I have written in prior posts about the concern that large scale budget restrictions can have on child protection. When there are fewer resources available to investigate, intervene or support families, then more children will fall through the cracks. Families that could be supported much earlier in the problem cycle, will be left to get worse. This will in turn increase the risks of children being removed from their families at a later date. This, of course, also increases the risks of another high profile child death.
Some interesting news from the UK, supports that budget cuts are indeed increasing risks for children.
"Are child victims of domestic violence being forgotten?
Natalie Valios
Thursday 14 April 2011 12:16
Higher intervention thresholds allied with the government's reductions in public spending are causing alarm among child protection professionals. Natalie Valios reports
Children can become victims of domestic violence in several ways: they may be physically abused, be traumatised either from witnessing it, or from the emotional and physical fallout that affects parental care.
There are signs that these children are falling through ever-widening gaps in services because of a combination of cuts and increasing child protection thresholds.
Last week's Community Care survey of 170 frontline child protection workers found 82% felt thresholds had risen in their area in the past year. This was across all types of abuse although it was most acute in cases of neglect and emotional abuse (which includes child witnesses of domestic violence).
One social worker who responded said: "There is a lack of support services in the community particularly services related to domestic violence. We have no perpetrators programmes in the borough so cases come back again and again but do not meet the now extremely high thresholds to stay open to long-term statutory teams."
A Women's Aid survey published last month found domestic and sexual violence services were being cut so much - in some areas by nearly 100% - that 70,000 women and children could be left without support. Nearly two-thirds of refuge services had no council funding and a further 60% of support services for child victims did not know whether they had funding for the next financial year.
Domestic violence services in England are provided mainly by voluntary agencies and, unlike those in Scotland and Wales, have no dedicated funding stream. This has made them easy targets for cash-strapped councils.
Devon Council, for example, has slashed funding for refuge and outreach children's workers who deal with those on child protection plans.
The chief executive of North Devon Women's Aid, Sue Wallis, says last year the group dealt with 140 children from 79 families. "All children who come to the refuge are traumatised and damaged," she says. "We have had to make redundant our full-time children's worker, who carries out therapeutic counselling, as well as our two part-time playroom workers. Without counselling these children are not going to be given any chance to heal and their life chances will remain rock bottom. They will grow into damaged adults who will repeat the cycle."
The fear surrounding such cuts is that not only will they feed into higher child protection referrals, but some women may no longer be able to access any services.
As Wallis points out: "We work with people who have a tremendous fear of statutory services. Some women may bolt straightaway if we mention social services and they could go back home and place themselves and their children in danger."
Nushra Mansuri, professional officer England for BASW - the College of Social Work, is also worried about the emotional fallout that these funding cuts could have on children. She does not believe that social workers have the time or expertise to work with children appropriately and says the cuts send a "crushing message" to them. "They need trained specialists; it has to be about a therapeutic approach," she says.
Maddy Coy, deputy director of the Child and Woman Abuse Studies Unit at London Metropolitan University, agrees: "One of the most critical things about the cuts will be the lack of experienced specialist workers to address the complex ways that children experience domestic violence. Voluntary organisations have decades of accumulated expertise that few statutory services have."
Barnardo's has several domestic violence projects providing therapeutic services to children. "Research shows that children who live with domestic violence are at an increased risk of behavioural problems, emotional trauma and mental health issues in adult life," says Emma Ramsay, children's services manager for the charity's domestic violence protection project in Newcastle upon Tyne. "It is important that they have someone to talk to."
Even in the short term, the damage could be fatal, says Fiona Dwyer, Women's Aid's national children and young people officer. "We have seen a decrease in the length of time women are staying with their partners but [fewer services] will lead to them staying longer, placing them and their children at more risk," she says.
"Child deaths are a definite possibility. If we look into any serious case review of a child who has been killed, domestic violence is a factor in almost all the deaths."
EXTENT OF THE PROBLEM
750,000 children a year witness domestic violence.
52% of child protection cases involve domestic violence.
54,000 children in England were affected by domestic violence in 2009-10.
68% of women using Women's Aid services have children with them or are pregnant.
60% of refuge services have no council funding from this month.
70,000 women and children could be without support due to cuts.
Source: Women's Aid
MANIFESTATION OF ABUSE
Children can experience emotional harm from a violent parent/carer in a number of overlapping ways, writes Dr Lynne Harne.
These include:
● Witnessing domestic violence either directly or indirectly towards the non-abusing parent (usually the mother);
● Being used in the violence and abuse against the non-abusing parent - usually in an attempt to undermine her self-esteem and her role as a parent - or getting caught up in the violence;
● Direct emotional abuse and neglect through harmful parenting; and emotional harm from having to cope with the consequences of domestic violence - such as having to leave home, experiencing loss of community, friendships, possessions and disruption to education.
There is a high overlap between the occurrence of emotional abuse from exposure to domestic violence and direct physical and sexual abuse and neglect of children by domestically violent parent/carers. Domestic violence is therefore a key risk factor for multiple abuse of children.
Research shows that the vast majority of children are aware of domestic violence through overhearing it, seeing it or observing the physical and emotional impacts on their mothers, even where parents believe they have kept it hidden it from them.
The impacts of domestic violence on children and young people vary, but studies generally indicate that they take the form of internal disorders such as anxiety, depression and withdrawal and, in some cases, trauma symptoms akin to post-traumatic stress disorder, and/or external disorders affecting behaviour such as aggression.
Recent research on general populations of children in the UK experiencing domestic violence has noted that they are more likely to experience behaviour disorders than other children and that the impact on children's mental health can continue into adulthood."
● This is extracted from a Community Care Inform guide
SOURCE: Communitycare.co.uk
Saturday, April 16, 2011
Monday, April 11, 2011
Have we forgotten that good enough may just be good enough
In a recent article on the New York Times Motherlode website, Christien Gottleib, a lawyer who represents parents in child protection matters, mused "parenting is something we are inclined to judge harshly at the same time that it is impossible to do in anything but an extremely flawed way. You can’t get it right. We all know this." (http://parenting.blogs.nytimes.com/2010/08/26/parenting-under-scrutiny
D.W. Winnicott, a British pediatrician and psychoanalyst noted in the 1960s that a parent can be good enough and we should not expect perfection. In essence, it may not even be appropriate to try and hold out some high standard as something that parents should strive for - its just not realistic. It may, in fact, not be helpful particularly in the world of child protection. In that world, getting a parent to the point where they are good enough is a valid goal particularly given the history that many parents in these circumstances enter the world of parenting with.
Trauma, grief, loss, neglect, maltreatment form part of the story for many of these parents. If we exclude those where poverty is the main story, then these other factors are features of cases that are prominent in the vast majority of families. Many child protection parents have disorganized attachments making it very hard for them to be attuned to their children. They simply don't know what it means.
Research also tells us that the first 5 years are the most crucial for parenting - so what would happen if parenting interventions were thought of as trying to get good enough. This might include supporting parents in trying to understand what child behaviour might mean; find ways to better read their children; try to comfort; be emotionally present and most of all accept some level of flaws as long as they can be essentially safe with the children? This might increase the possibility of family preservation and reduce demand on scarce foster placements. BUT - we will have to lower our expectations to something that most parenting text books do not talk about - good enough.
In the good enough family, parents will provide basics (food, clothing, shelter); avoid hitting and abusing; be emotionally and physically available and learn how to set reasonable limits. What we need is a wide spread discussion on accepting good enough.
There will be children for whom good enough is not going to be acceptable. These are children who have rather special needs such as disabilities of various kinds. But the majority of children in child protection might well be able to get the basics of what they need from a good enough parent.
Help parents to be positive, present and caring and that may be most of what children need.
This is a debate that we need in child protection particularly amongst those of us who assess parenting capacity. Budd, Clark & Connell, in their newly published book Evaluation of Parenting Capacity in Child protection, "...minimal parenting is the floor of acceptable parenting that is sufficient to protect the safety and well being of the child"(p.40).
It night well be argued that we have failed to really understand and articulate what this floor looks like meaning that the line separating good enough from not is fuzzy which in turn leads to erroneous conclusions about families.
Let us have this debate.
D.W. Winnicott, a British pediatrician and psychoanalyst noted in the 1960s that a parent can be good enough and we should not expect perfection. In essence, it may not even be appropriate to try and hold out some high standard as something that parents should strive for - its just not realistic. It may, in fact, not be helpful particularly in the world of child protection. In that world, getting a parent to the point where they are good enough is a valid goal particularly given the history that many parents in these circumstances enter the world of parenting with.
Trauma, grief, loss, neglect, maltreatment form part of the story for many of these parents. If we exclude those where poverty is the main story, then these other factors are features of cases that are prominent in the vast majority of families. Many child protection parents have disorganized attachments making it very hard for them to be attuned to their children. They simply don't know what it means.
Research also tells us that the first 5 years are the most crucial for parenting - so what would happen if parenting interventions were thought of as trying to get good enough. This might include supporting parents in trying to understand what child behaviour might mean; find ways to better read their children; try to comfort; be emotionally present and most of all accept some level of flaws as long as they can be essentially safe with the children? This might increase the possibility of family preservation and reduce demand on scarce foster placements. BUT - we will have to lower our expectations to something that most parenting text books do not talk about - good enough.
In the good enough family, parents will provide basics (food, clothing, shelter); avoid hitting and abusing; be emotionally and physically available and learn how to set reasonable limits. What we need is a wide spread discussion on accepting good enough.
There will be children for whom good enough is not going to be acceptable. These are children who have rather special needs such as disabilities of various kinds. But the majority of children in child protection might well be able to get the basics of what they need from a good enough parent.
Help parents to be positive, present and caring and that may be most of what children need.
This is a debate that we need in child protection particularly amongst those of us who assess parenting capacity. Budd, Clark & Connell, in their newly published book Evaluation of Parenting Capacity in Child protection, "...minimal parenting is the floor of acceptable parenting that is sufficient to protect the safety and well being of the child"(p.40).
It night well be argued that we have failed to really understand and articulate what this floor looks like meaning that the line separating good enough from not is fuzzy which in turn leads to erroneous conclusions about families.
Let us have this debate.
Monday, April 4, 2011
Criminal Charges against child protection workers in New York
In what may turn out to be a precedent setting case, 2 child protection workers have been charged with failing to protect a child and being somehow complicit in the death of Marchella Pierce. There is a claim, as yet unproven in a court, that the two workers created fraudulent records of visits. They say that the caseloads were too high to keep up with the record keeping. The records were written after the death of the child.
What this case represents is a liability chill that will fundamentally alter child protection if the case succeeds. Imagine, if you will, that a worker does the job, can't keep up with the records and then worries that they will be held criminally responsible if a child dies. And then do this for relatively little money. Why do it indeed. The case suggests that keeping up with the records is more important than keeping up with the cases.
If case loads were kept reasonable, then keeping up with paper would make sense as a daily priority. When case loads exceed what can be reasonably handled, record keeping will suffer. This is a point that politicians should remember each time they cut budgets and staff. A child will die when caseloads are high; budgets are too tight and turnover high because of the stress of the job - which will lead to high numbers of inexperienced workers doing front line work. The outcome of this recipe is inevitable - children will suffer; families will not get better; help will not be delivered in a way that makes a difference and, yes, children will die.
The issue is not therefore about the ineptitude of a particular worker but about the priority that society is willing to place on protection of children. Compare this to policing or other emergency services. If you put fewer police officers on the road, then high risk environments will be less protected and crime will go up. Who is to blame? The police officer or the society that does not wish to pay for services? Society gets the protection it is willing to pay for whether this be with policing, paramedics, fire or child protection.
Critics of child protection, and there are many, have legitimate points to raise but often fail to look at the role society plays in funding the work. Child protection is a balance between the needs of the child to be safe and the rights of families to be together. Examining a case to understand where that balance exists in a case takes time. The critics appear to have rarely spent time at the front line having to make those decisions. Workers having to do so on an urgent basis often have limited data to work with. Families may typically be reluctant information givers wanting child protection workers to disappear.
The critics take a distant view when much more data is known somehow anticipating that the front line worker should have been able to figure it out at the front door of the family home. We ask a lot of CPS workers. As a society, we should be willing to give them the tools to do the job.
This case may also lead to something that has been seen in England - managerialism and proceduralism. This is when protecting the system is more important than protecting the child.
If these workers did indeed fail to visit the family and created false records, then that may be a unique matter but let it be focused on that. Let not this case be about retrospectively holding workers accountable because a child died and they couldn't predict that.
Risk assessment is an inexact science. Workers take known factors of risk and compare them with the case in front of them. The closer a family fits in comparison to the risk factors, the greater the worry. However, it is also vital to understand that there are many who fit the risk profile who will not harm a child and many who do not fit the profile who will. There are times when risk assessment tools are no more effective than chance. What then is the worker to do but try and make the best decision possible with whatever information can tell them along with their own experience. This too will be inexact in the same way that a police officer must judge whether the person with the gun is going to shoot or not.
This trial will be well worth monitoring because of the major implications.
Related to this is a new publication from the National Association of Social Workers in the United States. Called Supervision: The Safety Net for front line Child Protection Practice, it highlights several facets needed for effective service delivery. These are timely given this New York case:
Training and Knowledge Development
• Lack of adequate training related to the roles, tasks and competencies for being a supervisor.
• Inadequate knowledge of the changing populations and communities being served.
• Over-focus on performance of administrative functions (managing staff and workloads) of the supervisor.
• Insufficient research-tested models of supervision (e.g., team models; identification of necessary education and training requirements and competencies; supervisor to supervisee ratios) and how these impact outcomes for children and families.
• Inadequate time to attend training programs or to remain current with the literature and research related to child welfare and supervisory practices.
• Absence of adequate dissemination tools and efforts to provide evidence-based information to supervisors and their staff.
• Insufficient timely use of data to inform and improve practice. Organizational Issues and Implementation of Child Welfare Practices
• Experiences of trauma, lack of safety and vulnerability, both within the agency and in some communities.
• Dealing with frequent turnover of high-ranking leaders and administrators.
• Difficulty in retaining competent front-line workers.
• Potential ethical conflicts in how services are provided to families, how families’ needs are assessed or regarding acceptable case plans.
• Addressing service and resource gaps. • Potential conflicts between the need to be transparent in terms of services provided and
confidentiality policies.
• Concerns about inadequacies in the built environment including lack of privacy for meetings, supervisory sessions and client interviews.
• Numerous oversight bodies that review practices and question how services are provided. • Absence of available and adequate supervision, peer consultation and support for the
supervisors.
• Problems in the organization’s culture and climate that heighten potential for burnout and turnover and add to the difficulty of providing supervision.
• Over-emphasis on administrative functions in supervision that take away from educational and clinical aspects of supervision to improve practice and outcomes. (pp. iii-iv)
What this case represents is a liability chill that will fundamentally alter child protection if the case succeeds. Imagine, if you will, that a worker does the job, can't keep up with the records and then worries that they will be held criminally responsible if a child dies. And then do this for relatively little money. Why do it indeed. The case suggests that keeping up with the records is more important than keeping up with the cases.
If case loads were kept reasonable, then keeping up with paper would make sense as a daily priority. When case loads exceed what can be reasonably handled, record keeping will suffer. This is a point that politicians should remember each time they cut budgets and staff. A child will die when caseloads are high; budgets are too tight and turnover high because of the stress of the job - which will lead to high numbers of inexperienced workers doing front line work. The outcome of this recipe is inevitable - children will suffer; families will not get better; help will not be delivered in a way that makes a difference and, yes, children will die.
The issue is not therefore about the ineptitude of a particular worker but about the priority that society is willing to place on protection of children. Compare this to policing or other emergency services. If you put fewer police officers on the road, then high risk environments will be less protected and crime will go up. Who is to blame? The police officer or the society that does not wish to pay for services? Society gets the protection it is willing to pay for whether this be with policing, paramedics, fire or child protection.
Critics of child protection, and there are many, have legitimate points to raise but often fail to look at the role society plays in funding the work. Child protection is a balance between the needs of the child to be safe and the rights of families to be together. Examining a case to understand where that balance exists in a case takes time. The critics appear to have rarely spent time at the front line having to make those decisions. Workers having to do so on an urgent basis often have limited data to work with. Families may typically be reluctant information givers wanting child protection workers to disappear.
The critics take a distant view when much more data is known somehow anticipating that the front line worker should have been able to figure it out at the front door of the family home. We ask a lot of CPS workers. As a society, we should be willing to give them the tools to do the job.
This case may also lead to something that has been seen in England - managerialism and proceduralism. This is when protecting the system is more important than protecting the child.
If these workers did indeed fail to visit the family and created false records, then that may be a unique matter but let it be focused on that. Let not this case be about retrospectively holding workers accountable because a child died and they couldn't predict that.
Risk assessment is an inexact science. Workers take known factors of risk and compare them with the case in front of them. The closer a family fits in comparison to the risk factors, the greater the worry. However, it is also vital to understand that there are many who fit the risk profile who will not harm a child and many who do not fit the profile who will. There are times when risk assessment tools are no more effective than chance. What then is the worker to do but try and make the best decision possible with whatever information can tell them along with their own experience. This too will be inexact in the same way that a police officer must judge whether the person with the gun is going to shoot or not.
This trial will be well worth monitoring because of the major implications.
Related to this is a new publication from the National Association of Social Workers in the United States. Called Supervision: The Safety Net for front line Child Protection Practice, it highlights several facets needed for effective service delivery. These are timely given this New York case:
Training and Knowledge Development
• Lack of adequate training related to the roles, tasks and competencies for being a supervisor.
• Inadequate knowledge of the changing populations and communities being served.
• Over-focus on performance of administrative functions (managing staff and workloads) of the supervisor.
• Insufficient research-tested models of supervision (e.g., team models; identification of necessary education and training requirements and competencies; supervisor to supervisee ratios) and how these impact outcomes for children and families.
• Inadequate time to attend training programs or to remain current with the literature and research related to child welfare and supervisory practices.
• Absence of adequate dissemination tools and efforts to provide evidence-based information to supervisors and their staff.
• Insufficient timely use of data to inform and improve practice. Organizational Issues and Implementation of Child Welfare Practices
• Experiences of trauma, lack of safety and vulnerability, both within the agency and in some communities.
• Dealing with frequent turnover of high-ranking leaders and administrators.
• Difficulty in retaining competent front-line workers.
• Potential ethical conflicts in how services are provided to families, how families’ needs are assessed or regarding acceptable case plans.
• Addressing service and resource gaps. • Potential conflicts between the need to be transparent in terms of services provided and
confidentiality policies.
• Concerns about inadequacies in the built environment including lack of privacy for meetings, supervisory sessions and client interviews.
• Numerous oversight bodies that review practices and question how services are provided. • Absence of available and adequate supervision, peer consultation and support for the
supervisors.
• Problems in the organization’s culture and climate that heighten potential for burnout and turnover and add to the difficulty of providing supervision.
• Over-emphasis on administrative functions in supervision that take away from educational and clinical aspects of supervision to improve practice and outcomes. (pp. iii-iv)
Thursday, March 31, 2011
Aboriginal Child Protection Case fails at the Canadian Human Rights Tribunal
The Canadian Association of Social Workers is reporting that "On March 14, 2011, the Canadian Human Rights (CHR) Tribunal dismissed on a legal technicality the complaint filed in 2007 by the First Nations Child and Family Caring Society of Canada (FNCFCS) and the Assembly of First Nations, which alleged that the Federal Government is racially discriminating against First Nations children by providing less child welfare benefit on reserves."
I have written before about the high impact on Aboriginal communities of public policies in the past. These policies certainly include the decision to take thousands of children away from families and place them in residential schools. About half of those children would not survive having been subject to abuse of various kinds, malnutrition and maltreatment in the form of loss of love, caring and nurturing. The legacy was inevitable. The Aboriginal communities of Canada lost generations of family and parenting modeling. Now we have children being raised by adults who lacked the teaching needed to build healthy inter generational parenting.
Several studies have shown that the impact has been dramatic problems with children that have resulted in very high rates of Aboriginal children within the child protection systems.
The First Nations Child and Family Caring Society of Canada notes on their website, "The inequalities in First Nations child welfare funding are longstanding and well documented (Royal Commission on Aboriginal Peoples [RCAP], 1996; McDonald & Ladd, 2000; Loxley et. al., 2005; Amnesty International, 2006; Assembly of First Nations, 2007; Auditor General of Canada, 2008; Standing Committee on Public Accounts, 2009) as are the tragic consequences of First Nations children going into child welfare care due, in part, to the unavailability of equitable family support services (McDonald & Ladd, 2000; Blackstock and Trocme, 2005; Amnesty International, 2006; Clarke, 2007; Auditor General of Canada, 2008; National Council on Welfare, 2008). This inequity is further amplified for First Nations children by shortfalls in education funding, housing and publically funded voluntary sector supports (Blackstock, 2008)."
It is our nation that created the legacy and our nation should be willing to find solutions - but solutions need to be properly funded. We underfunded care of Aboriginal children in the residential schools which led to some of the problems (although the program should never have been established) and now we underfund the solution.
This is a political issue and should be raised during our present Federal election.
I have written before about the high impact on Aboriginal communities of public policies in the past. These policies certainly include the decision to take thousands of children away from families and place them in residential schools. About half of those children would not survive having been subject to abuse of various kinds, malnutrition and maltreatment in the form of loss of love, caring and nurturing. The legacy was inevitable. The Aboriginal communities of Canada lost generations of family and parenting modeling. Now we have children being raised by adults who lacked the teaching needed to build healthy inter generational parenting.
Several studies have shown that the impact has been dramatic problems with children that have resulted in very high rates of Aboriginal children within the child protection systems.
The First Nations Child and Family Caring Society of Canada notes on their website, "The inequalities in First Nations child welfare funding are longstanding and well documented (Royal Commission on Aboriginal Peoples [RCAP], 1996; McDonald & Ladd, 2000; Loxley et. al., 2005; Amnesty International, 2006; Assembly of First Nations, 2007; Auditor General of Canada, 2008; Standing Committee on Public Accounts, 2009) as are the tragic consequences of First Nations children going into child welfare care due, in part, to the unavailability of equitable family support services (McDonald & Ladd, 2000; Blackstock and Trocme, 2005; Amnesty International, 2006; Clarke, 2007; Auditor General of Canada, 2008; National Council on Welfare, 2008). This inequity is further amplified for First Nations children by shortfalls in education funding, housing and publically funded voluntary sector supports (Blackstock, 2008)."
It is our nation that created the legacy and our nation should be willing to find solutions - but solutions need to be properly funded. We underfunded care of Aboriginal children in the residential schools which led to some of the problems (although the program should never have been established) and now we underfund the solution.
This is a political issue and should be raised during our present Federal election.
Sunday, March 27, 2011
More research on foster care impacts
J.J. Doyle of MIT has again done an extensive review of whether foster care is good for children. He concludes not using a large data base and builds on earlier work that he has done. Critics of foster care may well start to salivate at these results but, before they do, it is vital to see that the results again focus on a particular part of the foster care population.
His results show:
"The results suggest that placing children in foster care increases their likelihood of becoming delinquent during adolescence and requiring emergency health care in the short term. Along this one dimension of child safety, it does not appear that foster care is serving a protective role."
This is an important caution that replicates earlier work by not only Doyle but other researchers through the Chapin Hall Center for Children at the University of Chicago. But Doyle also notes that his work applies to a particular subset of children in the child protection system:
"The results do apply to a particularly policy-relevant group: those children where the investigator does matter. These are marginal cases where investigators could disagree about how to proceed. This variation is at the heart of the policy question of whether the child-protection system is too aggressive or not aggressive enough."
From a policy perspective this is quite crucial. How to proceed with cases for which the answer may not be clearly place or clearly keep in the family. In general, his work suggests that keeping those children in the family may be better. Bear in mind that other research tells us that effective supports are a crucial element to making that work.
Doyle places one other caveat: "Further, the results apply to somewhat older children, between the ages of 5 and 15, who were investigated for abuse or neglect in Illinois during the 1990s. To the extent that other foster care systems perform better than this one, the answer could change. Future research that considers younger children, other states, and other time periods would allow an examination of whether the results apply more generally to child protection policies in the U.S."
Thus, important questions related to younger children in particular remain unanswered. It is crucial that we continue to see the degree to which these impacts are true for younger children. Research in the UK suggests that getting a stable answer for children by age 7 is vital. As children age and family patterns (along with other related environmental problems) become more entrenched, negative outcomes become more likely.
As Doyle says in the introduction to his article: There is no dispute that severely abused or neglected children should be protected, and a foster family home has been judged the best alternative whenever possible. A key policy question is one of degree: how aggressive should child protective services be? Child protection agencies trade off two competing goods: family preservation and child protection ... More aggressive child protection may reduce child abuse or neglect, but removal from parents may be traumatic to children as well. For example, much has been written about the potential for such instability to hinder child development, and multiple placements once a child has been placed in foster care has been associated with greater emotional and behavioral problems among foster children."
Doyle's article is currently in press with the Children and Youth Services Review.
His results show:
"The results suggest that placing children in foster care increases their likelihood of becoming delinquent during adolescence and requiring emergency health care in the short term. Along this one dimension of child safety, it does not appear that foster care is serving a protective role."
This is an important caution that replicates earlier work by not only Doyle but other researchers through the Chapin Hall Center for Children at the University of Chicago. But Doyle also notes that his work applies to a particular subset of children in the child protection system:
"The results do apply to a particularly policy-relevant group: those children where the investigator does matter. These are marginal cases where investigators could disagree about how to proceed. This variation is at the heart of the policy question of whether the child-protection system is too aggressive or not aggressive enough."
From a policy perspective this is quite crucial. How to proceed with cases for which the answer may not be clearly place or clearly keep in the family. In general, his work suggests that keeping those children in the family may be better. Bear in mind that other research tells us that effective supports are a crucial element to making that work.
Doyle places one other caveat: "Further, the results apply to somewhat older children, between the ages of 5 and 15, who were investigated for abuse or neglect in Illinois during the 1990s. To the extent that other foster care systems perform better than this one, the answer could change. Future research that considers younger children, other states, and other time periods would allow an examination of whether the results apply more generally to child protection policies in the U.S."
Thus, important questions related to younger children in particular remain unanswered. It is crucial that we continue to see the degree to which these impacts are true for younger children. Research in the UK suggests that getting a stable answer for children by age 7 is vital. As children age and family patterns (along with other related environmental problems) become more entrenched, negative outcomes become more likely.
As Doyle says in the introduction to his article: There is no dispute that severely abused or neglected children should be protected, and a foster family home has been judged the best alternative whenever possible. A key policy question is one of degree: how aggressive should child protective services be? Child protection agencies trade off two competing goods: family preservation and child protection ... More aggressive child protection may reduce child abuse or neglect, but removal from parents may be traumatic to children as well. For example, much has been written about the potential for such instability to hinder child development, and multiple placements once a child has been placed in foster care has been associated with greater emotional and behavioral problems among foster children."
Doyle's article is currently in press with the Children and Youth Services Review.
Thursday, March 24, 2011
The sad case of Nubia Barahona
This is a child who died in Florida despite possible ways in which the child protection system may have saved her. Like so many cases before her, this is not a case where her death should lead to over reaction by CPS resulting in over apprehension of children - it should act as a way to reconsider how well we are doing with cases that do need protection. Like so many cases before, there were many opportunities to intervene if the voices being raised had been heard:
"The red flag of caution and warning was raised many times: By teachers and principals,by a Guardian Ad Litem (GAL) and her attorney, by a nurse, by a psychologist, byNubia's "family" stonewalling the search for fundamental information.But nobody seemingly put it all together" (p.2).
The case raises a number of flags that we have seen before:
* parents who stonewalled
* parents who withdrew from systems (e.g. school in this case) where behaviors were getting noticed -- "After the end ofthe 2009-2010 school year, the Barahonas chose to home school the children,taking away most of their visibility to outside eyes and increasing the dangerthat abuse and neglect would go unrecognized. This was further compoundedby the lack of formal requirements relating to the monitoring of students being home schooled" (p.7)
* professionals who failed to bring together data that would create a more global than partial picture of what was happening. As the report states at p. 5: " failed to consider critical information presented by thechildren’s principal and school professionals about potential signs of abuseand neglect by the Barahonas."
* parents refusing services
This death review offered something different than has been seen in many prior reviews which is a comment on the parenting assessment that had been done. There was a failure to properly gain data from multiple reliable sources that would have shown the assessor a broader picture. It also would have shown contradictory information such as school progress. A poor parenting capacity assessment creates the opportunity for child protection authorities to make bad clinical risk judgments that leave children vulnerable. As they state on p. 11, "What’s needed are clearly articulated expectations for any psychologicalevaluation as well as clear criteria for reviewing the performance of anycontracted psychologist or other expert called on to evaluate children on behalfof the court." Such guidelines do exist in the professional literature as well as a variety of publications.
The authors also note that delays in assessments leave cases without appropriate consideration. Such delays may not be the fault of anyone person but rather of processes that just move slowly. If assessment is going to be effective, then it must have access to a wide range of data. This point has been made by many authors and is repeated by this review. In addition, this assessor appears to have wrongly considered that attachment in a care home should have priority over the safety of the child. This is a growing area of concern given that legal processes leave young children in alternate care for long periods creating attachment between the child and the alternate caregivers that will need to be broken if a child is to come back to family.
A further area of concern that we have again seen too often in death reviews is the failure of CPS staff to properly assess and coordinate information coming in. Fragmented data has been behind many CPS failures. As the authors state on p. 10, "A serious deficiency, however, was the failure of individuals involvedin the case to talk with each other rather than relying on inadequateinformation technology. Many of the communications problems that can beidentified in this and other cases can be overcome by prompt and coordinatedinterpersonal interaction among those involved in the care of the child."
As one says with so many of these cases, let us hope that Nubia did not die in vain.
"The red flag of caution and warning was raised many times: By teachers and principals,by a Guardian Ad Litem (GAL) and her attorney, by a nurse, by a psychologist, byNubia's "family" stonewalling the search for fundamental information.But nobody seemingly put it all together" (p.2).
The case raises a number of flags that we have seen before:
* parents who stonewalled
* parents who withdrew from systems (e.g. school in this case) where behaviors were getting noticed -- "After the end ofthe 2009-2010 school year, the Barahonas chose to home school the children,taking away most of their visibility to outside eyes and increasing the dangerthat abuse and neglect would go unrecognized. This was further compoundedby the lack of formal requirements relating to the monitoring of students being home schooled" (p.7)
* professionals who failed to bring together data that would create a more global than partial picture of what was happening. As the report states at p. 5: " failed to consider critical information presented by thechildren’s principal and school professionals about potential signs of abuseand neglect by the Barahonas."
* parents refusing services
This death review offered something different than has been seen in many prior reviews which is a comment on the parenting assessment that had been done. There was a failure to properly gain data from multiple reliable sources that would have shown the assessor a broader picture. It also would have shown contradictory information such as school progress. A poor parenting capacity assessment creates the opportunity for child protection authorities to make bad clinical risk judgments that leave children vulnerable. As they state on p. 11, "What’s needed are clearly articulated expectations for any psychologicalevaluation as well as clear criteria for reviewing the performance of anycontracted psychologist or other expert called on to evaluate children on behalfof the court." Such guidelines do exist in the professional literature as well as a variety of publications.
The authors also note that delays in assessments leave cases without appropriate consideration. Such delays may not be the fault of anyone person but rather of processes that just move slowly. If assessment is going to be effective, then it must have access to a wide range of data. This point has been made by many authors and is repeated by this review. In addition, this assessor appears to have wrongly considered that attachment in a care home should have priority over the safety of the child. This is a growing area of concern given that legal processes leave young children in alternate care for long periods creating attachment between the child and the alternate caregivers that will need to be broken if a child is to come back to family.
A further area of concern that we have again seen too often in death reviews is the failure of CPS staff to properly assess and coordinate information coming in. Fragmented data has been behind many CPS failures. As the authors state on p. 10, "A serious deficiency, however, was the failure of individuals involvedin the case to talk with each other rather than relying on inadequateinformation technology. Many of the communications problems that can beidentified in this and other cases can be overcome by prompt and coordinatedinterpersonal interaction among those involved in the care of the child."
As one says with so many of these cases, let us hope that Nubia did not die in vain.
Saturday, March 12, 2011
Willful Blindness in Child Protection
I have spoken about Heffernan's recent book on willful blindness in a prior post. Its a rather amazing read and I again recommend it. The book raises a number of issues that are quite relevant to child protection work. Here are a few of the themes:
1. Belonging in the group - It is hard to dissent in a group. Her report of a broad range of research in a number of fields of endeavor shows that, even when an individual knew that the decision was likely wrong. The notion that a professional group might be stronger as a result of collective wisdom may well not be true. It appears that, within a corporate team, dissent is difficult to do and often not welcome. There is a strong need for affiliation in human beings. To dissent is to step outside that and create the risk of being ostracized. We do not do well in such a position.
2. Using case plans that don't work - Case planning in many child protection agencies is done under the heavy burden of high caseloads, high turnovers and a favored way of doing things. There is a "corporate" culture about "how" things are done. Unfortunately, this can also lead to interventions that are familiar but for which there is little evidence of effectiveness. For example, there is a great deal of in-home parenting programming for which there is scant data that suggests that any long term changes occur.
3. Failing to look at the research that tells us what does work. In the United States Senate Committee on Finance Hearings on March 10, 2011 a former Oregon foster child, Isha "Charlie" McNeely pointed out a fact that systems often ignore. Foster children, in very large numbers, will experience multiple placements meaning that home may be far less stable and nurturing than before coming into care. Thus, we may be blind to the impact of child protection decisions in which we may be doing harm in the name of protection. The practice question, of course, is whether or not we are considering that in our case planning. Does this child need to come into care, and if so, what is going to make that safe and productive.
4. Family connections matter but in child protection that can be messy so, once parental rights are terminated, it is easier to ignore them. McNeely notes that most foster children will make steps to find the biological roots either during or after aging out of foster care. So instead of being blind to that, how do we manage that? Finding ways to sustain relationships may serve many foster youth better. Child protection workers are reluctant because that can interfere with adoption planning. Even in cases where adoption will not occur, case managing difficult biological relationships is quite challenging within an overworked environment. Biological links may not mean, however, the parents who were incapable. There may be healthier people in the family system who can provide support.
5. Budget cuts mean reduced services. To be blind to that must be willful. In the media we have seen more and more reporting that as the economy has worsened, pressures on family have increased, there is growing poverty and children are in increased need of protective supports. With the right services, we can help families under these economic strains stay safe. The demand for the services is increasing while budgets in Canada, the United States and the United Kingdom are getting squeezed. A current example is a story out of Pittsburg in the United States ( http://www.pittsburghlive.com/x/pittsburghtrib/news/regional/s_726933.html
Good child protection has eyes wide open. These are but a few examples. Of course, a major challenge is to get the eyes of politicians open to the reality of their decisions.
1. Belonging in the group - It is hard to dissent in a group. Her report of a broad range of research in a number of fields of endeavor shows that, even when an individual knew that the decision was likely wrong. The notion that a professional group might be stronger as a result of collective wisdom may well not be true. It appears that, within a corporate team, dissent is difficult to do and often not welcome. There is a strong need for affiliation in human beings. To dissent is to step outside that and create the risk of being ostracized. We do not do well in such a position.
2. Using case plans that don't work - Case planning in many child protection agencies is done under the heavy burden of high caseloads, high turnovers and a favored way of doing things. There is a "corporate" culture about "how" things are done. Unfortunately, this can also lead to interventions that are familiar but for which there is little evidence of effectiveness. For example, there is a great deal of in-home parenting programming for which there is scant data that suggests that any long term changes occur.
3. Failing to look at the research that tells us what does work. In the United States Senate Committee on Finance Hearings on March 10, 2011 a former Oregon foster child, Isha "Charlie" McNeely pointed out a fact that systems often ignore. Foster children, in very large numbers, will experience multiple placements meaning that home may be far less stable and nurturing than before coming into care. Thus, we may be blind to the impact of child protection decisions in which we may be doing harm in the name of protection. The practice question, of course, is whether or not we are considering that in our case planning. Does this child need to come into care, and if so, what is going to make that safe and productive.
4. Family connections matter but in child protection that can be messy so, once parental rights are terminated, it is easier to ignore them. McNeely notes that most foster children will make steps to find the biological roots either during or after aging out of foster care. So instead of being blind to that, how do we manage that? Finding ways to sustain relationships may serve many foster youth better. Child protection workers are reluctant because that can interfere with adoption planning. Even in cases where adoption will not occur, case managing difficult biological relationships is quite challenging within an overworked environment. Biological links may not mean, however, the parents who were incapable. There may be healthier people in the family system who can provide support.
5. Budget cuts mean reduced services. To be blind to that must be willful. In the media we have seen more and more reporting that as the economy has worsened, pressures on family have increased, there is growing poverty and children are in increased need of protective supports. With the right services, we can help families under these economic strains stay safe. The demand for the services is increasing while budgets in Canada, the United States and the United Kingdom are getting squeezed. A current example is a story out of Pittsburg in the United States ( http://www.pittsburghlive.com/x/pittsburghtrib/news/regional/s_726933.html
Good child protection has eyes wide open. These are but a few examples. Of course, a major challenge is to get the eyes of politicians open to the reality of their decisions.
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