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Sunday, December 19, 2010

The Aboriginal lesson in child protection

Two recent reports on child protection have highlighted the ongoing issue of Aborginal children in the child protection system in Canada. The reports, one in Alberta and the other in Saskatchewan, show that between 7-8 out of 10 children in they systems are related to the Aboriginal communities. This is despite the fact that Aboriginals make up only about 15% of the Canadian population. Why then such disparities?

It is the legacy of bad policy that, as a society, we thought had been good policy. Through the residential schools Canada set out to eradicate the Aboriginal intending to assimilate their children into the dominant white society.


Father Joseph Hugonnard, principal, with staff and aboriginal students of the Industrial School, May 1885, Fort Qu'Appelle, Sask (O.B. Buell/Library and Archives Canada/PA-118765).

Perhaps no quote illustrates the poilcy better than this one: “I want to get rid of the Indian problem. I do not think as a matter of fact, that the country ought to continuously protect a class of people who are able to stand alone… Our objective is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic and there is no Indian question, and no Indian Department, that is the whole object of this Bill.” Dr. Duncan Campbell Scott - 1920

It is this policy that led around 150,000 Aboroginal children into the training and residential schools from the late 1800s to the late 1990s. Thousands died, most were abused, underfed and forced to live in a culture that was foreign while their own culture was oppressed.

Today, in child protection, we have the legacy which is why there are so many children involved with child care. There were generations raised in these schools who lacked any role mdoelling about how to be a parent or even a successful, nurturing adult. Such essentials as how to love, how to raise a child, how to build a child up, how to run a family were all lessons missing. The reservation system often robbed people of the chance to support a family and the schools typically failed at work training. It will take generations to fix this damage.

Not surprisingly, substance abuse and mental health problems are also a major part of the legacy which further damages the parenting capacity. Add to this entrenched poverty as a further consequence and you can see why there are so many Aboriginal famileis and why neglect is the major issue. It is hard to do what you have never been trained to do - parent effectively.

If we are to repair the damage, then Aboriginal communities are going to need to be supported in a multi-generational healing process. Yes, children need protection but families need support, healing and opportunities to learn how to parent. As a society we need to come to grips with this. The Alberta and Saskatchewan reports both highlight this crucial and complex issue.

Saturday, December 4, 2010

A New Review - Familiar Themes and some new ones

Clark County in Las Vegas, Nevada has just released a significant review of its child protection system. It is well done and quite thorough but the themes should sound very familiar to those following the challenges of child protection. We have seen similar recommendations throughout the western world as reviews are published.

In the Las Vegas case we see:

1. DOCUMENTATION - The need for better documentation that details what is and has happened in a case. This can include better indications of what inter agency activities have occurred as well as court processes.

2. TRAINING - "Based on this case review, DFS management believes that permanency in‐home, out‐of‐home, and licensing staff need additional training specifically related to child safety and risk" (p.3).

3. CHILDREN BORN INTO FAMILIES ALREADY RECEIVING SERVICES - This is something of a new theme. The idea here is that a child born into such a family should cause a review of what is happening in that family for that child.

This is quite a good idea as a substantial body of research shows that a new child changes the stresses in a family system (both positively and negatively).

Also quite fascinating is the idea that child protection might have a role in the lives of children who are left in the care of individuals receiving services from child protection. In my clinical experience, this is an area that is often ignored. We must also recognize that there are those in poverty or near poverty who have very few child care choices as they seek to work in often low paying jobs that are necessary for survival. They may not even know that the person caring for their children is involved with child protection.

4. Choose Your Partners Carefully campaign - This is a creative way to raise awareness about the impact of a new partner on children. An interesting prevention notion - I am curious if there is any data to support its effectiveness.

5. "Community Partnerships and Managing Child Maltreatment: Recognizing child maltreatment is a community‐wide effort, and it requires that DFS partner with community service providers, educational systems, medical providers, and law enforcement. This case review indicated that there may be a lack of understanding on the part of some community partners in understanding child welfare practices and/or in reporting child abuse/neglect"(p.4).

Inter agency cooperation (or lack of it) has appeared as a theme in a multitude of serious case or death reviews in many jurisdictions. It is one of the lessons that keeps getting raised and still requires efforts.

6. Court continuances or adjournments - This is an issue in many many jurisdictions. It is unfair to children and families who await a decision that allows them to get on with their lives. Research tells us that children left in uncertainty do not fare as well versus those children who get a chance at a permanent situation in which to live. Other research also tells us that children need answers as soon as possible in their lives. Developing brains do not fare well in uncertainty and stress.

7. Learning through case reviews - a worthy idea if there is a culture in which cases can be frankly and openly discussed; where mistakes can be considered for their learning potential and not for discipline or scapegoating.

8. Data management - Oh such a familiar theme but one that often creates approaches where the data gains greater importance than the services. Hours get lost in record management that could be used with clients.

Another data management theme seen in various forms elsewhere is repeated here. "The current State‐mandated child welfare information system, UNITY, is cumbersome to navigate and accessing information is challenging" (p.7).

9. "Mental Health Services Availability/Provision: Mental health services, particularly inpatient drug treatment services, are not readily available in the community"(p.8). Also a very familiar theme. Those of us who work with child protection systems frequently ask how families (often with long term and complex issues) can change with limited resources to support change.

10. The role of policy is also considered. In fact, what the report describes appears to be good - implementation is a challenge always with policy - resources and training are needed. Las Vegas seems to get this, at least in principle.

The report makes an important philosophical statement as well. "It’s easy to see and understand how many feel that every child who experiences abuse and/or neglect at the hands of their parents or caregivers should simply be removed and never returned. But, while our primary role as a child welfare agency is to ensure child safety and minimize risk, we also must work to help keep families together by working with parents to develop new parenting skills and capacity that will allow them to care appropriately for their children going forward" (p.11). This really helps to emphasize that child protection is about repairing and strengthening families.

The full report is at http://www.ktnv.com/link/467851/read-the-countys-report-on-the-department-of-family-services

Friday, December 3, 2010

A quick note on privatization

There are those who feel that privatizing child protection services may be the direction to go - balancing costs with outcomes. An experience and subsequent review in the USA suggests otherwise. A story in the Omaha World-Herald (Nebraska) shows the perils:

"Published Dec 3, 2010
Published Friday December 3, 2010
Report blasts foster care reform
By Martha Stoddard
WORLD-HERALD BUREAU

INCOLN — Shifting child welfare duties from state workers to private contractors has not improved the lives of Nebraska's foster children, a new report shows.


The shift made some conditions worse, produced no change in others and created several new concerns, according to the state Foster Care Review Board.

The board released a report on the state's child welfare reform effort Thursday, along with its annual report for 2009.

Carol Stitt, the board's executive director, said correcting the systems' problems is critical for children in foster care.

“These children don't have a do-over” for their lives, she said.

Todd Reckling, state director of children and family services, took issue strongly with the board's findings and its call to slow down the reform.

“We've said all along it's going to take some time to change,” he said. “We're seeing indicators we're moving in the right direction.”

The board's findings call into question the state's rationale for privatizing child welfare.

Nebraska Department of Health and Human Services officials have said they are pursuing reform to improve the child welfare system.

They note that Nebraska has among the nation's highest rates of children removed from their homes, yet the state has fared poorly on federal evaluations of its child welfare system.

The reform so far, however, has not significantly reduced the number of children in out-of-home care, according to the reports.

The number of such children on Oct. 10 — nearly a year after reform began — was lower than on Dec. 31, 2008, but about the same as on Dec. 31, 2009.

Nor has reform altered the rate of children returning to foster care, the number of cases progressing toward resolution or the number of placements children endure in foster care.

Reckling, in defending the reforms, said that the Kansas-based KVC has had fewer than 1 percent of the children in its aftercare program return to foster care.

He also said the state currently meets three of six federal standards for child welfare.

“We have shared this information with the (board), but they seem to be looking backward while we are focused on improvements,” Reckling said.

The board responded with a statement saying the data in the reports speaks for itself.

“The efforts and funding spent defending the new system would be better used focusing on correcting the issues identified in today's report,” the statement said.

In November 2009, the state contracted with five private agencies to provide and coordinate all services for children and families in the child welfare and juvenile justice systems.

Since then, three of the five agencies have lost or dropped their contracts.

In October, HHS officials announced plans to turn over more responsibilities to the private contractors, replacing state child welfare workers. The transfer is set for Jan. 3.

Many issues listed in the new board reports have appeared in previous years' reports.

Among problems worsened by the reform, Mario Scalora of Lincoln, vice chairman of the board, said the report found “significant gaps” in documentation of cases since the reform began.

Documentation is key to determining whether children are safe and getting needed services, whether parents are making appropriate changes and whether courts should reunify families or terminate parental rights.

“This is not just a paperwork issue. This is a safety issue,” Scalora said.

Among the new concerns is a 13 percent decline in licensed foster homes and a drop in the number of therapists and other service providers working with foster children and their families.

According to the report, pay for foster parents has dropped to an average of $600 per month, down from $725 per month before reform. Foster parents no longer receive clothing allowances or paid respite time..."

http://www.omaha.com/article/20101203/NEWS01/712039989

While there are certainly local issues here, the report helps us to see that reform for the sake of reform is not what children and families need. Effective, efficient and responsive services are needed but again we see budgets drive service - not needs.

Safeguarding young people

In July of this year, a comprehensive study on the needs of 11-17 year olds who are maltreated was published by Rees et al. The research has many significant findings that will be helpful to child protection workers and planners but there are a few that really strike me as a clinician.

One of the most striking is that child protection programs are often more geared to the needs of younger children. There can be a feeling that older children who are maltreated are better able to protect themselves and are not as vulnerable. This is an unfortunate view. In my own clinical work I have seen this although my experience is that such a view is diminishing. It was a bit disheartening to see it, therefore in this research.

A summary of the research also notes the challenges that young people face in making a disclosure of maltreatment - will they be believed can be a theme I have seen along with fear about how the disclosure will impact the family. As the researchers note in their summary, "One key issue highlighted by the study was that young people found a huge difficulty in disclosing maltreatment. Not only do they struggle to strike up trusting relationships with a consistent professional (social workers are often overworked and a young person’s social worker can often change), but even when they have this relationship they are acutely aware of the potential ramifications for themselves and their family of disclosing abuse. Additionally, young people did not always have sufficient knowledge or information on how best to make the disclosure."

Social workers are not the place that most young people turn to - instead the research helps us to see that peers and schools are the places where disclosures are most likely to occur. Thus, ensuring that teachers are well informed on these issues is vital.

But, the system also needs to be able to respond. A challenge seen in this research and elsewhere is the impact of high caseloads, reducing budgets, increased managerialsim to protect the system instead of the child and high staff turnovers make it hard for young people to build relationships with social workers - the kinds of relationships that are needed for effective change.

An example of this can be seen in Birmingham in the UK where the local council has floated the idea of restricting services. CommunityCare.co.uk reports that "The consultation document also proposed that non-statutory services be "reduced or ceased". It is more likely that children will self report through voluntary and not statutory services.

A recent story in South Carolina also informs us of the need to seek family based solutions when they are available. Mangerialsim and risk aversive policies often cause child protection systems to move too slowly in getting children into safe family homes. Fortunately, kinship care is a choice in an increasing number of cases. Yet, it is easy to understand the caution in many cases (although not all as the South Carolina case shows). Within a family system child rearing patterns exist and thus, it is valid to ask if one part of the system is neglectful or abusive, then is another part.

Sources:

Birmingham story: http://www.communitycare.co.uk/Articles/2010/12/01/115924/birmingham-to-refer-fewer-children-to-save-money.htm

Safeguarding young people summary: http://www.york.ac.uk/news-and-events/news/2010/research/older-children/

and full report - http://www.childrenssociety.org.uk/resources/documents/Research/21485_full.pdf

South Carolina story begins at http://www.thesunnews.com/2010/09/12/1688565/a-fathers-fight.html

Thursday, December 2, 2010

The effect of a high profile death

The case of Baby P in England continues to have a long term effect. While there is no question that Baby P's death was a horrible and no child should die in such circumstances, it is his legacy that is of note. Since his death, there has been a growing number of cases reported to child protection cases in the UK.

The latest numbers come out of Wales. "There were 2,700 children on the child protection register in March 2010, an increase of 31% from 31 March 2009, the Welsh Assembly Government figures found. The figures show an even more marked rise on statistics for March 2008, eight months before the Peter Connolly case hit the headlines, when 2,320 children were on the register." (Source: BASW news, December 1, 2010).

What is perhaps most interesting is how again we see the link between child protection concerns, particularly neglect, and poverty. A report reviewing child protection in Wales, From Vision to Action, notes that while social workers are often overwhelmed with caseloads, and budgets from governments often more limiting, there are powerful societal trends at work. "...the From Vision to Action report by the Independent Commission on Social Services in Wales which points to a calculation that 51% of looked after children in Wales live in the 17% of neighbourhoods identified as the most deprived (BASW).

The Welsh report wisely notes that budget cuts in services to vulnerable populations will lead to some long term costs. "Retreating into core services and away from prevention and collaborative improvement would undo gains made in recent years and would quickly become unsustainable" (p.6).

One of the more delightful insights from the Welsh report is how the bureaucratization of child welfare (often a response to high profile deaths) is counter productive. "Current assessment systems for adults and children are overly-bureaucratic, too concerned with process, poorly served by IT and do not assist professional judgment about risk" (p.7).

I am very struck by a quote in the Welsh report that puts into context the world in which services and programs for children and families operate: “ People want a life not a service” (p.27). If we are busy serving the bureaucracy and protecting it,how well do we really serve clients?

Welsh report:
Pearson,G., Jones, J.,Williams, R.H. & Robson, P. (2010). From vision to action: The report of the independent commission on social services in Wales. Downloaded December 2, 2010 from http://dl.dropbox.com/u/3522570/ebulletin/wales-visiontoactionenglish.pdf

Monday, November 29, 2010

Another high profile death awaits

At the risk of sounding alarmist, the risk of yet another high profile death of a child known to child protection authorities is just around the corner. How can I feel so secure in saying this?

News media are beginning to report the worrying trend of major cutbacks in funding. These inevitably lead to layoffs and the reduction of resources. Fewer child protection workers struggling with systems where there are fewer supports to offer families. This leads to the choice of apprehending a child where supports may have kept a child in the family or, in the alternative, simply determining that only the most serious cases will have files opened (and thus the hope that the child will make it through).

There are those, such as the NCCPR who say that only focusing on real cases of neglect or abuse may be a good thing. They might argue that too many cases are being opened and far too many children apprehended - put the resources against sustaining families and apprehend fewer children. They might suggest that is cheaper and better for society. One doubts that NCCPR spends much time at the front line trying to make the apprehension decision. But, they have a point that resources need to be used wisely and cases opened that really need intervention. If only we, as a society, could agree on that and avoid forcing social workers to make those decisions knowing that limited resources are available.

As Wotherspoon et al., note in a recent article on presenting infant mental health concerns to the courts, many of the interventions that we are using with families are not necessarily effective. Not enough evidence based resources are generally available that recognize the intense and long term supports that many families need. It is not enough to be critical of the apprehensions if you are also not willing to support the funds needed to actually make a difference in families while trying to keep the children with their parents.

Three articles in the last few days tell us that resources are getting tighter. An Australian writer today notes the problems of burnout in CPS workers (http://www.eurekastreet.com.au/article.aspx?aeid=24265).

CommunityCare.co.uk reports today, "All of Derbyshire Council's social care workers have been given the opportunity to apply for voluntary redundancy or early retirement in an attempt to save £84m following government spending cuts" http://www.communitycare.co.uk/Articles/2010/11/29/115904/council-offers-social-care-workers-voluntary-redundancy.htm

Another report from another area of the UK notes "Around 300 children's services posts are at risk in Cumbria as the county council braces itself for a raft of cuts to government grants." http://www.cypnow.co.uk/news/1043844/Cumbria-childrens-services-jobs-risk/

These cuts in the UK will affect a broad range of social workers and supports to families. Will the public stand in support of child protection when the next high profile death occurs looking to the politicians and say it was their responsibility because they cut so many resources? One doubts it!

Postscript:

The Representative for Children and Youth in British Columbia today issued a report on the progress from the Hughes Commission of Inquiry. It is not flattering but it also emphasizes how the economy adds to the challenges of child protection. The commissioner states, "Difficult economic times can mean harsher realities for many of B.C.’s families. Poverty will deepen for some, unemployment rates may climb, and previously successful families may struggle. Social services may be required more often, and community supports may disappear. Stagnant or decreasing budgets will not be able to address the needs of additional children and families" (p. 17).

The adage of doing more with less comes to mind - the recipe for one of those high profile deaths.

The full B.C. report can be found at http://beta.images.theglobeandmail.com/archive/01037/Final_Report_of_im_1037667a.pdf

Tuesday, November 16, 2010

Crisis in child portection

An Australian professor writing in the Sydney Morning Herald yesterday has again highlighted problems that are facing child protection there but the themes are familiar ones throughout the western world:

* under staffing
* need for more education and training
* weak management
* failure to recognize the workers
* high caseloads

These themes are seen in Canada, the UK, USA, New Zealand and elsewhere. Yet, government seems helpless to solve the problems. This may be a function of the child protection model but we may also have to ask some very challenging questions. Are we simply trying to protect too broad a range of problems and families with resources that we are not prepared to fund? In other words, are we simply saying that we have broadened the definition of who should be protected far beyond what we are willing to pay to address? Therefore, has the burden of the child protection system been expanded so far that success is virtually impossible in a broad way?

The ongoing saga of inquiries into the child protection systems suggests so. A redefinition of who needs protection is required but there is nary a politician who may be up to the task. Who, after all, wants to say that we should stop protection for families because we are going to narrow the definition of who is deemed bad enough for services?

Yet, by expanding the definitions of who should get intervention beyond what we can afford to support, we are saying that we will generally do a poor job across large portions of the caseloads. There are only so many cases that any worker can do well.

The social work profession should be leading this debate. With the many political mine fields that come with it, however, is it any wonder that there are few voices who suggest anything other than fewer cases per worker, hiring more workers (an increasingly scarce resource) and increasing funding (with government finances also an increasingly scarce resource).

These are just a few of the very difficult questions that need asking. It will be interesting to see what the Munro commission in the UK ultimately comes up with. Prof. Munro is in the challenging position of trying to suggest a direction for a child protection system that has been under siege in that country for years.

There is a need to challenge the very basic underpinnings of our present child protection systems. It will take a very brave leader indeed to do that.

The Australian article can be found at http://www.smh.com.au/opinion/politics/staff-crisis-at-the-heart-of-child-protection-problems-20101115-17u48.html

Sunday, November 14, 2010

Adoption

I have counseled children who have been adopted, their parents as well as biological parents who have lost their children.

Often, I am struck by what adoptive parents are not told. They are expected to take on the responsibility for raising a child who has frequently suffered in pre-adoption periods either through unhealthy pregnancies, attachment problems, neglect and abuse - or all of the above. Somehow, we expect adoptive parents to take on these children with one hand tied behind their backs as they only get to learn about what happened to the child as behaviors emerge.

I have regrettably even had cases where the truth about how bad it was for the child pre-adoption was not only withheld but downright misrepresented. In a letter to the editor of The Guardian newspaper in the UK, a magistrate has very nicely summed up the problem with this approach. She writes:

"You write in your editorial that parents who adopt "must be offered support" and that "children who are removed from dysfunctional homes need support for longer than is currently provided". I would like to suggest that using the term "support" in this context is to underplay the serious psychological damage which is the consequence of the "extreme abuse or neglect" suffered by 71% of those adopted, to quote again from your editorial. Where there is psychological damage, it is not support which is required, but serious therapeutic assessment and intervention of the sort offered by trained child psychotherapists.

We should not expect adoptive parents to provide psychotherapeutic treatment for traumatised children. We should be truthful about the extent of the trauma. We need to provide adequate finance for adopted children – and their adoptive parents – to be given therapeutic resources to address the complex issues involved. The long-term savings to the Exchequer would be considerable. Early intervention is well-known to obviate or reduce the need for future costly input." http://www.guardian.co.uk/theobserver/2010/nov/14/big-issue-adoption-child-welfare

The research increasingly tells us that early brain development has broad scale implications for life - be it school, relationships, family life, recreational activities - and that these are life long impacts. As a side note, these impacts are affecting people's capacity to even be successful with their careers as adults.

Given how broad ranging this research, why would we take a known vulnerable population, children being adopted from child protection, for example, and not do all that we could to focus on building as much brain strength as possible? As the magistrate suggests, that requires significant intervention over time.

As government budgets get cut, short term therapeutic interventions become fashionable. With this population, they don't work. One only has to look at the work of Dr. Bruce Perry to see this (his books should be essential reading for anyone who works with this population). The work of Terry Levy and Mike Orlans also shows this.

Adoption is only part of the solution but in the western world it has too often been seen as THE solution.

Tuesday, November 9, 2010

Paying for Sterlization

Child protection, by its very nature, will enter a family and feel like a divisive force to many. This may be true whether the child remains in the home or not. Parents being told that things must change - and being so told by powerful outsiders - can naturally garner some resistance.

For parents who are faced with very large struggles (addiction, serious domestic violence, extremes in poverty, mental illness to name the big ones), child protection often means that their children will be taken from them. An incapacity to make some fairly significant improvements will mean that several will lose their children through permanent guardianship orders or termination of parental rights. Those children will grow up in foster or adoptive homes with varying degrees of success or failure.

Cat McShane, writing in last Sunday's Guardian newspaper in the UK, spoke about Project Prevention. This is a very controversial effort by an organization to essentially stop drug addicts from procreating. As it says on its web site, "Project Prevention offers cash incentives to women and men addicted to drugs and/or alcohol to use long term or permanent birth control." Those who believe that there is a morality to ending the inter generational cycle of dysfunctional families will find some solace in this approach. Critics argue that the project simply pays addicts money to buy drugs in exchange for their fertility - an exchange that some might see as a pretty cheap exchange but not unlike the desperate exchanges that addicts will make many times in their lives.

Those who work in child protection will see some merit in the exchange as they go about their daily work with children affected in utero by alcohol and drugs as well as those who have come to live in the utter chaos of their parent's attempts to survive from one fix to the next.

McShane's column shows that addicts can turn their lives around and go on to become successful parents. He perhaps dismisses too easily the costs being paid by the children born into addiction. His stories of hope are welcome but so must also be the reality for the children who live with the legacy of their parent's addictions.

This is a tough moral debate - pay for avoiding the huge costs to society arising from caring for these children or prevent the births in the first place. While Project Prevention is voluntary, one is reminded of prior efforts by society to prevent unfit parents from giving birth. It reminds me of the eugenics movement where society sterilized thousands of mentally retarded people in order to ensure that they did not have children. While these were forced sterilizations, the moral judgment of who is fit to have a child and who not is a driving force in both.

The other side of the coin is seen in families who adopt children from the system. As someone who has worked with adoptive families, I am struck by the degree to which they are unprepared to deal with the challenges of children born into abuse, neglect and addiction. Thus, another Guardian article last weekend by Tracy McVeigh was not surprising as the challenges faced by these families was outlined - greater challenges than expected; not being told the full truth about the child and not having the full range of supports needed for the challenges being faced. This article is worth a read
http://www.guardian.co.uk/society/2010/nov/07/parents-adopt-child-abuse-support?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+socialservicesnews+%28Social+Services+News+from+IRISS%29

McShane's article is also worth a read as it is thought provoking. You can find it at http://www.guardian.co.uk/lifeandstyle/2010/nov/07/families-divided-by-the-state?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+socialservicesnews+%28Social+Services+News+from+IRISS%29

You can find Project Prevention at http://www.projectprevention.org/

Saturday, October 23, 2010

Australia - a horror story

In what can only be described as a horror story, a northern territory in Australia has admitted virtual failure of its child protection system, particularly with the indigenous people. The stories are horrific examples of a child protection system that has utterly failed to do the very thing it must - protect children. The Minister responsible has acknowledged how bad it is and the need for a complete restructuring of the system.

What is perhaps true but also frightening is the fact more children will suffer while they try to put together something that might work. The government deserves praise for seeing the necessity of change but one has to wonder how this could go on for as long as the news reports suggest.

We must learn here about the value of constant monitoring. Transparency should be an essential part of this monitoring. The UK system of serious case reviews is not perfect but there is at least some reporting to the public when something goes wrong. All jurisdictions should be willing to do that at least. Britain has shown how it can be done while still ensuring confidentiality as needed.

The Australian story can be found at
http://www.smh.com.au/national/we-failed-them--territory-to-overhaul-child-welfare-20101021-16w56.html

The official report identifies some themes that those of us in Canada will recognize such as the failure to allow Aboriginal groups a valid say in the protection of their children. Under resourcing is another very familiar theme. So is fragmented services, an unstable workforce with high demands matched with high turnover, lack of needed services and failures to monitor children.

This report echoes themes that we have been seeing in reports from New Zealand, Canada, the UK and elsewhere. If the themes are common, perhaps the problems are about the ways in which we have been building, funding and servicing child protection. Has the time come for a large scale debate?

Here is the official news release:

"19 October 2010A focus on prevention, collaboration, greater Aboriginal involvement and control of service delivery, and strengthening families and systems are at the heart of recommendations by the Inquiry into the Child Protection System in the Northern Territory.


In addressing what it described as the ‘overwhelming failure’ of the Northern Territory’s child protection system, the Inquiry’s three co‐chairs said it was important to focus on systemic failures not the many hard‐working, thoughtful, dedicated people struggling to cope with limited resources in an environment characterised by extreme need.


They said their inquiry had uncovered a “tsunami of need” that could be addressed only by immediate action to deal with an overburdened system, preventative measures to deal with the problems upstream and a dual response system to helping vulnerable families that doesn’t depend only on statutory interventions.


The inquiry’s report, “Growing them strong, together”, found the Northern Territory child protection system is in crisis because of:
• insufficient resources to deal with both the number of statutory interventions needed and the many issues beyond child protection that are integral to effective case management;
• the number of notifications of children formally identified as at risk which remain uninvestigated – currently there are nearly 1000 children in the Northern Territory identified as at risk who are receiving no support or investigation, with many more cases likely to be unreported;
• the fact that mandatory reporting was introduced without a commensurate increase in support services, with a tripling of notifications since 2003‐04 and a 79.4 per cent increase in the past two years;
• an almost complete lack of Aboriginal controlled services, despite the fact that 73 per cent of notifications relate to Aboriginal children;
• under‐resourced out of home care options (such as foster care and residential care) despite the fact that the $34 million budget is the most costly component of the Health and Families budget. The number of children in out of home care has more than tripled to 555 in the past 10 years, with Aboriginal children four times as likely as non‐Aboriginal children to be in care;
• a failure to monitor children in out of home care or provide appropriate support to foster parents, many of whom feel they are not respected, that they are subject to arbitrary decisions, and that children are moved in and out of their care with little planning or consultation;
• a non‐government sector that is poorly resourced yet could play a critical role in supporting families and children;
• fragmented service delivery across agencies, many of which lack confidence in the ability of the child protection system to respond to notifications of children at risk and to work collaboratively with them in addressing problems;
• overwhelming workforce issues, such as problems recruiting staff, high turnover, untenable caseloads, low morale, a lack of Aboriginal workers, ad hoc training and staff inductions and poor supervision;
• a lack of support and therapeutic services for protected young people in the Northern Territory, who are at risk of adverse mental health outcomes, relationship difficulties and becoming clients of the youth and adult justice systems.

The Board of Inquiry into the Child Protection System in the Northern Territory was appointed by the Chief Minister Paul Henderson in December 2009. Its three co‐chairs are Professor Muriel Bamblett, Dr Howard Bath and Dr Rob Roseb"
Source: http://www.apo.org.au/research/growing-them-strong-together-promoting-safety-and-wellbeing-northern-territory%E2%80%99s-children-r

It is noteworthy that the inquiry itself sums up what we have been seeing elsewhere with this statement from its introduction:

"The foremost finding of the Inquiry is that there needs to be organisational reform in child protection in the Northern Territory which includes a re-orientation towards a more collaborative approach to the task, as well as an immediate investment in more staffing resources for statutory child protection and out of home care (OOHC) services. This said, unless there is a robust concomitant commitment to developing culturally appropriate, early intervention and preventive services, the statutory service will never be able to keep up with demand. If change is to occur, we need to invest as much, if not more, into preventing the need for vulnerable children to be placed into care as we do to investigating and monitoring families and placing their children elsewhere" (p.2)

Like many jurisdictions, the question of demand for service outstripping supply should also tell us that there are serious problems in our society's framework when we simply can't fund enough child protection for the children who need protecting. Even if we narrow the definition of the kinds of family environments that require intervention, we are still unlikely to keep up with the demand.

The Australia report adds to the conversation about what is needed by outlining a series of principles - worthy ones indeed - but can we fund them as a larger society?

Services must:
Recognise 1. the principles central to the United Nations Convention on the
Rights of the Child (UNCROC) including:
• Children’s right to safety (including cultural safety), security and
wellbeing
• Families are best placed to care for children
• Government’s obligation is to provide the widest possible assistance to
support families in their child rearing role
• Children’s right to be free from abuse and neglect and that where
parents can’t or won’t protect and care for children (even with widest
possible assistance) the State needs to intervene and care for the child.
Statutory child protection is one part of a broad and robust system for
protecting children and ensuring their wellbeing.
2. Acknowledge the particular United Nations considerations that are
particularly relevant for Aboriginal children:3
• the interconnectedness between children, communities, culture and
context
• their present situation cannot be understood without reference to the
historical context and a large history of rights violations
• obstacles to the rights of Aboriginal self-determination remain a real
barrier to the realisation of the safety and wellbeing of children
• the significance of land and its loss and violation to Aboriginal people is
in part about its centrality in the future lives of the children.
3. Be child-centred in the context of family and community — protection of
children must occur within a framework of valuing children
4. Be based on the understanding that child protection is everyone’s
responsibility – whole of government and whole of community
5. Recognise the need to build capacity in families and communities which
requires family sensitive, culturally competent resources and systems for
families that they and their communities can influence and grow
6. Be culturally literate and competent enabling access and availability to all
cultural groups and able to acknowledge cultural differences and meet
unique cultural needs
7. Use local, place-based approaches and models as opposed to importing
ideas without adapting them to Northern Territory and local ways. Service
models need to be tailored to the local context – recognising that a system
for protecting children in remote communities, town camps, regional
communities and urban centres will be different
8. Be non-stigmatising and equitable and fair appreciating that all children
have the same rights to safety, security and wellbeing
9. Acknowledge that whilst procedures are important, the work involved in
caring for children, families and communities and keeping children safe is
deeply relationship-based
10. Establish a clear mission, philosophy and objectives; have a practice informed
management that can engage with front-line staff; and resource
and support a workforce that is enabled to do its work and have measurable
performance criteria
11. Use evidence-informed approaches and where this is not possible, at least
use theoretically informed approaches with a commitment to immediate
evaluation
12. Be accountable to specific performance standards that demonstrate defined
outcomes for children, families and communities.

Sunday, October 17, 2010

Intuition and child protection

Duncan Helm, a British researcher, has just published Making Sense of Child and Family Assessment. While I have yet to receive a copy (it is on the way) I am intrigued by an approach that he has taken in his work - that intuition does and must play a role in child protection decision making.

Such an idea runs counter to what has become the risk aversive atmosphere of child protection throughout the west. This has led to the introduction of more and more risk assessment tools which are not faring well under the scrutiny of researchers. Largely speaking, they are not yielding results that support them as being effective.

Social work is a human endeavor and, as such, requires human judgment. That requires assembling available data and making decisions. Intuition is part of that process but, as Professor Helm notes, not a valued or well researched part of it.

In an interview with the Herald Scotland, he stated, "Mr Helm argues that many social work leaders fear and try to prevent workers acting on intuition. After a series of high-profile failures in child protection, inquiries into cases which have gone wrong have compounded the problem....The human element at the core of good judgment seems to be getting written out.”

The article goes on to state, "When you have a gut feeling where do you go with that? “Workers say when they come to case notes and records there is no place to record gut feeling. But that sense that ‘I don’t know what this is but I know I’ve seen it before’, can be valuable.”

We need to enhance these skills so that experience can be used along side various other tools that enhance decision making. Denying the intuitive portion of decision making is to deny reality. Bravo to Prof. Helm for raising this.

Monday, October 11, 2010

Is child protection failing?

In a 2006 study Naristela Zell looked at child welfare workers and their views on the system. The research took place in New York and Chicago but anyone who has worked in the child welfare systems of the western world will find her results all too familiar.
"The major themes that emerged from the analysis indicate caseworkers believed that the child welfare system does not meet the needs of the children in care, lacks the resources to appropriately serve clients, and often establishes goals that cannot be attained by the biological parents. Caseworkers held negative views of the biological parents and, although most described their organization as well equipped, almost as many reported that their organization lacked technical, administrative, and personnel resources. Caseworkers' views of child welfare policies emphasized the need for reforming the system and reevaluating funding priorities" (abstract, p.83).
These are the views of people actually working in the system on a day to day basis. They help us to see that services are under resourced and the system is not creating the kinds of changes needed.

In 2010, Kristien Campbell and her colleagues have published a study of enormous value that helps us to see that the views of child protection workers are not disgruntled voices from over worked child protection workers. While Campbell et al.'s work has been celebrated by critics of child protection systems as being self evident and obvious to anyone who has bothered to look or listen to parents, the research adds dimensions to the public policy debate and practice standards needed to serve families.

Here are the highlights of their conclusions:

"Are modifiable risks associated with CPS investigation?
CPS investigation between ages 4 and 8 years was associated with
increased maternal depressive symptoms at age 8 years (P<.05)
(see next slide for comparison with other available measures).
Does CPS substantiation of maltreatment alter these findings?
CPS substantiation of maltreatment did not alter primary results.
Are modifiable risks reduced with time since CPS investigation?
Increased time from CPS investigation was associated with increasing household, caregiver, and child risk."

"We found an association between CPS investigation and subsequent increased depressive symptoms in maternal caregivers.

We found no association between CPS investigation and subsequent social support, family function, poverty, maternal education, and child behavior problems.

Our results suggest that a CPS investigation represents a missed opportunity to reduce risks in these high-risk households." (Source archpediatrics.com).

What this work helps to identify are very key public policy issues that are desperately in need of debate. The main, although not all of the issues are:

1. Child protection has become the sole purview of social work. (see also part 1 of the Munro report in the UK). This is wrong. As Bergman (2010) in an allied editorial with the Campbell research has noted, general practitioners and public health nurses will spend much more time with a family than will a child protection worker. We need get them fully integrated into protecting children through their powerful and trusted roles. CPS is better at working with families that are intransigent or distant from community based services such as doctors and nurses.

2. We need to be using proven and effective interventions as opposed to those that we have always used or are just available even though there is little evidence to show effectiveness. Dr. H. McMillan from McMaster University in Hamilton, Ontario noted in a presentation in 2009 that most current parent interventions are not achieving long term changes. This is part of the reason why so many child protection cases re-open.

3. We must accept that a large portion of child protection matters exist not because of failings of parents but failings of society that have yet to address poverty and other forms of oppression that are so closely ties to most child protection cases. Too often we blame the victim of the system as opposed to the society that created the problem.

4. We must be prepared to fund the kinds of interventions that do make a difference. CPS systems have been under such budget restraint that they no longer try for long term but focus on what is needed to address the current crisis only. Is it no wonder that so many cases re-open.

5. Child death cases (which too often create knee jerk reactions leading to poor case management, system protection and over apprehension of children) should have shown us that the current systems are not working.

6. When courts are involved, we set up an adversarial system between child protection and the family. The child is lost in the mix as the parents become the focus and not the child.

This is a topic that should not go away and requires much more debate.

References:

Bergman, A.B. (2010).Child protective services has outlived its usefulness. Archives of Pediatric and Adolescent Medicine, 164 (10), 978-9.

Campbell, K.A., Cook, L.J., LaFleur, B.J. & Keenan, H.T. (2010). Household, family and child risk factors after an investigation for suspected child maltreatment. Archives of Pediatric and Adolescent Medicine, 164 (10),943-9.

Zell, M. (2006). Child welfare workers: Who they are and how the view the system. Child Welfare, 85 (1), 83-108.

Sunday, October 3, 2010

Professor Munro offers her first view of her work on the UK child protection system

Professor Munro was appointed by the UK government to review the child protection system and to consider ways to make it effective. There is an exhaustion one imagines in the UK with public inquiries following the deaths of children known to the child protection system. The British public must surely be wondering why the system cannot seem to work. Professor Munro was a good choice as she has been an insightful author regarding the challenges of the system. She has a good record of looking at the broad issues and not getting mired in the details of a specific case at the expense of the bigger picture. Thus, it is with some excitement that one starts to see the product of her inquiry.

Very quickly she identifies one of the major themes that we have seen in the literature - the over managerial-ism of the system. In my view, this has been to protect politicians and senior managers from criticism if something went wrong - the policy and procedures were followed therefore we are blameless. But as Munro notes, this is not helping children:

"A dominant theme in the criticisms of current practice is the skew in priorities that has developed between the demands of the management and inspection processes and professionals’ ability to exercise their professional judgment and act in the best interests of the child. This has led to an over-standardised system that cannot respond adequately to the varied range of children’s needs" (p.5).

Managerial-ism would have you believe that risk can be predicted, that procedures will manage all kinds of situations and that families will neatly fit into categories. In my won work, I know that there are no cookie cutter views of families. What one might expect going in is often not what is founded. Flexibility is key to case management not procedural-ism. The problems are often not clear and the data emerges slowly and unpredictably. Munro recognizes this.

Fear that there will be yet another death drives a lot of worry in cases and can skew how a case gets perceived. She states, "The problem is that the evidence
of abuse and neglect is not clearly labelled as such. The causes of injuries are often hard to ascertain; children’s distress and problematic behaviour can arise from myriad causes. Fear of missing a case is leading to too many referrals and too many families getting caught up in lengthy assessments that cause them distress but do not lead to the provision of any help. This is creating a skewed system that is paying so much attention to identifying cases of abuse and neglect that it is draining time and resource away from families" (p.6). Equally, when budgets get too tight, cases can be shunned because the resources are not there to properly investigate and open for services. How government chooses to fund child protection has a direct impact on how cases will be addressed - too much fear leads to too many cases being opened and dissipated efforts being made creating funding pressure. Too few financial resources and cases will be missed that will lead children to remain in high risk situations. The balance is hard to find.

Munro raises a particularly crucial issue that can easily be lost in the myriad of efforts to protect systems from tragedies or overspending - social work is about relationships and the need to build them in challenging environments. Rules, technical solutions, procedures do not support that work. Earlier work by Munro has found that the amount of time social workers actually spend with families is going down as they strive to meet organizational versus client needs.

If the goal of child protection is to keep families together or to reunify them wherever possible, then social workers must be able to focus on the clinical needs of families. Referring to the work of Farmer (2008), Munro states, "Farmer
illustrates this point well reporting that the highest success rate for reunifying
children with their birth families was 64% while the lowest was 10%, with the key
determinant being the skill and investment of the social work team" (p.10).

The clinical lessons explored in Britain but seen around the English speaking child protection systems have not been successfully implemented. Thus, the errors keep getting made. As Munro states, "The efforts to improve practice have not addressed all the weaknesses in practice and have tended to focus mainly on the process of case management, increasing regulation, and standardised assessment frameworks. Difficulties such as forming working relationships with families, asking challenging questions to really understand the family’s history and current situation, keeping an objective view on what is happening, and coping with the emotional demands of the work have received less attention. The biennial reviews of SCRs report recurrent problems in practice, e.g. children being invisible to professionals because the focus is on the parents, inadequate assessment of the dangers of parental problems of substance misuse, domestic violence, and mental illness, and fixed judgments not being challenged and revised" (p.12).

We must also recognize that there are some families where the risks are not going to go down and things will not get better. Holistic views of the case including the use of effective intervention strategies will highlight those families. Social workers need to be able to do good case work for that to be seen. It then also leaves room to ask if we are doing what is right for this child; for this family as opposed to asking are we doing the right procedurally prescribed action.

There also needs to be the opportunity to learn from mistakes. Thus, we need a system where people can acknowledge mistakes without fear of reprisal or job loss. Most jurisdictions do not have that making it hard for the learning to take place. Instead, we have systems where somebody needs to be blamed. We must remember that we are not talking about malpractice but about errors that will occur because of the inherent nature of the work.

Munro also notes the power of supervision in helping keep workers analyzing what is going on with a case. As she states on p. 18, "Building strong relationships with children and families with compassion is crucial to reducing maltreatment, but trust needs to be placed with care, and ‘respectful uncertainty’ towards families, and interest and curiosity in their narratives, needs to be part of the practice mindset. To work with families with compassion but retain an open and questioning mindset requires regular, challenging supervision."

Several reviews of what goes wrong on child protection have commented on the lack of a voice for the child. Munro reminds us of that and emphasizes the importance of workers building a relationship with the child and actually hearing their story so that their needs can be understood as well. While this seems obvious, managerial-ism and procedural-ism work against that.

Critics of child protection are quick to attack if a child dies. Media leap on such stories. So to do the critics leap on perceived over zealousness. One only has to look at the US blog of the NCCPR to see this. Munro notes, "The media carry two perennial forms of stories about child protection: cases where the danger has been under-estimated and cases where the danger has been overestimated.
Professionals, in particular social workers, face the possibility of censure
whatever they do: they are ‘damned if they do and damned if they don’t.’"(p.20). There are no zero harm options in child protection!

Munro is providing a thoughtful look at this very complex system. The first report gives us reason to be optimistic that she may bring the kind of view where substantive improvements are possible (assuming the political will).

Saturday, October 2, 2010

Serious Case Reviews in the UK

The UK has just seen the publication of an overview of Serious Case Reviews for the period 2007-2009. Maybe only us academics will find it of interest but they have brought an important new dimension to their review - consideration of children who die or are seriously harmed in the community as opposed to within the family system. This is a perspective not often considered.

Before looking at this new dimension, there is reinforcement of the role that various community practitioners play in protecting the lives of the vulnerable - particularly the very young. As is often seen, the most vulnerable children are those under the age of 5 - the age where it is hardest for the child to have a meaningful voice about what is going on in the family. Thus, general practitioners, community nurses and other professionals that come into contact with these families are typically the most informed set of eyes about the family. If they do not stay alert to what concerns may be there for a child, it is unlikely that the problems are going to be addressed.

The report offers a good practice lesson when working with larger families. "Our analysis of a sub-set of these cases indicated that neglect featured prominently and
highlighted the danger that when agencies work with large families the focus on
an individual child can easily be lost" (p.27). More complex family dynamics can hinder the view of each child's needs. As Pearce and Pezzot-Pearce note in their book on parenting assessments in child protection matters, one is considering the ability to each parent in respect of each child. If the individual needs of a child is lost in a crowd, then it is not difficult to see the report author's concern.

Stanley et al., (2010, in press) remind us that domestic violence is a prevalent concern in high risk families. They state, "...domestic violence had been identified as a key feature in local reviews of child deaths and this is consistent with Brandon et al.’s (2009) overview of 40 serious case reviews in England which found that domestic violence was the most commonly occurring characteristic in the child deaths studied." What goes on in the home can help to normalize risk, violence, trauma and harm. This can make the connections to such behaviors and environments in the community that much easier and perhaps normal and expected.

In looking at the issues of harm in the community, it is also important to recognize the following point: Taking into account the children‟s ages, it is not surprising that the younger the child, the more likely it is that the abuse or maltreatment will occur at home. Older young people, who become, increasingly, part of the wider community as they age, are more likely to be harmed or to self-harm within a community context. As young people mature, outside family factors and „triggers‟ take on more importance in their lives and the perpetrators
of harm are less likely to be family members. However, young people still carry with
them the legacy of their early experiences of care and nurture which influences their ability to either cope with or to struggle to withstand outside influences" (p.29).

In terms of risk to children from the community, the report raises a fascinating point: Excluding young people from school has a wide ranging impact and limits their
protection and their access to a range of other services". (p.31). Suspending or expelling children from school invites them to become connected to other peers who are in a similar setting. A discussion needs to begin across a broad base of educators, social workers and other professionals to develop alternatives to avoid pushing children toward anti-social groupings. Are there ways to have children in school somehow contributing to the school in response to anti-social transgressions.

With children involved with child protection, the older they are the more able they are to be involved in high risk behaviors - sex, drugs and rock and roll to use an old metaphor. Regrettably, much research tells us that the older child is much more likely to be involved in these patterns if they have not had effective interventions when they are younger - this might be because of problems being unaddressed or cases dragging on with poor or ineffective case planning allowing the child to experience prolonged uncertainty about their lives.

When the authors looked at the older child who came to serious harm or death in the community, the authors notes, "Most young people had experienced neglect and or abuse and had grown up living with the „toxic trio‟ of family violence, parental substance misuse and parental mental ill health" (p.33). Combine this with poverty, housing instability, relationship changes and you can see the cumulative impact on families - stress levels grow over time with little chance for relief. Children become just another one of the sressors. This really emphasizes the need to think of families in an ecological perspective.

An important point is made about younger children harmed in the community. "Risks of harm to children „in the community‟ were posed within formal, regular child care arrangements (for example from a nanny and from un-registered child-minders and from a sexual offender whose wife was a registered childminder). Harm within the context of more informal, ad hoc childcare of young pre-school aged children came from leaving children in the care of unsuitable and often unstable young people or adults. Usually these informal carers or babysitters were known or loosely connected to the family, for example the teen-aged son of a mother‟s boyfriend" (p. 35). Far too often, marginalized families are forced to rely on whatever child minding might be available. These families often have very few choices for child care yet need the support in order to try and make ends meet.

The review also raises a very salient point about risk. We are more prone to worry about those with a history of known inappropriate behaviors but there are those for whom people have a concern, even though it is not substantiated. The authors state, "A number of sexual assaults were not from known sex offenders but from other
individuals about whom there were serious concerns, for example “a known associate of the family about whom many long standing concerns had been held" (p.38). When we use multiple sources of information about what is going on in a family, we may better identify those who constitute a risk for children including such as these individuals. From a practice level, this allows us to see a family from the more complex level of not only who is in the family but also who is informally involved with and perhaps trying to support the family and may be not appropriately so.

As the authors note, there are also recurring themes that are good clinical practice lessons. There are some children who are just very difficult and can stress a families ability to cope. As the report notes, "There are recurring themes about the particular vulnerability of many of the babies at the centre of the reviews, especially prematurity, time spent in intensive neo-natal care, drug
addicted babies, and „difficult‟ babies. All these factors present particular stresses for caregivers, and potentially dangers for the baby, especially where the family is already struggling and experiencing other difficulties" (p.52). Combine a parent with weak parental capacity and a demanding baby and you have a toxic mix.

We can make the mistake of assuming, however, that as children grow and become attached to schools that risks may diminish. The child is away from home more and there is more oversight. This may be a false assumption and care should be taken to not fall into it. It may well be that the risk of death diminishes but not the risk of injury.

As has been seen in other places, these authors also warn us about "Start again syndrome" where practitioners see a new baby or a new partner or a new something as a way for a family or a parent to start over and let go of past patterns. Indeed, with this thinking, the past patterns are often poorly understood or even ignored. The report raises other lessons that we have seen before:

* parents who are non-cooperative, miss appointments, fail to follow through or somehow manage to fall off the radar are then not achieving real change;
* social workers overwhelmed with high caseloads missing details or just not able to follow up on crucial data;
* the need for strong relationship building to be effective with families;
* being wary of the rule of optimism in which workers want to feel successful and are therefore reluctant to be negative or critical of families;
* being unwilling to change your mind about a case - once a view is adopted sticking with it despite new evidence that should alter the view;
* failing to see or interview all of the children creating the missing or unseen child.

Stanley et al., (2010, in press) reminds us that involving professionals from various agencies with varying roles brings more eyes into troubled families. Of course, there must be ways for the agencies to communicate or they operate in a vacuum which allows higher risk families to manipulate who knows what.

References:

Brandon, M., Bailey, S., Belderson P. (2010).Building on the learning from serious case reviews:A two year analysis of child protection database notifications 2007-2009. East Anglia, University of East Anglia.

Stanley, N., Miller, P.Foster, H.R., Thomson, G.(2010). Children’s Experiences of Domestic Violence:Developing an Integrated Response From Police and Child Protection Services. Journal of Interpersonal Violence, In Press.

Monday, September 27, 2010

Death Review themes get repeated way too often

While the work of a Cleveland Ohio panel looking into a series of deaths in families is not yet done, their preliminary work is suggesting a pattern that has become all too familiar in death reviews. However, one of the more interesting is that the county child protection agency seems to lack a sense of urgency about cases. The basis for that conclusion is not yet known but they appear to point to workers being more oriented to solving immediate safety concerns rather than focusing on the long term issues such as mental health, addictions and domestic violence.

The panel also talks about something that has been seen far too often and has become a feature of social work in too many cases - cookie cutter case plans. These can include sending parents off to parenting classes - the majority of which research tells us do not create any lasting change.

One of the goals of the panel is to see how children can be returned to parents more often. Yet, a weakness in child protection is raised in this work - how long do you stay involved? How can you know whether the parent can stay sober? Will the parent keep taking the medication for their mental health? Can the parent stay out of a violent relationship? In reality, there is only so far that a child protection system can go. There is a point where resources need to be allocated elsewhere and there is hope that parents will stay connected to the systems that have helped during CPS involvement.

Are there ways to better monitor after CPS cases are closed so that the revolving door of entering, leaving and re-entering foster care can be stopped? This is a core question that can be hard to solve when a weak economy is putting more pressure on families and the services they need are seeing year over year budget cuts. Those very services that can help keep families functioning are in jeopardy financially and so are CPS budgets. More families will have fewer supports at times when the stresses arising from the weak economy grow. The recipe for more children to fall between the cracks is there. More children will suffer because we, as a society, are not prepared to really solve the problems and pay for good child protection - one that solves rather than offers band aids.

Sunday, September 26, 2010

Is Foster Care Better

A sad reality in parts of the Western world is that foster care may not be better than the home that the children left. Group care has major challenges as well. Children may find themselves exposed to just as unhealthy a situation in care as what they left.

A reflection of care in Los Angeles echoes this concern. A news report from KPCC in that city notes: The foster kids themselves point to problems with the families into which they are placed, which sometimes are worse than the abusive situations from where they were removed. Shimia Gray entered foster care at age 2, removed from the care of her drug addicted mother, and went on to live in 10 different foster homes and 2 group homes.

“Most of the foster homes I got put in, I was in bad situations,” explained Shimia, talking about the tense and dangerous conditions that she endured. “One of my fosters homes, I was about five or six but we used to get beat on like really, really bad. When she knew the social worker would come, she wouldn’t hit us. Before the social worker came, when she knew they was coming, she’ll threaten us like don’t say this or I’m going to do this and then you aren’t going to tell on the foster parent.”

Workers in LA County are carrying about 30 cases on average which is double what we can typically manage effectively.

The report on KPCC, public radio in California, is worth a stop by http://www.scpr.org/news/2010/09/24/life-systemlong-odds-facing-ls-foster-kids/

Of course, the vast majority of foster care situations are good and provide nurturing, caring situations for children. One of the challenges in the system is that those apprehended from large families will see siblings separated because there are few situations where large groups of children can be kept together.

Children are also often not receiving the supports needed to help them recover from the early impacts of neglect and abuse in their lives. This makes it harder for the foster carer to sustain a child who is a behavioral challenge. Thus, the cycle of ever changing placements. This may lead to situations where children are placed in institutions that may not be good. In Nebraska, for example, a recent example can be seen. The World-Herald in Omaha reports, "Staffers at a Boys Town National Research Hospital program, for instance, sometimes placed children facedown on gurneys and locked them into place with belts. They used the practice, which has been discontinued, to prevent children from harming themselves and others."

The system is also desperately short of foster placements whether we are talking Canada, the UK, USA or elsewhere.

Consistently, we see the need for systemic changes. High caseloads are real and it does impact the capacity to provide good case management for children. It is the child who suffers none the less. Yet, we are not willing to pay, as a society, for good child welfare. We bury workers in paper, bureaucracy, procedures that leaves less and less opportunity for real case work. Giving good social work care is urgent because as a society we are paying bog prices - kids become young adults aging out into adult mental health, criminal justice and social welfare rather than successful, independent adults. There are exceptions of course but the research keeps telling us lack of success is more the norm than the exception.

Soon I will look at the benefits of kinship care.

Saturday, September 25, 2010

Foster Care and Stability

I was recently thinking about a variety of cases where children have been shuffled between foster homes creating a pattern of instability for them. Leaving one's home, family, familiar surroundings is traumatic even if the child is departing a very difficult situation. They are leaving the familiar for the unfamiliar and must adjust to a new family, new rules, new home, new neighborhood and new schools. Each move requires the adjustments.

School is more than a place of education for children - it is their connection to peers, activities and supports. If each foster home change brings a change of schools, then roots that can hep sustain a sense of stable connections to people that matter (friends and teachers for example) also get lost. There is a point when children stop trying to sustain relationships believing that they will just be moved anyway.

For sure, foster home stability is an urgent need. Children arrive in foster care often having suffered chaos at home that has left them struggling with managing their own emotions. This makes them hard to parent which in turn increases the risk of being moved from one placement to another. Dowdell et al., (2009) in the MCN: American Journal of Maternal Child Nursing note that multiple placements can negatively impact on health and well being. Lewis et al., (2007) found similar results when adopted children experienced placement instability. Writing in Developmental Psychology, they stated, "These results suggest that placement instability may adversely affect the social-emotional development of adopted children." Regrettably, there is a long line of research that shows the adverse outcomes of placement instability. There can even be an argument that if you cannot offer a child a safe and stable place to be out of home, are you really helping the child?

One interesting debate is to find stability through school. Trying to keep a child connected to the same school can offer some stability in spite of changes of household. They get to see the same school, teachers and peers and can continue in their same extra-curricular activities (something lost when changes of school occur).

A report recently released by the New Jersey Office of the Child Advocate (USA) states "Research shows that frequent school changes are seriously detrimental to children in foster care. School mobility negatively affects these youth academically, socially, behaviorally and psychologically, research documents. It also further exacerbates the lack of continuity and stability in their lives." (p.4). Given that children in the foster care system have demonstrably poorer educational, social, employment and behavioral outcomes (see material from Chapin Hill on this point), we should strive to offer as much stability as possible and school may be one important place to do that.

As the New Jersey report notes, there may be times when school change should be done such as when a child moves into a pre-adoption situation with a family. The report suggests criteria for a best interest determination on when to change or not change schools:

"The following criteria should be used in the best interest determination:
(1) safety considerations;
(2) the proximity of the resource home to the child’s school of origin;
(3) the age and grade level of the child as it relates to the other best interest factors listed in this subsection;
(4) the needs of the child, including social adjustment and well-being;
(5) the child’s preferences;
(6) the child’s performance, continuity of education and engagement in the school the child presently attends;
(7) the child’s special education programming, if the child is classified;
(8) point of time in the school year;
(9) the child’s permanency goal, the likelihood of reunification and the anticipated duration of the current placement" (p.6).

This may not be an exhaustive list but it does help us to see how we might consider the needs of the child before making school changes. The report is worth a review. It can be found at http://www.state.nj.us/childadvocate/reports/protection/SchoolStability01110.pdf

A poignant personal perspective can be found http://www.scpr.org/news/2010/09/24/life-systemlong-odds-facing-ls-foster-kids/ In this powerful look inside a life within foster care, consider this reflection on school: “There should have been somebody there,” Trayvon, who went to 10 different high schools in 4 years, told KPCC. “There was nobody there when I was going to all these different schools. I had repeated courses that I had already taken. That was the thing. I was actually completing courses and then when I went to a new school, “We didn’t get your transcripts”. I had to retake a lot of these courses. I [had a lot of] frustration and anger at that point.”

Tuesday, September 21, 2010

Dying for the wrong reasons

Children who go into foster care should be there for the right reasons and expect safety, nurturance and support as they struggle with what can only be thought of as one of the most difficult transitions that children can face. They are leaving the home that represents their known base of life - the one with parents and siblings - and going to a place that is unknown with people who are strangers. Who of us can conceive how challenging that must be (unless of course we have been there).

I have met success stories from foster care in my practice and with my students in university. They have shared personal insights into how foster care saved their lives. This is how it is supposed to work. Yet it doesn't always.

A report just published in Oregon looking into foster care raises some serious concerns that echo struggles with foster care elsewhere. Here is an interesting first recommendation:

"A foster care certifier carries a case load of 55 homes. In addition to certifying these homes, they are also recruiting, training, monitoring, supporting and placement matching. These roles require very different skill sets and cannot be effectively accomplished by one person. Certifiers, who often carry the same case load for several years, run the risk of becoming enmeshed with the foster parent because of the
relational aspect of the job."

Well - relationships are what social work is about so let's not criticize workers for doing that. But the point is fascinating - work is complex and at times, workers who are generalists may be faced with specialist challenges. Child proetction systems often don't like specialists because of the extra costs that can go with such roles.

Their second recommendation should look familiar to almost all child protection systems: A scarcity of foster homes in Oregon drives compromise, and certification violations may be overlooked due to the need for homes." Scarcity can lead to overloading homes, expecting foster parents to manage complex kids that they may not be qualified to handle or holding children in placements that are inappropriate while efforts are made to find a foster home.

Critics of child welfare will, of course, also note that children are being brought into care who should not be. With other supports, they argue, children could be maintained in their homes with family that may not be perfect but can be good enough. Critics will also argue that children are being brought into care because of poverty as opposed to real child protection concerns. That is a big discussion but one that our profession is not having widely enough. There is no doubt that poverty creates significant pressures in families and the majority of families in such situations do not abuse or neglect their children. But equally, there is little doubt that the poor are over represented in child protection cases.

The critics will further argue that if proper efforts are made to address these socio-economic conditions, fewer children would come into care thus easing caselods, improving the opportunities for more effective casework with families that truly are in need of protection and reducing the demands on foster care resulting in safer, better homes.

The Oregon study raised one very disturbing issue that has been seen in so many tragic cases - the lack of effective communication between professionals. This has been so widely discussed in child death reviews in the United States, Canada, the United Kingdom and other countries that it is distressing to see it again. The Oregon study notes, "Through the examination of two sensitive case reviews released in October 2009, as
well as a random sampling of “closed at screening” files, the FCST found that the lack of communication among DHS staff and/or foster parents contributed to the initial and long term abuse of children in foster care." They also state, "There is no ability for cross county information sharing which would allow foster care providers to move to other counties without the new county office having knowledge of their history of allegations." This is a broad systemic issue that is negatively affecting children.

In my own practice, I have seen it. For example, a person doing a parenting capacity assessment will deliver a report with striong concerns only to find that the children were returned to the parents without the assessor being told while the assessor was writing their report; assessors raise serious worries about the safety of a family but never hear from the case worker.

Systemically, these types of concerns that are so broadly reported are often a refelction of high caseloads, demanding systemic pressures and complex cases that leave workers scrambling from crisis to crisis. As a profession, we need to be willing to take steps to alter the systems that keep recreating the the kinds of circumstances where these problems will keep occuring otherwise.

The Oregon report can be found at http://www.oregon.gov/DHS/abuse/publications/children/fcst-final-report.pdf?ga=t

While I am not often in agreement with the comments of the National Coalition for Child Protection Reform (a US based organziation)their viewpoints on some of these issues merits hearing as part of the wider discussion. In response to a recent news report, they have offered some food for thought. See their report at http://www.nccpr.org/reports/censoredinmilwaukee.pdf

In a related idea about the impact of neglect, abuse, foster care, readers might want to look at the new book Born for love: Why empathy is essential and endangered by Maia Szalavitz and Bruce Perry, M.D. In particular, the chapter on resilience which includes reference to the very powerful Adverse Childhood Experiences study (see acestudy.org). They are the authors of another remarkable book, The boy who was raised a dog.

Friday, September 17, 2010

Children and their substance abusing parents

In 2007, Scottish researcher Dr. M. Barnard wrote the fascinating book Dtug Addiction and Families which chronicled various types of experiences that are endured by family members of addicts. In particular, her book explored how children are impacted.

In a recently published summary of their experience with chldren in the UK, Childline has summarised some fascinating information. This report really brings the voices of children front and centre:

“My mum drinks all the time and leaves me alone lots of times. I feel scared and lonely. I look after my mum when she drinks. I put her to bed. Mum shouts and hits me; she is worse on a Friday. I don't want to feel pain. I want to die.” (Angel, aged 10"

You can feel this child's pain. Children are worried for their parents, take on parenting roles and live in an environment where substance abuse is not the only challenge. As the report states:

"Children who were counselled by ChildLine about their parents’ alcohol and drug misuse often also talked about their experiences of physical abuse, family relationship problems, neglect and sexual abuse."

As the report helps us to see, it is more frequently alcohol that is the problem versus illicit drugs. Yet, the media and perhaps organziations with budgetary and political agendas will focus the story more on the illicit side. Either way, the impact on children is significant when substances take over the household daily story.

One of the most powerful conclusions of the report is the burden that children feel to make things better or take on household management and parenting duties. Regrettably, many families will have little or no intervention creating a legacy for the child that will endure through their lifetimes. Research by Johnson and Leff (1999) showed the power of intergenerational transmission of subtsnace abuse behaviors.

We have not found the keys for prevention in our society as we see use rates again climbing (see the report from SAMSHA in the US issued yesterday at http://www.samhsa.gov/newsroom/advisories/1009152021.aspx ) We also know that intervention can work but that we must be persistent with it. One time in a 15 or 28 day treatment centre is not the answer. Change is a long process.

I am reminded of advice I received as a young social wokrer from psychiatrist Tibor Bezeredi - People change when the cost of change is less than the cost of the status quo.

AS WELL - you might find this journal The Future of Childern of interest - free on the internet and a high quality journal
http://www.futureofchildren.org/futureofchildren/publications/journals/journal_details/index.xml?journalid=73

Wednesday, September 15, 2010

Delays hurt children

In recent posts, we have been looking at issues related to workloads. A report published in the UK a few days ago reaffirms that children remain at risk whne caseloads are too high or staffing inadequate to handle the cases.

It also raises an important area of debate - when high profile child abuse cases occur, referrals of new cases will soar. This adds to the workload and delays appropriate assessment. High profile cases will bring many marginal referrals for sure - but who can tell without an assessment.

Staffing is expesnive and the more limits put on staffing, the longer it will take cases to be seen and the more cursory will be some of those reviews. In the current economic crisis around the globe, the more we will see budget limitations. In turn this will lead to children being left in unsafe conditions. In turn there will be another high profile death. It is an ever repeating spiral.

What we are not doing is coming to grips with the real issues of the degree to which society wants and is willing to pay for child protection.

The UK Story:

Vulnerable children put at risk due to social worker shortage

by political editor Paul Francis

Vulnerable children in Kent are being put at risk of harm because it is taking too long to assess them and there are not enough social workers, inspectors have warned.

The county council has been ordered by Ofsted to take urgent steps to address the issue following an unannounced visit by inspectors.

Following the visit, Ofsted has told KCC it must sort out staffing and management issues.

In a letter setting out the findings, Ofsted inspector Brendan Parkinson states: "Some children in need do not recieve an adequate and timely assessment of risks and needs, leaving them at risk of harm. A significant shortfall in the capacity of qualified, experienced social workers and weaknesses in the quality of team manager oversight on child protection cases in some duty and assessment teams contribute to these serious concerns."

The watchdog carried out an unannounced inspection last month.

The report will make worrying reading for the authority, which has struggled to attract social workers and has increasingly looked abroad to recruit staff. Ofsted has told the council it will probably rate children's social services as performing poorly when the next performance ratings are made. KCC has previously been a top rated authority.

In addition to the "priority action" area, Ofsted also called for improvements in arrangements for prevention and early intervention, more in-depth risk assessments and better integration in the way children's records were kept.

In a statement, KCC managing director for children's services Rosalind Turner said: "The priority action refers to making sure there are timely assessments in all cases, but acknowledges the pressure our social care teams are under.

"This is due to the significantly increasing number of referrals while we are also carrying vacancies in social workers.

"KCC continues to run successful recruitment campaigns to increase the strength of our teams, but there is still a shortfall in the overall establishment. This is a national issue and we recognise its seriousness. We are absolutely committed to ensuring safeguarding and good outcomes for all our children and young people."

The shortage of social workers is not a problem just for Kent which, in common with other authorities, has recorded a dramatic rise in child protection referrals since the publicity surrounding a series of high-profile child abuse cases.

Referrals rose by 22 per cent in Kent last year to 17,360 - an increase of more than 5,000.

Vacancy rates at the start of the year in some child protection teams were as high as 40 per cent.

Cllr Trudy Dean, opposition Liberal Democrat leader at KCC, said: "Clearly, it is a very serious issue because if you are a child in danger, that danger increases if there are delays in assessing your needs."

Friday, September 10 2010 Kent Online - Retrieved Sept 15/10 at http://www.kentonline.co.uk/kentonline/news/2010/september/10/vulnerable_kids_put_at_risk.aspx

Saturday, September 11, 2010

Workload and Caseload Management

As discussed in a previous post, overloading workers is contrary to effective case management. The Child Welfare Information Gateway in the USA has published a review which shows how important this is.

The state:

"Reducing and managing caseloads and workloads are not simple tasks for child welfare administrators. Agencies face a number of challenges, including negotiating budget crises and hiring freezes, addressing worker turnover, finding qualified applicants for open positions, implementing time-intensive best practices, and managing multiple reforms simultaneously (Day & Peterson, 2008). Even the basic determination of what caseloads and workloads currently are and what they should be can be thorny." (CWIG, 2010 accessed 2010/09/11 at http://www.childwelfare.gov/pubs/case_work_management/ )

Of course, it is not just the number of cases being managed that must be considered, but also the complexity of the cases. Too often, it is only the number of cases that gets considered.

The CWIG review also looks at a variety of initiatives that are being tried that range from hriing more workers, better training and case load supervision and monitoring as well as the policy issues that lie behind effective social work.

A New Zealand report just published also illustrates that poor case load management can often lead to workers simply moving from crisis to crisis and never really getting to the kind of work that makes long term differences in the lives of children.

The New Zealand report also echos what has been seen in many western child protection systems - too little opportunity for children who are going to stay in care to experience stability. The New Zealand Herald noted that the report concluded:

"A major probe by the Children's Commissioner's office has found that almost a quarter of the 5582 children in care at the end of last year had had more than six caregivers, with a maximum in extreme cases of 39." (accessed 2010/09/11 at http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10672072 )

If we do not manage caseloads well, then these are the kinds of results that we can expect. Crisis oriented casework only addresses that which absolutely must be addressed leaving children and families with little oppportunity or support for the kinds of changes that alter the major trends that keep a family involved with child protection.

High caseloads also lead to burn out resulting in high staffing turnover. The New Zealand report concludes:

"But a quarter (of the children interviewed) said they had been moved to new placements 10 or more times and many experienced a high turnover of social workers. Caregivers also reported overworked social workers who failed to visit every two months as required, did not respond to messages and often quit without warning. One caregiver had three social workers in four months." (NZ Herald).

This result is inevitable. One wonders when we will start to see a different trend in child protection which will allow real and effective casework to be done more as the rule than the exception.

I will look at more of what the New Zealand report has to say in subsequent posts. Meanwhile, if you want to review the full report, you can do so at http://www.occ.org.nz/__data/assets/pdf_file/0008/7694/CC_ChildreninCareReport_09.09.2010.pdf

Friday, September 10, 2010

Operating policy affects outocmes

There are many who seek to criticize the performance of given social workers when a case goes horribly wrong - for example when a child dies. We have seen this in the Baby P case when social worker Shoesmith became vilified in the media. Critics might do better to focus on casework management.

A recent review in the UK has noted very high caseloads. It is not rocket science to see that social workers can only successfully manage so many cases. It is a human limitation. The metaphor of how many balls can you successfully juggle until one falls is appropriate.

If a social worker has 40 cases to manage at any given time, failure is inevitable. When we have not done a good job of staffing case loads get high, details get missed, signs of growing danger slip by unattended and the dangerous brew ferments.

Some will argue that the solution is to not open so many cases. Critics of child protection have long argued that too many cases are ones where there are no significant risks and child protection is meddling in families that are getting by at acceptable levels. They go on to argue that too many cases get opened in the wake of scandals such as Baby P in order to try and avoid another such case. The outcome is high caseloads and, perversely, more risk of another tragedy. Such critics have a point.

Equally, however, are the budget arguments that see politicians state that costs must be contained and staffing gets tightened. This also increases caseloads but it limits what cases are getting opened. This can increase the risk of a tragedy as well. As budgets get tighter and tighter, the criteria for opening a case also gets tighter. This means that the level of risk being tolerated increases within the community. It takes higher levels of damage or crisis to get child protection involved.

Researchers and policy think tanks need to work on where the balance exists. Too often this debate is informed only by the voices of those who are pro or con to child protection.

If you want to read about the UK story on high caseloads go to http://www.communitycare.co.uk/Articles/2010/09/08/115261/one-in-six-social-workers-have-more-than-40-cases.htm

Monday, September 6, 2010

Kinship Care

Incereasingly, there is a recognition that we need choices for protecting children that balance keeping chidlren away from unsafe family conditions while trying to place children in environments that will continue to support their growth and family ties. Foster care has difficulty achieving that given that these carers are not family. Kinship care has often been seen as the best way to achieve the balance.

Critics of kinship worry that such placements may not receive the same approval scrutiny that foster care placements receive. They wonder about family patterns that may exist in kinship that are the very same ones that caused child protection to be involved. Such a worry may be valid.

A recent review of kinship in the USA is suggesting that it remains an important placement option. It states:

"Kinship adoption is on the rise for many reasons, including
• increased understanding of the benefits of kinship care for children,
• state and federal preferences for kinship care,
• agency practices that place large numbers of children with kin as a means of
moving them out of foster care, and
• a recognition that relatives will adopt."

One interesting feature in this is the second bullet which helps us to see how policy drives lives in child protection. Why does the government preference exist - is the best interest of the child? Is it limited foster placements? Is it funding and cost saving? It might be all of these.

Yet, as has been discussed before, foster care is no panacea. Group care can be worse and instutional care in all but very specialized stuations is often hard on children. These placements can and do work in a variety of cases but they should not be the preferred choice. Nor should there be an assumption that kinship is the best until the kinship option is understood.

This same report from the USA also states:

"The benefits of kinship care over traditional foster care are well established.
Kinship care is more likely than traditional foster care to:
• reduce the stigma and trauma of separation from parents and family,
• result in placement with and connections to siblings and parents,
• respect family cultural traditions,
• be a stable placement, and
• result in fewer behavioral, educational and mental health problems...."

Any approach that can reduce the rates of behavioral, eduactional and mental health problems deserves attention as these are highly prevelant in child protection populations.

The report is not long and worth a review. It can be read at http://www.childfocuspartners.com/pdfs/CF_Kinship_Adoption_Report_v5.pdf