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Monday, April 29, 2013

Post partum depression as a child protection issue

Post partum depression (PPD) occurs in about 20 - 25% of women after giving birth. Some level of the "baby blues" might well occur in larger numbers. The risks of PPD are that women can then go on to experience longer term depression or, in a small number of cases, go on to post partum psychosis. The latter can often be quite dangerous as it can include risks of suicide and homicide. It tends to be a psychiatric emergency.

PPD has the potential to interfere with the attachment process between mother and child. It can reduce the mother's desire to interact with the baby and to provide stimulation (physical and emotional).

The good news is that it is highly treatable. A review by The Cochrane Library has shown that some very simple interventions can make a significant difference.

The piece of their extensive review showed that one intervention that is simple to manage and effective is peer support. Simply having someone touch base and ask, "How are you doing?" makes a difference. In essence, it is someone who just cares, is there and allows for the expression of a mother's true feelings. This can be a major preventative tool that reduces PPD. The Cochrane review found this to be the case.

The research also found that home visits by such people as community nurses are beneficial. Interpersonal psychotherapy was also valuable.

When we reduce PPD, we improve the situation for families which in turn will reduce the need for child protection intervention. What is most appealing about the results of this research is that we do not need to build new and elaborate programs. Peer or lay support by phone works. Keeping up with nursing post delivery visits work. And, when needed, access to basic mental health support.

Thursday, April 18, 2013

Alcohol and Pregnancy

Anyone who works in child protection knows that Fetal Alcohol Spectrum Disorder is a prevalent and devastating disorder that brings life long implications. The effects can range from profound to minor. Much depends upon what was consumed in what quantity during which periods of the pregnancy.

There are many things that can be toxic to a foetus which can include alcohol, tobacco and other drugs.

A recently published longitudinal study has suggested that minor amount of alcohol are not harmful to the foetus or the child as she develops. A study of more than 10,000 children followed to age 7 found that there were no indications of increased odds for mental or cognitive deficits. Light drinking was defined as 1-2 drinks per week.

What the study did not do is identify what level of alcohol consumption was safe and that which was not safe. That, of course, is a defining issue.

The challenge with this study is that, while it truly helps to advance the debate, it can easily be misinterpreted. It can be seen as a license to drink in pregnancy. While this is an impressive study, it still leaves many question unanswered.

The advice still should be to not drink in pregnancy but to also not encourage panic when a mother announces that she had a drink at a party. In addition, we should likely be paying a lot of attention to the issue of smoking in pregnancy as well.

Friday, April 12, 2013

The true experience of being falsely accused

We hear stories of people being falsely accused of sexual abuse. In the wake of Jimmy Savile, Jerry Sandusky, Theoren Fleury, Sheldon Kennedy, The Los Angeles Catholic Church Diocese and a myriad other Catholic Church sexual abuse stories, The Boy Scouts of America and numerous other high profile cases, it is hard to remember that, rare as they are, false accusations do occur. For those so accused, the impact is hard.

Recently, in the United Kingdom, the Guardian newspaper has published a first person account of a couple who went through the world of false accusation. It is compelling reading and can be read by clicking this link.

Monday, April 8, 2013

Child protection must present an unbiased view

A recent judgment in Nova Scotia raises some crucial issues for social workers and their lawyers who are presenting applications in court. The Honourable Justice Mona M. Lynch in the case of Ministry of Community Services v. F.B. noted some significant concerns with the bias of the presentation to court by the Ministry. She noted that the mother in this case was a difficult client. At paragraph 41, Justice Lynch notes:

There is no doubt that the mother was a difficult client to deal with, however, a parents failure to cooperate with the MCS does not equate to their child being in need of protective services

This matters a great deal. Difficult clients are hard to manage. They can seem to be "unworkable" when they are simply feeling powerless against the greater force of child protection. Justice Lynch appears to take the position that difficult should not be used as the basis for determining whether a child is in need of protection.

Justice Lynch goes on to make a much more crucial point - how invested should workers be in the outcome of the case. At paragraph 47, she states:

Witnesses for the MCS should not be personally invested in the outcome of a proceeding.   The proceeding is about the best interests of children, not who wins or loses. 

When a worker has been putting many hours into a case, has formulated a case plan and has aimed at succeeding with that plan, it is natural to want to achieve what one has set out to achieve. Being invested in that plan may hinder the view that one has to a case. Research has shown that this can create a information bias filtering out new information that contradicts the case plan. This is known as confirmation bias. Justice Lynch became concerned as she notes later in that same paragraph:

The court expects balance.  The court expects that the witnesses from the MCS provide evidence of both the good and the bad that they have witnessed.  The court expects that they will just relay the facts without attempting to colour the evidence in a negative light.  Sadly in this case, with few exceptions, the witnesses who work for the MCS were not impartial or unbiased.  They appeared to be so invested in the outcome of the case that it has affected the weight the court can give their evidence.  They appeared unable to say something positive about the mother even when there were positive things to say.   The evidence of many of the access facilitators can be given little weight.  This is unfortunate because the access facilitators spent the most time with the mother and the children of all of the witnesses.  

In essence, the bias was such that the credibility of the evidence was in question. If a case has merits, then it does not need workers to filter out data that may not support their preferred position. What this case shows is that when a judge becomes concerned that the data has been selected to support a position as opposed to offering the court the data it needs to weigh the merits, then the usefulness of the child protection witnesses wanes.

It is rare that a parent is totally without merit. By putting both the strengths and the weaknesses before the court, the judge can then weigh the balance. If the worker feels that they must do that ahead of time, then the worker is beginning to take the place of the court. That is dangerous.

Justice Lynch's comments are a good reminder that courts are ultimately responsible for determining the best interests of the child when child protection takes matters before them.