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Sunday, July 3, 2011

Collateral Interviews Really Matter!

Mary Ellen Turpel-Lafond, the Representative for Children and Youth in British Columbia on Canada’s west coast begins her report Isolated and Invisible: When Children with Special Needs are Seen but Not Seen with the poignant summary of why her office would see the topic as needing special focus:

“This investigation focuses on the critical injury of a 15-year-old girl with special needs. The investigation began after this developmentally disabled girl was found alone with her dead mother. Neighbours, concerned that they hadn’t seen the girl and her mother for many days, looked through a front window and saw the girl on the floor beside the body of her mother. The mother had been deceased for an undetermined length of time, possibly seven days.” The girl in this story, not named, suffered from Down’s syndrome. Her life would intersect with various government ministries. She would be failed too often. Her story teaches us more about the kinds of direct service activities that better serve vulnerable populations.

This girl would require supports for her complex needs starting right at birth. She was apparently not an easy child to parent. This is also one of those cases where efforts were made to get good programming into place. The mother did not have a good record of following through, it seems. She did get her daughter on medication and this helped with behavioral concerns.

However, the mother would also experience her own health demands. This limited her capacity to work placing very significant financial demands on the family unit. The mother would also lose her care due to an accident creating isolation as neither she nor her daughter could get around easily. Disconnect from supports occurred.

The family came to the attention of child protection with accusations of abuse along with the mother’s own problems with alcohol and prescription drug abuse being raised. An investigation would cause the girl to be returned to the mother’s care with concerns not being validated.

Child protection will come under criticism for what is a too often seen problem in critiques of the system – a failure to gather appropriate collateral data. On p.19 of the report, it notes:

“On June 2, 2010, the MCFD child protection report was concluded and the file was closed. The child protection social worker closed the file without consulting with the respite caregiver, any medical professionals involved with the family, the behavioural support worker or the police who investigated the April 2010 motor vehicle accident.” However, there would be further investigations and opportunities for intervention. The report details those steps including an apparent incongruence between what child protection did and the level of risk that they apparently noted.

The report contains a timeline on pp26-27 that shows the many involvements without this child being properly protected.

The Representative concludes on p. 29:

“his vulnerable girl’s needs were not adequately addressed throughout the period covered by this investigation. There was no assessment of her situation as a child with special needs requiring a range of health, education and social supports for positive development. She was not safe. She was left with compromised hearing and physical mobility, in an impoverished environment and primarily cared for by a severely ill and challenged mother. This girl was invisible. If there had been an assessment and a plan in place to ensure high visibility, the harm caused to this girl by being left with her deceased mother would likely have been prevented. “

A lesson that should be taken from this case is the importance of collateral data. It is these various sources that afford an opportunity to garner information that is being withheld by a family or, on the other hand, to corroborate what is being told.

Collateral checking will also help to identify who is working with the family. This creates the opportunity for more coordinated case planning and delivery. The Representative has avoided the trap of laying blame on the workers and focuses instead on the systemic issues. Here too, however, she has managed to avoid the trap of suggesting grand schemes. She is to be congratulated. Instead shoe observes:

“t would be easy to blame the front-line workers who did have contact with this child and her mother. Although standards were not met, that would take us in the wrong direction, and would not address the central issue. The systems they work in failed, and these systems must improve. They must focus on the children and the supports and services they need. Not grand schemes of reorganization or governance, but solid, cost-effective, accountable programs that improve outcomes for vulnerable children. We need clarity about who does what, and we need programs that require child protection social workers, special needs workers, therapists, physicians and teachers to work together effectively with the child as the focus. “ (p.46)

We have seen this need for coordination in many case reviews. It is a lesson taught repeatedly but often not applied.

If interested in the full report, it is available at

http://www.rcybc.ca/Content/Publications/Reports.asp

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