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Thursday, April 28, 2011

Health News Child abuse may change brain Published: April 25, 2011 at 2:00 AM

Dr. Bruce Perry is amongst a group of researchers who have spoken about how maltreatment changes the brain. He has support from new research being reported this week.

KINGSTON, Ontario, April 25 (UPI) -- Physical, sexual or emotional abuse in childhood increases the risk of depression in teens by altering a person's response to stress, Canadian researchers say.

Kate Harkness of Queen's University in Kingston, Ontario, says adolescents with a history of maltreatment and a mild level of depression were found to release much more of the stress hormone cortisol than is normal in response to psychological stressors such as giving a speech or solving a difficult arithmetic test.

"This kind of reaction is a problem because cortisol kills cells in areas of the brain that control memory and emotion regulation," Harkness says in a statement.

"Over time, cortisol levels can build up and increase a person's risk for more severe endocrine impairment and more severe depression."

Harkness and colleagues say youths with a history of maltreatment had a total blunting of the endocrine response to stress suggesting that the normal operation of the stress response system can break down in severely depressed adolescents.

These results are important because they show that environmental stress in childhood changes the function of the brain in ways that may cause and/or maintain severe psychiatric disorders such as depression, Harkness says.

Harkness presented her findings at the International Society for Affective Disorders Conference in Toronto.

Those of use who work with maltreated children may not find that research shocking but certainly helps explain why they respond to a variety of common social situations and stimuli differently. There are real clinical implications here!

Read more:

Friday, April 22, 2011

When child protection workers lie

A case that has received a high profile in the United States revolves around the integrity of evidence presented to support intervening and apprehending children. Critics of child protection will see this as the tip of the iceberg representing a general issue of concern versus an isolated one. The two social workers were found to have lied and the state of Oregon faces an over $9 million penalty.

In addition to the lying, there are two features of this case that are perhaps most concerning. The first is that the state of Oregon did not appear to conduct a good investigation itself into the behaviours of the social workers. This is an important part of ensuring that the public can have confidence in child protection. The second is, of course, that children may have been unnecessarily subject to disruption of their family life. That is not a benign impact but one which will have long term sequalae for them.

Cases like this are examples where professional regulating bodies might have been effective. One wonders of something more effective and expedient might have occurred with that or the use of a state child advocates office. There are several good examples in various jurisdictions where those bodies can be useful. If these social workers are part of a professional regulating body, one wonders where they have been.

This case and the criminal prosecution of social workers I spoke of in an earlier post may be indicative of a new way for consumers to challenge child protection. This would be unhelpful but, if the public does not perceive that the profession can self regulate or have effective oversight, then they may see the courts as a place where behaviour can be challenged. By this, I mean, of course, courts other than the family court where some critics feel there is too cosy a relationship between the courts and child protection (although this has certainly not been my experience).

The media report can be seen at

Saturday, April 16, 2011

Budget cuts and child protection

I have written in prior posts about the concern that large scale budget restrictions can have on child protection. When there are fewer resources available to investigate, intervene or support families, then more children will fall through the cracks. Families that could be supported much earlier in the problem cycle, will be left to get worse. This will in turn increase the risks of children being removed from their families at a later date. This, of course, also increases the risks of another high profile child death.

Some interesting news from the UK, supports that budget cuts are indeed increasing risks for children.

"Are child victims of domestic violence being forgotten?
Natalie Valios
Thursday 14 April 2011 12:16
Higher intervention thresholds allied with the government's reductions in public spending are causing alarm among child protection professionals. Natalie Valios reports

Children can become victims of domestic violence in several ways: they may be physically abused, be traumatised either from witnessing it, or from the emotional and physical fallout that affects parental care.

There are signs that these children are falling through ever-widening gaps in services because of a combination of cuts and increasing child protection thresholds.

Last week's Community Care survey of 170 frontline child protection workers found 82% felt thresholds had risen in their area in the past year. This was across all types of abuse although it was most acute in cases of neglect and emotional abuse (which includes child witnesses of domestic violence).

One social worker who responded said: "There is a lack of support services in the community particularly services related to domestic violence. We have no perpetrators programmes in the borough so cases come back again and again but do not meet the now extremely high thresholds to stay open to long-term statutory teams."

A Women's Aid survey published last month found domestic and sexual violence services were being cut so much - in some areas by nearly 100% - that 70,000 women and children could be left without support. Nearly two-thirds of refuge services had no council funding and a further 60% of support services for child victims did not know whether they had funding for the next financial year.

Domestic violence services in England are provided mainly by voluntary agencies and, unlike those in Scotland and Wales, have no dedicated funding stream. This has made them easy targets for cash-strapped councils.

Devon Council, for example, has slashed funding for refuge and outreach children's workers who deal with those on child protection plans.

The chief executive of North Devon Women's Aid, Sue Wallis, says last year the group dealt with 140 children from 79 families. "All children who come to the refuge are traumatised and damaged," she says. "We have had to make redundant our full-time children's worker, who carries out therapeutic counselling, as well as our two part-time playroom workers. Without counselling these children are not going to be given any chance to heal and their life chances will remain rock bottom. They will grow into damaged adults who will repeat the cycle."

The fear surrounding such cuts is that not only will they feed into higher child protection referrals, but some women may no longer be able to access any services.

As Wallis points out: "We work with people who have a tremendous fear of statutory services. Some women may bolt straightaway if we mention social services and they could go back home and place themselves and their children in danger."

Nushra Mansuri, professional officer England for BASW - the College of Social Work, is also worried about the emotional fallout that these funding cuts could have on children. She does not believe that social workers have the time or expertise to work with children appropriately and says the cuts send a "crushing message" to them. "They need trained specialists; it has to be about a therapeutic approach," she says.

Maddy Coy, deputy director of the Child and Woman Abuse Studies Unit at London Metropolitan University, agrees: "One of the most critical things about the cuts will be the lack of experienced specialist workers to address the complex ways that children experience domestic violence. Voluntary organisations have decades of accumulated expertise that few statutory services have."

Barnardo's has several domestic violence projects providing therapeutic services to children. "Research shows that children who live with domestic violence are at an increased risk of behavioural problems, emotional trauma and mental health issues in adult life," says Emma Ramsay, children's services manager for the charity's domestic violence protection project in Newcastle upon Tyne. "It is important that they have someone to talk to."

Even in the short term, the damage could be fatal, says Fiona Dwyer, Women's Aid's national children and young people officer. "We have seen a decrease in the length of time women are staying with their partners but [fewer services] will lead to them staying longer, placing them and their children at more risk," she says.

"Child deaths are a definite possibility. If we look into any serious case review of a child who has been killed, domestic violence is a factor in almost all the deaths."


750,000 children a year witness domestic violence.

52% of child protection cases involve domestic violence.

54,000 children in England were affected by domestic violence in 2009-10.

68% of women using Women's Aid services have children with them or are pregnant.

60% of refuge services have no council funding from this month.

70,000 women and children could be without support due to cuts.

Source: Women's Aid


Children can experience emotional harm from a violent parent/carer in a number of overlapping ways, writes Dr Lynne Harne.

These include:

● Witnessing domestic violence either directly or indirectly towards the non-abusing parent (usually the mother);

● Being used in the violence and abuse against the non-abusing parent - usually in an attempt to undermine her self-esteem and her role as a parent - or getting caught up in the violence;

● Direct emotional abuse and neglect through harmful parenting; and emotional harm from having to cope with the consequences of domestic violence - such as having to leave home, experiencing loss of community, friendships, possessions and disruption to education.

There is a high overlap between the occurrence of emotional abuse from exposure to domestic violence and direct physical and sexual abuse and neglect of children by domestically violent parent/carers. Domestic violence is therefore a key risk factor for multiple abuse of children.

Research shows that the vast majority of children are aware of domestic violence through overhearing it, seeing it or observing the physical and emotional impacts on their mothers, even where parents believe they have kept it hidden it from them.

The impacts of domestic violence on children and young people vary, but studies generally indicate that they take the form of internal disorders such as anxiety, depression and withdrawal and, in some cases, trauma symptoms akin to post-traumatic stress disorder, and/or external disorders affecting behaviour such as aggression.

Recent research on general populations of children in the UK experiencing domestic violence has noted that they are more likely to experience behaviour disorders than other children and that the impact on children's mental health can continue into adulthood."

● This is extracted from a Community Care Inform guide

Monday, April 11, 2011

Have we forgotten that good enough may just be good enough

In a recent article on the New York Times Motherlode website, Christien Gottleib, a lawyer who represents parents in child protection matters, mused "parenting is something we are inclined to judge harshly at the same time that it is impossible to do in anything but an extremely flawed way. You can’t get it right. We all know this." (

D.W. Winnicott, a British pediatrician and psychoanalyst noted in the 1960s that a parent can be good enough and we should not expect perfection. In essence, it may not even be appropriate to try and hold out some high standard as something that parents should strive for - its just not realistic. It may, in fact, not be helpful particularly in the world of child protection. In that world, getting a parent to the point where they are good enough is a valid goal particularly given the history that many parents in these circumstances enter the world of parenting with.

Trauma, grief, loss, neglect, maltreatment form part of the story for many of these parents. If we exclude those where poverty is the main story, then these other factors are features of cases that are prominent in the vast majority of families. Many child protection parents have disorganized attachments making it very hard for them to be attuned to their children. They simply don't know what it means.

Research also tells us that the first 5 years are the most crucial for parenting - so what would happen if parenting interventions were thought of as trying to get good enough. This might include supporting parents in trying to understand what child behaviour might mean; find ways to better read their children; try to comfort; be emotionally present and most of all accept some level of flaws as long as they can be essentially safe with the children? This might increase the possibility of family preservation and reduce demand on scarce foster placements. BUT - we will have to lower our expectations to something that most parenting text books do not talk about - good enough.

In the good enough family, parents will provide basics (food, clothing, shelter); avoid hitting and abusing; be emotionally and physically available and learn how to set reasonable limits. What we need is a wide spread discussion on accepting good enough.

There will be children for whom good enough is not going to be acceptable. These are children who have rather special needs such as disabilities of various kinds. But the majority of children in child protection might well be able to get the basics of what they need from a good enough parent.

Help parents to be positive, present and caring and that may be most of what children need.

This is a debate that we need in child protection particularly amongst those of us who assess parenting capacity. Budd, Clark & Connell, in their newly published book Evaluation of Parenting Capacity in Child protection, "...minimal parenting is the floor of acceptable parenting that is sufficient to protect the safety and well being of the child"(p.40).

It night well be argued that we have failed to really understand and articulate what this floor looks like meaning that the line separating good enough from not is fuzzy which in turn leads to erroneous conclusions about families.

Let us have this debate.

Monday, April 4, 2011

Criminal Charges against child protection workers in New York

In what may turn out to be a precedent setting case, 2 child protection workers have been charged with failing to protect a child and being somehow complicit in the death of Marchella Pierce. There is a claim, as yet unproven in a court, that the two workers created fraudulent records of visits. They say that the caseloads were too high to keep up with the record keeping. The records were written after the death of the child.

What this case represents is a liability chill that will fundamentally alter child protection if the case succeeds. Imagine, if you will, that a worker does the job, can't keep up with the records and then worries that they will be held criminally responsible if a child dies. And then do this for relatively little money. Why do it indeed. The case suggests that keeping up with the records is more important than keeping up with the cases.

If case loads were kept reasonable, then keeping up with paper would make sense as a daily priority. When case loads exceed what can be reasonably handled, record keeping will suffer. This is a point that politicians should remember each time they cut budgets and staff. A child will die when caseloads are high; budgets are too tight and turnover high because of the stress of the job - which will lead to high numbers of inexperienced workers doing front line work. The outcome of this recipe is inevitable - children will suffer; families will not get better; help will not be delivered in a way that makes a difference and, yes, children will die.

The issue is not therefore about the ineptitude of a particular worker but about the priority that society is willing to place on protection of children. Compare this to policing or other emergency services. If you put fewer police officers on the road, then high risk environments will be less protected and crime will go up. Who is to blame? The police officer or the society that does not wish to pay for services? Society gets the protection it is willing to pay for whether this be with policing, paramedics, fire or child protection.

Critics of child protection, and there are many, have legitimate points to raise but often fail to look at the role society plays in funding the work. Child protection is a balance between the needs of the child to be safe and the rights of families to be together. Examining a case to understand where that balance exists in a case takes time. The critics appear to have rarely spent time at the front line having to make those decisions. Workers having to do so on an urgent basis often have limited data to work with. Families may typically be reluctant information givers wanting child protection workers to disappear.

The critics take a distant view when much more data is known somehow anticipating that the front line worker should have been able to figure it out at the front door of the family home. We ask a lot of CPS workers. As a society, we should be willing to give them the tools to do the job.

This case may also lead to something that has been seen in England - managerialism and proceduralism. This is when protecting the system is more important than protecting the child.

If these workers did indeed fail to visit the family and created false records, then that may be a unique matter but let it be focused on that. Let not this case be about retrospectively holding workers accountable because a child died and they couldn't predict that.

Risk assessment is an inexact science. Workers take known factors of risk and compare them with the case in front of them. The closer a family fits in comparison to the risk factors, the greater the worry. However, it is also vital to understand that there are many who fit the risk profile who will not harm a child and many who do not fit the profile who will. There are times when risk assessment tools are no more effective than chance. What then is the worker to do but try and make the best decision possible with whatever information can tell them along with their own experience. This too will be inexact in the same way that a police officer must judge whether the person with the gun is going to shoot or not.

This trial will be well worth monitoring because of the major implications.

Related to this is a new publication from the National Association of Social Workers in the United States. Called Supervision: The Safety Net for front line Child Protection Practice, it highlights several facets needed for effective service delivery. These are timely given this New York case:

Training and Knowledge Development
• Lack of adequate training related to the roles, tasks and competencies for being a supervisor.
• Inadequate knowledge of the changing populations and communities being served.
• Over-focus on performance of administrative functions (managing staff and workloads) of the supervisor.
• Insufficient research-tested models of supervision (e.g., team models; identification of necessary education and training requirements and competencies; supervisor to supervisee ratios) and how these impact outcomes for children and families.
• Inadequate time to attend training programs or to remain current with the literature and research related to child welfare and supervisory practices.
• Absence of adequate dissemination tools and efforts to provide evidence-based information to supervisors and their staff.
• Insufficient timely use of data to inform and improve practice. Organizational Issues and Implementation of Child Welfare Practices
• Experiences of trauma, lack of safety and vulnerability, both within the agency and in some communities.
• Dealing with frequent turnover of high-ranking leaders and administrators.
• Difficulty in retaining competent front-line workers.
• Potential ethical conflicts in how services are provided to families, how families’ needs are assessed or regarding acceptable case plans.
• Addressing service and resource gaps. • Potential conflicts between the need to be transparent in terms of services provided and
confidentiality policies.
• Concerns about inadequacies in the built environment including lack of privacy for meetings, supervisory sessions and client interviews.
• Numerous oversight bodies that review practices and question how services are provided. • Absence of available and adequate supervision, peer consultation and support for the
• Problems in the organization’s culture and climate that heighten potential for burnout and turnover and add to the difficulty of providing supervision.
• Over-emphasis on administrative functions in supervision that take away from educational and clinical aspects of supervision to improve practice and outcomes. (pp. iii-iv)