Fragile Families:Handle with Care

Emeritus Professor Dorothy Scott

Inquiries and...reform?The Protecting Victoria’s Vulnerable Children Inquiry (2012) is the most recent in a long line. Such inquiries do not necessarily lead to reform. Some do more harm, especially those with narrow terms of reference and undertaken in reaction to a highly politicised child protection tragedy. This Inquiry was not hindered by these factors. Time will tell whether it leads to action which will protect Victoria’s vulnerable children.

The knowledge gap

“Maltreatment is one of the biggest paediatric public-health challenges, yet any research activity is dwarfed by work on more established childhood ills.”

The Lancet Editorial 2003, p. 443

Key Foci of Recommendations1. Prevention2. Early Intervention3. Statutory child protection services4. Aboriginal children and young people5. The law and the courts6. Workforce Development7. System governance

How might we take the first step?

PreventionChild abuse and neglect cannot be solved solely by services. It requires population-based measures to tackle the key social determinants, including reducing risk factors such as parental alcohol misuse, and strengthening protective factors such as parent-child attachment and social support. Social marketing targeting harsh physical discipline, family violence and supervisory neglect is also worth trying and evaluating.

Parental Alcohol Misuse

• 13.2% of children in Australia live with at least one adult who regularly binge drinks (Dawe, 2006), and is the single largest contributing factor to children coming into out-of-home care.

• Effective population based strategies include volumetric taxing, restricted advertising, licensing reform, and social marketing to change social norms

Parent-Child Attachment• In utero – using ultrasound as an opportunity

to individualise the foetus• avoiding threats to ante-natal attachment• Promotion of breastfeeding• Paid parental leave• Reducing separations in first year of life• Evidence-informed “clinical” interventions with

vulnerable parent-infant dyads offered from universal service platforms

Social Support

• first time parent groups via maternal and child health and playgroups

• tailored groups for young mothers, cultural/linguistic groups, women who have post-natal depression

• facilitated playgroups• individualised befriending programs

MCH related recommendations“The increased investment in MCH and Enhanced MCH should focus on: 1.Enhanced support to families whose unborn babies are assessed as vulnerable to abuse or neglect, especially as a result of pre-birth reports to child protection.2.A more intensive program of outreach to families of vulnerable children who do not attend MCH checks, particularly in the first 12 months of life.”

Why do we need reform?

1. The prevalence and long term effects of child abuse are so serious (The Lancet 2009 Special Issue).

2. Demand has outstripped the capacity of child protection systems to respond, placing the most vulnerable children in jeopardy.

3. The current “cure” of removing children is likely to be harming many children (Doyle, 2007; Rubin et al 2007).

Australian prevalence estimates

• Child physical abuse: 5-10% of adults • Penetrative child sexual abuse: 4-8% of males

and 7-12% of females• Witnessing domestic violence: 12-23%

(Price-Robertson, Bromfield & Vassallo, 2010)

Long-term effects

• Impairment of early brain development through neglect and witnessing violence

• Higher incidence of adult health and mental health problems

• Higher incidence of adolescent and adult substance misuse and offences

• Greater risk of inter-generational child abuse and neglect

Demand greatly outstrips capacity

Based on current reporting rates, one in five Victorian children will be notified to statutory child protection services by the age of 18. A small minority of these are “substantiated”, and an even smaller proportion proceed to statutory intervention. No child protection system can cope with such demand pressures. It increases the likelihood that children at greatest risk will receive inadequate assessment and protection.

Removal carries long-term risksA data linkage study of 45,000 Illinois child protection cases compared children at similar risk level where some were placed in foster care and others remained at home. School aged children on the margin of placement who remained at home had lower adult arrest rates, lower teen pregnancy rates and better employment than those placed in foster care. Doyle, National Bureau of Economic Research, 2007

Parental characteristics of children in out-of-home care, 2007

Parental substance abuse 69.4%Domestic Violence 65.2%Parental mental health problems 62.6%

Delfabbro, Kettler, McCormick & Fernandez (2012), The nature and predictors of reunification in Australian out-of-home care, AIFS Conference, Melbourne.

Single input services for families with multiple and complex needs???

We have a service system largely organised around single input services based on categorical funding. Families with multiple and complex needs often end up involved with a large number of organisations and in a revolving door of referrals and fragmented care. Engagement of parents remains a major challenge, and relationship-based practice is greatly diminished.

The challenge…

“The challenge of ending child abuse is the challenge of breaking the link between adults’ problems and children’s pain.”

(UNICEF, A League Table of Child Maltreatment Deaths in Rich Nations, 2008)

A wider role for adult services“The Government should enhance its capacity to identify and respond to vulnerable children and young people by providing funding to support specialist adult services to develop family-sensitive practices, commencing with an audit of practices of adult specialist services that identify and respond to the needs of any children of parents being treated, prioritising drug and alcohol services.” Recommendation 15.Cummins,P.,Scott, D. & Scales, B. (2012) Report of the Protecting Victoria’s Vulnerable Children Inquiry

And MCH services?

Have we enabled our MCH workforce to acquire the necessary competencies in parenting in the context of alcohol and other drugs, mental health, family violence and intellectual disability? Overall, I would say that MCH has made great gains in relation to parental mental health and family violence, but less so in relation to alcohol and other drugs and intellectual disability.

What about collaboration?

If we were to do an audit of the way in which services work together to address the adult problems linked to children’s pain, what might we find? While MCH is now much better linked with a range of child and family services, there is a long way to go generally in children’s services and adult specialist services working effectively together.

Families at risk of violence

Disability

Correctional servicesHomelessness services

Drug and alcohol services

Mental HealthIServices Children in

need of placement

Child Protection Intervention

Universal Prevention for all Children/Families

Targeted Prevention and Intervention for Vulnerable Families

Moving from “it’s not my concern” to “it’s part and parcel of my job”

1. ‘core role only’ (‘it’s not my concern’)2. ‘core role plus assessment of ‘other needs’, leading to

referral’ (‘it’s a concern but someone else’s job – refer on’)

3. ‘other needs incidental but unavoidable’ (‘not my core role but I have to do it’)

4. ‘other needs’ intrinsic part of core role (‘it’s part and parcel of my job’)

Policy Context

Organisational Setting

Service Providers

Three levels of service reform

The triangle of values, knowledge and skills

Values for working with vulnerable families: ERGO

EmpathyRespect

GenuinenessOptimism

What we know about ‘the therapeutic relationship’

Client factors andenvironmental factors(eg. social support)

Qualities of thetherapeuticrelationship

Hope and expectancyof positive outcome

Specific interventionof technique

From The Handbook of Psychology Integration by

M.J. Lambert, 1992, P97.

40%

30%

15%

15%

Relationship-based Practice

In relationship-based practice with vulnerable families, we are the instrument of our own work. How do we care for and fine tune this instrument so we are able to convey the empathy, respect, genuineness and optimism required? How do we share our practice wisdom? What sustains us in our work with families?

…a vocationwhich sustains usin working withvulnerable families

ReferencesDawe, S. et al (2006) Drug Use in the Family: impacts and implications for children. Australian National Council

on Drugs

Delfabbro, P., Kettler, L. McCormick, & Fernandez, E. (2012), The nature and predictors of reunification in

Australian out-of-home care, AIFS Conference, Melbourne.

Doyle, (2007) “Child Protection and Child Outcomes: Measuring the Effects of Foster Care” American Economic

Review, 97(5). December : 1583-1610.

Rubin, D., O’Reilly, A., Luan, X., & Localio, R. (2007) The impact of placement instability on behavioral well-being

for children in foster care, Pediatrics, 119: 336-344.

O’Donnell, M., Scott, D. & Stanley, F. (2008) Child abuse and neglect – is it time for a public health approach?

Aust & NZ Journal of Public Health, 32,4,325-330

Price-Robertson, R., Bromfield ,L.& Vassallo , S. (2010) What is the prevalence of child abuse and neglect in

Australia? A review of the evidence. AIFS conference, Melbourne. www.aifs.gov.auScott, D, (1992) Reaching vulnerable populations: framework for primary service provision, American Journal of

Orthopsychiatry, 62,332-341

Scott, D. (2009) Think Child, Think Family, Family Matters, 81:37-42.

Emeritus Professor Dorothy Scott Australian Centre for Child Protection

University of South Australia dorothy.scott@unisa.edu.au

www.unisa.edu.au/childprotection