A passion for protecting children (Spring, 2009)

May 08, 2009

Dr. Jonathan Kotch speaks out for the most vulnerable

Jonathan Kotch is known nationally for strengthening policies to protect children, including his grandson, Daniel, shown here.

When Dr. Jonathan Kotch sees things he doesn’t like, he takes action.

He protested the Vietnam War. He spearheaded nonconfrontational sit-ins while in college, spurring discussions of issues. When his sons’ baseball team was within hours of folding because there was no coach, he stepped up to the plate and coached for the next 12 years.

And when he sees injustice affecting children — the most vulnerable among us — he drives himself and others with his high standards, sparking them to take action, too.

Kotch, MD, MPH, MA, FAAP, professor of maternal and child health at the UNC Gillings School of Global Public Health, has been a vocal and determined proponent of strengthening legislation and policies to protect children, especially in North Carolina. His expertise and quest for injury prevention and safer child care — not to mention his formidable networking skills — regularly place him and the School on the national stage.

Committed to social justice

Tristan Bruner, evaluation director of the Lenoir-Greene Partnership for Children (in N.C.’s Lenoir and Greene counties), sees on Kotch’s face his response to the range of children’s issues: “He has a special presence and demeanor and smile when he talks about young children, and sternness when he talks about maltreatment.”

Kotch’s specific areas of interest and study include child abuse and neglect, injury prevention, and health and safety in child care. Currently, he is the project director of the National Training Institute for Child Care Health Consultants (NTI), funded by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services.

He also directs the North Carolina Child Care Health and Safety Resource Center of the North Carolina Family Health Resource Line, funded by the state’s Divisions of Public Health and Child Development. He has more than 70 articles published or in press with scientific journals and edits a popular maternal and child health textbook. He also has received several awards, including the prestigious Martha May Eliot Award from the American Public Health Association in October 2008.

“We are learning more about the vulnerability of all families, and not just poor families,” Kotch says. “It is harder to raise a child, because public resources are not as accessible as they used to be, and there’s not enough social and community support.”

His passion for bettering the world around him was evident early on.

“From the first time I met him, I knew he was very committed to social justice, to communities taking care of their most vulnerable people,” says Anne Kotch, his wife of nearly 40 years. “He uses knowledge and reason but has a strong underlying philosophy and belief that vulnerable people should be taken care of.”

Kotch knows that today’s world poses more risks for children. Asthma is on the rise, and childhood obesity is at epidemic levels. He recognizes the stress that many young children and their families endure when one parent is in the military or when both have to work to support the family.

“We are learning more about the vulnerability of all families, and not just poor families,” he says. “It is harder to raise a child, because public resources are not as accessible as they used to be, and there’s not enough social and community support.”

Child care and safety on the radar

Kotch did not plan to be an academician. He began his college career as a pre-med student, tried surgery, fell in love with the field of anthropology, and practiced pediatrics. Clinical stints in New York City and California made him see that for him, being a clinician only would be a limitation.

“I had a strong sense of community and of justice, and wanting to improve the lot of disadvantaged families,” he says. But his penchant for making systemic changes — rather than healing people on an individual basis — came after working in a mission hospital in Liberia, where he saw cases of malnutrition and intestinal worms in patient after patient. “It occurred to me that nothing was going to change unless we address these issues on the community level.”

So he came to UNC’s public health school for his master’s degree and to the medical school for a residency in preventive medicine. At the N.C. Division of Public Health, he served as medical director of the SIDS (sudden infant death syndrome) project and coordinated and edited a child health manual, keeping up with clinical work by commuting to Columbus County (N.C.). In 1981, he accepted a full-time position in the UNC public health school’s Department of Maternal and Child Health.

Herbert B. Peterson, MD, FACOG, professor and current chair of the department, attributes much of Kotch’s success to his ability to transition from conducting research to applying research.

“His clinical experience has helped him be particularly accomplished at translating research into practice,” says Peterson. “He has just a tremendous understanding of the issues, commands them fully and knows how to use the best available science to make improvements.”

Longtime friend and colleague Susan Aronson, MD, FAAP, clinical professor of pediatrics at The University of Pennsylvania, credits Kotch’s leadership for successful state and federal initiatives to make child health care safer and better for children.

“He has made a huge contribution by launching health professional involvement in early education and child health care,” she says. “He was identified as a leader and a strategist to pull together the right people for a new federal initiative, and brought federal attention to the need to establish standards to ensure a health component in child care. He has been stellar in his contributions, bringing academic credibility from UNC to this work.”

Training consultants and training the trainers

Thanks to Kotch’s efforts, those who care for children are now aware of more ways to make children safer and healthier, including frequent hand washing to tackle infectious diseases and better-designed playgrounds to reduce injuries. His impressive track record of peer-reviewed child abuse research has brought him acclaim, but Kotch’s true legacy is the training of thousands of child care consultants through the National Training Institute (NTI).

Kotch established NTI in 1997 as a cooperative undertaking by the UNC School of Public Health’s Department of Maternal and Child Health and UNC’s Frank Porter Graham Child Development Institute (FPG). Funded by the U.S. Maternal and Child Health Bureau, the NTI has developed and implemented a renowned train-the-trainer program. Based on Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (American Academy of Pediatrics and American Public Health Association, 2nd ed., 2002), NTI ensures that qualified health and child care professionals from every U.S. state and territory are available to train child care health consultants, who in turn provide assessments and guidance to out-of-home child care centers and family child care homes.

The Institute has trained more than 4,000 child health care consultants and more than 300 trainers from all over the United States, Europe and the U.S. Army. The UNC training model has become the national standard.

A gatherer of people, ideas and information

If all of this makes Kotch sound like a busy man, he is. He moves so quickly and is seen in so many places that his staff fears he has been cloned. And wherever he goes, he seems to draw people to him.

“He is a gatherer of people,” says Dr. Aronson.

Jackie Quirk, project coordinator for the N.C. Family Health Resource Line and the N.C. Child Care Health and Safety Resource Center within the School’s maternal and child health department, admires his good memory and ability to connect well to what people are doing.

“If you are looking for information, he has a good sense of mapping out the resources and expertise that will help you — very quickly,” says Quirk.

Living his message: A down-to-earth family man

For all of his professional accolades, Kotch is described as someone comfortable in his own skin, who does serious work without taking himself seriously, a workaholic so efficient that he has always managed to make his own family a top priority.

“He was very present when he was home with us, and so devoted to us that it just seemed a natural part of who he was,” middle son Seth Kotch says.

Other parts of his work and home life merged naturally, too. For instance, he made the kids wear helmets while bike riding, and he “never let us get on a trampoline,” Seth Kotch continues. “He has a heartfelt concern for the well-being of all children, whether they are his or someone else’s.”

— Kim Gazella and Ramona DuBose

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit www.sph.unc.edu/cph.