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Sunday, February 16, 2014

Is the Canadian child protection system broken?

Albertans might well be wondering if the child protection systems in Canada are falling apart. Well they might. In December the Calgary Herald / Edmonton Journal ran a series of articles detailing concerns arising from the deaths of children in care. This was followed by Alberta Human Services Minister Bhullar announcing even more deaths.  Recently Justice Ted Hughes’ report into the death of Phoenix Sinclair in Manitoba was released. He determined the death was preventable by the very system that should have saved her. This past week, the Coroner's Jury made 103 recommendations to arising from the death of Jeffrey Baldwin in Toronto a decade ago.

Jeffrey Baldwin

Canada has had over 50 public inquiries into children who have been killed or harmed while child protection has been involved in their lives. Each report has detailed errors made by social workers. Each has left readers shaking their heads that professionals could have done such a bad job. The reports, of course, only focus on the “big” cases where things have gone badly wrong. Truly, these are stories that deserve to be told. They should not be hidden from the public as no system can sustain any level of confidence when it is not open to scrutiny. Such reviews though should highlight what goes well and what does not. The stories of the successes also need to be told such as the three young women at the Minister Bhullar’s roundtable on child protection who have spent significant parts of their lives in the care of child welfare. These young adults who are taking steps to transition into adulthood showed their individual strength overcoming adversity. They had the support of an effective child protection system.

Child protection is hard work. Imagine showing up at a family’s home, knocking on the door and announcing that you are there to investigate an allegation of abuse or neglect. You cross a boundary. We view the family unit as a basic of society that should largely be left alone to get on with the task of being a family. Child protection steps into that world with the force of law. The social workers will need to determine if the child is safe and, if not, what needs to be done to ensure that child’s safety. Sometimes, that means removing the child from parental care for a temporary period. In a small but profound number of cases, that may lead to the permanent removal of the child. Even when parents have acted quite dangerously towards their children, these removals are almost always traumatic for both parents and children. There is a delicate balance between sustaining the family unit and achieving safety.

There are checks and balances. A child protection worker removing a child is subject to the scrutiny of the courts. For the parent who has lost their child, that can be little solace as they wander down the hall and stare at the empty bed that only a few hours ago was occupied by their child.

Imagine, however, if there were no child protection system. There would be more children dying at the hands of caregivers. Simply put, there would be more stories like Phoenix Sinclair. That is not a world that appeals to me. A child protection system that is not subject to review is equally unappetizing as there can be no belief except by faith that they are getting it right. Courts are one way that scrutiny happens. As the roundtable noted, there needs to be more transparency. The public should be able to get data that tells them how the system is doing.

Phoenix Sinclair

Yet, there is no child protection system that can guarantee that another child will not be seriously harmed or killed by a caregiver. This is very human work in which social workers must make decisions with highly imperfect information. There are no tools, nor will there ever be, that can come even close to absolutely predicting the risk that a parent presents. There is only probability. To expect that social workers can prevent all deaths of children by parents is to expect the impossible.

Child protection also cannot solve poverty, unemployment and lack of appropriate resources across this country. Yet, child protection is asked to pick up the pieces of these social problems. Thousands of children would not be in care if these problems were better addressed.

If we want better child protection services, fund them appropriately so that case loads are manageable, prevention and healing work is achievable and bring in social programs that will help to reduce the need for child protection across Canada. This also means that the federal government must start funding First Nations child welfare programs at the same rates that provincial programs are funded. Why should an Aboriginal child on a reserve receive less funding than a child under provincial authority?

The system is not broken, but it is certainly imperfect. Thus it must be transparent. The Calgary Herald and Edmonton Journal took four years to get the records on child deaths. That is just wrong and erodes public confidence.

Wednesday, February 12, 2014

The income gap contributes to child maltreatment

A study published in the current issue of Pediatrics helps to identify that the growing income gap in the world has an impact on child maltreatment. There may be many reasons to be concerned about the increasing concentration of wealth in a small pool of people, but this study concludes that child maltreatment is one of the reasons to be concerned.

The study concludes:

Higher income inequality across US counties was significantly associated with higher county-level rates of child maltreatment. The findings contribute to the growing literature linking greater income inequality to a range of poor health and well-being outcomes in infants and children.

This is a very real issue for larger society that will be expected to pick up the costs of this growing problem through health care, child protection and the criminal justice and mental health systems. Child maltreatment has life long implications.  One of the authors, John J. Eckenrode stated:

"Child maltreatment is a toxic stressor in the lives of children that may result in childhood mortality and morbidities and have lifelong effects on leading causes of death in adults," they wrote. "This is in addition to long-term effects on mental health, substance use, risky sexual behavior and criminal behavior … increased rates of unemployment, poverty and Medicaid use in adulthood." (Science Daily February 12, 2014).

When one links this research with what is known from the Adverse Childhood Experiences research, we can see that there is growing data that child maltreatment creates emotions, physical, social and economic impacts across the lifespan. This is just more data that shows it is a big deal.


J. Eckenrode, E. G. Smith, M. E. McCarthy, M. Dineen. Income Inequality and Child Maltreatment in the United States. PEDIATRICS, 2014; DOI:10.1542/peds.2013-1707


Sunday, February 2, 2014

Phoenix Sinclair Report recommendations go over all too familiar ground

The inquiry headed by Justice Ted Hughes into the death of Phoenix Sinclair has now issues its report. It turned out to be the most expensive inquiry in Manitoba's history but it covers territory that is all too familiar. Mistakes by social workers that should never have been made in a system that ought to have prevented the death. This is part of a long line of inquiries that reach very similar conclusions.

The full report can be read here.

Phoenix Sinclair

The report does make some very valuable suggestions such as all child protection workers should be trained social workers who are registered with the Manitoba social work association; case loads be kept manageable; records be well maintained; better communication with others involved including when transferring a case; the system be more transparent and that more effort be put into prevention.

The big idea that Hughes came up with is that child protection requires a national conversation. He suggests that the issue belongs on the agenda of the next Premier's conference which the Manitoba premier has asked be done. The notion of a cross country conversation makes a great deal of sense. I recently attended a roundtable on child protection here in Alberta which was organized by Human Services Minister Manmeet Bhullar. In his opening comments, the Minister noted that there have been over 50 reports on child protection problems across Canada. I have read them. They have a numbing familiarity raising problems about caseloads, funding, the decision making environment, poor communication between agencies, poor record keeping, the need for better training, missing cues and so on.

What so many reports do not address is the very human nature of child protection work. Social workers are rarely invited into families. Most often, they arrive because there has been an allegation of abuse or neglect which requires investigation. Families are very understandably defensive and sometimes downright resistant. This is so much an issue that last year Siobhan Laird wrote a text on managing conflict, hostility and aggression in child protection. It is in that environment that a worker must try to determine the safety and risks for a child.

The information is always (and I use that word very consciously) incomplete. No social worker ever knows everything that is relevant. Thus, the decision making is done with an information set that is changing constantly. Decisions often need to be revisited. There is no way (again I use that phrase consciously) that a worker can predict with absolute certainty the risks. There is probability. We are still faced with the fact that the best predictor of future behaviour is past behaviour in the absence of a compelling story of change.

Part of the challenge with child protection is that there is an expectation of perfection. There is a zero tolerance in the public's mind regarding a death of a children. But there is a reality that no system anywhere can guarantee that. We do have an obligation to provide the best system we can and to really understand how we can reduce risks.

There is also an obligation by society at large to fund prevention which is best done by poverty reduction. The majority of children brought to child protection attention are related to neglect - which is very strongly rooted in poverty. Reducing poverty reduces children in care which increases the attention that can be paid to the higher risk cases.