Tar Heel Footprints in Health Care

When she began her career in the 1980s, Catherine Joyner, MSW, was a family preservation social worker, working with families at risk of being involved in the child welfare system and with reunified families to prevent further involvement with the system. In this role, and later as a foster care social worker and adoption social worker, Joyner directly observed the effects of trauma and adverse childhood experiences (ACEs) on families. While research about the impact of ACEs on brain development and overall health outcomes had not yet been published, Joyner recognized the need for both parents and children to be treated for trauma and the significance of factors that can protect against the negative effects of trauma.

Much of Joyner's work in child maltreatment prevention continues to emphasize the importance of protective factors that minimize the impact of trauma and ACEs on children's growth and development. Joyner acknowledges the most important of these protective factors is a safe, stable relationship with a responsive adult. Others include environmental factors such as social influences, positive school environments, high-quality friendships, and problem-solving skills.

Joyner decided her experience could be put to good use at the state level through directing and implementing public policies and community programs aimed at the prevention of childhood trauma and ACEs. As part of this work, Joyner has been instrumental in securing support through the Division of Public Health and other stakeholders for scaling up the implementation of Triple P (Positive Parenting Program), a system of evidence-based family and parent support programs, throughout North Carolina. Triple P is currently implemented in 36 North Carolina counties and monitors substantiated child abuse and neglect, out-of-home foster care placements, and emergency department visits for child injury as program outcomes [1].

Additionally, the 2005 North Carolina Institute of Medicine (NCIOM) Task Force on Child Maltreatment Prevention recommended the establishment of a leadership position at the Division of Public Health (Department of Health and Human Services). Joyner has held this position since its creation and continues to facilitate public efforts for the integration of child maltreatment prevention into existing public programming. Joyner works with state partners and stakeholders to shift the focus of efforts and resources from responding to the tragedy of child maltreatment to preventing it before it occurs, with the ultimate goal of building a developmentally-focused, integrated child maltreatment system at the community and state levels.

Joyner is also currently the project director for the North Carolina Essentials for Childhood initiative. This 5-year project is funded through the Centers for Disease Control and Prevention (CDC) and aims to apply a collective, public health orientation to child maltreatment prevention. Previously, in partnership with Joyner and the Division of Public Health, the NCIOM convened the Task Force on Essentials for Childhood in 2013–2014. Joyner's innumerable and valuable stakeholder partnerships have served to strengthen the statewide impact ofthe initiative and Task Force recommendations.

According to Phillip Redmond, director of child health at The Duke Endowment and a long-time partner on much of Joyner's work, “Catherine knows this state has the resources and expertise to improve outcomes for all our children, but particularly the most vulnerable. She believes that all children deserve the opportunity to be the ‘best they can be.’ The one-to-one connection she makes with children as their champion drives the system to be better and do better.” Redmond touts Joyner's dedication to improving and disseminating effective evidence-based programs such as Nurse Family Partnership, Incredible Years, and Strengthening Families, and recognizes her connections with individual children and families as the driving factor in her work. In noting Joyner's commitment, Redmond says, “Tar Heels, as legend has it, never retreated from overwhelming odds. Catherine never retreats!”

Joyner hopes, as the work to address child maltreatment continues, that investments in prevention become the priority and that stakeholders continue to implement collaborative, evidence-based solutions with a known return on investment. As she says, “We have an obligation to the children and families, and to the taxpayers in our state, to implement what we know will ensure safe, stable nurturing relationships and environments for every child in North Carolina.”

• ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.