The impact of child abuse - greater than we might imagine

It became one of those quick national stories that flips onto the front pages for a day and is then lost. But that surely should not be the case with this one. A Canadian study soon top be published in the Canadian Medical Association Journal reports on the prevalence of child abuse and mental disorders. The results are profound.

The sample is based on just over 25,000 Canadians in 10 provinces (The 3 Northern Territories of Canada were not included).The authors looked at physical abuse, sexual abuse and exposure to intimate partner violence.  The adult responders reported on experiences before the age of 16.  Here's what they found:

1. The prevalence of any of the 3 types of child abuse was 32.1%, with physical abuse being the most common (26.1%), followed by sexual abuse (10.1%) and exposure to intimate partner violence (7.9%).
2. All child abuse types were associated with increased odds of all mental conditions (such as depression, bipolar disorder, generalized anxiety disorder, substance abuse and dependence, suicidal ideation and attempts, ADHD, Eating Disorders, PTSD, learning disabilities). 

These are quite profound numbers. It is highly probable that this data would be replicated in many Western countries that share similar family and parenting patterns. The costs (emotional, physical and financial) are astounding. Society is also paying a very large price for this through the health care, child protection, criminal justice and education systems. The strongest linkages that the authors found was between exposure to these 3 types of abuse and suicidal ideation, and attempts as well as substance abuse and dependence. 

Even more profound is the "…the least severe type of physical abuse (being slapped on the face, head or ears, or hit or spanked with something hard) showed a strong association with all mental conditions in models adjusting for sociodemographic covariates." In other words, even mild abuse has long term implications. 

This also brings us back to the spanking debate - minor abuse seems to be harmful. This research comes at a time when a study just published in the Journal of Family Psychology notes that in 73% of the cases where there was corporal punishment, the child misbehaved again within 10 minutes. That research is based on a small sample but it adds the very large body of research that tells us that spanking remains an ineffective form of parenting. The Canadian data also suggests that the impact may be long term and not what most parents would hope for - a greater risk of mental illness.

This research should help social workers and others working with families to underline why other forms of parenting and discipline are better for the child.

Aging out - or being dropped off?

A recent editorial on the US news network CNN spoke about the degree to which youth in child protection care are becoming abandoned as they reach the age of majority. There are certainly significant differences across jurisdictions, but far too often youth are told that, upon reaching that magic age of adulthood, that they must now find their pathway as an adult. Many do so with only scant resources to support the transition, although there are again differences between jurisdictions.

YouTube is full of stories about youth experiences, with many of them negative and disheartening. The CNN editorial offered some data that adds to the dismal picture.

This data mirrors longitudinal studies which have been done in the USA and the UK.

I find myself contemplating the aging out process at the same time as often seeing research and media stories that talk about how the generation presently growing up is living at home longer. They are taking more years to become independent facing tough challenges with employment and the cost of education. Yet we seem to expect that foster youth, who have typically faced significant emotional, mental health and physical challenges, are expected to do so much sooner. Greater disadvantage is heightened by this approach.

To change this requires taxpayers to understand that these youth need longer supports. Yet, they should be keen to offer this support given how much it costs to address the mental health, unemployment, jailing and early pregnancies that occur when supports are pulled before youth are ready to be independent adults. As a society, we are going to pay one way or the other. I suggest that longer supports to help foster youth make into the adult world is the cheaper option - and the more socially responsible one.

We need to get the attention of policy makers on this one.

Adoption breakdowns

New research in the United Kingdom is helping us to better understand what is most likely to lead to an adoption breakdown. These are tragic situations for both sides. It means that the child is no longer really a member of the family that many had understood at the time of the adoption would be their "forever" family. It also means that parents, who had taken the step of committing to a child, now face the failure which brings with it shame and guilt. There is also a myriad of emotions for the siblings in the family. For those who continue to live in the family, there can also be a sense of relief that problems with the now departed adopted child are gone. This too brings guilt.

The UK study looked at over 37,000 adoptions over a 12 year period. The rate of breakdown was actually low - just over 3%. The breakdowns tend to occur more often in the teenage years, particularly if the adoption occurred after the child was 4 years old. Adopting a teenager was particularly risky for a breakdown.

Some breakdowns were avoided because of the tenacity and commitment of the families - they were just going to get through somehow.

A summary statement about the report is particularly helpful:

Of those children whose adoption placements had broken down, 91 per cent had witnessed domestic violence and 34 per cent had been sexually abused before they were adopted. Mental health problems were prevalent in the children who had left home, with 97 per cent scoring in the clinical range of mental health problems (compared to 10 per cent in the general population) and a quarter had been diagnosed with autistic behaviours.

Violence was a significant factor in the young person leaving their adoptive home in 80 per cent of cases, combined with involvement in crime, life threatening self-harm and running away. Of those interviewed, 27 per cent of parents reported worrying behaviour shown by their child around the use of knives. Services did not know how to respond when it was a young person being violent to a parent. (Source - Science Daily)

This helps to show that what goes on before adoption has real implications for the post adoption reality. It also helps us to see that, when it is clear that a biological parent will not be able to look after their child, that child protection should move towards permanency as quickly as possible with a view to finding a solution that fosters the well being of the child. Kinship care and adoption are options that can do both.

This report also reminds us of the needs for post adoption supports to aid families through the kinds of crisis that can arise as children mature and are faced with the impacts of their pre-adoptoin life.

If you want to read the full report click here

The use of art for child sexual abuse investigations

Imagine you are investigating allegations of sexual abuse. You want to gain as accurate a disclosure as possible, with as much detail while still trying to ensure that the disclosure is truthful. The gold standard is the NICHD Protocol. But gaining a full picture may be aided by the use of drawing.

Three Israeli researchers have offered some fascinating insights in an article just published online in the journal Child Abuse and Neglect. They speak of the fine line that investigators must walk - gathering reliable information while also trying to focus on the wellbeing of the child. These can appear to be opposing forces. Just being interviewed by a social worker or a police officer can be traumatic in itself. Consider that many victims have been told that the activity must be kept a secret - and now these virtual strangers want you to tell. What an incredible conundrum for the child!

Drawing has been found to aid in recall and to offer richer descriptions of what occurs, particularly for younger children. But as these researchers note, non directed drawing is the way to go. Free recall yields better results as opposed to those that might be in some coached or guided.

These researchers sought to gain an understanding of of the consequences of the forensic interviewing for the child. They looked at before, during and after periods as well as comparing the experience of children who were asked to draw from those who were not. One finding that seemed particularly important is "Apparently during the investigate, drawing gave the children control and strengthened then during the process…" (p.8). The authors go on to say that "Following the interview, in response to free recall invitations, the children used three main words indicating their experiences following the investigation - relief, hope and success." (p.8).  However, children in both groups (whether they had drawn or not) also felt relief from the investigation. Age did not seem to matter suggesting that drawing was also useful for older children.

Succes was found to be more prevalent with children who had drawn.

What this research helps us to see is how important it is to not forget the various ways that children have to tell us their stories but also that their stories matter. We can get caught up in the forensic need to gather information while not giving the child's wellbeing the highlight that it needs.

Reference: Katz, C., Barnetz, Z., & Hershkowitz, I. (2014). The effect of drawing on children's experiences of investigations following alleged child abuse. Child Abuse & Neglect (In Press) http://dx.doi.org/10/1016/j.chiabu.2014.01.003 

Sibling Abuse as a Child Protection Issue

I recall some years back a family that I and a colleague were working with. Child protection had become involved due to parental behaviours. These were addressed and some significant progress was made. Yet the abuse of the younger sibling by his older brother continue. It was both physical and emotional - and it could be quite brutal. When we tried to raise it as a child protection issue, we were told that it did not fit within the mandate of child welfare. They saw themselves as protecting children from parental or other adult caregiver behaviours not those that occurred between siblings.  Things have changed in many places around this issue but research to be published soon in the journal Qualitative Social Work suggests that we have a long way to go.

There has been a number of efforts since the case I refer to above, but these authors tell us that even coming to agreement on what constitutes sibling abuse remains a challenge.

The researchers help us get a sense of how the victims in their study saw the abuse which, in this sample, went on for at least 5 years in each of the cases. (19 cases from which saturation was achieved).

 The participants in this study identified sibling abuse as physical or psychological torment involving brutal physical force or emotional devastation. It

created feelings of helplessness as victims were unable to protect themselves or

gauge and anticipate actions that incited an assault. Abusive sibling acts engendered a pervasive state of fear and vulnerability; they resulted in hyper-vigilance and feelings of loneliness and isolation when it occurred and which endured into adulthood.

In another powerful theme, the researchers found that the role of parents matters:

 In the families of these informants, limited social and economic resources and

marital strain made it difficult for victims to obtain critical support inherent to

development. Parents were unable to model positive communication or manage

interpersonal conflict and emotional turmoil productively. This inhibited their children’s ability to modulate their own emotional experiences and mitigate the effects of abuse.

For me, this really speaks to the nature of family systems around abusive behaviour. We tend to think of abuse between adults or from adults to children. But if abuse exists in a family system, why would we not expect it could happen between siblings. Indeed, this research found that other abusive behaviour was evident in at least half of the homes. Further, parents did not protect either by failure to act or by minimizing the abuse between siblings. For the victim, the whole of the family system was then unsafe making it hard for the victim to find or seek out safety.  The perpetrator may have even been in a preferred position within the family by comparison to the victim.

I agree with the authors that we must seek legislation in child protection that includes sibling abuse as one form of abuse that should be within the consideration of child abuse. We have a ways to go on finding workable definitions but that has not stopped us with other forms of abuse in a family.

Reference:

Meyers, A. (2014). A call to child welfare: Protect children from sibling abuse. Qualitative Social Work, online first. DOI: 10.1177/1473325014527332

Doing the same thing over and over expecting a different result? Insanity?

You might well ask this question upon reading the new report from the Irish Ombudsman for Children, titled A meta-analysis of repetitive root cause issues regarding the provision of services for children in care. While the title is not likely to push this report to the best sellers lists, it should be read by child protection agencies everywhere. The Ombudsman, Emily Logan, pertinently asks why the same issues are being investigated repeatedly. In many ways, this could have been asked in a multitude of jurisdictions.

The report identifies concerns in 7 areas:

1. Assessment and care planning - "Effective intervention for each individual child depends upon a clear assessment and understanding of his/her needs" (p. 11)
2. Record keeping - The report sees this as a way to help focus action.
1. plan work with service users;
2. aid assessment and decision making processes
3. monitor staff's involvement with service users
4. monitor and review progress of set objectives and goals
5. monitor and review plans for children
6. provide an accurate account to a child as to the decisions made in relation to them and why (pp.14-15)
3. Provision of residential care - this raises the concerns around multiple placements and those that are inappropriate  for the needs of the child
4. Child protection for children in care - on p. 18 the report states that "The previous life experiences of many children in care have exposed them to increased risk of victimization. They have the right to expect and receive protection from within the child care system.
5. Social work practice and supervision - The report outlines that the public have expectations of high quality service from well trained workers. "However, social work is not well understood and public confidence is frequently influenced by the media's handling of individual cases" (p. 19). In this section, the report goes on to state a crucial conclusion: "If alternative care arrangements (foster care and residential care) are to promote stability and resilience it must promote opportunities for children to develop secure attachments." (italics added). Too often the child is lost in the process and instability is the result of poor management.
6. Interprofessional and multi-agency collaboration - This is an issue that is seen in multitudes of reports on child protection errors.
7. Governance arrangements - a clear focus on why an agency exists and how it is fulfilling its mandate

The report makes a profound and often forgotten statement on p. 19:

It is important to recognize that social workers are the lead professional group which assists the Sate in protecting children from harm through neglect, abuse or exploitation

The report also does an excellent job of covering the international obligations for children arising from United Nations conventions that many countries have signed.

I am finally struck by the reports use of the term corporate parenting. This is a concept that is often lost. It is indeed the State who acts as the parent for children in care in most jurisdictions. How accountable is the state for its actions? This is an important question that we should be asking on a frequent basis.

This report is crucial. It asks the hard questions that need asking - particularly if we continue to repeat the same errors across multiple jurisdictions as my own research is showing.

Why are changes made in child protection?

I was intrigued by an article published recently in the journal, Australian Social Work. It asked the question - Driving child protection reform: Evidence or Ideology? The short answer is that, in this study of one change process, it was ideology. The article looked at the introduction of Structured Decision Making (SDM) in Queensland. The changes were made in response to significant scrutiny through public inquiry. Quoting Nigel Parton from the UK, the author, Philip Gillingham notes that change is often driven through "political imperatives to respond to the deaths of children at the hands of their parents" (p.1).

Gillingham also notes that change often leads to increased bureaucracy, manageralism, technical fixing as opposed to enhancing the skills that make social work effective. These approaches in response to public inquiry create a more formulaic approach to the work which reduces the relationship based effectiveness of our work. It creates more distance, more processes to be completed and checklists to manage as opposed to direct time with the client. Eileen Munro, also from the UK, earlier noted that social workers are spending less time with child protection clients and more time on the administrative tasks.

What really struck me, though, was the failure of the process in this case. On p. 6 of the article, Gillingham notes that the goal of the reforms in Queensland was to respond to the need for "a suite of professional practices and decision tools to help regulate, standardize and record the frontline decisions taken by Child Safety Officers" (quoting Forster, 2004). But Gillingham's research found "The SDM tools had had no discernible impact on the promotion of consistency in decision-making." He adds,. "The findings that SDM tools were not used to assist decision-making and did not promote consistency suggest that neither were they used to target the children most in need" (p. 8).

SDM has been used effectively elsewhere according to other reports. This article helps remind us that introducing change requires careful thought on how to support the real work of child protection. Other research has shown that when you allow workers to build relationships with clients where clients can feel heard, respected and seen for the own circumstances, you end up with better outcomes. Tools such as SDM should not be used to replace that but need to be part of a process that enhances what clients need. Those driving change feel that social workers make poor decisions and they need these structured tools in order to solve that. Gillingham's article notes, as has been seen in other research, that workers would go back and fit the data into SDM in order to support the decision they had already made - they were meeting the bureaucratic needs.

Reference: Gillingham, P. (2014).Driving child protection reform: Evidence or ideology? Australian Social Work, online first  http://dx.doi.org/10.1080/0312407X.2013.877948