The British Columbia Representative for Children and Youth Nails it Again

Mary Ellen Turpel-Lafond is the Representative for Children and Youth in British Columbia. She has just issued a report, The Thin Front Line that analyzes staffing and related problems in the province's child welfare system. It's a read that is relevant to child protection authorities across Canada and likely elsewhere.

She states that "The problems are systemic and have accumulated over time, worsening and not improving." She adds that the complexities of working in child protection have increased over time but there are fewer workers to manage these caseloads. This should sound familiar in many places.  She notes that workers have had to struggle with budgetary cuts, staff shortages, high turnover and pressure to meet strict timelines.

The government of B.C. says she is working with old data. Perhaps so, but the issues that Turpel-Lafond raises are hardly new. Thus, there may be some improvement but one doubts that the picture is much out of focus given what is seen in scrutiny of child protection throughout the Western world. Indeed, her themes very much mirror my own research on child protection errors. Her conclusions also strongly mirror reviews done by many authors.

Where she gets the story quite straight is in her major themes:

• Workloads are high and complex;
• Processes change and are not necessarily clinically focused;
• The issues that must be dealt with are often connected to long standing inequities that may be beyond the capacity of a worker to solve. An example is the legacy of the Residential Schools and the Sixties Scoop which decimated the parenting and family structure in Canada's First Nations communities;
• Bureaucracy is a burden that takes many hours away from clinical work;
• It's tough work so people leave and it's hard to get replacements quickly;
• The geography of Canada (in this case B.C.) means that many rural and remote communities get spotty services;
• Clinical supervision is required regularly but there are not enough supervisors to manage the needs;
• She found too many offices operating in crisis mode which tends to lead to "band aid" social work, as she put it.

Turpel-Lafond offers several recommendations which include:

• Sufficient budgets to address the staffing and workload issues;
• Improve the management systems to reflect the complexity and volume of cases;
• Track performance and respond to gaps or poor results;
• Get more First Nations workers in place.

She notes that there have been some positive steps such as the introduction of the Family Development Response to help support families with lower intensity issues. 

These are not new issues so perhaps the one question she did not ask that needs asking is "Why do these issues keep happening, time and again, from jurisdiction to jurisdiction?" In other words, we are consistently getting it wrong. So how can it be done better. Public reviews need to start talking about that versus repeating themes and recommendations we have seen so often --- or is that governments are not really committed to child protection beyond the band aids? Is that governments don't really want to tackle the complex socio-economic factors that lead to children being at risk - poverty, inter-generational trauma, mental health and addictions and so on?

Investigation in British Columbia may be asking the wrong questions

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

Paige as an infant, child and youth

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

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

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

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

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

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

Paige is a distressing story

The story of how a British Columbia First Nations girl was let down by child protection authorities has been documented in a report by the province's Representative for Children and Youth. It is a hard read. Page after page, you are left wondering how social workers decided to make the decisions they did - leaving this vulnerable child in care situations that were clearly risky; believing that interventions would work when there was little evidence that they would; failing to see the child. As the report notes on p.5, "Professional standards of care were not upheld in how Paige was treated."

This is a child who was subject to maltreatment throughout her life - from infancy to early adulthood when she would die. In some ways, looking back, you can see that she was destined to die early given the amount of maltreatment in her life. She experienced a number of adverse life experiences (ACEs). The ACE research project shows convincingly, that people who experience three or more of these events, have a dramatically higher rate of illness, addiction, mental illness and early death. Based on what is written in the report, her score may have well been in the range of 6.

It didn't have to be that way. Early intervention could have made a difference in terms of both the quality of her life and its duration. She need not have ended up in the Downtown Eastside of Vancouver - one of the most social disadvantaged communities in Canada.

Having researched hundreds of reports like Paige, I am struck by the similarities of repeating problems including (but certainly not limited to):

• being too optimistic that change will occur thus minimizing or not seeing the ongoing and growing risk factors;
• failing to see that repeated efforts at change are not making a difference;
• not putting the needs of the child as the most significant priority;
• failing to coordinate information available from a variety of sources;
• failing to look for the permanent solution believing that being with biological parents was somehow preferable; 
• creating instability through multiple moves and placements;
• failing to follow up on case plans;
• having poor case supervision;
• not really knowing the file;
• not completing needed risk assessments;
• not understanding the nature of addiction.

The Representative's report states on p. 6:

This is a child who should have been permanently removed from her mother’s care at an early age. She was the subject of no less than 30 child protection reports during her 19 years, involving allegations of domestic violence, neglect and abandonment. Her mother was actively using alcohol and drugs and there were no signs of that behaviour abating. Paige was repeatedly returned to her mother by the Ministry of Children and Family Development (MCFD) despite glaring and unavoidable evidence that this was not a healthy, nurturing or safe environment for any child and wasn’t ever likely to be.

As a result, Paige’s life was a case study in chaos. By the time she was 16, she had moved no less than 40 times, between residences with her mother, foster homes, temporary placements and shelters. After her mother moved them to the DTES in September 2009, Paige lived with her in toxic environments and moved another 50 times, living in various homeless shelters, safe houses, youth detox centres, couch-surfing scenarios, foster homes and a number of Single Room Occupancy (SRO) hotels.

As I noted, I have read quite literally hundreds of these reports from Canada, Australia, the USA, England, Ireland, Scotland --- the themes are painfully consistent. So why is that?

Often we think of systemic problems - poor resourcing, over worked social workers, funding problems, weak supervision of front line managers. These are all true. As a profession, however, we must start to look at the quality of care that we are providing. Ultimately, we are responsible for what we do with a client.

We also need to look at the education social workers receive. How well are we preparing students for the real world challenges of managing cases like Paige? We also need to look at politicians for honest leadership that is backed up with funding, resources and the sense that child protection is a priority as opposed to a service to keep the sad stories in check. Political leadership also recognizes that there are problems which child protection cannot solve - poverty, crime in communities and so on.

As a society, we need to have a longer attention span to these issues. Stories like page hit the headlines, people shake their heads and wonder how such a tragedy could occur, politicians nod and speak of change and then……… nothing. The story fades while the media seeks out the next big tragedy to talk about. The themes are telling about tragedy not about actual real change. When society really pays attention, things might change because then the politicians can expect to be held accountable.