Providing services to parents - which services matter

While the court decision is Canadian, there are some principles in it that will apply to virtually any jurisdiction that gives family preservation or reunification a priority. The Honourable Madam Justice C.S. Phillips of the Court of Queen's Bench (Alberta) has indicated that services provided to a family must focus on what is needed to increase the probability of parenting successfully. Thus, it is not the provision of services that matter but the actual purpose of those services. She states in para. 86:

It is important to remember, therefore, that it is not the number of services that are provided but the quality of the services and their "fit" in relation to the needs of the family that are critical.

This decision is a reminder that "cookie cutter" case plans can be challenged. It is clear that this decision helps us to see how case plans need to be catered to the demands of the particular case. A core question becomes, "What will possibly make a difference to the needs of this family to better parent these children?"

In her decision, Justice Phillips also looked at expert evidence. One thing that struck me was her concern with assessments that had been prepared long before trial. The implication seems obvious that the more dated they are the more they should be viewed cautiously. Yet, in many jurisdictions, the legal process can move slowly with trails being booked some months away. Must then CPS be constantly seeking to update assessments, including Parenting Capacity Assessments, as trails loom closer? Must CPS then amend case plans to reflect changing circumstances as seen in revised assessments? Decisions need to made in the lives of children expeditiously but that often is not the case as the courts plod along with their process. The rights of parents to be heard can be at odds with the right of the child to permanency in their lives. Brown and Ward (2012) have made a cogent case for case planning to be done with the child's needs in mind which have more urgent developmental requirements. The longer that a child experiences instability, the harder it will be for the child to do well over time.

Courts need to make their decisions faster. To help the courts, case managers also need to get their case plans right reducing the room for appeals of permanent guardianship orders. Good case plans have, in most cases, tried to provide the interventions that will make a difference in the ability of the parent to parent to meet the specific needs of their children.

References:

Brown, R. & Ward, H. (2012). Decision-making within a child's timeframe: An overview of current research evidence for family justice professionals concerning child development and the impact of maltreatment: Working paper 16. London: Childhood Wellbeing Research Centre.

RS v Alberta (Child, Youth and Family Enhancement Act, Director), 2012 ABQB 715

Child Maltreatment Fatalities - Questioning Assumptions

New research just published by Emily Douglas in the United States questions some long held beliefs about the workers involved in child maltreatment fatality cases within child protection systems. As she points out at the beginning of her article:

Some argue that the child welfare profession is out of control: workers who

experience fatalities are young, inexperienced, and lack professional training, and they miss warning signs leading up to the deaths

Indeed, there has been much criticism of the failings of the child protection systems when a child dies. One needs only recall the ,media frenzy in the UK around the cases of Victoria Climbie and Peter Connelly.

About 30 - 40 % of children who die from maltreatment will be known to child protection, she advises. Douglas' research however, tells us that workers did know their families and that, unlike previous suggestions, workers tended to not be new and inexperienced. The workers in her sample were not overly burdened with high case loads, although she may not have fully explored whether these more experienced workers were handling much more complex cases. The workers felt that they had the skills needed to manage the cases and also that they were appropriately supported. She notes that 27% saw that the fatality was likely unavoidable.

Douglas' sample was small and retrospective - limitations that she notes. However, her research does open up new understandings of these cases and the workers managing them. This is an important addition to the conversation. Hopefully, it leads to further work.

References:

Douglas, E.M. (2013). Child welfare workers who experience the death of a child client. Administration in Social Work, 37 (1), 59-72. http://dx.doi.org/10.1080/03643107.2012.654903 

Jimmy Savile and Jerry Sandusky - Hiding in Plain View

Social workers and others who work with children around the world, have much to learn from these two high profile sexual abuse case. The material published in the UK today about the breadth and extent of the sexual abuse committed by Savile farnkly boggles the mind. As the CBC reports today:

Detectives said the scale of Savile's sex abuse was "unprecedented in the U.K." They have recorded 214 offences allegedly committed by Savile between 1955 and 2009, including 34 rapes, on victims aged 8 to 47. In all, 450 people have come forward with information about abuse by the late TV presenter.

Jimmy Savile

The details that are coming out show that the range of sexual behaviors and the settings in which Savile committed his alleged crimes includes children who were pre pubescent and teenagers. He did it under the cover of his fame and charity work. As one police officer has noted, he hid in plain view. The Guardian newspaper in the UK offers insight not only into the staggering size of Savile's crimes but also the utter failing of a system that refused to believe, deal with, or collate the data that was available from victims who had come forward. The system failed those who were willing to seek justice - a system that the report clearly shows bent badly in the wind that blew from the magnitude of Savile's deemed importance.

Like Savile, Sandusky had a huge public reputation which appears to have allowed him to hide as well. The power that both men possessed made coming forward with the allegations incredibly challenging. It would be a brave victim indeed who could challenge the reputation of these powerful men. Bear in mind that sexual abusers have an uncanny capacity to choose victims who are weak, vulnerable and desperate for the attention of the powerful.

These two cases are not unique but rather help us to see, yet again, the role that power plays. We have seen hundreds of victims in the cases of priests in various churches and also in such revered organizations as the Boy Scouts.

Sexual abusers take full advantage of the power of role - Savile as the music industry icon; Sandusky as the winning coach; the priest as the sacred leader; the Boy Scout leader as the person to be trusted as a guide in life. These are all very socially supported and revered positions.

Social workers need to be very mindful of the ability of the predator to use position. The sexual abuser does it time and again. When the social worker hears the stories, we need to be open to the telling. Sexual abusers in these positions count on their reputation and the notion that those speaking against them won't be believed.

The rate of false allegations is small.

I like some key points from Dr. D.L. Reed:

* A substantial proportion of sexually abused children are quite reluctant to disclose their abuse; many are ambivalent about disclosing; many delay disclosing•Disclosure of sexual abuse is typically a “dynamic process” not a “one-time event.” Consequently, confirmed victims often make inconsistent statements•When CSA victims are interviewed only once, they often minimize the extent of their abuse; and some deny it altogether•When children’s abuse allegations include fantasy elements, this does not necessarily mean that they weren’t abused 

 The point is that disclosure occurs in a variety of ways, over time and often with a great deal of shame and guilt (the victim may well think that the abuse is their fault). Victims may let slip little details by accident at the start or as a way to test how people will react. We have a need to just listen and not judge.

There are many more perpetrators out there that have yet to be discovered. Social workers are key in hearing these stories as are parents, teachers, police officers and many others with whom a child has contact. A child alleging it occurred with someone powerful should not deter us hearing them.

Rape Victim in India is an inter personal violence issue worldwide

As the world media focuses on the death of the woman in India who was gang raped, they may focus on two themes - the outrage in India which is leading to large scale public demonstrations and on the charges against the alleged assailants which may lead to the death penalty.

One hopes that the many protests will, however, cause a larger discussion about the role of sexual abuse in India. I have done some volunteer work there around the issues of child protection and sexual abuse. The official statistics in India are that 53% of children will be sexually abused. This may be the biggest story that should now become the focus of attention. It is a discussion of what has become too normal. Challenging the status quo such that sexual abuse of any person in India should be seen as wrong. This is an opportunity to bring to the national stage this very large discussion.

It is also a discussion of the remarkably few resources that exist in India to heal. I am impressed with the organizations that do exist such as the Tulir Centre for Prevention and Healing of Sexual Abuse located in Chennai. But they do not have the supports they need. Indeed, I am advised that there is a real shortage of skilled therapists to help with those who have been abused and those that abuse. Creative approaches are needed (An example is the wonderful ideas of Vikram Patel which can be hear in his TedTalk.

But there should be no nation that sits in judgment of India. For interpersonal violence is an international concern. We need only look at Sandy Hook in the United States where a shooter in a rampage killed children and adults. Then there is Amanda Todd who committed suicide after taunting bullying. Or how about Phoenix Sinclair, the Aboriginal child in Canada who died at parental hands? The point is, that this sexual assault in India should be seen as an incident of world wide inter personal violence that needs to be addressed by all of us.

Holding mental health and child protection professionals criminally liable

An interesting case in France should send a chill to many mental health professionals.  It is the case of Daniele Canarelli, a French psychiatrist. Dr. Canarelli has been held criminally liable for the actions of a patient who killed his grandmother. As BioEdge reports:

Daniele Canarelli, 58, was guilty of a "grave error" in her treatment of Joel Gaillard, her patient of four years. She should  have had him committed or referred him to another medical team. Instead, he escaped from a consultation with her and went on to hack to death the 80-year-old partner of his grandmother.

French Psychiatrist Daniele Caranelli

The implications for mental health professionals, if this became commonplace, are astounding. At the heart of the notion is the idea that it is possible to accurately predict the behavior of clients. The reality is that is not possible. This court decision could create an over response. We have seen that with child protection workers when governments and the media lambast them for failing to protect a child.

This is different from those situations where a social workers might be held liable for a failure to protect in that this involves criminal convictions. That is very different than malpractice.  The latter is becoming more of a concern for child protection workers. For example, earlier in 2012, we saw a case in which civil liability was deemed appropriate in a Colorado case. The Juvenile Justice Information Exchange reported:

Earlier this month, the Colorado Court of Appeals ruled that social workers in Adams County may be held legally responsible for failures to protect children in foster care from abuse....The ruling allows the siblings to proceed with their lawsuit against the Adams County Department of Social Services, on the grounds that their rights to safety were violated by county social workers...The appellate court determined that the state’s division director of Child Welfare Angela Lytle, who supervised social workers Joan Forsmark and Cathy O’Donnell, acted “recklessly in conscious disregard” of the plaintiffs’ safety.

There can be a strong argument that a failure to act when the risk is known is quite different from holding a professional criminally accountable for something that may or may not occur within an unspecified level of risk. It will be fascinating to see if this French case leads to other such actions in other jurisdictions. However, we continue to await the results of charges against 2 American social workers in the Marchella Pierce case. As the New York Times reported in March 2011:

A former New York City child welfare worker and his supervisor were indicted on charges of criminally negligent homicide, the Brooklyn district attorney announced on Wednesday, saying that their failures had contributed to the death of a 4-year-old, Marchella Pierce, who had been repeatedly beaten and tied to a bed and weighed 18 pounds at the end of her life in September.

Damon Adams and Cheerece Bell - Social workers accused in the Marchella Pierce case

 Such cases will make child protection workers fearful of the implications of their decisions. This trend can make them more cautious, less willing to risk family preservation and more intrusive. This is a trend that needs to be watched.

We might reflect on the now famous Tarasoff case in the US and the ways that it led to changes in intervention - some good but often very concerning. As The Guardian noted in their coverage of the Caranelli case:

In the 1970s, a psychologist who had been treating Prosenjit Poddar, a student at the University of California at Berkeley, was held liable by the California supreme court for failing to warn Poddar's girlfriend, Tatiana Tarasoff, that he intended to kill her, as Podder had told the psychologist in therapy he intended to do.

"Psychiatrists rushed about rounding up their patients," said Turner. They looked for reasons to put them in institutions. "It set up a lot of concerns as to risk management and risk assessment."

Recovering from Sandy Hook Elementary Shooting

To have not heard about the tragic shooting at Sandy Hook Elementary School would have required that you have been cloistered. The details have been plastered on news outlets around the world. It has been sensational - many killed, out of control gun access, theories trying to unravel what happened, traumatized families and first responders. These are the elements that have been repeated over and over again.

Some images, like the one below of police officers leading children away, have been seen by millions. Viewers have been glued to televisions as the minute details trickle out surrounded by multiple repetitions of what is possibly known.

There are at multiple sets of traumas here. The first is obviously the children and staff who were in the school. They witnessed or heard what went on. The second is the family members of both the deceased and the survivors. Then there is the community that must grieve the loss of the children but also the rewriting of what they had come to understand their town was all about. There are the first responders who faced head on the victims. There is a larger series of traumas though that occur vicariously. It is comprised of those millions who are over consuming this story. It is becoming too much their personal reaction to the tragedy.

Fortunately, most people recover from trauma as long as they take steps to connect with what really matters in their life. In other words, tragic as this is, they come to see that the tragedy is an isolated event in what is otherwise a life that they can manage. It is much more difficult for those who have other traumas upon which this adds further baggage. But that is not the case for most.

So what can we do? One of the most important things we can do for children is ensure that they are surrounded by people, things and places that make them feel safe. This often means family. The message needs to be that they are safe and they are and will be ok.

The child may need to talk about what happened. This is important while not causing the child to tell the story multiple times. Allow them to grieve and let them know that such feelings are normal. Let them participate in healing activities such as commiserating with friends. It is important to ensure that they feel resilient - they will get over this.

Why would I write these things - I am not at Sandy Hook nor will I be. It is because children have been widely exposed to these stories in the media.

Real child protection occurs in families who make their children feel safe and secure. This is a chance for that to happen. For the children who have been exposed to these stories, they need to know how rare these events really are. They also need to know that it won't happen to them. This is a chance for parents to talk to their children about how their lives are ok.

For some few children who have other traumas or losses, however, this may be more complicated. But be assured, making them now feel safe will help. For a small few, professional help may be required. But they are the few.

Another vital step adults can take, is to model that things will be safe, secure and manageable. Kids take their leads from adults on this. Something very constructive that the adults can do is limit the amount of exposure that the child has to this and similar stories. In other words, turn the news off - it is not helping the child and really not helping most adults.

I have worked in emergency cases such as through the ER of a major hospital and on a child abuse team. Taking these tragedies into your home life does not help you or your family.

Instead, turn the family focus on to things that are normal, fun and engaging. This reinforces the child's sense of security. That is real help.

Harassment as domestic violence

The Ontario Court of Appeal in its decision regarding R v. Doherty has emphasized a powerful legal principal which affirms that abuse can include harassment. This means that physical violence is not a necessary element of a criminal charge and conviction. 

Mr. Doherty is a man with a lengthy criminal record that includes prior convictions for regarding three other women. He also had a record for failing to honour the direction of police, probation and the courts. However, what matters in this case is the inclusion of non physical injury as the basis for a conviction.

The court states at para. 7 of its decision:

Ms. Mikulska suffered greatly as a result of the harassment. She was terrified of the appellant.

The decision further notes at para. 13:

Ms. Mikulska suffered mentally and physically as a result of the appellant’s harassment. She lost weight, lost sleep and was anxious and worried about what he may do to her. The impact on her was magnified each time he ignored her pleas to stop, the police warnings and the court orders    

In other words, his harassment caused her injury but not through physical force. 

The court also makes reference to a comment from the trail judge that is worth considering. The giving of evidence against your abuser also has an impact on the victim:

In my view, she fell within that category of witness who was re-victimized by having to come to court and give evidence.

In para. 15, the appeal court affirms that physical force is not necessary:

I agree with the respondent that the appellant is not entitled to mitigation on the basis that there were no physical assaults. As the trial judge noted, submissions suggesting that the lack of physical violence makes this offence less serious, “reflect a failure to appreciate that the primary impact of harassment is very often psychological … there is no requirement that there be physical harm to make out a very serious case of criminal harassment.”

This decision will not solve domestic violence including harassment. It does give the police and the judiciary good guidance on the role that harassment plays as part of the world of abuse.