Post partum depression as a child protection issue

Post partum depression (PPD) occurs in about 20 - 25% of women after giving birth. Some level of the "baby blues" might well occur in larger numbers. The risks of PPD are that women can then go on to experience longer term depression or, in a small number of cases, go on to post partum psychosis. The latter can often be quite dangerous as it can include risks of suicide and homicide. It tends to be a psychiatric emergency.

PPD has the potential to interfere with the attachment process between mother and child. It can reduce the mother's desire to interact with the baby and to provide stimulation (physical and emotional).

The good news is that it is highly treatable. A review by The Cochrane Library has shown that some very simple interventions can make a significant difference.

The piece of their extensive review showed that one intervention that is simple to manage and effective is peer support. Simply having someone touch base and ask, "How are you doing?" makes a difference. In essence, it is someone who just cares, is there and allows for the expression of a mother's true feelings. This can be a major preventative tool that reduces PPD. The Cochrane review found this to be the case.

The research also found that home visits by such people as community nurses are beneficial. Interpersonal psychotherapy was also valuable.

When we reduce PPD, we improve the situation for families which in turn will reduce the need for child protection intervention. What is most appealing about the results of this research is that we do not need to build new and elaborate programs. Peer or lay support by phone works. Keeping up with nursing post delivery visits work. And, when needed, access to basic mental health support.

Alcohol and Pregnancy

Anyone who works in child protection knows that Fetal Alcohol Spectrum Disorder is a prevalent and devastating disorder that brings life long implications. The effects can range from profound to minor. Much depends upon what was consumed in what quantity during which periods of the pregnancy.

There are many things that can be toxic to a foetus which can include alcohol, tobacco and other drugs.

A recently published longitudinal study has suggested that minor amount of alcohol are not harmful to the foetus or the child as she develops. A study of more than 10,000 children followed to age 7 found that there were no indications of increased odds for mental or cognitive deficits. Light drinking was defined as 1-2 drinks per week.

What the study did not do is identify what level of alcohol consumption was safe and that which was not safe. That, of course, is a defining issue.

The challenge with this study is that, while it truly helps to advance the debate, it can easily be misinterpreted. It can be seen as a license to drink in pregnancy. While this is an impressive study, it still leaves many question unanswered.

The advice still should be to not drink in pregnancy but to also not encourage panic when a mother announces that she had a drink at a party. In addition, we should likely be paying a lot of attention to the issue of smoking in pregnancy as well.

The true experience of being falsely accused

We hear stories of people being falsely accused of sexual abuse. In the wake of Jimmy Savile, Jerry Sandusky, Theoren Fleury, Sheldon Kennedy, The Los Angeles Catholic Church Diocese and a myriad other Catholic Church sexual abuse stories, The Boy Scouts of America and numerous other high profile cases, it is hard to remember that, rare as they are, false accusations do occur. For those so accused, the impact is hard.

Recently, in the United Kingdom, the Guardian newspaper has published a first person account of a couple who went through the world of false accusation. It is compelling reading and can be read by clicking this link.

Child protection must present an unbiased view

A recent judgment in Nova Scotia raises some crucial issues for social workers and their lawyers who are presenting applications in court. The Honourable Justice Mona M. Lynch in the case of Ministry of Community Services v. F.B. noted some significant concerns with the bias of the presentation to court by the Ministry. She noted that the mother in this case was a difficult client. At paragraph 41, Justice Lynch notes:

There is no doubt that the mother was a difficult client to deal with, however, a parent’s failure to cooperate with the MCS does not equate to their child being in need of protective services

This matters a great deal. Difficult clients are hard to manage. They can seem to be "unworkable" when they are simply feeling powerless against the greater force of child protection. Justice Lynch appears to take the position that difficult should not be used as the basis for determining whether a child is in need of protection.

Justice Lynch goes on to make a much more crucial point - how invested should workers be in the outcome of the case. At paragraph 47, she states:

Witnesses for the MCS should not be personally invested in the outcome of a proceeding.   The proceeding is about the best interests of children, not who wins or loses. 

When a worker has been putting many hours into a case, has formulated a case plan and has aimed at succeeding with that plan, it is natural to want to achieve what one has set out to achieve. Being invested in that plan may hinder the view that one has to a case. Research has shown that this can create a information bias filtering out new information that contradicts the case plan. This is known as confirmation bias. Justice Lynch became concerned as she notes later in that same paragraph:

The court expects balance.  The court expects that the witnesses from the MCS provide evidence of both the good and the bad that they have witnessed.  The court expects that they will just relay the facts without attempting to colour the evidence in a negative light.  Sadly in this case, with few exceptions, the witnesses who work for the MCS were not impartial or unbiased.  They appeared to be so invested in the outcome of the case that it has affected the weight the court can give their evidence.  They appeared unable to say something positive about the mother even when there were positive things to say.   The evidence of many of the access facilitators can be given little weight.  This is unfortunate because the access facilitators spent the most time with the mother and the children of all of the witnesses.  

In essence, the bias was such that the credibility of the evidence was in question. If a case has merits, then it does not need workers to filter out data that may not support their preferred position. What this case shows is that when a judge becomes concerned that the data has been selected to support a position as opposed to offering the court the data it needs to weigh the merits, then the usefulness of the child protection witnesses wanes.

It is rare that a parent is totally without merit. By putting both the strengths and the weaknesses before the court, the judge can then weigh the balance. If the worker feels that they must do that ahead of time, then the worker is beginning to take the place of the court. That is dangerous.

Justice Lynch's comments are a good reminder that courts are ultimately responsible for determining the best interests of the child when child protection takes matters before them.

 

Victoria's Secret Bright Young Things

One might immediately wonder what the economic enterprise of the Bright Young Things line of clothing has to do with child protection. Before answering that, in case you missed it, Victoria's Secret has introduced a line of underwear for pre teen girls. This is not a dumb company so I am sure they have ascertained that there is a market for these products that sexualize this pre adolescent market.

The question of course, is why is there a market to begin with?

We know that girls who become highly sexualized earlier have a tendency to engage in a variety of higher risk behaviours as they move into and through their teen years. This relates to sexual activity, poorer academic performance, alcohol and drug use as well as risk for earlier pregnancy. These problems have a tendency to be of concern to child protection as such youth come to their attention.

Will the promotion by Victoria's Secret be responsible for this? Clearly not although they add a powerful name to endorsing such early sexuality. They add momentum!

A more important question is to ask what parents will do with this initiative. A wise parent just won't allow it but will instead focus on family, educational, social and community endeavours that lead to successful, lower risk adolescent experiences. That will also help to reduce risks that lead to child protection involvement.

Apparently not all trauma is created equal

I am fascinated by a new study just published by Hickman et al., in the Journal of Interpersonal Violence. As the abstract notes, the research set out to look at how lifetime vioklence exposure is realted to a set of negative symtpoms in children. Those included child internalizing and externalizing behavior, child trauma symptoms and parenting stress. In essence, these are core questions in child protection. A high number of children involved with CPS have been exposed to various forms of trauma. The research had a good sample size meaning that the data was robust. The children were under 5 years of age.

The research spoke about poly-violence as being more dangerous in its long term effects. They defined this as being exposure to multiple violence categories. Intuitively, this makes sense. If there are few, if any, safe environments in your life, it is quite hard to ever settle down. The alarm system of the body is heightened on a continuous basis. Such individuals will tend towards hypersensitivity and hyper alertness.

As the researchers note on p. 1339 of their article. "...exposure to violence has been linked in numerous studies to various developmental and mental health consequences...."

A child who has been exposed to a single form of violence may have resiliency options elsewhere in their lives. In other words, they may have safe havens. One exception seems to be sexual abuse which has a special meaning which was the least common (likely the most damaging) whereas witnessing violence was the most common.

Discussions about broad safety in our society need to consider this type of research. It is perhaps quite relevant given the discussions in the USA about gun violence which can be pervasive in some areas and the high profile issues of rape and the safety of women in India. Perhaps what we have not been focusing on is the creation of true safety for people.

Reference:

Hickman, L.J., Jaycox, L.H., Setodji, C.M., Kofner, A., Schilt, D. & Harris, R. (2013). How much does "How much" matter? Assessing the relationship between children's lifetime exposure to violence and trauma symptoms, behaviour problems and parenting stress. Journal of Interpersonal Violence, 28 (6), 1338-1362. http://dx.doi.org/10.11770886260512468239 

Rape from two powerful perspectives

Friends in India at the Tulir Centre for Prevention and Healing of Sexual Abuse brought two stories to my attention. In the first one, American filmmaker Sandi Higgins tells the story of being raped at an ashram in Mumbai.



The video can be seen here. It is a powerful, first person account.

In the second story, Ruben Rosario tells the very personal story of being a victim of sexual abuse. It too is a very powerful first person account published in the New York Daily Record.

These stories need to be told as inter personal violence remains an epidemic throughout the world. It comes in many forms - bullying, physical, emotional and sexual abuse, pornography - to name a few. This is a child protection issue as many victims are children, as Rosario describes. Many children will be exposed.

I hope that you take a few moments to review these two first person accounts.