Do interventions reduce recidivism in child protection?

The idea of writing about the impact of therapy in child protection cases seems somewhat mundane. However, a recently published study by Soloman and Asberg (2012) looked at the issues of child protection interventions and recidivism, or the revolving door. The reality is that there is not a significant research base on this topic. Thus, the contributions from these authors is welcome.

There were a couple of areas that particularly struck me. Past research tells us that isolation is a risk factor in child protection cases. These authors tells us that the creation of social support networks can help to reduce recidivism. Giving parents therapy to help them address such things as mental health, emotional issues, trauma and substance abuse also helps to reduce recidivism. While this might make intuitive sense, it is nice that research is quantifying the impact.

A major finding is seen on p. 2316:

Overall, findings suggest that cases with at least one minority caregiver and cases in which caregiver(s) have received therapy are less likely to involve abuse or neglect recidivism, while cases in which children were temporarily taken from their caregivers' custody
are nearly nine times more likely to involve abuse or neglect recidivism. Although some studies found that neglect cases have higher recidivism rates (e.g., Hindley et al., 2006), this association was not found in the current study.

While this study has a skewed sample, it does tell us that some of the assumptions that have been held as true, may not be universally so. There may be sub samples where the assumptions prove untrue, as the above quote suggests

The point here is that each case must be considered on its own merits. It also tells us that each case should have a unique case management plan that reflects what might be done to assist families. This study does affirm that therapy is a worthwhile endeavour. The reason might well be that it helps parents deal with stress which is strongly related to the frequency of abuse. Parents who are unable to manage stress that pushes them towards their coping limits are more prone to abuse. This includes rates of neglect. Therapy can increase the coping skills which then reduces risk.  Consider what the authors states on p. 2312:

It has been found that 30% of investigated child maltreatment cases involve at least one
instance of recidivism within 3 years from the original index event (Connell et al., 2009), and these rates of re-referral to CPS seem to continue to climb as more time passes, with life-time re-referral rates upward of 40% (Connell et al., 2007; Drake, Jonson-Reid, Way,

& Chung, 2003) or 50% (English, Marshall, Brummel, &; Orme, 1999).

If therapy can reduce these recidivistic patterns, it is worth continuing to try. Children who are subject to repeated apprehensions and placement into foster care do worse. Can therapy help, this study suggests possibly so.


Reference

Soloman, D. & Asberg, K. (2012). Effectiveness of child protective services interventions as indicated by rates of recidivism. Children and Youth Services Review, 34, 2311-2318 http://dx.doi.org/10.1016/j.childyouth.2012.08.014

Oxford child sexual abuse scandal

Child protection again finds itself under scrutiny as a result of the failure to protect girls caught up in a sexual abuse ring.

Oxford gang members: (top left to right) Akhtar Dogar, Anjum Dogar, Kamar Jamil, Assad Hussain, (bottom left to right) Mohammed Karrar, Bassam Karrar and Zeeshan Ahmed who were found guilty of child sexual exploitation. Photograph: PA

Some of the girls who have come forward tell stories of classical grooming behaviours that led to them be enslaved within the power of the men who ran the ring. One of the girls gave the British newspaper, The Guardian, an exclusive interview. In it, she states:

She described how the gang began to abuse her when she was 13, plied her with crack cocaine and threatened to cut off the head of the baby she had by one of her abusers if she ever tried to escape them.

What perhaps is most disturbing about this case is that it did not occur without the knowledge of the social service and police agencies. The Guardian goes on to state:

A litany of failings by police and social services had allowed the men between 2004 and 2012 to groom young, vulnerable girls they met on the streets, outside schools and in cafes, entice them with the promise of alcohol and trinkets, and subject them over years to sexual atrocities and torture....

Girl C said her adoptive mother went to social services in 2004 to beg for help. She said: "Mum wrote to all the key people in social services, called her own case conferences, invited agencies and got them sitting around the table, but they just passed the parcel between them – and all the while, I was getting increasingly under the power and influence of the gang."

It is astonishing on one level that this could go on. There will be a Serious Case Review which may help us to better understand why. But there are some common themes arising in this matter. Perhaps the one that stands out for me is the failure of organizations to  collectively gather what was happening and build a coordinated response. Agencies are prone to see problems such as this belonging to the jurisdiction of another. There may well be shared responsibility. Silos in child protection work run directly contrary to the needs of children whose problems and situations often cross mandates of various agencies. Silos are simply dangerous for the well being of children. To illustrate this point, the Chief Constable in Oxford stated:

She said the cases were originally looked at individually. "I don't think we understood the extent that the abuse was systematic and it was organised," she said. "It was only when we sat down, pooled our information with that of the social workers, that we began to piece together the picture which explained what was happening in terms of this criminal network in Oxford."

This raises another area of concern which is looking only at cases in isolation as opposed to looking for the trends.

A fundamental principle of social work is to see the person within an environmental context. That means looking at not only the facts of the particular case but also the context in which the person is operating. In this case, a troubled girl (as she would be in prostitution and drug addiction) but those behaviours do not exist in isolation.

One hopes that the various authorities did not just see a troubled girl and a mother who wasn't an effective parent. Hopefully, the inquiry will also look beyond such possibly narrow views and see why the systems failed these girls.

Finally, one has to ask about leadership. Uncoordinated work such as appears to exist in these cases, will too often be the result of weak leadership both locally and beyond. This includes managers who are not giving the strength of supervision needed for cases like this but also funding and policy issues that make co-ordinating this work challenging. Limited resources tend to narrow the focus of workers to what can and must be done immediately. This is not an excuse but should encourage those that will do the SCR to look beyond the local issues. That too requires leadership.

 

 

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.