Investigation in British Columbia may be asking the wrong questions

The Royal Canadian Mounted Police (RCMP) announced in B.C. what has been hailed as a groundbreaking investigation. They will look into the actions of care workers who were involved with a First Nations youth, Paige, who died as a young adult from a drug overdose. Paige's case was the subject of a scathing report by the B.C. Representative for Children and Youth, Mary-Ellen Turpel-Lafond.

Paige as an infant, child and youth

In that report, social workers are noted to have failed to properly assess her needs; failed to communicate between regions as she moved around the province; didn't persist in trying to work with her as she became more challenging to engage; allowed her to live in some of the most dangerous, drug addicted areas of the province and often saw her without arranging further contact with child protection authorities. She died at the age of 19. She had many problems including Marfan syndrome which left her with very challenging eyesight, medication and cardiac health issues along with her addiction, trauma history and likely mental health issues.

As the CBC reported on September 18, 2015, "Paige as taken to hospital or detox at lest 17 times after being found unconscious or incoherent; she changed schools 16 times; and she featured in more than 40 police files, mostly for public intoxication." Yet, these incidents generally did not result in filing a report to child protection in accordance with provincial legislation. Like most Canadian provincial child welfare legislation, B.C. requires professionals to contact child protection whenever they suspect that a child is in need of protection.

It is the failure of authorities to make these reports that is the subject of the police investigation. But are they asking the right questions? It's tempting to be satisfied that the police may hold these workers accountable for their failures. That may make many professionals more aware although that might also lead to flooding the system with reports and more children coming into care. There can be a "fear chill" arising from such police efforts.

Despite the merits of a police investigation, it may be that the wrong questions are indeed getting asked. I find myself wondering (as I have with virtually all of the over 900 child welfare practice reviews I have read) what structural conditions lead to these kinds of failures.

• What causes professionals to believe that a report should not be done?
• What allows workers to believe that hard to reach youth are so challenging that you let them be in dangerous situations?
• What circumstances lead workers to fail to gather data from others who have worked with a youth?
• What did professionals believe would make a call to child welfare not worth doing?
• What is that professionals did not understand about their duty to report or has past experience caused them to believe that such calls are not worth doing because they cannot see any changes occurring?
• What kinds of supervision exists to support these decisions?

Yes, it is worth asking why these workers did not do what should be done but the questions are much broader. There has never been a prosecution under this section of the B.C. legislation. Turpel-Lafond hopes that this will be a turning point. I fear it may not be the one she wants. How many professionals will now decide that working with child protection cases should be avoided, for example.

Taking a resiliency approach

One of the challenges in child protection, is being faced with an onslaught of significant problems. There is the daily dose of abuse, neglect, addictions and violence. It is not hard to become overwhelmed with the repeated stories of tragedy. Case loads, when high, also make it challenging to get out from under.

Workers faced with this, have a natural tendency to see deficits as the story of the client or the family. Further, the majority of assessments tend to emphasize those issues. Many of the mental health and psychometric tools are largely focused on the deficit or identification of problems. Mental health practitioners look for diagnostic clues which can skew their perspective to a symptom based analysis.

I have become interested in the notion of resiliency in child protection as a way to shift not only our view of the client but also the nature of the relationship that we have with them. There is research that tells us that the relationship is the most powerful tool that we have in our work. I am reminded of the work of Maiter, Palmer & Manji which notes:

Parents appreciated workers who were caring, genuine, empathetic, exceptionally helpful, non-judgmental, and accepting. Negative qualities of workers identified by parents were being judgmental, cold and uncaring, poor listeners, critical, and insincere.(from the abstract, 2006)

To gain trust and be effective, we also need to have patience and begin to understand the ecological reality of the client - including their strengths. What got me thinking about that is a TedTalk by Dr. Gabor Mate speaking about addiction. He suggests that we ask the question "What is right about it?" Imagine asking that question with our clients. We begin then to explore the value of what the client has been doing even when we can easily see it as harmful. 

The power of the relationship can also be seen in a Canadian study in 2012 by Gladstone et el.:

 A relationship was found between workers' perception of parent engagement and parents' perception of their own engagement, as well as between the perceptions that workers and parents had around their own respective engagement. Workers who were satisfied with service outcomes were significantly more engaged than those who were unsatisfied. Parents thinking that their children were safer as a result of intervention were significantly more engaged than parents who thought that their children were less safe. The strongest reason given by parents for positive change was being able to trust their worker (p < .001) and believing that their worker was knowledgeable about parenting (p < .01). (again from the abstract)

I reflected further on this when working with a client recently who has a substance abuse problem, mental health issues and self harming behaviours. It is quite easy to get focused on the problems. But when I went to Mate's question, I began to see how she had survived and coped with a long list of traumas in her life. Her support system had collapsed and her internal resources were overwhelmed. She had found a way to exist. Reframing the behaviours in this way changes how she is seen but most importantly, how she reacts to the relationship.

One of the barriers to change can be what we believe is possible. If we do not see that it can be done, then it takes a strong client to prove us wrong. Not to be mistaken, there are clearly situations where clients resist change or it is just too much for them.

There are also now indicators that, just as trauma can pass between generations through DNA (e.g think of the study of epigenetics) there is also data that suggests that recovery, resilience and strength can pass as well. For an interesting brief read on this, you might look at Dr. Laura Kerr's blog. 

There is also research out of the United Kingdom suggesting that it is worth looking at the child's well-being. The Children's Society has recently published the 2015 Report, The Good Childhood. I like this report as it invites us into a broader and richer view of seeing how a child is doing. The report starts by noting:

Though it is easy to slip into a shorthand of happiness, well-being is about so much more than this. It is about how young people feel about their lives as a whole, how they feel about their relationships, the amount of choice that they have in their lives, and their future. Wellbeing matters as an end in itself, but also because it is correlated with other outcomes in life such as physical and mental health...

In essence, what this all begins to tell us that there are very good reasons to be hopeful in many of the cases we work with - not all - but many. It is also worth remembering that our goal is not perfection but good enough (Choate & Engstrom, 2014).

References:

Choate, P.W. & Engstrom , S. (2014) The “Good Enough” Parent: Implications for Child Protection, Child Care in Practice, 20:4, 368-382, http://dx.doi.org.10.1080/13575279.2014.915794

Gladston, J., Dumbrill, G., Leslie, B., Koster, A., Young, M. & Ismalia, A. (2013). Looking at engagement and outcome from the perspectives of child protection workers and parents. Children and Youth Services Review, 34 (1), 112-118. doi:10.1016/j.childyouth.2011.09.003

Maiter, S., Palmer, S. & Manj, S. (2006). Strengthening social worker-client relationships in child protective services: Addressing power imbalances and 'ruptured' relationships. Qualitative Social Work, 5(2), 161-186. doi: 10.1177/1473325006064255

Pople, L. The Children's Society, Rees, G., Main, G. & Bradshaw, J.. (2015). The Good Childhood Report 2015. London: The Children's Society.