Is parent alienation a child protection problem?

Imagine a parent who is so angry or so despises the other parent, that they are prepared to do all they can to ensure that the child or children do not want to have anything to do with the other parent. They begin a campaign to ensure that the other parent is seen for all flaws possible, real, imagined, exaggerated. The child will be told as much as possible and rewarded for efforts to avoid the other parent.

Now imagine that both parents are in this position and engaging battle with each other through loyalty binds.

Anyone who works in the area of divorce, separation and custody will tell you that these are simplistic examples of a common problem that they encounter constantly. The term Parent Alienation Syndrome was coined by American psychiatrist Dr. Richard Gardner in the 1980s.

Dr. Richard A. Gardner

His theories were controversial in that they were built upon clinical observation as opposed to rigorous research. Yet, to those working in the field, they became instantly recognizable to cases that  they were dealing with. The concept has not received recognition through the American Psychiatric Association's DSM system. Courts seem to accept that alienation occurs but PAS as a concept remains debatable/

At the heart of the problem is the child caught in the middle of parents engaged in unending war. They have lost sight of the needs of the child and are strictly focused on their own need to "win". Certainly, they will protest that they have the interests of the child at heart. 

Alienation cases are different from those where there is real reasons to keep the other parent away or with very limited contact. The legitimate cases involve sexual or other forms of abuse, drug addiction and alcoholism or serious unmanaged mental health issues. Alienation cases may involve allegations of this, but mental health and forensic experts will fail to find merit in the claims.

In alienation cases, children are emotionally abused by the alienating parent. They are deprived of a healthy relationship with both parents. One is kept at a distance and the other is involving the child in unhealthy loyalty binds. The child is denied an understanding of what healthy parenting can be and what a normative relationship can be like with a caring parent figure.  Instead, the child is exposed to a model of abuse, ego oriented parenting and often are allied into lies or misrepresentations. The child learns that it is easier to ally with the alienating parent - it is just less stressful to go along than try to fight.

Alienating parents can also subject their children to multiple court cases which may include multiple custody assessments. Many alienating parents will not give up if the courts or mental health professionals do not agree. They will fail to honour court rulings and orders. 

Child protection professionals have been loathe to get involved. They typically see this as a problem for the divorce courts. Certainly one would have to worry about the impact on child protection caseloads if they started to get more involved. However, there is every reason to suggest that the more extreme cases are abusive parenting and should be subject to child protection review. It is often a big hurdle to get CPS involved but there is good reason to push for it, at least in those more serious cases.

Custody assessors in divorce proceedings will speak about those cases where the parent does not give up and engages in these multiple court proceedings. This is abusive and may be one of the major criteria for CPS involvement. 

Harsh physical punishment creates long term problems

Many may be familiar with the Adverse Childhood Experiences research. This powerful, robust work helps us to see that negative events in childhood have long term implications for physical and emotional health. A new study published in Paediatrics online this week adds to the data that what goes on in childhood has significant implications for our health as adults.

Drawing on data from the US National Epidemiological Survey on Alcohol and Related Conditions, which has a sample size of 34,226 people, the researchers were able to conclude:

Harsh physical punishment was associated with higher odds of cardiovascular disease (borderline significance), arthritis, and obesity after adjusting for sociodemographic variables, family history of dysfunction, and Axis I and II mental disorders (adjusted odds ratios ranged from 1.20 to 1.30).

This is important as we really come to understand that even in the absence of childhood maltreatment, harsh physical discipline does not lead to the desired outcome of better adults. This is important data in the ongoing debate about the use of corporal punishment. Consistently we see little objective data that supports its use.

Reference:

Harsh Physical Punishment in Childhood and Adult Physical Health

1. Tracie O. Afifi
, PhD, 
2. Natalie Mota, MA, 
3. Harriet L. MacMillan, MD, FRCPC, and 
4. Jitender Sareen, MD, FRCPC. 

Methadone maintenance and pregnancy

It might be a common perception that methadone maintenance is a good way to stabilize people who have long term addiction problems with drugs like heroin. Research still tends to support that notion. But there is one small study in the U.K. that should cause us to take a hard look at mothers on methadone maintenance programs who are pregnant.

This study of 56 mothers raises some very specific concerns that their fetuses have been exposed to multiple drugs beyond the methadone. This study, to be published in the Archives of Diseases in Childhood, Neonatal and Fetal edition shows that:

Most of the babies (51; 91%) had been exposed to other illicit drugs while in the womb, mostly opiates (73%) and benzodiazepines (70%). And 59% had been exposed to cannabinoids, 14% to amphetamines, and 7% to cocaine. The most common drug combo was opiates, benzodiazepines, and cannabinoids.

Almost half the babies (47%; 21) also had high FAEE levels, although only 5% of their mums admitted to drinking more than 7 units of alcohol a week during their pregnancy, a finding that has "significant implications" for the longer term health of an already vulnerable group of babies, say the authors.

This is not a study to draw widespread policy options from, but it does open up a need for careful consideration of a population that may present real risks to fetuses.  Given how significant these issues can be to the child protection population, one hopes that larger scale research will now follow.

Child molesting, pedophiles and grooming

A recent inquiry led me to think about how people perceive sex offenders. Based on what the media writes, one would have to conclude that the group is viewed very homogeneously  - all are pedophiles. However, there are real distinctions between a pedophile and a child molester. To the victim, the difference may not seem important, but to those of us who assess these individuals the differences are quite important - in terms of motivation, risk and treatment.

A pedophile is an individual who has a predominant or exclusive sexual attraction to children or minors. It is that population that gives them sexual stimulation and gratification.  While they can certainly be opportunistic in their offences (in other words take advantage of an opportunity that presents itself) they often engage in grooming behaviours. They will take time to get a trusting relationship to gain access to their victims.

This can be done from a position of being a valued family friend, a committed volunteer in a community or an organization or by having a position of trust in the community - a teacher, a coach, a religious figure, for example.

Anne-Marie McAlinden from Belfast University also notes an emerging trend in grooming:

...new and emerging forms of grooming including 'street' or 'localised grooming' as typified by recent cases in England and Wales, 'self-grooming' by offenders, 'peer-to-peer grooming' among children and young people, and what I have termed 'institutional grooming' (McAlinden, 2006) where sex offenders may seek to exploit organisational features or relationships in order to minimise the perceptions of others about potential risk.

Either way, the goal of grooming is to accomplish certain essential goals. The first is to gain predictable access to the child. The second, and this is crucial, is to gain a trusting relationship with the child. In many cases, the groomer also seeks to ensure that those around the child, such as parents, will see the groomer as someone to be trusted. This is why they use things like their position with the child or the community as evidence of their trust worthiness. This helps them to be seen as above reproach. The idea being, who would not trust the child's favourite teacher who spends extra time ensuring that the child is successful at school? Who would not trust the coach who builds the child's talent?

The next crucial element is building a secrecy between the pedophile and the victim. The purpose is obvious but it is such a powerful element in allowing the pedophile to carry on. Sexual activity may come slowly with many enjoyable, but secret activities occurring beforehand.

Grooming can be done in person, but with the advent of internet technology, this is also a potent form of building relationships. Not often discussed is peer to peer grooming where one victim slowly brings another into the equation. The first victim, now fully under the influence of the pedophile, will draw in another friend.

There is another form of grooming which requires attention and reflects some cases which I have seen recently. It is the young adult male who is grooming for prostitution but is using pedophiliac behaviour to gain trust. These victims are brought in through a friend or through drug related street connections. The perpetrator will gain trust through access to drugs and gifts which result in the victim being indebted to the perpetrator. This then leads to demands for sex in exchange going on to sexual favours for friends and then to prostitution.

One  of the greatest powers that pedophiles have in grooming is the naiveté of the victims and those around them. They miss the grooming as grooming.

It is essential that professionals working with vulnerable children recognize that grooming is a conscious process. The groomer is quite aware of what they are doing and what their ultimate goal is. Pedophiles do not enter sexual behaviour by accident or as one off mistake.

Child molesters can be just as damaging although they have sexual attraction to adults. They are not exclusively interested in children. They may also be more prone to opportunity that makes itself available. In my clinical experience, this group is also more willing to place the blame on the child as having come on to them or having initiated the sexual activity. This is simply an effort to shift blame.

Once an offender has begun to victimize a child, the difference between a pedophile and molester may make little difference. Child molesters (as they have come to be known) tend to operate within family systems where they have also sustained "healthy" adult relationships. It is also vital that there be recognition that the child molester in the family system can have many victims.

Either way, sexual offending against children has long term significant damage to the victims. It impairs their sense of safety, seriously disturbs their understanding of relationship , hampers their ability for healthy peer to peer and adult intimate relationships and badly hampers their sense of self.

Most of the pedophiles I have assessed have had strong attractions to children but I have certainly met several who have also sustained long term adult relationships. A hypothetical example illustrates the point:

Joseph is a 58 year old man who has been married to Jenny for 32 years. They had 2 children who both grown up to be quite successful. They went to university and are working professionals. Joseph enjoyed a healthy and appropriate relationship with both children. Joseph, also a professional, has a successful career and is a leader in the community. He has 3 grandchildren, all of whom are quite close to him. The oldest, Sally, aged 6, recently mentioned to her mother that she and grandpa have very special private time. This concerned her mother who inquired further and learned that grandpa (the mother's father) had been touching Sally inappropriately, although there had been no sexual contact. The mother called the police and Joseph was charged. A careful investigation which coincided with a great deal of publicity in the community, yielded no suggestion that there were other victims.

Joseph may well be categorized as a child molester. He does not fit the profile of a pedophile, although to Sally there is little reason to see the difference. She was violated by her grandfather and that will be a long legacy in her life. Fortunately, her mother responded quickly and appropriately. I have seen many cases where the disclosing child was not believed which meant that the child remained in the clutches of the offender. The statistics clearly indicate that false allegations are few.

Professionals need to help families and communities see grooming behavior and focus on steps to stop the offender and protect the child.

Mandatory reporting in child protection - it still remains a controversy

The following is from a briefing paper I wrote for an organization in India where there is some discussion about introducing mandatory reporting laws. It is still controversial. In Canada and the United States we have had them for many years and we forget that they have been both beneficial and harmful.

Introduction

Mandatory reporting to child protection authorities (CPS) is an issue that receives consideration in various jurisdictions. The essence of it is that certain persons or professionals are mandated to contact CPS when they believe that a child is at risk as a result of abuse and, in some cases, neglect.

The purpose of this briefing paper is to review the main arguments for and against the use of this tool. Such reporting is typically embedded within child protection legislation by the competent authority, In some countries, that may be a national mandate whereas in others, it is the responsibility of state or provincial governments.

Context for Mandatory Reporting

The moral and ethical basis for seeking to bring in mandatory reporting is that children who are being subject to harm, from parents or other guardians, deserve to be protected. In this context, it is thought that the state should perform this role when those who are otherwise entrusted to care for a child show themselves to be unable to do so.

Intervention by the state is often thought to be an action that should be taken with extreme care, as most nations with child protection systems believe that family should be the primary unit to raise children. The state should only intervene when the family cannot or will not do that. Even then, child protection legislation will typically focus on efforts to preserve the family unit. CPS social workers will have, as a mandate, to intervene with a goal of helping the family to stay together. When children are removed from the family, the goal will be to return the children to family care as soon as possible with intervention aimed at correcting whatever caused the children to be temporarily removed. Severing parental rights to raise their children is considered a last resort.

The notion is that CPS should use the least intrusive option available. The best interest of the child is thought to reside in the family, which is an underpinning of many cultural beliefs about family.

Families who are abusive or neglectful to their children would not typically seek out the attention of CPS. Thus, mandatory reporting has been framed as a way to ensure that these families are brought to attention so that children can be protected.

Present Mandatory Approaches

Mandatory reporting is used in several Western countries who have highly developed child protection systems. This includes Canada, Australia, and The United States. As Matthews & Kenny (2008) note, it is these three countries who are most invested in this approach.

Matthews & Kenny (2008) report that there are other countries which have some form of mandatory reporting legislation. These are outline in Table 1. Some of these countries do this by policy as opposed to legislation. Others have a voluntary system.

Mandatory by Legislation or Policy

Argentina, Armenia, Bangladesh, Belarus, Benin, Bosnia and Herzegovina, Brazil, Bulgaria, Canada, Chile, Columbia, Democratic Republic of Congo, Denmark, Egypt, England, Estonia, Ethiopia, Finland, France, Honduras, Hungary, Iceland, Israel, Italy, Japan, Republic of Korea, Lebanon, Malaysia, Mauritius, Mexico, Mongolia, Montenegro, Nepal, Peru, Philippines, Portugal, Romania, Russia, Rwanda, Serbia, South Africa, Spain, Turkmenistan, USA, Zambia

Voluntary Reporting Systems

Cameroon, China, Germany, India, Netherlands, New Zealand, Pakistan, Saint Lucia, Scotland, Singapore, Sri Lanka, Togo

Table 1: Reporting systems by legislation, policy or on a voluntary basis – Source: Matthews & Kenny, 2008

It is apparent in Table 1 that there are nations identified with poorly developed child protection systems.

Countries that use this reporting mechanism place an obligation on various professionals (such as doctors, teachers, social workers, psychologists, dentists and so on) while others also place an obligation upon all citizens.

It would appear that other countries have felt that this approach lacks evidence of effectiveness. Others feel that this approach has a tendency to increase the conflict between a family and the state, thus reducing the effectiveness of interventions.

Arguments in Favour

The prime argument is, as noted above, the need to protect children from abuse and neglect when primary carers are unwilling or unable to do so. While legislation demanding reporting cover all children who would fall within the child protection legislation, the main focus is around small children who would be otherwise incapable of telling about the abuse.

Yet, for older children, the harm may have become so normalized for them that they are unable to recognize that what goes on in the family is harmful.

A third argument is that children are often hidden within the family structure. Therefore, the risks that they live through are typically invisible to the larger society. When a professional finally sees them, the harm may have been going on for some time. The child may still be reluctant to disclose and thus it is up to the professional, as opposed to the child, to then take steps to protect.

It might also be argued that, in the absence of mandatory reporting, professionals may be very reluctant to report for fear that they will alienate the child and / or the family. The case vignette in box 1 illustrates the point. Professionals can feel very much caught in a bind between their loyalty to the child and family versus a professional obligation. Mandatory reporting takes the professional out of that bind.

There are other arguments that also favour this approach. Mandated professionals will tend to know the family circumstances or the risk factors in a way that leads to better and more detailed referrals to child protection. Thus, when a case is reported, the case has a far higher probability of being one that should truly matter to CPS.

 Dr. Paul Johnston has been seeing Evan, a 4 year old boy, as his patient since Evan was born. He has also been the family doctor for his mother, Betty, now 26 years old, since she was a teenager. Dr. Johnston has had some concerns with her parenting although feels that he has been able to give her good advice. While Evan has been a bit behind on his developmental milestones, with his advice, Betty has been trying to ensure that Evan gets the support he needs.

However, for the past 2 visits, Evan has had bruising on his stomach and buttocks that Betty says is the result of Evan falling while playing. To Dr. Johnston, these explanations do not seem to make sense given the injuries.
She has also told him that she has a new boyfriend living at the house. She says that Evan does not like him.
Dr. Johnston suspects that the new boyfriend is hitting Evan. He fears that if he calls child protection that Betty will be upset and stop coming to see him. He believes that he has a good relationship with her and has been able to help her be a better parent.
BOX ONE

The argument further goes on to suggest that the professional can then be used as an ally to help build better and more effective interventions given their knowledge of the family.

For many legislators, the approach has appeal as they can be seen as taking concrete steps to protect children. In general, this may then receive broad support in the community. It could be seen as offering a symbolic message to the community that abusive and neglectful behavior by caregivers should not be tolerated,

For many professionals, such legislation has a significant protection. They are typically protected from allegations of professional misconduct if they report in accordance with mandatory reporting guidelines.

Proponents of mandatory reporting suggest that it has the ability to increase the awareness of child abuse in the larger community. Thus, it can serve both awareness and prevention purposes. There are also those who would look at some of the major scandals of recent years such as the Sandusky matter in the USA, the Catholic church and other clergy in various parts of the world and the Boy Scouts in Canada and the USA as proof that mandatory reporting laws are needed. Yet some of those cases occurred in jurisdictions with such laws in place.

Arguments Against

Perhaps one of the most significant arguments that can be mounted is that mandatory reporting must be connected to a responsive child protection system that can effectively assess and intervene. If a system cannot manage the referrals, or if there is no effective system, then mandatory reporting becomes a futile effort. Building support of professionals, who are called upon to report, requires that they believe the cases are managed well. 

Reporters also fear that they will be identified leading to angry families then venting upon them. Many laws seek to protect the identity of the reporter. The context of the report can make it fairly easy for a family to determine who called child protection in many cases. In the same vein, it can also act as a barrier to families seeking help fearing that they will be reported to CPS (Munro & Parton, 2007)

Another barrier is when systems are over loaded and social workers face high caseloads. This means that reported cases may be poorly managed or not managed at all. Professionals will then wonder what was the value in filing a report in the first place.

This gets further compounded when the system receives more reports than it imagined would occur when mandatory reporting legislation was brought into place. Melton (2005) argues that abuse is a far more reaching problem than CPS can manage, particularly when neglect is included. This can get even murkier when cases that are being reported are a result of such societally systemic issues such as poverty and community disadvantage. There are also indicators that heavy mandatory reporting levels can result in serious cases being missed or receiving insufficient attention, to the detriment of the safety of the child.[1]

Other critics have argued that mandatory reporting, especially when it includes the public, leads to a number of cases being referred that simply should never be. Spiteful family members, former spouses, alienated parents can all become the source of reporting. This then causes limited CPS resources to be used for cases that should never be in the system.

A further argument against such a policy relates to the amount of training that is required to make such a system effective. Those that will be required to report need to understand what is required, to whom they should report and what they can expect will happen. Training costs are not one-time expenditures. People change, new people come, circumstances change – all leading to an ongoing training requirement. This can be expensive. Critics suggest that such monies are poorly spent, as there is little evidence that mandatory reporting actually reduces rates of child abuse and neglect (Centre for Social Research and Education, 2012). Training is also needed to ensure that there is some understanding about what is meant by various terms such as physical, emotional, sexual abuse as well as neglect. There may be other conditions that fall within the requirements that will also need explanation. Those who are required to report must understand what and when they are to do so.

The understanding of what constitutes abuse also changes over time. In some jurisdictions things such as exposure to criminal activity by parents, drug or alcohol dependency in the home, exposure to domestic violence are all examples of understanding that emerged in the relatively recent times. When mandatory reporting laws came into vogue in the 1970s and beyond, they followed the work of American pediatrician C. Henry Kempe and his colleagues who wrote about the Battered Child Syndrome (1962). They were concerned with physical abuse. Today, a much broader range of behaviors is of concern.

There also remains a question about what level of suspicion is required for a report to be made (Matthews & Kenny, 2008). Many who report may be quite confused about when a case crosses that threshold. These same authors also raise the question of the suspected timing of the abuse. Is it reportable if the abuse occurred at some time in the past or must the risk be a current one?

There are also forms of abuse that occur outside the family. Sexual abuse is such an example. The West has seen a series of very high profile cases that involve media personalities, coaches and clergy, for example. Critics worry about how far reaching child protection reporting should be as opposed to matters that more properly might be the domain of the criminal justice systems.  

Even for matters occurring within the family, there must be clarity as to who is to be included in such legislation or policy. Many might feel comfortable that a report under such laws should include a parent harming a child. What, however, if the perpetrator is a sibling? There are many approaches.

What about research on effectiveness?

There is little hard data that suggests mandatory reporting reduces the impact of abuse and neglect or benefits child protection systems (Centre for Social Research and Evaluation, 2012).  The Australian Doctor’s Fund (2009) reported that they were unable to find any substantial research evaluating the impact of mandatory reporting. What research does exist suggests that mandatory reporting leads to high case loads with large proportions of reported cases being unsubstantiated. Yet, valuable resources were undertaken in order to investigate the unsubstantiated cases (Delfabbro, Hirte, Wilson & Rogers, 2010).

Some data suggests that reporting to CPS is often more focused on disadvantaged and marginalized populations (Choate, 2013).

What would need to happen?

If a mandatory reporting system were to be introduced, there are several steps required:

·      Legislation would need to be clear on what is to be reported by who and to whom. The legislation will also need to be clear on the definitions of terms such as abuse, neglect, maltreatment and so on. It must also carefully articulate the persons who could be reported upon;

·      There needs to be a vibrant, structured child protection system that is capable of receiving, investigating and managing referrals as well as the follow up with cases where abuse is substantiated;

·      Training is required for all professionals who would be covered by the reporting requirement. This would need to be complex ensuring that reporters fully understood their obligation as well as the thresholds. Legislation is often vague leaving professionals unsure about the criteria;

·      Effective inter-agency communication protocols that ensure data can be shared with child protection workers and related care professionals;

·      Mechanisms for effective case load management. This would include means by which reports that come in from various sources can be collated allowing the investigator to build a comprehensive picture;

·      Follow – up procedures with mandatory reporters in order to build faith in the child protection system; and

·      Intervention services that are designed to assist families to correct and manage parenting risks.

References:

Australian Doctor’s Fund. (2009). Mandatory reporting – Does it work?  Author.

Centre for Social Research and Evaluation. (2012). Mandatory reporting: Literature snapshot – July 2012. Auckland, NZ: Ministry of Social Development.

Choate, P.W. (2013). Parents with Fetal Alcohol Spectrum Disorders in child protection systems: Issues for Parenting Capacity Assessments. First People's Child and Family Review, In press.

Delfabbro, P., Hirte, C., Willson, R. & Rogers, N. (2010). Longitudinal trends in child protection statistics in South Australia. Children Australia, 35 (3), 4-10.

Harries, M. & Clare, M. (2002). Report for the Western Australian Child Protection Council: Mandatory reporting of child abuse: Evidence and options.  Discipline of Social Work and Social Policy: University of Western Australia.

Kempe, C.H., Silverman, F., Steele, B. Droegmueller, W. & Silver, H. (1962). The battered child syndrome.  Journal of the American Medical Association, 181, 4-11.

Matthews, B. & Kenny, M.C. (2008). Mandatory reporting legislation in the United States, Canada and Australia: A cross-jurisdictional review of key features, differences and issues. Child Maltreatment, 13, 50-62. http://doi.dx.org/10.1177/1077559507310613    

Melton, G.B. (2005). Mandated reporting: A policy without reason. Child Abuse and Neglect, 29, 9-18. http://doi.dx.org/10.1016/j.chiabu.2004.05.005  

Munro, E. & Parton, N. (2007). How far is England in the process of introducing a mandatory reporting system? Child Abuse Review, 16, (1) 5-16.  http://doi.dx.org/10.1002/car.973

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[1] The author is presently conducting research in this area. This is one of the preliminary themes found in the data.