Richard Dawkins just has it wrong

Speaking in an interview with Times magazine, author Richard Dawkins stated:

‘Just as we don’t look back at the 18th and 19th centuries and condemn people for racism in the same way as we would condemn a modern person for racism, I look back a few decades to my childhood and see things like caning, like mild paedophilia, and can’t find it in me to condemn it by the same standards as I or anyone would today.’

At one level, it is perhaps easy to see the merits in Dawkins argument - times change and so do standards of what is and is not acceptable. Yet, he suggests that what took place 50 or 60 years ago represented such a different standard that sexual and physical abuse should be seen as indicative of the times.

Richard Dawkins

The Sovereign Independent goes on:

In a new autobiography Professor Dawkins told how a master at his Salisbury prep school had pulled him on to his knee and put his hand inside his shorts’, adding that other boys had been molested by the same teacher.

While he said that he had found the episode ‘extremely disagreeable’ he wrote: ‘I don’t think he did any of us any lasting damage.’

Those of us who work in and around child protection have worked with enough parents from that age to know that they live with the haunting memories of the abuse from those times. In my view, Dawkins minimizes the impact but also creates a patina of acceptance for what took place. Consider the following:

• In Mount Cashel orphanage in St. John's, Newfoundland where state wards were routinely physically and sexually abused by the Christian Brother's of Ireland. This occurred through the 1950's;
• How about the literally hundreds of victims of Jimmy Savile in the UK;
• In Canada, there were several churches involved in the residential schools where Aboriginal children were stripped of their identity and dignity through neglect, physical and sexual abuse;

These are but three high profile cases amongst thousands that could be added to the list. But most importantly, Dawkins fails to see that what he is describing is the abuse of power by a teacher who is engaged in grooming a child towards greater sexual involvement. In his case, it may have stopped for any number of reasons. One can almost be certain that the teacher he speaks of has other victims, some of whom would have been less fortunate than Dawkins.

The clinical research tells us that those who use their position of authority to take sexual advantage of a minor, typically have several victims. In order to help reduce this type of sexual abuse, we need to educate children about both protecting themselves and being open about advances that may occur. As a society, we also must respond to those who do offend. Seeing it as Dawkins describes it is dangerous as it dismisses the importance of the offence.

Dawkins says that he got over it - maybe he had a good support network; had resiliency; had a way to compartmentalize the event - but for millions of others, these sorts of events have created life long damage that has impacted their lives in multiple ways.

In essence, he has become the apologist for the abusers. That is the most dangerous aspect of his thinking.

Coincidentally, some rather poignant research was published in Frontiers in Psychaitry:

Child sexual abuse (CSA) occurs frequently in society to children aged between 2 and 17. It is significantly more common in girls than boys, with the peak age for CSA occurring when girls are aged 13–17. Many children experience multiple episodes of CSA, as well as having high rates of other victimizations (such as physical assaults). One of the problems for current research in CSA is different definitions of what this means, and no recent review has clearly differentiated more severe forms of CSA, and how commonly this is disclosed. In general we suggest there are four types of behavior that should be included as CSA, namely (1) non-contact, (2) genital touching, (3) attempted vaginal and anal penetrative acts, and (4) vaginal and anal penetrative acts. Evidence suggests that CSA involving types (2), (3), and (4) is more likely to have significant long-term outcomes, and thus can be considered has having higher-impact. From the research to date approximately 15% of girls aged 2–17 experience higher-impact CSA (with most studies suggesting that between 12 and 18% of girls experience higher-impact CSA). Approximately 6% of boys experience higher-impact CSA (with most studies suggesting that between 5 and 8% experience higher-impact CSA). The data also suggests that in over 95% of cases the CSA is never disclosed to authorities. Thus, CSA is frequent but often not identified, and occurs “below the surface” in the vast majority of higher-impact cases. 

This research emphasizes the long term impact of sexual abuse in most cases.

Reference for research

Martin, E.K. & Silverstone, P.h. (2013). How much child sexual abuse is "below the surface" and can we help adults identify it early? Frontiers in Psychiatry. published online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711274/

 

Are we making progress with sexual abusers of children?

There is likely no topic that can stir a highly charged debate like the one around sexual abusers of children. I am careful to not use the word pedophile as the broad descriptor as they are a subset of the sexual abusers of children. A pedophile has a sexual orientation to children whereas not all sexual abusers have that.

None the less, there is a major abhorrence of sexual abusers in our society. There is a strong sentiment against them that might be summed up as, "Throw them in jail and toss the key away." The research, however, offers a somewhat different view.

There is not doubt that sexual abuse is prevalent. It is estimated that up to 20% of women and around 8% of men report that they have been abused prior to age 18. There are some highly visible examples such as with the Catholic Church, Jerry Sandusky, the former UPenn coach, the Boy Scouts of America, Jimmy Savile in the UK, all coming to mind.

As well, the long term consequences of sexual abuse are significant in both physical and mental health. Some victims of sexual abuse will also go on to become perpetrators.

With all that in mind, I was fascinated to see research published by Langstrom et al., in The British Medical Journal. It looked at the data on preventing sexual abusers of children from reoffending. Overall, they did not find that there was significant research to conclude that many interventions have an evidence base to support that they are effective. There is simply a significant need for well designed research to help answer the question. This was a rather disappointing conclusion.

There were a few points in the article that merit specific mention:

1. The observed rate of re-offence for sexual abusers of children is low. One study with a sample size of 9,603 found only 12.7% re-offended after 5 years. Yearly hazard rates are less than 3%;
2. Treating all sex offenders alike is dangerous. By low risk offenders with high risk offenders we create a significant concern of increasing the risk level of the low risk offender - a contamination effect;
3. Even keeping low risk offenders in long term therapy may increase their risk;
4. The Risk, Needs and Responsivity principle is important - offenders should be matched with treatment that matches their level of risk; the specific treatment needs of the client and their responsivity to intervention.

To be as effective as we can be with sexual abusers of children, we need to understand more, but also be sure to apply what we do know. Policy should be driven by the research. There is no taking away the pain of sexual abuse. Effective intervention with offenders is one of the tools we need. We have yet to develop effective prevention tools that reduce the frequency of sexual abuse. As the authors note, rates of abuse have not differed substantially in recent decades (although regional variations exist).

Reference:

Langstrom, N., Enebrink, P., Laure, E., Lindblom, J., Werko, S. & Hanson, K. (2013). Preventing sexual abusers of children from reoffending: Systemic review of medical and psychological interventions. The British Medical Journal, 347, f4630.  http://doi.org/10.1136/bmj.f4630

Access to children after Termination of Parenting Rights

When courts terminate parental rights (TPR), the prevailing wisdom has been that the connection between the parents and the children will typically be severed. Exceptions might occur when the children are placed in kinship homes with extended family who may offer some connection. This is often the case as TPR is usually a last resort that has followed a variety of efforts to help parents change. After all, the goal of most legislation is to try and sustain families through a variety of family preservation programs.

TPR is often associated with unmanageable or unmanaged mental health, addictions or family violence as well as chronic neglect. Quicker efforts to TPR can occur in cases of serious physical harm or sexual abuse. Thus, the prevailing wisdom associated with no contact with biological family has made some sense.

Yet, there are situations where contact may make sense. When extended family is willing to act in the role of primary caretaker while accepting that the biological parent has significant limitations that preclude acting as caregiver, then contact can be managed. Extended family keeps the child safe and looked after while also allowing the child some level of relationship with the parent.

There are also cases where the parent, later on, takes steps to address the problems. What then of a parent who sustains sobriety later?

In this day of social media, it is much easier for children to find their biological roots. Searching in Facebook, Google, Linkedin and so on can yield connections. Children often want to know their roots and go looking. I have seen this in several cases.

Then there is the reality of small towns and rural areas. I recall a case where the foster home was only a few blocks away - inevitable in the small community. The child exercised the "right" to see the parent by just walking down the street. In that case, counselling to help the child understand the risks while also managing the relationship was the best solution.

It may be different when the child is an infant or toddler, but it becomes much more problematic with older children. This is a challenging discussion but it is one that we need as the new ways for children and parents to find each other demands that we rethink.

Child protection industry conspiracy

Having your parental rights to a child terminated must be a traumatic experience. Whether the parent has intentionally abused a child, suffered from serious mental health issues or intractable addictions, there is a permanent hole in the parent's life when a child is lost to them. Even parents who have children removed on a temporary basis, still get up in the morning and see the place where the child used to sleep and feel the loss. Taking a child into care is a step that impacts all involved.

However, there is also a belief amongst some that child protection workers are somehow rewarded with removals and the subsequent adoption of children. Some theorists argue that funding formulas, such as those in the USA, support states taking children into care as opposed to leaving children in families and then trying to improve the family situation.

An example of this thinking can be found in a YouTube video Documentary on the Child Protection Industry. It is not that well done, but it certainly illustrates the thinking.

Critics are able to point to some high profile cases where child protection really did get it wrong. An example is the death of Logan Marr. She was placed in foster care. The foster mother, who was also a former child protection worker, was subsequently convicted of killing Logan. The PBS program Frontline has done a documentary on the case.

Logan Marr

There are many other cases where errors have led to high profile media reports. Like any system, a child protection system is going to get it wrong at times. The challenge of course, is that the price of errors can be high. At the same time, little pubic attention is given to the multitude of cases where things go well and sometimes, brilliantly. Little media time is given to the child who is alive and well today because of CPS interventions.

Child protection workers are constantly walking the line between protecting a child and preserving a family unit. Most child protection legislation seeks to have this balance tip towards family preservation. The appropriate standard for a parent to keep raising the child is not perfection or even being close to it. The standard is good enough.

As my colleague Sandra Engstrom and I are noting in an article we are preparing for publication:

Budd, Clark & Connell (2011) identiCied three domains that they concluded formed elements of minimally adequate parenting. These include:

• meeting the physical needs of the child including the provision of a stable and safe home environment as well as meeting such things as medical and dental needs;
  
• providing for the cognitive and developmental needs; and
  
• addressing and responding to emotional needs including affection and sensitivity, appropriate discipline in order to promote positive behavior (p. 105).

 These same authors also suggest that issues of fit between parent and child form part of minimal parenting capacity. These include child factors such as the developmental stage of the child and the presence of any special needs. Can the parents meet both the needs of the child as well as their own needs? These authors further note that environmental considerations come into play such as culture, socioeconomic status and interpersonal stressors (p. 105). 

However, to suggest that child protection workers, in general, seek to remove children in order to meet the needs of adopting parents, as the above noted documentary suggests, is not supported in any credible research I have been able to find. No doubt, there are some outlier cases where this may appear to have occurred, but there simply is not the evidence to suggest that this is a goal of child protection. Yet, those who have been affected by CPS can well feel aggrieved and seek to shift blame.

My research focuses on child protection errors - cases where they indeed got it wrong and children have suffered. Yes, there are definitely cases of practice errors - Logan Marr is one of those cases. Many errors occur, however, due to systemic problems such as high case loads and insufficient funding of CPS and the intervention systems that can help families.

Social work needs to keep working on the practice errors. Like any system, engineering, aviation, medicine, the profession must learn from its errors. That is essential.

Allegations of conspiracy to take children in order to support adoptions as well as the employment of social workers and other allied mental health professions does little to advance an understanding of the errors. Yet, within their criticisms can be found some powerful areas for discussion as well as an understanding of the deep pain that parents feel who lose their children.

Daniel Pelka: The power of parental evasion and deceit

There has already been much written about the murder of Daniel Pelka. I obtained the sentencing remarks of Mrs. Justice Cox when she imposes a 30 year minimum. She reviews the evidence in her 6 page statement. It is gruesome reading. Within it, are a few powerful lessons about how this case has been evolving. The Serious Case Review which is likely to be published next month will add more details.

The urine stained mattress; the door of the room Daniel was kept in with interior handle removed and a

model of how emaciated he was at death

Yet, some of what Justice Cox has to say reminds practitioners of just how duplicitous parents can be, particularly when they are engaged in a campaign of torture as was happening in this case. The decision outlines how the mother and step father lied, avoided contact with authorities. When they did have contact, they created stories that were just plausible enough.

These caregivers, step father Mariusz Krezolek and mother Magdelan Luczak, if they can be called that, picked on Daniel as opposed to the other children making him the targeted child. Justice Cox seems perplexed at this but it is not an uncommon phenomena. She also notes that the siblings were coached to tell the story that the parents wanted told. These combined efforts made piercing the veil to find the truth difficult. Certainly there were signs that the Seroius Case Review will probably highlight.

Parents who engage in this behavior are more difficult to work with, and even get any meaningful connection in the first place. They may be amongst the hardest population to gain any significant relationship with, much less progress.

Mariusz Krezolek, the step father,  testifying before Mrs. Justice Cox

Some examples from Justice Cox's decision:

Both of you constructed a careful and wholly untruthful account that Daniel had a serious eating disorder and learning difficulties, which he may have inherited and for which he was receiving medical treatment. This account was deliberately designed to prevent interference by school, medical and welfare personnel, and to perpetuate the brutality being meted out to him. You instructed and encouraged Daniel’s older [sibling] to tell lies to the authorities if she were asked any questions about what was happening at home.  (p.3)

I am in no doubt that, before you made that call, you had deliberately planned the detailed lies you would tell in an attempt to deceive the authorities and save your own skin. That plan was put into action even in the call to the emergency operator. 

Before your arrest you made concerted efforts to remove evidence by deleting the computer search history, attempting to tidy the house and concealing the stained mattress from the box room. You lied persistently when you were interviewed by the police. (p.4)

Both of you carried out a deliberate and cynical deception of teaching, welfare and medical personnel, which was designed to conceal what was happening, to prevent any help being provided for Daniel and to enable you to continue your ill treatment of him without interference. You instructed and encouraged Daniel’s older [sibling] to tell lies to anyone in authority about what was happening at home. 

Once you became aware that Daniel had stopped breathing, you made a concerted and deliberate attempt to deceive the authorities from the outset, and to seek to remove evidence of your involvement in Daniel’s abuse and death. (p. 5) 

The media has also noted that the mother kept Daniel away from medical care, missing appointments and avoiding contact.

There are deficiencies in how people did respond to what was before them. But, in my view, we must also bear in mind that parents can put up significant barriers to accessing children. We must not be daunted by the barriers but, rather, be prepared to challenge. Having an empathic mind in child protection is important, but so is having a curious one where you challenge the data before you - ask whether it makes sense? Does the explanation intuitively seem to explain or is it off?

I raise the notion of intuition because, at times, it is paying attention to our gut feeling that can cause us to ask further probing questions.

This is a case where there were opportunities to ask - the paediatrician who saw Daniel shortly before his death; school officials who saw many signs of concern (bruises, stealing food, eating large quantities when he could get food, rummaging for food in garbage cans, declining attendance). A curious mind might well have probed beyond the parental explanations. Assembling even the school data might have caused one to say, "There is just too much going on here." Yet, the mother suggested that there were problems and that she was getting help from a doctor. Just the kind of response that assures an observer that the issues are known and being taken care of.

It will be easy to point fingers in this case. I hope that those considering it will not lose sight of the power of parental evasion and deceit which can be very effective in keeping inquiring eyes away.

Child protection's inconvenient truth: Is Daniel Pelka an example?

Media in the United Kingdom are swarming around the death of Daniel Pelka. He was four years old at his death at the hands of his mother, Magdelena Liczak and step father, Mariusz Krezolek, . They have now been convicted of his murder. He was starved and treated cruelly for at least 6 months prior to dying.

Daniel Pelka

The media reports are slowly leaking into Canada, although they are not creating the sensation that even a casual reading of UK papers suggests is going on there.

There is a serious case review in the matter, but its publication has been delayed until next month. Apparently the SCR panel learned information in the trial that it must now consider. That, in itself, is a fascinating statement suggesting that those working on the case had information gaps. At this point, it is not clear the child protection had a significant, or even any role in the family. The case is, none the less, highly reminiscent of many cases such as Jeffrey Baldwin, Victoria Climbie, Khyra Ishaq, Logan Marr and so on. Here in Canada, we have another tragic case subject to a public review that has just finished up. This is the case of Phoenix Sinclair. It will be several months before we hear what the commissioner, Justice Ted Hughes has to say.

In all of these cases there are valuable lessons to be had on child protection practice. These cases highlight the ways in which case management and interventions can go wrong. They also help us to see the sorts of common errors that occur. It is those errors, in particular, that need avoidance.

Cases such as these raise the delicate balance between protecting children and preserving families. The challenge with these cases is that they inevitably result in several things:

1. A scapegoat will be sought. In Daniel's case, the politicians are already doing this;
2. In some fashion, a politician will also state that the protection of children is paramount and that they intend to get to the bottom of this so it will not happen again;
3. New procedures will be introduced, manualized and bureaucratized; 
4. New training will be recommended; 
5. Social workers will become wary and fearful of making a mistake; and
6. Another child will die.

I am reminded of the article by anthropologist  China Scherz in the United States who looked at how social workers try to put into place good judgement while also trying to manage that balance between protection and family. She looked at the introduction of actuarial tools to help better identify risk. Her article is well worth reading. What one concludes is that there is a real risk that we create what looks to be science (e.g. actuarial tools, structured decision making processes, formal assessment processes) which mask the reality of child protection in science. It is a false mask.

While I am a supporter of these various types of tools, there is still the reality that a front line worker is going to have to make decisions from that information - leave the child in the home? close the file? remove the child? offer services? Scherz's article shows that this still is a very individual decision that a worker must make, and that there can be a wide variance in the ways that workers see a case.

There is no way to remove the worker and the personal decision making from the work. Workers bring training, experience and, yes, beliefs into the day to day interaction with families. No matter how much structure and science you try to wrap around that, this truth remains.

Which leads to the inconvenient truth in child protection - mistakes will be made, children will be subject to further abuse and maltreatment that might have been avoided if a different decision was made, and a small number of children involved in child protection will die - but most will not.

To expect perfection in child protection is unrealistic. Let these tragic cases continue to serve as educational opportunities so that the common mistakes can be highlighted and the highly unusual errors can also be brought to light.

Reference:

Scherz, C. (2011). Protecting children, preserving families: Moral conflict and actuarial science in a problem of contemporary governance. PoLAR: Political and Legal Anthropology Review, 34 (1), 33-50.

Know thy case - History does matter

It was several years ago that I was watching the Canadian Broadcasting Corporation program, The Fifth Estate and its story on the death of Jeffrey Baldwin. I have written in an earlier post the full details of the death, but simply put, as the CBC summed it up, Jeffrey died of starvation at the hands of his grandparents in one of the world's richest cities, while those who could have stopped it did not.

Like all cases where a child dies with child protection involvement, there were many factors at play. One was certainly information that was buried in child protection files about past convictions for child abuse involving both grandparents. In addition, there had been some form of parenting capacity assessment that had apparently concluded that the grandmother was unfit to parent.

Jeffrey Baldwin

I was reminded of this as I read an excellent review from Child Family Community Australia titled Rarely and Isolated Incident. One of their main conclusions:

Practice and policy responses to children who experience single maltreatment events should be different to those for children who experience multiple maltreatment events. Survivors of multiple maltreatment events are more likely to experience complex trauma and the negative effects of cumulative harm, both of which require more comprehensive intervention and treatment. 

They note that there is a lack of success in interventions with children when maltreatment or abuse are seen as isolated or single events. They identify that research shows quite the opposite - that the majority of children experience multiple events and often in multiple forms.  They also note that children who have these experiences inside a family are also quite vulnerable to experiencing them outside the family as well.

Drawing upon a wide body of research, the authors take time to share with the reader the various important categories that child protection workers must consider when assessing the histories of children:

1. multiple type maltreatment which would include sexual abuse, physical abuse, psychological maltreatment, neglect along with witnessing domestic violence;
2. polyvictimisation which outlines how a child may have various sources of maltreatment within the family and the community (including bullying);
3. complex trauma which is greater than presently thought of through the lens of Post Traumatic Stress Disorder (PTSD). It involves disturbances to the cognitive, affective and behavioral dimensions of a person's life. This reflects the prolonged nature of the disturbance and the impact on multifactorial functioning on into adult life. Psychological and physical health are impacted. This is combined with high rates of subsequent victimization in adulthood;
4. Cumulative harm describes both the cumulative harm of multi victimization along with the multiple harms of multiple types of maltreatment from multiple sources. However, cumulative harm can also occur with multiple victimizations to single perpetrator events (the victims of Ariel Castro come to mind).

The implications for practice are profound, not the least of which is that, given the high probability that single maltreatment events are low, that investigation should seek to consider a longitudinal view of the child and family. Maltreatment should not be seen as a discrete event. That a previous complaint led to investigation, services and file closure should not suggest that this meant the issues were resolved. Research keeps telling us that many of the interventions used in child protection are not leading to long term changes in many families.

For clinicians, this also means that there is a need to think about the ways in which therapy is approached. Psychological, behavioral as well as developmental concerns are likely requiring attention in the recovery process. My own work with assessing and treating those with addiction (both in and out of the child protection system) speaks to the validity of seeing these four categories as extremely relevant to our work.

Reference:

Price-Robertson, R., Rush, P., Wall, L. & Higgins, D. (2013). Rarely and isolated incident: Acknowledging the interrelatedness of child maltreatment, victimization and trauma. Melbourne: Australian Institute of Family Studies