Prevention, Protection, or Institutional Oppression? Exploring the Institution of Child Abuse and Neglect Prevention in Alabama

Abstract

In light of the need for child abuse and neglect prevention efforts to target institutional and social conditions underlying family challenges, I use institutional ethnography to analyze focus group discussions (secondary data); interviews (primary data); and key texts to identify how child abuse and neglect prevention work is organized across the state. Across social locations, prevention work occurs amid contexts of shared organizational, cultural, and institutional challenges and constraints. Community conditions of poverty, inequitable access to supports and opportunities that promote health and well-being, and oppressive employment conditions create challenges for families. Experiences of poverty are individualized as indicators of neglect, directing prevention efforts and public discourse towards individuals and away from institutions that underlie challenges. Prevention work contributes to a system of surveillance and monitoring and perpetuates public perceptions about causes of poverty and other social challenges. I make research, policy, and practice recommendations to shift the focus of prevention practice from individuals to the conditions that promote health equity, opportunity, and well-being and redirect the public discourse from individuals ‘at-risk’ to ‘in-risk.’ I suggest that a prevention approach that focuses on social determinants of health may help overcome existing challenges to a public health approach to prevention.