Value Framework Research Articles

Evolving assessment pathways for precision oncology medicines to improve patient access: a tumor-agnostic lens.

Genomic and molecular alterations are increasingly important in cancer diagnosis, and scientific advances are opening new treatment avenues. Precision oncology (PO) uses a patient's genomic profile to determine optimal treatment, promising fewer side effects and higher success rates. Within PO, tumor-agnostic (TA) therapies target genomic alterations irrespective of tumor location. However, traditional value frameworks and approval pathways pose challenges which may limit patient access to PO therapies. This study describes challenges in assessing PO and TA medicines, explores possible solutions, and provides actionable recommendations to facilitate an iterative life-cycle assessment of these medicines. After reviewing the published literature, we obtained insights from key stakeholders and European experts across a range of disciplines, through individual interviews and an industry workshop. The research was guided and refined by an international expert committee through 2 sounding board meetings. The current challenges faced by PO and TA medicines are multiple and can be demonstrated through real-world examples of the current barriers and opportunities. A life-cycle approach to assessment should be taken, including key actions at the early stages of evidence generation, regulatory and reimbursement stage, as well as payment and adoption solutions that make use of the evolving evidence base. Working toward these solutions to maximize PO medicine value is a shared responsibility and stands to benefit all stakeholders. Our call to action is to expand access to comprehensive genomic testing, foster a learning health care system, enable fast and equitable access to cost-effective treatments, and ultimately improve health outcomes.

Leveraging organizational culture to create competitive value from environmental practices

There has been a long-standing debate in the management literature as to the performance implications of environmental practices. Drawing upon the contingent resource-based view, we hypothesize that organizational culture moderates the relationship between environmental practices and firm performance. We use the competing value framework to explore the effects of developmental, group, rational, and hierarchical culture types on three key capabilities (i.e., stakeholder integration, higher-order learning, and continuous innovation) that stem from implementing environmental practices. We test our hypotheses using data from the fourth round of the High Performance Manufacturing survey. We find that the developmental, group, and rational culture types positively moderate the relationship between external proactive environmental practices and firm performance. By contrast, hierarchical culture negatively moderates the relationship between internal proactive environmental practices and firm performance, but positively moderates the relationship between external reactive environmental practices and firm performance. As such, our study contributes to the literature by unpacking the influence of organizational culture on the capabilities through which environmental practices affect firm performance. Our results can guide operations management executives in choosing the most suitable environmental practices that will align with their organizational culture.

Implementing a stakeholder capitalism approach through values-based leadership: case studies in the private, nonprofit and educational sectors

Purpose Stakeholder capitalism has gained attention among business practitioners and academia, often discussed within the context of corporate social responsibility, ethical practices and values-based leadership. Many societal institutions, including businesses and higher education institutions, have a role to play in the transition toward stakeholder capitalism. This study aims to discuss insights gained from a multiyear research and pedagogical project coordinated among a group of academics and an Israel-based holding company to study the implementation of a values-based leadership process focused on establishing a stakeholder-oriented model in a variety of organizations. Design/methodology/approach Conducted over a decadal period, this project relied on a qualitative case study methodology. The project was conceived as an exploratory and inductive study examining organizations that implemented a values-based leadership model and a university that used this model for curriculum and pedagogy. Semi-structured interviews, observations of leadership practices and operations, and substantive reviews of organizational documents informed the study’s iterative methodology. Findings The case studies presented explore the benefits of a stakeholder capitalism and values-based leadership transformation in organizations and highlight the importance of senior leadership engagement at the outset to set the tone and direction of implementation while also role modeling values-based behaviors for the organization. The utility of aligning the new values-based approach with existing elements of the organizational culture and priorities was also identified in addition to the benefit of individuals linking the new values initiative to their personal values and life. These practices, and a broader stakeholder dialogue on values, helped establish a transition that was inclusive within the organizational hierarchy and in its connections to the larger society. The cases also explored how stakeholder principles and values-based leadership models can be integrated into management education based on the outcomes of the organizational investigations. Originality/value These case studies offer insight into the implementation of a values-based leadership framework, which draws on stakeholder theory, in diverse organizations across a for-profit to non-profit spectrum. These studies also provide a unique opportunity to evaluate the implementation of a common values framework in different sectors. The cases further highlight the potential role of business-education sectoral partnerships in educating a workforce that is dedicated to business for good.

Blockchain-enabled Data Governance Framework for Enhancing Security and Efficiency in Multi-Cloud Environments through Ethereum, IPFS, and Cloud Infrastructure Integration

In today's digital landscape, the exponential growth of big data demands secure and efficient processing, particularly in complex multi-cloud environments. This paper proposes an innovative blockchain-enabled data governance framework, revolutionizing data management, processing, and security across diverse cloud infrastructures. The framework integrates cutting-edge technologies, including the Ethereum blockchain, the InterPlanetary File System (IPFS) protocol, and cloud solutions like OpenStack and Red Hat OpenShift. At its core, the framework utilizes Ethereum's robust smart contracts and consensus mechanisms to establish a decentralized and secure data governance model. This ensures data integrity, transparency, and immutability, mitigating risks associated with centralized storage and processing. The IPFS protocol complements blockchain by offering efficient data sharding and retrieval mechanisms, enhancing data accessibility and fault tolerance in distributed cloud environments. Through comprehensive testing and analysis, the proposed framework's value is demonstrated. Performance metrics, including throughput, latency, CPU utilization, and memory utilization, were meticulously evaluated to assess system efficiency and scalability. Results indicate high performance, with Ethereum's Proof of Authority (PoA) consensus mechanism enabling efficient transaction throughput of up to 1000 transactions per second. Additionally, the IPFS protocol exhibits effective data retrieval capabilities, with an average latency of 15 milliseconds for data access operations.

Risk management maturity and robustness in the Chinese manufacturing supply chain: a comparison study across organisational cultures

ABSTRACT Chinese manufacturing, a major engine of the world economy, has been at the heart of the challenge of major global supply chain disruptions. This research explores the relationships among different dimensions of supply chain risk management maturity and supply chain robustness in Chinese manufacturing organisations. A structural equation model is developed and tested based on the participation of 296 supply chain managers. Based on the Competing Values Framework, four different culture groups are assessed to determine whether the relationships differ by culture type. While all model relationships were found to be significant and positive across the culture groups, the weights associated with certain relationships were significantly different. The adoption of the proposed framework could bring the benefit of a more comprehensive evaluation of supply chain risk management maturity, as well as the identification of both strengths and areas where improvements may be necessary for achieving supply chain robustness.

Brazil’s multiple coffee markets: an ethnographic study of coffee production from family growers to coffee gourmets

ABSTRACT The article contributes to the studies of “multiple markets” based on ethnographic reflections on the process of singularization of the coffee market in southeastern Brazil. Our discussion is based on two different in-field investigations that happened separately and at different times and places, compared here with the purpose of mapping the multiple coffee markets in terms of the valuation frameworks that are used by a family-based agriculture production and by tasting specialists of specialty coffee. Looking at these instances of coffee valuation, we investigate different attempts to increase the coffee value in the marketplace by emphasizing local traditions and values or by producing an objectively refined value coffee. Nevertheless, we argue that both sites produce frameworks to construct coffee value through future projections of commercialization, defined here as an analytical mechanism for the identification of “multiple markets” that have not been noticed by the current specialized literature yet.

Russian University Students’ Volunteering within the Framework of Sustainable Development Goals and Values

The article deals with the issue of university students’ volunteering aimed at pursuing the sustainable development goals under conditions of global crisis and transformation of Russian educational policy in terms of renewal of the higher education upbringing function on the basis of traditional values of the Russian civilization. Russia’s activities on achieving sustainable development goals address carrying out infrastructure projects and Green Agenda. Although large-scale state program of volunteering support and development is being executed, volunteering for sustainable development is not given close attention. Ecological and social volunteering prioritized by governmental regulatory documents is not consistent with implementing sustainable development goals. The need to facilitate volunteering development in universities accomplishing the mission of social and economic development of society in partnership with businesses and civil society institutions is underestimated both in research and in practice. Using system and activity approaches, the authors set the goal to describe the present state of students’ ecological and social volunteering as an efficient platform for attaining sustainable development goals and necessitate its further systemic support. It is shown that the concept of sustainable development is not being an ideological orientation of volunteering practices, although students’ competences aimed at promoting common welfare could be more efficiently developed not only at theoretical level but through real volunteering for the good of future generations. In cross-sectoral partnership of universities, businesses and state, ecological and social goals are achieved by means of volunteering under the supervision of the state while Russian businesses, applying the ESG (Environmental, Social, Governance) principles, do not spare their efforts on collaborative development. As for the subjective factor impeding the development of university students’ volunteering the lack of ideological orientation towards sustainable development, which could be based on universal values specified by Russian culture codes

Organizational culture, knowledge sharing and organizational performance: a multi-country study

PurposeDrawing on the competing values framework, we look at the relationship of different organizational cultures (clan, hierarchy, adhocracy and market) with organizational performance. Furthermore, we examine the mediating role of knowledge sharing (attitude and behavior) in the organizational culture and organizational performance relationship.Design/methodology/approachWe draw on survey data from 241 respondents working in the aerospace and aviation manufacturing and services firms in Pakistan (85), Turkey (65) and the United Arab Emirates (91). We employ structural equation modeling for data analysis.FindingsResults suggest that knowledge sharing partially mediates the relationship between clan culture and organizational performance, and fully mediates the market culture and organizational performance relationship. Hierarchy culture is only positively related to organizational performance, while adhocracy culture shows no relationship with knowledge sharing, let alone organizational performance.Originality/valueWhile knowledge sharing enhances organizational performance, there is limited knowledge with regard to the specific organizational culture(s) conducive to knowledge sharing and organizational performance. The study extends existing research on the topic and contributes by showing which cultures are more conducive to knowledge sharing and organizational performance and which are less.

Professional values education for undergraduate nursing students: developing a framework based on the professional values growth theory

BackgroundEducation has been recognised as necessary in forming and internalising professional values. The system and instructors' content in existing educational institutions focus on developing students' knowledge, skills and practices. Still, the development of values has yet to achieve significant effects, leading to a crisis in students' professional identity.AimsTo construct a professional values growth theory for undergraduate nursing students and develop a corresponding education framework.MethodsThrough the review, some databases(PubMed、CINAHL、Web of Science、Wiley and Google Scholars)were searched using a systematic search strategy to collect relevant literature on professional values education. Based on the nursing professional values growth theory (Li and Li, Nursing Ethics In press, 2022), a theory of professional values growth of nursing undergraduates was developed using the method of theory derivation. Two rounds of expert meetings were conducted to review and revise an education framework of professional values of nursing undergraduates derived from that theory.FindingsA total of 10 studies were included. The contents of two themes were analysed: theories and models and the current status of the professional values development of nursing students. The resulting professional values growth theory for undergraduate nursing students consists of five parts: key aspects, decisive opportunities, drivers, embodiment (humanistic sentiments, moral emotions), and outcomes. A total of five experts in the relevant fields were invited to this study. After two rounds of expert meetings, an education framework for undergraduate nursing students was finally developed, which consists of four parts: education objectives, education process and content, environment and conditions, and evaluation.ConclusionThe education framework developed in this study has practical implications for the development of professional values of undergraduate nursing students, providing educational strategies and methods for the growth and internalisation of professional values of undergraduate nursing students.

Using a two-price market value framework to value differences in metabolizable energy concentration of pasture across seasons

CONTEXTInternationally, there have been focused efforts to develop methods of ranking pasture cultivars to assist livestock producers make informed decisions about investments in pastures. The Australian Forage Value Index (FVI) currently ranks cultivars for the dairy industry based on the value of differences in seasonal dry matter (DM) yield only. Metabolizable energy (ME) is the most important nutrient supplied by pasture for livestock production; its inclusion in the FVI may provide useful information for decision making. OBJECTIVEThe objective was to apply a two-price market value framework to value differences in both seasonal DM yield and ME concentration for valuing and ranking pasture cultivars. METHODSThe two-price market value framework allocates a replacement cost or salvage value to extra ME supplied by pasture during seasons when pasture is typically in deficit or surplus, respectively, of animal demand. The replacement cost and salvage value were calculated using a single (Method 1) or multiple (Method 2) nutritional components, and compared. The estimated market values for extra ME were combined with corresponding market values for extra DM yield and applied to a data set of 20 perennial ryegrass cultivars. Cultivars were ranked based on their extra annual market value compared to base cultivar Victorian. Rankings were first calculated based on the value of seasonal differences in DM yield, and then re-calculated using differences in both seasonal DM yield and ME concentration. RESULTS AND CONCLUSIONSReplacement costs of a MJ of ME of $0.023 and $0.010 were estimated for seasons of pasture deficit using Methods 1 and 2, with corresponding salvage values of $0.018 and $0.007 for seasons of pasture surplus. Compared with rankings based on the value of differences in DM yield alone, including the value of differences in ME concentrations had little effect on the rankings of individual cultivars. This result is strongly influenced by the fact that those cultivars that lead the ranking based on seasonal yield also have relatively high values for ME. SIGNIFICANCEThe two-price market value framework is one method for estimating the value of nutrients supplied by pasture and offers a simplified alternative to more common approaches for valuing pasture. The approach used here has potential for broader application and could be particularly useful for informing decisions about investments in research and innovation into traits which alter the nutritive concentrations of pastures swards and pasture species.

The moderating impact of organizational culture on information security compliance

This research paper investigates the association between organizational culture and employees' compliance with information security policies. Drawing upon rational choice theory (RCT) and the competing values framework (CVF), our study explores the moderating effects of cultural dimensions on information security compliance in a diverse range of organizations. We employ a scenario-based approach and analyze the data using Partial Least Squares Structural Equation Modeling (PLS-SEM). Our findings underscore the robustness of the model and emphasize the pivotal role of cultural dimensions in influencing employees' compliance intentions.
 The study contributes by synthesizing non-fear-based deterrence theory with organizational culture theory, offering practical insights for information security managers. Recommendations include framing compliance as a moral duty, involving end-users in policy development, utilizing effective communication, implementing monitoring systems, and fostering a consistency culture. For organizations, the research underscores the importance of cultivating an ethical culture, emphasizing moral beliefs, and leveraging cultural dimensions to enhance compliance intentions.
 Acknowledging limitations related to single-country data collection, a focus on compliance intentions, and the selection of organizations with established policies, this research paves the way for future studies. Future research should aim to replicate this study in diverse cultural settings, consider individual-level culture measurement, and explore additional moderating factors. This research contributes to understanding the intricate relationship between organizational culture and information security compliance, offering actionable insights for practitioners and prospects for further exploration in the information security field.

DeRDaVa: Deletion-Robust Data Valuation for Machine Learning

Data valuation is concerned with determining a fair valuation of data from data sources to compensate them or to identify training examples that are the most or least useful for predictions. With the rising interest in personal data ownership and data protection regulations, model owners will likely have to fulfil more data deletion requests. This raises issues that have not been addressed by existing works: Are the data valuation scores still fair with deletions? Must the scores be expensively recomputed? The answer is no. To avoid recomputations, we propose using our data valuation framework DeRDaVa upfront for valuing each data source's contribution to preserving robust model performance after anticipated data deletions. DeRDaVa can be efficiently approximated and will assign higher values to data that are more useful or less likely to be deleted. We further generalize DeRDaVa to Risk-DeRDaVa to cater to risk-averse/seeking model owners who are concerned with the worst/best-cases model utility. We also empirically demonstrate the practicality of our solutions.

Affective Commitment, Organizational Culture and Turnover Intention among Health Professionals in National Referral Hospitals in Kenya

The study aimed to assess the influence of affective commitment on turnover intention among health professionals in public national referral hospitals in Kenya. It also examined whether organizational culture mediates the effect of affective commitment on the turnover intention of health professionals in public national referral hospitals in Kenya. Theories anchoring this study included Social exchange theory and Theory Z. Descriptive and correlational research designs were used in the study. The research designs were to assess: 
 
 The relationship, effect and mediation between variables. 
 The influence of affective commitment on turnover intention and organizational culture mediation of affective commitment effect on turnover intention. 
 The Target population was all health professionals in public national referral hospitals in Kenya. 
 
 The study used SPSS version 25 for scale accuracy. The study findings showed that the relationship between affective commitment and turnover intention was significant, that of affective commitment and organizational culture was moderate and significant, and that the organizational culture turnover intention was significant. Further, the study found that organizational culture did not mediate the effect of affective commitment on turnover intention. Based on the study findings, the study concluded that affective commitment influences the turnover intention of health professionals in public national referral hospitals in Kenya and that affective commitment effect on turnover intention is not mediated by organizational culture. The study recommended that human resource practitioners use the study to come up with policies and guidelines that improve service delivery in referral hospitals. Board members of public national referral hospitals should borrow ideas from competing values frameworks to enhance a culture of high performance in their hospitals.

ANALISIS VRIO UNTUK MEMPEROLEH KEUNGGULAN BERSAING BERKELANJUTAN DALAM INDUSTRI PANGAN ORGANIK

This research aims to analyze the internal resources-based of PT X on the conceptual framework of Value, Rareness, Inimitability, and Organization. Primary data were obtained from the internal workings of PT X as the unit of analysis. The data originated from interviews conducted with selected informants by the researcher. Apart from primary data, this study also incorporated secondary data derived from literature reviews. Categorical analysis was used to dissect interview data and findings from other sources providing information about PT X's competitive advantages. The researcher delineated the results of the VRIO analysis of PT X across aspects such as product quality, product types, marketing, manufacturing, customer experience, digital technology, innovation, human resources and culture, as well as brand image. PT X possesses Sustainable Competitive Advantage in innovation, product quality, customer experience, and brand image due to its unique resources that enable the production of high-quality products for a clearly defined target market of upper-middle-class individuals. PT X is capable of combining these resources with storytelling to strengthen its brand image

Manifestations of purpose in life among Finnish student teachers

ABSTRACT This study investigates how purpose manifests itself among purposeful Finnish student teachers (N = 12) using Schwartz’s framework of personal values and Westheimer and Kahne’s model of citizenship to further the understanding of what purposeful student teachers’ sources of purpose are, how they contribute to the world beyond the self, and what actions they take to realize these contributions. Purpose is defined as personally meaningful long-term engagement to a goal with consequences for the world beyond the self. The interviews showed that although teachers’ work was deemed important, purpose contents associated with the value of benevolence, such as family and friends, were student teachers’ main content of purpose and their beyond-the-self motivations mostly manifested as actions intended to contribute within the familial circle. To increase student teachers’ future willingness to act on participatory and justice-oriented levels, more effort needs to be invested in the development of purpose and civic engagement-oriented higher education.

Outpatient Embedded Palliative Care for Patients with Advanced Thoracic Malignancy: A Retrospective Cohort Study.

Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but also with consideration of quality of life and financial cost. Early palliative care for patients with advanced cancer is associated with improved quality of life, mood, symptoms, and overall survival for patients, as well as cost savings. While palliative care has been shown to have numerous benefits, the impact of real-world implementation of outpatient embedded palliative care on value-based metrics is not fully understood. We sought to describe the association between outpatient embedded palliative care in a multidisciplinary thoracic oncology clinic and inpatient value-based metrics. We performed a retrospective cohort study of 215 patients being treated for advanced thoracic malignancies with non-curative intent. We evaluated the association between outpatient embedded palliative care and inpatient clinical outcomes including emergency room visits, hospitalizations, intensive care unit admissions, hospital charges, as well as hospital quality metrics including 30-day readmissions, admissions within 30 days of death, inpatient mortality, and inpatient hospital charges. Outpatient embedded palliative care was associated with lower hospital charges per day (USD 3807 vs. USD 4695, p = 0.024). Furthermore, patients who received outpatient embedded palliative care had lower hospital admissions within 30 days of death (O.R. 0.45; 95% CI 0.29, 0.68; p < 0.001) and a lower inpatient mortality rate (IRR 0.67; 95% CI 0.48, 0.95; p = 0.024). Our study further supports that outpatient palliative care is a high-value intervention and alternative models of palliative care, including one embedded into a multidisciplinary thoracic oncology clinic, is associated with improved value-based metrics.

Game‐theoretic approaches to product introduction strategies for durable products

AbstractNew product demand continuously fluctuates throughout the life of the product. As a result, markets typically experience high volatility. Most companies operate in highly competitive industries where the product volume supplied by the competitors significantly affects production plans. These conditions necessitate companies to be flexible and rapidly adapt to such volatility. In this study, we investigate the product introduction strategies under two microeconomic theories: real‐option valuation and game theory. Specifically, we develop a real‐option valuation framework with a flexible capacity based on two game‐theoretic models, namely, Stackelberg and Cournot, in a duopoly market where competitors have either perfect or imperfect information. Furthermore, we construct a lattice to discretize the demand evolution and adopt a regime‐switching approach to characterize the stochastic product lifetime. We conduct an extensive numerical study and compare net present values (NPVs) and optimal capacities obtained from the game‐theoretic models. Our results show that under perfect information, the Stackelberg competition generates more supply with lower prices and less total than the Cournot competition. Moreover, we find that, compared to the fixed‐capacity system, the flexible capacity system increases the in the Stackelberg game (by 5.5%) more than in the Cournot game (by 3.3%). We provide further results on the performance of the companies based on detailed sensitivity analysis for various model parameters. In particular, we observe that fixed and variable production and installation costs majorly impact capacity allocation decisions and profits.

Quantifying the Financial and Climate Impacts of Greenhouse Gas Abatement Pathways in Residential Space Heating

New York State (NYS) has set strict greenhouse gas (GHG) emission reduction targets across all sectors of its economy, including the heating sector. This study examines the financial value and environmental impacts of the residential space heating sector in NYS under different GHG abatement options by comparing the existing natural gas heating pathway with three potential GHG abatement pathways: renewable natural gas (RNG), hydrogen blended into RNG, and air-source heat pumps (ASHPs). These pathways are analyzed via a comparative net present value (NPV) framework from 2022 to 2042 with the emission reduction represented as a revenue stream that serves as a function of the social cost of GHGs. The investment timing of each of these pathways is also accounted for to reflect the pathways’ varying deployment timelines. The ASHP pathway with a 10% financial discount rate and a 2% social cost of the GHG discount rate achieves the lowest NPV. The RNG pathway achieves the highest NPV. A sensitivity analysis determines the impact of key factors on the NPV results. This study aims to inform policymakers, homeowners, and stakeholders of the potential benefits and costs of each of the four pathways to aid them in their decision-making process.

Evaluation of changes in the clinical benefits of oncology drugs over time following reimbursement using the ASCO-VF and the ESMO-MCBS

PurposeThis study aims to estimate changes in the value of oncology drugs over time from initial data of the reimbursement decisions to subsequent publications in Korea, using two value frameworks.MethodsWe retrieved primary publications assessed for reimbursement between 2007 and July 2021 from the decision documents of Health Insurance Review and Assessment and subsequent publications made available following reimbursement decision from ClinicalTrials.Gov and PubMed databases. Changes in the clinical benefit scores were assessed using the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). A paired t test was performed to test whether there was a difference in the scores between primary and subsequent publications.ResultsOf 73 anticancer product/indication pairs, 45 (61.6%) had subsequent publications, of which 62.5% were released within 1 year of reimbursement decision. The mean ESMO-MCBS and ASCO-VF Net Health Benefit scores increased from primary to subsequent publications, although the differences were not significant. The mean ASCO-VF bonus score significantly increased from 15.91 to 19.09 (p = 0.05). The ESMO-MCBS and bonus scores increased by 0.25 and 0.21, respectively, and the bonus score had a greater impact on the ESMO-MCBS score than the preliminary score did.ConclusionThe value of drugs demonstrated in subsequent publications varies considerably among oncology drugs, depending on uncertainty associated with the initial evidence and the availability of updated evidence. As decision-making in the face of uncertainty becomes more prevalent, the value frameworks can serve as simple screening tools for re-evaluation in these cases.

Advancing a prevention-oriented support system for the health and safety of children

Child welfare and child protection systems are entrenched institutionally and their value stances on working with marginalized groups are, at times, antithetical to the value framework of public health approaches. Differences are sufficiently wide as to render these child welfare systems incapable of advancing a robust prevention agenda focused on child safety and well-being. In this article, we argue for institutionally distinct, yet cooperative approaches focused on universal and secondary-level family and community supports, aimed at breaking down silos and shifting our attention from child welfare reform to community-based systems that are better positioned to proactively meet the needs of children and families before they find themselves in crisis. Within the article, we focus on key tensions and arguments for separate yet cooperative approaches across systems and organizational silos, including the divide between preventive and responsive frameworks, the capacity constraints on existing–reactive–child welfare systems, and shifting the dial to population-wide prevention strategies to address the growing awareness that child maltreatment is a far wider problem than indicated by the number of children reported to child welfare agencies.