The Shift: Voices of Prevention — A podcast by Prevent Child Abuse America
How do we create a future where every family is safe, supported, and filled with hope? The Shift explores bold, upstream solutions to the public health challenges facing children and families today.
Hosted by Prevent Child Abuse America, each episode features transformative conversations with experts, changemakers, and people with lived experience. Together, we dive into prevention strategies, policy breakthroughs, and the systemic shifts that have the power to change lives.
Part of PCA America’s movement to make family well-being the new normal, The Shift amplifies the voices and ideas shaping a brighter, more hopeful future for all families.
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Guest ideas or feedback? Email us at theshift@preventchildabuse.org
The Shift: Voices of Prevention — A podcast by Prevent Child Abuse America
Ep. 1: Dr. Melissa Merrick and Dr. Allison Arwady | PCA CAP Month 2024
PCA America is thrilled to bring you its first ever conversation series hosted by our very own President & CEO, Dr. Melissa Merrick.
Dr. Merrick explores the impacts of Adverse Childhood Experiences (ACEs) on children’s lives with a special guest, the esteemed Director of the CDC’s National Center for Injury Prevention and Control, Dr. Allison Arwady. This groundbreaking conversation marks a significant milestone in our mission to prevent child abuse and neglect.
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Hi everyone, we're joined today by Dr. Allison Arwoody, the director of the National Center for Injury Prevention and Control. Dr. Arwoody leads the CDC's innovative research and science-based programs to prevent injuries and violence and to reduce their consequences. And she most recently served four years as the commissioner of the Chicago Department of Public Health, leading the health department of the nation's third largest city, and of course, home to PCA America, including through the COVID-19 pandemic. Dr. Allison Arwoody, welcome to the PCA America's podcast in celebration of this year's Child Abuse Prevention Month.
SPEAKER_01:Yeah, thanks so much for having me. I really am looking forward to the conversation. Obviously, PCA America loves partnering with CDC and vice versa. I think there's a lot of things that we have to talk about because we care about a lot of the same work and uh really looking forward to the conversation. So thanks for that.
SPEAKER_00:I sure do. Oh, thank you so much for being with us. And obviously, such a special place in my heart for you, all of the great work you did here in Chicago. But then also, of course, I spent uh numerous years at the injury center doing such that important public health work. And I'm just so excited uh for your new role. So, first of all, congratulations on this humongous role. What an exciting opportunity and such a critical role at the CDC for real prevention impact. Tell us a little bit about your vision on how that impacts families.
SPEAKER_01:Absolutely. So, you know, as you said, yes, this is a big role. And just because everybody may not know the injury center, uh, it's the center at CDC that is focused on preventing injuries. But what does that mean? That means overdose, that means suicide, that means violence in all forms, which is where there's some overlap. It also means other injuries, things like drowning, uh, things like falls, uh, even some of the injuries that come from car crashes, for example. Um, and so in all of these approaches, you know, the reason I'm attracted to it is first of all, these are preventable, right? And I'm a pediatrician and an internal medicine doc by training. I really like taking care of patients. I like helping them get well after they're sick. But for me, the reason I'm attracted to the work of the injury center and really to public health overall is we have the ability to think about before an injury happens, before one of these really life-changing events uh comes along. Um, and we can use data and we can use evidence and we can make investments and we can try things uh in partnership with community to really say what works. Um, and so when I think about, you know, a vision overall, we like to have a vision in the positive, right? Not in the negative. Um so, you know, thinking about having a vision where we've got healthy and safe childhoods for all kids, right? Something as basic as that. Um, thinking about the fact that when we can create safe and stable and nurturing relationships and environments for all children, that in turn leads to better development of the brain and the endocrine and the immune systems. That in turn leads to healthier children, not just physically, but emotionally and socially and behaviorally. And that in turn, healthy children, leads to healthy adults. Um, and when I think about how hard this country is being hit right now by the issues that the injury center works on, we are never gonna treat our way out of these crises, right? Uh and so just to put a couple more um out there, and then I'll stop talking about it because I want to get into the prevention piece. But right now in this country, injuries related to firearms are actually the number one cause of death for kids one to 19 year olds. Overdoses are the number one cause of death for adults 18 to 45 year olds. We see statistics that just take my breath away when we're interviewing young people. The most recent survey for the youth risk behavioral surveillance, which is a survey that's done in high schools, one out of 10 high school kids told us that they had not just thought about, but attempted suicide. We have to think about getting upstream. We have to think about preventing these outcomes because when they happen, you know, it's it's it's a tragedy for the person, but for their family, for their community. Um, and so I know we're gonna have a chance to talk a little bit more about adverse childhood uh experiences, um, but I think that that the ability to think about these really hard outcomes that that are difficult for everybody to talk about, but then change the lens and say it's not always just about responding to these traumatic events. It's about doing the investments, doing the work to prevent them in the first place. As a society, uh, that that's why I do public health. And so the vision is a really, you know, it's a positive one of healthy and safe childhoods, which then lead to healthy and safer adults. Um, but there are real things in all of these complicated spaces that we can do to prevent that work.
SPEAKER_00:Oh my gosh, I'm so it's just wonderful to hear you say that and express that vision in such a clear way because prevention is possible. And I think that's what we learn and our science shows is true, right? When we make sure that families have what they need when they need it, delivered in their own communities, you know, with love and respect and trust without stigma before they're in crisis. That's how we are really operationalizing prevention and how we operationalize equity for that matter, right? It's like, what can we all do to assure the conditions for health, well-being, and thriving and prevention of violence and all of the adversities for children and families? Such an important public health lever that I'm so glad that you highlighted there. We can really meet our nation's health, well-being, and prosperity goals when we have healthier kids. And we know that our healthier kids live in healthier families, healthier communities, and really live in a country that can better support children and families to reach their maximum health and life potential. So, Dr. Arwoody, just so excited that you're in this role at this time. And speaking of critical roles, you served as the leader of the third largest city during a national, well, really a global health crisis. Um, so we have so much to learn from you about supporting diverse communities. And you've highlighted the importance of partnerships and communication in lots of venues, but we'd really love to hear more about your perspective, especially through the lens of diversity and equity.
SPEAKER_01:Yeah, absolutely. I mean the COVID response was just such a fracturing of the way that we normally do things in ways that were terrible, but also I think had a lot of potential and a lot of ability to really think differently and in ways that center diversity and equity, not as sort of a nice to have, but as essential to really making a difference, you know, when it matters at the heart of the issue. And so, you know, as you noted, I was lucky enough to be in Chicago at the Chicago Department of Public Health for about eight years before coming into this role, and then the last four as commissioner. And that did that was almost the perfect overlap with COVID. And I learned a lot during that about what it looks like to not just say that you're engaging quote unquote community, but to really start from a point of listening and not talking and bringing solutions, of recognizing that there is no monolith community, that that in a city as diverse as Chicago, but in a city as diverse as anywhere that you are, and in this country of ours, there are by definition groups and subgroups, no matter how you slice and dice the population, that are gonna have different needs, that are gonna have different um areas of strength and areas of focus, and that are going to need to be part of any real solution. Because again, public health is not so much about medical care. There is work to do on the medical care side too, don't get me wrong. But in public health, where you're thinking about systems and you're thinking about environments, if you start having conversations that assume, you know, as government, for example, coming in or as a public health department coming in during COVID, that you know what is needed for this environment or this community. Like you're never gonna have a real conversation. And I was really, really appreciative in Chicago that we saw a lot of really honest conversation um about where things had not gone well previously. There's all kinds of reasons why um different groups are not very likely to, you know, trust the health department, honestly. If you're a representative of the government and you're a representative, you know, indirectly of the healthcare system, and you're um, you know, a representative of long histories of power and sort of how those have landed in different ways and not always of really centering community voice, you're starting from a point where there's not always that much trust at baseline. Right. But in a crisis um like COVID, but I would also argue in a crisis like romantic children the glass, like working on uh suicide prevention, you've got to make sure that we're not just thinking about how to tailor our message as public health, but to make sure that the messages that are we're even developing kind of make sense in terms of uh the people we're listening to. And then so much about who the messenger is, right? And that and that trusted, um, that trusted messenger stance. And so, you know, in in in Chicago, for example, we we did a lot of work to say equity is not just a nice to have. If you're in a crisis, you've got to make sure that resources are getting to where they are most needed to actually control the outbreak, right? It's not just a theoretical nice idea. It's about saying, where in Chicago is COVID hitting the hardest? Why is that where COVID is hitting the hardest? Is that because of, you know, crowded housing and um, you know, essential work that can't be done from home and food insecurity where you, you know, are not able to just stock up and stay home? Uh, is that about intergenerational? You know, it's about all of these things and so much more. And if you don't design your responses um to be tailored to those needs uh and recognizing that those needs are going to be different, even in different parts of the city, you're not gonna really make the progress that you need to make, both on building some of that trust so that when we've got things like a vaccine to offer, communities understand that that where that is coming from, that that this is something that is uh is is going to be valuable everywhere, but it's going to be valuable in their community specifically. Um, but it's also about not having this be something that's tacked on after the fact. We really need to center a lot of the, you know, especially racial and ethnic disparities, but you know, there were disparities around age, there were disparities around, you know, neighborhood, all kinds of other ways that you could look at this. Um, and and we we measured our success in a lot of ways based on whether we were seeing um improvements and outcomes in the neighborhoods, for example, or um the various subgroups um that were furthest from where you would want to be. Are we making progress there? Is in a lot of ways more important. And that's what's going to move the lens overall, I think, when you're wanting to make impact on these huge societal programs. And, you know, I think frankly, at the injury center at CDC, you know, there is also a lot of, you know, prioritization, really centering of health equity. I think there's a lot still that we are all thinking about. What does that really look like? How do you make sure that that resources are going where they're most needed, that the voices of people with lived and living experience and communities are central to how we are shaping and evaluating interventions? Um, how are we really developing some of that evidence base and the partnerships? Um, but I think when you look at it doesn't matter which of the topics you look at within the injury center, um, they don't land in the same way on people in this country, broadly speaking. And again, there's different ways to think about diversity. Um, but the ability to have that kind of a focus and then to recognize that diversity also brings the amazing strength, right? And the resilience. And that anytime that you are making a decision, you've got to have diverse voices in that room to make the best decision possible. That you've got to really recognize that there is such an incredible amount of resilience and um connectedness and sort of culture building that again can look different in different subsets, but you don't you want to be careful when you're thinking about partners and you're thinking about equity and you're thinking about diversity, that you're not just thinking about sort of the negative outcomes, but you're thinking about the incredible positive work that can come. And I think when I think back to the time in Chicago, I think we we did not everybody got everything perfect. There's a million things, you know, that everybody wishes we would have been able to do more of in COVID. But I'm incredibly proud that we centered equity not just as a buzzword, but as a way to make decisions about things like how resources and vaccines were distributed, how community voice was involved in creating messaging campaigns, and how we were pushed to really focus on things like food insecurity, even before we started thinking about PPE, because that is frankly where the needs were greatest. And so I learned a whole lot kind of personally, um, and am bringing that to the injury center, where there are similarly so many people really committed to thinking about how do we do this work in a way that that moves the needle, um, doesn't just move the needle for the median, but kind of moves the needle uh for both positive, kind of and negative in in ways that that can impact on these huge problems. And we're never gonna make the progress we need to make, in my opinion, um, on these issues if we're not thinking about those issues from the beginning at the end and at all points in between.
SPEAKER_00:Oh my gosh. I so much that you said there is just true to the work of public health. You know, I always refer back to that um institutes of medicine, like in 93, 1993 definition of public health. And it says it's what we as a society do collectively to assure the conditions in which all people can be healthy and can thrive. And so it's that collectively, right? It requires partnerships, it requires a difference of experience, the lived and living expertise, the centering of families and of communities and of youth, right, into what those prevention solutions are. And I know that in our work, our collective work, you know, to prevent adversity, you know, early adversity, child abuse and neglect, other things before it occurs. Like we're all talking about co-design. And I think it's exactly what you just described in this beautiful way, right? Until we actually celebrate diversity and recognize that we're going to be stronger with diverse perspectives early and often and throughout the process, we're not going to be able to maximize the possibility of prevention, right? And we we already said and we say again and again here that prevention is possible. So we want to maximize that possibility. It's just really wonderful to hear you say it in such a clear way. And I'm glad that you feel proud of the work that you did in Chicago because we are now a Chicagoan and we feel proud of the leadership that you provided to this city and still uh think of you often and are so happy that now you have this platform at our nation's you know public health agency to really elevate um uh the different uh different perspectives and different approaches that are necessary to really be in the business of doing the work of public health. So I just I just love everything you said, and I'm so um excited um to be in partnership with you. One of our aspirations, as you know from the PCA America, I know that you share this aspiration, is that for children, you know, that the children and families have mental and physical health and well-being across the lifespan, right? And here in Chicago, you took an innovative approach to the promotion of mental health. Tell us more about that and some key lessons learned that could be replicated as we build a primary prevention ecosystem in this country that doesn't currently exist. Like you said before, you know, we wait for families to be in crisis before they can get the services and supports that could have kept them healthy and strong in the beginning. And yes, the prevention continuum has a real need always for treatment and trauma-informed responses, but until we really move upstream, we're kind of kind of be like in the position we're always at. So tell us more about that, um, specifically in mental health and some key lessons learned that could be replicated as we build this primary prevention ecosystem for our country.
SPEAKER_01:You know, you are correct that not just me, but my incredible team at the Chicago Department of Public Health helped me think in newer and bigger ways about what does it look like to take a public health approach to mental health. I think for a long time, public health has not been as focused, frankly, on the mental health side of things. But you don't have to look any further than COVID, right? Uh to sort of recognize that, yes, it was physically, you know, the the in terms of the illness and the deaths, I mean, devastating. But that physical illness had really consequential mental health impacts. Also just the changes, whether it was just the isolation, that, you know, so many, so many things that upended connection in ways that were critical early in the pandemic, especially when we really didn't have the tools to be able to help keep people safer. Um, and so in Chicago, we made a decision not to pull anybody from our behavioral health team, which was our mental health substance use and violence prevention teams, into sort of quote unquote COVID. Everybody was working on COVID, of course. But we said there's gonna be even more need for mental health resources as a result of COVID. And so different than most other folks across the health department, keep going, keep building. And just to kind of put this in some perspective, when I came in as commissioner, again, most of this was not my work, it was a citywide effort, my team, lots and lots of advocates, support from the mayor's office, et cetera, the health department, we were um supporting the mental health care for around three to four thousand Chicagoans who otherwise would not have been able to get that care. And again, especially for people with serious mental illness, there are people who absolutely we've got to make sure can get into treatment. But we were seeing such a gap in terms of the number of people who needed that care and what was available. And importantly, people didn't know how to navigate it very well, right? For as complicated as our physical health system is, our behavioral health system is even harder to navigate, especially if you are uninsured, underinsured, uh, you know, perhaps undocumented, have other issues going on in your life, need substance use disorder treatment at the same time as you need mental health treatment, you name it, it's more complicated. And so we did a whole host of things, um, really pulling together. Everybody working in the safety net mental health care did a lot of investments to make sure that there were mental health resources outside of traditional clinic settings. So making sure that schools and food pantries and uh, you know, service sites, libraries could have therapists, for example, in a no-rong door approach, sort of to thinking about mental health on a continuum while really working on that treatment. We went from between three and 4,000 people getting care that year that I came in as commissioner to while COVID was going on, uh, up to over 70,000 Chicagoans, you know, getting care, getting treatment. And that was through the work of really building collaborations, helping to think about how you navigate and you know, this system and making sure that when we were uh promoting any of these resources, funding any of it, pulling together, it was all by definition for you, no matter who you are. This is not, we don't care if you're insured, we don't care what language you speak, we don't care, we don't care, but it's again thinking about a systems-wide approach, which is actually public health is pretty good at that. Like, where what do we need to do kind of as a whole system? And then getting upstream, saying for the people with the most acute needs, yes, there's work to do on treatment, and we're gonna embed for the first time mental health professionals into the 911 uh, you know, call response system. Yes, we're gonna for the first time embed behavioral health care in homeless shelters. Yes, for the first, you know, there are these sort of pockets you work on. But when you think upstream from that, what does it look like? First of all, to change the conversation around mental health. Mental health is health. We had a campaign in Chicago that was called Unspoken that was really about trying to take issues of mental health or substance use disorder or, you know, suicide prevention, things that we frankly often don't talk about, turning these into things that we talk about. What does it look like to reduce stigma around that? Again, working in very focused ways with a whole host of um people from different backgrounds and communicators, and thinking about things like we're never gonna treat our way out of this. And so, what does it look like for coaches? What does it look like for uh faith leaders? What does it look like for people who interact with young folks, especially sort of across this city? What does it look like for peers to feel like they have some language to start those conversations and then know what to do for more resources? And this really for me, just to tag into the work at CDC and the injury center, I've been really pleased in the way that the center, and I know this is work that we've shared with PCA America, working on this adverse childhood experiences prevention work. Um and, you know, I think your audience knows about adverse childhood experiences, but but the work of thinking about things like child abuse or neglect as being something that when it happens in childhood, first of all, it is preventable, but then when it happens, um there is the potential for longer-term uh mental health, physical health, all kinds of outcomes there. And when I see data like that, if we were able to decrease the amount of adverse childhood experiences that Americans were having, we would cut adult depression diagnoses by more than 40%. That's the kind of upstream work that we need to do. And so CDC has a website, for example, um, it's veto violence, uh, V-E-T-O-violence.cdc.gov, that puts together trainings around ACEs prevention that are tailored for a whole host of different groups. It's not just about um pediatric care providers, although they're in there. There's there are modules in there for training educators, uh, for training spiritual and religious leaders. Like again, this idea of how do we broaden the conversation beyond clinicians? How do we think about creating connections uh in all of the ways that we that we mean that as communities? And that work of building connections, building networks, making sure that young people in particular know where to go, have people to talk to, um, are able to sort of feel some more support around that at a time when brains are developing and there's a lot of impulsive behavior, that is the kind of work that you do to prevent mental health crises, right? To prevent some of that suicidal ideation attempts work. Um, and so that's just that, I mean, that's just one example. But I really think that this work of thinking about what happens early, how do we prevent what happens early, and then how do we promote the positive childhood experiences that can help mitigate some of those adverse childhood experiences? That kind of work is pretty invisible a lot of the time, or it can be, but it is what sets you up later in your life to have fewer challenges in sort of being able to lead that full and healthy life from both a mental and physical health standpoint.
SPEAKER_00:Yeah, no, I just love how you've underscored that we all have a role to play in keeping children and families safe and healthy and thriving. And like truly, the science shows that when we get it right in the first place, it's less costly, it's more effective, it has all of these transformational intergenerational impacts as well, right? So when we really think about, you know, especially as it relates to child abuse and neglect, I think still there's this dominant narrative that it's like that bad mom or that poor family or whatever, and really demystifying that for people that it's like we're all just trying to do the very best we can do, but none of us does this job of parenting and and and uh nurturing alone. We all rely on each other. And I mean, in some ways, I'm like a perpetual optimist, but I think a silver lining of COVID was that we kind of saw public health in action, right? We saw how my health was completely connected to my neighbor's health, right? Or the person next to me on the airplane. And, you know, if I wore a mask, but my neighbor didn't, it's not as effective, right? I curbing, and the same is true in prevention evases, right? It's like we all have a role to play. We want to get to those root causes, which are not bad parents. It is structural and social determinants of health, you know, all the isms, all the, you know, uh uh things that we challenges that we're all experiencing and that some of us have experienced for generations. And it's like, yes, but even with all of that, we know and the science show that that prevention is possible if we reduced ACEs, right, in this country. And I love that you quoted the vital science. I was uh an author on that, and and just love the work that you can find on veto violence because those are some of the coolest, most interactive tools that CDC has, you know, those trainings on ACEs, obviously, our website, other tools for people who are listening who want to get to that. But I just feel like really preventing ACEs, preventing early adversities, early challenges for families is really such a critical public health lever that really the primary prevention of, as you said, mental health problems start with healthier children, right? Of insert health outcome here. There's been over 80, you know, that have been tied with ACEs in the literature. So I guess as we're wrapping up today, what do you see in your really like just unique role given the collection of experience and leadership positions that you've held? Uh, what do you see as the future of primary prevention in this country? And what should we really be focusing our time on now so that we were all prepared in the future?
SPEAKER_01:Yeah, you know, I really think, I mean, I think so much about that. I think one thing, and I thank you for doing this, is continuing to really help folks understand this space. We talk about it in public health, but not everybody outside public health even understands the term primary prevention, right? And again, most Americans, when they think about health, they think about when they go and seek health care. It's very obvious when that happens. So much primary prevention work goes unseen by definition, when the outbreak doesn't happen, when the abuse doesn't occur, when the overdose doesn't result. And helping uh I think folks to recognize that this work is also quantifiable, that this work is extraordinarily cost effective, actually. Um, and that it is we actually we have a lot of data on what works. And so when I think about the future, the future of primary prevention, I think some of it is about just continuing that education. And I would hope, you know, folks who are listening uh into this podcast, you know, are part of that, really thinking about how do I, how do I help people who maybe aren't in public health all the time understand this work, understand the criticality of it. I also think we've got to make sure that we are getting health outcomes clearly inserted into other investments. So you take something like um ensuring a strong start for children through things like access to high-quality childcare, right? We've got all kinds of evidence, you know, the conversation tends to be on are the kids ready to read, right? Like what's gonna happen, like sort of on the educational, and those are amazing. But those, those are also, there's good evidence, as you know, that that that kind of work helps to prevent aces, right? Helps to lead to better health outcomes. Similarly, you know, work of thinking about, you know, skills for both parents and kids around healthy relationships and resilience, like those kinds of really concrete investments, they actually do pay off. They're not just sort of nice, fluffy things to have. Uh, there's evidence around them. And when you do them well and you do them at scale, uh, you are able to make an impact in a way that is measurable. Uh, and we're able to really start making progress on these issues that we are we're never gonna get ahead of, I fear, as a country, if we can't get, if we can't get upstream and if we can't help sort of tell this story um in really concrete, uh, in really concrete ways. The theory of change, I know that PCA America has done a lot of work on. You know, I love that work. I love that really thoughtful piece around, you know, how do you create this? How do you raise awareness of this? How do we change this conversation? COVID did offer some opportunity, I think, to think differently about that in connectedness, in prevention, um, in in being more sort of prepared and thinking kind of as a society ahead of a crisis that might come. That is the entire bench of public health. And so, you know, I'm glad CDC's director, uh, Mandy Cohen, Dr. Mandy Cohen, you know, has made supporting young families a priority for this agency, um, just as she's made improving mental health a priority for this agency. And the ability to do that with partnership across the government, across partners like you outside of government, but also with people who don't are not the most natural partners, but can understand that we've got to, for these huge problems, like it, like the injury center faces, like PCA America faces, we just have to think about preventing them from the beginning uh and and make the case for that with with one concerted voice that is not just coming from public health.
SPEAKER_00:I totally agree. I am so honored um to be in partnership with you, with the CDC, um, you and and Dr. Cohen, who you referenced, you know, we are just coming on the heels of Women's History Month, and I'm in awe of your uh leadership. Uh, and now we're in Child Abuse Prevention Month, and prevention is possible. You've helped us understand um a little bit better what a public health approach to prevention looks like. Something that requires all of us, there's a role for all of us to play. And we need to make prevention visible, and you know, because it can be really invisible, but prevention visible is joy, health, well-being, thriving, prosperity. It's all the good stuff. It's all the stuff that's within our reach. And so not only is prevention possible, we want to always be maximizing that possibility. Thank you so much for your great leadership, Dr. Rwoody, and for your partnership. And um I hope soon friendship, because I want to talk more and more to you every day. And I want to, you know, learn about your uh favorite hobbies in Chicago. And so we'll take that offline. Um, and maybe we could have a part two that's like a more fun conversation. So thanks so much um for everything you do and the way you do it and for joining us today.
SPEAKER_01:Yeah, I mean, it's really, it's really been my pleasure. I, you know, I know from my my new colleagues here at the injury center, you know, how valued your your work personally was while you were here, but also the work that you're doing at PCA America. And I just want all of us to think about how we broaden this conversation so that it is one that is happening um in kind of all corners of this country, because that's what we're gonna need to get on top of these issues. So, yeah, looking forward, of course. Uh I love always, you know, I could talk about this stuff forever, as you can tell. Um me too. So um thanks. Thanks for thanks for doing this. Thanks for having me on. Um, and certainly more conversations to come between you and me, but also I think more conversations, I hope, for the folks who are, you know, listening in on this podcast. Um, because we've we've got to get this conversation happening uh across the country.
SPEAKER_00:Absolutely thanks for tuning in to this exclusive episode. The 2024 Cat Month series can be streamed on our Cat Month page, preventchildabuse.org backslash catmonth 2024, and wherever you listen to your podcasts. You can find more information at preventchildause.org and on our social media channels. Remember, prevention is possible, and together we can prevent child abuse, America, because childhood lasts a lifetime.