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Thursday, September 29, 2011

Are we creating the platform for another high profile death?

In the UK, where budgets for child welfare have been under increasing pressure, caseloads are rising. The number of children on protection plans and in care are on the increase as well. It is this mix which creates the sorts of pressures where managing cases for child protection workers becomes more and more challenging. Things will get missed. This is the bringing together of the types of factors that lead to the high profile death.

Unfortunately when that happens, it is the front line social worker who will often bear the focal brunt (along with the immediate supervisor). If such a case occurs, one would like to think that this would be the time when we would question systemic effects on casework and accept that there is a balance between what society will pay for and therefore, what child protection can realistically do.

Community Care has reported on this story suggesting that it is the perfect storm for local councils who must try juggle these budgetary demands.

One of the ways pressure in the system eases (and this is but one) is through adoption. In the UK that appears to be a growing problem as well. Children and Young People Now are reporting a decline in the adoption rate of 5%.

This UK data matters to all in chid protection as it illustrates pressures that are building in many Western jurisdictions as the economy worsens. It begs the question of whether we need to look at different models for the delivery of child protection services. Nebraska, in the USA experimented with privatizing the work.  As the Omaha World Herald reports, that experiment seems fraught with problems that are familiar to publicly run programs - high caseloads and high turnover. When you essentially privatize the same model, you are likely to encounter the same problems.

All this is to suggest that the really hard questions of how the system is created and managed are not yet getting asked (although the Munro Review on Child Protection in England has tried hard). It is the political level that must be willing to address the changes needed - and accept that no system of child protection will be perfect and that means in all systems, mistakes will be made. But our present economic woes may be fermenting the next crisis.

Sunday, September 25, 2011

Supervised visits - An analysis

In a fascinating article to be published in the Children and Youth Services Review, Canadian researchers Michael Saini, Melissa Van Wert, Jacob Gofman have helped to consider the differences in supervised visits depending upon why they are occurring.  As they note, child welfare visits protect the child while rebuilding the relationship with the parent. The goal is working towards reunification. In divorce, custody matters, the goal is protection of the child from a parent deemed a long term risk to the child. A common ground between both populations is that they are suffering from loss and trauma - be it through being placed in alternate care or through a parent that has left because of separation or divorce.

One significant difference that the authors note between the child protection and the custody/divorce population is, "In other words, child protection is not an exercise in the proactive service of a child’s best interests but a reactive series of steps where basic needs of a child are not served. Accordingly, child welfare cases are not, at least initially, a contest of best interests of the child as it is in a custody case"

A point raised is the issue of trying to understand the concept of the Best Interests of the Child. They note that in Canada (and very likely in virtually any jurisdiction where the best interest test exists), it is poorly defined and thus will see wide variations in court interpretation. This is a challenge for social workers. The legal literature and the social work and psychology literatures lack consensus. Thus, clinicians and judges are having to assess the test on a case by case basis trying to use precedent and the clinical literature as a guide.

Equally challenging is what constitutes good supervision practice. There is a dearth of good standards around. The authors do help by noting, "Visitation may function as a therapeutic experience, an evaluative method for assessing parental bonding, or a proactive method of enhancing poor parenting skills " This may help to give a clear goal to visits. Too often, there is a supervisor attending who is merely observing and writing down all that goes on. For parents in such cases, they typically feel under the microscope. Those visits, of well documented, could serve as a basis for better understanding what needs to be done to enhance parental skill. As the authors state, "Although monitoring the safety of these interactions is critical, supervisors should do so by actively assisting parents to engage with their children and to be attuned to the needs of their children within the supervised session."

Good visitation programs preserve the relationship with the parent and the child. If visits are frequent, they appear to also offer increased probability for return of the child to the parent's care.

When it comes to custodial disputes, the authors note that the results are mixed and should be relied upon with caution. "These preliminary findings suggest that children involved with supervised visitation experience an increase in visits with non-custodial parents over a six month period, and parents involved experience a decrease in aggression (Flory et al., 2001), and defensiveness (Tutty et al., 2006). However other research indicates that while most parents and children are satisfied with supervised visitation services, service receipt is not associated with decreases in parental hostility or increases in children’s understanding of the divorce process (Jenkins, Park, & Peterson-Badali, 1997), nor are services associated with changes in parental attitudes or child functioning (Dunn et al., 2004). Other research reports that many families utilizing supervised visitation require the services for long periods of time (Sheehan et al., 2007)."

There is an important note of caution for supervisors in custodial matters: "Neutrality and safety are paramount for these visits to effectively facilitate and maintain parent-child contact within the context of custody disputes and it is imperative that supervisors do not get caught in the tribal warfare (Johnston, Roseby, & Keuhnle, 2009) of the litigation battle between of conflicting parents."

It is good to see this article. It offers a well thought out perspective in an area with little research.

Saini, M., Van Wert, M. & Gofman, J., Parent–child su- pervised visitation within child welfare and custody dispute contexts: An exploratory comparison of two distinct models of practice, Children and Youth Services Review (2011), doi: 10.1016/j.childyouth.2011.09.011

Monday, September 19, 2011

Recession and Child Abuse

It will be hard over the next few days to miss the reporting of the research published in Paediatrics. The lead author, Dr. Rachel Berger notes that the research covers the period from January 2004 to June 2009. The recession was in the 2007-2009 period, although there is every reason to believe that the economic troubles her research connects to is far from over. It is also important to note that she is looking at Abusive Head Trauma which is a more dramatic form of abuse. It is often associated with individuals who are already stressed within the parent role and are thus having a great deal of difficulty coping. Unemployment and the financial pressures arising from it only serve to add to the pressures.

The research team concludes, "The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship" (p.637). 

This research highlights a powerful issue in child protection which surrounds the high incidence of poor or impoverished and stressed families in the system. We are failing to support these families. Critics of child protection take issue with the over representation of the poor and disadvantaged yet do not seem to push for the kinds of economic reforms needed to get at the root of so much child abuse - stressed parents.

The authors state, "Specifically, the presence of an association between the economy and the AHT rate should be sufficient to spur a discussion of specific stressors and mediators of these stressors and how they could be modified to decrease the risk of AHT to young children" (p.640). I doubt that it will.

As a society, we pay a huge price for poverty.

If you would like to read the whole article, it is available for free.

Tuesday, September 13, 2011

The Marchella Pierce case should send shivers into every child protection office

In New York City, a former child protection supervisor and the case worker are facing criminal charges arising out the death of Marchella Pierce. The essence of the case is that, had they done their job and properly supervised the family, the child would likely be alive.

Prosecutors may well think that, by engaging these charges, child protection workers will do a better job of ensuring the safety of children. Given the massive budget cuts in child protection offices in thousands of jurisdictions in the western world and the increasing complexity of cases, it can be expected that other children will also die. Truly managing these complex cases cannot be done with limited budgets and high caseloads. The impact from these prosecutions will not be better case management but greater fear.

The real life remedy for the fear is to bring more children into care reducing the risk that the child will be harmed by parents. That serves neither the child nor society.

The story of this case also highlights what has become a theme in child protection in Canada, USA, Britain, Australia and elsewhere - management is dealing with systemic risk by insetting high levels of paperwork be done which leads to less front line case management. This too will increase the possibility that a child will be harmed when a social worker should have been monitoring.

The article covering this case makes for fascinating reading. It is available on line from New York Magazine.

Tags: Marchella Pierce; Chereece Bell; Child Protection New York

Wednesday, September 7, 2011

Measuring the wrong things in child protection

A recent headline in the US screamed "CPS removes 40 percent fewer children from homes than in 2009" This started as a celebratory story that fewer children were being brought into care. The head of the relevant child protection system was attempting to portray that better focused social work was the reason. Her point may well have merit - improved practice guidelines that help workers to better assess what is and is not a concern will likely lead to better case work.

At the same time, she also talked about severe budget cuts, staff shortages and poor prospects for improved spending that may well lie at the core of why fewer children are coming into care. This is a natural fallout to the widespread budget cuts that are occurring throughout western countries as the economic instability hangs around. If there are fewer resources available, then the natural effect is that only more urgent cases will get attention.
It also tends to mean that prevention programs will also become more restricted. Families will not get the support they need to reduce risks; risks will need to be worse for child protection to take action and long term community outcomes may well decline. Unfortunately, it is longer term research that will show this.

Critics of child protection systems may well laud the reduction in children coming into care but their narrow view seems to miss the point. With appropriate budget support, trained staff able to investigate and a mandate the support families with good prevention work, real reductions in children coming into care are possible. Just cutting budgets and staff is  not the right direction.

Budgetary restrictions also mean that the risk of a child dying is increasing and this tends to lead to high profile media stories and demands that child protection do a better job. The front line social workers are stuck in the middle and there may well be fear that they will get blamed when the inevitable death occurs.
One wonders what we are really measuring.

CPS removes 40 percent fewer children from homes than in 2009

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