Suicide and children within the child protection system

A new research report has been published in the current issue of the Canadian Medical Association Journal. In it, the authors note that children in the system have higher risks of suicidal behaviors. Katz et al., report that there is clearly a higher rate of suicidal behaviours with this population at a level that is statistically significant when compared with a population that has not been in care. This may not be a surprise for those of us working with these children.


An aspect that was surprising is about the impact of actually being in care. As they note, "Increasing length of time in care and increas- ing number of placements were not significantly associated with increases in the rates of suicide, attempted suicide or admissions to hospital, and parental psychopathology did not affect rates of suicide or attempted suicide" (p.3).


There are further surprises was that suicidal rates actually dropped once a child came into care as opposed to the period before they were in care."In the cohort of children and adolescents who were in the care of child and family services, the rate of attempted suicide was significantly lower in the years after entry into care than in the two years before entry into care" (p.3). A drop was also noted for physician visits and admission to hospital, although not psychiatric status.


This research is a valuable contribution to the literature as it is not well studied. It also causes us to reflect on some beliefs that have been taken as true, yet unchallenged. 


The article can be source at http://www.cmaj.ca/content/early/2011/10/17/cmaj.110749 

Some thoughts on effective child protection - challenging ideas

"Research shows that the most dangerous families are skilled at evading the attentions of child protection services. This should not blind us to the tens of thousands of cases each year where children are protected because engagement between families and professionals succeeds.. . . The task facing us is to work out how we can improve the capacity of our practitioners to tolerate ‘thinking the unthinkable’ and so have a better chance of interrupting the unthinkable things to which some children are subjected. (Cooper 2008, 30)"

This quote cited in a new article Akister to be published in the journal Practice is part of an elegant review on the central role of knowledge in child protection practice. An interesting question that arises in this article is that the actions of a social worker may be focused on the question or task (investigating abuse; preserving the family; managing services) and this affects the knowledge that is gathered. This may mean that crucial data then gets missed.

Akister notes research on the Baby P case and other serious case reviews in the UK that the central lesson for social workers is that they must challenge parents more. Critics of child protection will not find that suggestion comforting but one has to wonder how knowledge in a case can get developed more thoroughly without doing so. As he states, what we observe is also influenced by what we see as well as what we expect to see as well as what we think is possible.

On the other side of the equation is the social worker faced with the angry, aggressive or uncooperative client who then restricts what the social worker becomes knowledgeable about as the safety of the worker becomes the focus.

This article challenges social workers to also learn from allied professions. They have a wealth of data on issues related to child protection that should be used. But silo thinking keeps such information compartmentalized. How often does a social worker read material from psychology, psychiatry, medicine, nursing and so on? Regrettably, the answer is not often. But there are many altering services that can open up pathways to these allied resources. A very good example is Information for Practice . Another example is Science Daily . 

There is also competing challenges in child protection of protecting children and trying to rebuild families. This means that there is a dual role and thus a broad set of knowledge and skills to be obtained and applied. Although Akister does not raise this, I wonder if social work students are receiving a broad enough education.

In a report from Washington, DC in the USA, DC Citizens Review Panel noted that they are concerned about the number of cases where children are brought into care and then returned to parental care in a short time. They question whether the apprehension was required in the first place. They identify the competing challenges stating, "On one hand, removal represents a dramatic ␣ often traumatic ␣ event for any family. These separations can impose an emotional toll on children or parents. On the other hand, very real safety concerns are at stake. Some children do suffer serious abuse and neglect at the hands of their parents;; in some cases the only available response is to separate the child from the parent because the emotional harm of that separation is less than the harm inflicted .High quality investigations and removal decisions are essential because these competing concerns are both so important." (p.2). 

The panel goes on to state, "The Panel concludes that CFSA generally was right to have significant concerns about the  families on an emergency basis was necessary to address those concerns. In contrast decisions to return children to their families were virtually always right ␣ children rarely faced either significant safety concerns in those homes at the time of their exit from foster care or had documented cases of further maltreatment in that home. Taken together, these findings attest to the need for significant reforms to prevent unnecessary removals ␣ and to prevent the unnecessary harm they cause to children and families. " (p.4)

This goes to the heart of Akister's arguments that workers require comprehensive knowledge to better assess what risks amy or may not be present. They need training on how to not only assess risk but to also better determine what information really matters and when the situation is adversely impacting their perceptions. This will help reduce risks on both sides - necessary and unnecessary apprehensions of children.

Youth remind us that they need ongoing support

A recent conference of youth involved in foster care, saw them raise a series of points that should act as a wake up call to child protection workers everywhere. The story in The Hartford Courant notes that children who are in permanent care of child protection still want the kind of support, encouragement and monitoring that says they matter.  They also want to be encouraged to achieve such as going on to post secondary education.


The need for ongoing contact was sought even when the youth was doing well. As these youth note, and as I have heard clinically on many occasions, if you are seen as managing and not getting into difficulty, then the social worker tends to not see you. An example is seen from the story, "Rohan Brown, who lives in Shelton and attends Mitchell College, said that one reason he does not hear often enough from his social worker is because he is doing well.

"I was told I'm supposed to have a monthly visit," said Brown, 21. "I haven't had a monthly visit in six months."

Rohan said he'll get a call from his social worker, who says: " 'Oh you're doing fine … I'll see you some other time.' That's absolutely not fine. My mom didn't want to see me; now I feel like you don't want to see me."

Large caseloads can often mean that workers focus on kids who are not doing well. This is understandable, but may not be serving the kids who need supports to ensure that "doing well" translates into successful transitions into adulthood.

One youth at the forum also raised the idea that, like parents in families where children go onto post secondary education, start talking about it long before the transition is to occur - plant the idea that it is a good thing and possible not just before high school graduation.

These are good reminders for social workers who are acting as parents to children. Regrettably, for many children, there are too many changes in social workers making it hard for them to develop a relationship. In British Columbia, a youth actually applied to the court to keep his social worker even though the worker would be stationed hundreds of kilometres away. The court granted his application. The youth credits the relationship as part of why he has been able to continue a successful life course.

Best Interest for the Child - Really?

Two Australian academics have questioned the holy grail of Best Interest for the Child test. This has been the standard that is so often spoken about in legal and mental health circles. But these academics have raised serious doubts about just what the standard means. Writing in the journal Children Australia, they conclude:

"It is clear that child protection systems can and should be managed is such a way as to reduce the number of children removed from parental care (Ainsworth & Hansen, 2008) while at the same time protecting children from harm.

The removal of a child from parental care is traumatising for the parents and the child. For it to be in the best interests of the child there has to be overwhelming evi- dence that without removal from parental care the child would be at risk of significant harm. In addition, we argue that there has to be a guarantee that removal from parental care and the placement of a child into state care will enhance the child’s future life chances" (p.15).

What Hansen and Ainsworth raise in the article is the idea that we may not really understand best interest. They cite a legal scholar who notes:

"I do not believe that we will ever be able to create a standard, a test, a rule of practice or of law that will be able to definitively to establish what is or is not in the best interests of a child. (Zito, 2010, p. 51)" (p.13)

How can it be in the child's best interest when so much research suggests that in cases where the parent could be good enough, the child will be better off with the parent. Long term outcome research on children raised in foster care versus those raised in even marginally good enough homes do poorer. Let there be no misunderstanding - where the children are truly at risk, they are better off in care. What this research and much other is suggesting is that we need to develop better understandings of when it is and is not in the child's interest to not be in the care of parents. The research keeps leading us to the conclusion that if it is a marginal case (one where it could go either way), keep the kids with the parents and try to make it work.

That is of course a risk in and of itself. If it does not work out then the children will have been in more harmful situation longer. It seems however, that the research is suggesting that the risk may be worth it for the majority of children in these marginal situations.

You can read their article at:

In ‘The Best Interests of the Child’: Critical Reflections on an Overused Construct

Are we creating the platform for another high profile death?

In the UK, where budgets for child welfare have been under increasing pressure, caseloads are rising. The number of children on protection plans and in care are on the increase as well. It is this mix which creates the sorts of pressures where managing cases for child protection workers becomes more and more challenging. Things will get missed. This is the bringing together of the types of factors that lead to the high profile death.

Unfortunately when that happens, it is the front line social worker who will often bear the focal brunt (along with the immediate supervisor). If such a case occurs, one would like to think that this would be the time when we would question systemic effects on casework and accept that there is a balance between what society will pay for and therefore, what child protection can realistically do.

Community Care has reported on this story suggesting that it is the perfect storm for local councils who must try juggle these budgetary demands.

One of the ways pressure in the system eases (and this is but one) is through adoption. In the UK that appears to be a growing problem as well. Children and Young People Now are reporting a decline in the adoption rate of 5%.

This UK data matters to all in chid protection as it illustrates pressures that are building in many Western jurisdictions as the economy worsens. It begs the question of whether we need to look at different models for the delivery of child protection services. Nebraska, in the USA experimented with privatizing the work.  As the Omaha World Herald reports, that experiment seems fraught with problems that are familiar to publicly run programs - high caseloads and high turnover. When you essentially privatize the same model, you are likely to encounter the same problems.

All this is to suggest that the really hard questions of how the system is created and managed are not yet getting asked (although the Munro Review on Child Protection in England has tried hard). It is the political level that must be willing to address the changes needed - and accept that no system of child protection will be perfect and that means in all systems, mistakes will be made. But our present economic woes may be fermenting the next crisis.

Supervised visits - An analysis

In a fascinating article to be published in the Children and Youth Services Review, Canadian researchers Michael Saini, Melissa Van Wert, Jacob Gofman have helped to consider the differences in supervised visits depending upon why they are occurring.  As they note, child welfare visits protect the child while rebuilding the relationship with the parent. The goal is working towards reunification. In divorce, custody matters, the goal is protection of the child from a parent deemed a long term risk to the child. A common ground between both populations is that they are suffering from loss and trauma - be it through being placed in alternate care or through a parent that has left because of separation or divorce.

One significant difference that the authors note between the child protection and the custody/divorce population is, "In other words, child protection is not an exercise in the proactive service of a child’s best interests but a reactive series of steps where basic needs of a child are not served. Accordingly, child welfare cases are not, at least initially, a contest of best interests of the child as it is in a custody case"


A point raised is the issue of trying to understand the concept of the Best Interests of the Child. They note that in Canada (and very likely in virtually any jurisdiction where the best interest test exists), it is poorly defined and thus will see wide variations in court interpretation. This is a challenge for social workers. The legal literature and the social work and psychology literatures lack consensus. Thus, clinicians and judges are having to assess the test on a case by case basis trying to use precedent and the clinical literature as a guide.


Equally challenging is what constitutes good supervision practice. There is a dearth of good standards around. The authors do help by noting, "Visitation may function as a therapeutic experience, an evaluative method for assessing parental bonding, or a proactive method of enhancing poor parenting skills " This may help to give a clear goal to visits. Too often, there is a supervisor attending who is merely observing and writing down all that goes on. For parents in such cases, they typically feel under the microscope. Those visits, of well documented, could serve as a basis for better understanding what needs to be done to enhance parental skill. As the authors state, "Although monitoring the safety of these interactions is critical, supervisors should do so by actively assisting parents to engage with their children and to be attuned to the needs of their children within the supervised session."


Good visitation programs preserve the relationship with the parent and the child. If visits are frequent, they appear to also offer increased probability for return of the child to the parent's care.


When it comes to custodial disputes, the authors note that the results are mixed and should be relied upon with caution. "These preliminary findings suggest that children involved with supervised visitation experience an increase in visits with non-custodial parents over a six month period, and parents involved experience a decrease in aggression (Flory et al., 2001), and defensiveness (Tutty et al., 2006). However other research indicates that while most parents and children are satisfied with supervised visitation services, service receipt is not associated with decreases in parental hostility or increases in children’s understanding of the divorce process (Jenkins, Park, & Peterson-Badali, 1997), nor are services associated with changes in parental attitudes or child functioning (Dunn et al., 2004). Other research reports that many families utilizing supervised visitation require the services for long periods of time (Sheehan et al., 2007)."


There is an important note of caution for supervisors in custodial matters: "Neutrality and safety are paramount for these visits to effectively facilitate and maintain parent-child contact within the context of custody disputes and it is imperative that supervisors do not get caught in the tribal warfare (Johnston, Roseby, & Keuhnle, 2009) of the litigation battle between of conflicting parents."


It is good to see this article. It offers a well thought out perspective in an area with little research.

Saini, M., Van Wert, M. & Gofman, J., Parent–child su- pervised visitation within child welfare and custody dispute contexts: An exploratory comparison of two distinct models of practice, Children and Youth Services Review (2011), doi: 10.1016/j.childyouth.2011.09.011

Recession and Child Abuse

It will be hard over the next few days to miss the reporting of the research published in Paediatrics. The lead author, Dr. Rachel Berger notes that the research covers the period from January 2004 to June 2009. The recession was in the 2007-2009 period, although there is every reason to believe that the economic troubles her research connects to is far from over. It is also important to note that she is looking at Abusive Head Trauma which is a more dramatic form of abuse. It is often associated with individuals who are already stressed within the parent role and are thus having a great deal of difficulty coping. Unemployment and the financial pressures arising from it only serve to add to the pressures.

The research team concludes, "The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship" (p.637). 


This research highlights a powerful issue in child protection which surrounds the high incidence of poor or impoverished and stressed families in the system. We are failing to support these families. Critics of child protection take issue with the over representation of the poor and disadvantaged yet do not seem to push for the kinds of economic reforms needed to get at the root of so much child abuse - stressed parents.


The authors state, "Specifically, the presence of an association between the economy and the AHT rate should be sufficient to spur a discussion of specific stressors and mediators of these stressors and how they could be modified to decrease the risk of AHT to young children" (p.640). I doubt that it will.


As a society, we pay a huge price for poverty.


If you would like to read the whole article, it is available for free.


http://pediatrics.aappublications.org/content/early/2011/09/15/peds.2010-2185.full.pdf+html