Photograph of Dr. Jonathan Kotch

Child abuse and neglect is a significant problem in the United States.  Nationwide, in 2003, there were 906,000 substantiated cases of maltreatment, and at least 1,500 children died from abuse or neglect, the vast majority of whom were preschoolers.  Through its health care and child care divisions, the Duke Endowment has a particular interest in the health and well-being of North Carolina's young children.

"Family-Friendly Child Care" focuses on licensed child care centers, the only such group setting where children and their families can be reached on a large scale prior to enrolling in public school. Nearly a third of all young children in the U.S. attend regular child care, and so the opportunity exists to discover problems early and offer early intervention on behalf of at-risk children.

The program has recruited 20 child care centers, 10 each in Lenoir and Beaufort counties.  Over the course of the grant period:

• Staff at the centers will be trained to identify and work with children who show signs of behavioral or emotional distress and to work with parents on parenting skills.
  
  
• Local health and social service departments will refer at-risk children to the centers with specially trained staff.
  
  
• Child care health consultants will provide liaison and assistance for the families to receive needed services (including mental health and substance abuse treatment).
  
  
• A family support specialist will offer individualized parent education and support, including home visits.

The current grant funds two years of development and training and a final year in which services will be fully implemented.

Kotch, who has conducted research on illness and injury in child care settings for more than 20 years, is pleased that the Duke Endowment invests in direct services for these underserved families.

"We hope to demonstrate that child care centers can be resources for the whole community," he says, "not just warehouses where children stay during the day.  We are training child care providers as role models in child-rearing techniques."

The program aims to train parents in effective parenting, conflict resolution, communication and other life skills, as well as educating them about the availability of community resources.

Response to the effort is enthusiastic. Tristan Bruner, program coordinator for the Lenoir-Greene Partnership for Children, describes a serious need and desire by child services workers to be trained and educated in best techniques, in areas from sanitation, to legal protocol, to how one recognizes the signs of maltreatment.

"We are grateful for the personal time of Dr. Kotch on this project," Bruner says.  "His expertise is prized in Lenoir County."

In fact, many prize Kotch's lifelong dedication to the well-being of children and families and his active involvement in social causes. Dr. Dana Hagele, a former student of Kotch's and now research associate professor in the UNC Department of Social Medicine and physician consultant for the Child Medical Evaluation Program, finds that her work frequently overlaps with that of her mentor, and she admires his choice to be involved in evidence-based public policy research, after being trained as a pediatrician.

"It takes a great deal of courage to 'hang up your stethoscope' after all the medical training and focus on public policy," Hagele said. "Not many people take that on as their life's work.  He's a real role model for me."

After receiving a bachelor's degree in anthropology from Columbia University and a doctor of medicine from Stanford University, Kotch earned bachelor's and master's degrees in social anthropology from King's College, Cambridge, followed by a master of public health from UNC.  He was associate chair for graduate studies in the Department of Maternal and Child Health from 1992 to 2006 and has been a professor in the department since 1994.

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UNC Gillings School of Global Public Health contact: Ramona DuBose, (919) 966-7467 or ramona_dubose@unc.edu.