Learning from the deaths of children

Children die when involved with child protection systems. It is inevitable that some children will die as it is impossible to predict which parent is going to kill a child. However, there are several behaviours by social workers that can reduce the risks. This poster represents some of the most important themes that we have found in our research of Canadian published case reviews.

There are a few I would like to highlight:

1. Supervision really matters - when a front line worker gets good supervision we have another set of informed eyes talking about the case. The supervisor gets to ask questions about missing data, why case plans are structured the way they are and to offer ideas and suggestions about what might be done. Remember that a large number of front line workers have less than 5 years experience. Supervision matters.
2. The child is the reason the case exists - it is not hard to get distracted by the needs of the parent. This can be particularly true in cases where there is a conflict through the court system. Indeed, in a recent case I was involved in, I experienced counsel for the parents as being strongly focused on what was best for the parent but disguised in questions that made it seem about the child. Our task is to bring the case back to what serves the child.
3. Being open to the unimaginable - case workers do not like to think that the parent or caregiver that they are working with would kill the child - but if we are open to that as a possibility then we ask better questions and consider the data more thoroughly.
4. Front line social workers are generalists - they often lack specialist training in the complex issues that child protection work brings. This can range from mental health to addictions to inter personal violence to FASD and so on. BUT, the front line worker does need to know how to get at experts who can aid them in understanding the case. These experts also need to learn how to talk to front line workers in ways that make the issue clear.
5. One assessment at the beginning is not the end of assessment - assessment is an ongoing process. Things change in cases and so should the social workers understanding of the case.
6. If the child is at the centre of the case - see the child - see the child frequently.
7. History does matter - it tells us a lot - what have been the problems in the past and how successful were interventions; how are things different now that may yield strengths or ongoing deficits; is there a pattern that needs to be considered and so on.
8. The new partner is a risk - they need to be met and assessed. 

One of the big lessons for us is how important it is to talk to students about these issues - but talk with students inter professionally. Child protection requires an ability to work across professions - medical, psychology, social work, criminal justice, law - and be able to do so with a grounding in what protecting a child is all about. Inter professional communication has been a problem at the heart of many cases.

There are also cultural implications to our research which I will review in the next posting.

I do want to leave with this message as well - case reviews where things have gone wrong need to be done at the front line - but not in a way that is hanging people out to dry but rather in using the case to enhance learning and improve practice. That helps to reduce the risks of the death for children involved with child protection.

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

Child abuse statistics - what's real

In the United States, child protection services have been indicating that the rates of child physical abuse have been decreasing. Critics of child protection services, as well as those who are focused on prevention services, have trumpeted these numbers. Reason to celebrate whenever there are indications that child physical abuse is decreasing.

However, a new study published on October 1 through the online version of the journal, Paediatrics, suggests that there is another way to look at the data. They focused on serious child abuse which included head injuries, burns and fractures. The data showed a modest increase of 5%.

Both sets of data are useful. The first looks at the broader picture, although it may represent a number of differences in how cases are reported to child protection agencies. Thus, it might be report affected as opposed to being a true me sure of frequency. The more recent data tells us though, that the serious cases remain a growing problem. Public policy should focus on that truth.

A question now opens - to what degree is this trend true in other countries.

Leventhal, J.M. & Gaither, J.R.. (2012)  Incidence of serious injuries due to physical abuse in the United States: 1997 to 2009. Pediatrics, online, DOI:10.1542/peds.2012-0922

Mortgage default, foreclosure and Child Abuse

Many who have worked in the area of child abuse know that stress in family can be related to increased risk for abuse in a household. There has been recent suggestions that child abuse may be down in the economically struggling United States. A new article to be published in the journal Paediatrics puts a damper on such hope.

However, the article does show an important link between mortgage delinquency and foreclosure trends. Child abuse went up as these economic hardship factors also increased. The team looked at data from 38 hospitals meaning that the numbers are quite robust. The research concludes:

CONCLUSIONS: Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends

The research also noted that unemployment did not show such a causation.

From a public policy perspective,  this really helps us to see that families facing the effect of losing housing are really under significant stress which affects the safety of children. This might well suggest that the appropriate intervention is to help find some form of place to live that offers dignity and safety for a family.