Managing the undefineable - the human judgments of child protection

Child protection is the front end of a bargain between a child and society. Essentially, society says that they will leave a family to raise their children as long as they do so safely. The deal with the child is that, if that does not happen, society will protect the child and the child protection authority will act on behalf of society. It's a bargain that we often do not know how to uphold.

To begin with, we lay that bargain out through legislation. Inherent in most such laws is a belief that the family is the root of society and is an institution that requires preservation. In other words, society should intrude into the family only as much as needed to protect the child.

Next comes the decision by child protection to enter the family - but there are certain hurdles:

• Someone must alert the child protection authority that there is a concern. Many countries have mandatory reporting laws that require a variety of professionals to call them. Many do but there are many examples of professionals who do not because past efforts to report a concern have led to no apparent action. Some won't because they are so uncertain about whether the child really is in danger. Some professionals feel that there is little point in reporting a child because the child is already so disconnected and won't comply with efforts to help. This was seen very clearly in the Paige case that led to a blunt review by the B.C. Representative for Children and Youth. 
• Once the report is filed, a human judgment is made by an intake worker to investigate or simply note the report in case there are further reports. This very human  judgment is influenced by such factors as how the report was framed, the degree of danger seems to exist, the resources available as well as the presence or absence of past reports.
• If the report is investigated another human judgment is made which is whether or not there is a risk to the child; how serious is that risk; is it serious enough to open a case; could it be handled in a less intrusive way or is the risk sufficient to become quite intrusive.

Inherent in this series of human judgments is defining safety and risk. There are a  multitude of factors that are taken into consideration and the investigator must try to weigh the various options and meaning of the data. Some have suggested that this means structured decisions should be used by entering data into various investigative formats. Yet, in those cases, someone must still find a way to operationalize a way to define and measure safety. Even in cases of structured tools, the front line worker must make meaning out of the data; must find the data; must contextualize the data; must know what to look for and be able to see it. To enter the data they must be able to discern what is in front of them. It is a human judgment process to make meaning out of information even when you enter it into a decision making tool.

Safety is an incredibly complex concept in which many factors interact in an unpredictable way - parenting, mental health, addiction, community, culture, poverty, housing, schooling, resources, temperament and personality of the child to name a few. The worker has to figure out the interactions. The worker is asked to predict probability for the safety of the child.

The worker is but one of the decision makers. The data gathered by the worker will be presented to a variety of other human judgment makers as the open case moves along - supervisors, colleagues, contracted community resources, lawyers and the courts, for example. Each will weigh the data (which is typically constantly changing) and judge what is and should happen.

The family are also making a series of human judgments - what to tell; what to cooperate or not cooperate around; what to try and self manage; how to interpret the direction of child protection and other parties. 

It is a series of human judgments made by many parties with ever changing data that is typically imperfect seeking to predict the behaviour of human beings in an environment where no prediction tool shows reasonable accuracy. No wonder child protection gets things wrong at times - indeed how could they not. So why are we not telling that story?

Learning from the death of Alex Gervais

This CBC story about the death of Alex Gervais helps to continue our needed conversation of how we can learn from the deaths of children in care.

Alex Decarie-Gervais' tragic life in the care of B.C's ministry of Children and Family development is the result of a series of missed opportunities by child protection officials, according to his family and at least one expert in social work.

"The system let him down by refusing my aunt the capability of adopting him," said Christopher Decarie-Dawson, Alex Decarie-Gervais' half-brother, from his home in Hull, Quebec.

Alex Gervais arrives in Quebec in 2008 to visit his half brother Chris and Aunt Line Decarrie, who tried twice to get custody of him. (Line Decarie)

Decarie-Dawson remembers a week long visit with his younger brother in 2008 when Alex was just 10 years old.

Social workers arranged for the boy to leave his foster home in B.C. to visit their aunt's lakefront home in Quebec.

Missed chance at a normal childhood

"I spent the week with him. He was very nice but very on edge and very jittery … he was very fidgety and anxious," remembered Decarie-Dawson, who, eight years earlier, was born to the same mother as Alex. 

It's not clear how many foster homes Alex had been in by then.

Christopher Decarie-Dawson says he tried to reach out to his little brother, Alex Gervais, for years, but social workers would not help. (Christopher Decarie-Dawson)

His placement, at age 18, at the Super 8 motel in Abbotsford, where he jumped, or fell from a 4th floor hotel room Sept 18., was his 16th in B.C.'s child protection system.

"The system let both of us down because I've gone through the exact same thing. I was abused by my mother as well, but I got lucky that I was taken by my father who was not sick," said Decarie-Dawson, who says his mother was diagnosed with schizophrenia and was unable to care for him or Alex.

Aunts attempts to get custody failed

The elder brother credits his aunt, Line Decarie, for saving him and helping his father gain custody.

A then ten year old Alex Gervais enjoys an afternoon tubing during a visit prior to Aunt's failed adoption attempt home in 2008. (Line Decarie)

He is angry her attempts to adopt Alex were blocked by B.C. officials who "refused to give custody to (her) because his father was still around, still alive."

Line Decarie first tried to gain custody of her nephew years earlier, when Alex was four.

She says police called her to tell her he'd been thrown down a flight of stairs by his father but an Ontario judge decided to give Alex's father a second chance.

Alex Decarie-Gervais (seated), then 10 , enjoyed riding his cousins's boat and spending time at his Aunt's lakeside home in Quebec in the summer of 2008. (Line DeCarie)

"Alex's father had mental health issues. Why they gave him full custody of Alex I don't understand up to this day," said Decarie, who lost touch with her nephew for several years when his father took him to B.C., where he ended up in foster care.

The Decarie family didn't see him again until he visited their home.

At the request of CBC News, Decarie dug through boxes to locate photos of that trip.

Images of a timid child tubing on his uncle's boat, bonding with the aunt who wanted to be his adoptive mother, and being embraced by relatives paint a picture of a childhood that could have been much different.

Family lost contact

The family says it was more than willing to adopt Alex, so long as it had assurances his father would have no contact.

B.C. social workers refused, and the Decaries lost all contact with Alex.

The next time child protection officials called the family would be to notify them of his death says Decarie-Dawson.

"Because he was in the foster system, so we couldn't get a message to him; we couldn't even find out if he was still alive until we found out that he died," said Decarie-Dawson, angry his brother was placed alone in a motel for nearly three months.

"I'm appalled about what has happened to him.  He should have had help. He should've had someone to call."

B.C.'s Ministry of Children and Families would not answer specific questions about the adoption attempt citing privacy law.

Bias towards biological parents says expert

"There might be some missed opportunities," said Dr. Peter Choate, professor of social work at Mount Royal University in Calgary, who has testified as an expert witness in more than 100 child protection cases.

He says social workers are trained to preserve families, but some give too much preference for parents over aunts and uncles.

Family preservation sometimes means social workers are biased toward parents in custody decisions says Peter Choate, professor of social work at Mount Royal College in Calgary. (Mount Royal University)

"We can be too biased at times towards biological parents and not contemplate what other opportunities may be there that would serve the best interests of the child," said Choate.

He believes there is a lot to learn from reviewing Alex Decarie-Gervais's case.

"Why did we want to keep Alex in contact with his biological parents as long as we did?"

"Did we do enough assessment to see the impact of mental illness on the capacity to parent?"

Choate hopes an independent inquiry will answer those questions, though he warns against a "witch-hunt" against social workers, who have a tough job.

"You are working with the unpredictability of human behavior … the public has to recognize that these are human beings engaged in very human work."  

http://www.cbc.ca/news/canada/british-columbia/alex-gervais-s-tragic-life-defined-by-missed-opportunities-1.3372859 

Opposing forces in child protection

There are some challenging opposing forces that case managers in child protection must constantly juggle.

The use and misuse of research in child welfare

I recently came across the notes for a speech by Harvard Law Professor Elizabeth Bartholet on this topic. The link is below for this fascinating work which challenges to a great deal of research in the field of child welfare that has become accepted as de facto truth.

Prof. Elizabeth Bartholet

Harvard Law School

One very strong point that she offers is that "overall the research in this field is skewed in an adult-rughts direction..." It is this that is the foundation for much of the belief that family preservation is the foremost principal in most legislation in North America. 

Prof. Bartholet also raises questions about the ways in which research, funded by private agencies with agendas, are prone to have research developed that will support that agenda. For example, she walks the reader through material that shows the growing prohibition on international adoption is premised upon flawed research. Yet, it has become the basis for a common voice among the agencies that are involved in international child welfare opposing international adoption. 

Her comments also caused me to reflect upon the family preservation agenda as being very skewed towards the rights of parents. It results in strong efforts to keep children in family homes. As Prof. Bartholet suggests, this means that the focus becomes more about keeping the child within the family home - it is the measured goal. As she states, the goal is to avoid removal or apprehension by CPS as opposed to asking what is the risk for further abuse or maltreatment if the child is left in the home. 

In my experience, many social workers are worried about further abuse but they work with family preservation as a priority, along with increasing budgetary pressures that limit alternative placement options. At the same time, foster care is not a good permanent solution for children. Yet, she reviews good quality research by Putnam-Hornstein & Needell that 82% of children in California referred for maltreatment before their first birthday were kept at home. Of those kept at home, more than half were referred again before the age of five. Out of those kept at home following substantiation of the charges and receiving services, 65% were re-referred by the age of five. Thus, a family preservation agenda may be good, although it may be that we are not providing the kinds of services that really do work.

In research, it truly matters what you decide to measure. If the measure is reduced removals from families, then other forms of questions may be ignored or minimized - such as what are the rates of further abuse or maltreatment if the child is left in the home. If we research to support a political agenda that is adult focused, we may well not be serving the needs of the children for whom child protection exists.

Reference:

Bartholet, E. Creating a child-friendly child welfare system: The use and misuse of research. Unpublished manuscript. Boston, MA: Harvard Law School.

 http://nrs.harvard.edu/urn-3:HUL.InstRepos:1077661 

Putnam-Hornstein, E. & Needell, B. (2011). Predictors of child protective service contact between birth and age five: An examination of California's birth cohort. Children and Youth Services Review, 33 (11), 2400-2407. 

Parenting interventions can work --- and save money

Research published today in the journal, Research in Social Work Practice has shown that evidence based parenting interventions can save money and be effective. The frequency with which cases were subject to reinvestigation were reduced in the state where the program was used. Based on the Nurturing Parent Program (NPP) the researchers were able to show these gains. Not only are there economic benefits but one must also consider that this means less intrusion by child protection over the long term in many more families. It also means increased family preservation.

As other research has shown, keeping families together at a level that is at least good enough reduces other long term costs when compared with children raised in foster care. There is less difficulty with mental health, employment, school completion and crime. These cost benefits were not even considered in this current research.

Reference:

Maher, E.J., Corwin, T.W., Hodnett, R., & Faulk. K. (2012). A cost-saving analysis of a statewide parenting education program in child welfare. Research in Social Work Practice, published online 2012/06/13. doi: 10.1177/1049731512449873.

Texas child death story highlights prevention need

A story appearing this week in San Antoni, Texas talks about continuing concern with the effectiveness of child protection to prevent the deaths of children from abuse by caregivers, mainly parents. The importance of the story is really the piece that does not get highlighted in the headlines. It is twofold - the impact of the economic failures in the past several years and the failures to properly fund prevention services.

When we look at the economic crisis that has been prevalent in the world economies, the abuse, neglect and maltreatment of children appears to be one of the consequences. Families most directly hit by the downturn find themselves struggling to put food on the table and provide shelter. These pressures create poverty induced effects on families that can bring child protection into the household. As a society, we need to face the crisis not as a family failure but rather as a failure of society. Too often, the marginalized populations find themselves involved with CPS. Social workers must respond to what goes on in the family, but when will we as a society be willing to address the root causes?

This leads to the second issue which is the underfunding of prevention services. When social policy is driven by the most recent child protection fatality, it is response services that get the funding. Certainly good funding is needed here so that caseloads are not out of control and CPS response times are reasonable. But good social policy is also about preventing problems through things like home care nursing, teen pregnancy supports, domestic violence interventions and so on. These programs help to reduce the need for child protection and will also aid in preserving family units which is the goal of most child protection legislation.

Too often, children are involved in child protection programs because of the pressures in families that arise from larger social issues that society is not addressing.