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INTERNATIONAL PERSPECTIVES ON CHILD PROTECTION
REPORT OF A SEMINAR HELD ON 20 MARCH 2002
Part of the Scottish Executive Child Protection Review PROTECTING CHILDREN TODAY AND TOMORROW
Edited by Malcolm Hill, Anne Stafford and Pam Green Lister Centre for the Child & Society University of Glasgow With papers by Adam Tomison Evelyn Khoo, Lennart Nygren and Ulf Hyvönen Catherine Marneffe Andrew Cooper
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CONTENTS
Contributors to the Seminar Page No
Part I – Summary of key issues 1. Introduction and summary of papers…………………………
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2. Issues highlighted and discussed by seminar participants……
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3. Conclusions……………………………………………………
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References for Part I………………………………………………
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Part II – Plenary papers 4. Child protection and child abuse prevention “down under”. Key trends in policy and practice, Adam M Tomison…………
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5. Child welfare or child protection. A comparative study of social intervention in child maltreatment in Canada and Sweden, Evelyn Khoo, Lennart Nygren and Ulf Hyvönen……
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6. Voluntary Child Protection Work in Belgium, Catherine Marneffe…………………………………………….
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7. International perspectives on child protection, Andrew Cooper…………………………………………………
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Contributors to the Seminar ADAM M. TOMISON is the Research Advisor for Australia’s National Child Protection Clearinghouse, and a Senior Research Fellow at the Australian Institute of Family Studies. LENNART NYGREN is Professor of Social Work in the Department of Social Welfare at the University of Umeå, Sweden EVELYN KHOO was formerly a child protection worker in Ontario, Canada, and currently carrying out research at the University of Umeå, Sweden. CATHERINE MARNEFFE is Director of the Paediatric Medical Centre, Clairs Vallons, Brussels, Belgium. ANDREW COOPER is Professor of Social Work at the Tavistock Centre, University of East London, England.
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PART I – SUMMARY OF KEY ISSUES CHAPTER 1. INTRODUCTION This report provides an account of a seminar about international perspectives on child protection, held on 20 March 2002. The report includes copies of the four plenary papers presented at the seminar, together with summaries of the main discussion points and implications. The seminar was organised by the Centre for the Child & Society on behalf of the Scottish Executive as part of the Executive’s review of child protection arrangements in Scotland, Protecting Children Today and Tomorrow. The review was prompted by an inquiry into the death of a 3 year old child. The aims of the Review were to promote the reduction of abuse or neglect of children, and to improve the services for children who experience abuse or neglect. Members of the Scottish Executive and Review team attended the seminar, along with individuals from other agencies who belonged to the Review’s Consultative Group. The purpose of the seminar was to provide the Child Protection Review with information and ideas from other countries to stimulate learning and thinking about how the Scottish system and approach to child protection might improved. Such comparison would give an opportunity to examine alternative directions and critically re-examine the Scottish situation in the light of the differences and similarities that emerged. One of the speakers invoked a metaphor from a famous Scot, R.D. Laing, that: ‘Comparison allows you to unpickle yourself from your place in the pickling jar and see that there is a different kind of life’. It is possible for specific ideas to transfer productively across national boundaries, as the Family Group Conference has illustrated, but usually some degree of fit is required with the existing values and structures and also some adaptation to them. Probably just as important is that a comparative view helps highlight what is desirable and feasible to change, as well as what is worth retaining and strengthening. Child abuse and child protection can be defined in very broad terms (National Commission 1996). In order to give the seminar a sharp focus and accord with the priorities of the Review, it concentrated on the identification of intra-familial abuse and responses to abuse within the family. Contributions to the seminar covered other ‘Western’ countries that are reasonably prosperous and have well established welfare systems, since the transfer of ideas, policies and practices tends to be easier between countries that have similar socioeconomic systems. Within that broad common ground, contributors were chosen for their ability to share knowledge about child protection systems that were different from those in Scotland and/or included innovatory approaches. It was decided not to include contributions with a focus on England and Wales or the United States, partly because the bases for child protection in these countries are very similar to that in Scotland and they have been the most important external influences, hitherto. Also many of the easily available publications relate to the UK or USA. 4
The speakers at the seminar covered two types of country. Firstly were those which have welfare state heritages akin to those of the UK and US – Australia and Canada1. Secondly, details were provided about several continental Western European countries, which have distinctive traditions in relation to social and family policy: Sweden, Belgium, France and Germany (See Esping-Anderson 1990; Hantrais 1995; Hill 1995; Clasen 1999). Two of the papers concentrated on a single country – Australia (Tomison) and Belgium (Marneffe), while the other two made comparative analyses of Canada and Sweden (Khoo, Nygren and Hyvönen) and of France, Germany and England (Cooper). The rest of this introductory chapter summarises the key points made in the plenary presentations. This is followed by a review of the main issues raised in workshop and plenary discussions, which were designed to draw out the points that had most impact on participants and to identify the main lessons for child protection policy and services in Scotland. A brief concluding section completes Part I and highlights the most important messages from the seminar. Part II comprises four chapters which are revised versions of each of the plenary papers presented at the seminar. Contrasts in overall approach to child protection We begin with a brief overview of the main similarities and differences among the countries considered at the seminar, then present a brief review of each. Some oversimplification is inevitable when making broad statements about national systems, let alone groupings of systems. There is often diversity within countries, especially those that are federal or have a high degree of decentralisation. All the countries considered at the seminar had considerable common ground, but the presentations and discussion suggested a major distinction between UK-North American-Australian and Continental West European approaches2 (Table 1). Each of the speakers indicated how the principles and details of the child protection systems were linked to the wider socio-economic contexts and the nature of the social welfare system. While all countries were affected by the revival of economic liberalism in the 1980s, continental West European states have retained a stronger emphasis on social solidarity and public provision.
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These are sometimes described in the comparative social policy literature as ‘Anglo-Saxon’ See also Parton 1991; Pringle 1998. West European continental welfare states are sometimes divided into two: the Scandinavian (social democratic) and Bismarckian (corporatist) 2
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Table 1. Contrasts in Welfare State and child protection systems BROAD TYPE OF UK-North AmericanContinental West SYSTEM Australian European COUNTRIES COVERED AT THE SEMINAR
Australia, Canada, Scotland, England
Belgium, Sweden, France, Germany
TYPE OF WELFARE STATE
Tendency to residual and selective provision
Tendency to comprehensive and universal provision
PLACE OF CHILD PROTECTION SERVICES
Separated from family support services
Embedded within and normalised by broad child welfare or public health services
TYPE OF CHILD PROTECTION SYSTEM
Legal, bureaucratic, investigative, adversarial
Voluntary, flexible, solution-focused, collaborative
ORIENTATION TO CHILDREN AND FAMILIES
Emphasis on individual children’s rights. Professionals’ primary responsibility is for the child’s welfare
Emphasis on family unity. Professionals usually work with the family as a whole
BASIS OF THE SERVICE
Investigating risk in order to formulate child safety plans
Supportive or therapeutic responses to meeting needs or resolving problems
COVERAGE
Resources are concentrate on families where risks of (re-)abuse are immediate and high
Resources are available to more families at an earlier stage
The papers at the seminar indicated that many of the recent developments in Canada and Australia have paralleled those in the UK and USA. Child abuse inquiries, responding to and fuelling public and political concerns, have promoted a focus on attempts to establish conclusively whether or not allegations are false and to identify the risks associated with abusive situations (Parton et al 1998; Waldfogel 2002; Cooper). The common first language has also facilitated mutual influence. Tomison also points to the influence of economic rationalism. However, some provinces and states have introduced much more standardised risk assessment and case response differentiation mechanisms than in Scotland. By contrast, Sweden, France and Germany – for all their differences – have evolved more gradually, with a strong emphasis on family support and mediation. Belgium, like its neighbour the Netherlands, introduced major changes in the 1980s with the Confidential Doctor service, which placed at the heart of the system easy access to
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family treatment. It was noted at the seminar that in Sweden and Belgium child protection is rooted in traditional social policies that seek to provide social assistance and public services on a comprehensive basis. This means that not only can specialist services build on the foundations of universal general provision, but they also draw on a greater measure of goodwill towards representatives of the state than tends to be the case in the UK-North American-Australian systems. Cooper noted that in contrast with France, Germany and the other continental countries, the UK also has fewer or weaker institutions mediating civil society, so that relations between government agencies and the public tend to be more distant or antagonistic. Among the features of child protection in Canada and Australia described by Tomison and Khoo et al. were the following: • high input into investigation • prominent use of risk assessment models • detailed agency policies and procedures • child protection staff with highly specialist roles and often operating separately from other child welfare services • targeting of attention on high risk (strong signal) cases • mandatory or expected reporting of abuse • ready use of compulsory orders As Marneffe pointed out, most of these characterise British and American systems too. She singled out the following contrasts with the Belgian approach: Table 2. Differences between British/American and Belgian systems Countries UK-American Belgian GENERAL WELFARE Residual Universal STATE APPROACH STATE-CITIZEN BASIS Individualism Solidarity VIEW OF CHILD Resulting from individual Linked to common social ABUSE pathology and parenting problems APPROACH TO CHILD Authoritarian and Helping families ABUSE punishment oriented Expectation to report cases Confidentiality and health CONTEXT FOR promotion and deal with families in DEALING WITH segregated ways CONCERNS RESPONSES TO Investigation and collation Immediate help REFERRALS of information She notes however that the Belgian approach has been under threat as a result of Belgian governmental responses to the Datroux case. The inquiry prompted moves towards a risk-avoidance, controlling approach as inquiries have done in the UK. Each of the speakers noted how risk-aversion strategies tend to limit the capacity for early intervention by concentrating effort and resources on ‘high-risk’ cases. Hitherto Belgium has had a clear separation of its child protection services from legal frameworks and processes. This linked with an emphasis on confidentiality intended to promote confidence in professionals among those needing or seeking help. Also the family therapeutic thrust of the work entails mobilising families’ own resources rather than doing things to the family (Marneffe). Likewise in Sweden the service works in
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solidarity with parents, as part of a well developed system of social welfare offered as a right, voluntarily, and, with resources to support families. The threshold for intervention is low, so that any concern elicits an early, preventive response (Khoo et al). Culturally different understandings: culturally congruent interventions3 The presentations amply illustrated the complex ways in which cultural differences between countries imbue approaches to child welfare and child protection. Examples of different cultural understandings between countries and temporal changes in orientation include the lack of a term for child protection in Sweden, the recent inclusion of neglect as a form of abuse in Canada and changes in laws regarding sexual abuse in Belgium. The British and American readiness to sever kin ties and place children for adoption following abuse is alien to French and Swedish viewpoints. A point crystallised by Cooper and generally accepted was the necessity for interventions to be culturally congruent – i.e. the wholesale importing of lessons from elsewhere would not be feasible. Cooper argues that interventions must be appropriate to the prevailing culture and the system. However the cultural diversity within countries was also emphasised, indicating that a country’s culture should not be understood as homogenous. Illustrations include the more parentalist approach taken by Quebec, with its French traditions, than other parts of Canada, and the different timing and nature of setting up specialist teams for child protection in the Flemish and Walloon parts of Belgium. In recent years, Canadian legislation has provided greater autonomy for Native peoples to organise their children’s services in keeping with their beliefs and heritage. Yet measures have been taken which stress that children have certain universal rights, which can be insisted on. These include the emphasis in law on the child’s best interests in all the countries considered. The unconditional Swedish ban on the hitting of children indicates that there no allowance on the basis of differing attitudes is seen as acceptable, although the absence of such legislation in other countries illustrates the variety of views that exist on that point. In the UK concern has been expressed that professionals may be over-cautious in intervening in black and minority ethnic families. The dangers of cultural relativism of this sort might lead to black and minority ethnic children being under-protected. All the countries give some scope for variation according to local needs and influences, but Sweden appeared to have the most decentralised system, with significant powers resting with many small municipalities. In Australia, Belgium and Canada the main level for determining law and policy was at the state, province or community level. Ontario appeared to have the greatest thrust towards standardisation of detailed practice, although this trend has also been present in some Australian states.
3 See e.g. Channer and Parton, 1990, Phillips 1995, O’Hagan 2001 for further discussion of these issues
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Risk assessment The presentations about Sweden, Belgium and France showed that, although concerns about children’s welfare are thoroughly explored, this is done largely as part of broad professional or judicial assessments in dialogue with family members in order to reach a shared view of the appropriate response. Evidence was presented from Belgium to show that the introduction of its confidential health-based system, using systemic assessment and intervention, resulted in a much higher rate of referral than previously, but with a very low failure rate. In contrast the UK, US, Canadian and Australian systems have, to a greater or lesser extent, adopted some kind of more formalised risk assessment. Cooper refers to the widespread culture in child protection of risk aversion, performance monitoring and quality assessment. Risk assessment has a gate keeping function by producing definitions and categories, which raise thresholds for intervention. This results in fewer people receiving attention from child protection agencies, which fits well with the residual model of welfare policy. Accompanied by policies, guides, protocols and working definitions, precise risk assessment tools have been used in North America and Australia with the aim of ensuring judgements about eligibility for services or the need for investigation and intervention are standardised and comprehensive. Tomison and Khoo et al show that there are differences in how the systems are employed. In the USA risk assessment is used primarily after a decision has been taken that abuse has taken place. Some Australian states use the model at an earlier stage, as an initial assessment tool by centralised intake centres. In Ontario three tools of risk assessment are used in order to establish eligibility for services. Tomison identifies the benefits and drawbacks of risk assessment models. Statistical models are considered to be more accurate and less judgmental. They enable decisionmaking to follow logical steps and be more consistent from case to case, team to team. They can help target scarce resources and reduce high caseloads. Thresholds are transparent and they can assist interagency working when agencies are working to a common conceptual framework. One danger is that they can act as a rationale and means of limiting resources. Unless accompanied by family support work, they may mean that early intervention to prevent situations deteriorating is precluded. Risk assessment measures may also be applied inflexibly and result in mechanical decision making. No tool can include all abusive factors nor indicate the precise weighting that a factor or combination of factors can be given in any particular situation. Moreover, the research base for risk factor analysis has a number of weaknesses. Hence this approach needs to be used carefully, following appropriate training and alongside professional judgement. Having considered several of the broader features and contrasts among the countries considered, we now present a brief overview of each country, summarising the material presented in the seminar plenary papers (Chapters 4-7 in this Report) Developments in Australia (Tomison) The Australian system varies from State to State, but there are many common features. Influences have included a large increase in reporting and hence workloads,
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a wish to provide more specialist and targeted services and a growing realisation of the extent of inappropriate labelling of cases as child maltreatment. Some States and agencies have adopted policies aiming to work more in partnership with families and to differentiate levels of risk and need. They were influenced in part by the British ‘Messages from Research’. (Department of Health 1995). North American risk assessment models have also become popular. Tomison argues that the widespread use of risk assessment in Australia is in part a response to the desire to rationalise and in some instances minimise use of resources. Several initiatives have been established to create tighter case management, notably central intake systems, differentiated responses and structured risk assessment. Central intake teams were introduced to replace more localised offices in orders to reduce differences in practice, standardise responses and minimise the impact of resource issues on decision making. There is evidence of some success, for example enabling departments to target scarce resources to the most dangerous cases. However, the teams have usually experienced increased demands, which need to be planned for and responded to with appropriate resources. Moreover, performance indicators based on recorded levels of child maltreatment may encourage staff to improve the figures by re-defining cases rather than through any change in family functioning. Often central intake teams use a differentiated response system, which relies on categorising families and then taking action that differs according to the category. A variant of this in Victoria (the Enhanced Client Outcome System) has proved popular with staff and is experienced as less intrusive by families. Like most systems, it is more difficult to implement when families are unco-operative. Besides altering their case management systems, certain agencies have pioneered new ways of helping families. For instance, the Strengthening Families Model in Victoria provides support to families ‘at risk’ to prevent them becoming child protection clients. Staff work primarily to build on families’ strengths rather than modify their deficiencies and seek to engage families in developing their own solutions. Multidisciplinary teams have been established to deal with all stages of child protection from investigation to intervention. Despite developments such as this, Tomison admits that the Australian system is still struggling to develop better interagency partnerships between professionals and to provide parents, particularly those defined as ‘at risk’, the support they need to address their problems. Like other speakers Tomison argues that the investigation driven child protection responses of the early 1990s will fail without support and other preventive services. American evidence about the effectiveness of early intervention programmes has begun to influence Australian agencies. These are increasingly seen as a cost effective means of preventing social ills like child maltreatment through promoting social competence and fostering resilience. Whole community projects are also proliferating. These have comprehensive strategies to promote mutual help, participation and volunteering in communities, alongside early intervention programmes. Child protection in Ontario, Canada (Khoo, Nygren and Hyvönen) Khoo, Nygren and Hyvönen highlight differences between Ontario in Canada and Sweden, with the former apparently having more similarities to Australia – and
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Scotland. The principles behind child welfare legislation in Ontario are very similar to those of the Children (Scotland) Act 1995. However, in practice there has tended to be an even more sharp emphasis on ‘least intrusive intervention’ for the majority of cases and concentrated attention on ‘high risk’ cases. Much stress is placed on efforts to differentiate cases that need full investigation and to take legal and procedural steps in accordance with detailed protocols. Central to the work is the use of highly structured and standardised risk assessment measures resembling those used in parts of Australia. Workers have the advantage of clear guidance and standardised ways of acting. The main goals are to determine the extent of harm or dangers to children and to take measures to ensure safety. The image and status of social workers dealing with child protection is low, partly because their investigatory and intervention functions are segregated from positive family service. A high proportion of children (compared with Sweden) are removed from home. Most are in care under a court order and in many of these cases birth parents’ responsibilities and rights have been transferred by means of permanent wardship. Protecting children in Sweden (Khoo, Nygren and Hyvönen) In Sweden child protection does not constitute a distinct system, but is embedded in a wider system of child welfare. Indeed there is no equivalent term for ‘child protection’4 and the idea of investigation is alien, replaced by assessment. Social workers in Sweden have relatively high status and a positive image. This both reflects and contributes to good relations with the public in general and, usually, service users. Most staff are experienced and well-trained. Child welfare personnel operate within broad duties under family law, which leaves them considerable discretion. They have a duty to intervene if there are signs that children are showing unfavourable development. Referrals are dealt with by means of the typical methods of engaging with families and formulating social work assessments, without recourse to specific risk assessment models. The orientation contrasts strongly with that in Ontario: Table 3.
Ontario and Sweden compared
Ontario Standardised assessments and actions Assessment is forensic Prime focus is to investigate risk and safety Emphasis on legal authority and regular use of court orders to secure parental co-operation or alternative care The overriding concern is to achieve change so the child is safer
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Sweden Flexible assessments and actions Assessment is psycho-social Prime focus is to understand problems and needs Emphasis on professional authority and voluntary cooperation with parents Building relationships with all family members is crucial
This term was new to Britain in the late 1980s 11
Unlike Canada (and Scotland), the principles and procedures of permanency planning have had little influence in Sweden, especially as regards the stress on use of the law to over-ride parental wishes when this is seen to be in children’s long term interests. The Swedish child welfare philosophy is strongly committed to birth family preservation (except in extreme cases). Practitioners regard foster care arrangements as a positive long-term alternative for children, so that adoption and removal of parental rights are seldom considered as options. Flexibility and patience are seen as preferable to strict time limits for progress. An example of the great lengths taken (and expense incurred) to work with families to keep them together while ensuring appropriate care is the possibility of housing whole families together for 4 months for assessment. The Belgian alternative (Marneffe) The Swedish system is very different from that in Scotland, but in many respects resonates with the situation in the UK before Maria Colwell and permanency planning, but significantly enhanced by high quality staff, a wide range of resources and family support orientation advocated during the 1990s (Department of Health 1995; Canavan et al 2000). The Belgian confidential doctor system, however, has at first sight few resemblances. The principal means of dealing with concerns about children’s welfare is not through inter-agency investigations with social work agencies taking a lead role. Instead cases are handled by a multi-disciplinary team led by medial practitioner. As in Sweden, the aim is to engage with the family as a whole on a voluntary basis, whenever possible. Assessment of harm and risk is not the main priority. Rather systemic family therapy principles and methods are used to help parents acknowledge their problems and responsibilities and to achieve change. Not only is the Confidential Model distinctive, but its introduction contrasted with both the inquiry-driven nature of British policy change and the gradual evolution in Sweden. During the 1980s the Belgian government took a decision to revolutionise the system of child protection by creating the specialist ‘Confidential Doctor’ service. Marneffe herself was centrally involved in shaping the new system in Belgium, and is currently Director of one of the multidisciplinary centres set up for prevention and treatment. Behind the new system lay the principle of not considering child abuse and neglect to be the act of pathological parents but as having grown out of wider social problems. The new system was also designed to give the quality and respect to service users that all families and individuals should be entitled to receive. This would help minimise stigma and avoid the provision of inferior services for the ‘undeserving’, so that families are encouraged to approach the team in the knowledge that they will not be reported or blamed. Hence access to the service is free, anonymous, confidential and usually inclusive of both parents. When children refer themselves, then confidentiality is normally maintained unless or until the child wants the parents to be involved. The system is clearly separated from the police and courts. Professionals are not actively looking for proof of ill-treatment, but assist the family to talk openly about family problems and the consequences for the child, in order to establish a shared plan for improving care and protection of the child. Parents are not required to make a
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confession, but it is made clear to them that the professionals know abuse has occurred. The service thus has gained positive connotations for actual and potential clients, in keeping with the generally rights-based approach to welfare provision more generally in Belgium. As in Sweden, the professionals operating the service have public respect. Marneffe argues that parents are usually willing to co-operate, since they are less fearful of being punished or having their children removed than in the UK. Moreover, staff are encouraged to focus on positive change within the family, since separation is not a ready option. The Confidential Doctor service does not deal with all child abuse cases, however. Just under 10% of abusive parents are considered impossible to cope with, for instance on account of chaotic drug addiction or chronic mental health problems. Marneffe claims that the system quickly identifies those families who will not cooperate or cannot be helped, making it possible to take legal action quickly. Lessons from other European countries In the final paper, Cooper draws on his experience of comparative research in France, Germany and several other European countries to reflect on the general values and principles that underpin different systems and to draw out possible implications for England and by extension Scotland. He argues that each system is a product of a particular history and context, so that wholesale transposition to another country is unrealistic and undesirable. Rather, it is important to see what might work in the context of the UK or Scotland. Furthermore, no system is problem-free. In all the countries he and his colleagues studied, they found that child protection work was complex and conflicted. Therefore it is unhelpful to expect any system to be satisfactory for everyone. He argues that effective intervention is only possible if the system is flexible and supportive in relation to the anxieties and conflicts workers face. He believes three vital and interdependent elements provide a basis for judging how systems do or should operate, namely trust, authority and negotiation. For instance the nature of authority held by key professionals and agencies is linked to the capacity to build and sustain relationships, and develop trust in those relationships. While British and kindred systems have sought certainty of judgement as the main guide to action, other systems allow more time and space for negotiation to reach consensual plans. The French Children’s Judges, for example, rarely use their authority to impose measures, but instead develop trust and negotiate outcomes with professionals and families. In contrast to English Family Courts (though with more similarity to Scottish children’s hearings), cases can be considered without full legally admissible evidence. When the French children’s judge does make an order, s/he is bound to seek parents’ agreement, reflecting the strong emphasis on kinship continuity in French traditions5. As in Sweden and Belgium, this happens in a context where removing children is rarely the main option and, partly as a result, parents seem less fearful of the system. Similarly, conflict of viewpoint and interest is regarded as something to be worked with, rather than necessitating separation. 5 Seen also in the concept of ‘simple adoption’, whereby adopted children maintain some of their links with the birth family
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Cooper argues that the split in England between child protection work and the system of family support, as in Ontario and Australia, makes the process of using authority to build trust and negotiate more difficult. He raises the interesting notion of the need for an alternative negotiated space where conflict can be named, discussed and maybe averted (as happens in France and Belgium). The ability to negotiate depends on trust, i.e. beliefs that the other party has your interests at heart and is acting in good faith. Interestingly, Cooper has begun testing these ideas with some success in Nottingham in collaboration with the NSPCC. A Multi-agency Consultation Forum for Child Protection has been set up for staff working with high risk complex cases with a view to providing authoritative but reflective consultation on plans and decisions. It authorises workers to exercise professional judgement in difficult circumstances, with the long term aim of institutionalising reflective consultation to replace the culture of proceduralism which has dominated social work practice in recent times. The implications for Scotland of the seminar papers will now be drawn out in Chapters 2 and 3. The final four chapters provide the full details of the papers prepared for the seminar.
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CHAPTER 2. ISSUES HIGHLIGHTED AND DISCUSSED BY SEMINAR PARTICIPANTS The papers provided much food for thought and provoked widespread interest and discussion among participants. This chapter reviews issues and themes that were raised in the workshops and final plenary discussion. Workshop groups were asked to identify: • what were the key points that interested them? • the implications for the work of different professionals and agencies in Scotland • what might work in Scotland and what not? • what changes might be needed in law, policy, services and practice? The main points were recorded at the time and a summary is presented below, grouped into broader themes. Naturally, many of the issues are interconnected. How much change is desirable or possible? People were generally agreed that any alterations in the Scottish child protection system should be compatible with prevailing values and principles. Different views were expressed on whether incremental or radical change is needed. Some saw the current review as an opportunity at least to consider a fundamental transformation. The introduction of the hearings in Scotland during the early 1970s and the Belgian child protection reforms of the 1980s demonstrated that wholesale innovation can be made. Others suggested that the political and cultural climate was not right for root and branch change. For some, the children’s hearings already offer many of the benefits attributed to continental European systems, such as accessibility, informality and flexibility. However, there are tensions and gaps between the hearings processes and the agencycourt systems for dealing with child abuse allegations. Many cases in Scotland still need to go to Court for proof and there the adversarial nature of proceedings is very difficult for children and the chances of success are low. There was interest in examining more closely the differences and similarities between Reporters and Children's Judges in France The wider social policy and service context One of the key messages to emerge from speakers, endorsed by participants, was the recognition that child protection was not simply a responsibility of dedicated services. The wider system of welfare and universal provision has a crucial influence on the nature of the child protection system and its capacity to respond to children’s families’ needs. Moreover, attempts to change child protection policies and services need to take account of the fact that these are embedded in the broader welfare system and affected by attitudes towards the role of the state. One workshop group suggested a combined agenda of extended universal provision, an improved social inclusion agenda and child protection services developing pro-active engagement with families. Several seminar participants voiced reservations about the French and Belgian systems, wondering if they glossed over issues of power, gender and race. It was also observed that most Continental European professionals find it hard to understand 15
British anti-discriminatory perspectives. This difference in outlook was apparent in critiques from Scotland of family meetings, since the presence of the abusers (who are mainly men) could place children in very difficult if not impossible positions. Another point made was that by ‘dealing’ with sexual abuse as a within-family matter, the dangers to children outwith the family might not be attended to. In various ways, it was noted that systems can be affected by fixed thinking. This was illustrated by the ways in which UK-North American-Australian systems tend to pursue legal and compulsory options, while Continental European professionals tend to assume a voluntary arrangement is usually desirable and possible. In the former, adoption is a possible outcome of child abuse, in the latter it is not. A different kind of observation was that professionals and academics may have different awareness and interpretations of research evidence, especially about the nature and prevalence of sexual abuse.6 Resources The point was made that judgements that a system was not working well could result more from the dearth of support services than from the workings of the system itself. Partly as a result of the long-standing commitment to wide-ranging public services for families in many continental countries, assessment and decisions about families were made easier by the knowledge that suitable services were likely to be available. In Scotland, current shortages and work overloads were mentioned (e.g with respect to health visitors, reporters, forsensic psychiatric places). Lack of staff was said to have diluted some services, while the channelling of money into special projects had left mainstream services starved. Family or child orientation In varied ways, the French, Belgian and Swedish systems all appeared to have as their primary focus the family as a whole or the child within the family. This contrasted with British emphasis on separating the interests of children, women and men in families (also found in Ontario and Australia). The family orientation in Continental Europe was presented positively by some as enabling professionals to engage productively with parents for the sake of children and avoiding as often as possible the need to separate children from their families and communities. Others expressed concern that the child’s interests might be subordinated to parents’ rights and wishes. More particularly, it was feared that while agencies sought to work with parents, children could undergo continuing abuse, A linked worry was that family therapy may not address effectively issues of gender and power within families. Also the presumption in favour of keeping the family together might prolong an unhappy experience in circumstances where in Scotland a child would be placed in a substitute family. It was suggested that for some children living apart from an abusive parent figure, any arrangement to meet that person would be unacceptably distressing.
6
See e.g. Eldridge 2000; Bolen et al 2000 16
On the other hand, the present Scottish approach may be too rigid when children want the abuse to stop but also to maintain a relationship with the abuser. It was proposed that children and young people should have more influence on the system. For instance, young people’s forums and the availability of a designated person to assist a child could be helpful. The relationship between judicial and therapeutic systems Child protection in Australia, Canada and England has been marked by professionals’ adherence to detailed legal duties and assessments geared towards potential or actual legal measures. Participants at the seminar saw the Scottish system as having a ‘softer’ legal approach as a result of the hearings, which allows for child care issues to be handled without necessarily involving prosecution. Nevertheless concern was expressed that many children do not receive quick or appropriate help when they are involved with the courts, as the majority now are. It was also suggested that all the systems with a strong legal component have low rates of self-referral. In Belgium and Sweden, the responses to child abuse concerns, except in extreme cases, are largely independent of judicial influences. French children’s judges are very much involved in determining what happens, but act in a way that to British eyes may seem more therapeutic than legal. Discussions took place on whether it is now possible in Scotland to think the unthinkable and not prosecute abusers in child protection cases. One powerful argument in this direction is that prosecution does not achieve the desired results. Children are put through extremely difficult proceedings and rarely see a satisfactory outcome. The length of time waiting for court creates problems and delays therapeutic work. However non-prosecution would remove the opportunity of public disapproval and sanctions for unacceptable acts. Space for negotiation Many were intrigued by Cooper’s suggestion that it was crucial to clarify the basis of authority, trust and negotiation on which official child protection is based. Some stated that children’s hearings offered a fruitful setting for such negotiation as a matter of routine. Also attractive was the notion of a 'space for negotiation' on a more selective basis, with workers and families able to go and negotiate with external help when they had reached an impasse or were uncertain what to do. Similarly it would be useful to have access to a multi-agency consultation forum where workers can go and be supported in decision making around complex cases. One suggestion was that space should be created where people can negotiate self-reporting. Despite the many differences in details, it seemed that Sweden, Belgium, France and Germany all shared the capacity to establish relations of trust with parents and children in order to negotiate agreed action whenever possible. Wide discretion was exercised by judges (France), doctors (Belgium) and social workers (Germany and Sweden) in order to adapt to individual family circumstances. This contrasted with the reliance on standardised procedures in the UK. That was also true in Ontario and Australia with the added dimension of highly formalised categorisations of families.
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The quality, image and status of child protection professionals The presentations had mostly examined the role of social workers as the lead professionals in child protection, except in Belgium and France. Many at the seminar were very struck by the contrast between the poor public image of social work and child protection services in Scotland and Ontario, especially compared to the favourable public regard for social work and child welfare in Sweden, the normalised access to the Confidential Doctor service in Belgium and the approachability and mutuality of French children’s judges. A further point was that in the UK professionals experience a blame culture whereas elsewhere it is accepted that no system will prevent all child injuries or deaths, so there is a greater preparedness to accept risks and not to vilify individuals when things go wrong. The Dutroux scandal in Belgium has led the government to introduce changes that may undermine the trust and acceptance that has been built up by the Confidential Doctor centres. The continuity of employment among Swedish child welfare workers also provided a striking contrast with high staff turnover in Ontario, which echoes the position in Scotland, where low job satisfaction and loss of skilled staff are common. The stability in Sweden presumably reflected greater job satisfaction and in turn was likely to foster confidence in experienced and familiar personnel. Another thought was that staff morale is likely to be better when they are given more autonomy and scope for negotiation. It was seen as valuable for any citizen and members of families where abuse has occurred to have ready access to non-stigmatising, universal services. This could be via public health practices or school-based. Ideally such provision should be staffed by multi-disciplinary teams. The primary responsibility for children should not be owned by just one professional group. In remote areas of Australia, different professionals of necessity operate from a one-stop base. In a Scottish context, some people wondered if joint funding of child protection services and co-location of different professional groupings would be helpful. It is also necessary to ensure that good links are made between children’s and adult services (e.g. in relation to drug misuse). Community ‘ownership’ of child welfare and protection The image of services signified a close connection between public trust of the system and its capacity to engage and then work positively with families. Some argued that it is a priority in Scotland to adapt and publicise the child protection system so that it gains the understanding and respect of the whole community and so that professionals are trusted to act in the interests of families. This requires gaining an active commitment by everyone to the project of child protection and child welfare, as illustrated by the saying ‘it takes a whole village to raise a child’. The public were currently said to have a poor understanding of the hearings system and the role of reporters. A number of people present at the seminar said that the public at large does not value children sufficiently. Also ‘the family’ is often idealised. Pejorative images of young people can be fostered by the media, as with respect to child prostitution. In Victoria, a public education programme has been developed to try and achieve better general understanding. School prevention programmes in Australia have now moved beyond
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stranger danger to encompass other forms of danger to children, including within their own families. Confidentiality, referral and reporting The Belgian system is premised on confidentiality, as the name of the service shows. It was recognised that this facilitates co-operation with parents, but questions were raised whether this might result in the child’s views and interests being compromised. Confidentiality is also a feature of the German approach. It was observed that confidentiality for young people, as in Germany, empowers them and may encourage more to refer themselves. Some qualms were expressed that adherence to children’s wishes in this regard might act against their best interests. Also openness can help deal with problems more readily. The introduction of ChildLine as a confidential helpline service had been resisted at first, but was now widely respected. Few families in Scotland refer themselves directly on account of abuse. Members of the public were seen as reluctant to intervene in relation to others. Schools and doctor’s surgeries were seen as good access points. More children might be helped if child abuse was seen as non-stigmatising public health issue, as in Belgium. In some parts of Australia, the school is a base for services. New Community Schools in Scotland could offer a similar opportunity. The presentations indicated that it does not matter much whether reporting is mandatory or not. It is the response to any suspicion of abuse that is crucial. Assessment and decision-making Some welcomed the idea of standardised risk assessment leading to differentiated responses. This could be seen as a form of triage, allowing practitioners to concentrate their efforts on the most needy. On the other hand, evidence from Australia and Canada indicates this may work poorly when it becomes largely an administrative measure. Warnings were also made about the danger that risk assessment schedules would take up a lot of staff time and lead to a more rigid response to families. Their use is also dependent on appropriate training. More joint assessment extending beyond social work and police could lead on to better shared understandings. Joint teams in the same location could work together effectively, though there would be a danger of becoming cut off from mainstream services. There is also a need to engage services whose primary orientation is towards adults (e.g. in relation to drug misuse, criminal justice). Questions were asked about the checks and balances required in any system. Do the French judge and Belgian doctor perhaps have too much freedom to decide and act alone? Similarly, it seemed that social workers in Canada could operate without much external restraint. Voluntarism versus compulsion The idea of moving towards a system based more on voluntary agreement and partnership was attractive, but some discomfort was felt too. It was suggested that attitudes about criminality in relation to child abuse may change, as has happened with respect to abortion. Without fear of prosecution or other sanctions, some adults
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would be more willing to admit that they had ill treated a child and work towards change. On the other hand, might parents become too powerful in the process at the expense of children? Removal of children from home In the UK, inquiries, policies and practice have fluctuated in their emphasis on birth family preservation or continuity as a crucial component of children’s interests and on the removal of children as a requisite for the safety and development of some children (Harding 1991). Nevertheless, in Scotland as in other UK-North American-Australian systems emergency removal remains a major if reluctant option in investigations, with adoption or permanent fostering regarded as the preferred choice for a small but significant minority of abused children. Knowledge of this has helped shape not only the anxieties of those undergoing investigation, but also the suspicious attitudes of many families in need and the public more generally. At the seminar people were interested to learn that this is not a feature in all systems. In some European models the possibility of permanently placing a child in another family against parental wishes is barely considered and is anathema in some eyes. Presenters argued that when services providers have no alternative, they are more likely to find ways of achieving a satisfactory solution with the child’s birth family. A further benefit is that families are much less fearful of professionals. Even where it seems impossible to work with the families, a ‘clean break’ is not espoused since the family is seen as a constant in a child's life. Screening and unresponsive families There was interest in the fact that across all the different types of systems, seemingly regardless of the approach, a relatively constant proportion of referred cases of between 7% and 10% proved very difficult or impossible to work. Although continental systems are usually more measured in their response than in the UK, it seemed that in Belgium at any rate a quick decision is made when families cannot be helped and alternative usually court-based action is needed. This ability to distinguish such families promptly would be useful in Scotland, where such cases may tie up a disproportionate amount of agency time unproductively. Canadian and Australian models do have a screening approach, but based on risk to the child more than prospects of working effectively with the family, although these two will often be related. Another matter to be addressed is the impetus in UK-North AmericanAustralian systems to take action too slowly in some cases and too precipitously in others. Prevention Ideas about early intervention were generally welcome. The importance was registered of educating the next generation of parents so they are less liable to ill-treat children. Domestic violence The effects on children of domestic violence towards their mothers has received growing attention in Scotland. Reporters have experienced an upsurge in this kind of referral, as apparently have French children’s judges. Uncertainty was voiced about whether this helps children. Questions were raised about whether family therapy models are appropriate or not. In particular, the emphasis on obtaining family
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agreement for decisions and actions could mean that parents’ power and children’s relative powerlessness produced outcomes not in children’s interests. In Australia, school based prevention programmes could be helpful, but the government wish to portray the family as preponderantly benign may mean that attention to violence within the family is minimal. Evidence-based policy The seminar reinforced for some people the importance of having sound evidence, including comparative evidence. However it is difficult to draw conclusions from national differences, since these can be caused by a wide range of factors. It was noted that broad indicators of children’s well-being tend to reflect standard of living and levels of general welfare provision, rather than the specifics of child protection systems. Thus, both Sweden and Canada have very good records in this respect, even though the approach to child protection is very different. Cooper observed that ideas about child welfare systems are culturally specific, so it is difficult to reach agreement about how to judge outcomes and is more useful to consider principles. The presentations emphasised the value of understanding differences and similarities in daily practice and the assumptions, often taken for granted, that underpin practice in different countries. Several participants wondered if presenters were talking about the same kinds of family and levels of difficulty or risk, when describing different types of response. It was also unclear how far the apparent success of continental systems in facilitating co-operation in the majority of families was accompanied by a failure to gain a purchase with tough cases. Conversely, the UK-North American-Australian investigative approach may discourage openness generally, but use of the law may help some children where otherwise family closure would leave children unprotected from harm. Set against this is evidence from Australia and Scotland that authorities can be rendered powerless by the insufficiency of legally admissable evidence, whereas continental European professionals or children’s judges have the authority to proceed. Research can guide more specific developments. For instance, evaluations have shown the value of intensive home visiting, yet in Scotland the health visiting service is currently being cut back. Several participants were conscious of significant gaps in the information routinely available in Scotland to guide policy-making and provide feedback about the operation of the system. There was interest in the idea of a 'Clearing House' along the lines of the Australian one outlined by Tomison. Funded by the federal government, it has an information, advisory, support and research role. There was interest in exploring the possibility of something similar for Scotland.
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CHAPTER 3. CONCLUSIONS The aims and length of the seminar were not intended to create consensus about a way ahead for Scotland, but rather to stimulate thinking about possibilities for change. Hence this concluding section of the report does not provide a blueprint for action, but highlights some of the issues that apparently had a strong impact on most participants or that evoked divided responses. In one way it can be seen as reassuring that all of the systems were grappling with similar issues and none was free of problems or dissatisfactions. In particular, everywhere it is difficult to cater for those families with little capacity to change. Each of the papers contained details about innovations that might be adapted to the Scottish context, but there was broad support for the view that the most important thing is to be clear about the values and principles that should underpin services in Scotland dealing with child abuse and neglect. Also it was accepted that cultural differences shape welfare systems in various ways, reflecting different values and perceptions as regards child-family and family-state relations, so that grafting ideas from elsewhere needs to be done when they can adapt to the local context and vice versa. ‘Bolting on’ isolated developments may have limited success. Similarly, the capacity of specific child protection or child welfare measures to achieve change is limited unless they rest on a foundation of good universal services. Equally it is important to examine or re-examine prevailing assumptions that affect choices and decisions. In several European countries, plans and actions may be seen as either restricted or liberated by the fact that court action is seen as a rare option and that domestic adoption of older children against parental wishes is virtually unheard of. Conversely, professionals in Scotland may be diverted from offering help or working towards voluntary solutions with parents, because of the emphasis on legal solutions. Allowing for these cautionary comments, two contrasting directions appear possible. The more fundamental one would be to align the system more with continental West European practices. Key features would include: • a range of flexible preventive and therapeutic resources • an agency, profession or multi-disciplinary team taking the lead role in responding to concerns about children, This requires well qualified staff acting with flexible discretion and trusted by the public, service users and government • ready access by children and parents, as well as professionals, to the lead agency sited in a non-stigmatising context, ideally linked and identified with universal services • an emphasis on thorough assessment of problems and needs as well as risk, rather than investigation • therapeutic help offered quickly without the need to worry about forensic and evidential considerations • the goal of achieving solutions agreed with parents and children on a voluntary basis wherever possible 22
• •
resort to the use of courts in only a small minority of cases, but with early identification of those families where this route is necessary allowing children’s wishes about confidentiality and contact with abusing family figures to have a major influence on the timing and nature of communication and decisions
For the most part, the feedback at the seminar on these qualities of continental systems and their impact was positive. Many of them run against the grain of British social policies, state-citizen relations and judicial traditions, but the Scottish children’s hearings system offers both a precedent for change and a value base that is more consistent with the above elements than the current thrust of central government, local government and court policies and practices. Legal requirements would have to be loosened for professional/judicial autonomy to operate as it does in Sweden, Belgium and France. The requirement to place more trust in achieving voluntary solutions with parents is appealing, but in the context of serious abuse is contrary to trends in the UK. These have moved away from a stress on family unity and optimism about change towards an emphasis on children’s separate rights and confidence in the appropriateness of one parent or alternative families meeting their needs. Likewise the British propensity to consider separation when there is persistent violence towards children or women and preparedness to consider long-term compulsory ‘clean breaks’ would need considerable modification to accommodate a view that children’s child’s best interests are almost always located within persisting family relationships, even when these have been negative and disruptive. Evidence about Ontario and Australia indicate an alternative direction, which involves refinement and standardisation of case and risk management. This would probably entail a less substantial adaptation of the present procedures and mechanisms for handling child abuse in Scotland. Among the key elements might be: • specialised and possibly centralised intake systems • clear categorisation of families so that different kinds and levels of service are provided according to need and risk • better targeting of resources • more co-operative relationships with families where risk is not high • greater consistency of response • emphasis on the child’s safety as the primary consideration On the whole the presenters indicated more disadvantages than advantages in this approach, especially within a context of limited support services. However, there were also indications that as part of an overall strategy with a strong preventive component, developments along these lines can help overcome pervasiveness of suspicion and compulsion, while retaining the capacity to safeguard the care of children in extreme circumstances with unresponsive parents. In all the countries considered, evidence indicated the importance of having a child protection service staffed by skilled, experienced people with high public status. Where this occurs in parts of Europe, it is associated with a willingness of society and the authorities to trust in professional judgement. Moreover, in Sweden staff turnover is low and job satisfaction reasonable, whereas in much of Scotland there is low morale and high staff turnover (as in Australia and Canada). These points suggest that attention and resources must be committed to professional education and public information. 23
In every presentation, the drawbacks were pointed out of having child protection arrangements too closely aligned with judicial processes and segregated from broader child welfare, family support or health promotion systems. Continuity with universal services fosters co-operation and reduces stigma. Yet all systems use compulsion for a minority of extreme cases. It is important to clarify the relative balance among needs, risks and rights. Each system attempts to meet children’s needs, protect children from harm, solve family problems and support parents, but they have different emphases and thresholds for making safety the overriding consideration. In both continental Europe and parts of Australia, as well as elsewhere, a recent shift has been to work wherever possible with family strengths rather than deficits. Certain specific ideas were attractive to many participants. The notion of creating space and time for negotiation is useful. Professionals are likely to welcome the opportunity to have time and access to external people in order to discuss their concerns informally. This could be particularly applicable when they are uncertain or the risks not great, without or before invoking the full child protection procedures. In Scotland, as elsewhere in the UK, a recurrent problem has been the difficulty of giving children effective therapeutic help, because of the way action has been driven by the need to gather evidence for courts. This has often added to children’s distress rather than alleviated it (Roberts and Taylor 1993; Westcott and Davies 1996). The Belgian Confidential doctor system makes very early access to help possible, though some would not wish to import the emphasis on including abusive parents. In different ways, other systems as in Germany appear able to let (older) children’s wishes guide communication and action. It would also be beneficial in Scotland to extend the multi-agency co-operation that has been established with respect to investigation into joint or collaborative therapeutic work, as in Belgium and parts of Australia. Whole community preventive strategies are consistent with current social inclusion initiatives in Scotland. Another valuable measure would be the capacity to identify quickly families who are very unlikely to respond to change efforts. In this respect the prompt assessments made by Confidential Doctor teams produced outcomes that are aspired to by the risk assessment and differentiated response mechanisms used in Ontario and parts of Australia, even though its orientation is otherwise quite different. A number of issues evoked complex responses and require further thought and discussion. This applied particularly to confidentiality and power relationships. Evidently plans for any changes in Scotland should be based on thorough assessment of the strengths and weaknesses of the present child protection system, as has been carried out by other elements of the Child Protection Review. The seminar showed that there are alternative values, principals, ways of staffing and organising services and specific mechanisms that could help improve arrangements to promote children’s welfare and safety in Scotland.
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References for Part I Bolen, R.M., Russell, D.E.H. and Scannapieco, M. 2000. ‘Child sexual abuse prevalence. A review and re-analysis of relevant studies’, in Itzin, C. (ed.) 2000, Home truths about sexual abuse influencing policy and practice. A Reader. London: Routledge. Canavan, J., Dolan, P. and Pinkerton, J. 2000. Family Support: Direction from Diversity. London: Jessica Kingsley. Channer, Y. and Parton, N. 1990. ‘Racism, cultural relativism and child protection’, in the ‘Violence against children study group’ Taking child abuse seriously, London: Unwin Hyman. Clasen, J. (ed.) (1999) Comparative Social Policy, Oxford, Blackwell. Eldridge, H. 2000. ‘Patterns of sex offending and strategies for effective assessment and intervention’, in Itzin, C. (ed.) 2000, Home truths about sexual abuse influencing policy and practice. A reader. London: Routledge. Esping-Andersen, G. 1990. The Three Worlds of Welfare Capitalism. Princeton (New Jersey): Princeton University Press. Hantrais, L. 1994. 'Family policy in Europe' in Page, R. and Baldock, J. (eds.) Social Policy Review. Canterbury: Social Policy Assn. Harding, L.F. 1991. Perspectives in Child Care Policy. London: Longman. Health, D.o. 1995. Child Protection: Messages from Research. London: HMSO. Hill, M. 1995. 'Family Policies in Western Europe' in Hill, M., Kirk, R. and Part, D. (eds.) Supporting Families. HMSO: Edinburgh. Parton, N. 1991. Governing the Family. London: Macmillan. Parton, N. 1996. 'Social work, risk and the blaming system.' in Parton, N. (ed.) Social Theory, Social Change and Social Work. London: Routledge. Phillips, M. ‘Issues of ethnicity and culture’, in Wilson, K. and James, A. (eds) 1995. The Child Protection Handbook, London: Bailliere Tindall. Pringle, K. 1998. Children and Social Welfare in Europe. Buckingham: Open University Press. Roberts, J. and Taylor, C. 1993. 'Sexually abused children and young people speak out', in Waterhouse, L. (ed.) Child Abuse and Child Abusers. London: Jessica Kingsley. Waldfogel, J. (2001) The Future of Child Protection, Cambridge (Mass.), Harvard University Press.
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Westcott, H.L. and Davies, G.M. 1996. 'Sexually abused children's and young people's perspective on investigative interviews.' British Journal of Social Work 26: 451-474.
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PART II – PLENARY PAPERS CHAPTER 4. CHILD PROTECTION AND CHILD ABUSE PREVENTION ‘DOWN UNDER’ - KEY TRENDS IN POLICY AND PRACTICE Adam M Tomison The child protection system in Australia is quite fragmented. At the national level, the Commonwealth Government has a role in the prevention of child maltreatment and some aspects of child and family support (particularly parent and relationship education). The Commonwealth also addresses issues of child abuse that arise through marriage dissolution in the Family Court of Australia. However, the responsibility for providing statutory child protection services, Children’s Courts and child welfare legislation rests with the individual Australian State/Territory governments (Boss 1987; Goddard 1996). As a consequence, there are major variations in child welfare laws governing children in need of care and protection, including how child abuse and neglect are defined. Further, there are differences between the states and territories with regard to the structure of the child protection system and the services that have been developed. This has led to substantial variation in the reporting, investigation and intervention in cases of suspected and/or substantiated child maltreatment (Goddard 1996; Australian Institute of Health and Welfare [AIHW] 2002). Yet in spite of the quite significant differences between the State/Territory services, each service plays a similar role and has been affected by a number of inter-related issues that have impacted on the provision of child protection and child welfare/family support services across the western world7. In this paper the aim is to provide an overview of the development of Australian child protection systems and to describe historical and current trends that are currently shaping child protection services. Further, in response to requests from the Scottish Executive, a number of key aspects of service delivery are discussed, drawing on Australian experiences, followed by a discussion of the increased interest and developments in the wider field of preventing the occurrence of child abuse and neglect. Child Protection in Australia: white settlement to the 1990s In Australia, the earliest form of child protection developed within weeks of the first white settlements being established in New South Wales (Gandevia 1978), in response to what would be defined as neglect today. The settlement’s abandoned and neglected children, or children whose parents were considered ‘socially inadequate’ were boarded out with approved families, or later, resided in orphanages, the first of which was established on Norfolk Island in 1795 (Liddell 1993).
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In responding to the need for change, it is worth noting that Australian child protection services have often drawn on (and adapted) U.S. and U.K. innovations and directions in the development and operation of child protection service systems 27
Over the next century a strong voluntary or ‘non-government’ child welfare sector was developed in Australia (and overseas) (Picton & Boss 1981), with the Christian churches becoming involved in running orphanages and occupying prominent positions within the non-government child welfare system – positions that are still held today. However, it was not until after the modern ‘discovery’ of child maltreatment, prompted by Kempe and colleagues 1962 paper on the ‘battered-child syndrome in the USA’ (Kempe et al. 1962), that governments really began to take significant responsibility for looking after children’s welfare. By the 1970s, statutory child protection services had been developed and were operational within the various Australian States and Territories. The 1970s and 1980s were characterised by the development and refinement of systems for investigating and managing child maltreatment cases (Liddell 1993) and the increased ‘professionalisation’ of the child protection response8. In the 1980s and 1990s, the desire to enhance the professional response to child maltreatment, along with a strong desire for greater accountability (see below), led to the widespread adoption (following a U.S. trend) of a variety of professional decision making aids, guides or checklists, commonly referred to as ‘risk assessment’ measures. The intention was to provide child protection workers with additional resources they could use when assessing the risk of abuse or neglect to a child. Specifically, the aids could assist workers in determining: if abuse or neglect had occurred; the risk of further harm; and whether the child should be removed from her/his parents’ care. Economic rationalism Child protection services in many western countries have been shaped by the current political philosophy of economic rationalism, espoused by the 18th century Scottish academic, Adam Smith (McGurk 1997). Economic rationalism has resulted in a number of significant changes to child protection practice. First, the development of the user pays system, which has led to an increasing expectation on the part of governments for families and communities to look after and manage their own needs with minimal government intervention (McGurk 1997). Second, the welfare system and social policy has been framed in terms of cost-effectiveness and efficiency criteria, a particularly difficult task when applied to the prevention of child maltreatment and the protection of children. It has also resulted in the privatisation of government services and the introduction of compulsory competitive tendering. In harsh economic times, particularly in the early 1990s, an economic rationalist approach translated into the rationing of resources and the increasing pressures and controls being applied to non-government family support and child welfare agencies. This forced some non-government agencies to close, many agencies were forced to amalgamate to survive, and the non-government sector’s ability to provide services and support for children and families was significantly hampered (Mitchell 1996). In practice, what this meant was that agencies’ ability to provide support for families suffering from social problems, but who were not actually maltreating their children (so-called ‘at risk’ families) was severely reduced. 8 Another significant change in the 1980s and 1990s, was the widespread adoption of mandatory reporting for various forms of suspected child abuse across the nation (with the exception of Western Australia). For a detailed analysis of interstate differences in mandatory reporting, see ‘Child Protection Australia 2000-01’, (AIHW 2002).
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These families were often not able to gain access to services, or were placed on long waiting lists as the depleted non-government system struggled to cope with the influx of clients referred by child protection services (Scott 1998). Bureaucratisation of child protection practice At the same time as the reductions in public spending on welfare and child protection began to take place, child protection work became increasingly driven by administrative requirements and the adherence to strict procedures (‘bureaucratisation’). Management issues rather than professional practice became central to child protection practice, with efficiency, effectiveness and a focus on accountability overriding and conflicting with professionals’ values and orientation towards the needs of children and their families (Liberman 1994). It has been argued that the bureaucratisation of child protection practice has led to workers’ professional skills, knowledge, discretionary powers and decision making, being replaced by standardised practice, developed without a clear understanding of the complexity of child protection practice or of the dilemmas and the moral and political factors that workers must take into consideration when making decisions (Howe 1996). The legalisation of child protection practice Concomitantly, a legalistic framework and ‘rules of evidence’ were increasingly determining the facts of a case and whether abuse or neglect is serious enough to warrant protective intervention (Stanley 1997). Under a legalistic framework, developing a legal response pervaded child protection practice and usurped the therapeutic needs of the child and family. A consequence of the adoption of the legalistic framework has been that attempts have been made to restrict definitions of maltreatment in order to limit coercion and stigma. This has conflicted with the therapeutic need to widen definitions and to increase the identification of ‘at risk’ or maltreating families in order to offer help (Hallett & Birchall 1992). A further consequence of the law becoming the standard by which cases are judged and maltreatment defined, is that cases with legal consequences are, by definition, more likely to be singled out for attention (Lynch 1992). Emotional abuse or neglect, typically more difficult to prove legally, may therefore be less likely to receive adequate attention. In addition, there is a danger that maltreated children may receive less care and protection as a function of a lack of evidence, or until the evidence is such that the case is able to be dealt with under the legal system (Stanley 1997). Finally, the evidential standards required by courts may permeate the work of nonjudicial agencies, with evidential issues dominating case investigations, with child protection concerns being subsumed and therapeutic work hampered by a focus on criminal concerns (Mouzakitis & Varghese 1985). Reframing child protection service provision: the shift to family support In the late 1990s, statutory child protection services in the Australian States/Territories, like those in other western countries, were struggling to cope with ever-increasing numbers of reports of suspected child maltreatment and fewer resources (Tomison 1996a). These pressures, some caused or exacerbated by the over-emphasis on cost effectiveness and bureaucratic structures at the expense of professional practice, led governments and child protection services to seek alternative solutions.
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It was apparent that a substantial proportion of the child maltreatment reports received by child protection services were inappropriately labelled as allegations of child maltreatment by those who referred cases to child protection services (Dartington Social Research Unit 1995; Tomison 1996a). Many of the reports involved families who had not maltreated their child but who had more generic problems, such as financial or housing difficulties, an incapacitated caregiver, or serious stress problems. Although such ‘at risk’ families may require assistance, they do not require child protection intervention. Their labelling as cases of child abuse or neglect was further taxing what were generally limited child protection resources (Tomison 1996a). Despite the fact that legal action was not taken for the majority of families with whom child protection services were involved, it was argued that the style of intervention for all families had become ‘forensically driven’, (Tomison 1996a; Armytage, Boffa & Armitage 1998). One consequence of this ‘forensic’ or legalistic approach was an emphasis on statutory child protection services as ‘expert’, and to alienate essential non-government agencies and professionals from a partnership approach to the prevention, support and protection of children (Armytage et al. 1998). These developments have led to the shifting of scarce child protection resources away from confirmed or ‘substantiated’ child maltreatment cases to enable the conduct of investigations. It also raised general questions in relation to both child protection services’ screening or ‘gatekeeping practices’ and the nature and availability of broader child welfare and family support services in the community. Within this, the dilemma was described as one of distinguishing child protection problems from broader welfare concerns and, in all instances, delivering an appropriate response matched to the needs of the client children and families. In developing alternative service models as a response to these critiques, attention has therefore focused on both the operations of child protection services and the broader child and family welfare system that the statutory child protection services operate within (Dartington Social Research Unit 1995). Most Australian State and Territory governments have adopted ‘new’ models of child protection and family support (Tomison 1996a), based predominantly on the recommendations proposed in the UK Department of Health’s Messages from Research report, (DOH 1995). Such approaches are often not new, but are a revisiting or recapitulation of solutions previously tried and tested since the development of child protection services. One of the major differences is that there is now formal recognition of the vital role played by the broader child and family welfare system in supporting families and thereby preventing the occurrence and recurrence of child abuse and neglect. Back to the future Under these new approaches, the balance between child protection and the role of family support services is altered such that child protection no longer drives the system but becomes merely one important facet in an overall welfare assessment of the family. Good practice and adequate child protection thus both emerge from adopting a wider perspective on child protection by means of which underlying problems in the family that may put a child ‘at risk’ or have a detrimental effect on the child’s long-term welfare are addressed (Tomison 1996a).
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With the recognition that merely conducting an investigation and applying the label ‘child abuse’ to a family would not do much to reduce the risk of further harm to children, has come a renewed focus on addressing family ills holistically, to supporting children and families, in order to prevent the development or recurrence of child abuse and neglect. Most services have therefore adopted practice principles that promote co-operation between workers and families in order to achieve greater levels of parental co-operation and, subsequently, a better outcome for children and families. In addition, child protection workers have been provided with a greater range of options to select from when responding to a report. These differentiated responses provide workers with more scope to tailor the assessment process to the perceived family needs and the level of risk to the child. Thus, a case that appears to be mainly about a need for general family support rather than the occurrence of actual child maltreatment, may receive a less intrusive assessment, involving non-government agencies, while a serious child abuse concern continues to receive a more authoritarian response from child protection workers, perhaps in the company of police officers (see below for detailed discussion). The benefits of the new systems are that, ideally, families are not unduly stigmatised or traumatised by inappropriate or unnecessary investigations, and are therefore more likely to accept assistance. In addition, family problems can be comprehensively assessed and (in theory) appropriate services put in place to address them, thus preventing the development of maltreating behaviour, or reducing conditions detrimental to a child’s long-term development. Equally importantly, the models recognise the need for effective collaboration between child protection services and other family support agencies in order to more effectively assess family needs and to provide a response that can positively affect family wellbeing and ensure the protection of children from abuse and neglect. Such models, if appropriately resourced, enable agencies to regain prominence in preventing child maltreatment and the early detection of ‘at risk’ children, a role which many services were unable to perform substantially in the 1990s because of a lack of resources, exacerbated by the high demands for services that accompanied the recession of the late 1980s and early 1990s (Tomison 1996a; Armytage et al. 1998). A cautionary note However, while the adoption of a ‘family support’ model of child protection can be beneficial for many children and families, it can also have potentially negative consequences. If inadequate resources are put in place to enable agencies to cope with the demand for services which results from such an approach, then families, particularly families labelled as being ‘at risk’, or as having a generic welfare or family support concern, are no more likely to receive support or remediation of their problems than they would under the current ‘forensic investigation’ models of child protection (Tomison 1996a). Case screening and risk assessment may more effectively target protective investigations and legal intervention to those families where children are ‘at risk’ or are being maltreated, but without the resources to treat and support these families and those screened out with more generic family problems, nothing may be done to alleviate the concerns which led to a notification in the first place.
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In addition, the interprofessional and interagency communication and co-ordination problems that have beset child protection systems for many years, may be exacerbated by a ‘family support’ model. With child protection services reducing their role as primary or co-ordinating agencies, family support services will have greater responsibility for case co-ordination. It is therefore of paramount importance that adequate means are put in place to ensure adequate resourcing of the family support system and the development of a structure to enhance comprehensive interprofessional involvement in case plan discussions. If not, it is likely that history will repeat itself, with cases slipping through cracks in the system or families being inadequately serviced (Tomison 1996a). In the following sections a number of inter-related key components of child protection systems that have developed (or been re-visited) over the past few years are discussed, with particular reference to their operationalisation in Australian child protection systems. The key components are: central intake systems, differentiated response models, risk assessment and multidisciplinary teams. Central intake systems One means of reducing variability in child protection decision making, particularly at intake, has been the adoption of a central intake service designed as the sole point of access for the receipt of reports of suspected child abuse and neglect. The intention is for a team of highly trained workers to make all intake decisions for a particular child protection service (in Australia, the teams usually operate an intake service for an entire State or Territory). Local workers elicit preliminary information from the notifier or reporter, make a judgement as to whether or not the case is to be accepted for further investigation, and then refer the case to a regional office of the State child protection team for action. Such centralised services have been developed in order to reduce inter-regional, inter-office or inter-worker differences in decision making, and to ensure that local issues (such as resourcing) do not impact on the threshold for accepting a case. Thus, central intake services provide a means of standardising service response and increasing accountability. Two examples are described next. South Australia In 1997, South Australia was one of the first Australian states to develop a ‘new’ child protection system. This new approach incorporated most of the key service elements currently identified in Australian child protection systems: a central intake system, the use of structured risk assessment measures, a differential response system, and an attempt to enhance interagency co-operation (Department for Family and Community Services 1997). As part of the reform a central telephone intake team (CIT) of skilled and experienced social workers was established in April 1997 so that all child abuse and neglect reports from across the state would be received on a 24-hour child abuse report telephone line. [A central Aboriginal consultation and response team - Yaitya Tirramangkotti - was also established at the same time.] It was hoped that use of a single phone number would provide easy access for notifiers, especially children and young persons. Team members utilise safety assessment and initial risk assessment instruments to ensure consistency and accountability of assessments.
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Initial evaluation An initial evaluation of the child protection reforms identified a number of benefits, some of which appeared to be associated, at least in part, with the introduction of the central intake team (Hetherington 1998a). First, the average rate of increase in notifications (reports), was more than twice that of the prior three years (18% c/f. 8%)9. During consultations and implementation of the central intake system, some concerns were expressed that notifiers from country and remote areas might be reluctant to phone a central telephone line in Adelaide and might prefer to use their local networks. In reality, the opposite appeared to occur (Heatherington 1998a), with the increase in notifications in country areas increasing from 5 per cent to 22 per cent. ‘In the most remote districts (more than 750 kilometres from Adelaide) the increase in notifications in the year post-CIT has been 30 per cent. Possible explanations for this significant increase in reporting from country districts include the introduction of a free call system, and the greater anonymity provided to notifiers by a central abuse report line’ (Heatherington 1998a:8). Second, another objective of the CIT was to reduce some of the significant variation between district centres with regard to the proportion of cases they screened in and out (that is, to reduce variation in the threshold for action across the state). ‘In the twelve-month period prior to reform, the average screening-out rate was 30 per cent. However, five of the nineteen district centres in South Australia screened out less than 20 per cent of notifications whereas three screened out more than 40 per cent. Significantly, there appeared to be an association between work pressure in district centres and their screening-out practices, with the busier district centres tending to screen out the highest proportion of cases and those with the least work pressure screening out the least’ (Heatherington 1998a:8). In the twelve months following the introduction of the central intake system, there were four observable changes to case screening practice: •
a slight increase in the overall screening-out rate (from 30% to 32%);
•
the range of screening-out rates was significantly reduced;
•
the screening-out rate no longer correlated with workload pressure. The two district centres identified at either end of the workload spectrum had, since reform, produced screening out rates of 27 per cent and 29 per cent - close to the state average (32%) (Heatherington 1998a).
The introduction of the CIT, when combined with a three-tier differentiated response system, also appeared to enhance the Department’s ability to target ‘scarce investigative resources towards the most dangerous cases’ (Heatherington 1998a), increasing the number of direct, face-to-face investigations undertaken with tier 1 9
It should not be assumed that the use of the CIT was the only reason for the increase in notifications; service reform does not operate in a vacuum and is influenced by community education campaigns, increased public awareness of child abuse etc.. 33
(‘children in danger’ - most urgent) and tier 2 cases (children at risk), and lessening the involvement with tier 3 cases (children in need - minimal protective concerns). Unfortunately, no other evaluations have been undertaken (or have been released publicly), so firm conclusions about the effectiveness of the CIT can not be drawn. More recently, in 2001-2002 the National Child Protection Clearinghouse has been providing advice and support to the SA Department of Human Services who are currently undertaking a reform of child protection and alternative care systems. It has been apparent from this involvement that the Department has no plans to phase out the Central Intake Team; this may indicate a degree of satisfaction with the service. New South Wales Approximately eighteen months ago, the NSW Department of Community Services (DoCS) introduced a major reform of child protection. Together with the introduction of new legislation (with wider definitions of what constitutes child maltreatment) and the use of risk assessment guides, DoCS introduced a central intake service. Like the South Australian CIT, a central telephone intake team of skilled and experienced social workers was established, with all child abuse and neglect reports from across the state being received on a single 24-hour child abuse report telephone line. Although there has been no formal, published evaluation of the service, the author has been able to gather anecdotal evidence about the impact of the introduction of the central intake service from DoCS, media reports (Videnieks 2002) and from a variety of professionals who regularly report suspected child maltreatment to DoCS. First, in a recent presentation, the Director-General (DoCS) reported a 30 per cent increase in the number of reports received by DoCS in the first 12 months of the operation of the central intake service (there had been an expectation of a 15% rise) (Niland 2002)10. Overall, DoCS received 107,000 calls in 2001, of which 52,000 were designated as ‘not about child abuse’ (Niland, quoted in Videnieks 2002). The remaining 55,000 cases were investigated (although this may not involve face-to-face contact with the child or family), and 10,000 were substantiated. Noting that there had been some initial accessibility problems (caused by high demand and a limited number of staff), Niland (2002) reported that the service had achieved a level of performance such that call waiting times were now able to be kept to a minimum. This had been made possible by the recent recruitment of 180 additional CIT staff which ensured the unit could now cope with the greater-thanexpected service demand. In contrast, anecdotal evidence collected from a number of service providers (police, medical personnel, key non-government family support agencies) over the past six months has generally indicated that access to the CIT remains difficult. Although acknowledging that there had been an improvement in service delivery, a number of professionals consistently reported call waiting times of between 60-180 minutes when trying to make a report. Further, anecdotal evidence from professionals operating in rural and remote regions of New South Wales indicated that there had been a concomitant sizeable decrease in the number of cases being accepted by DoCS 10
The rise has also been attributed to the widening of the definitions of child abuse and neglect in the new NSW Children and Young Persons (Care and Protection) Act and a widening of the mandatory reporting requirements for the state (Ainsworth 2002). 34
for investigation or action since the introduction of the child protection reform and CIT. That is, there has been a significant rise in the threshold for taking action. Acknowledging that this assessment should be treated with caution, a key issue in the development and use of central intake services, or any mechanism that increases the number of reports (e.g. changes to legislation; the introduction or extension to mandatory reporting; community education campaigns) is the child protection system’s ability to cope with the increased demand. As noted above, what has been evident in the 1990s has been that significant increases in demand, combined with limited or inadequate resourcing of the child protection system, has frequently led to a child protection system unable to respond effectively to children and their families and a ‘forensic investigation’ response. Thus, adequate resourcing of both statutory and wider child welfare/family support systems appears to be a vital consideration prior to introducing any new service system. The drive for greater accountability and uniformity in intake processes needs to be considered in light of the service’s ability to deliver an effective service response. Consideration should be in terms of both the central intake response and the state’s child protection offices’ ability to deal with increased reports, particularly when arising from regions already having difficulty in responding to local child protection concerns. Overall, merely raising the threshold for taking action (investigative or statutory intervention) has not provided a useful answer for child protection services, other service providers or ‘at risk’ and maltreating families. A key theme underlying this paper therefore, is the need to ensure that there are services able to provide family support, for both ‘at risk’ and maltreating families, and to anchor the tertiary prevention (child protection) response within a wider child abuse prevention strategy. Differentiated intake response models Another major service change across a number of Australian State/Territory child protection services (allied at times, with the development of central intake services), has been the development of differentiated response models for child protection intake processes. The three main models presently operating in Australia are described. South Australia Between April and November 1997, the SA Department of Human Services introduced a three-tier response system to child protection notifications, differentiating between children in immediate danger (tier 1), children at risk (tier 2), and children primarily ‘in need’ where the risk of future abuse is low, but the family are identified as perhaps failing to cope with one or more social ills or ‘stressors’ (tier 3) (Department for Family and Community Services 1997; Heatherington 1998b). Under this system the level of risk is determined by CIT staff using a ‘safety assessment’ risk assessment checklist. For ‘children in danger’ (tier 1 ) ‘an immediate response is arranged, usually in conjunction with specialised police and health units. Departmental standards and quality feedback measures ensure response times are kept to a minimum, and only skilled and experienced workers investigate tier 1 cases’ (Heatherington 1998b:8). Tier 2 children are investigated along traditional departmental lines, that is one or two workers carry out a face-to-face investigation of the child and family situation.
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Written outcomes of the investigation are provided to all families investigated. However, families classified as a tier 3 case do not receive a visit from child protection staff. Rather, the initial response to these cases is to contact the family (usually in writing) and invite them to a meeting to discuss their situation with a social worker. The emphasis with tier 3 cases is on assisting families to find a solution to their problems rather than investigating a reported incident. ‘Departmental and family perceptions of the reported concerns are shared and community support sought where necessary’ (Heatherington 1998b:8-9). The evaluation of the first six months of operation indicated that the central intake and differential response systems had together led to a ‘significant improvement in the proportion of immediate (that is, within 24 hours) responses made to children in danger (tier 1), from 60 per cent in February 1996 to 85 per cent in July-December 1997’ (Heatherington 1998b:9). Little evidence is available concerning the response able to be provided to those families classified as ‘in need’ (Tier 3). However, evidence of the effectiveness of a West Australian differentiated response system may shed some light as to the impact on families. Western Australia In 1995, Western Australia set up a new differentiated model of case intake, where cases were classified as either a generic ‘child concern report’ requiring a more generic, ‘problem solving’ approach or as a ‘child maltreatment allegation’ (Tomison 1996a). Regardless of the ‘stream’11 into which it is initially designated, the intention of the model is that all cases undergo a full risk and needs assessment and would then receive professional supports where necessary. The process Under the West Australian approach, an experienced child protection worker decides at the time of receipt of a report, whether a case requires a protective assessment by the child protection team, thereby being designated as a ‘child maltreatment allegation’ (CMA), or whether it can be managed as a ‘child concern report’ (CCR) and can therefore be referred to welfare services for an assessment and the provision of services. In this model, only severe incidents of maltreatment are initially referred to the child protection team: for example, where an illegal act has been committed; where there is evidence of severe or persistent harm; or where a significant history of child maltreatment in the family exists. The majority of cases are expected to be assessed as CCR’s and dealt with by a generic social work team. The CCR has been designed as an interim category, one that describes the assessment process undertaken, after which a case is then finally reclassified as either ‘no viable departmental role’; ‘requires some form of family support’; ‘substantially resolved’; or as a CMA requiring child protection involvement. Regardless to which stream a case is assigned however, appropriate services are meant to be provided to address the families’ needs.
11
In Tomison (1996a) the approach is referred to as a ‘case streaming’ model, although the WA Department of Community Development prefers to classify the system as one based on ‘differentiated response’. 36
Evaluation In a recent assessment of New Directions, Parton and Mathews (2001) identified a number of changes they considered to be evidence of the positive impact of the new differentiated response system. Analysing the WA Department of Community Development’s child protection data, they reported that the total number of reports received by the Department post-implementation (CMA’s and CCR’s), approximated the total number of reports pre-implementation. This was taken as an indication that reporting practice had not been negatively affected by the new approach. Further, Parton and Mathews reported that the differentiated response system had enabled a better targeting of those cases rated as more severe and/or as involving high risk (especially sexual and physical abuse cases). They concluded that New Directions had enabled the Department to prioritise its work and to focus resources more effectively on serious child maltreatment matters despite increasing demands for service and an environment of rapid change. They also noted, however, the high proportion of CCR cases where no services were provided (despite original intentions) and the relatively high rate of CCR re-referrals (27%). Tomison (1996) sounded a warning was sounded regarding the introduction of differentiated response systems, and particularly ‘streaming’ approaches, such as the Western Australian model. It was predicted that unless appropriate resources were put in place to enable agencies to cope with the demand for services, that families, particularly families classified as CCR, would be no more likely to receive support or amelioration of their problems than they would under the traditional ‘forensic investigation’ models of child protection. Analyses by both Parton and Mathews (2001) and McCallum and Eades (2001) would seem to confirm this outcome. The analyses indicate that the New Directions reform has increased the threshold for both taking investigative action and for the provision of support to children and families. This has occurred despite the potential for the CCR classification to ensure comprehensive assessment and service provision for ‘at risk’ families and ‘low level’ maltreatment, that is, to prevent maltreatment. While CCR cases were reported to be comprehensively assessed (Parton & Mathews 2001), it would appear that in a substantial number of CCR's that therapeutic or practical supports are not being provided (Parton & Mathews 2001; McCallum & Eades 2001). Thus, New Directions has not had its intended preventative effect, rather it has become merely a more effective way to target scarce resources to those most in need. A related consequence of New Directions has been a substantial decrease in the number of official child maltreatment cases recorded, as many cases have been labelled as a generic concern (CCR) rather than as a child maltreatment allegation (CMA). The former are not perceived to be child maltreatment reports by the Department and are not formally counted as notifications. Overall then, with many cases no longer recorded as child maltreatment, and a failure to increase family support resources, there is a danger that the incidence of child abuse and neglect is reduced by definition rather than by a reduction in actual maltreatment. It could therefore be argued that such a system is a cosmetic reduction of concerns which, through inaction and the failure to provide adequate support, may contribute to the development of more serious problems in some families and/or the maltreatment of children in the long term (Tomison 1996). As McCallum and Eades note:
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‘there is danger in organisations seeking to make the numbers of notifications to which they must respond less, rather than working to reduce the incidence of child abuse and neglect: the former is a re-shuffling of the cases. The latter is effective intervention’ (2001:270). Enhanced Client Outcomes (ECO) An alternative to the case streaming system applied in Western Australia, is the Victorian differentiated response system. Here the Department of Human Services (DHS) has implemented the Enhanced Client Outcomes (ECO) system within its child protection services. The aims of ECO are: • reaffirming the importance of risk assessment as the basis of decision making in child protection and the key to discriminating between different client needs, including high risk and urgency issues • providing access to a range of differential response options ensuring sensitive and flexible responses to the full range of presenting problems • promoting interagency relationships that ensure maximum knowledge of local resources and networks and use of advanced collaborative practic • building on the principles of child centred family focused practice to ensure that the principles of partnership, strengths, sensitivity and respect underpin all transactions with families and other professional service providers ECO practice incorporates the principles of: • greater attention to developing practice skills and strengthening supportive structures to enable greater linkages and collaboration between statutory child protection and other service providers • the articulation and ongoing development of child centred, family focused practice principles and strategies for use by the protective worker in their work with children, young people and their families Put simply, ECO provides workers with an opportunity to use a graded scale of assessment and investigation, tailoring responses to identified concerns, such that where it appears there is a generalised family dysfunction, rather than a child protection issue, families are provided with a less intrusive response, possibly involving family support agency workers making an assessment, rather than having two child protection workers conduct an unannounced home visit. In many ways ECO is a formalisation of practice as it was undertaken in the 1980s, recognising the expertise of other professionals and involving them collaboratively in case assessments and caseplanning, where appropriate. Solution focused or strengths-based practice At the centre of ECO is the principle of ‘child centred, family focused practice’ which affirms the primary importance of ensuring the safety and wellbeing of children; recognises the mutual significance of the child and family to each other; and, promotes the importance of service professionals developing a strengths based partnership with client families (Tomison, Burgell & Burgell 1998).
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Pioneered in the early 1960s by Otto, the underlying tenet of ‘solution focused’ or a ‘strengths perspective’ is that all families have strengths and capabilities (De Jong & Miller 1995). If practitioners take the time to identify and build on these qualities, rather than focusing on the correction of skills deficits or weaknesses, families are more likely to respond favourably to interventions and thus the likelihood of making a positive impact on the family unit is considerably enhanced (Dunst, Trivette & Deal 1988). A focus on the positive aspects of family functioning does not imply that family problems and/or the protection of the child are forgotten. The child centred family focused philosophy ensures that the protection and care of the child remain paramount, while maintaining a focus on building family members’ competence and self-esteem in order to tackle protective concerns and other family issues effectively. The objective is to develop a true partnership between family members and workers, involving the family as much as possible in case management decision-making and encouraging families both to set their own goals and to take responsibility for achieving them. Such competency-based, family-centred practice is not a denial of a family’s problems or shortcomings but a focus on client strengths is perceived to be a more fruitful means to address issues and achieve positive change. Such an approach to working with families is currently quite common in Australian family support and child protection systems [e.g. Western Australia - the Signs of Safety approach (Turnell & Edwards 1999]. Differentiated response options The type of investigative response options available to workers under the ECO approach are dependent upon the worker’s assessment of the level of risk to the child, the urgency of the required response, the wider assessment of family functioning and strengths and by establishing the type of intervention most likely to engage the family in addressing the child and family’s needs. Overall, workers can select from any of 19 different responses which are presented in Table 1.
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Table 1: The ECO differentiated response options 1 – Notifier offered advice only. No follow up calls to third parties necessary 2 – Notifier referred to another agency 3 – Further follow up: phone calls to other agencies/relatives – case closed 4 – Further follow up, with ongoing consultancy role for Protective Services but no client contact by Protective Services 5 – Professional intake case conference, family not present 6 – Case conference involving family 7 – Telephone contact with parents where no visit is anticipated as necessary 8 – Arranged appointment with parent/s not at their home (usually at the office) 9 – Arranged appointment with child/young person with parents prior knowledge 10 – Arranged appointment with child/young person without parents knowledge 11 – Arranged home visit to parents with other agency or relative or notifier 12 – Arranged home visit to parent/s – one protective worker 13 – Arranged home visit to parent/s – two protective workers 14 – Unannounced visit, parents first then (if necessary)child – one protective worker 15 – Unannounced visit, parents first then (if necessary)child - two protective workers 16 – Unannounced visit, child first then parent/s – one protective worker 17 – Unannounced visit, child first then parent/s – two protective workers 18 – Joint investigation with police 19 – Other – includes after-hours callouts and transfers after notification
These options can be categorised into three broad response types designed to ensure workers have sufficient flexibility to acknowledge and respond to the individual needs of children and their families. These are forensic/protective responses (the traditional unannounced visit by protection workers, with or without police); protective/community responses (a level of co-work with community professionals); and community responses (the provision of advice or consultation to notifiers). Within each category the range of possible options ensures the flexibility to vary the response if new information or changed circumstances alter the worker’s assessment of risk to the child. Evaluation An unpublished evaluation of the ECO pilot study (Tomison, Wise and Murray 1998) produced evidence that the system can produce positive changes to the intake process for protective workers, non-government service providers and the families. It involved an in-depth analysis of 200 child protection cases, focused primarily on the 12 month period prior to ECO and the 12 month ECO pilot implementation period; participant feedback, collected from a sample of child protection workers, other service providers and client families; and the presentation of two case studies which highlighted issues of case management and the effect of the ECO approach on practice. Overall, despite a lack of statistically significant differences, it was apparent that the ECO pilot implementation had produced:
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• • •
•
an increase in the proportion of cases directly investigated within seven days in the pilot regions significant increases in child protection workers’ attempts to gather detailed background information on families as a means of informing their case management decision making the use of the range of differentiated response options. Staff had clearly been tailoring their responses to the perceived demands of the notified cases, utilising a range of responses. Workers had been able to reduce the number of traditional ‘forensic investigations’ in favour of other less intrusive assessments, where possible a substantial increase in the involvement of other service providers in the various stages of case practice (by DHS staff)
Feedback also indicated that the ECO approach was well-received by both child protection workers and other service providers alike and effective implementation was reported to have resulted in some obvious practice benefits. When workers were familiar with ECO, there was good overlap between service provider and DHS reports of what constituted a well-handled and not well-handled case, and much commonality in delineating the principles of effective practice. Cases that responded well to the ECO approach had the following features: • • • •
there were positive outcomes for child and family the principles of child centred family focused work were adhered to they cases were characterised by good inter-agency collaboration, and working partnerships between child protection services, the families and service providers were established
Child protection workers reported that working in partnership with community professionals improved outcomes for clients, and resulted in a better managed case at all levels of investigation (including interviewing, case closure and decision-making). Conversely, child protection staff and the service providers reported that ECO was more difficult to implement when: • • • • • •
families did not acknowledge protective concerns families were resistant to working with child protection services families did not accept services families were ‘dishonest’ services were unavailable and/or there were worker safety concerns
However, these issues are equally applicable to child protection practice as a whole. While work should continue to reduce their impact, these problems were not a result of, nor necessarily caused by, the implementation of the ECO framework. It was apparent that significant changes to child protection practice and to workers ‘ways of seeing’ had taken place since the implementation of ECO. The challenge appeared to be one of strengthening the adoption and utilisation of the ECO approach by workers, rather than making further substantial changes to child protection practice.
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Client feedback Feedback from a small sample of client families also indicated that DHS had been quite successful in adopting the tenets of child centred family focused work and a strengths-based approach to practice. Again, suggestions for improvement related to the further strengthening of workers’ use of the new practice approaches and to enhance their adoption into everyday work. It was also clear from participant feedback and case studies, that the limitations of the statutory child protection role will at times challenge the extent to which partnershipbased practice can be achieved. Some cases, particularly those that involve significant risk of harm to the child or uncooperative caregivers, may by their nature limit the extent to which such practice may be implemented. Such cases may require the use of child protection’s statutory authority to ensure the protection and care of a child. It is therefore important that workers maintain a child centred focus, and that the promotion of family focused work takes place in a manner that does not jeopardise child (or worker) safety. Finally, the evaluators made specific reference to the need for adequate resourcing of the larger child welfare/family support system if the practice benefits of ECO were to be truly recognised, and the need to ensure effective interagency communication and collaboration. In addition, it was recommended that DHS regularly monitor and review ECO practice to ensure that the use of the differentiated responses and the adoption of child centred family focused practice did not result in some cases, in a minimisation of the intervention required in particular cases, and as a result, a minimisation of the abusive concerns. It was believed that it would only be via the regular reinforcement of ECO practice, that the framework would be fully utilised and the results for the service system and families realised. In summary Although the benefits to be gained will vary depending upon the approach utilised, introduction of a central intake service and/or a differentiated response system do seem to provide some benefits to agencies in terms of resource targeting and prioritisation of more severe concerns. Perhaps more importantly with regard to differentiated response models, there is some evidence indicating that they can provide more scope for professional judgement at intake, by allowing workers to tailor a response to the given situation. Combined with the use of a solution focused approach, a differentiated response system can offer a means of ensuring that all cases are responded to in a manner more likely to lead to client engagement, enhanced interagency collaboration and information sharing. Further, by explicitly working with the wider child welfare/family support system to ensure adequate assessment and supports are provided for ‘at risk’ and maltreating families, such approaches appear to offer the potential for a reduction in the level of risk in the short and longer term. The key issue affecting the benefits that may result appears to be the underlying purpose driving such reform. Clearly, central intake and a differentiated response system may be used to better target scarce resources and to prioritise work with the most severe maltreatment concerns. If the aim is to also ensure a better response for families, then there is a need for adequate investment in the resources available to
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support families. Otherwise, the approach merely improves investigatory processes with limited impact on client families. Risk Assessment The use of some form of risk assessment guide, measure or tool, is now widely used as part of the child protection intake process in Australia. Along with a desire to enhance worker decision making, the need for greater accountability and a more targeted response for limited child protection resources, have clearly helped to drive the introduction of risk assessment measures. In this section the pros and cons of using such tools are discussed, and recommendations made for their use. Researchers investigating child protection decision making have usually utilised one of two alternative methods, traditionally referred to as the statistical and clinical approaches (Wiggins 1981; Ruscio 1998). The statistical approach commonly consists of controlled experimental and quasi-experimental studies that result in the development of a statistical decision model which identifies the factors which account for the variance (or a proportion of the variance) in making a particular decision. It is argued that a statistical decision model provides good accuracy (i.e. a better ‘hit rate’) and few judgement errors (i.e. ‘false positives’ and ‘false negatives’). It is not claimed that all decision errors are eliminated ‘levels of accuracy are higher than we could achieve if we did not possess the risk assessment tool in question’ (Johnson 1996:14). Such experimental, logical positivist, decision modelling studies were initially used to determine the factors which influence decisions. In the 1980s and 1990s, most modelling studies have been designed to construct structured risk assessment scales designed to predict case outcomes for use in child protection practice. In contrast, the clinical approach, is associated with a desire to develop causal explanations for decision making, involving ‘nothing more than a human judge evaluating available information and arriving at a decision.’ (Ruscio 1998:145). The clinical approach generally utilises qualitative-descriptive methods of data collection to describe the decision making process, such as: self-report measures; behavioural observational techniques; case tracking; and the content analysis of case records. Such methods are ecologically valid and their flexibility enables their application to a variety of research questions. However, the generalisability of their results and their ability to test cause and effect relationships are hampered by their lack of experimental control (Ruscio 1998). In an excellent conceptualisation of the realities of human decision making, Dalgleish (1997) notes that the relationships between the indicators or factors, the worker’s judgement and the actual reality of the family situation is ‘inherently probabilistic’. He argues that statistical models focus on a family’s situation and environment, while clinical judgement studies focus on the factors and influences affecting the decision maker, in this case, the child protection professional. The ‘irreducible uncertainty’ present in both actuarial and clinical models leads inevitably to some degree of error.
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Structured risk assessment The assessment of risk is intrinsic to the child protection role, beginning with Kempe et al.’s (1962) paper, which discussed the decision to return an abused child to her/his family and the inherent risks involved. ‘The physician should not be satisfied to return the child to an environment where even a moderate risk of repetition [of abuse] exists’ (Kempe et al. 1962:24). Kempe and his colleagues also anticipated a time when a: ‘. . . better understanding of the mechanisms involved in the release of aggressive impulses [would] give us a better ability to predict the likelihood of further attack in the future’ (Kempe et al. 1962:20). In the early 1980s research utilising statistical approaches to child abuse decision making began to shift away from the identification of the factors influencing decisions, to develop ‘risk assessment’ models which would enable the prediction of future risk to children (Jones 1996). In the 1990s risk assessment became the primary area for decision making research. Risk assessment can be defined as ‘. . . the systematic collection of information to determine the degree to which a child is likely to be abused or neglected in the future. [It also refers] … to an estimation of the likelihood that there will be an occurrence of child maltreatment in a case where maltreatment has not occurred …’ (English & Pecora 1994:452). Risk assessment has several objectives: to help workers identify situations where children are at risk of maltreatment; to improve consistency in service delivery; and to help child protection services determine the appropriate priorities within their caseloads (Browne & Saqi 1988; English & Pecora 1994). The instruments which have resulted, known as structured risk assessment measures, organise information related to risk (Schene 1996). Specifically, they ‘comprise risk factors selected for assessment and forms designed to capture the procedures and calculations needed to determine risk’ (Saunders & Goddard 1998:16). Developed at a time when economic rationalism was beginning to have a significant effect on resources while the demand for services was increasing, the introduction of structured risk assessment measures was due partly to the need for services to screen out inappropriate reports, or cases where the maltreatment was suitable for a community-based caseplan without the involvement of child protection services (Wald & Woolverton 1990; Doueck English, DePanfilis & Moore 1993a; English & Pecora 1994; Parton 1996; Tomison & McGurk 1996; Saunders & Goddard 1998). Another motivation was to improve the ability of workers to detect high risk cases prior to the child suffering some form of injury. Child death inquiries in Britain and Australia have identified errors in worker judgements, their relative inexperience, lack of knowledge of risk factors and ‘danger signals’, failures in interagency co-
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ordination and communication and a lack of ‘rigour’ and ‘consistency’ in the management of cases (Jones et al. 1987; Armytage & Reeves 1992; Howe 1992). Similarly, in the United States child protection services had been criticised for ‘irrational decision-making, subjective and inconsistent investigations, ineffective interventions and inefficient resource allocation (Cicchinelli 1995; English 1996, Saunders & Goddard 1998:21). Overall, child protection services have ‘. . . sometimes failed to protect severely abused children and have also tended to become over-intrusive in low-risk families where inadequate parenting skills, inappropriate controls and failings rather than harmful intent are the key issues’ (Department of Family & Community Services [South Australia] 1997:8). The adoption of structured risk assessment systems Since 1987 at least 42 U.S. States have adopted some form of structured risk assessment system (English 1996). In most of those states, statutes governing child protection services have meant that risk assessment procedures are only allowed to be used after a child has already been defined as a substantiated case of child maltreatment (English & Pecora 1994). Risk assessment is generally used as a tool to determine the appropriate levels of service to provide to the child and family, based upon an assessment of severity of the maltreatment (English & Pecora 1994). The speedy adoption of structured risk assessment measures by U.S. child protection services has recently begun to be repeated in Australia. However, unlike in the U.S. where the use of risk measures has been somewhat restricted by legislation, some Australian State/Territory child protection services have explicitly or implicitly developed screening and/or risk assessment tools for use at intake, as well as at later stages of the child protection case management process (Tomison 1996; Department of Family & Community Services 1997; McPherson, Macnamara & Hemsworth 1997). The efficacy and importance of structured risk assessment measures When considering structured risk assessment systems in the context of the overall field of child protection decision making research, there are two important questions: • Does structured risk assessment offer the means of enhancing professionals’ decision making in child protection cases? • Is the decision making research focus on structured risk assessment systems misplaced? When evaluating the utility of risk assessment tools, it is important to acknowledge that no decision model will be 100 per cent accurate (Dalgleish 1997), and that this has real life consequences. Hammond (1996) proposes that that such ‘inevitable error’ will lead to ‘unavoidable injustice’ for the child, the family, the worker, the worker’s team, the agency, the local community and society as a whole. However, it has been generally recognised that the use of statistical or actuarial procedures to inform judgements is more accurate than the reliance on unassisted clinical judgment (Dawes et al. 1989), and that 45
‘. . . a probabilistic relationship [which forms the basis of structured risk assessment measures] is more readily obtained and verified than a causal understanding, that historical truth is more accurate than narrative truth, and that the acceptance of a fixed amount of error leads to a minimal number of incorrect decisions’ (Ruscio 1998:145). English and Pecora note that: ‘. . . the necessity of managing high caseloads with limited resources makes it imperative that child protective service agencies develop methods to identify children who are most at risk of serious harm so that they can receive services first’ (1994:454). In contrast, Schene (1996) contends that, ‘. . . if we really wanted to primarily improve case decision making to advance the safety of the child and address family problems, would we have developed risk assessment as our tool?’ (1996:8). Similarly, Wald and Woolverton caution that structured risk assessment measures should not be seen as a panacea for an ailing child protection system: ‘. . . many agencies are adopting risk-assessment instruments in lieu of addressing fundamental problems in existing child protection systems, such as the excessive number of inexperienced or incompetent workers and the lack of adequate resources. In fact, the use of inadequately designed or researched instruments may result in poorer decisions, because workers will rely on mechanical rules and procedures instead of trying to develop greater clinical expertise’ (1990:484). The perceived benefits DePanfilis (1996), utilising the work of Cicchinelli (1990) and Hornby (1989), identified some of the potential benefits of risk assessment procedures. These included: • • • •
good casework practice in operation providing a base for the allocation and prioritisation of cases in risk-related groups having case information readily available via the case record broadening workers’ knowledge and investigation of relevant child maltreatment ‘risk’ factors, and • providing a basis for worker training and supervision In addition, because structured risk assessment measures are designed to promote consistency in worker decision making and subsequent service provision (English & Pecora 1994; Schene 1996), the instruments can reduce arbitrary case classification and management practices (Stone 1993). Finally, risk assessment measures were developed at a time when the demand for services had increased as resource allocation remained constant or had decreased. In 46
consequence not all children or families in need were able to be provided with the services they might require (Wald & Woolverton 1990; English & Pecora 1994; Parton 1996; Tomison & McGurk 1996; Saunders & Goddard 1998). Concomitantly, there was increasing demand for highly accountable service provision (Doueck et al. 1993a; Parton 1996). Risk assessment measures could provide ‘a pseudo-scientific, ostensibly rational basis for decision-making’ (Saunders & Goddard 1998:22). The overall efficacy of structured risk assessment measures however, is reduced for a number of reasons, leading Goddard et al. to conclude that overall, the ‘. . . current conceptualisation of risk assessment at best appears to provide a crude heuristic strategy to focus the attention of workers to particular forms of information during the investigation process’ (Goddard et al. 1996:60). Definitional issues There is little unanimity in terms of defining fundamental terms like ‘maltreatment’ and ‘risk’, (Hutchison 1990; Zuravin 1991; Lyons, Doueck & Wodarski 1996). Being ‘at risk’ is not an objective state, but a complex, multidimensional concept that is both socially and professionally constructed and whose meaning has evolved over time (Freeman 1983; Douglas 1992; Parton 1996; Ryan 1996). It has evolved from a ‘. . . neutral concept associated with the possibility of both positive and negative chance occurrences to a concept which threatens danger, which assumes an objectivity which legitimises its use in fields of mathematics and science, and which can be usefully applied forensically’ (Saunders & Goddard 1998:12). There remains a clear need to develop a uniform means of quantifying the levels of risk and to establish clear parameters for the appropriate actions to be taken with each level of risk and type of maltreatment (Wald & Woolverton 1990). Methodological issues Bateson (1979) identifies one problem with the application of structured decision making systems to child protection case management. He argues that throughout history there has been a constant tension in the use of probability-based statistics to describe individual behaviour based on the behaviour of groups of individuals. Actuarial tools are derived from statistical generalisations believed to be predictive of the behaviour of a group of like individuals. In essence, it is invalid to argue that the risk to an individual child can be predicted from an analysis of variables drawn from aggregated data for groups of children with common characteristics: ‘. . . there is a deep gulf between statements about an individual and statements about a class . . . prediction from one to the other is always unsure’ (Bateson 1979:51). Thus, in spite of some general similarities which may be evident between ‘at risk’ or maltreating families, such measures may be of limited utility in child protection work where the task is to predict the behaviour of particular parents and particular children with unique circumstances (Saunders & Goddard 1998).
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Second, Lyons et al. (1996) reviewed the published, empirical literature on 10 risk assessment models currently employed by various U.S. state child protection services. They focused their examination on the psychometric qualities of the risk measures, reliability and validity in particular, and the outcomes which resulted from the implementation of the risk models. Overall, despite many of the models appearing to have acceptable psychometric properties, such as internal consistency, inter-rater reliability and concurrent validity, the current level of predictive validity for the models: ‘. . . would not allow for major dependence on them for case decision making . . . [although] the research on actuarial models, such as those used in Alaska, Alameda County and Vermont, is somewhat encouraging’ (Lyons et al. 1996:153). Implementation of risk assessment tools Mandel, Lehman and Yuille (1995) contend that statistical models of decision making, such as structured risk assessment systems, fail to take into account implementation issues. That is, the failure of agencies to train their workers to utilise risk factors identified by a particular statistical model, or to routinely collect data on the risk factors. Similarly, most evaluations of risk tools are outcome evaluations which fail to determine the extent to which a tool has been implemented in practice, (Doueck et al. 1992). Adequate evaluation requires a focus on the degree to which a risk assessment model is being used as intended and the impact of the model on the case management process, including outcomes for families. Failure to conduct both process and outcome evaluations may lead to what Scanlon and colleagues (Scanlon, Horst, Schmidt & Walker 1977; as cited in Doueck et al. 1992) called a Type III error - the evaluation of a program that has been inadequately implemented. Lyons et al. conclude that minimising ‘implementation problems may be as important for model development as concern about sensitivity and specificity currently is’ (1996:153). Lyons et al. (1996) note that the evaluation research, published to date, on process evaluation or implementation research is ‘less than adequate’. The available evidence does, however, suggest that: risk assessment models are being imperfectly implemented; that the measures are being completed after the assessment decisions have been made, merely as a means of documenting decisions, rather than as a guide to the decision making process itself; and finally, that they are perceived by some workers as irrelevant to their work with both ‘at risk’ and maltreating families. Why are risk assessment models inadequately implemented, even under ‘unusually favourable’ conditions, such as was reported for the implementation of the CARF system (Doueck et al 93b)? A number of reasons have been proposed: • •
there may be problems integrating the risk model into case management practice (Gleason 1984; Dalgleish 1997) the complicated nature of some models
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• •
the fact that workers have been shown to complete the measures after making their decisions, which in turn may lead the workers to perceive the measures as redundant12 (Sheets 1996), or because of the perception of staff that the measures will increase their workload (Hornby & Wells 1989, as cited in Doueck et al. 1993b; English & Pecora 1994; Sheets 1996)
As Doueck et al. concluded in their evaluation of the CARF system, generalisation ‘to other counties with a different mix of populations and different caseloads is particularly hazardous’ (1993b:465). Similarly, there is no reason to believe that the factors which predict the occurrence of child maltreatment will also predict re-abuse. McDonald and Marks (1991) noted that only half of the 88 variables commonly used to predict child maltreatment had been empirically validated, and that there is ‘virtually no research on the correlates of maltreatment recurrence for any type of maltreatment’ (Lyons et al. 1996:144). Risk factors Part of the appeal of risk assessment measures is that they are designed to ensure that workers give consideration to a wide range of factors in a relatively consistent manner (Corby 1996). However, the selection of risk factors is typically based on reported cases (Milner 1995) and retrospective research (e.g. archival analysis. The research is plagued by problems associated with the use of secondary data (Doueck et al. 1992; de Vaus 1995; Krysik 1997). If risk assessment is to have validity, ‘it is essential that risk factors are measured accurately’ (Wald & Woolverton 1990:490), yet it is clear that the level of accuracy required is not always forthcoming. In addition, no checklist or model can include every possible risk factor; it is possible therefore, that a significant factor, or the significant factor for a specific case may be omitted (Saunders & Goddard 1998). Similarly, although specific factors, or the combination of a number of factors, may be important in a case, it is the interaction of factors, or ‘volatile combinations’ (Holder & Corey 1993), that may especially endanger a child. To date however, ‘nobody is able to point out which interaction of factors makes a difference’ (Wald & Woolverton 1990:495). Finally, in addition to the various risk factors, operating in isolation or in combination, which may increase the likelihood or risk of maltreatment, unpredictable ‘triggering events’, often significant only to the maltreater (e.g. accidental breakage of crockery, a child returning home with muddy clothes), may determine a child’s safety (Pullan-Watkins & Durrant 1996). Applying risk assessment in situ - ecological effects A critical element frequently ignored when risk assessment is under discussion, is the effect of the decision environment on the use and implementation of the measures. Scott (1993) perceives the child protection field as operating in, what has been termed by the organisational theorists Emery and Trist (1965), a ‘turbulent field’. Child protection by its very nature is ‘dominated by significant moral, emotional and sociopolitical turbulence’ (McPherson et al. 1997:27). 12
Workers have been shown however, to incorporate the risk factors into their investigations and client assessments (Hornby & Wells 1989, as cited in Doueck et al. 1993; Sheets 1996). 49
Risk assessment, like any case management decision, is not carried out in a ‘scientific vacuum’, but within a ‘socio-legal environment which defines preferred courses of action’ (Corby 1996:23). However, because the State is ‘highly ambivalent about setting parameters for intervention into families, [the result is] fluctuating approaches and policy reversals’ (Corby 1996:14). Thus, when a child is removed from the family, in most cases the objective is to work for child and family reunification. Risk tools must therefore be able to take account of the effect of particular treatment plans, for example, if a parent attends drug rehabilitation, what is the potential for re-abuse? The question then becomes, under what circumstances is the risk of further maltreatment unlikely? As Wald & Woolverton note, since ‘. . . the availability of services, treatment, or monitoring will alter the risk posed by a given individual, a risk-assessment instrument is truly useful only if it identifies the likelihood of re-abuse given specific interventions’ (1990:491). Statistical models fail to take into account the other systemic or organisational factors which may affect decision making, or to allow for workers’ individual differences in decision making. Even if it is assumed that risk can be objectified, individuals respond subjectively, and thus, differently to the same events (Brearley 1982). Studies of economic decision making support the view that risk taking is not fixed, but a dynamic process dependent on the context of choice and the extent of adversity (Waterhouse & Carnie 1992). The model in Figure 1, developed from the author’s doctoral research, provides a more accurate picture of the realities of the influences on decision making. Based on an ecological framework, it takes into account the effects of systemic and professional-related factors, in interaction with aspects of the family system.
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Figure 1: An ecological framework for the investigation of professional decision making in child protection case management (Tomison 1999)
SOCIETY socio-cultural influence child protection system effects
COMMUNITY local community/regional effects local professional network practice
FAMILY
AGENCY/PROFESSION
intrafamilial effects
inter-agency effects intra-agency effects
WORKER
CHILD PARENT ABUSER (family factors)
Worker effects Risk assessment measures have the potential to homogenise different levels of practice expertise and qualifications and the possibility of a reduction of the impact of worker idiosyncrasies or biases in decision making (Stone 1993). Jones and May 51
contend that standardised procedures also ‘reduces the decision options of front-line workers, defines the boundaries of their work [and] minimises [their] discretion’ (1992:491). On the other hand, without good quality control and worker supervision, the system can be used to support potentially poor decisions (Doueck et al. 1993a). Workers, particularly the inexperienced, may be lulled into a false sense of security, believing they can reliably predict case outcomes by using risk assessment tools, and thus only focus on the checklist factors when making a case assessment (Reder, Duncan & Gray 1993). That is, such lists may constrain worker thinking, leading to a heuristical ‘check’ of the variables listed, rather than a comprehensive assessment and ordering of all case information and the worker’s own professional observations (Reder et al. 1993; Goddard 1996). As Sheets notes ‘. . . caseworker judgment is not only a critical factor in interactive risk assessment but also in gathering the information needed to fill out the risk instrument later . . . [the] act of determining that [a] risk factor is present, or the degree to which it is present, is a sensitive assessment process involving “unstructured” but highly trained human judgment’ (Sheets 1996:9). Lyons et al. (1996), concluded for their review of American models that risk assessment actually demands ‘quality in education, training, and supervision, as well as vigilance on the part of administrators hoping to use it’ (Lyons et al. 1996:154). Thus, there is an obligation upon the test user to have adequate clinical and legal education before attempting to make a child abuse assessment (Monahan 1993). In summary Overall, there has been a concerted effort in recent times to focus much of the research investigating aspects of child protection decision making on statistical approaches, and specifically, the development and enhancement of structured risk assessment systems. It is apparent however, that there is currently insufficient information available to determine the efficacy of risk assessment tools for identifying children at risk of serious maltreatment (Wald & Woolverton 1990; Camasso & Jagannathan 1995; Lyons et al. 1996; Dalgleish 1997, Cleaver et al. 1998; Saunders & Goddard 1998). While it is generally recognised that the use of statistical or actuarial procedures to inform clinical judgements is more accurate than the reliance on unassisted clinical judgment (Dawes et al. 1989), there has been very little evidence derived from the child welfare/child protection field on the extent to which statistical models offer improvements in consistency and accuracy beyond that of child protection workers’ clinical judgements. Thus, the argument that risk assessment tools (statistical models) should replace clinical judgement is a difficult one to make (Johnson 1996; Ruscio 1998). Given the limitations of applying risk measures to individual cases, workers’ professional judgement is needed to fill the gap (Saunders & Goddard 1998). Many researchers and practitioners, although acknowledging the importance of assessing risk in child protection practice (Saunders & Goddard 1998), have therefore
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maintained an allegiance to clinical decision making research and the use of education and training to improve professionals’ child protection decision making rather than the use of structured decision making tools. This position is aptly summed up by Dr. Pat Cawson, Head of Child Protection Research for the NSPCC, when introducing the new NSPCC risk assessment package in the U.K. (Cleaver et al. 1998): ‘. . . nothing can replace basic observation and attention to what children and parents say . . . [however] the research also stresses the importance of agencies of having adequate risk management policies and providing support to front line social workers who are dealing with complex, stressful and possibly dangerous situations’ (Cawson, personal communication 1998). In spite of their limitations, however, the use of risk assessment systems is becoming more and more common in child protection services in the U.S., Australia and other western countries as governments and bureaucracies continue to see them as a solution when attempting to balance high caseloads, less resources and the need for service accountability (Browne & Saqi 1988; Wald & Woolverton 1990; Doueck et al. 1993a; English & Pecora 1994; Parton 1996; Tomison & McGurk 1996; Saunders & Goddard 1998). Concomitantly, workers’ clinical experience and intuition is increasingly being undermined (Saunders & Goddard 1998). An alternative approach Radical proponents of a reliance on professional expertise (based on specialist training and experience) argue against the use of any checklist, or guide to risk assessment and child protection decision making. However, the realities of current child protection work are that few workers have received extensive post-qualifying training in child maltreatment and child protection research and theory. What studies that have been done suggest, is that workers do not rely on research and theory to make decisions. In actuality, they appear to be suspicious of research and theory and ignore it (Preston-Shoot & Agass 1990), remain unaware of it (Stevenson 1992; Farmer & Owen 1995), or have few opportunities to acquire it (Carew 1979; Preston-Shoot & Agass 1990; Fisher 1997). Thus, they lack the requisite information and a framework for the organisation of such information. One approach to this issue, is to support practice experience (and the concomitant provision of supervision), with a guide to inform practice. Such guides are not meant to be used to make the decisions, but to highlight issues for consideration and to provide a framework for conceptualising and justifying a decision. The United Kingdom experience Although researchers in the United Kingdom have investigated various means of improving the prediction or assessment of the likelihood of future maltreatment (e.g. Greenland 1987; Browne & Saqi 1988), Britain has generally been more hesitant than either the United States or Australia in adopting structured risk assessment instruments. In 1988 the U.K. DoH introduced ‘guidelines of extraordinary detail’ (Howe 1992:501), known as the ‘Orange Book’, which was over 90 pages long and comprised of 167 questions. The Orange Book was developed to enhance the quality of assessments made by social workers and to assist in the identification and
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prediction of risk of future harm to a child (Howe 1992). However, the emphasis was on ensuring a thorough assessment was completed, rather than risk assessment per se. In 1998 the NSPCC published Assessing Risk in Child Protection (Cleaver, Wattam, & Cawson 1998), a report of a research and development project commissioned by the DoH. The project was designed to feed results of research into risk assessment into social work practice, making it accessible to social workers, trainers and students (Cleaver et al. 1998). The resultant package includes a brief review of salient aspects of the research literature, a discussion of the findings which resulted from a study of workers’ perceptions of assessing risk (based on a series of interviews with workers), and an outline of the subsequent development and refinement of two ‘decision aids’. These were: a chart to assist with the recording of essential information at referral; and a data book to summarise some basic findings to assist with the identification of the full range of services required by the child(ren) and family. They were designed to: ‘. . . meet the needs of less experienced workers, and to cover basic requirements, since both the research literature and the present fieldwork indicated considerable difficulties for less experienced staff in dealing with child protection and other child welfare inquiries’ (Cleaver et al. 1998:31). The assumption underlying the research and the resultant package was that evidencebased practice, not the use of structured risk assessment measures, should form the basis of effective child protection and child welfare practice. This approach would appear to provide some of the uniformity and rigour of structured risk assessment measures, providing a useful guide to some of the salient factors (risk and protective) which may affect an assessment of risk, in conjunction with an overall clinical approach. Such a ‘collaborative path’ has been supported by Webster & Cox (1997), in a discussion of the use of risk assessment when making decisions as to the mental state or ‘dangerousness’ of particular individuals. They argue for a system where clinicians engage in practice supported by statistical evidence (e.g. risk assessment tools), where possible, but that statistical approaches are not seen as ‘almighty’ without reference to clinicians’ reality (‘the overgeneralization of research findings without due heed to case particulars is inappropriate and misleading’ [Stricker & Trierweiler 1995:997]). Victorian Risk Framework A generic matrix applicable to risk assessment across maltreatment types was introduced into Victorian statutory child protection services in 1997 in order to guide risk assessment (McPherson et al. 1997). Further development led to the introduction of the Victorian Risk Framework (VRF) (Boffa & Armitage 1999; DHS 1999 - a complex, generic risk, safety and needs assessment guide.13 It was developed, in part, to provide a common conceptual framework to aid the assessment and decision making of various professionals who had some involvement in the management of cases of children at risk of child maltreatment throughout the intake phase of case practice. The hope was that this 13
Victoria has not, however, ruled out the development of a structured risk tool in the future.
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would minimise interagency threshold disputes and result in the creation of more ‘consistent decision making across workers and, with the same worker across cases’ (McPherson et al. 1997:22). The Department of Human Services is currently training child protection staff in the use of the VRF and plans are being considered for the training of police, sexual assault counsellors, and social workers from a variety of family support agencies in the use of the framework. Anecdotal worker feedback on the VRF, however, has indicated that the guide was perceived to be too complex and too comprehensive for effective use. In response, the Department is working towards reducing the number of risk factors identified in the guide - effectively reducing aspects of the framework to a smaller checklist of factors (Boffa 1999, personal communication). On the other hand, the VRF does not provide enough information on the realities of decision making for workers. Like many previous guides and tools, it does not attempt to raise workers’ awareness of many of the in situ (real life) factors that have been identified as affecting decision making, such as the agency’s threshold for action and resource availability (agency and systemic factors). Overall however, the development of a detailed guide, one that can supplement quality child protection training, may provide a positive outcome for child protection departments (consistency and accountability) and workers, while allowing for the complexity of child protection decision making. Such guides will be of limited utility in central intake services, given their role as service gatekeepers, where decisions are made on the basis of the information gleaned from the source of referral and a family’s prior history of child protection involvement. Interagency and interprofessional co-ordination It is common for complex health and social issues to be managed by a number of professionals (Jones, Pickett, Oates & Barbor 1987). Within the Australian child welfare and family support systems, a variety of government and non-government agencies and professions are involved with different aspects of child maltreatment case identification, support and treatment. Among these groups there are variations in philosophy of service, work protocols, the proportion of their workload which consists of ‘at risk’ or child maltreatment case management, and differences in their definitions of what constitutes a ‘case’ for service delivery. Interagency (and interprofessional) co-ordination and communication have been welldocumented as having the potential to enhance or undermine child protection case management, and the decisions professionals make. Interagency co-ordination in child protection networks has been generally adopted in the western world as a desirable work practice (Jones et al. 1987). A coordinated response to the problem of child abuse and neglect can produce more effective interventions, greater efficiency in the use of resources; improved service delivery by the avoidance of duplication and overlap between existing services; the minimisation of gaps or discontinuity of services; clarification of agency or professional roles and responsibilities in ‘frontier problems’ and demarcation disputes; and the delivery of comprehensive services (Hallett & Birchall 1992; Morrison 1998).
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Overall, the generally accepted objectives of a coordinated child protection response are: to achieve a comprehensive perspective in case assessment; comprehensive caseplans or interventions; support and consultation for the workers involved in child protection; and the avoidance of duplication or gaps in service delivery (Hallett & Birchall 1992). Interagency co-ordination however, is not a natural state of affairs and it does not result merely from good intentions (Reid 1969). While there would appear to be overall agreement that co-ordination in child protection is a necessary and valuable practice, it has been commonly reported as being difficult to achieve (for example, Dale et al. 1986; Jones et al. 1987; Morrison 1998). The desire for a coordinated response to child protection is often ‘asserted, rather than demonstrated, and [is] taken to be self-evident’ (Hallett & Birchall 1992:18). Problems of service co-ordination, especially where many services are involved, have often been cited in the literature as leading to less than optimal case management (Jones et al. 1987; Hallett & Birchall 1992; Morrison 1998; Tomison 1999). There is the potential for children and families to miss out on services, or to become victims of duplicated services, or incompatible treatments, potentially causing the child and family more distress (Hallett & Birchall 1992). Poor co-ordination and co-operation14 have also been mentioned as contributing factors in a number of child abuse death inquiries (for example, Reder et al. 1993; Victorian Child Death Review Committee 1997). Inaccurate information, the failure to receive relevant case information, interagency disputes and/or ignorance of the role of other professionals involved in a case’s management all reduce the ability of professionals to make informed decisions when dealing with suspected or substantiated child maltreatment cases. For these reasons many social scientists have argued for a clearly structured ‘teamwork’ approach to child abuse case management (eg. Jones et al. 1987; Tomison 1999), and stressed the importance of the participating services being coordinated by a designated key worker and/or agency. Formal communication structures There is the potential for agencies to develop a large variety of inter-organisational (or inter-professional) links for the purpose of coordinated service delivery. These may range from low-key, unstructured, informal links between workers from different agencies, to the formalised inter-relationships which may occur with agencies or professions in (and between) particular organisational networks, to highly formalised, centralised co-ordination structures (Challis et al. 1988; Hallett & Birchall 1992). More formal structures or mechanisms that commonly facilitate interagency and interprofessional co-ordination are referral protocols, case conferencing and the development of multidisciplinary teams. In the United Kingdom, the case conference is commonly identified in the literature as one of the formal mechanisms for case coordination, the other being the child protection case register (for example, Jones et al. 1987; DoH 1991; Hallett & Birchall 1992; Birchall & Hallett 1995; Hallett 1995). 14 Interagency coordination can be defined as ‘different agencies working together at an organisational level’ , while interprofessional collaboration may be defined as, ‘committed individuals from different disciplines working together’ (Morrison 1998:6).
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In Australia, formal referral protocols between statutory agencies, and mandatory reporting legislation (Goddard et al. 1996; Tomison 1999) are perhaps the primary formal means of communication in most States/Territories. In addition, although not mandated as they are in the United Kingdom, case conferencing is also a significant means of interagency co-ordination and communication in Australia. For example, in Victoria, child protection workers are expected to hold a case conference within 28 days of the commencement of protective intervention in cases which have not been closed or transferred to another child protection office (CSV 1988). The conference may only involve child protection staff (internal case conference), or it may involve child protection staff and other professionals (external case conference). Where it is deemed necessary, a case conference may be called by child protection services, or other professionals, in cases where protective intervention is to cease (within 28 days), in order to develop an ongoing caseplan to ensure treatment and support of the child and family. It should be noted however, that a number of authors (e.g. Challis et al. 1988; Morrison 1998; Tomison 1999), have highlighted the important role that informal professional relationships and communication paths can play in combination with formal child protection structures (that is, informal friendships and contacts between workers). Although an over-reliance on informal communication methods and the circumventing of formal co-ordination and communication mechanisms may lead to the variety of interagency communication problems identified above, strong informal linkages operating in conjunction with more formal communication structures appears to lead to a more effective interagency network (Morrison 1998; Tomison 1999). As Tomison notes: ‘to be effective, interagency and interprofessional communication and collaboration should be based on formal structures, such as referral protocols, case conferencing procedures and the placement of substantiated cases onto a central register. The underlying formal structure can then be supplemented or enhanced by the development of informal links or ‘working relationships’ (Challis et al. 1988; Morrison 1994; 1998)’ (Tomison 1999:353). Australian models In order to create an environment that enhances interagency or multidisciplinary work, some Australian States/Territories have adopted some form of joint investigation or formal multidisciplinary teams approach to assessment and caseplanning. Some of the more important interagency structures are described here. Suspected Child Abuse and Neglect (SCAN) Teams - Queensland Developed in 1980 by Queensland’s Co-ordinating Committee on Child Abuse15, SCAN teams have been described as a ‘best practice’ model for the investigation, management, treatment and prevention of child abuse and neglect (Cameron, Roylance & Reilly 1999). The statewide system of SCAN teams is designed to ensure an effective, coordinated, multidisciplinary response to notifications of suspected child maltreatment, 15
Established by the Queensland Government to provide a formal mechanism to coordinate the activities of various government departments response to child maltreatment. 57
particularly by the three government departments with statutory responsibility for child protection in Queensland (Department of Families, Youth and Community Care, Queensland Police, Queensland Health). The Teams have a compulsory core membership of representatives from the three statutory departments, although a number of the teams have also permanently co-opted members from the education and mental health sectors. SCAN teams are predominantly involved with the investigation and management phases of the child protection process, although they may be consulted about any aspect of child protection work. SCAN teams undertake to provide ‘an interagency forum for case discussion and planning to ensure: • • •
the safety of the child that assistance is available to the family and child that intervention is effective and coordinated’ (Cameron et al. 1999:8)
The teams also provide a forum for formulating recommendations for action, including the actions to be undertaken by the three statutory departments; and have a review role such that the effectiveness of the SCAN Team recommendations made are assessed in terms of meeting the needs of the child and family (Cameron et al. 1999). In 1996-97, SCAN teams discussed approximately half of all substantiated child maltreatment cases in Queensland (one in six of all notifications received) (Cameron, Roylance and Reilly 1999). The SCAN teams do not however, have a formal role in monitoring or sanctioning the actions of the statutory departments, rather the focus is on case planning and case coordination. The Team determines the best course of action for each case via consensus, but individual agencies retain the statutory and/or professional responsibility for their own actions. Each agency does however have an obligation to report back on the outcomes of the actions taken. Further, if an agency decides not to implement a Team plan, they are also expected to refer the matter back to the SCAN team for further deliberation (Cameron et al. 1999). Why is the model effective? • • • • •
the SCAN Teams have a focus on the holistic management of cases, not just the investigation process they ensure information is shared between agencies in an effective manner they are a professional forum, allowing all participants to voice their concerns and to hear others’ perspectives each member is informed of the views and plans of other members yet each participant agency retains its statutory obligations and powers
The teams also play a key role in identifying regional education and training needs and initiating activities to meet those needs. Joint Investigation Teams (JIT) - New South Wales Given the difficulties of co-ordinating interagency or interprofessional work for separate agencies and/or individual professionals, there have been some attempts to develop an integrated, co-located multidisciplinary team. Many such attempts have 58
focused on the creation of a combined child protection/police team for child protection investigations - the aim being to have all relevant, reported cases jointly assessed at intake by a social worker and a police officer. Such schemes have been operating in a number of jurisdictions overseas (e.g. in Scotland, Bowman 1992) and is reported to work well (McCarthy 1995). One such teams approach is currently being run successfully in New South Wales - the Joint Investigation Teams (JIT) (Cosier & Fitzgerald 1999). Since an initial pilot project begun in 1994/95, the NSW Department of Community Services and the NSW Police Service have implemented a statewide network of JIT teams. These multi-agency investigation teams made up of DoCS child protection workers and Police officers are jointly responsible for the ‘investigation and management of serious child abuse notifications which might constitute a criminal offence’ (Cosier & Fitzgerald 1999:935), (generally physical and sexual abuse). JIT teams are co-located in premises separate from both Police and DoCS offices and adopt a child focused philosophy. The teams are jointly managed by a senior child protection worker (DoCS Assistant Manager) and a Police Sergeant. Once a referral is received, a police officer and child protection worker are assigned to the case. The core business of JIT is the investigative interview16, where the child protection worker and police officer jointly interview the child (the primary interviewer role is determined by a number of factors, but typically it goes to the person who is best able to establish rapport with the child). Following the interview and other initial investigation tasks, the JIT staff have a case debriefing with the Team Leaders. This session provides an opportunity for any differences of opinion to be raised and resolved, for Team Leaders to provide feedback and support to their staff, and for a plan of further action to be developed. If legal action is planned, the police member initiates criminal proceedings, and the DoCS worker handles any protective intervention through the Children’s Court. Following investigation however, the case is referred back to DoCS and/or the Police Service for follow-up. The benefits which have resulted from such an approach include a reduction in the emotional trauma experienced by victims and the eliciting of higher quality case information, resulting in more effective investigations. This in turn has enhanced the decision making process and enabled a higher degree of quality in planned interventions and a large increase in the number of prosecutions carried out. As Cosier and Fitzgerald note: ‘we have found that one of the significant advantages of joint work is being able to utilise the most appropriate and optimal forms of intervention from either Police or DoCS to provide protection or to ensure safety and wellbeing of the child. Police are able to apply for apprehended violence orders, lay charges and request bail conditions to protect a child and to remove an offender from the home is a major step forward . . . . In our experience the joint investigative process provides a timely, coordinated and comprehensive 16
Prior to conducting the investigation both DoCS and Police databases are searched to elicit any previous history of statutory involvement.
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service for children and their families and produces significantly better outcomes’ (1999:946). Cosier and Fitzgerald also highlight some of the issues that have needed to be resolved in order to ensure JIT has been effective. Recognition and acceptance of other professional’s roles, duties and values has been vital. To ensure the units are effective, case decisions are always made jointly by police and DoCS staff. In addition, JIT members are required to participate in joint training to ensure the development of the skills required for the team and to facilitate shared understanding. The units also have a conflict resolution policy in place to ensure interprofessional disputes are able to be resolved in an effective manner. Area child protection committees There have also been a number of attempts made in various Australian jurisdictions (with and without government mandate) to promote interagency co-ordination and collaboration via the development of interagency area committees. The New South Wales Area Committees and the Barwon Child Rights and Maltreatment Committee (BCRMA) Victoria provide examples of the range of vehicles employed to enhance interagency co-ordination and collaboration. New South Wales has perhaps the strongest, legislated interagency co-ordination mechanisms. For more than a decade the NSW Department of Community Services, which has the statutory responsibility for child protection, has been required to consult at the highest levels with the Police Service, Education and Health departments and peak family support and child welfare bodies when developing policies, contemplating changes to service delivery, and in order to develop effective, coordinated cross-sectoral case practice (Tomison & Wise 1999). In 1985, the government created the NSW Child Protection Council to coordinate the Government’s child protection response. In addition to leading (or being the vehicle) for much of the senior inter-departmental contact, the Council also had responsibility for the establishment of formal interagency guidelines (updated regularly) and for developing and supporting a series of regional interagency Area Child Protection Committees, which were set up across the state. The NSW Child Protection Council provided information, training and support to local agencies and professionals via the Area Committees and they became a key mechanism for imparting knowledge and training, and for the identification of local issues or needs that the Council then attempted to respond to. With the passing of the Children and Young Persons (Care and Protection) Act 1998, the NSW Government legislated for strengthened interagency partnerships, developing a series of clauses specifying the mutual obligation of government departments in responding to child abuse and neglect. The Act explicitly states that Health, Education, the Police Service and the non-government sector all share the responsibility for child protection and are expected to share some of the burden of responding to maltreating families. In 1999, the NSW Government set up a Commission for Children and Young People, which replaced the NSW Child Protection Council. The Commission took on many of the duties of the Council, including some responsibility for interagency co-ordination. The Commission recently
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released an updated version of the NSW Interagency Guidelines for Child Protection Intervention (2000). Barwon Child Rights and Maltreatment Association In contrast, the Barwon Child Rights and Maltreatment Association (BCRMA) did not have Government support. BCRMA was a local child rights and child protection advocacy group that operated from the late 1980s until 1998 in one region in Victoria. It was comprised of professionals representing many of the health, welfare and educational agencies operating in the Barwon region of Victoria. The Association’s major roles were to: provide an ongoing community and professional education program; a research program; to monitor the local child protection system; and to provide a forum for workers to raise professional and case management issues. The forums were held monthly, and were regularly attended by members of the local child protection service and specialist police squads, along with most of the other agencies/professions involved in child abuse case management in the region. For a number of years the forum was a neutral and supportive venue for workers to resolve interagency or interprofessional differences, to learn more about developments in child protection and the respective roles of other service providers, and allowed workers to form informal relationships with other workers. Thus, the BCRMA was successfully fulfilling the formal mediation role of the British Area Committees, but in a more informal manner. It is important to note that while the BCRMA had the active support of the local child protection service manager and senior regional police, all involvement in the forums was voluntary. Thus, in the early 1990s when a series of substantial disputes occurred between child protection services and the local police, the result was the withdrawal of child protection and police support for the group and their staff were subsequently forbidden to attend forum meetings. Perhaps not surprisingly, the interagency forum ended soon after. This outcome highlights the need for legislated or mandated interagency co-operation, where statutory services are expected to work together and to resolve differences rather than withdrawing from relationships when (as they often do) interagency disputes arise. Strengthening Families - Victoria Finally, the Victorian Department of Human Services has created a new service that provides another slant on both caseplanning and case co-ordination for ‘at risk’ families, or those where the protective concerns are ‘minimal’. Strengthening Families (initially piloted as the Brimbank Family Outreach Service) was designed to provide support and advice to the ‘at risk’ families who were not currently identified as maltreating, and to ameliorate their problems in order to prevent their becoming child protection clients and the need for the provision of significant family support resources. Under this model, child protection services or other professionals, would refer ‘at risk’ families to the Strengthening Families (SF) team. Using strengths-based approaches, a worker would then approach the family and seek to engage them in developing solutions for their practical and/or therapeutic needs. Having worked with the family to develop a caseplan, SF workers would then purchase and coordinate service delivery by local agencies. In order to fulfil the case planning, service brokerage and co-ordination roles, the SF team had to create a
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network of local services, or at the very least, enhance local interagency coordination. The SF model had the benefits of responding effectively to the needs of ‘at risk’ families, reducing service duplication; enhancing interagency relationships and reducing the number of inappropriate reports received by local child protection agencies. In an evaluation of the pilot program, Tomison, Burgell and Burgell (1998), found that the SF team had more than adequately fulfilled the tasks of case coordination and planning. They had been able to develop solutions for ‘at risk’ families in a manner perceived by other service providers and the families themselves, as being very effective. Agencies reported that they had initiated contact with SF mainly for the purposes of information exchange and professional consultation, to involve SF workers in a joint home visit, or as a result of accepting a referral from SF team members and subsequently becoming involved in service provision. Overall, SF was perceived by other workers as: Families were reported to have benefited from SF involvement because of: • •
the better engagement and rapport that was established, which in turn led to greater family co-operation and a better case outcome, and the case co-ordination and planning done by SF workers (which enhanced family functioning)
Overall, it was apparent that partner agencies perceived SF to be a valuable resource which enhanced both their work with families and the outcomes for the families themselves. SF was able to develop and provide effective support for these client families, decreasing the probability of the families becoming abusive (at least in the short term) and entering the statutory child protection system. In addition, the Service made a clear, positive impact on interagency communication and co-ordination throughout the local service network. The SF service was subsequently initiated across Victoria in 1999. Anecdotal reports indicate that the quality of the local service network (i.e. the degree of co-operation and level of existing interagency disputes) has often determined the level of success the SF program has been able to achieve. Perhaps one other way in which the Strengthening Families program stands out, is that it has a focus on ‘at risk’ families only. Thus, it is a true child abuse prevention program, and highlights the growing interest in child abuse prevention. In summary For professional decision making and intervention in child protection cases to be effective, it is vital that effort be put into developing clear, coordinated interagency and interprofessional practice. Unfortunately, effective interagency practice is difficult to achieve, particularly when the number of professionals or agencies involved is high. A joint team approach appears to be a promising development that has the potential to reduce the chances of co-ordination and communication problems arising. Unfortunately, such teams have generally been developed as a police-child protection unit, and the evidence of their effectiveness is still quite limited. It would therefore be useful to further develop the team concept by developing a co-located, permanent 62
multidisciplinary structure for a larger, more diverse group of professionals. A joint team for both investigation and subsequent professional intervention (even if only in the caseplanning and service brokerage phase such as the SCAN Team and Strengthening Families models) may be a more effective way of working, and lead to better outcomes for children and their families. In the absence of such teams, legislating for inter-departmental collaboration would appear to be desirable, in conjunction with formal and informal opportunities for workers to develop a ‘shared understanding’ of key issues and the different professional ways of working, Such work should be (and usually is) supplemented with formal, mandated, mechanisms of case conferencing and/or referral protocols to ensure a degree of interagency work on a case-by-case basis. Child abuse prevention - focus for a new millennium? Interest in the prevention of child abuse and neglect has increased substantially in the last 20 years, and even more dramatically in the last decade. As noted above, this interest was boosted by the recognition that the investigation-driven child protection response of the early 1990s would ultimately fail without adequate family support and other prevention services. Thus, there has been greater acceptance that while statutory child protection services are necessary, they should be anchored within a wider network of prevention initiatives that can potentially reduce the incidence of actual maltreatment, and thus, the need for statutory intervention. Interest in prevention has also been prompted by a humanitarian desire to remedy or prevent the suffering of children and awareness of the harmful and expensive long term consequences of abuse (Harrington and Dubowitz 1993) A small, but growing body of empirical evidence that prevention programs are effective has also given impetus to a more prevention-focused service philosophy. Early intervention programs first run in the 1960s in the United States, like the Perry Preschool program (Zigler & Styfco 1996), Head Start (Zigler & Styfco 1996), and later, the Elmira Prenatal/Early Infancy home visiting program (Olds et al. 1997) have demonstrated some improvement in disadvantaged children’s lives, and a reduction in the number of ‘at risk’ or maltreating families who will require more intensive support in order to reach an adequate level of parenting and overall functioning. Early intervention has therefore become a vital, cost-effective component of any approach to preventing social ills like child maltreatment or promoting social competence (Barnett 1993; Zigler & Styfco 1996). The resurgence of interest in early intervention preventative approaches has been strengthened by growing empirical evidence that early exposure to chronic violence, a lack of nurturing relationships and/or chaotic and cognitively ‘toxic’ environments (Garbarino 1995), may significantly alter a child’s neural development and result in a failure to learn, emotional and relationship difficulties and a predisposition to violent and/or impulsive behaviour (Perry et al. 1995; Shore 1997). Thus, although early intervention to prevent child maltreatment or other social ills may be beneficial across the lifespan from birth to adulthood, the prenatal/perinatal period, in particular, has become a predominant focus for intervention. Infancy is a period of developmental transition that has been identified as providing an ideal opportunity to enhance parental competencies and to reduce risks that may have implications for the lifelong
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developmental processes of both children and parents (Holden, Willis & Corcoran 1992). Equally, if not more important, under an economic rationalist society, was the development of evidence that child abuse prevention is cost-effective. For example, in an often-quoted Perry Preschool study, Barnett (1993) calculated that by the age of 27 years, for every dollar taxpayers spent on the preschool children enrolled in the Perry Preschool early intervention program (developed in the 1960s), there had been a subsequent saving of over seven dollars in health, welfare, criminal justice and social security expenditure. Such cost-benefit analyses have resulted in a revitalised attitude towards the effectiveness of such early intervention programs, given that not only were they able to assist the nation to attain educational targets, but they were ‘lucrative social investments’ (Zigler & Styfco 1996:144). In the following section some of the key components of current child abuse prevention strategies will be briefly described, along with the new interest in wider health promotion or ‘wellness’ programs. Resilience Researchers investigating the risk factors that may heighten children’s vulnerability to various social ills, such as child abuse and neglect, have consistently identified some children who are able to achieve positive outcomes in the face of adversity – children who are ‘resilient’ despite facing stressful, high risk situations (Kirby & Fraser 1997). Resilience appears to be determined by the presence of risk factors in combination or interaction with the positive forces (protective factors) that contribute to adaptive outcomes (Garmezy 1985, 1993). The interaction of risk and protective factors occurs at each stage of child development and within each ecological level (that is, it is affected by a child or parent’s internal characteristics, aspects of the family, and of the wider social environment) (Kirby & Fraser 1997). A number of studies, particularly those by Werner (Werner & Smith 1989; Werner 1989, 1993; Rutter 1987; Garmezy 1985, 1993), have led to further investigation of the interaction of risk factors and the buffering, or protective factors, that may protect a child from risks and enhance resilience (Bowes & Hayes 1999). However, research is still required to determine precisely the ways in which interactions between risk and protective factors may influence child outcomes (Kaufman & Zigler 1992). Implications for prevention As part of the adoption of approaches where the enhancement of protective factors or ‘strengths’ are valued as part of a policy of promoting healthy communities, there has been some government interest in further developing the concept of resilience and using it as the basis for Australian community-level interventions. For example, in Victoria, the Department of Human Services has contracted the Centre for Adolescent Health, Royal Children’s Hospital to pilot and run a Victorian adaptation of Hawkins and Catalano’s (1992) Communities that Care model as a means of identifying risk and protective factors for Victorian adolescents. A pilot study has been completed and the Centre recently conducted a statewide survey of almost 13,000 secondary students which will enable the development of regional and local government area profiles of risk factors, protective factors, and the incidence of social problems.
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Developmental prevention In order to prevent child maltreatment more effectively, strategies are required that focus on both reducing risk factors and strengthening protective factors that foster resiliency. As Cox (1997:253) notes: ‘Truly ecological approaches that are developmentally attuned demand concurrent programs that work on protective as well as risk factors and that reflect and impact on processes working within and across various domains of the child’s world.’ Such an approach has been adopted in order to prevent other social ills. For example, Tremblay and Craig (1995:156-157) describe developmental prevention, a key component of crime prevention strategies, as ‘interventions aiming to reduce risk factors and increase protective factors that are hypothesised to have a significant effect on an individual’s adjustment at later points of development.’ Prevention or promotion? Such a developmental approach (Tremblay & Craig 1995) has implications for not only the creation of future child abuse prevention strategies but, more specifically, the terminology employed. Many prevention initiatives have taken a problem-focused approach, where the objective is the prevention of a social ill and a reduction in risk rather than the promotion of positive, life-enhancing strategies (protective factors), such as good interpersonal relationships, appropriate parenting and pro-child policies (Tomison 1997). Use of the term ‘child abuse prevention’ may also tend to focus attention on the problems of individual parents or families, without adequate recognition of the connection between individuals’ problems and the influence of the wider social context (NSW Child Protection Council 1997). Thus, any models framed around prevention without promotion may be considered to offer a somewhat restrictive means to address social ills (NSW Child Protection Council 1995; Albee 1996; Zubrick, Silburn, Burton & Blair 2000). Recently however, a ‘revolution’ has begun among professionals working in the child protection and child welfare arenas, such that there has been considerable focus on the development of broad-based, ‘health promotion’ or ‘wellness’-type programs (Prilleltensky & Peirson 1999), where the objective is the promotion of positive, lifeenhancing strategies, such as good interpersonal relationships, appropriate parenting and pro-child policies, rather than the prevention of child maltreatment per se. Taking an example from an allied health field, the prevention of mental disorder in the community is generally described as mental health promotion (encouraging the development of positive mental health) rather than mental illness prevention (the prevention of a social ill). Competence building and mental health promotion efforts are perceived as being among the most promising strategies for preventing mental illness (Reppucci, Woolard & Fried 1999). Overall, it appears that associated health fields and elements of the child welfare/family support system have moved to adopt a philosophy (and associated terminology) that promote universal health, wellbeing and the enhancement of individuals’, families’ or communities’ ability to cope effectively with life’s challenges and crises, rather than those which merely signify the minimisation of social ills (World Health Organisation 1986; Australian Health Ministers Conference 1995; NSW Child Protection Council 1997; National Crime Prevention 1999). As Reppucci et al. (1999: 401) note:
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‘In the 1990s principles of community mobilisation and development have increasingly been used in health and wellness promotion efforts . . . concentration of effort on at-risk populations has been de-emphasised, in favor of promoting healthy behaviors in all people within a community.’ Thus, the promotion of general health and wellbeing, or ‘wellness’ (Prilleltensky & Peirson 1999) is best perceived as a broad, field of action focused on the development of child, family and community resiliency via the enhancement of a number of protective factors. Early intervention Early intervention strategies, often closely linked with universal services, are one of the most effective ways to ameliorate the effects of maltreatment (Widom 1992; Tomison & Wise 1999). When used as a preventative measure, it has been argued that early intervention approaches should incorporate both the promotion of health and wellbeing and the prevention of social ills like child maltreatment (LeGreca & Varni 1993). Much of the current approach to child abuse prevention results from a re-visitation and extension of the programs and tenets of early intervention programs, that were first begun in the United States 30 years ago (Tomison & Wise 1999). The US Civil Rights movement provided the impetus to develop new ways of thinking and to overhaul the existing social structure. Education was seen as the key to eliminating social and economic class differences (Zigler & Styfco 1996; Ochiltree 1999) and resulted in attempts to improve the cognitive and social competence of disadvantaged young children. Programs such as Head Start and the Perry Preschool projects were effectively secondary prevention programs, given that they targeted specific ‘at risk’ populations for service provision; more accurately however, their focus was one of health promotion and the development of resiliency. As noted above, rigorous evidence that programs such as Elmira and the Perry Preschool Project have a positive, measurable impact, and that they are also cost effective, has led to a significant resurgence of early intervention program development. In Australia, the National Investment For The Early Years (NIFTEY) group (Vimpani 2000) has been developed by a body of researchers and practitioners dedicated to promoting the benefits of early intervention in infancy to governments and service providers. Home visiting services Family support services carrying out an ‘early detection’ role, especially home visiting services, have been particularly noted for their success in identifying families at risk of maltreatment prior to the concerns reaching a level that would require protective intervention. Whether they be similar to the Health Visitor service operating in the United Kingdom, the universal maternal and child health nurses operating in Scandinavian countries, or the infant welfare nurses operating across Australia, such services are well placed to monitor the family over time. Where resources allow, they are able to support and educate parents, and are much more likely to detect problematic changes in family functioning (Drotar 1992). These services are also able to divert/refer families to the most appropriate support and can
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often alleviate the family situation without the necessity of child protection services involvement. However, the value of the preventative role played by the non-government sector, including early detection services, in preventing child abuse and neglect was relatively unacknowledged and undervalued, particularly by governments intent on cost-cutting during the recession of the late 1980s and early 1990s. The subsequent widespread service reduction caused by the significant decrease in available funding, combined with a substantial increase in requests for assistance, resulted in the cessation of much of the preventative family support work being done with ‘at risk’ families by child welfare and family support services. With very few exceptions, the non-government sector focused predominantly on providing assistance to the families in greatest need, typically those referred by child protection services as substantiated child maltreatment families. Thus, those ‘at risk’ families who sought assistance were left to resolve their problems without professional assistance, and not surprisingly, a number subsequently failed to cope and eventually became abusive or neglectful. It was not until the shift to a family support model of child protection practice in the mid to late 1990s, and a greater recognition of the benefits of home visiting and other early intervention programs, that governments began re-investing in the family support system and the non-government child welfare and family support system began to reclaim some of its prevention role with ‘at risk’ families. One of the differences was that governments now explicitly funded the provision of treatment and support for families identified as maltreating, but explicitly set about developing and funding a number of services specifically designed to work with ‘at risk’ families. Implications for prevention The evaluation of these and other early intervention projects has resulted in the development of some guiding principles for the development of effective programs. Of primary importance, programs must be comprehensive in scope and attend to the various factors underlying social problems like child maltreatment (Emens et al. 1996; Zigler & Styfco 1996; Bowes & Hayes 1999; Reppucci et al. 1999). The best results appear to be achieved via the adoption of a cross-sectoral response to ensure that the needs of child and family are met with a partnership between program staff, other professionals working with the child or family, and with the family itself (Powell 1982), what in this paper is described as a ‘whole of community’ response. However, it is apparent that early intervention programs in isolation cannot transform disadvantaged children and parents’ lives. No program can enable children to develop optimally when their larger child rearing environment is not conducive to healthy development, supporting calls for greater attention to the structural societal forces that impact on the quality of children’s and families’ lives (Emens et al. 1996; Zigler & Styfco 1996; Tomison 1997; Hayes & Bowes 1999). As Zigler and Styfco note: ‘Thirty years of experience with early intervention have yielded a clear but unwelcome truth: such programs cannot overpower poverty in shaping a child’s developmental outcome . . . Although children do better than they would have without the experience, they still do not approach the achievements of middle-class students’ (1996:152).
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Yet early intervention programs like Head Start and Elmira have demonstrated some improvement in disadvantaged children’s lives, and may reduce the number of ‘at risk’ or maltreating families who will require more intensive support in order to reach an adequate level of parenting and overall functioning. Early intervention remains a vital component of any holistic approach to preventing social ills or promoting social competence (Emens et al. 1996; Zigler & Styfco 1996). ‘Whole of community’ approaches The African proverb, ‘It takes a village to raise a child’, epitomises the importance of the role of the wider community in raising children and young people. The larger socio-economic system in which child and family are embedded can influence family functioning, child development and the availability of helping resources, such as universal child and health services, within communities and neighbourhoods, (Martin 1976; Garbarino 1977; Garbarino & Sherman 1980; Schorr 1988; US Advisory Board on Child Abuse and Neglect 1993; Hashima & Amato 1994). The importance of community is currently undergoing a resurgence of interest (Korbin & Coulton 1996), with governments and the child welfare and family support sectors redesigning services to become more community-centred, and forging alliances with local communities to help improve the physical and social environment of communities (Cohen, Ooms & Hutchins 1995; Argyle & Brown 1998) and to develop ‘social capital’ (Coleman 1988; Fegan & Bowes 1999). Until recently, despite the development of ecological theories of child maltreatment (for example, Garbarino 1977; Belsky 1980), researchers, policy makers and practitioners working to prevent child maltreatment have often perceived such structural forces as being beyond the scope of prevention. The tendency has been to tailor prevention activities to run within environmental or structural constraints (Parton 1991: Garbarino 1995). However, there has been growing recognition that truly to prevent child maltreatment requires the development of the means to address the societal factors underpinning child maltreatment and other family violence (Altepeter & Walker 1992; Tomison 1997). This in turn, has led to the adoption of holistic prevention strategies with a focus on ‘whole of community’ approaches and early intervention strategies designed to influence a broad network of relationships and processes within the family and across the wider community (Wachtel 1994; Hay & Jones 1994; US Advisory Board on Child Abuse and Neglect 1993; Tomison 1997; NSW Child Protection Council 1997; National Crime Prevention 1999). Program development Begun in the late 1980s and early 1990s, ‘whole of community’ approaches, better known in the United States as ‘comprehensive community initiatives’ (CCI's) represent the most recent generation of a long line of community-level interventions (Kahn & Kamerman 1996; Kubisch, Fullbright-Anderson & Connell 1998; Pawson & Tilley 1998). Such an approach is founded upon the formation and strengthening of partnerships between families, governments, child welfare, family support, health and education agencies, business, unions, religious organisations, as a means of integrating private and social responsibilities for families (Cass 1994).
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Although these initiatives may take a variety of structures and forms, they are all based around the adoption of a comprehensive approach with the aim of empowering community members to participate in a partnership with government and the professional sector as a means of promoting the development of healthier communities. They promote positive change in disadvantaged neighbourhoods for individuals, families and the community as a whole, by improving physical, social and economic conditions (Kubisch et al. 1998). In the 1990s the approach became advocated widely in the United States. For example, in 1993 the US Advisory Board on Child Abuse and Neglect (1993:3) recommended that: ‘We must strengthen our neighbourhoods, both physically and socially, so that people care about, watch, and support each other’s families. Child protection must become a part of everyday life, a function of all sectors of the community.’ The Board also advocated for the development of prevention zones, model neighbourhoods in which intensive efforts were made to facilitate ‘neighbors helping neighbors’ and to promote social and economic development as a means of preventing child maltreatment at the structural level. So popular has CCI become in the States that a Roundtable on Comprehensive Community Initiatives for Children and Families has been convened regularly since 1992. It currently has 30 members, including foundation members, program directors, experts in the field and public servants engaged in ‘cross-system, geographically targeted initiatives’ (Kubisch et al. 1998). These forums provide a venue to share the lessons that have been learned, to receive updates on innovations and to work on common problems facing program providers and evaluators. Australian developments In Australia, recognition of the benefits of adopting a ‘whole of community’ approach has been a much slower process. In 1994, the International Year of the Family provided a forum for a discussion of social provision for individuals and families in Australia (Smith & Herbert 1997). A conclusion of the National Council was that social provision ‘should occur in a framework of partnerships between individuals, families, and the private and public sectors’ (Smith & Herbert 1997:5). Australia’s adoption of interventionist strategies to facilitate the greater participation of people in an active society has largely been confined to the promotion of participation in the labour market (Smith & Herbert 1997). In the past few years however, Australia has begun to incorporate ‘whole of community’ approaches into frameworks designed to prevent child maltreatment (NSW Child Protection Council 1997) and a number of other social ills, such as crime (National Crime Prevention 1999) and youth homelessness (Prime Ministerial Youth Homeless Taskforce 1998). Crime prevention The National Crime Prevention (1999) report, Pathways to Prevention, written by a consortium convened by Professor Ross Homel, identified the need for a local, community-based approach to crime prevention. The Report recommendations exemplify the current convergence in thinking in the prevention of social ills, with
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much of the report advocating early intervention and ‘whole of community’ approaches. For example, the consortium concluded that future prevention initiatives should include: ‘a neighbourhood or small area intervention targeting multiple risk and protective factors at multiple life phases and transition points. The focus should not only be on individual children and families, but, more generally, on the functioning of both local and non-local institutions, policies and aspects of social organisations that affect the quality of the local environment for children. The overall aim should be to create a more supportive, friendly and inclusive environment for children, young people and families that better promotes healthy, pro-social development’ (National Crime Prevention 1999:99). The core component of such a demonstration project, or prevention zone, was perceived to be a process of community building that promoted the creation of an inclusive ‘child friendly’ or ‘family supportive’ environment, and that promoted the normal, pro-social development of children’ (National Crime Prevention 1999). However, the consortium also noted that mounting a large-scale community-based program in Australia would not be quickly achieved because of the current tendency of ‘funding agencies and the political system [to be] mostly oriented to short term "quick fix" initiatives that fit within the three year election cycle’ (1999:100). One Australian initiative that is currently operating and receiving much attention is the New South Wales Inter-agency School Community Centres Pilot Project. Inter-agency School Community Centres Pilot Project Until recently, there has been a general reliance on the school system to provide the prime access for child abuse prevention purposes to children, young people and their families. Clearly the time demands on the school curriculum are increasing. In addition, there is a growing recognition that child abuse and child abuse prevention are too complex for schools, or any one sector, to manage alone (Tomison 1996b). In the United States a number of communities have developed programs that link a number of services to schools through school-linked Family Resource Centers (Dupper & Poertner 1997). This has arisen as a function of the opportunity schools provide to access children and families, and the ‘seemingly intractable problems with the current US network of social services . . . which has been characterised as disempowering, fragmenting and confusing for families (Lerner 1996)’ (Dupper & Poertner 1997:416). The Inter-agency School Community Centres Pilot Project has used schools as venues to access children and families in an effort to involve the wider community in the development of healthy families and communities and the prevention of child maltreatment and other social ills. In a cross-sectoral collaboration, the NSW Departments of School Education and Community Services and Health have worked together to fund a two-year pilot program to establish four interagency school community centres. Administered by the NSW Department of School Education and located at public schools, the aim of the program is to develop and trial models of interagency co-ordination, and to support families with children of five years and under with a view to preventing disadvantage at school entry.
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The project objectives are to: encourage and support families in their parenting role; to identify needs, knowledge gaps and issues in the local community; to promote community involvement in the provision and co-ordination of services for children and families; and to promote the school as a community centre. Managed by an interagency management committee, a full-time facilitator appointed to each site works closely with a community advisory group to identify needs and issues for families. The types of local initiatives developed under the project include: play groups; parenting groups; before school screening; literacy programs; transition to school programs; home visiting; and nutrition programs. An interim evaluation report based on interviews with parents, community members, organisations involved in the local projects, school personnel and various management staff concluded that each of the four pilot centres had met its objectives (Social Systems and Evaluation 1996). In particular, parents whose children attended transition or preschool programs identified benefits to their children in terms of readiness for school and general socialisation; such benefits were also noted by principals and preschool staff. Parents reported that the project had lessened their own social isolation and provided them with opportunities for self-development. Health professionals perceived the projects as contributing to the health and wellbeing of children, particularly at two centres which introduced Before School Screening Programs; and there was enhanced interagency co-operation between government departments and with local community agencies. Finally, the report indicated a high level of community support for the continuation of the project, and a strong level of community involvement. Community representatives noted the positive impact of the local centres on the communities’ perceptions of themselves: ‘People have begun to feel good about their community and to take action to improve amenities’ (Social Systems & Evaluation 1996:2). Community participation The crux of a ‘whole of community’ or CCI approach is the development of an effective partnership between professionals and the local community, such that participants are more likely to have some control of decision making and a sense of mutuality and common purpose (Smith & Herbert 1997). Participation leads to a greater sense of empowerment when addressing a problem such as child abuse and neglect, with participants having a greater sense of ownership of the plans and activities that result from such a process (Kaufman & Poulin 1994; Smith & Herbert 1997). An underlying aim of the approach may be the development of a level of selfsufficiency and independent action such that the local community eventually take a greater role in the development of activities and ventures aimed at improving the health and wellbeing of community members, with less involvement by the government or the professional sector. The ‘promotion of voluntary involvement in community-based initiatives can be an effective additional means of helping people on low incomes to find new ways of improving their personal and family living standards . . . [Community-based initiatives] offer more opportunities and greater choices, which in turn can enhance the capacity of all citizens, particularly those on low incomes, to participate constructively in . . . society’ (Smith & Herbert 1997:65).
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The Commonwealth’s role in prevention Australia’s Federal Government, followed by most Australian State and Territory governments, has also moved to embrace the concept of creating family and community resiliency as a buffer to social ills, like child maltreatment. The most significant initiative to date, has been the Stronger Families and Communities strategy (Department of Family and Community Services 2000), announced by the Commonwealth in April 2000. An investment of $240 million will be made to help support and strengthen Australian families and communities. The Strategy takes a prevention and early intervention approach to helping families and communities build resilience and a capacity to manage problems before they become severe. It recognises the importance of local community and the wider social and economic environment for the wellbeing of citizens, the special protective role strong communities have for the very young, and the importance of supporting families to care for their members. The Strategy focuses on the importance of early childhood development, the needs of families with young children, improving marriage and family relationships, balancing work and family responsibilities and helping young people in positive ways. It also includes new initiatives to encourage potential community leaders, to build up the skills of volunteer workers, to help communities develop their own solutions to problems and promote a ‘can do’ community spirit. The prevention of the intergenerational transmission of violence Fry (1993) proposed a two-level approach to stop violence and the intergenerational transmission of violence. First, taking a cultural perspective, Fry advocates the promotion of attitudes and beliefs that run counter to the use of physical force: all violence in the community, from corporal punishment to domestic violence, needs to be portrayed as unacceptable (Fry 1993). Second, explicit training on non-violent conflict resolution, problem-solving and childrearing techniques needs to be widely available, particularly to children and young people. This would have two benefits: a reduction in corporal punishment and abuse; and the disruption of the intergenerational cycle of violence (as children would acquire problem-solving and conflict resolution techniques not involving violence) (Fry 1993). Such training could be incorporated into existing life-skills programs in schools and counselling agencies, indicating the ineffectiveness of corporal punishment (Fry 1993; Cashmore & de Haas 1995), and providing instruction in alternative childrearing and conflict resolution strategies. School-based health education or ‘healthy relationships’ programs are being increasingly incorporated into Australian school curricula (Tomison & Poole 2000). They are seen as a means of intervening early with children and young people to shape their attitudes and behaviour in an attempt to prevent the occurrence (or recurrence) of violence. The programs are designed to educate young people on gender issues and non-violent attitudes, the development of appropriate, non-violent relationships and the enhancement of health and wellbeing) (Chalk & King 1998; Poole & Tomison 2000).
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Secondary schools are perceived to offer a prime opportunity to address violence in relationships via primary prevention – preventing violence in young people’s relationships and affecting the attitudes of some ‘soon-to-be professionals and community residents’ (Reiss & Roth 1993; Webster 1993; Suderman & Jaffe 1997). It is unrealistic to expect such programs in isolation to be enough to alter ‘complex socially derived patterns of behaviour. Well-designed curricula could, however, be useful components of more comprehensive community wide strategies that involve parents, community leaders, mass media, advocacy and law enforcement’ (Dryfoos 1990, as cited in Webster 1993:132). Secondary prevention - support for ‘at risk’ families Finally, as has been noted throughout this paper, under-resourced family support systems have been swamped by referrals from child protection services, effectively ending many of the opportunities for secondary prevention work that had existed and creating substantial waiting lists for all but the most severe child maltreatment cases. In effect, the focus on child protection investigations at the expense of prevention and treatment services was ‘the same as having a health system in which ambulances and casualty departments are increased while immunisation programs and surgical wards are closed’ (Scott, 1995:85). Clearly therefore, a key component of any child abuse prevention strategy, must be the allocation of funds and services that are focused on preventing ‘at risk’ families from becoming abusive or neglectful (e.g. the Strengthening Families program, Victoria - see above). Conclusions Acknowledging the realities of current child protection practice, this paper has provided an overview of some of the issues in the identification, assessment and management of suspected child maltreatment cases. It is contended that the recent restructuring of Australian child protection systems - based predominantly on the UK experience and Messages from Research - has concentrated on enhancing case screening or gatekeeping, and matching services to family needs, although the focus remains predominantly on significant harm. For the most part, these changes have been translated into better identification and assessment practices, and the development of new risk assessment tools or guides. Few child protection systems, including the UK Social Service Departments (Parton 1997) have enacted policies to develop better partnerships between workers and families, or to ensure all families are actually assisted to remedy their problems, whether they be child protection matters, or generalised family dysfunction. Overall, it could be argued that the role of child protection services is only to deal with families where there are significant issues of child maltreatment or a risk of maltreatment. Generalised family support needs are then seen as the responsibility of the child welfare and family support system. While this demarcation may be appropriate, the substantial increase in the number of reports to child protection services experienced across the nation (and the western world) in the past few years has seen the bulk of the resources diverted to the child protection system at the expense of family support and child abuse prevention. As a result, many ‘at risk’ families, or those with more general social problems have struggled to obtain assistance through either system.
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The question that should then be asked is, what is the point of assessing risk more effectively, if as Corby has noted, ‘the resources needed to achieve risk reduction are not available’ 1996:27)? Most children at severe risk of maltreatment, or who are being seriously maltreated, are already known to statutory agencies. Gatekeeping procedures are generally quite successful at identifying children at serious risk. They also include cases with minimal maltreatment concerns without providing suitable help in many instances. It is therefore concluded that for changes to identification and assessment processes to have meaning for children and their families, there must be a change in the conceptualisation of the roles of child protection and the wider child welfare and family support systems. Focusing on minor adjustments to the threshold for statutory action and enhanced accountability without adequately resourcing the child protection and wider family support systems will significantly reduce any possible benefits for children and families identified by the system, particularly those with generic welfare concerns. Thus, it is contended that child protection ‘success’ clearly rests more with the provision of adequate family supports to ‘at risk’ and maltreating families than intake assessment. The ‘system’ must therefore be conceptualised as a prevention-protection ‘continuum of action’, where regardless of the level of protective concerns, children and families receive some form of support to alleviate their concerns. The threshold for action can then be seen as less important than ensuring the protection of children within a process of family support, of true child centred family focused work. Governments and child protection departments have recognised the need to address the needs of ‘at risk’ families, (e.g. Western Australia’s New Directions), but the reality is that greater investment is required to ensure that there is a significant secondary prevention impact. Such a framework will only result if governments and senior departmental managements recognise the importance of preventing social ills, particularly child maltreatment and the social and economic costs which can be saved. Under such an approach, identification and assessment, while important, truly no longer drive the child protection system, but maintain an important position in a model where remedying dysfunction is given primacy. Although it is unlikely that this framework will be adopted in the short-term, it is proposed that the ‘continuum of action’ be retained as a benchmark against which future re-structuring and innovation in practice are measured. Child protection and family support in the 21st century In the coming decades it can be expected that the adequate provision of family support will remain a driving force in the prevention of child maltreatment. It is likely that further evidence will be produced of the social and economic benefits of early intervention and family support services, leading to a continued focus on prevention, and in particular, an expansion of the family support services. It could be expected that there will be an emphasis on ensuring greater accessibility to services, especially by those families most in need; and that the range of services available will be increased to better cater for children and families. It is to be hoped that this expansion will include the provision of long-term monitoring and support
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options for families, particularly those with ongoing ‘chronic’ problems, as this is a serious gap in the existing family support system (Tomison 2001). Continued efforts to strengthen and expand family support services, should also lead to a much stronger (and highly valued) role for the non-government sector. In many ways this can be considered a reclamation of the prominent role held by such agencies for much of the nineteenth and twentieth centuries (Tomison 2001). Should the preventative approach prove successful, there is likely to be a gradual de-emphasis on the government-run statutory child protection response. Much like the ideal proposed by proponents of the current ‘family support’ child protection models, only a small number of families - families that health surveillance, early intervention and family support services are unable to help - will receive a child protection response. In many ways such a system could look much like it did before the rise of statutory child protection agencies in the 1970s. Such a utopian system may also lead to greater attention being placed on addressing the structural forces impacting on families. References Ainsworth, F. (2002), ‘Mandatory reporting of child abuse and neglect: Does it really make a difference?’, Child and Family Social Work, vol.7, pp.57-63. Albee, G.W. (1996), ‘Revolutions and counter-revolutions in prevention’, American Psychologist, Vol.51, pp.1130–1133. Altepeter, T.S. & Walker, C.E. (1992), ‘Prevention of physical abuse of children through parent training’, in D. J. Willis, E. W. Holden & M. Rosenberg (Eds), Prevention of Child Maltreatment: Developmental and Ecological Perspectives, (pp.226–48), John Wiley & Sons, New York. Argyle, B., & Brown, J. (1998), ‘An innovative approach to child protection involving schools and young people in early intervention work with families’, Paper presented at the Twelfth International ISPCAN Congress on Child Abuse and Neglect, September 1998, Auckland. Armytage, P. & Reeves, C. (1992), ‘Practice insights as revealed by child death inquiries in Victoria and overseas’, in G. Calvert, A. Ford & P. Parkinson (Eds.), The practice of child protection: Australian approaches (pp.122-140), Hale & Iremonger, Marrickville. Armytage, P., Boffa, J. & Armitage, E. (1998), ‘Professional practice frameworks: Linking prevention, support and protection’, paper presented at the Twelfth International ISPCAN Congress on Child Abuse and Neglect, ‘Protecting Children: Innovation and Inspiration’, September 6-9, 1998, Auckland, New Zealand. Australian Health Ministers Conference, (1995), The Health of Young Australians: A National Health Policy for Children and Young People, AGPS, Canberra.
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Australian Institute of Health and Welfare (AIHW), (2002), Child protection Australia 2000-01, Child welfare series no.29, Australian Institute of Health and Welfare, Canberra, ACT. Available online at http://www.aihw.gov.au/publications/cws/cpa00-01/index.html . Barnett, W.S. (1993), ‘Benefit-cost analysis of preschool education: findings from a 25 year follow-up’, American Journal of Orthopsychiatry, vol. 63, pp. 500-508. Bateson, G. (1979), Mind and Nature: A necessary unity, Bantam Books, New York. Belsky, J. (1980), ‘Child maltreatment: an ecological integration’, American Psychologist, Vol.35, pp.320–335. ] Birchall, E. & Hallett, C. (1995), Working together in child protection, HMSO, London. Boehm, B. (1964), ‘The community and the social agency define neglect’, Child Welfare, vol. 43, pp. 453-464. Boffa, J. & Armitage, E. (1999), ‘The Victorian Risk Framework: Developing a professional judgement approach to risk assessment in child protection work’, published in the Proceedings of the 7th Australasian Conference on Child Abuse and Neglect, Perth, 17-20 October, 1999, (pp.71-83), Promaco Conventions, Perth. Boss, P. (1987b). Systems for Managing Child Maltreatment in Australia: A study of the six states. Children’s Bureau of Australia and The Creswick Foundation, Melbourne. Bowes, J.M. & Hayes, A. (1999), ‘Contexts and consequences: impacts on children, families and communities’, in J.M. Bowes & A. Hayes (eds), Children, Families, and Communities: Contexts and consequences, Oxford University Press, South Melbourne. Bowman, A.J. (1992), ‘Police and social work joint investigations of child abuse’, paper presented to the Ninth ISPCAN International Congress on Child Abuse and Neglect, 31 August -2 September, 1992, Chicago, USA. Brearley, C.P. (1982), Risk and Social Work: Hazards and helping, Routledge & Kegan Paul, London. Briggs, F. & Hawkins, R.M.F. (1997), Child Protection: A guide for teachers and child care professionals, Allen & Unwin, St Leonards, NSW. Browne, K.D. & Saqi, S. (1988), ‘Approaches to screening for child abuse and neglect’, in K. Browne, C. Davies & P. Stratton, (Eds.), Early prediction and prevention of child abuse (pp.57-85), John Wiley & Sons, Chichester.
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Camasso, M.J. & Jagannathan, R. (1995)’ ‘Prediction accuracy of the Washington and Illinois risk assessment instruments: An application of receiver operating characteristic curve analysis’, Social Work Research, vol.19, pp. 174-183. Cameron, P., Roylance, R. & Reilly, J. (1999), ‘Interagency approach to child abuse’, paper presented at the Australian Institute of Criminology’s ‘Children and Crime: Victims and Offenders Conference’, 17-18 June, Brisbane. Carew, R. (1979), ‘The place of knowledge in social work activity’, British Journal of Social Work, vol. 9, no.3, pp.349-364. Cashmore, J. & de Haas, N. (1995), Legal and social aspects of the physical punishment of children, AGPS, Canberra. Cass, B. (1994), ‘Connecting the public and the private: social justice and family policies’, Social Security Journal, December, pp. 3-32. Chalk, R. & King, P.A. (eds) (1998), Violence in Families: Assessing Prevention and Treatment Programs, National Academy Press, Washington DC. Challis, L. et al. (1988), Joint approaches to social policy - rationality and practice, Cambridge University Press, Cambridge. Children and Young Persons (Care and Protection) Act 1998, NSW Government, Sydney. Cicchinelli, L.F. (1990), ‘Risk assessment: Expectations, benefits, and realities’, in T. Tatara (Ed.), Fourth national roundtable on CPS risk assessment summary of highlights (pp.7-22), American Public Welfare Association, Washington D.C.. Cicchinelli, L.F. (1995), ‘Risk assessment: Expectations and realities’, The APSAC Advisor, vol.8, no.4, pp.3-9. Cleaver, H., Wattam, C. & Cawson, P. (1998), Assessing risk in child protection, NSPCC Policy Practice Research Series, NSPCC, London. Cohen, E., Ooms, T. & Hutchins, J. (1995), ‘Comprehensive community-building initiatives: a strategy to strengthen family capital’, Background Briefing Report, Family Impact Seminar, Washington. Coleman, J.S. (1988), ‘Social capital in the creation of human capital’, American Journal of Sociology, vol.94, pp.94-120. Community Services Victoria (CSV) (1988), Victorian children at risk register procedure manual, Community Services Victoria, Melbourne. Corby, B. (1996), ‘Risk assessment in child protection work’, in H.Kemshall & J. Pritchard (Eds.), Good practice in risk assessment and risk management, (pp.13-30), Good Practice Series 3, Jessica Kingsley, London.
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Cosier, R. & Fitzgerald, D. (1999), ‘Joint Investigation Teams: The inside story’, in the 7th Australasian Conference on Child Abuse and Neglect, Conference Proceedings vol. 2, (pp.935-946), Promaco Conventions, Canning Bridge WA. Cox, A. (1997), ‘Preventing child abuse; a review of community-based projects I: Intervening on processes and outcomes of reviews’, Child Abuse Review, vol. 6, pp. 243-256. Dale, P., Davies, M., Morrison, T. & Waters, J. (1986), Dangerous families: Assessment and treatment of child abuse, Tavistock, London. Dalgleish, L.I. (1997), ‘Risk assessment approaches: The good, the bad and the ugly’, paper presented to the 6th Australasian Conference on Child Abuse and Neglect, 20-24 October, 1997, Adelaide. Dartington Social Research Unit, (1995), Child protection: Messages from research. Studies in Child Protection, HMSO, London. Dawes, R.M., Faust, D. & Meehl, P.E. (1989), ‘Clinical versus actuarial judgement’, Science, no.243, pp.1668-1674. De Jong, P. & Miller, S.D. (1995), ‘How to interview for client strengths’, Social Work, vol. 40, no. 6, pp. 729–36. Delsordo, J.D. (1963), ‘Protective casework for abused children’, Children, November-December, pp. 6-51. DePanfilis, D. (1996), ‘Implementing child mistreatment risk assessment systems: Lessons from theory’, Administration in Social Work, vol, 20, no. 2, pp. 41-59. Department for Family and Community Services, (1997), Child protection in South Australia: A new approach, Department for Family and Community Services, Adelaide, SA. Department of Family and Community Services, (2000), Stronger Families and Communities Strategy, Dept of Family and Community Services, Canberra. Department of Health (DoH), (1991), Child abuse: A study of inquiry reports 19801989, HMSO, London. Department of Human Services (DHS). (1999), Victorian Risk Framework (version 2), Unpublished manual, DHS, Melbourne. De Vaus, D. (1995), Surveys in social research (4th ed.), Allen & Unwin, St Leonards, NSW. Doueck, H.J., Bronson, D.E. & Levine, M. (1992), ‘Evaluating risk assessment implementation in child protection: Issues for consideration’, Child Abuse & Neglect, vol. 16, pp. 637-646.
78
Doueck, H.J., English, D.J., DePanfilis, D. & Moore, G.T. (1993a), ‘Decisionmaking in child protective services: A comparison of selected risk assessment systems’, Child Welfare, vol. 72, no. 5, pp.441-452. Doueck, H.J., Levine, M. & Bronson, D.E. (1993b), ‘Risk assessment in child protective services: An evaluation of the Child at Risk Field System’, Journal of Interpersonal Violence, vol.8, no.4, pp.446-467. Douglas, M. (1992), Risk and blame essays in cultural theory, Routledge, London. Drotar, D. (1992), ‘Prevention of neglect and nonorganic failure to thrive’, in D.J. Willis, E.W. Holden & M. Rosenberg (Eds), Prevention of Child Maltreatment: Developmental and Ecological Perspectives, New York, John Wiley & Sons. Dunst, C. J., Trivette, C. M. & Deal, A. G. (1988), Enabling and Empowering Families: Principles and Guidelines for Practice, Brookline Books, Cambridge, MA. Dupper, D.R. & Poertner, J. (1997), ‘Public schools and the revitalization of impoverished communities: School-linked, Family Resource Centers’, Social Work, vol. 42, no. 5, pp. 415-422. Elmer, E. (1966), ‘Hazards in determining child abuse’, Child Welfare, vol.3, pp.2951. Emens, E.F., Hall, N.W., Ross, C. & Zigler, E.F. (1996), Preventing Juvenile Delinquency, in E.F. Zigler, S.L. Kagan & N.W. Hall (Eds), Children, Families and Government: Preparing for the Twenty-first Century, Cambridge University Press, New York. Emery, F. & Trist, E. (1965), ‘The causal texture of organisational environments’, Human Relations, vol.18, no.1, pp. 21-32. English, D.J. (1996), ‘The promise and reality of risk assessment’, Children, vol. 12, no.2, pp.9-13.
Protecting
English, D.J. & Pecora, P.J. (1994), ‘Risk assessment as a practice method in child protective services’, Child Welfare, vol. 73, no. 5, pp.451-473. Farmer, E. & Owen, M. (1995), Child protection practice: Private risks and public remedies, Studies in child protection, HMSO, London. Fegan, M. & Bowes, J. (1999), ‘Isolation in rural, remote, and urban communities’, in J.M. Bowes & A. Hayes (eds), Children, Families, and Communities: Contexts and consequences, Oxford University Press, South Melbourne. Fisher, T. (1997), ‘Learning about child protection’, Social Work Education, vol. 16, no. 2, pp. 92-112. Freeman, M. (1983), The rights and wrongs of children, Pinter, London.
79
Fry, D.P. (1993), ‘The intergenerational transmission of disciplinary practices to conflict’, Human Organization, vol.52, no.2, pp.176-185. Gandevia, B. (1978), Tears often shed: Child health and welfare in Australia from 1788. Charter, Gordon. Garbarino, J. (1977), ‘The human ecology of child maltreatment: a conceptual model for research’, Journal of Marriage and the Family, Vol. 39, pp.721–736. Garbarino, J. (1995), Raising Children in a Socially Toxic Environment, Jossey-Bass Publishers, San Francisco. Garbarino, J. & Sherman, D. (1980), ‘High-risk neighbourhoods and high-risk families: the human ecology of child maltreatment’, Child Development, Vol.51, pp.188–198. Garmezy, N. (1985), Stress-resistant children: the search for protective factors, in J.E. Stevenson (ed.), Recent Research in Developmental Psychology, Pergamon Press, Oxford. Garmezy, N. (1993), ‘Children in poverty: resilience despite risk’, Psychiatry, vol. 56, pp. 127-136. Gleason, J.P. (1984), The use of structured decision making procedures at child welfare intake, unpublished doctoral thesis, University of Illinois, Chicago. Goddard, C. R. (1996), Child Abuse and Child Protection: A Guide for Health, Education and Welfare Workers, Churchill Livingstone, South Melbourne. Goddard, C.R., Tucci, J., Liddell, M., Hiller, P. & O’Connell, J. (1996), A provisional analysis of decision-making by statutory child protection workers in a rural context, Child Abuse and Family Violence Research Unit, Monash University, Melbourne. Greenland, C. (1987), Preventing CAN deaths: An international study of deaths due to child abuse and neglect, Tavistock, London. Hallett, C. (1995), Inter-agency co-ordination in child protection,. HMSO, London. Hallett, C. & Birchall, E. (1992). Co-ordination and child protection: A review of the literature., HMSO, Edinburgh. Hammond, K.R. (1996), Human judgment and social policy: Irreducible uncertainty, inevitable error, unavoidable injustice, Oxford University Press, New York.
80
Harrington, D. & Dubowitz, H. (1993), ‘What can be done to prevent child maltreatment?’, in R. L. Hampton (ed.), Family Violence: Prevention and Treatment, Issues in Children’s and Families’ Lives, vol. 1, Sage Publications, Newbury Park, Ca. Hashima, P.& Amato, P. (1994), ‘Poverty, social support, and parental behaviour’, Child Development, Vol.65, pp.394–403. Hawkins, J.D. & Catalano, R.F. (1992), Communities that Care, Jossey-Bass, San Francisco. Hay, T. & Jones, L. (1994), ‘Societal interventions to prevent child abuse and neglect’, Child Welfare, Vol.72, pp.379–403. Heatherington, T. (1998a), ‘Child protection reform in South Australia: Initial evaluation’, Child Abuse Prevention, vol.6, no.2, pp. 7-10. Heatherington, T. (1998b), ‘South Australian Integrated Child Protection Model’, Child Abuse Prevention, vol.6, no.1, pp. 8-9. Holden, E. W., Willis, D. J. & Corcoran, M. M. (1992), ‘Preventing child maltreatment during the prenatal/perinatal period’, in D. J. Willis, E. W. Holden & M. S. Rosenberg (eds), Prevention of Child Maltreatment: Developmental and Ecological Perspectives, John Wiley & Sons, New York. Holder, W.M. & Corey, M. (1993), Child protective services risk management: A decision making handbook (revised ed.), ACTION for Child Protection, Charlotte, NC. Hornby, H. (1989), Risk assessment in child protective services in field implementation, National Child Welfare Resource Centre for Management and Administration, Portland, ME. Howe, D. (1992), ‘Child abuse and the bureaucratisation of social work’, Sociological Review, vol.40, no.3, pp.491-508. Howe, D. (1996), Surface and depth in social work practice, in N. Parton (Ed.), Social theory, social change and social work, (pp.77-97), Routledge, London. Hutchison, E.D. (1990), ‘Child maltreatment: Can it be defined?’, Social Services Review, vol. 64, pp. 60-78. Johnson, W. (1996), ‘Risk assessment research: Progress and future directions’, Protecting Children, vol.12, no.2, pp.14-19. Jones, A. & May, J. (1992), Working in human service organisations: A critical introduction, Longman Cheshire, Melbourne. Jones, D.N., Pickett, J., Oates, M.R. & Barbor, P.R.H. (1987), Understanding child abuse (2nd ed.). Macmillan, Basingstoke.
81
Jones, R. (1996), ‘Decision making in child protection’, British Journal of Social Work, vol.26, pp.509-522. Kahn, A. & Kamerman, S. (eds.) (1996), Children and Their Families in Big Cities: Strategies for Service Reform, Cross National Studies Research Program, Columbia University, New York. Kaufman, S. & Poulin, J. (1994), ‘Citizen participation in prevention activities: a path model’, Journal of Community Psychology, vol. 22, no. 4, pp. 359-374. Kaufman, S. & Zigler (1992), ‘The prevention of child maltreatment: programming, research and policy’, in D.J. Willis, E.W. Holden, & M.S. Rosenberg (eds), Prevention of Child Maltreatment: Development and Ecological Perspectives, John Wiley & Sons, New York. Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemuller, W. & Silver, H. K. (1962), ‘The battered child syndrome’, Journal of the American Medical Association, vol. 18, no. 1, pp. 17–24. Kirby, L. & Fraser, M. (1997), ‘Risk and resilience in childhood’, in Fraser, M. (ed.), Risk and Resiliency in Childhood: An Ecological Perspective, NASW Press, Washington, DC. Korbin, J.E. & Coulton, C.J. (1996), ‘The role of neighbors and the government in neighborhood-based child protection’, Journal of Social Issues, vol. 52, pp. 163-76. Kubisch, A.C., Fullbright-Anderson, K. & Connell, J.P. (1998), ‘Evaluating community initiatives: a progress report’, in K. Fullbright-Anderson, A.C. Kubisch & J.P. Connell (eds), New Approaches to Evaluating Community Initiatives: Volume 2: Theory, Measurement, and Analysis, Roundtable on Comprehensive Community Initiatives for Children and Families, The Aspen Institute, Washington DC. Krysik, J. (1997), ‘Secondary analysis’, in R.M. Grinnell Jr., Social work research and evaluation: Quantitative and qualitative approaches (5th Ed.), (pp.391406), F.E. Peacock, Ithaca, Ill. LeGreca & Varni (1993), ‘Intervention in pediatric psychology: A look towards the future’, Journal of Pediatric Psychology, Vol.18, pp.667–679. Liberman, A. (1994), Should child welfare workers have an M.S.W.?, in E. Gambrill & T. Stein (Eds), Controversial issues in child welfare, Allyn & Bacon, Boston. Liddell, M.J. (1993), Child welfare and care in Australia: Understanding the past to influence the future, in C.R. Goddard & R. Carew, R., Responding to children: Child welfare practice (pp.28-62), Longman Cheshire, Melbourne.
82
Lynch, M.A. (1992), ‘Child protection - have we lost our way?’, Adoption & Fostering, vol.16, no.4, pp.15-22. Lyons, P., Doueck, H.J. & Wodarski, J.S. (1996), ‘Risk assessment for child protective services: A review of the empirical literature on instrument performance’, Social Work Research, vol. 20, no.3, pp. 143-155. Magura, S. & Moses, B.S. (1986), Outcome measures for child social services: Theory and applications, Child Welfare League of America, Washington D.C.. Mandel, D.R., Lehman, D.R. & Yuille, J.C. (1995), ‘Reasoning about the removal of a child from home: A comparison of police officers and social workers’, Journal of Applied Psychology, vol.25, pp.906-921. Martin, H. (1976), The Abused Child: A Multidisciplinary Approach to Developmental Issues at Treatment, Ballinger, Cambridge, Mass. McCallum, S. & Eades, D. (2001), ‘Response to: “New Directions in child protection and family support in Western Australia: A policy initiative to re-focus child welfare practice”’, Child and Family Social Work, vol.6, pp.269-274. McCarthy, K. (1995), ‘The joint investigative team experience’, Current Issues in Criminal Justice, vol.7 no.2, pp.231-238. McDonald, T.P. & Marks, J. (1991), ‘A review of risk factors assessed in child protective services’, Social Services Review, vol. 65, pp. 112-132. McGurk, H. (1997), ‘Context for a research program for the Division of Youth and Family Services, Department of Human Services Victoria’, Paper presented to the Research Agenda Workshop, Youth & Family Services Division, Department of Human Services Victoria, 20 March, Melbourne. McPherson, L., Macnamara, N. & Hemsworth, C. (1997), ‘A model for multidisciplinary collaboration in child protection’, Children Australia, vol.21, no.1, pp. 21-28. Milner, J.S. (1995), ‘Physical child abuse assessment: Perpetrator evaluation’, in J. Campbell (Ed.), Assessing dangerousness , (pp.41-67), Sage, Thousand Oaks. Mitchell, B. (1996), Report from America: Child welfare and child protection services, St Anthony’s Family Services, Melbourne. Monahan, J. (1993), ‘Limiting therapist exposure to Tarasoff liability: Guidelines for risk assessment’, American Psychologist, vol.48, pp.242-250. Morrison, T. (1994), ‘Collaboration in a changing world: Developing an intergrated response to child sexual abuse’, paper presented to the First National Conference on Child Sexual Abuse: 'Developing an intergrated response to the prevention and treatment of child sexual abuse’, March, 1994, Melbourne.
83
Morrison, T. (1998), ‘Inter-agency collaboration and change: Effects of inter-agency behaviour on management of risk and prognosis for change in dangerous family situations’, paper presented at the Twelfth International ISPCAN Congress on Child Abuse and Neglect, ‘Protecting Children: Innovation and Inspiration’, September 6-9, 1998, Auckland, New Zealand. Mouzakitis, C.M. & Varghese, R. (Eds.) (1985), Social Work Treatment with Abused and Neglected Children, Charles C. Thomas, Springfield, Ill.. National Crime Prevention (1999), Pathways to Prevention: Developmental and Early Intervention Approaches to Crime in Australia, Commonwealth AttorneyGeneral’s Department, Canberra. Niland, C. (2002), Informal presentation to the Children & Domestic Violence Forum, Tamworth Community Centre, Violence Against Women, NSW Attorney-General’s Department, 15 February, 2002, Tamworth, NSW. NSW Child Protection Council (1995), Child Abuse Prevention: Everybody’s Business, Child Protection Seminars Series no. 13, NSW Child Protection Council, Sydney. NSW Child Protection Council (1997), A Framework for Building a Child-Friendly Society: Strategies for Preventing Child Abuse and Neglect, NSW Child Protection Council, Sydney. NSW Commission for Children and Young People (2000), Interagency guidelines for child protection intervention, Sydney, NSW Commission for Children and Young People. Ochiltree, G. (1999), ‘Lessons from Head Start in the USA’, Brotherhood Comment, May, pp.10–11. Olds, D.L. et al. (1997), ‘Long-term effects of home visitation on maternal life course and child abuse and neglect’, Journal of the American Medical Association, Vol. 278, No. 8, pp.637–643. Parton, N. (1991), Governing the Family: Child Care, Child Protection and the State, MacMillan, Basingstoke, UK. Parton, N. (1996), ‘Social work, risk and the ‘blaming system’, in N. Parton (Ed.), Social theory, social change and social work. (pp.98-114), Routledge, London. Parton, N. (1997), Child protection and family support: Current debates and future prospects, in N.Parton (Ed.), Child protection and family support: Tensions, contradictions and possibilities (pp.1-24), The State of welfare series, Routledge, London. Parton, N. & Mathews, R. (2001), ‘New Directions in child protection and family support in Western Australia: A policy initiative to re-focus child welfare practice’, Child and Family Social Work, vol.6, pp.97-113.
84
Pawson, R. & Tilley, N. (1998), ‘Caring communities, paradigm polemics, design debates’, Evaluation, vol. 4, no. 1, pp. 79-90. Perry, B.D. et al. (1995), ‘Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: How “states” become “traits”’, Infant Mental Health Journal, No.16, pp.271–291. Picton, C. & Boss, P. (1981), Child welfare in Australia: An introduction, Harcourt Brace Jovanovich, Sydney. Powell, D. (1982), ‘From child to parent: changing conceptions of early childhood intervention’, Annals of the American Academy of Political Science, vol. 461, pp. 135-144. Preston-Shoot, M. & Agass, D. (1990), Making sense of social work: Psychodynamics, systems and practice, Macmillan Education, Houndsmills, Basingstoke. Prilleltensky, I. & Peirson, L. (1999), Mapping the Terrain: Framework for thinking and action, Promoting Family Wellness and Preventing Child Maltreatment: Fundamentals for Thinking and Action, Dept of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Prime Ministerial Youth Homeless Taskforce (1998), Putting Families in the Picture: Early Intervention into Youth Homelessness, Commonwealth Department of Family and Community Services, Canberra. Pullan-Watkins, D. & Durrant, L. (1996), Working with children and families affected by substance abuse: A guide for early childhood education and human service staff, The Centre for Applied Research Education, New York. Reder, P. Duncan, S. & Gray, M. (1993), Beyond blame: Child abuse tragedies revisited, Routledge, London. Reiss, A. & Ross, A. (eds), (1993), Understanding and Preventing Violence: Report of the National Research Council Panel on the Understanding and Control of Violent Behavior, National Academy Press, Washington, D.C.. Reppucci, N.D., Woolard, J.L. & Fried, C.S. (1999), ‘Social, community, and preventive interventions’, Annual Review of Psychology, Vol.50, pp.387–418. Reid, W.J. (1969), Inter-organizational co-ordination in social welfare: A theoretical approach to analysis and intervention, in R.M. Kramer & H. Specht (Eds.), Readings in community organization practice (pp.176-187), Prentice Hall, Englewood Cliffs, NJ. Ruscio, J. (1998), ‘Information integration in child welfare cases: An introduction to statistical decision making’, Child Maltreatment, vol.3, no.2, pp.143-156.
85
Rutter, M. (1987), ‘Psychosocial resilience and protective mechanisms’, American Journal of Orthopsychiatry, vol. 57, pp. 316-31. Ryan, T. (1996), Risk management and people with mental health problems, in H. Kemshall & J. Pritchard (Eds.), Good practice in risk assessment and risk management (pp.93-108), Good practice series 3, Jessica Kingsley, London. Saunders, B. & Goddard, C.R. (1998), A critique of structured risk assessment procedures: Instruments of abuse?, Child Abuse & Family Violence Research Unit, Monash University, Melbourne. Schene, P. (1996), ‘The risk assessment roundtables: A ten-year perspective’, Protecting Children, vol.12, no. 2, pp. 4-8. Schorr, L.B. (1988), Within our Reach: Breaking the Cycle of Disadvantage, Doubleday, New York. Scott, D. (1993), ‘Interagency collaboration: Why is it so difficult? Can we do it better?’, Children Australia, vol. 18, no. 4, pp.4-9. Scott, D. (1995), ‘Child protection: Paradoxes of publicity, policy and practice’, Australian Journal of Social Issues, vol.30, no.1, pp.71–94. Scott, D. (1998), ‘Yesterday’s dreams, today’s realities’, Children Australia, vol.23, no.2, pp.5-14. Sheets, D.A. (1996), ‘Caseworkers, computers and risk assessment: a promising partnership’, The APSAC Advisor, vol.9, no. 1, pp.7-12. Shore R. (1997), Rethinking the Brain: New insights into early development, Families and Work Institute, New York. Smith, B. & Herbert, J. (1997), Community-based Initiatives: Gateways to opportunities: A report on the Commuity-based Action Research Element of the Community Research Project, Research paper no. 73, Commonwealth Department of Social Security, Canberra. Social Systems & Evaluation (1996), Inter-Agency School Community Centres Pilot Project: Interim Evaluation Report for the NSW Departments of School Education, Health and Community Services, Social Systems and Evaluation, Perth. Stanley, J.P. (1997), The Hostage Theory: An exploration of its presence and importance as a partial explanation of protection failure, Unpublished Doctoral Thesis, Department of Social Work & Human Services, Monash University, Melbourne. Stevenson, O. (1992), ‘Social work intervention to protect children: research and practice,’ Child Abuse Review, vol.1, pp. 19-32.
86
Aspects of
Stone, M. (1993), Child Protection: A model for risk assessment in physical abuse/neglect, Surrey County Council, Surrey. Stricker, G. & Trierweiler, S.J. (1995), ‘The local clinical scientist: A bridge between science and practice’, American Psychologist, vol.50, pp. 995-1002. Suderman, M. & Jaffe, P. (1997), ‘Children and youth who witness violence: New directions in intervention and prevention’, in D.A. Wolfe, R.J. McMahon & R.DeV. Peters (eds), Child Abuse: New directions in prevention and treatment across the lifespan, Banff International Behavioral Science series, Sage, Thousand Oaks. Tomison, A.M. (1996a), ‘Child protection towards 2000: commentary’, Child Abuse Prevention, National Child Protection Clearing House Newsletter, Vol.4, No.2, Spring, pp.1–3. Tomison, A.M. (1996b), Child Maltreatment and Substance Abuse, National Child Protection Clearinghouse, Discussion Paper no. 1, Australian Institute of Family Studies, Melbourne. Tomison, A.M. (1997), Overcoming Structural Barriers to the Prevention of Child Abuse and Neglect: A Discussion Paper, NSW Child Protection Council, Sydney. Tomison, A.M. (1999), Professional decision making and the management of actual or suspected child abuse and neglect cases: An in situ tracking study, Unpublished Doctoral Thesis, Monash University, Melbourne. Tomison, A.M. (2001). A history of child protection: Back to the future?, Family Matters, no.60, pp.46-57. Tomison, A.M. & McGurk, H. (1996),Preventing child abuse: A discussion paper for the South Australian Department of Family and Community Services, Australian Institute of Family Studies, Melbourne. Tomison, A.M. & Poole, L. (2000), Preventing Child Abuse and Neglect: Findings from an Australian Audit of Prevention Programs. Australian Institute of Family Studies, Melbourne. Tomison, A.M. & Tucci, J. (1997), Emotional Abuse: The hidden form of maltreatment, National Child Protection Clearinghouse Issues Paper No.8, Australian Institute of Family Studies, Melbourne. Tomison, A.M. & Wise, S. (1999), Community-based Approaches in Preventing Child Maltreatment, National Child Protection Clearinghouse Issues Paper No.11, Australian Institute of Family Studies, Melbourne. Tomison, A.M., Burgell, R. & Burgell, D. (1998), An evaluation of the Brimbank Family Outreach Services, Department of Human Services, Melbourne.
87
Tomison, A.M., Wise, S. & Murray, B. (1999), An evaluation of the Enhanced Client Outcomes Project, unpublished report for the Department of Human Services Victoria. Tremblay, R.E. & Craig, W.M. (1995), ‘Developmental crime prevention’, in M. Tonry & D.P. Farrington (eds), Building a Safer Society: Strategic Approaches to Crime Prevention, The University of Chicago Press, Chicago. Turnell, A. & Edwards, S. (1999), Signs of safety : A solution and safety oriented approach to child protection, Norton, New York. US Advisory Board on Child Abuse and Neglect (1993), Neighbors Helping Neighbors: A New Strategy for the Protection of Children, Department of Health and Human Services, Washington D.C.. Victorian Child Death Review Committee (1997), Annual report of inquiries into child deaths: Protection and care 1997, Melbourne, Department of Human Services. Videnieks, M. (2002), ‘DOCS not negligent: minister’, The Australian, 9 April. Vimpani, G. (2000), ‘NIFTEY – The National Investment For The Early Years’, paper presented to the 7th Australian Institute of Family Studies Conference, Family futures: Issues in research and policy, 24-26 July 2000, Darling Harbour, Sydney. Wachtel, A. (1994), Improving Child and Family Welfare: A Summary and Reconsideration of 11 Recent National Welfare Grant Demonstration Projects, National Clearinghouse on Family Violence, Ottawa, Canada. Wald, M.S. & Woolverton, M. (1990), ‘Risk assessment: The emperor’s new clothes?’, Child Welfare, vol. 64, no. 6, pp.483-511. Waterhouse, L. & Carnie, J. (1992), ‘Assessing child protection risk’, British Journal of Social Work, vol.22, pp. 47-60. Webster, D. (1993), ‘The unconvincing case for school based conflict resolution for adolescents’, Health Affairs, vol.12, pp.126-141. Webster, C.D. & Cox, D. (1997), ‘Integration of nomothetic and ideographic positions in risk assessment: Implications for practice and the education of psychologists and other mental health professionals’, American Psychologist, vol.52, pp. 1245-46. Werner, E.E. (1989), ‘High risk children in young adulthood: a longitudinal study from birth to 32 years’, American Journal of Orthopsychiatry, vol. 59, no. 1, pp. 72-81. Werner, E.E. (1993), ‘Risk, resilience and recovery: perspectives from the Kauai Longitudinal Study’, Developmental Psychopathology, vol. 5, pp. 503-515.
88
Werner, E.E. & Smith, R.S. (1989), Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth, Adams-Bannister-Cox, New York. Widom, C. S. (1992), ‘The cycle of violence’, Child Protection Seminar Series No.5, NSW Child Protection Council, Sydney. Wiggins, J.S. (1981), ‘Clinical and statistical prediction: Where are we and where do we go from here?’, Clinical Psychology Review, vol.1, pp.3-18. World Health Organisation (1986), Ottawa Charter for Health Promotion, WHO, Ottawa. Zigler, E.F. & Styfco, S. (1996), ‘Head Start and Early Childhood Intervention: the changing course of social science and social policy, in E.F. Zigler, S.L. Kagan & N.W. Hall (eds), Children Families and Government: Preparing for the Twenty-first Century, Cambridge University Press, New York. Zubrick, S.R., Silburn, S.R., Burton, P. & Blair, E. (2000), ‘Mental health disorders in children and young people: Scope, cause and prevention’, Australian and New Zealand Journal of Psychiatry, Vol. 34, pp.570–578. Zuravin, S.J. (1991), ‘Research definitions of physical child abuse and neglect: Current problems’, in R.H. Starr & D.A. Wolfe (Eds.), The effects of child abuse and neglect. (pp.100-128), Guildford Press, New York.
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CHAPTER 5. CHILD WELFARE OR CHILD PROTECTION. A COMPARATIVE STUDY OF SOCIAL INTERVENTION IN CHILD MALTREATMENT IN CANADA AND SWEDEN Evelyn Khoo, Lennart Nygren and Ulf Hyvönen Aim In this paper the aims are to: (a) present general information about child welfare and child protection policies in Canada and Sweden, and (b) present some results from a separate study comparing how social workers in two cities, Barrie in Canada and Umeå in Sweden, describe how they work with child abuse and neglect. Background and Context The research project, “How do we protect our children?” presented in this paper began with a broad interest in comparing social services in different countries. Partly, our project, is a response and alternative to the dominant approach in comparative social policy research, specifically the approach that is based on data on social insurance systems. Perhaps the most influential example is the famous typology of welfare state regimes constructed by Gösta Esping-Andersen (1990,“Three worlds of welfare capitalism”). Care services – such as elderly care, care for the disabled and child care – are neglected in such comparative research, so we were challenged by the idea of developing a comparative framework even though we were aware of the obstacles in dealing with person-to-person activities as compared with money transfers, and with local variations as compared with nationally designed insurance schemes (see: Alber, 1995; Sipilä, 1997). We regard child welfare and child protection specifically as areas of great interest for comparative research, since there is an international framework available (the UN Convention on the Rights of the Child). Yet there is a large variation in how different countries and even local communities have developed their work in terms of legislation, organisation, and the role of professionals. Thus, our larger research project includes analyses of legislation, political documents and research on the systems in the two target countries. Further, it includes a study of case files from two cities, Barrie, Canada and Umeå, Sweden. We will show that there are significant differences between the two countries and that these differences are, as we see it, are possible to capture as one "model" of child protection (Canada) and one "model" of child welfare (Sweden). While our research cannot explain all the reasons behind the observed differences, the data presented here allows us to propose such hypothetical models. In order to contextualise the study, we need to provide the reader with at least some background information about Canada and Sweden. Our intent is not to cover all possible factors that might affect how the work with abused and neglected children is carried out, but to give some pillars that frame an analysis of the similarities and differences. One way to describe differences is to identify the two countries within the “regime-debate” using Esping-Andersen's typology. Canada can be described as a liberal, Anglo-American model with a relatively high proportion of NGOs and having
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a moderate level of ambition to intervene with redistributive measures in “free” markets and in family life. Sweden is the “crown jewel” of the social democratic, Scandinavian model with extensive and publicly funded and produced welfare systems. Its ambition to redistribute incomes and to intervene in the labour market, housing market and social security has historically been among the highest in the world. We see these differences in state intervention in the family sphere reflected to some degree in both family policy in general and in child abuse and neglect in particular. Even if the two countries show significant differences in those terms, they are also similar in many ways. The local variation in social care services seems not to be dependent on the welfare regimes in the countries. It has been hard to find good, scientific explanations for local variation. In Sweden a large study on this was published recently, showing that there are large variations and these have not changed much the last ten years. It may be asked whether these differences constitute a problem (inconsistency in service delivery) if they actually reflect the influence of local politics, i.e. something that improves democracy on the local level (See: [OACAS, 2001 #69] and KommitténVälfärdsbokslut, 2001). In some areas that have been studied, the variations are “explained” by the path-dependency hypothesis - local organisations work the way they have worked for a long time independent of structural, global trends or changes in political majorities at the local level. Canada Canada is the world’s second largest nation geographically covering over 9 million square kilometres. It has a population of 30.7 million people the vast majority living within 200 km of the border with the United States of America. Politically, Canada is both a constitutional monarchy and a federation of 10 provinces and 3 territories. Each jurisdiction has wide- ranging powers to raise taxes and organise health and welfare services. Canada’s diversity is reflected in its policies of bilingualism and multiculturalism. Eighteen percent of citizens report a mother tongue other than English (59%) or French (23 %). Furthermore, only 20 % of citizens identifying a single “Canadian” ethnic origin. Over 30 % report origins other than British, French, Canadian and combinations of these (Statistics Canada, 2001). The Canadian child welfare system has developed within this complex geographical, political and social landscape. Therefore, it may be more accurate to say that there are many child welfare systems. However, there are several shared characteristics across the Canadian context. Historically, two traditions have framed the bases for child welfare provisions in Canada. First, children are seen as the property of their parents – that has been a concept, particularly in Quebec. Second is the notion of parens patriae – a British doctrine which is stronger in the rest of Canada which justifies intervention into the privacy of the family for the protection of children (Khoo, 1999). The various systems are premised on the belief that parents bear the primary responsibility for the welfare of their children. Systems across Canada are residual in that only the most serious problems and most vulnerable families are served. Legislation Each province and territory in Canada has developed its own child protection legislation and definitions though there are many similarities among them. The principles enacted in the legislation are:
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• • • • •
Families are responsible for the care, supervision and protection of their children. Children have rights that are to be protected Governments are also responsible to protect children from harm “Best interests of the child” is a guiding principle Least intrusive forms of intervention should be provided
Ontario’s Child and Family Services Act (CFSA,1984; with amendments up to 2001) The CFSA (Ontario, 2001) is a law governing the provision of child welfare services for children under age sixteen in Ontario, Canada’s most populous province (8 million inhabitants). The CFSA defines and interprets the role of the province’s children’s aid societies, defines child protection and sets out procedures for child protection. The paramount purpose of the CFSA is to promote the best interests, protection and well being of children. Other purposes of the Act, so long as they are consistent with the best interests, protection and well being of children, are: 1. To recognise that while parents may need help in caring for their children, that help should give support to the autonomy and integrity of the family unit and, wherever possible, be provided on the basis of mutual consent. 2. To recognise that the least disruptive course of action that is available and is appropriate in a particular case to help a child should be considered. 3. To recognise that children's services should be provided in a manner that, i. respects children's needs for continuity of care and for stable family relationships, and ii. takes into account physical and mental developmental differences among children. 4. To recognise that, wherever possible, services to children and their families should be provided in a manner that respects cultural, religious and regional differences. 5. To recognise that Indian and native people should be entitled to provide, wherever possible, their own child and family services, and that all services to Indian and native children and families should be provided in a manner that recognises their culture, heritage and traditions and the concept of the extended family. Criminal Code of Canada Cultural variation within Canada leads to disagreements in the definition of what can be considered discipline and abuse. The matter is further complicated by a provision in the Criminal Code of Canada which permits “reasonable force” to be administered to children by parents and teachers. They are “justified in using force by way of correction toward a pupil or child…if the force does not exceed what is reasonable under the circumstances”. This provision creates many difficulties for child protection workers across Canada. Definitions Child abuse is a term rarely seen in Canadian legislation. Provinces instead render precise what counts as physical or other harm or risk of harm. Sexual molestation and 92
exploitation are clearly defined in the child welfare legislation whereas neglect is a term only recently introduced into Ontario’s child welfare legislation. Administration Child welfare structures are administered variably across Canada. In the west and the Maritime Provinces of eastern Canada, child protection departments are departments of provincial governments, usually organised on a regional basis. The Quebec model has regionally based health and social service centres. Within each is a Child and Youth Protection Centre Although high local variations exist, all agencies are accountable to their provincial social welfare ministries. The Canadian part of our study focuses on the child welfare system in Ontario. This province’s child welfare agencies (Children's Aid Societies) are community-based, governed by voluntary boards of directors, and are non-profit transfer payment agencies (OACAS, 2001). There are substantial differences in how Ontario’s 54 children’s aid societies organise the delivery services. Reporting Reporting child protection concerns is mandatory in Canada. Reports are to be made by “anyone” with information that a child may be in need of protection. Professionals are especially mentioned in the legislation and may face sanctions if they fail to report. However, there is considerable public confusion and reluctance to make reports given the Criminal Code provisions and media reports of children dying in care. Investigation Child welfare authorities must respond to reports and investigate “protection” allegations within a specified time. It is the “front line” worker who responds to referrals and screens complaints or makes a complete investigation when appropriate. Several layers of directives and guidance influence how they respond: legal, provincial protocols, precedent, and care supervision. Ontario Risk Assessment Model Each province has policy manuals, guides and protocols providing working definitions of child maltreatment and procedures to be used. The Ontario Risk Assessment Model is a system of three tools used by social workers across the province to establish eligibility for child protection services and assess risk (Trocme, Mertins-Kirkwood, MacFadden, Alaggia, & Goodman, 1999b). The Model was implemented in 1998 in order to bring a standardised, comprehensive approach to child protection work. The three tools are: • • •
The Ontario Eligibility Spectrum – a third generation tool The Ontario Safety Assessment – a minor adaptation of the British Columbia Safety Assessment The Ontario Risk Assessment – adapted for the province from the New York Model.
Sweden Sweden is also geographically and culturally diverse. Its 9 million inhabitants live in a landmass that stretches 1600 km north to south although 50% of the people live in 93
only 3 % of the country’s total area. In addition, 18 % of the population report family roots outside of Sweden. Sweden is part of the European Union, but since social policy is still a national matter within the union, it is to be regarded as a self-sufficient national unity. Sweden has a political structure that most easily can be described as a three-level parliamentary democracy. Legislation is a national matter, the production and the major tax-funding of health care is a matter for the 18 county councils, while the 289 municipalities, funded by local taxes, are the ones who organise and produce social care services. The system is still dominated by public service production, but there are more private, non-profit and for-profit producers of care than before. Areas where decisions are made that can go against citizens are always public. Legislation Social service interventions for children and young people are guided by the Social Services Act (SoL), the Care of Young Persons (Special Provision) Act (LVU) and the Parental Code (FB). The Parental Code The Parental Code regulates parenthood and adoptions by defining the rights of children and responsibilities of parents. This law states that children have a right to: 1. care, security and a good upbringing; 2. be treated with respect and regard to their individuality; and 3. not be subjected to physical punishment or other degradation. The Social Services Act The Social Service Act is a framing law that has been in force for some 20 years. The law regulates all social interventions. It specifies entitlements for financial assistance, pre-school child care, care of older and disabled people and substance abusers. The Act was supplemented in 1998 to reinforce children's rights and to affirm the local authority’s obligation to intervene if there are signs that a child shows “unfavourable life conditions”. The Act now emphases “the best interests of the child” and, when measures affect children, the child's opinion is to be clarified as far as possible. Care of Young Persons Act Interventions for children and young people must primarily be provided in voluntary form according to the Social Service Act. Compulsion enters only when this is not possible and this is then regulated through the Care of Young Persons (Special Provisions) Act (LVU). The act regulates when a young person can be taken into care or protected without his or her consent. The social welfare committee has the authority to intervene when the following criteria are met and is obliged to do so: (a) a deficiency must exist in the young persons home environment (known informally as environment cases) or the young person's own behaviour (known as behavioural cases); (b) the deficiencies must lead to a manifest risk of damage to the young person's health or development; and (c) the necessary care required for the child cannot be given by voluntary means. Assessment Unlike Canada, Sweden does not use standardised assessment models. The Social Service Act states that assessment must start immediately there is any information available that might lead to measures from the social services (Section 50, SoL). If
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the assessment is related to protection or support of a young person, Social Services can use consultants and the assessment must end within four months. Under Section 50 it is possible to assess the situation even if the parents do not agree. As soon as a social worker receives a referral it has to be acted on. First, the responsible social worker evaluates the situation to decide if the case demands immediate measures. If not, a pre-assessment is done to provide the basis for deciding how to proceed. Sometimes this leads to the conclusion that the case is not the business of the social services, but the most common outcome is that a full assessment has to be done. In a “traditional assessment”, the usual process consists of one or more meetings with the parents together or separately, interviews with the child(ren) and with a number of so called referees, which include nursery teachers, doctors, school teachers and friends of the family. Sometimes other authorities are asked to provide reports . The process is sometimes described as “putting together a jigsaw puzzle”. The consequences of this approach are that there is a large variation in how assessment is done in Sweden. Many municipalities have tried to develop alternatives to traditional assessment. One such alternative is to move the family to an assessment apartment in order to get a better view of the family's way of functioning and to have more opportunities to talk to family members in an everyday-setting. Other alternatives are structured family interviews, family counselling and a solution oriented assessment model, that integrates assessment with change efforts. Administration The support given under the Social Service Act varies between different municipalities in Sweden. To place the child outside the home is expensive and different non-residential alternatives have developed: family counselling, activities to improve the interplay between parent(s) and children, various forms of group activities for vulnerable families (for example, where there is alcohol abuse, or different kinds of psychiatric problems). Even if the social services are dominant actors in these activities they frequently co-operate with child health care, child psychiatry, and various non-profit or religious organisations. An organisational solution that is directed to discover problems at an early stage are the Family Centers (Familjecentralerna) where child health care, maternity welfare and the "open" nursery school have been localised together with child welfare (KommittenVälfärdsbokslut, 2000). An increasingly common measure for the social services is to support young persons and their families with practical home-based interventions or establishing contact with a befriender or befriending family. family. Less common but becoming more and more common is to work more broadly with family networks and family therapy. It is common for the municipalities to offer a priority right to day-care in order to provide the child with extra stimuli or to relieve the parents (KommittenVälfärdsbokslut, 2000). Twenty-four hour care placements have decreased in Sweden, partly a function of high costs and partly resulting from the development of more open care alternatives.
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As the National Board of Health and Social Affairs concludes: “The trend appears to be moving towards care adapted to the individual and the local situation carried out in the young person's home environment”. (http://www.sos.se/fulltext/0077018/kap5.htm). The number of young people in compulsory care under LVU has remained virtually unchanged the last ten years. About 4500 children/young people are in care outside the home at some point, in 72% cases due to circumstances in the home environment and 28 % due to the young person's own behaviour (Socialstyrelsen). A notable trend is that the number of emergency placements of young people has increased significantly and that young people with a foreign background are over-represented both in the round-the-clock care and as receivers of a befriender. Reporting The Act encourages the general public to report to the social services if they suspect that a child is being ill-treated in the home or outside it. All authorities working with children and young people, as well as other authorities in the health care sector, are obliged to notify the municipal social welfare committee immediately if anything comes to their knowledge which may lead to interventions in order to protect a child or young person. This duty to notify applies to both private and public professionals working with children and youth, in health and medical care, or in the “context” of social services. Teachers and social workers employed in private schools have this duty. The Comparative Study The research project design integrates comparative and case study methods. Thus, we selected two agencies that must respond to referrals regarding a child who has been harmed or may be at risk of being harmed. The two samples we chose were: Team A, Barrie Office of the Simcoe County Children's Aid Society and Family Care Team, Umeå Social Services. Focus Groups We believed that focus groups would be an effective method of determining social worker’s perceptions, feelings, and ways of thinking about what they actually do in practice. We used a total of four focus groups, two at each agency in Barrie and Umeå, during a two-month period. The number of participants in the focus groups ranged from seven to twelve. The analytical procedure will be presented in the findings section below. There are many advantages in using focus groups as a tool to uncover perceptions in a defined area of interest. But, working with focus groups also revealed some conceptual and semantic problems. One was the lack of a Swedish equivalent term for child protection and the broader definition of child welfare services. While there is an international trend toward harmonisation of terms regarding physical abuse and all forms of sexual exploitation, the so-called grey areas involving neglect continue to defy singular definitions. Nevertheless, we found important indications that the different orientations of child protection and child welfare (Jack, 1997) are not just of abstract interest. These
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concepts affect how social intervention takes place. One social worker in Canada succinctly highlighted these different orientations: We're no longer in the child welfare business. Child welfare is a term of the 1980's. It's an 80's philosophy. And the 90's pretty much pounded the word “child welfare” into oblivion. So, now it's the child protection business. (Excerpt from a focus group in Barrie, Canada) Analysis Tapes of the focus groups were transcribed verbatim. The co-moderators then examined the transcripts for responses to questions posed and for content outside of the questions posed. Themes from each group were coded. Related themes were grouped into categories and assembled for data analysis within each thematic category. Each co-moderator reviewed the transcripts and assisted in the assignment of themes. Below we outline these categories, giving relevant data items from the focus group transcripts. 1. Gate Keeping In both Barrie and Umeå, the Gate Keeping Function is a dominant theme in their discussions of what they say is important to understand about social intervention. Social workers in both groups identified gate keeping as a significant aspect of intervention because resources are limited and not everyone can receive services. In Barrie, the Eligibility Spectrum is a tool designed, to assist social workers in making consistent and accurate decisions about eligibility for service at the time of referral (OACAS, 2000). Use of this tool was cited 19 times. The following quotes exemplify the Barrie situation: … what we’re doing at the beginning stage is the whole thing is investigation. So we’re trying to decide “is this child in need of protection?” and if intervention is needed. We’d like to go in and offer some more assistance but the reality is, “is it really child protection?”…If we could sit down for several hours with the family and be a support maybe things would get better but that’s not really our job…And that’s not an option at the agency. The Eligibility Spectrum is not only used to determine if a case will be opened but to label it – and the child and family with it – along certain dimensions. In this way a 11A case would mean the same thing in a large city or small community anywhere in the Province. Furthermore “it reduces the grey areas in the work we do”. In Umeå, social workers do not have a tool equivalent to the Eligibility Spectrum upon which to base their gate keeping decisions. The social workers talked about how the law gives them a great say in what services are offered and what the priorities are. Nevertheless, the local authorities must investigate all concerns that a child might be at risk. The investigation then forms the basis for deciding what is to be done (Socialstyrelsen, 1996). Two social workers work together on intake of new referrals and make first contact with children and their families:
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And then make a judgement; is this something that we must get into or not. Mmm, so the question is a little bit about whether or not the child is at risk but also whether Social Services can be some help and that can be the object for some kind of measures from us, right… a lot of referrals come in and we can’t divide them all up and that changes one’s determinations about whether or not they will lead to investigations or not. So, sometimes you put more responsibility on the parents or on those who did the referral. This is what I think about myself, what are the values that guide me and how much are they influenced by my workload… Thus, the gate keeping function may be viewed as a process of determining eligibility or entitlement for services. In both Barrie and Umeå, there are certain situations in which each agency must intervene. These can be generally understood as the clear-cut physical and sexual abuse cases. In Barrie specifically, the Eligibility Spectrum, as indicated both in the naming and defining of this tool, is used by social workers to establish whether “protection” criteria have been met thus allowing a child to be eligible for services. In Umeå, social workers identified that the law entitles children to “good care” but since this is not defined for them, they must make this judgement. The law further entitles clients to the support of social services. 2. Skills in Context When social workers in Sweden and Canada were asked what they had to be good at in their respective jobs, they typically provided examples of skills connected to the environment in which they work. In responses from both groups, we see how social work values, skills and principles guide. Swedish and Canadian social workers both talked about the importance of “empathy” in their relationships with clients and particularly with children. They talked of needing to be flexible given the wide range of problems they have to deal with and because of the unpredictability of their working environments. They all mentioned needing organisational skills to manage a demanding administrative workload. Finally, workers at both agencies talked about the importance of using their assessment skills in determining presenting and underlying problems to be addressed by themselves or their agencies. Differences first appear in the ways that social workers contextualise their work. In Barrie, one worker described the trauma of having to deal with: …some of the most difficult stuff that there is. We are dealing with children who are abused. Kids that are burned and bruised and sexually abused, and neglected. That’s awful. There’s a toll. In the “wearing, adrenaline-filled” context of Barrie’s children’s aid society, social workers described using their observational, assessment, documentation and interviewing skills are used primarily in a “forensic” and “protective” sense. This comment is exemplifies of how the group talked about skills in context: It’s not a normal type of clinical social work that we do…We try to form healthy relationships if we could but it is something that often times the help that we do is not viewed as helpful. Our primary focus is the kids. Their well being, safety, is first and foremost and then the helping relationship comes after that… So it is a different type of social work that we do.
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In Umeå, one social worker described the “most vulnerable” children as: Those we don’t see. Children who aren’t supported in the situation and …who don’t have anybody who sees them. Another added that: Even worse is the child that is “seen” by us but we don’t do what we maybe should do anyway…the borderline case…sometimes with our caseloads, we don’t have the space to follow up a situation like we should. So, the child is cheated somehow. In the Umeå focus groups, the social workers did not independently bring up defining the parameters of child abuse or neglect. They described using a solution-focused approach to get as thorough an understanding of a family’s problem as possible. They also specifically mentioned working from the principles of participation and consent. Thus, social workers must bring all their skills to bear to work voluntarily with clients. It is being a little like a chameleon, I think…There is a lot to that in treating clients like they themselves want to be treated…we need to check things out a little first. And then deal with different people in different ways. Given that in Sweden, the focus is on client participation, social workers focus on determining what the clients themselves what to change and what the clients themselves want help with. Flexibility in that context means being able to be “down to earth” with rural families and “respectful” of differences but, at the same time, “clear” with immigrant families. For example, “Corporal punishment is against the law. Period”. 3. Client Identity We arrived at this category by analysing how many times social workers identified their clients and in what ways, directly and indirectly. The chart below demonstrates how often social workers made references identifying their clients.
Child’s situation Parent or Family Mother Father Safety of Child Risks to Child Focus on child Immigrants
Barrie # of utterances 52 31 16 7 27 57 14 0
Umeå # of utterances 65 56 44 22 5 7 1 12
In addition to analysing these numbers, we looked at how the social workers talked about their clients. In Barrie, they talked about the child being the focus during investigations and assessments of risk and safety but it is often one or both of the parents to whom services are directed. In Barrie, they work “in the best interests of the child”. The worker is the voice of the child and thus the worker's role is to keep the
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child safe though sometimes child can get lost in this. “We make decisions for them and not necessarily what they want, like to go home to the family”. . You are there for that little person under 16 who doesn’t have their own voice and their own power…I say “Look. Your little person is my client. You are my secondary client. You are part of a family system”…I bring them into the equation certainly…but my goal is to keep your child safe. In Umeå, the social workers identified more often the parents, as well as mothers and fathers individually as the focus of assessment and intervention. There the focus is on investigating the child’s circumstances in relation to the parents and family. Social workers widely agreed that they lack specific tools to help talk to a child in the context of abuse assessments. They are also working at developing a “child perspective”. Nevertheless, they talked about the legislation being strengthened to emphasise both the child’s “best” and the child’s position regarding measures taken by Social Services. However, one social worker described the current situation in these terms: I sometimes feel that we don’t really see the child’s needs. It’s more about the parents…to put all the possible supports in place so that the child can remain at home. And that is, after all, the meaning of the law. And, everything should be done by mutual consent and this here co-operation. 4. Decision Points Once a child or family has entered into the agency system because of a concern for well-being, social workers in Sweden and Canada have to make decisions upon which to take action. In both countries, social workers talked about deciding what the problem is and whether this is something the agency will address directly or in liaison with other agencies. These decision points are reflected in the different questions identified by the social workers in each focus group. In Barrie these were the main questions: • What are we going to do to intervene in this family to ensure the child is safe? • Will this family agree to voluntary involvement or oversight by the agency? • Will placement of the child be necessary? • Does the child continue to be eligible for child protection services? In Barrie, the social workers talked about having a specific mandate that gives them the formal authority to intervene if the threshold of evidence is there. Not surprisingly, procedures under the Ontario Model, and particular references to safety, risk and protection, were given great salience by the social workers in Barrie. References to Risk: References to Safety: References to Protection:
27 57 28
In Umeå, decision-making is driven by different influences and mandates, as reflected in their questions: • Is the client consenting to investigation? • Are there sufficient risks to the child to continue the assessment without consent? 100
• • • •
Does the child have favourable life conditions? What supports will be put in place for the child or family? How is the child? Is the child safe and secure?
In both Umeå and Barrie, decisions are influenced by how the social workers identify the presenting problem, the severity of the situation, and on how their clients react to becoming clients. For example, there was uniformity of response when social workers talked about how to handle a referral regarding severe physical abuse. A fullblown, joint investigation with police would occur. There would be interviews with the child and non-offending parent and as well as medical checks and the strong possibility of the emergency placement of the child during the investigation. Although all the social workers described this as a “nightmare” perhaps only slightly less “horrible” and “complicated” than sexual abuse, the social workers in Barrie identified the severe physical abuse case as part of “daily life” whereas the Umeå group thought these cases were rare occurrences. Decision-making becomes more complicated in the less clearly defined cases as when a parent is described as potentially abusing alcohol or putting the child at emotional risk e.g. a parent swearing, yelling, and grabbing. Once again, procedures are used by the Barrie team to ascertain whether such information warrants further involvement and whether statutory actions are required. The Umeå team was quicker to see the less extreme situation as risky for the child, in that “the child is doing poorly”, and wanting to intervene by doing an investigation, potentially placing the child and mother together during the investigation. But, in spite of their wishes, they said that they would not do unannounced visits or speak with neighbours, and could not see the child alone without parental consent. Further, while the law permits them to carry out investigations without parental consent, it limits the social worker’s ability to be intrusive in the decisions they make. In Umeå, investigations tend to be more like psychosocial assessments than forensic investigations. Social workers spoke of being interactive with clients during the investigation, having their participation, respect and consent. There is a wide variation in how assessments are carried out and in what decisions are made. Workers described the challenge as being to include social work, as a helping activity in the investigation. They feel there are greater possibilities for social work if they have this freedom. 5. Compulsion Compulsion was an important but complex theme to come out of all of the focus groups in Sweden and Canada. All the social workers talked about compulsion as: i) services provided on a non-voluntary basis, ii) to coerse or control, and iii) to be used only as a last resort. And, in both countries there was a shared understanding that social workers can exert a powerful influence and control on individuals or families even in the most egalitarian systems. In Barrie, the social workers made explicit reference to their use of authority 12 times and referred to a client’s power (the child) twice. As three Canadian social workers said, 101
Certainly at the Children’s Aid Society there is an incredible power imbalance, an incredible authority we have to go into people lives, and it’s totally intimidating for these people. You know… the level of co-operation the family meets us with is the more defiant they are of our involvement that just increases the amount of intrusiveness that we are forced to use. We have the ultimate ability to go in and make an intrusive plan regarding the child regardless of what anybody says because the evidence is there. Interestingly, no direct use of the words “power” or “authority” was made in the Umeå group. In Umeå, professional authority involved keeping a positive contact with clients and to work with them on the basis of respect, consent and co-operation. “It’s not easy. I mean we work with children and families and it’s not at all easy…to be cool but caring...to be careful not to go the other way and be too distanced and uncaring. That’s the balancing act.” When the well-being or safety of a child is at issue, compulsion becomes a major factor and is manifest in even more obvious ways – in court and in the compulsory care of children. While, in both countries, work begins wherever possible voluntarily and social workers find many creative and skilled ways to avoid court-ordered services, in Barrie court occurs frequently with between 15 and 20 % of caseloads defined as involving court. Most of these court cases involve children in care rather than supervision orders. In Umeå, legal means can only be used to place a child into care and the court-mandated caseload of workers there is closer to 5 %. In Barrie, court is most frequently used: when families disagree with an agency recommendation to remove the child from the home, when a child is to be made a permanent ward of the state, or as the “least intrusive” means of working with long term “borderline” families requiring supervision. Children can be placed in emergency care for up to five days pending the outcome of an investigation. Children can then also be placed in the care of a children’s aid society for a period of up to two years (one year for young children). Children may also be made wards of the crown and placed in permanent care. In Barrie, the workers talked about court “going two ways”. The first involves a process of working with the family and getting their consent to court ordered care. That is, the child is in need of protection and the least intrusive measure is to place the child in care for a determined period of time. The other way to go is the trial route. If parental consent cannot be reached, then the legal process of pre-trial hearings and eventually a trial are followed.
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Compulsory Care in Barrie On average, 80% of children are in care under a court order. Half of the children in care are permanent wards. About 5 % of the child population of Simcoe County is “in care”. Compulsory Care in Umeå On average, 25 % of children in care are under a court order. All care must be reviewed every six months. About 0.5 % of the child population in Umeå is “in care” 6. Measures Social workers in Barrie and Umeå all recognised the monetary and social costs of separating children from their parents. Therefore, foster homes and other institutional placements are measures of last resort though in the table above we see significant differences in the proportion of the total child population who are in care. In both countries, alternatives to placement have developed. They include: family counselling services (offered in conjunction with other agencies), open pre-schools or play groups, and home-based interventions. Social workers in both contexts talked of the need to be more broadly involved with family networks and to increase collaboration between themselves and health care, mental health and other service agencies. In Barrie service plans also include supervision of the home environment through unannounced visits and interviews alone with a child. In Umeå, the use of volunteer befriending by contact families and contact persons is frequent. The contact family program is an intervention frequently used for families with young children or problem youth. A volunteer individual or family, without special training, provides support to a parent or relief care for a child. Another unusual measure at Umeå Social Services is an assessment home where parents and children can reside together with up to four staff members during a period of an assessment. The home consists of four apartments integrated with common group living and eating areas. The home serves a very important function of maintaining children’s connection to their parents and avoiding foster home placement. Another common measure in Umeå is to offer a priority right to day-care in order to provide the child with extra stimuli or to relieve the parents. 7. Professional Status Finally, lively discussions took place regarding the status of social work at the Children’s Aid Society and in Umeå’s Social Services. In Barrie, child protection work is considered “bottom of the barrel” and a place for new graduates from schools of social work regardless of the social worker’s recognition that the job requires creativity and a high skill level. Some argue that the status is low because the profession is female dominated. 103
If you see a fireman carrying a baby out of a fire, he’s a hero. And yet, if we take a child out of a home that is high risk, then we aren't heroes. We still get shat on. It's a no win situation. A male in the group became quite upset at the analogy. “We are also social workers who are tampering with family composition and when you are putting out a fire, you can't really compare the two. …For the $ 4000 more a fireman gets, we don't have to run into a burning building and get ourselves killed”. To which the reply, “No, we just go into a psychopath's home and get shot.” Child welfare social workers in Umeå seem to have a higher status in relation to other social workers in the community but not necessarily in relation to other professionals such as child psychologists, doctors and lawyers. Indeed, the special status of the social workers in Umeå’s Child and Family Group, is reflected in the fact that all of the workers there had more than 5 years experience before entering that Group. Furthermore, these social workers observed that the District Court lacks knowledge about children and that: They are guided by the way in which we express ourselves…though what child psychiatry says is weighed more heavily today than what we say. Still the thing about the social work role is …what is our knowledge and what can we learn on…to make a prognosis. Discussion Focus groups in Canada and Sweden revealed much about the nature of social intervention and provided a “really good flavour of the kind of work we do”. Group members responded that they thought it was important to have a “serious discussion about what we do and what we think is important”. Workers were unanimous in their passion for their work and in wanting to share their feelings about the challenges inherent in being a social worker. Much remains to be done to establish “best practices” in work with children who have been abused or neglected. Before that can be done, we need to make sense of differences that exist between the orientations of child protection and child welfare. One informant clearly stated these differences. “It’s a very important distinction because child welfare had this kind of a scope (holding two hands wide apart) and child protection has this kind of scope (holding thumb and index finger a few inches apart)”. That a social worker would make this statement is indicative of its importance not just at a policy level but in practice as well. The evidence from the focus groups, insofar as they can be related to other research, support the following propositions: •
That there is a Swedish model of child welfare and a Canadian model of child protection and,
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•
That these models produce significantly different orientations to social intervention. The Child Welfare Model • • • • •
The “bar” is lower in Sweden where any signal elicits an investigatory response by social services. Child Welfare is assessment driven. Child Welfare may be more successful at matching services to the needs of both children and their families. Family preservation is a guiding principle. Social workers maintain their professional identity.
_______________________________________________ The Child Protection Model • • • • •
Response/Eligibility in Child Protection requires a strong signal – above a clearly defined “bar”. Child Protection is structure driven. Child Protection may be more consistent in identifying abused and neglected children. “Best interests” and permanency planning more often mean compulsory and permanent removal of child. Child protection requires a shift in professional identity.
The response that an agency or individual worker makes to a signal regarding the well-being of a child is closely connected to the theory and ideology that shape the service structure. Taken cross-nationally, the two agencies have different states of readiness to intervene in the family. A preponderance of the data from the Barrie groups suggests a strong protection emphasis in social work at the Children’s Aid Society. In Barrie, the response is clear and relatively uniform. If a case is rated above a certain line in the Eligibility Spectrum, a case will be opened. A case generally means a family even though the subject of attention is the child(ren). An investigation as well as safety and risk assessments are carried out to determine the ongoing plan. The child welfare emphasis in evidence in Umeå suggests that social workers there may respond more readily to any signal that a child is “in need”. The marked lack of proceduralisation (Scott, 1998) there allows social workers to ask the question, “How is the child?” rather than being driven to determine, “Do we have a case?” We therefore further propose that there are different driving forces in Swedish child welfare and Canadian child protection.
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The Driving Forces – Assessment and Structure Social work dealing with child maltreatment is driven by different models of intervention. In the Swedish model, social intervention is characterised by a tendency to focus on understanding acts or circumstances in the context of psycho-social difficulties experienced by families. Responses often involve further assessment and the provision of therapeutic and practical services (Spratt, 2001). In Sweden, social intervention therefore is founded on the guiding principles of solidarity, parental rights and upholding the child’s best interests but within the framework of family preservation (Norström & Thunved, 1996). A general welfare consensus there combined with a broad, rights-based framing law means that social workers have the professional space and authority to focus on non-statutory interventions to ensure that the child has “good enough” living conditions. In child protection both the philosophical underpinnings of policy as well as intervention by social workers are built around investigative and legislative concerns. Social intervention therefore becomes most concerned with defining the features of a case (Parton, 1988) to establish whether the child in need of protection In the name of standardising good practices, all children’s aid societies in Ontario now have a three tool risk assessment model (the Ontario Model) used at every stage in the life of a case from point of first referral to termination. Social workers in the focus group in Barrie praised the 1998 province wide implementation of the Ontario Model. But, highly proceduralised social intervention in child protection means that social workers are constrained by a more limited mandate. Furthermore, the elements of investigation and measures take on greater statutory characteristics. Strengths and Pathologies In comparing and contrasting child welfare and social work in England and Sweden, Weightman and Weightman (1995) identified strengths and pathologies in each system. If we extend this comparison to our study, we can present the following hypotheses: • •
Child Welfare in Sweden may be more successful at matching services to the needs of both children and their families. Child Protection in Canada may be more consistent in identifying abused and neglected children.
Since child welfare in Sweden is assessment driven, social workers there may spend more time identifying the needs of a child and family. Sweden’s broad based social services mean that there is a wider variety of services available to assist children “in need”. Intervention may begin earlier with more preventive services and more services are available to deal with problems as they arise. However, since social workers there are not specifically trained to recognise, classify or process abuse cases differently, some cases may fail to be identified. In Canada, it has become politically and socially intolerable for children to “fall through the cracks” or for social workers to fail to protect children. Therefore, we have seen in Ontario and elsewhere a move to standardise the procedures for identifying abused and neglected children and children at risk. While risk assessment tools have not been particularly successful at predicting future risk, they have been
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identified as helping workers to define their role consistently and to decide how services will be offered. Guiding Principles Family preservation is a guiding principle in Swedish child welfare. This contrasts with the “best interests” and “permanency” principles of child protection in Canada. With these different guiding principles, social workers in the two countries must attend to different variables. Implications for Social Work Social workers maintain their professional identity in Swedish child welfare. In Canada a shift in professional identity has occurred with social workers becoming child protection workers. Despite the major differences, the study identified similarities among social workers in Sweden and Canada. They share core social work skills including the ability to empathise, to prioritise, and to link needs with available services. Also significant were the factors social workers attended to in their assessments and investigations. In both Umeå and Barrie social workers looked at alcohol or substance abuse, violence in the home, a protective parent, extended family, age of the child, previous history, child behaviour, socio-economic factors, and mental health concerns in assessing a family’s or a child’s situation. It is no wonder that one worker in Umeå questioned whether a tool such as the Ontario Model would make a significant difference in practice. Child protection has now become firmly entrenched in Ontario whereas Swedish social services in general and services for children in particular are coming under increasing pressure to produce standardised assessment tools. In Barrie, at least this has resulted in an apparent clarification of purpose. The principles of “protection”, “best interests” and “least intrusive” no longer compete as they did in the 1980’s (Trocme, 1999a). Today, the protection of the child is paramount both in legislation and in the words of the social workers. We hoped that the focus groups would provide some insight into social workers’ experiences of working under different orientations. In our study, we cannot claim that all social workers in Sweden and Canada would respond in the same ways to the same questions we posed to the focus groups in Barrie and Umeå. But, it is likely that the orientations of child welfare and child protection unmasked in these two cities will remain true to Sweden and Canada. We would argue that these two orientations of child welfare and child protection are each driven by the particular features of service structures. Some have argued that cross-national comparisons are pointless since it would be impossible to simply superimpose the social services of one country on another. However, if we become locked into the viewpoint that our social welfare policies and child protection services cannot be radically re-made, we will have no end to our problems. All things are both comparable and changeable and therefore have the potential to be re-cast in a new and dynamic way.
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References: Agathonos-Georgopoulou, H. (1998). Future Outlook for Child Protection Policies in Europe. Child Abuse and Neglect, 22(4), 239-247. Alber, J. (1995). A Framework for the Comparative Study of Social Services. Journal of European Social Policy, 5 (2), 131-149. Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Cambridge: Polity Press. Jack, G. (1997). Discourses of Child Protection and Child Welfare. British Journal of Social Work, 27, 659-678. Johnson, L. C. (1986). Social Work Practice. (Second ed.). Toronto: Allan and Bacon, Inc. Khoo, E. G. (1999). Constructing Child Welfare Practice in Ontario, Canada. In K. J. a. T. P. A. Jokinen (Ed.), Constructing Social Work Practices . Aldershot: Ashgate. KommittenVälfärdsbokslut. (2000). Välfärd, vård och omsorg. SOU 2000:38. Stockholm: Fritzes. KommitténVälfärdsbokslut. (2001). Välfärdstjänster i omvandling. SOU 2001:52. Stockholm: Fritzes. Norström, C., & Thunved, A. (1996). Nya sociallagarna - med kommentarer, lagar och författningar som de lyder den 1 juli 1996. Stockholm: Norstedts Juridik AB. OACAS. (2000). Ontario Child Welfare Eligibility Spectrum . Toronto: Ontario Association of Children's Aid Societies. OACAS. (2001). http://www.oacas.org, [Internet web page]. Ontario Association of Children's Aid Societies [2001, . Ontario, (2001). Child And Family Services Act, 1984. Toronto: Ministry of the Attorney General. Payne, M. (1999). The moral bases of social work. European Journal of Social Work, 2(3), 247-258. Sipilä, J. (1997). Social care services: The key to the Scandinavian model. Aldershot: Ashgate. Socialstyrelsen. (1996). Social service, vård och omsorg i Sverige 1996 . Stockholm: Socialstyrelsen. Spratt, T. (2001). The Influence of Child Protection Orientation on Child Welfare Practice. British Journal of Social Work, 31, 933-954.
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Trocme, N. (1999a). Canadian Child Welfare Multi-Dimensional Outcomes Framework and Incremental Measurement Development Strategy. In J. Thompson & B. Fallon (Eds.), The First Canadian Roundtable on Child Welfare Outcomes . Toronto: University of Toronto Press. Trocme, N., Mertins-Kirkwood, B., MacFadden, R., Alaggia, R., & Goodman, D. (1999b). Final Report. Ontario Risk Assessment Model. Phase 1: Implementation and Training. Toronto: Centre for Applied Social Research. Bell Canada Child Welfare Research Unit. Faculty of Social Work, University of Toronto.
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CHAPTER 6. VOLUNTARY CHILD PROTECTION WORK IN BELGIUM Catherine Marneffe Introduction Belgium is a small European country of 10 million inhabitants that has existed since 1830. It is composed of 3 linguistic communities (French, Flemish and German), plus Brussels, the capital consisting of two linguistic populations (French and Flemish). Although small, the country is very divided, which makes it rather complicated to understand for the outsider. Belgium has about 2.3 million children representing 23% of the total population. Belgium has a fully-fledged welfare state, built on strategies of compensation for life risks. Insurance contributions are collected for sickness, unemployment and other social risks. The Belgian welfare system includes universal health insurance, subsidised physical and mental health care, free education, monthly allowances for each child in school and for each pregnant mother for several months after birth, subsided day-care and home maker services as well as maternal child health services. The Belgian social security system is well organised and people are protected from poverty by means of different types of financial benefit. Every child is entitled to receive a family allowance until he is 18. The amounts are higher for orphans. Medical help is offered free to every child younger than 4 years. Primary and secondary education is free of charge. In 1993, 8.7% of the Belgian active population was unemployed; 18% was considered as being poor, having an individual income of 705Euros per month (842 Euros for 2 active persons and 1 child). Public assistance in Belgium thus provides people with a subsistence minimum, which is the legal income guaranteed, augmented with family allowance (Cantillon, 1993) Of course, since Margaret Thatcher tried to demolish the welfare state that was well established in the United Kingdom since 1945, a similar trend as in the USA cannot be overlooked in Europe. There are still the basic structures, but one can observe today that many European countries are tending towards this residual model, based on targeting of groups labelled as having specific problems. This is well illustrated by societal reactions to child abuse. Given a free choice, all parents want their children to grow up in a healthy, wellfunctioning way that enables them to maximize their potential (Solnit, 1980). However not all parents are given a free choice in their own lives, enabling them to maximize their potential, which results in violent crises in many families. Inevitably there will always be children injured, harmed or abandoned or having problems; there will always be disturbed parents and families in need of services. Child abuse and neglect can therefore be seen as a relative phenomenon somewhere on the line between love at the one extreme and murder at the other. This contrasts with the perception of abuse as an “inhuman act” that is not connected to the behaviour of other human beings. The choice about which way to view abuse determines society’s answer and the type of child protection system. Systems based on a sharp split between “them” and “us”, perpetrators” and “victims”, have resulted in the creation of a new social problem: child abuse, which needs to be
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controlled. This is turn results in segregated services, authoritarian in concept and method, based on “fact finding” and judgements about “bad behaviour”. On the other hand a continuum approach sees child abuse as an extreme form of normal family relations. It results in attractive, accessible, non coercive services, which aim to strengthen parents’ autonomous efforts to nurture and protect their children. When child abuse and neglect are viewed as illegal destructive individual acts and not as a consequence of social injustice, the way is open to the absence of solidarity. Universal child welfare services can then easily be replaced by child protection systems, based on a network of informers investigating needy families to control better them and their eventual outbursts. In this residual model, the exaggerated preoccupation with child abuse and use of resources for child protection not only inhibits the implementation of services for families in general, but distracts attention away from common inequalities in the system. There is no doubt that the main stream in child protection throughout the world is punitive, although we have tried to make a change in parts of Europe like Belgium. There is a clear dividing line between the American and English approach (generally relying on a mandatory reporting system and punishment in combination with service systems) and “new” child protection work in the Netherlands, Germany and Belgium. The same orientations can be observed in Austria, Switzerland, Italy and Scandinavia, although these countries have a mandatory reporting system. Legal aspects of child protection in Belgium The first Belgian Act concerning child protection was passed on May 15th, 1912. It stated that offences committed to children under the age of 16 were to be punished severely. It also provided for specific protective measures for these children. However, many problems concerning the abused children and their families were not addressed by this law. For instance, abusive parents could be punished, while the underlying causes remained untreated. Moreover, judges needed hard evidence to be able to prosecute the abuser, so that the child almost had to be beaten black and blue before any legal action could be taken. The 1912 Act did not include preventive measures. Not until 1965 was a new law adopted, which also addressed prevention. The Act of April 8th, 1965 concerning youth protection provided for a whole range of preventive measures to reduce the number of dangers to which minors (younger than 18) could be exposed. Central to the Act was the notion of “child in danger”, defined as: “Minors whose health, safety or morality are in danger, because of the environment in which they are brought up, or because of their occupations, or when the circumstances in which they are brought up are made dangerous by the behaviour of their carers.” Before 1980, two authorities, each having a specific role, dealt with youth protection: namely local Committees, offering “social protection” and the Juvenile Courts guaranteeing “legal protection”. The Committees could be asked to intervene when the child was in danger. However, they did not possess any legal power and could only intervene when help was refused by parents or carers. The Committees had to
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inform the Attorney about threats to children of physical health or the morality. They were also expected to co-operate with the Attorney if the minor was “in danger”. After 1980, Belgium was divided into 3 regions: Flanders, Wallonia and Brussels. As a result, separate French and Flemish Youth Protection Committees were established for the two main linguistic populations. Critical reflection on the 1963 Act led to changes in both areas. During the 1980s, the Flemish Government took legislative initiatives, of which the decree of 27 the June 1985 is the most powerful, co-ordinated in a later decree in 1990 (Moniteur Belge, 1990). The Committees are now called “Committees for Special Youth Care” and have to work on a voluntary basis with a clear separation from the Juvenile Court. Children have to be heard and must be kept in their family whenever possible. However, a Mediation Commission was established to resolve conflicts between families and carers or among carers and to reduce interventions by the Juvenile Judge (Decock, 1991). In Wallonia the evolution was slightly different and was more centred around the UN Convention on the Rights of the child. The Committees in Wallonia, called “Services for Help to Youngsters” are comparable to the Flemish Committees, but they work more closely with the Juvenile Court. Their director is also the contact-person with the Juvenile Court. When families disagree with his decision for help (e.g. placement of a sexually abused child), he is obliged to report the case to Court. Still the director can take measures to change the Court decision, but it has to be on the same level as the decision taken by Court (e.g. if the Court decides the child has to be placed in an institution, the director can propose a foster family, but he cannot decide that the child can remain at home). He always has to inform the Court (Belgisch Staatsbald 1991 – Decret de l’Aide à la Jeunesse, 4 mars 1991). Since March 1988 the French Community has had a Mediation Service, which consists of just one person who has to safeguard the rights of the children and defend them in Court. (Boermans et Al, 1988; Eliaerts et Al, 1990). On November 1st 1991 two Children’s Rights Delegates were nominated for the defence of children, one for the French Community, one for the Flemish one (Lelièvre, 1993). The Juvenile Courts and the Juvenile Courts of Appeal are responsible for the legal protection of youth, and can take the necessary protective legal measures. Unlike under the 1912 Act, these measures are not necessarily punitive. In Belgium, the Juvenile Courts have a remit in three types of situation: Criminal offences The Juvenile Judge can take measures toward minors (
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