Hampshire create and distribute a resource guide to support child and family well-being during the COVID-19 emergency?
LESSONS FROM OTHER FIELDS
How did New Hampshire create and distribute a resource guide to support child and family well-being during the COVID-19 emergency?
By Scott Kleiman, managing director, Jess Lanney, assistant director, and Grace Palmer, government innovation fellow, Harvard Kennedy School Government Performance Lab*
To engage community members in proactively supporting children and families during the COVID-19 emergency, New Hampshire’s Division of Children, Youth and Families (DCYF) developed and released a “Supporting Child and Family Wellbeing” resource guide. This strategy brief describes why and how the guide was developed, how it has been distributed, and plans for sustaining these tools as part of regular agency operations.
Why the guide was needed
Since the beginning of the COVID-19 pandemic in early spring 2020, reports of suspected child abuse and neglect across the country plummeted at the same time that children and parents faced increased stressors. In New Hampshire, DCYF saw a 40% reduction in the number of child abuse and neglect reports it was receiving relative to the two years prior. The state’s data also showed that the sources and nature of reports were changing, with the most substantial drop in calls from schools and healthcare professionals, and an increase by nearly half in the portion of allegations citing lack of supervision.1
Pandemic-related school and business closures, along with isolation from friends and family, have been linked to increased unemployment and financial instability, substance use, mental-health challenges, and instances of domestic violence — issues that often are risk factors for child abuse and neglect.2,3 After New Hampshire’s stay-at-home order was issued, many community members (including school administrators, teachers, and social workers) had fewer opportunities to interact with families. In addition, professionals working with families across a range of services reported widespread confusion about what resources were still available and how to help families access them during the pandemic.
New Hampshire’s “Supporting Child and Family Wellbeing” resource guide was developed to encourage community members who regularly interact with children and families, such as teachers, neighbors, or child care providers, to check in on families and help them access needed supports. The simple yet detailed two-page guide provides sample questions for professionals and community members to ask both parents and children to help determine resource or support needs. It also contains lists and links to access concrete services, including financial assistance, food and nutrition resources, crisis support, and housing programs. (A copy of the state's original resource guide can be found in the appendix of the PDF version of this brief.)
By creating and distributing a simple, holistic resource guide to inform both professionals and community members about different ways to help families during the pandemic, DCYF sought to proactively support child and family well-being to both prevent child abuse and neglect and, in the case of legitimate child safety concerns, intervene most effectively.
How the guide was created
DCYF had three main priorities in creating the resource guide: 1) produce it as quickly as possible, as families already were navigating the effects of COVID-19; 2) offer helpful and accessible guidance and resources to support a wide range of community members and their needs; and 3) articulate a supportive message that encouraged families to reach out for help, rather than a surveillance-based message that might cause vulnerable families to avoid interactions with potential reporters.
To accomplish this and create the guide, DCYF:
- Used data analysis from the hotline to prioritize audiences for the guide and inform the state’s distribution strategy. DCYF found that the total number of calls to the child abuse and neglect hotline had fallen by roughly 40% in the weeks after COVID-19 hit. One of the largest declines in reports was from schools and teachers (down more than 60% compared to a typical week in 2019), many of whom were still in contact with families virtually and could leverage the guide in these virtual interactions. DCYF also prioritized other traditionally high-volume reporter groups as prospective audiences, such as law enforcement, mental health professionals, medical professionals, and social workers. DCYF analyzed local level data to identify specific organizations — schools, law enforcement agencies, mental health clinics, and hospitals – that had shown the most marked declines compared to prior year reporting, and then used those findings to drive community-level outreach and target distribution.
- Drew on insights from existing networks of human services professionals to identify resources for inclusion in the guide. DCYF tapped into an existing working group, comprised of professionals both from DCYF and the wider Department of Health and Human Services (DHHS), to gain insight on how best to help families. This workgroup helped identify useful and current family support resources to include in the guide. Using this feedback, DCYF prioritized concrete services to list in the guide, including resources for financial assistance, food and nutrition, housing, crisis support, substance use treatment, child care, and guidance specific to coping with COVID-19. When deciding on which resources to include, DCYF also prioritized those that were easy to access and could serve as a gateway for referral to more intensive services, if needed. DCYF highlighted general supports that families can connect with if unsure about what resources they may need, including family resource centers that serve as a community-based front doors for accessing services. The centers help families to connect with peers, speak directly with professionals, and be connected to the right services, if necessary.
- Engaged individuals with lived experience in child welfare to better align the guide with community needs. DCYF also sought feedback from parents with lived experience in the child welfare system, using an existing advisory group to quickly get input on the guide’s design. Parents with lived experience reviewed early drafts of the guide and provided concrete recommendations to make it more accessible and supportive, including: 1) starting with a clear statement affirming DCYF’s belief that parents are their children’s most important protectors and should, whenever possible, be supported in caring for their children themselves; 2) reducing any perceived stigma about reaching out for support by altering the language to validate that most families were struggling during the emergency; and 3) targeting the guide to all community members in New Hampshire, not just select professionals, so that families could help themselves and one another.
- Drafted the guide in jargon-free language, and with concrete advice, so it could be widely distributed and used by non-professionals and families. DCYF wanted the guide to be written and presented clearly so that non-professionals and families could digest the information easily and access needed resources. To increase usability by non-professionals, the two-page guide includes talking points and sample questions for community members to use as they check in with parents, caregivers, and children. Tips for handling cases of suspected abuse and neglect are offered at the end of the guide, communicating both when and how to contact DCYF in the case of a safety concern. The guide also was translated into Spanish, the most frequent language spoken at home in New Hampshire among those not proficient in English.
Stakeholder questions asked by DCYF during the guide design process
Questions for agency professionals
- What are the most important things for families to know right now?
- Have any services or resources changed as a result of COVID-19?
- What are some strategies to engage families and children in conversations that are non-threatening and supportive?
- What are the best ways to ask what a family might need right now, particularly for families who might not know what is available to them?
Questions for parents and community members
- What are some of the biggest needs families might have right now?
- Is the current framing of the guide supportive? How can we adjust the questions in ways that feel accessible, helpful, and supportive?
- Are the resources currently listed on the guide reflective of what you might need?
How the guide was distributed
After finalizing the resource guide, DCYF began its dissemination efforts. The agency emailed the guide to service providers, community organizations, homeless shelters, child care facilities, and other organizations identified as still in regular contact with families. The email included a cover letter written by the DCYF director that encouraged recipients to continue forwarding the guide to anyone in their contact list. (A copy of the letter is included as an appendix to this brief.)
DCYF’s regional field offices circulated the guide to local service providers and community organizations and asked them to distribute the guide directly to families in their networks. Staff regularly followed up to resolve questions and encourage proactive outreach to families. DCYF headquarters supported this local outreach effort by sending its district offices a “how to” packet, which included analysis of the decline in reporter data specific to their region so they could target organizations showing more marked declines, a sample email to reach out to community partners, and a suggested conversation guide to use when engaging community partners. The agency also distributed the guide to about 700 parent partners who previously had been involved in DCYF’s regional advisory committees and practice-improvement workshops.
At DCYF’s central intake hotline, staff referred to the guide to counsel reporters on potential resource connections for families, as well as emailing it directly to reporters as a follow-up to their calls. The agency encouraged intake hotline workers to directly transfer callers to local family resource centers (one of the “go-to” general resources featured in the guide) in circumstances where a report would not be investigated but the family otherwise might benefit from additional supports — a previously rare practice.
To reach the broader public, DCYF launched an earned media campaign to bring attention to the resource guide, including a press release, multiple newspaper articles, and an hour-long segment on New Hampshire Public Radio.
Other state agencies also helped distribute the guide. New Hampshire’s Department of Education shared the guide with every teacher across all of the state’s 167 school districts, and the Attorney General’s office sent the guide to the state’s 200-plus law enforcement agencies. The education agency and DCYF also partnered with the New Hampshire National Guard to pack the guide inside 25,000 “health and wellness” kits distributed to families, alongside dental supplies, medication disposal pouches, and resources. New Hampshire’s refugee health coordinator also circulated the guide to resettlement agencies.
The state has plans to sustain much of this work as part of regular agency practice after the COVID-19 emergency ends. DCYF will continue to closely monitor reporting trends at intake. The guide will be updated as resources in the community change. The agency also is working with the state’s family resource centers so that central intake hotline staff can continue to directly connect callers to the centers when reports are screened out.
1. NH Department of Health & Human Services, Division for Children, Youth, and Families. “Trending in Data During COVID-19.” June 10, 2020. https://www.dhhs.nh.gov/dcyf/documents/dcyf-covid19-tracking-06102020.pdf
2. Nirmita Panchal et al. “The Implications of COVID-19 for Mental Health and Substance Use.” Kaiser Family Foundation. April 21, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
3. Centers for Disease Control and Prevention. “Child Abuse & Neglect: Risk and Protective Factors.” Accessed July 7, 2020. https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html
*The Government Performance Lab (GPL) at the Harvard Kennedy School of Government conducts research on how governments can improve the results they achieve for their citizens. An important part of this research model involves providing hands-on technical assistance to state and local governments. Through this involvement, the GPL gains insights into the barriers that governments face and the solutions that can overcome these barriers. By engaging current students and recent graduates in this effort, the GPL is able to provide experiential learning as well. The GPL wishes to acknowledge that these materials are made possible by grants and support from Casey Family Programs, the Endowment for Health, and the New Hampshire Charitable Foundation. For more information about the Government Performance Lab, please visit our website at http://govlab.hks.harvard.edu.