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.
Saturday, October 23, 2010
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.
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.
"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).
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.
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.
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