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.

Blame the worker or blame the system?

There is a case unfolding in Richmond, Virginia in the USA in which several child protection files may have been closed improperly. There is a possibility that this has placed a number of children at risk. The story has been reported in the Richmond Times. What strikes me is the way in which the media can so easy seek out the social worker scapegoat. They named the social worker.

Yet this story also raises the oft repeating themes of too many cases, too few workers and weak management. What matters for me here is the ways in which workers could not seek out their leadership to gain support. Rather, they started to fly on their own as they seemed to fear the repercussions of supervision.

If there is a strong lesson to be learned from the multitude of death review that have taken place in numerous countries it is that effective supervision can be a protective factor. When workers can go to their supervisors and review what is happening with cases, then they are able to get a different persecutive on the case. This opens up options and can improve case management.

This case should help us to reflect on the power of good supervision. Even if, as the news report suggested, the worker acted on her own, one has to wonder about the divide between supervisor and worker that the system would allow such actions to take place without alarms going off. This says a lot about how a system should work that was not happening here.

60 year old man in a sexual relationship not abusive Italian court says

In a rather stunning verdict, the Italian Supreme Court has overturned the conviction of a 60 year social service worker, Pietrio Lamberti,  for having a sexual relationship with an 11 year old girl. The reasons are reported to be that the lower courts failed to consider the amorous relationship and the consensus between the two. In some fashion, this is seen as justifying the relationship.

This seems astounding for several reasons. The first seems to be that many victims of sexual abuse can feel good in some way about the relationship. It can make them feel special and they may receive treats that others do not. In this case, the girl came from a poor family.

Even more important, is an 11 year old really capable of consenting to sex with a 60 year old? There is little reason to believe that such consent could be valid. The age difference creates a power differential. A child of this age (and she is clearly a child at that age) cannot really appreciate what she is consenting to.

In rather classic fashion, the social worker is reported to have gained the trust of the family. This is grooming behavior.

In this case, the court appears to have failed to understand the true nature of child sexual abuse. They have been hoodwinked by the kind of rationale that pedophiles create. How unfortunate. 

Why disclose abuse?

Child protection workers are often faced with the dilemma of abuse cases where the child simply won't confirm that the abuse took place. Part of the reason can lie in the way in which the child is asked. In an article by Reder and Duncan (2004) in the UK, they note that CPS workers are often not properly trained in how to actually talk with and interview a child. This may partially explain why some of the really high profile cases of child protection failures have included a failure to see and/or interview the child.

Yet, there is more to it. In a rather interesting article soon to be published in the journal Child Abuse and Neglect Israeli authors Katz & Barnetz remind us of some very important issues but place a new light upon them. Those children who are the recipients of physical abuse seem to less likely to dispose as the are so reliant on the parent for the essentials of life. More resistance may be encountered as the child ages. What I found rather disturbing in the research, is the ways in which some victims of physical abuse incorporate the abuse into their life - accommodating it and taking ownership of it.  They gave as examples:

“Daddy was yelling on me because I didn’t do my homework, so I told him I am sorry you are right and brought himhis belt.”

“I knew that after he is drinking he will be looking for me, so I went there and set next to him. . .after he finishedhitting me I took him to his room so he will rest a bit.”

One can hardly see a child who has so accommodated the abuse into their living reality being easily open to disclosing the abuse. As the authors go on to state:

These narratives stress the unbearable situation for the children: they know when the abuse will take place, by whom,and how, and they have no real power to end it or to prevent it from occurring. In other words, they expect their fate andlive with/near this tragedy  

They also found that when a child is being sexually abused by a parent, the child will have a greater tendency to accommodate the abuse. This seems to be particularly true when the sexual abuse is of higher severity. Lower levels may see more fight or flight behaviours.

Thus, when a child is going to be interviewed about abuse, it is vital to understand that the child may well be accommodating the abuse as they do not feel a power to do otherwise. This can have profound implications for interviewing the child. It also strongly re-enforces that the interview should be done by someone who is skilled in the task. Poorly done, one can easily imagine how that child will lose faith in the potential value of disclosing.

It would require a great deal of effort for a child to disclose when they have accommodated the abuse into their reality. They may not believe that it can be otherwise and would see no reason to try and create change given that.

Katz, C., & Barnetz, Z. The behavior patterns of abused children as described in their testimonies. Child Abuse & Neglect (2013), http://dx.doi.org/10.1016/j.chiabu.2013.08.006 

Assessing risk in child protection - but what risk?

When one thinks of assessing risk in child protection, one might automatically think about risk to a child. Is the child safe? If not, what needs to be done? Should the child be left with parents or removed? If there are immediate risks, can they be mitigated. These are all important risk questions.

However, there are two other facets of risk that are often not spoken about but can play very crucial roles in assessing risk in a family - risk to the social worker and risk to the agency. Both of these risks are by products of the outrage that occurs when a child is seriously harmed or killed while child protection is involved. There have been a myriad of high profile cases in Canada, Australia, New Zealand, the UK, Ireland, the United States and elsewhere. Here in Canada, we are awaiting the release of the Hughes Inquiry into the death of Phoenix Sinclair. It is expected to be released early in 2014. Based on prior inquiries that Justice Hughes has done in other provinces, one can expect a thorough report that will make for grim reading. It is these types of reports that are needed but also create a fear response - who wants to have the next high profile case in the media after all.

Phoenix Sinclair

For the social worker, this means that each case decision is also influenced by the risk to the social worker. What is likely to happen if this decision turns out to be riskier and problems occur? When this pressure exists within the decision making process, then there develops a tendency at self protection. This leads to more conservative decision making where getting more intrusive with a family seems like the best path.

So too for the agency or the team managers who do not want to be the next team under public scrutiny. 

Thus, the decisions around what a child needs are influenced by matters that have really nothing to do with the risks to the child.

Some attempts have been made to influence this decision making process by introducing programs such as Signs of Safety. This looks to a family's strengths that can be utilized and enhanced. The goal is to reduce the number of children living away from home. It does require that the agency take more risks that enhancement can occur. The early research tends to be promising. But it does require that the agency be able to tolerate the higher risks. Even more important, is for the politicians to be able to accept the risks.

When things go wrong, politicians have zero tolerance for errors even though errors under any program are inevitable. Child protection decision making is done in a reality of partial information that is almost constantly changing. It is politically difficult to defend the imperfections of decision making when the public is outraged.

There are also factors that child protection cannot solve particularly poverty, crime in neighbourhoods, family breakdowns and unemployment - even those increase risks. Politicians can create social policies that do reduce those risks - but cannot eliminate them.

Thus, while we want social workers to be the best they can at the work they do, no matter how well budgets are managed and case loads are kept low, there will still be errors and fatalities - albeit fewer. This is a very hard argument to sell as a politician but it is reality.

Readers might also find this comparative work between the UK and Belgium of interest

Also of interest will be this blog from Chris Mills in the UK.