Depressed Mothers in the child welfare system

Kohl, Kagotho and Dixon have just published a rather interesting piece of research regarding depressed mother's parenting. They looked at a child protection population. As they note, women are more likely to experience depression as compared to men. Further, those referred to a child protection system will more likely have cumulative stressors that may add to the problems. Women are more likely to be the caregivers in child welfare families and depression is a common concern. Depression has also been found to have a relationship with dysfunctional parenting.

These researchers looked at 92 sampling units across 36 states in the USA. The sample was robust with 5501 children. The families were followed for 36 months and comprised those where the children spent no more than 5% of time in an out of home placement. Thus, while this is a child welfare population, it is one where family preservation is occurring. This might suggest that the population is less severe than might other samples be, but it also afforded the researchers a chance to see what unfold with parenting when the parent stays in that active role. Given the focus of the research, the mother also needed to be the primary caregiver, but could be biological, adoptive or step mother.

The results showed some surprising conclusions, the most important being that it did not replicate the previously seen conclusion that there is a connection between depression and harsh parenting. However, it did increase from 9% to 14% over the course of the study. That is a statistically significant increase. Even so, harsh parenting was a rare event. This is an important result.

The connection between neglectful and emotionally abusive parenting was found. The latter grew over time which is of course, rather concerning. As these authors note,

These high rates of ongoing emotional maltreatment after a CPS referral are a concern, given the long-term adverse consequences of experiencing this type of maltreatment in child- hood. Emotional maltreatment has been found to be an important contributor of psychological adjustment in young adulthood, with higher levels of emotional maltreatment being associated with poorer outcomes (Miller-Perrin, Perrin, & Kocur, 2009).(p.223). 

In their discussion about the implications of their work for clinical practice, the authors note that parents in child protection system are much less likely to receive mental health services as opposed to the overall population. That is worrisome given the implications for these families. This result comes from the USA and may vary across jurisdictions. None the less, it is an acute reminder that assessing for mental health concerns remains a priority in child protection populations. Getting mental health services in place may well serve to increase family preservation outcomes and also reduce such parenting practices as emotional abuse and neglect.

This research underlies the value of good assessment and then connection to needed services.

Reference:

Kohl, P.L., Kagotho, J.N. & Dixon, D. (2011). Parenting practices among depressed women in the child welfare system. Social Work Research, 35, (4), 215-225.

Creating a sense of "Hardiness"

An interesting piece of research has been published this month in the American Journal of Family Therapy. It looks at men and women in relationships who are also survivors of abuse in childhood. The work by  Sandberg, Feldhousen and Busby had a sample of 338 females and 296 males, which is a robust size.

they defined hardiness as a sense of control or influence in one's life especially when faced with adversity. They also acknowledge that previous research has identified that abuse in a person's life can have long term implications. Depression and substance abuse can also serve to negatively moderate the influence of abuse in childhood and, in term, negatively impact parenting. They also note that the quality of the adult relationship between the parenting partners can negatively or positively mediate. In other words, a strong and positive husband and wife relationship can reduce the negative impact of childhood abuse on the survivor's parenting behaviours. This, of course, adds to the building literature that helps us to see that not all people abused in childhood will necessarily go on to be abusive in adulthood.

The implications for practice in child protection are valuable. Building self efficacy and resiliency in a parent increases their hardiness. This, in turn, improves the way in which they can engage parenting. Further, increasing the quality of the couple's relationship will increase the hardiness and again benefit parenting.

It is not a surprise then that it is also important to address issues such as depression in parents as this can impact the hardiness of the individual. This too, then, will have a probable negative impact on parenting. Depression and hardiness, the authors state, have a bi-drectional relationship.

They also noted some gender differences which may help when working with survivors of childhood abuse. Females will benefit from a strengths based approach as opposed to one with a problem base. When working with men, they note:

 "When working with men, clinicians should note that these results suggest childhood trauma, particularly sexual abuse, is correlated with feeling depressed and a weakened sense of hardiness. Clinicians must recognize that overtly addressing this type of abuse may be very difficult for men struggling against gender stereotypes, and as a result patience and persistence will likely be needed" (p.88).

This is valuable research and helps us to see how we can create strength in parents who have been the victims of abuse in their own childhoods.

Reference: Sandberg, J.S., Feldhousen, E.B. & Busby, D.M. (2011). The impact of childhood abuse on women's and men's perceived parenting: Implications for practice. American Journal of Family Therapy, 40 (1), 74-91. DOI: 10.1080/01926187.2011.566827

What happens to children placed in care?

This is the essential question that a new UK study posed. American research previously referred to on this blog has suggested poorer life trajectories. Thus, the British study adds more to the picture. There were 431individuals who, at age 30, provided details on what had occurred in their life trajectory. The report notes that "Compared with cohort members with no public care history, a greater proportion...from public care were from poorer socio-economic background, single motherhood and were underweight at birth." There was also a larger minority representation, particularly blacks. This is not an unexpected result given the long history of poor and minority populations within child protection systems throughout the western countries.

However, for those children admitted to foster care earlier and younger, the outcomes are more favourable. Non foster care outcomes, such as residential care, are less favourable. Pre-care characteristics could not full explain the differences. One vital conclusion is the quality of staff in residential group care really does seem to matter.

Some of the key findings in this research include:

• longer stays in care tended towards poorer outcomes;
• placement instability was also related to poorer outcomes;
• care systems are typically not able to offer all of the supports and roles that a family offers;
• a single, stable and caring long term placement generally leads to better outcomes and, not surprisingly, unstable placements and frequent placement changes lead to poorer outcomes;
• one-off placement, even short term, may have long term negative implications if that placement was a traumatic process for the child, if that admission was mishandled;
• older age at placement is also related to poorer outcomes;
• placement prior to age 1 did not seem to have the poorer outcomes which may challenge some of the assumptions of attachment theory according to the authors;
• Adverse events of the first year appear to be overcome-able by longer term subsequent positive events.

They also postulate that pre-placement negative events and the effects of placement may be countered by providing good support to a family such that the family environment is much improved for the child upon return. They also note that it is important to support the family changing while the child is out but also offering specific services to support the child. If, upon return home, the family life is one of continuing adversity for the child, then longer term outcomes may well continue to be poorer.

This research has real implications for clinical practice. Perhaps the most vital lessons are that the child protection system continues to be one that is most likely to serve the poor, disadvantaged and minority populations. The life circumstances of these populations are such that they are more likely to come to the attention of CPS. Society, which has the power to solve many of these complex problems seems unwilling to do so. A recent report in Canada from the National Council of Welfare presents data that tells us that a 2% increase in the goods and services tax, with proceeds targeted to poverty reduction, could provide the funds needed to eliminate poverty. It is highly improbable that this would happen. Such policy options exist but instead, we are going to see governments avoid such solutions meaning that CPS will continue to end up dealing with the implications of poverty and its related challenges.

Child protection is a clean up service, in some respects, for the problems that larger society does not wish to effectively address. Yet child protection will also face criticisms at three crucial points: when a child known to child protection dies; when a child is wrongly apprehended and when child protection remains over involved in disadvantaged populations creating an image of focusing upon them.

Reference:

Dregan, A. & Guilford, M. (2011). Foster care, residential care and public care placement patterns are associated with adult life trajectories: Population-based cohort study. Social Psychiatry and Psychiatric Epidemiology, In Press. DOI 10.1007/s00127-011-0458-5.