Universal Approaches to Promoting Healthy Development: Introducing the Issue

How can society best support parents, beginning early in their children's lives?

That's the most basic question we ask in this issue of Future of Children. The articles that follow describe several ways that local communities have tried to provide such support, by implementing new interventions, reforming existing systems of care, and improving the coordination and planning of services. The primary assumption underlying these efforts is that unless we can develop programs and strategies with universal reach to help parents at all levels of need, we will fight a never-ending battle to deal with families and children exhibiting individual problems that affect child development and child safety. Perhaps even more important, the efforts we highlight in this issue are showing scholars and policymakers how programs that help all or nearly all families in a community might be developed, tested and used as a platform to employ existing resources more efficiently. The most important point of all is the growing realization that parents rarely succeed entirely on their own, and that providing support from community resources to families in need is a worthy goal of public policy.

Before we turn to briefly summarizing the content of each article, it's useful to consider why the program innovations described in these articles are widely seen as the next step in evidence-based policymaking. Those concerned with children's welfare and safety can no longer be content to support individual families deemed to need assistance only after they have demonstrated serious problems or substantial risk. Our approach must be organized around offering assistance to all or nearly all families in a given community early in children's lives, and trying to bring supports and services at the moment family problems and vulnerabilities are identified or shortly thereafter. We contrast this broader preventive approach with strategies that confront family issues only after serious problems such as abuse or neglect have arisen and seem to pose an immediate or potential risk of harm to children.

If we saw children in a canoe heading for a waterfall, we wouldn't be content to wait at the bottom and mend their wounds after they crash; instead, we would climb to the top of the falls and try to stop them from going over the edge in the first place. Similarly, we must begin earlier in children's lives and come equipped to identify family needs and offer assistance in a timely fashion before problems surface. Yet this issue of the journal is not merely about prevention versus treatment—it's about universal approaches that can reduce the population rate of adverse outcomes.

Many questions remain about the appropriate design, implementation and funding of universal strategies. Still, the programs described in this issue suggest that building the infrastructure to support a universal approach involves three important steps. The first is a mechanism that allows all families in a community to be assessed and to receive advice from qualified professionals about how to ensure the healthy development of their children. Second, when giving advice, these professionals must recommend specific prevention or treatment services that are available and accessible in the local community—and, often, help parents gain access to and pay for the services. Third, programs need a way to track families' developmental and other issues, the services they seek and receive, and the results of those services. The various strategies reviewed here illustrate not just how all three steps can be accomplished, but also the advantages of this approach to serving families.

A few words are in order about how child protection currently operates in the United States. Over the past few decades, child protection has been governed largely by the accepted belief that parents should make most of the decisions regarding their children's care and wellbeing. Laws overriding parental preferences are generally limited to cases in which a child has experienced physical harm or neglect, or is at imminent risk. And usually, public concern is triggered only after a parent fails. Unfortunately for parents who have limited access to family...