Parenting interventions can work --- and save money

Research published today in the journal, Research in Social Work Practice has shown that evidence based parenting interventions can save money and be effective. The frequency with which cases were subject to reinvestigation were reduced in the state where the program was used. Based on the Nurturing Parent Program (NPP) the researchers were able to show these gains. Not only are there economic benefits but one must also consider that this means less intrusion by child protection over the long term in many more families. It also means increased family preservation.

As other research has shown, keeping families together at a level that is at least good enough reduces other long term costs when compared with children raised in foster care. There is less difficulty with mental health, employment, school completion and crime. These cost benefits were not even considered in this current research.

Reference:

Maher, E.J., Corwin, T.W., Hodnett, R., & Faulk. K. (2012). A cost-saving analysis of a statewide parenting education program in child welfare. Research in Social Work Practice, published online 2012/06/13. doi: 10.1177/1049731512449873.

Assessing parent in drug manufacturing cases

Two colleagues and I have just published an article on assessing parents for child welfare in drug manufacturing cases.

Abstract

Child protection services frequently become involved with families engaging in substance abuse, and addiction, with a growing presence of drug manufacturing as an important component of the case. Assessors are called upon to consider how this impacts parenting capacity. However, while there are many protocols for assessing substance abuse and dependency, little attention has been paid to how to consider drug manufacturing and parenting capacity. The authors suggest a protocol that will guide assessors on determining the level of risk for children and the impact drug manufacturing may be having on parenting.

The article is published in the Michigan Child Welfare Law Journal in the Spring 2012 issue. It can be found at this link

Reference:

Choate, P., Harland, D. & McKenzie, A. (2012). Assessing parents for child protection in drug manufacturing cases. Michigan Child Welfare Law Journal, 14 (3), 10-19.

Dennis and Terence O'Neill

During World War II Dennis O'Neill was murdered by Mr. and Mrs. Gough. The death occurred in rural England. It occurred while these two boys were placed with them as foster children. During their stay with the Goughs, two other foster children were removed from their care as the home was deemed as quite unfit. Dennis died but his brother Terence barely survived. On the very, very few occasions that child protection systems interviewed the boys, they were either under the watch of the Goughs or were too afraid to speak up. The abuse grew over time until the brutal night that Dennis would be killed.

What is fascinating about this case is the amazing similarity to present day cases - children who were moved about within the foster care system; rarely seen by child protection workers; failure of information to properly flow between those who could have saved Dennis; failure to properly inspect the Gough house; failure to have the children properly assessed by a physician.

It is sad to see, some 60+ years later, the same mistakes being made by child protection systems.

Terence O'Neill has written an autobiography of his story in the book, Someone to Love Us. In it he tells of the unstable journey through the child protection system of the day. What is even more fascinating, is the story of his life afterwards. He wrote the book only a few years ago - in his seventies.  In the book, you get to experience the trauma and its legacies throughout the lifespan. How the damages of childhood becomes the hungry ghost of adulthood.

This is a book that anyone interested in child protection should read.

Liability Chill in child protection

The notion of liability chill is not unknown in various endeavours. Essentially, an enterprise begins to behave in a protective fashion to protect itself from liability claims. Often, this can mean conservative practices. In child protection, it can mean an increase in children being brought into care. It can also mean a risk aversive approach to clinical practice. Rather than take a reasonable chance on a parent or family reunification, it can lead to being more intrusive or taking longer to consider the possibility of return to parental care.

Two unrelated cases - one on the USA and one in the UK - may well lead to liability chill but, if looked at for the clinical lessons that both offer - should not lead there at all. Yet, both cases can scare social workers.

In the first case in North Carolina (the case of Aubery Kina-Marie Littlejohn), the child protection agency and social workers are being sued for the failure to protect a 15 month child from the fatal abuse of a parent. The Republic notes that:

The new complaint filed in Swain County Superior Court names the county DSS as a defendant along with seven current and former social workers, including the former head of the agency, Tammy Cagle. 

The lawsuit goes a bot further and raises an issue that is resonate across North America, Australia and New Zealand - the nature of child protection involvement with Aboriginal populations. In this case, the allegation is that not enough is being done to protect children within these populations. This is a dangerous approach - on the one hand, children regardless of where they live deserve a vibrant and effective child protection service. Thus, no part of society should receive less service. Yet, there is the real concern that child protection might target populations deemed less able to care for their children (see the prior post on racial bias). The Aboriginal populations have received racially based interventions. Care must be taken to not return to those ways. If this case were to succeed, it has the potential to raise the idea that Aboriginal populations may need targeted services. They do not need to be ignored but neither do they need to be singled out.

The second case in the UK has seen a social worker, David Alexander Fry, struck off as a registered social worker. He was found to have failed in many areas of practice. What is worrisome is that the General Social Care Council (GSCC) felt that it was the social worker's job to raise concerns that his case load was too high to manage. Perhaps so, but where was the responsibility of the management to effectively supervise the worker and manage the volume of cases assigned.

This is not to take away from the rather serious clinical failings of the worker. As CommunityCare.co.uk reports:

He also had a number of different team managers and received supervision only three times during that five-month period...“If the registrant was unable to keep up with his workload and record keeping, he should have done more to bring that to the attention of his managers, even allowing for the fact that those managers were constantly changing,” the committee said.

 That is bad management. A worker might well start to take cover and try to protect themselves in such a situation. Sure, good case management does that but so does "C.Y.A." case management. Clients suffer when that occurs. It is one thing to hold the worker accountable for poor social work - but do the same for poor supervision and management.

All of this is not to say that social workers should not be held accountable - like any profession they should be - but care should be taken to ensure that the liability is for the right thing.

Engaging parents in change

Research has suggested that the relationship between the social worker and the family is crucial for effective intervention in child protection. However, social workers often find themselves stuck in the dual role of both trying to assist a family and gathering forensic evidence. When parents perceive that the forensic role is the primary function, it will be hard for them to buy into the notion that the social worker is there to help. It's a bit like that old adage "Hi. I'm from the tax office and I'm here to help". Who of us feels like that is a likely outcome of a visit from the tax office. For many parents, they feel the same way with child protection workers.

With that in mind, an new article from the United Kingdom was most welcome. Platt, from the University of Bristol, addresses the conflict for parents. One area that he addresses that I think is most useful, is address the utility of the classic stages of change model that DiClemente and Prochaska wrote about. Platt suggests that it may not be appropriate for use as a model for this population. Of course, the model was developed for use with addiction.

It might be better to think about readiness for change.

We must also be wary of using engagement as the criteria for success in child protection. Is that doing what is needed to get the worker to go away or is it about meaningful change. Thus, what is happening matters more than the appearance of something happening.

Multidimensional or integrated models of engage- ment appear to offer the best way forward. Engage- ment with services is understood as a function of multiple influences, including caseworker and pro- gramme effects, as well as the circumstances of the client or patient and their interaction with those services (pp. 139-140).

Platt also reminds us that the focus of change needs to about the child - how is the intervention making the family system better for the child? Change that does not improve that may be good for the parent but child protection is about the child. Does the parent see the cause of the issues for the child as serious and thus believes that change is needed? Can the parent see that as important for the child?

Platt talks about several important factors to consider:

* internal and individual determinants;

* external determinants

* engagement as seen in behavior, attitude and interactional levels; and

* outcomes for both the parent and the child.

Platt also notes some research that helps us to understand how to work with mandatory clients. This improves engagement. He states:

Role clarification: Ensuring clarity about what the worker can or cannot do, what the client’s role is, and what each can expect from the other.

• Collaborative           problem         solving:           Providing       help    to address the problems that led to the current situa- tion; the worker needs to take a collaborative approach.

• Pro-social modelling and reinforcement: Identifying and trying to build on pro-social strengths, such as good relationships within the extended family. The worker should model ‘good behaviour’ by keeping appointments and doing what he/she said he/she would do.

• Challenge and confrontation: Extreme challenging is generally unhelpful although some level of chal- lenge is appropriate. Better outcomes occurred where clients believed that workers were clear about their own authority and how they might use it. (summarized from Trotter 2008). (p.146)

The point here is that effective case work can be done with mandatory clients when efforts are made to properly engage them.

Reference:

Platt, D. (2012). Understanding parental engagement with child welfare services: An integrated model. Child and Family Social Work, 17, pp. 138-148. doi:10.1111/j.1365-2206.2012.00828.x

Racial Bias in Child Protection

The question of racial bias in child protection is a crucial one that is not often subject to systemic research. There is an apparent case that it does exist as non-Caucasian children are over represented in child welfare systems in both Canada, Australia and the United States, for example. A question that is in need of review is whether this is due to racial bias or other factors.

In Canada, there has been a series of public policies that have targeted Aboriginal populations. The Residential Schools that ran for over 50 years (with the last one being closed in 1996) meant that several generations of children were removed from parental care. They did not get healthy, culturally significant parenting modeled to them. To the contrary, they received harsh, emotionally and physically abusive (and at times sexually abusive) caregiving. They did not receive the nurturing parenting that created a basis upon which they would know how to care for their own children.

Canada also saw the implementation of policies designed to remove large numbers of children from Aboriginal parental care and placing children in non-Aboriginal homes. This came to be known as the “60s scoop”. Australia saw some similar policies.

Research in the United Sates has shown that black populations are over represented in the child protection system there. Research by Berger et a., (n.d.) raised the question of whether this racial bias might be systemic. They concluded that racial bias is more evident when subjective decisions must be made.

However, their research also indicates that many of the expected bias results were better accounted for socio-demographic issues. Clearly, poverty is one of the most powerful. It can be strenuously argued that, if we really seek to address a lot of child protection concerns, we need to address the question of poverty. A significant portion of child protection caseloads involve economically distressed families. This is particularly so for questions of maltreatment. Thus, we may be bringing into care children because we are not prepared, as a society, to address these fundamental economic questions.

Research that I have reviewed in earlier blogs shows that children growing up in the care of child protection authorities tend to have much poorer long term outcomes as opposed to growing up in their own families. This is true even if those families are just good enough. Thus, the long term societal problems grow because we do not address the question of poverty. This can be construed in the classic economic argument of the rich v. poor and the need for the redistribution of wealth. Given the increasing gaps between the rich and the rest of society, that is a tempting argument.

But it is not one that is likely to influence present political structures where taxpayers are pressing government to be more frugal. We see economic collapses in major economies in several countries. Curiously, of course, such forces will increase poverty and raise the number of maltreatment cases that child protection must address. That in turn, will increase the cost to society.

In the alternative, child protection budgets may not increase resulting in changes to the kinds of cases the get opened. When resources are tight, the threshold for opening a case rises.

Rather than looking at the redistribution of wealth, one might also recognize that costs in the long term for taxpayers go down as we solve these poverty issues. Children who grow up in care cost us dearly – not just in the day to day costs of the state being their caregivers. They tend to have much higher rates of mental illness, crime, substance abuse, incarceration and unemployment. Their children are more likely to also be brought into care. This is very expensive.

Of course, this is not a new argument but it is one that has, thus far, fallen on fallow ground. As citizens, we have trained our politicians to look at shorter term outcomes because we want immediate results. Societies today have little interest in long term thinking. We want solutions now! These are problems that cannot be solved in the now.

Reference:

Berger,L., McDaniel, M., & Paxson, C. (n.d.). Assessing Parenting Behaviors across Racial Groups: Implications for the Child Welfare System. Unpublished manuscript. Downloaded 2012/05/26 at http://socwork.wisc.edu/files/race_parenting_SSR_final.pdf

Texas child death story highlights prevention need

A story appearing this week in San Antoni, Texas talks about continuing concern with the effectiveness of child protection to prevent the deaths of children from abuse by caregivers, mainly parents. The importance of the story is really the piece that does not get highlighted in the headlines. It is twofold - the impact of the economic failures in the past several years and the failures to properly fund prevention services.

When we look at the economic crisis that has been prevalent in the world economies, the abuse, neglect and maltreatment of children appears to be one of the consequences. Families most directly hit by the downturn find themselves struggling to put food on the table and provide shelter. These pressures create poverty induced effects on families that can bring child protection into the household. As a society, we need to face the crisis not as a family failure but rather as a failure of society. Too often, the marginalized populations find themselves involved with CPS. Social workers must respond to what goes on in the family, but when will we as a society be willing to address the root causes?

This leads to the second issue which is the underfunding of prevention services. When social policy is driven by the most recent child protection fatality, it is response services that get the funding. Certainly good funding is needed here so that caseloads are not out of control and CPS response times are reasonable. But good social policy is also about preventing problems through things like home care nursing, teen pregnancy supports, domestic violence interventions and so on. These programs help to reduce the need for child protection and will also aid in preserving family units which is the goal of most child protection legislation.

Too often, children are involved in child protection programs because of the pressures in families that arise from larger social issues that society is not addressing.