Our Approach

Incorporating Lived Experience: A Novel Approach to Developing Recommendations

The AAP is a membership organization representing pediatricians that focuses on policies designed to improve the health and well-being of children and their families. Our subject matter expert leaders marshal the latest science and evidence to determine which policies are most likely to benefit children. However, the AAP recognizes that the intention of our policy work alone is not sufficient; our work must calibrate to the impact of the policies the AAP supports. With that in mind, the AAP took a fundamentally new approach to developing these priorities that involved compensation of and close collaboration with individuals who have lived experience in the child welfare system to inform the AAP’s work developing public policy recommendations at every stage. Their invaluable input shaped the structure of the project, guided the policies and the outcomes considered, and informed the deliberations. These recommendations would not exist without their expertise.

To support this work, the AAP engaged as consultants five individuals with lived experience in the system to serve as expert consultants on a project to bring together thoughtful, strategic, and diverse stakeholders to reimagine a 21^st child welfare system through a series of convenings to examine pressing issues facing the system. Those stakeholders included other child welfare, diversity, equity, and inclusion, juvenile justice, homelessness prevention, childcare, mental health and substance use disorder treatment, and child health advocates. Inviting stakeholders who also had their own lived experience in the system was a key priority and added to the unique perspective of our panelists. By bringing together a diverse group to examine these issues and centering the voice of lived experience at the core, we hoped to find creative solutions to address long-standing problems. The results of the partnership exceeded expectations. Over a six-month period, the AAP listened to new perspectives, learned from their examples and insights about how policies can spur practice improvements but also bring unintended consequences, and jointly considered bold solutions. In concert with this expert panel, we engaged diverse partners in the child welfare policy community¹ on a variety of topics, including how to build upon the successes of the AAP-supported Family First Prevention Services Act, opportunities to continue and expand work to eliminate inappropriate congregate care, and the need for a public health approach to child welfare policy.

We hope these recommendations will inform federal policy makers and the broader child welfare community on the direction of child welfare policy. This project has helped further fuel the AAP’s commitment to engaging individuals impacted by the policies for which we advocate, and we hope this example will encourage our partners to pursue similar approaches so that all organizations advocating on behalf of children and families benefit from widespread adoption of this approach. 

The Family First Prevention Services Act: Landmark Legislation is Foundation for Further Reform

Children in foster care experience disproportionate exposure to adverse childhood experiences and trauma. The experience of removal from the home and placement in care itself contributes to a child’s trauma history. Trauma contributes to toxic stress and negative health and social outcomes across the lifespan. The prevention and treatment of trauma is essential to promoting the well-being of children in foster care, and care and services for children in foster care should be trauma-informed. The research is clear that children fare best in families, which is why the AAP advocated for the Family First Prevention Services Act. Family First focuses on keeping families together whenever possible and providing them with the necessary supports to heal. This prevents unnecessary foster care placements and can prevent children from experiencing the unnecessary trauma that can take place when being removed from their home. We also know that like many institutions in our society, including health care, systemic racism is embedded into the structures of our child welfare system, and that current child welfare policy continues to exacerbate inequities.

Family First offers the chance to adapt current funding streams and policies in ways that enable access to critical supports and services for families as an alternative to removing children from their families. The law also offers new incentives to ensure that children are in family placements (as opposed to institutional care) when they truly do need to be in out-of-home care, and that non-family settings are only used when needed to address an identified treatment need. These are vital steps forward, but significant additional policy change is necessary in order to support the transformation to an anti-racist child welfare system that focuses on eliminating disparities and improving health and well-being to support the thriving of all families.

Through this project, the AAP has endeavored to bring together critical perspectives to inform our policy priorities, and in particular to center the point of view of diverse individuals with lived experience within the child welfare system to help ensure that the impact of the policies we promote is shared equitably by all children and families. At this key juncture in child welfare policy development, we see incredible opportunities to reform child welfare policy and build upon the goals of Family First so that all children and families can thrive.

¹Diverse child welfare partners included organizations serving and advocating for older youth, kinship caregivers, Indian child welfare, and more.