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Monday, October 28, 2013

Depression in parents really does matter

In an editorial review in Psychological Medicine, Psychogiou & Parry have managed to capture the essence of our current understanding of the effects of depression on parenting and implications for children. They note that these implications may also exist for some other conditions such as anxiety, ADHD and Borderline Personality.

Some of the highlights of the article note:

* Parents with low positive affect interact less with their children;
* Parents high on negative affect tend to be intrusive or excessively critical;
* Depressed mothers may show  poorer emotion-regulation strategies;
*They may lower parenting motivation;
* Mothers and fathers with post partum depression may not interact as well with their infants and may, as a result, not build some of the brain circuitry that play a key role in a parent's motivation to be responsive and involved caregivers;
* Rumination in parents affects motivation but it may be more so with fathers;
* Depressed parents may also have lower cognitive flexibility to deal with the demands of parenting.

The authors also note that contextual or environmental factors that a parent operates within also are important. This would include marital conflict, single parenthood or socio-economic realities.

This review certainly brings increased credence to the need to ensure that we are intervening with depressed parents quickly and effectively so that their emotional awareness, regulation and interactions can be encouraged towards a child development lens.

In another recent report, Lewandowski and colleagues note how important the self esteem and resiliency of a child is in buffering the effects of depressed parents. Thus, our interventions need to look beyond the parents to also ensure that we are focused on what the child needs to build internal strengths. Parenting is bi-directional and thus, both parts of the interactional equation, parent and child, should be the focus of attention.

Properly treated, the vast majority of cases of depression respond positively to intervention. These recent publications help us to see that they are useful ways to think about avoiding the need for child protection involvement when other health care systems can see the problem and act quickly and effectively.


Lewandowski, R.E., Verdel, H., Wickramartne, P., Warner, V., Mancini, A. & Weissmann, M. (2013).  Predictors of positive outcomes in off spring of depressed and non-depressed parents across 20 years. Journal of Child and Family Studies, early view, doi: 10.1007/s10826-013-9732-3

Psychogiou, L. & Parry, E. (2013). Why do depressed individuals have difficulties in their parenting role? Psychological Medicine, early view. doi: 10.1017/S0033291713001931

As a result of the comment below, I am adding a link to their rather excellent info graphic

Sunday, October 6, 2013

Kaenu Williams and Marchella Pierce - some common territory in their tragic deaths

By chance, the Serious Case Review (SCR) into the death of Keanu Williams in Birmingham, UK and the grand jury deliberations regarding the death of Marchella Pierce in Brooklyn, NY were published in the same week. Also by chance, are some common themes. For any of us connected to the world of child protection, both reports are disturbing not only in their details but also in the familiarity of the concerns that they raise.

Injuries to Keanu Williams

The injuries to Keanu were extensive as the above illustration shows. The mother had prior history with child welfare as a child in need as well as with her other children. Prior history is something that is seen in many cases, although certainly not all. But the all too familiar aspects of the case were, as the SCR notes "...various agencies involved had collectively failed to prevent Keanu's death as they missed a significant number of opportunities to intervene and take action" (p.6).  The SCR concludes that the death could not have been predicted.  This is a point that many media have noted. But, also on p. 6, the SCR goes on to state,

However, in view of the background history of Rebecca Shuttleworth and the older Siblings including the lifestyle and parenting capacity of Rebecca Shuttleworth and the vulnerability of Keanu in Rebecca Shuttleworth’s care; it could have been predicted that Keanu was likely to suffer significant harm and should have been subject of a Child Protection Plan on at least two occasions to address issues of neglect and physical harm.

In other words, had the various agencies and authorities been paying attention, communicating with each other and giving priority to the child, the outcome may well have been different. As the SCR notes on p. 8, there had been a lack of focus on the children of this mother. The SCR found themes that have been repeated often in these kinds of reviews:

A number of the issues which have arisen in this Review are also familiar themes in Serious Case Reviews nationally, such as: poor communications between and within agencies, a lack of analysis of information as well as a lack of professional curiosity in questioning the information, a lack of confidence among professionals in challenging parents and other professionals, short comings in recording systems and practice, professional over optimism rather than to ‘respectfully disbelieve’ and dealing with events as one off episodes often referred to as the ‘start again syndrome’.

The start again syndrome is dangerous. There is no other way to put it. It is a way to ignore history. Something that a child protection agency does at its peril. In Canada, we are experiencing the brutal inquest into the death of Jeffery Baldwin where the child protection authorities failed to read their own files to see that the grandmother who starved Jeffery to death had been previously convicted of child abuse.

As the Keanu Williams SCR notes, it is the business of child protection to stay focused on the child's journey. But to do so requires the time to be so focused. This brings us to the Marchella Pierce case where the former case worker and the case work supervisor are both facing charges in her death.

Amongst other things, the Brooklyn Grand Jury notes that the workers faced a system that had failed before. But, case loads are high. Problems have been identified and not corrected. Now, rather than the system being held accountable, there is a risk that the people working in the system will be the scapegoats. We have seen that before as well with the Baby Peter case in the UK where Sharon Shoesmith was vilified in the media.

Marchella Pierce

Workers faced with high caseloads will make mistakes and the clients, children and their families will suffer as a result. Should we hold the caseworkers liable or should we be having a discussion about whether or not society should be held accountable by failing to fund child protection at a rate needed? Or by not funding the kind of prevention services needed?

There is also the ugly truth that, no matter what we do, some parents will kill their children.

In my research, I have catalogued about 900 cases where children have died when child protection was involved. I have missed many cases I am sure, Each week, I add to the list. But each week I see a repetition of the systemic issues such as these.There is no easy solution. We need to continue to highlight these cases putting pressure on governments to properly fund both prevention and reaction services.

Tuesday, October 1, 2013

What if the war on drugs was failing?

What if we were to come to the conclusion that the war on drugs has been a failure? What if we were to link that war to increased violence in communities? What if, despite the war on drugs, they have become more potent and less expensive? These are the conclusions of research done by the International Centre for Science in Drug Policy (Disclosure: I am a recent member).

The answer to these questions raises significant concern for the child protection systems. If indeed, the war on drugs has failed, then we must conclude that the billions of dollars being spent in interdiction are not being spent wisely. These monies may indeed not be reducing the demand for drugs and are not assisting those that have become drug dependent.  It may also mean that too many families have been disrupted as interdiction leads to high levels of incarceration (particularly in the United States) for individuals who have been in possession of small amounts of drugs or have been at the lower end of the drug dealing enterprise.  For children, this has meant reduced family cohesion, a parent in jail, increased financial strain in the family and possibly placement in care outside the family.

What perhaps may be missing is a focus on rehabilitation via seeing the person who is abusing or dependent on drugs as having a medical disease. A large volume of research supports that addiction is just that – a disease. Indeed, the Canadian and American societies on Addiction Medicine have taken a stand that addiction is a primary disease. What other medical condition do we treat as a crime in the way that we treat addiction?
What the body of research leads us to is that the financial resources should be redirected to health interventions. The research also leads us to a discussion about the role that gover
nment should play in the marketplace. We need a better discussion about whether government should retail marijuana, for example, in the way that it retails alcohol.  

Where I live, in Calgary Canada, not a single day goes by that I do not walk down a main street smelling someone using marijuana. It is now prevalent. Access is easy.
The ICSDP research notes:
     The study authors conclude that there is a need to re-examine metrics of drug strategy effectiveness, which currently place a disproportionate emphasis on seizures as a marker of reducing drug supply rather than reducing problematic drug use. For example, rather than using indicators of the quantity of drugs seized, which appear to be unrelated to actual supply, governments could assess the effectiveness of their drug policies by employing indicators of drug-related harm such as the number of overdoses, the rate of blood-borne disease transmission (e.g., HIV and hepatitis C) among people who use drugs, or emergency room mentions of drugs.  

Children in the child protection system will benefit from greater family cohesion if a health approach is taken. We can reduce the costs of child protection by focusing community efforts on treating. This is not an easy discussion but when the evidence keeps mounting that the present approach is not working, it is needed discussion.