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Tuesday, May 31, 2011

World Conference on Psychology, Cousneling and Guidance

I had the opportunity to attend this conference in Antalya, Turkey. This is apparently the third effort with the first being a scaled down version followed in 2010 by a successful full blown conference. I also had the opportunity to present a paper on the impact on parents whose children become alcohol or drug addicted.

There were several interesting papers presented included one by a group called the Dubai Foundation for Women and Children. They are doing some very interesting work on trafficked children. Their website is http://www.dfwac.ae/programs-services.htm

A colleague from Mount Royal University did a presentation on aboriginal women in Canada. An important point is how solutions for cultural oppression can often be found in empowering women including through education.

I was impressed with some presenters from Iran who showed that an important discourse is taking place in that country including through Jungian psychology and some health methods that perhaps we take for granted such as biofeedback. Clearly, what we hear through the western media about Iran is so skewed that it misses the day to day life of the average Iranian. We met a couple of very powerful feminists from there as well. But we also met many who would truly welcome coming to the West in order to study and achieve academic growth they feel is blocked to them in their home country. They spoke with pride about Iran but regretted that links with the West are nota s open.

A lack of open communication around the globe has meant that some researchers are quite behind. the topics they present could well be seen as "old news" to Western researchers but are cutting edge in countries where their access to academic material is limited. Even so, things such as feminism are growing forces along with desires for peace and an environment that will sustain families. This lady saw feminism as a way to heal the physical environment that we are polluting by changing to a focus of loving the space we live within.

There is a need for learning about each other and seeing the amazing things that are getting done. We met a great grandmother who, at 75, is actively supporting child protection through running an orphanage.

One keynote speaker, Dr. M. Campbell from Australia presented on cyberbullying showing show pervasive it has become. It is there 24/7 as technology does not get turned off but we lack effective resources for interventions at this point. This is an emerging area that we need to better understand.

Regrettably, the conference was held at an all inclusive resort, Cesar's Temple in Antalya, that ran counter to a productive meeting. The organization was pathetic leaving many sessions in chaos, poorly attended and causing much resentment among those who came to share ideas and learn from each other. In the absence of Herculean efforts to change how the conference is run, those considering attending in the future should do so with great caution. I, along with many who were there this year, will not return.

Friday, May 20, 2011

Drug Courts and Child Protection

The drug court experience has been used in the USA for several years with largely promising outcomes. An interesting pilot project has been underway in the United Kingdom. A major goal has been to see whether or not it will be possible for children to be kept within the family. If moved out of the family, can the child be returned sooner?

Just published, The Family Drug & Alcohol Court (FDAC) Evaluation Project Final Report has some good news that should encourage the role that courts can play in altering outcomes in families where parental addiction is a factor. The drug court experience has some significant differences that can be a very powerful reason why such interventions have a higher prognosis for success. As the authors note:

There are a number of key differences between FDAC and ordinary care proceedings.
In ordinary care proceedings:
 There are no dedicated judges or magistrates and little judicial continuity.
 There is no specialist team attached to the court.
 Assessments may be ordered from a range of different experts and can take
months to be carried out and reported on.
 There are no hearings without lawyers.
 Guardians are not appointed to cases immediately.
 There is little co-ordination of services for parents.


While the cases that were being dealt with were often complicated and the history challenging, this approach brought intervention sooner. Perhaps vital, the level of support was also greater, more coordinated and more intense due to this coordinated response. This led to a plan that was structured towards the specific needs of the client. Sustained sobriety looks to be more promising with the parents who went through the program.

One area of disappointment is that the research could not help to identify who was more or less likely to be successful. "Although the lack of clear predictors may be because of the small samples in this study, the same overall result was found in the large-scale research into Family Drug Treatment Courts in the USA." Thus, this factor seems to be one that eludes researchers making the clinical targeting of this type of intervention difficult to plan - we may not yet have the kind of data that will help identify which families will benefit the most. This is unfortunate as increasing budgetary pressures in child protection programs in many countries mean that well targeted programming is increasingly needed.

This is not a cheaper process although children were in care for less time which may be where the most cost savings can be found - again - important in our budget conscious world.

The overall conclusions:

"The evidence from this evaluation suggests that FDAC is a promising approach. More FDAC
than comparison parents had controlled their substance misuse by the end of proceedings
and had been reunited with their children. FDAC parents were engaged in more substance
misuse services over a longer period of time than comparison parents. There is evidence of
financial savings in FDAC cases in relation to court hearings, out-of-home placements, and
the reduction in the number of contested proceedings.

FDAC is operating as a distinctive model of a problem-solving court. All those involved in
FDAC thought that this was a better approach than ordinary care proceedings. Nearly all
parents would recommend FDAC to other parents in their situation. The professionals and
parent mentors were clear that FDAC should be rolled out." (p. 12 of the Executive Summary)

However, like so many researchers, the authors point out the challenge of getting and sustaining sobriety. Concurrent planning is needed where that cannot be achieved and, as seen in other research, more parents will fail to achieve long term sobriety versus those that will.

This option shows promise as one way in which these cases can be managed effectively. It is not nirvana. It is one option that will work in some places some of the time. Yet, where it can work and the services to support it exist, this is a worthwhile idea.

Reference:

Harwin J, Ryan M and Tunnard J, with Pokhrel S, Alrouh B, Matias C and MomenianSchneider S (May 2011) The Family Drug and Alcohol Court (FDAC) Evaluation Project
Final Report. Brunel University.

Monday, May 16, 2011

For Some - Foster care works

I wouldn't normally just copy and paste a research briefing, but in this case I think it is worth it. TACT in the UK has followed a group of foster care children (albeit a small, qualitative sample) and found some different experiences from those that are so often reported (the negative outcomes). Well, as TACT has found out, it need not always be so:

"TACT and London South Bank University publish 'Aspirations Three Years On'

10 May 2011

Today TACT publishes research setting out the views of children in foster care and their carers. The research is a follow up to the 2007 study ‘Aspirations: the views of foster children and their carers’ making it the first longitudinal study into the opinions and experiences of a group of foster children and those who look after them. Both reports were written by Professor Bob Broad of London South Bank University’s Institute for Social Science Research.

In that initial 2007 study, responses were collated from 56 young people and their foster carers. This follow-up study records the experiences of all 30 of those 56 young people who are still in the same foster placement as in 2007. The study also records the views of their 24 foster carers.

Key findings in the report include:

The importance of foster carers to a young person in care. Ninety six percent of young people identified their relationship with their current foster carer as being ‘very important’. By comparison, 65 percent said the relationship with their birth mother was very important and 43 percent said the same about their birth father.

That for children in stable placements, their experience of school can be extremely positive. They were asked 14 questions concerning school with the opportunity to respond ‘Excellent’, ‘Good’, ‘Average’, ‘Below Average’ and ‘Need more help’ to each question. Overall, 81 percent responded with replies of either ‘Excellent’ or ‘Good’ being given.

Foster carers’ assessment of the improvement in the health and wellbeing of the young people in their care shows that, while they identify ongoing improvement throughout the placement, the rate of improvement slows down. The improvements identified between arriving in placement and the 2007 survey were more significant than between the 2007 survey and this 2010 study. The most significant gains occur in the first nine months to a year of a placement.

Young people in placement had developed a wide range of interests and activities. The young people were given a list of twenty one potential activities carried out individually, with the foster family and outside with friends. The responses showed that nearly all the activities were carried out by at least some of the children.

TACT CEO Kevin Williams said “This longitudinal study allows us to see how vital a stable foster placement is for a young person’s achievement and life chances. It is striking that 96 percent of young people describe their relationship with their current carer as ‘very important’. The report should send a loud message to everyone involved in fostering about the long term societal and economic benefits of ensuring that decisions are only made in the child’s best interests.”

Professor Bob Broad of London South Bank University, the report’s author, said; “Our research demonstrates the value of a longitudinal study of foster care based on the views of young people and their carers. “The evidence shows how young people’s positive and improving health and wellbeing outcomes are associated with them being contented living with their foster family, and feeling safe, cared for and supported, It also demonstrates the value of dedicated foster carers who feel their support needs are being met. “

The entire report can be found at http://www.tactcare.org.uk/data/files/Research_n_Policy/TACT161_Aspirations6.pdf

Saturday, May 14, 2011

Children coming into care

One of the most difficult decisions a child protection worker must make, is whether or not to bring a child into care. In a 2007 study, Joseph Doyle from MIT in the United States concluded "Large marginal treatment effect estimates suggest caution in the interpretation, but the results suggest that children on the margin of placement tend to have better outcomes when they remain at home, especially for older children"

In a very fascinating presentation available on Doyle's website, he talks about Type I and Type II errors - being False Positive and False Negative errors. Public scrutiny is often placed on Type II errors as these are the ones that lead to deaths of children and thus high profile media cases (Jeffrey Baldwin in Canada and Bapy P or Victoria Climbe in England would be examples). He suggests that not enough attention is given to Type I errors which can lead to children coming into care who should not be there (Logan Marr in the USA is a good example). In his talk, Doyle notes that children at the margin of whether or not they should be brought into foster care ---"Taken together: children at the margin of removal perform better when they remain home:
– Adult Arrests
– Delinquency
– Teen Pregnancy – Employment & Earnings"

A newly published study in the UK looked at the views of children who have come into care. There is quite a bit of fascinating material here. One finding that struck me is that 3 out 10 children either do not know why they are in care or are unsure. Along the lines of what Doyle talks about, 43% believed that, with supports, they could have stayed with their families. The report makes a very valid point on that, however: "We also heard that it is not enough for social workers to say that a family needs help and support, and to refer them for this. The help and support needs to come quickly. If a family needs urgent help to keep a child out of care, children told us that it can be a long time after a referral is made before help actually happens, and things can get worse in the meantime: ‘Help needs to come quickly.’ Appointments for services to help families also need to be at times the family can manage, and need to be often enough for things not to go badly wrong between one appointment and the next." (p.9)

They note that 42% of children thought that they should stay in care as it was the best place for them.

Returning home for children in care is often thought as something that is desirable and should be done quickly. This research suggests that there should be some careful thought into how this is done. "Our discussion groups gave us their ideas on how children’s services should go about reuniting children with their families when this was safe and the right thing for the children concerned. One group suggested having regular respite care for the child once they had returned home. Another stressed that both parents and children need reassurance, and that going back home should not be sudden but gradual, done cautiously and with support to children in getting to know their parents again. We heard that going back home will always bring back underlying issues for both children and parents, and these need to be thought about and dealt with. Both parents and child ‘need to build confidence with them by getting to know them’ again." (pp.14-15)

The children in the study also noted that timing matters. The longer they are out, the harder it is to go back. "f they are returning home, children should go back before it has become too late for it to work, because as time goes on the emotional attachments between children and parents change and may become weaker. As one child put this,
‘The bond that the child used to have will never come back.’ Others described how things had changed after they left home, making it difficult to return later on: ‘As soon as I left home, I did not exist; my picture was taken off the wall.’" (p. 15)

The children were wise in their views about how to make being back home successful. They recognized that it was more than just being there. They need transition support as well as supports that may go on in order to make being back home workable. "A very strong view from many of the children and young people in our groups was that help and support needs to carry on for both children and parents after a child goes home from care. One child summed this up for us: ‘Keep offering the support that a child had while in care – social services shouldn’t just cut us off.’ Another said that in their experience of going back home, ‘It’s like a ghost really – once they are gone they are gone.’ They should not be ‘cutting the ties off straight away’.
Children going home should not have their hobby and interest activities cut off by the move, and the money they had to support their schooling, for clothing and for activities, should not just be cut off when they go home, or that could cause going back home to break down again. One young person explained this and proposed a solution: ‘When young people are in care they receive a lot of stuff that their parents can’t give them so a lot of arguments are caused. The council should give parents something to keep the young person on track.’" (p. 17).

Some very important key messages came out of this research:

1. Social care services should communicate better with children and families – for example, not moving a child to a new placement just after telling them they will be staying in their placement.

2. Parents with mental health problems are less likely to get their children back.

3. There’s more attention paid to you while you’re in care than after you have been sent back home.

4. ‘Give parents more support before taking kids off them.’

5. If family problems really have improved, you can give them a second chance.

6. When siblings are separated and the younger ones are adopted, all the contact between the siblings is stopped. Something should be in place so siblings could still have contact.

7. Being settled in a placement and then being moved is not a good thing

8.‘Don’t take them in care too quickly.’

9. Children should not go home until things have cleared up there.

10. ‘When I moved into care I got told what to do and given more discipline, whereas I’d never had that before. So it was a good thing.’

References:

Doyle, J. (2011). Consequences of Placing Children in Foster Care: Issues in Child Welfare Research. Presentation to the 2011 Children in Court Summit, Princeton N.J. Accesses 2011/05/14 at http://www.mit.edu/~jjdoyle/pres_NJ_may11.pdf

Doyle, J. (2007). Child Protection and Child Outcomes: Measuring the Effects of Foster Care American Economic Review 97(5). December 2007: 1583-1610

Morgan, R. (2011). Children on the edge of care: A report of children’s views by the Children’s Rights Director for England. Manchester: Ofsted. Accessed 2011/05/14 at http://offlinehbpl.hbpl.co.uk/NewsAttachments/PYC/Children%20on%20the%20edge%20of%20care.pdf

Tags: child protection; foster care; returning children; Joseph Doyle; Ofsted; views of children;

Thursday, May 5, 2011

Florida Story matters

A story out of Florida talks about the inability to effectively track what is going on in a child welfare system. This matters! It is not only a matter of good fiscal management but, most crucially, of good clinical practice management. There are now hundreds of well publicized cases where things have gone wrong in child protection partially because clinical work was not being properly reviewed.

In addition, research is increasingly telling us that many practices in child welfare work are not effective. The need for evidence based practice is there so that money (which is in short supply) is spent effectively and families receive services that really do make a difference in the functioning of families.

Here is the story:

Child Welfare System - Florida

May 3rd, 2011 | Categories: Children and Families, Social Services | Tags: Child welfare, Florida, Foster care, Privatization

Fla. can’t track child welfare contractors, By Kelli Kennedy (AP), May 3, 2011, Miami Herald: “A decade ago, Florida began turning its child welfare program over to private contractors instead of state workers. Almost everyone involved feels that the change has been for the best, but that’s all it is - a feeling. Despite spending a half billion dollars a year, the Department of Children and Families does not have a standardized system for evaluating in most areas its 20 child welfare contractors, making it impossible to prove that the 40,000 children in the system are being helped. Nor can the state show with confidence which contractors are performing well, adequately or poorly. ‘We’ve got to create better statewide data. We have very little,’ new DCF Secretary David Wilkins told The Associated Press. He plans to introduce a new system next year. Critics and advocates agree that the child welfare system has improved overall and cite numbers that prove their point…”