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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

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