The use of art for child sexual abuse investigations

Imagine you are investigating allegations of sexual abuse. You want to gain as accurate a disclosure as possible, with as much detail while still trying to ensure that the disclosure is truthful. The gold standard is the NICHD Protocol. But gaining a full picture may be aided by the use of drawing.

Three Israeli researchers have offered some fascinating insights in an article just published online in the journal Child Abuse and Neglect. They speak of the fine line that investigators must walk - gathering reliable information while also trying to focus on the wellbeing of the child. These can appear to be opposing forces. Just being interviewed by a social worker or a police officer can be traumatic in itself. Consider that many victims have been told that the activity must be kept a secret - and now these virtual strangers want you to tell. What an incredible conundrum for the child!

Drawing has been found to aid in recall and to offer richer descriptions of what occurs, particularly for younger children. But as these researchers note, non directed drawing is the way to go. Free recall yields better results as opposed to those that might be in some coached or guided.

These researchers sought to gain an understanding of of the consequences of the forensic interviewing for the child. They looked at before, during and after periods as well as comparing the experience of children who were asked to draw from those who were not. One finding that seemed particularly important is "Apparently during the investigate, drawing gave the children control and strengthened then during the process…" (p.8). The authors go on to say that "Following the interview, in response to free recall invitations, the children used three main words indicating their experiences following the investigation - relief, hope and success." (p.8).  However, children in both groups (whether they had drawn or not) also felt relief from the investigation. Age did not seem to matter suggesting that drawing was also useful for older children.

Succes was found to be more prevalent with children who had drawn.

What this research helps us to see is how important it is to not forget the various ways that children have to tell us their stories but also that their stories matter. We can get caught up in the forensic need to gather information while not giving the child's wellbeing the highlight that it needs.

Reference: Katz, C., Barnetz, Z., & Hershkowitz, I. (2014). The effect of drawing on children's experiences of investigations following alleged child abuse. Child Abuse & Neglect (In Press) http://dx.doi.org/10/1016/j.chiabu.2014.01.003 

Sibling Abuse as a Child Protection Issue

I recall some years back a family that I and a colleague were working with. Child protection had become involved due to parental behaviours. These were addressed and some significant progress was made. Yet the abuse of the younger sibling by his older brother continue. It was both physical and emotional - and it could be quite brutal. When we tried to raise it as a child protection issue, we were told that it did not fit within the mandate of child welfare. They saw themselves as protecting children from parental or other adult caregiver behaviours not those that occurred between siblings.  Things have changed in many places around this issue but research to be published soon in the journal Qualitative Social Work suggests that we have a long way to go.

There has been a number of efforts since the case I refer to above, but these authors tell us that even coming to agreement on what constitutes sibling abuse remains a challenge.

The researchers help us get a sense of how the victims in their study saw the abuse which, in this sample, went on for at least 5 years in each of the cases. (19 cases from which saturation was achieved).

 The participants in this study identified sibling abuse as physical or psychological torment involving brutal physical force or emotional devastation. It

created feelings of helplessness as victims were unable to protect themselves or

gauge and anticipate actions that incited an assault. Abusive sibling acts engendered a pervasive state of fear and vulnerability; they resulted in hyper-vigilance and feelings of loneliness and isolation when it occurred and which endured into adulthood.

In another powerful theme, the researchers found that the role of parents matters:

 In the families of these informants, limited social and economic resources and

marital strain made it difficult for victims to obtain critical support inherent to

development. Parents were unable to model positive communication or manage

interpersonal conflict and emotional turmoil productively. This inhibited their children’s ability to modulate their own emotional experiences and mitigate the effects of abuse.

For me, this really speaks to the nature of family systems around abusive behaviour. We tend to think of abuse between adults or from adults to children. But if abuse exists in a family system, why would we not expect it could happen between siblings. Indeed, this research found that other abusive behaviour was evident in at least half of the homes. Further, parents did not protect either by failure to act or by minimizing the abuse between siblings. For the victim, the whole of the family system was then unsafe making it hard for the victim to find or seek out safety.  The perpetrator may have even been in a preferred position within the family by comparison to the victim.

I agree with the authors that we must seek legislation in child protection that includes sibling abuse as one form of abuse that should be within the consideration of child abuse. We have a ways to go on finding workable definitions but that has not stopped us with other forms of abuse in a family.

Reference:

Meyers, A. (2014). A call to child welfare: Protect children from sibling abuse. Qualitative Social Work, online first. DOI: 10.1177/1473325014527332

Doing the same thing over and over expecting a different result? Insanity?

You might well ask this question upon reading the new report from the Irish Ombudsman for Children, titled A meta-analysis of repetitive root cause issues regarding the provision of services for children in care. While the title is not likely to push this report to the best sellers lists, it should be read by child protection agencies everywhere. The Ombudsman, Emily Logan, pertinently asks why the same issues are being investigated repeatedly. In many ways, this could have been asked in a multitude of jurisdictions.

The report identifies concerns in 7 areas:

1. Assessment and care planning - "Effective intervention for each individual child depends upon a clear assessment and understanding of his/her needs" (p. 11)
2. Record keeping - The report sees this as a way to help focus action.
1. plan work with service users;
2. aid assessment and decision making processes
3. monitor staff's involvement with service users
4. monitor and review progress of set objectives and goals
5. monitor and review plans for children
6. provide an accurate account to a child as to the decisions made in relation to them and why (pp.14-15)
3. Provision of residential care - this raises the concerns around multiple placements and those that are inappropriate  for the needs of the child
4. Child protection for children in care - on p. 18 the report states that "The previous life experiences of many children in care have exposed them to increased risk of victimization. They have the right to expect and receive protection from within the child care system.
5. Social work practice and supervision - The report outlines that the public have expectations of high quality service from well trained workers. "However, social work is not well understood and public confidence is frequently influenced by the media's handling of individual cases" (p. 19). In this section, the report goes on to state a crucial conclusion: "If alternative care arrangements (foster care and residential care) are to promote stability and resilience it must promote opportunities for children to develop secure attachments." (italics added). Too often the child is lost in the process and instability is the result of poor management.
6. Interprofessional and multi-agency collaboration - This is an issue that is seen in multitudes of reports on child protection errors.
7. Governance arrangements - a clear focus on why an agency exists and how it is fulfilling its mandate

The report makes a profound and often forgotten statement on p. 19:

It is important to recognize that social workers are the lead professional group which assists the Sate in protecting children from harm through neglect, abuse or exploitation

The report also does an excellent job of covering the international obligations for children arising from United Nations conventions that many countries have signed.

I am finally struck by the reports use of the term corporate parenting. This is a concept that is often lost. It is indeed the State who acts as the parent for children in care in most jurisdictions. How accountable is the state for its actions? This is an important question that we should be asking on a frequent basis.

This report is crucial. It asks the hard questions that need asking - particularly if we continue to repeat the same errors across multiple jurisdictions as my own research is showing.

Why are changes made in child protection?

I was intrigued by an article published recently in the journal, Australian Social Work. It asked the question - Driving child protection reform: Evidence or Ideology? The short answer is that, in this study of one change process, it was ideology. The article looked at the introduction of Structured Decision Making (SDM) in Queensland. The changes were made in response to significant scrutiny through public inquiry. Quoting Nigel Parton from the UK, the author, Philip Gillingham notes that change is often driven through "political imperatives to respond to the deaths of children at the hands of their parents" (p.1).

Gillingham also notes that change often leads to increased bureaucracy, manageralism, technical fixing as opposed to enhancing the skills that make social work effective. These approaches in response to public inquiry create a more formulaic approach to the work which reduces the relationship based effectiveness of our work. It creates more distance, more processes to be completed and checklists to manage as opposed to direct time with the client. Eileen Munro, also from the UK, earlier noted that social workers are spending less time with child protection clients and more time on the administrative tasks.

What really struck me, though, was the failure of the process in this case. On p. 6 of the article, Gillingham notes that the goal of the reforms in Queensland was to respond to the need for "a suite of professional practices and decision tools to help regulate, standardize and record the frontline decisions taken by Child Safety Officers" (quoting Forster, 2004). But Gillingham's research found "The SDM tools had had no discernible impact on the promotion of consistency in decision-making." He adds,. "The findings that SDM tools were not used to assist decision-making and did not promote consistency suggest that neither were they used to target the children most in need" (p. 8).

SDM has been used effectively elsewhere according to other reports. This article helps remind us that introducing change requires careful thought on how to support the real work of child protection. Other research has shown that when you allow workers to build relationships with clients where clients can feel heard, respected and seen for the own circumstances, you end up with better outcomes. Tools such as SDM should not be used to replace that but need to be part of a process that enhances what clients need. Those driving change feel that social workers make poor decisions and they need these structured tools in order to solve that. Gillingham's article notes, as has been seen in other research, that workers would go back and fit the data into SDM in order to support the decision they had already made - they were meeting the bureaucratic needs.

Reference: Gillingham, P. (2014).Driving child protection reform: Evidence or ideology? Australian Social Work, online first  http://dx.doi.org/10.1080/0312407X.2013.877948 

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.

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.

Reference:

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

 

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.