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Monday, July 28, 2014

Government economic policy as a social determinant to childhood maltreatment

This is a notion that has been written about largely in academic presses. A recent book by the English academic, Nigel Parton, who has written extensively on child protection issues in the UK has raised the subject again. The book is worth a read, but in particular is the final chapter which brings together how government policies can, in and of themselves, act as forms of child abuse - or at least as the social determinant of maltreatment.

Parton and others have noted that, as economies worsen, so do the rates of child maltreatment. The pressures on the poorer populations, those facing greater levels of marginal and challenging existence, will face extraordinary pressures that connect to maltreatment. Thus, government policies that make social security weaker, access to health care more difficult, reduce access to reasonably paying jobs are instigators of the social determinants of child abuse. Yet, in this world of renewed political conservatism, the answer is found in the belief that these people need to take responsibility for themselves and manage their lives better.

As the economic gap between the advantaged and the disadvantaged grows, the ability of the lower economic groups of people to just survive is a world of strain. As people like the Koch brothers pressure for policies that increase their advantage, there are direct costs to society at the other end.

There are other government policies that also are forms of child abuse. Consider policies that place parents in jail for a variety of minor crimes that are associated with economic survival. Consider three strike laws. Consider the utter failure of the war on drugs and the large numbers of low level dealers and users incarcerated. Consider minimum mandatory sentences that keep parents and economic family supporters in jail longer. Also consider the new law in Tennessee which jails a women who has used substances in a pregnancy.

The governments who drive these policies are done so by ideology, not science. It is known that increased rates of incarceration and longer sentences do not make neighborhoods safer. Yet, playing to ideology leads to ignoring science and doing it anyway. As Parton notes, when economic policy punishes the poorer classes through unemployment and restricted social service benefits, it is their neighborhoods that get more dangerous.

Child protection is mainly an activity that has the poorer or economically challenged populations at their doors more so than other groups. Most forms of child maltreatment are not from the more economically advantaged sectors, with the exception of sexual abuse which is more spread through the population.

Parton and others also note that child maltreatment is not just at the hands of family and that many others can threaten a child – such as institutional abuse as seen through the Catholic Church, the Boy Scouts and cases where the image of the abuser has caused a blindness to the behavior (such as Rolph Harris and Jimmy Savile).

This should cause us to think about the role that our institutions play in child maltreatment – government through its social policies and other institutions through their policies as well as the blind eyes to the behaviors of the
powerful. The highly influential and very rich who press government to engage in policies that are very much to their benefit, and at the cost of the lower classes, should also be thought of as child maltreaters through their approaches that create direct harm. When a company believes that its profits should not be reduced for a higher minimum wage, it creates further pressures in lower classes which is a further social determinant of child maltreatment.

This is not a polemic against profit and corporations. To the contrary, vibrant economies do reduce rates of maltreatment. It is a case against the “greed” that believes the income gap growing is justified regardless of the costs to others and the costs to children. This is not a socialist manifesto but rather a democratic one where the rights of all really do matter.

It is also worth noting from Parton’s book that the majority of cases of maltreatment are not known to child protection services. Child maltreatment may be a much more common form of parenting than we are prepared to acknowledge.  As he states on p. 182 of the book, referring to UK data:

“…only a small proportion of abuse ever becomes known to official agencies and is therefore included in official statistics. The research also established that in 22.9% of cases where a young person aged 11-17 was physically hurt by a parent or guardian, nobody else knew about it, as with 34% of cases of sexual assault by an adult and 82.7% of cases of sexual assault by a peer.”

Of course, this also tells us that there are risks for children that are very real outside of the family which says something about the real behavioral values of society. Peers are a major source of maltreatment but one has to ask where did that value come from. In far too many cases, they reflect what has existed in the family.

Parton also goes on to point out how much of the violence that occurs to children, from a parent or guardian or from a peer, is initiated by males. This is not to say that a female cannot and does not initiate violence, only that males continue to be the major source. Despite the myriad of social and public health marketing, we continue to fail to alter gender based violence. Very concerning indeed.

Tuesday, July 1, 2014

The child welfare bargain

On any given day, children are brought into the care of child protection authorities. The basis of most such cases surrounds the inability of the parent to provide appropriate care for the chid. The reasons can be complex but the "state" determines that removal is necessary. In doing so, however, the "state" enters in a bargain with the child - we, "the state" can do better. This bargain is at the heart of every removal so why do we talk about it so infrequently.

We live up to the bargain many times but there are far too many times when we do not. So what goes into the bargain:

1. We will provide a safe place to live - this is true most of the time but we know there are exceptions -- cases where the children are abused in alternative care; where conditions are deficient or, on occasion, dangerous.

2. Your life will be more stable - we fail in cases where we cannot offer a child a stable place to live over time. The bargain isn't just stability this week but as long as the child will be in the care of the state.

3. You will be cared for - but how does an alternate caregiver who cannot be sure that the child will be with them over the long term provide the kind of care that is found in love and meaning? It is in the day to day rhythm of the family that a child finds these moments - the hug; the desire to take the child along to events; the holiday and special family days. Alternate caregiver try hard in these areas but if the child is not a permanent part of the family, these efforts, no matter how well meaning, lack depth.

4. We will give you a good education - this is more than just access to a school. If there is instability in placement, then there will often be instability in schooling. I recall one foster youth saying that she did not really bother making friends at school because she knew she wouldn't be there very long.

5. We will help you get on life - this means being able to finish high school but also the transition to adulthood. A child in care faces aging out when they are no longer part of the child welfare system. This means that placements come to an end. This is crucial in an era when more and more youth are taking longer and longer to leave home. Many who do leave find themselves coming back home for periods. It is taking longer to build firm roots in adulthood. Who does the foster child come back to?

6. We will look after your needs - a traumatized child coming into care requires long term mental health supports. Can the child count on that?

7. We will try to get you home to your family - But has the family changed in a way that the chid can count on being able to stay there? Or will the child become part of a revolving door where they will go in and out of care? In other words, will the family truly be offered the supports it needs to have the child back? Will those supports last long enough for change to become engrained in family life?

8. While in care, you will be allowed to be who you are - this would mean placing a child of colour or an Aboriginal child in a home where they will feel culturally connected and not the odd one out.

9. You will be allowed to disagree with the decision - and this will be done in a way that will not patronize you.

10. Your voice will matter enough that it will be heard often by social workers who will spend time with you on a regular basis.

There are no doubt more points but I think the essential message is there - if we truly intend to live up to the bargain then we must invest in creating a world for the child that is truly better while also trying to allow the child to be connected to family. It's a big deal!