Government economic policy as a social determinant to childhood maltreatment

This is a notion that has been written about largely in academic presses. A recent book by the English academic, Nigel Parton, who has written extensively on child protection issues in the UK has raised the subject again. The book is worth a read, but in particular is the final chapter which brings together how government policies can, in and of themselves, act as forms of child abuse - or at least as the social determinant of maltreatment.

Parton and others have noted that, as economies worsen, so do the rates of child maltreatment. The pressures on the poorer populations, those facing greater levels of marginal and challenging existence, will face extraordinary pressures that connect to maltreatment. Thus, government policies that make social security weaker, access to health care more difficult, reduce access to reasonably paying jobs are instigators of the social determinants of child abuse. Yet, in this world of renewed political conservatism, the answer is found in the belief that these people need to take responsibility for themselves and manage their lives better.

As the economic gap between the advantaged and the disadvantaged grows, the ability of the lower economic groups of people to just survive is a world of strain. As people like the Koch brothers pressure for policies that increase their advantage, there are direct costs to society at the other end.

There are other government policies that also are forms of child abuse. Consider policies that place parents in jail for a variety of minor crimes that are associated with economic survival. Consider three strike laws. Consider the utter failure of the war on drugs and the large numbers of low level dealers and users incarcerated. Consider minimum mandatory sentences that keep parents and economic family supporters in jail longer. Also consider the new law in Tennessee which jails a women who has used substances in a pregnancy.

The governments who drive these policies are done so by ideology, not science. It is known that increased rates of incarceration and longer sentences do not make neighborhoods safer. Yet, playing to ideology leads to ignoring science and doing it anyway. As Parton notes, when economic policy punishes the poorer classes through unemployment and restricted social service benefits, it is their neighborhoods that get more dangerous.

Child protection is mainly an activity that has the poorer or economically challenged populations at their doors more so than other groups. Most forms of child maltreatment are not from the more economically advantaged sectors, with the exception of sexual abuse which is more spread through the population.

Parton and others also note that child maltreatment is not just at the hands of family and that many others can threaten a child – such as institutional abuse as seen through the Catholic Church, the Boy Scouts and cases where the image of the abuser has caused a blindness to the behavior (such as Rolph Harris and Jimmy Savile).

This should cause us to think about the role that our institutions play in child maltreatment – government through its social policies and other institutions through their policies as well as the blind eyes to the behaviors of the

powerful. The highly influential and very rich who press government to engage in policies that are very much to their benefit, and at the cost of the lower classes, should also be thought of as child maltreaters through their approaches that create direct harm. When a company believes that its profits should not be reduced for a higher minimum wage, it creates further pressures in lower classes which is a further social determinant of child maltreatment.

This is not a polemic against profit and corporations. To the contrary, vibrant economies do reduce rates of maltreatment. It is a case against the “greed” that believes the income gap growing is justified regardless of the costs to others and the costs to children. This is not a socialist manifesto but rather a democratic one where the rights of all really do matter.

It is also worth noting from Parton’s book that the majority of cases of maltreatment are not known to child protection services. Child maltreatment may be a much more common form of parenting than we are prepared to acknowledge.  As he states on p. 182 of the book, referring to UK data:

“…only a small proportion of abuse ever becomes known to official agencies and is therefore included in official statistics. The research also established that in 22.9% of cases where a young person aged 11-17 was physically hurt by a parent or guardian, nobody else knew about it, as with 34% of cases of sexual assault by an adult and 82.7% of cases of sexual assault by a peer.”

Of course, this also tells us that there are risks for children that are very real outside of the family which says something about the real behavioral values of society. Peers are a major source of maltreatment but one has to ask where did that value come from. In far too many cases, they reflect what has existed in the family.

Parton also goes on to point out how much of the violence that occurs to children, from a parent or guardian or from a peer, is initiated by males. This is not to say that a female cannot and does not initiate violence, only that males continue to be the major source. Despite the myriad of social and public health marketing, we continue to fail to alter gender based violence. Very concerning indeed.

The child welfare bargain

On any given day, children are brought into the care of child protection authorities. The basis of most such cases surrounds the inability of the parent to provide appropriate care for the chid. The reasons can be complex but the "state" determines that removal is necessary. In doing so, however, the "state" enters in a bargain with the child - we, "the state" can do better. This bargain is at the heart of every removal so why do we talk about it so infrequently.

We live up to the bargain many times but there are far too many times when we do not. So what goes into the bargain:

1. We will provide a safe place to live - this is true most of the time but we know there are exceptions -- cases where the children are abused in alternative care; where conditions are deficient or, on occasion, dangerous.

2. Your life will be more stable - we fail in cases where we cannot offer a child a stable place to live over time. The bargain isn't just stability this week but as long as the child will be in the care of the state.

3. You will be cared for - but how does an alternate caregiver who cannot be sure that the child will be with them over the long term provide the kind of care that is found in love and meaning? It is in the day to day rhythm of the family that a child finds these moments - the hug; the desire to take the child along to events; the holiday and special family days. Alternate caregiver try hard in these areas but if the child is not a permanent part of the family, these efforts, no matter how well meaning, lack depth.

4. We will give you a good education - this is more than just access to a school. If there is instability in placement, then there will often be instability in schooling. I recall one foster youth saying that she did not really bother making friends at school because she knew she wouldn't be there very long.

5. We will help you get on life - this means being able to finish high school but also the transition to adulthood. A child in care faces aging out when they are no longer part of the child welfare system. This means that placements come to an end. This is crucial in an era when more and more youth are taking longer and longer to leave home. Many who do leave find themselves coming back home for periods. It is taking longer to build firm roots in adulthood. Who does the foster child come back to?

6. We will look after your needs - a traumatized child coming into care requires long term mental health supports. Can the child count on that?

7. We will try to get you home to your family - But has the family changed in a way that the chid can count on being able to stay there? Or will the child become part of a revolving door where they will go in and out of care? In other words, will the family truly be offered the supports it needs to have the child back? Will those supports last long enough for change to become engrained in family life?

8. While in care, you will be allowed to be who you are - this would mean placing a child of colour or an Aboriginal child in a home where they will feel culturally connected and not the odd one out.

9. You will be allowed to disagree with the decision - and this will be done in a way that will not patronize you.

10. Your voice will matter enough that it will be heard often by social workers who will spend time with you on a regular basis.

There are no doubt more points but I think the essential message is there - if we truly intend to live up to the bargain then we must invest in creating a world for the child that is truly better while also trying to allow the child to be connected to family. It's a big deal!

Opposing forces in child protection

There are some challenging opposing forces that case managers in child protection must constantly juggle.

10 Thoughts about Child Protection

I was asked by a group of students to offer some ideas about things that social workers should think about as they consider entering child protection work. Here is the video that raises some questions - I don't expect that everyone will agree with all of these ideas. These are issues that require conversations as we think about child protection.

I would welcome any thoughts you may have.

The law is a blunt weapon to be used carefully

The Guardian newspaper in the UK is reporting on a proposed law in the state of Victoria, Australia that would create a criminal offence for anyone knowing of child abuse to not report it. Earlier this month, The Huffington Post told of the law passed in Tennessee that would allow the incarceration of women abusing drugs while pregnant.

Both of these legislated actions are well meaning. One is designed to ensure that children can be protected from the impact of drug abuse prior to birth. The other is designed to increase the rate at which abuse is reported and can thus be addressed. Yet both fail due to the unintended consequences. They are the actions of politicians who grasp on to a problem and then seek the simple answer. They are able to justify the action based upon the desirable goal - reduce harm to children.

What is so often missed though, are the unintended consequences. Let's look at the notion of incarcerating a pregnant women. As a student in one of my classes pointed out when we were discussing this, what stress arises for the mother being in jail? How will that impact the baby? How will withdrawal be managed in jail? I also wonder about the capacity of many jails to be drug free.

The Australian example raises a number of questions for non professionals. Does this mean that the neighbour who suspects that abuse is going on would be charged because they did not report suspicions? What of an adult child who has been the victim of abuse, knows that the abuser is still doing it, but still believes the threats to kill that the abuser has held over the victims head for years? What of the spouse who lives in terror of what will happen to her and the children if the abuser is found out - as the abuser has warned her that he will kill her and the kids? Or the mother who has been told by the violent partner that if anyone finds out she will never see her kids again? Are these people to be criminalized?

Putting someone through the criminal justice system, putting someone in jail, costs a lot of money. Why not spend that money on health care, rehabilitation and safety services? In other words, why not do something that will really help?

If you incarcerate pregnant women using drugs, then you drive them away from services that can address the addiction or substance abuse. If you criminalize a victim of abuse who was too afraid to tell, then you drive the victims further underground.

Let us not also forget that when you put people in jail, you fracture families. This too is an unintended consequence of these actions creating more victims - the children left behind. The policy makers should  be asking with each proposal - is this the best solution available? 

The war on drugs is a war on children

There have been two publications in the past week or so that have struck me as profound evidence that the war on drugs is an utter failure. Let me say up front, I see addiction as a health issue.

The first report is from The National Academies and is a report titled, The growth of incarceration in the United States: Exploring causes and consequences.  It points out that the USA incarcerates more people than any other country in the world and that drug issues are the prime reason.  The report concludes:

The change in penal policy over the past four decades nay have had a wide range of unwanted social costs, and the magnitude of crime reduction benefits is highly uncertain (p.7)

The report also brings into question mandatory minimum sentences and long sentences. They note that incarceration is used when there are less intrusive and more beneficial options.  If imprisonment is not reducing crime, then why use it as the prime response pattern. Insanity is defined as doing the same thing over and over expecting different results.

The second report comes from the London School of Economics titled Ending the drug wars. It concludes:

The pursuit of a militarised and enforcement-led global ‘war on drugs’ strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilisation in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world. 

These reports tells us that, despite over 40 years of prohibition and interaction as the prime social policy approach for which literally billions of dollars have been spent, we have not been successful in even reducing the problem. The LSE report notes that prices have been falling while purity has been increasing.

What neither of these reports talk about directly is the impact that the prohibition approach has on children:

1. When a parent is incarcerated, the child essentially loses the parent. When incarceration is for long periods, then the child must go through a grieving process that leaves the child with an emotional hole. As the Adverse Childhood Experiences research shows, incarceration of a parent has long term impacts;
2. The child is more likely to exposed to violence when a parent has an active addiction as the parent must go through illegal channels;
3. The family system lives in fear when the addiction is present but health resources are seriously underfunded;
4. Incarcerating a parent is more likely to impact the child's economic survival;
5. More chance of being brought into care

We also know that untreated addiction has long lasting impacts on a child. Thus, if we shift our focus to one where health resources are enhanced, then the impact on children will be more intact families and more present parents. As well, rehabilitation is likely to be much less expensive.

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.