the impacts of accessible service delivery on front-line helping relationships in child welfare

The impacts of accessible service delivery on front-linehelping relationships in child welfarecfs_840 1..11

Gary Cameron*, Ian DeGeer**, Lirondel Hazineh†, Karen Frensch‡, Trudy Smit Quosai§ andNancy Freymond¶*Professor and Lyle S. Hallman Chair in Child and Family Welfare, and †Research Coordinator, Transforming

Front-Line Practice Project, and ‡Manager, Partnerships for Children and Families Project and §Partnerships for

Children and Families Project, and ¶Assistant Professor, and **PhD Candidate, Faculty of Social Work, Wilfrid Laurier

University, Kitchener, Ontario, Canada

ABSTRACT

This paper presents the results of a study comparing the impacts onhelping relationships of locating front-line child protection serviceproviders in central locations or in accessible school and neighbour-hood service delivery sites. Creating easier access to front-line childprotection service providers, fostering more positive community per-ceptions of child welfare services, improving client and service pro-vider satisfaction with helping relationships and services, andincreasing families’ willingness to ask for help were core objectives atthe accessible sites. Using a quasi-experimental outcome design, filereviews and qualitative interviews with service providers and parents,this study presents evidence that accessible sites had substantialsuccess in achieving these objectives when compared with centralservice delivery locations.

Correspondence:Gary Cameron,Faculty of Social Work,Wilfrid Laurier University,120 Duke Street W.,Kitchener, Ontario,Canada N2H 3W8E-mail: [email protected]

Keywords: accessible services, childprotection, child welfare, helpingrelationships, satisfaction

Accepted for publication: January2012

INTRODUCTION

A persistent challenge for child protection modelsinternationally has been developing meaningfulhelping relationships with families. In many settings,children and parents are often fearful and resistant toinvolvement with child protection agencies. Serviceproviders are heavily constrained by competingdemands on their time. Yet some argue that creatingmore positive helping relationships is central toimproving outcomes in child welfare (Trotter 2002;Lee & Ayón 2004). Others suggest that it is feasible toincrease the proportion of positive child welfare

helping relationships, despite existing child protectionsystem constraints (Ribner & Knei-Paz 2002; Maiteret al. 2006).

This paper presents selected findings from abroader investigation that compares the impacts onhelping relationships of locating front-line child pro-tection service providers in central and accessibleservice delivery sites. Accessible service providers inthis study were located in local schools or neighbour-hood centres geographically close to their clientele.Central service providers were located in child welfareagency premises not physically close to most of theirclientele. A main goal of the accessible communityand school service delivery settings was to createbetter access to front-line child protection service forfamilies. Additionally, the intent was to improve theperception of child welfare services in the communi-ties served and to reduce the stigma and fear of serviceinvolvement. The hope was that families would bemore willing to ask for help.

This investigation is part of the Transforming Front-LinePractice Project research funded by the Ontario Ministry forChildren and Youth. More information about this pro-gramme of research and its products is available at http://www.wlu.ca/pcfproject.

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doi:10.1111/j.1365-2206.2012.00840.x

1 Child and Family Social Work 2012 © 2012 Blackwell Publishing Ltd

Research findings from the full research programmethat are reported elsewhere showed that these acces-sible sites also wanted to expand service partnershipswith community associations and local service orga-nizations (Cameron et al. 2010). Also reported else-where is discussion of the accessible sites’ anticipationthat more satisfactory service delivery experiencesmight reduce turnover in front-line child protectionjobs (Cameron et al. 2011).

LITERATURE REVIEW

All of the central and accessible child protection sitesin the research study operated within the general flex-ible response framework recently initiated in Ontario,Canada. Studies of flexible or differential responsechild protection demonstration projects suggest thatmore families receive assistance, there are more coop-erative helping relationships, and families are moresatisfied with service involvements (Siegel & Loman2000; Differential Response Sub-Committee ofOntario Children’s Aid Society Directors of Service2004; Schene 2006). Additionally, some of these flex-ible response projects have emphasized child protec-tion service delivery settings that are familiar andcomfortable for the families, similar to the accessiblesites in this research (Taylor et al. 2001; Children’sBureau, Office on Child Abuse and Neglect 2010).

However, most of the available information aboutcommunity-based or school-based child protectionservice delivery focuses on why these settings shouldimprove services. Suggested reasons include lowerperceived stigma in accessing services and sharedcommunity responsibility for the welfare of childrenand families (Schene 2006). Onyskiw et al. (1999)found that, compared with traditional service delivery,clients involved with community-based child protec-tion services reported that services were more acces-sible and responsive, they felt less stigmatized, andthey had fewer transportation challenges.

Innovations in community-based child protectionhave included partnering with school boards to locatechild protection service providers in schools. In onestudy, parents, teachers and child protection serviceproviders all believed that locating child protectionservice providers in the school contributed to a betterunderstanding of children’s behaviours. Students aswell as parents and teachers felt there was betteraccess to child protection service providers andreduced feelings of fear and stigma in using theseservices (Taylor et al. 2001).

Recently, in Ontario, Canada, there have beeninvestments in community service hubs in low-incomeneighbourhoods, some of which are located in schools(Ontario Ministry of Finance 2009). The literatureabout full-service schools also explores the benefits ofcommunity and service partnerships. However, thereis little discussion of the challenges or the conse-quences of locating front-line child protection serviceproviders within these community hubs or at full-service schools (Dryfoos & Quinn 2005; Quinn 2005;Prakash et al. 2010). Overall, our review revealed verylittle research about how either community-based orschool-based child protection service delivery affectsservice involvement experiences or outcomes for chil-dren or families or service providers.

Freymond & Cameron (2006) portray an emergingconsensus about the central importance of buildingpositive helping relationships in the major childwelfare paradigms in western countries. In addition,there is ample evidence that cooperative relationshipswith child protection service providers in NorthAmerica are valued by children and parents(Chapman et al. 2003; Fine & Mandell 2003; Lee &Ayón 2004; Altman 2008; Gockel et al. 2008; Kempet al. 2009; Cameron et al. 2010). Other programmesof research have indicated that many child protectionservice providers as well as parents, with some cautionon both sides, were open to more cooperative helpingrelationships (Frensch & Cameron 2003; de Boer &Coady 2007).

Research in counselling and psychotherapy indi-cates that the quality of helping relationships oftenhas important impacts on intervention outcomes(Horvath 2001).There is also evidence to suggest thatsimilar helping relationship characteristics are impor-tant in child welfare (Shulman 1978; Dore & Alex-ander 1996; Drake 1996; Holland 2000; Littell 2001;Lee & Ayón 2004; Leigh & Miller 2004; Yatchmenoff2005). On the other hand, when the focus is on theinvestigatory and enforcement aspects of the childprotection mandate, and the everyday work demandson service providers are high, it is easy to question thefeasibility and the centrality of good helping relation-ships in child protection work (de Boer & Coady2007).

METHODS

This study included six accessible (three schools andthree neighbourhoods) and five central child protec-tion service delivery sites at six child welfare agen-cies in Ontario, Canada. A full description of the

Impacts of accessible service delivery G Cameron et al.


procedures for this multiple method investigation anddetailed descriptions of the individual research sitescan be found at (http://www.wlu.ca/pcfproject). Theresearch methods described in this paper providedinformation on parent and front-line child protectionservice provider helping relationships.

Data collection

The study’s outcome design included gathering datafrom parents at case opening and at follow-up,approximately 10–12 months later. In addition,selected system indicators (e.g. out-of-home place-ments, court involvements, etc.) were gathered fromfamily files at the child welfare agency. Semi-structured qualitative interviews with parents wereconducted about their service involvement experi-ences. Finally, semi-structured individual and groupinterviews were carried out with front-line child pro-tection service providers and selected supervisorsabout their perceptions of service delivery. The dataon helping relationships came from the followingsources:

• 261 parents completed a set of standardizedoutcome measures to assess parent, child and familyfunctioning at the time their case was opened toongoing services.

• 188 parents completed the same set of measuresoccurring approximately 10 months later.

• 73 parents participated in a semi-structured quali-tative interview about their service experiences andsatisfaction with services. This sample was a ran-domly selected subset of the larger sample at eachsite.

• 201 agency files were reviewed to gather data onselected system indicators including court applica-tion supervision orders and child placements.

• 18 focus groups involving approximately 150 front-line child protection service providers were con-ducted about their perceptions of service delivery.

• 17 individual qualitative interviews were completedwith child welfare supervisors and adminis-trators about their perceptions of front-line servicedelivery.Parents who received ongoing child protection ser-

vices from either the accessible or central sites duringthe recruitment year of 2007 were invited to partici-pate in the study. All participants gave their writteninformed consent. All parents received $25 each timethey participated in the research. Parents had toconsent for researchers to view their child welfareagency file. All service providers and supervisors/

administrators participated based on their writteninformed consent. These research procedures wereapproved by the research ethics review committee atWilfrid Laurier University.

Data analysis

Individual qualitative interviews were recorded andtranscribed. These transcripts were analysed for dif-ferential patterns among service delivery models usingthe NVivo software program (Richards 2000). In thequalitative analyses, before a pattern was consideredto represent a difference between accessible andcentral sites, two conditions had to be satisfied. First,the pattern had to be substantially more prevalent ininterviews representing a particular service deliveryapproach. For example, only patterns that clearlyexisted at accessible sites but not at the central sites,and vice versa, are reported as a difference. Second,when an accessible and a central site were hosted bythe same agency (five of the six agencies), patternssuggesting differences also had to be evident at thesetwo sites. These conditions ensured that the patternsidentified were robust and represented central andaccessible service delivery site rather than agency dif-ferences. Finally, in examining qualitative data, carewas taken to clarify whether the patterns were sharedacross all or some of the sites representing particularservice delivery approaches.

Statistical analyses of quantitative data focused onidentifying similarities and statistically significant dif-ferences between accessible and central service deliv-ery sites on a variety of indicators. Descriptivestatistics were computed for central and accessiblesites. In addition, tests of significant differencesbetween accessible and central sites were conducted.The chi-square statistic was used when data were cat-egorical; the Mann–Whitney test was used for ordinaldata. Finally, the statistical significance of change overtime on various indicators at both types of sites wascalculated. The Wilcoxon signed-rank test was usedfor non-parametric repeated measures data. Differ-ences were considered statistically significant forP-values of 0.05 or smaller.

Site comparisons

At the time of the study, most of the child protectionservices at these agencies were delivered through cen-trally located service teams. Accessible sites wereintended to serve particular geographic areas as werethe central service delivery sites at these agencies.This



precluded the possibility of assigning families to dif-ferent service delivery approaches in an experimentalstudy design to increase confidence in the credibilityof any cross-programme differences detected.

Within Ontario’s flexible response framework, allcentral and accessible sites in this study followed thesame child protection regulatory guidelines inresponding to calls and determining eligibility forservice. Each was governed by the same service deliv-ery timelines and case documentation procedures.Each received financial resources based upon thesame state funding formula. Front-line child protec-tion caseloads were similar at central and accessiblesites. Accessible site service delivery was not enhancedby the provision of more resources or by lower serviceprovider workloads.

However, there were two general areas of differencebetween the accessible and central sites in this study.First, within existing work constraints, accessible siteswere developed with the explicit intention of trying toimprove relations with families and communities.They stressed being welcoming and available to fami-lies as everyday priorities. Second, accessible servicedelivery sites were chosen in order to be geographi-cally close to the children and families that theyserviced. Usually, accessible sites were located in com-munities or schools where the historical demand forchild protection services was high.

There were very few accessible child protectionservice delivery sites in existence in south-westernOntario at the time of the study. This study includedall available accessible sites. A comparison central siteserving a similar catchment area to each accessibleprogramme was selected at each host agency.

The child protection service provider ratings of riskof child maltreatment at case opening showed no dif-ference between accessible and central sites. Informa-tion from agency files included a standard overall riskrating. The most frequently occurring overall riskrating at the point of transfer to ongoing service was‘moderate’ (46% and 49%), followed by ‘high’ (42%and 42%) risk ratings for both accessible and centralprogramme clients, respectively. The most frequentlycited reason for continued agency involvement was‘caregiver capacity’ – 40.7% for central sites and42.4% for accessible sites. ‘Caregiver with a problem’was the most frequently cited nature of the problemneeding intervention for central-site parents (30.8%)and accessible-site parents (30.3%).

The average age of parents at central sites was34.22 years and 35.44 years for parents at accessiblesites. More than half of all parents were not currently

living with a spouse or partner: 58.4% of central-siteparents and 51.9% of accessible-site parents.Approximately 38% of parents at central sites and30% of those at accessible sites had not completedhigh school.

A larger proportion of parents at central sites hadlived in their current home for less than 1 year atcase opening (50.4% vs. 32.1%) (X2 [3, n = 196] =7.846, P = 0.049). Families at accessible sitesappeared to have more financial resources than thoseat central sites with a smaller proportion with lessthan $20 000 annual household income (33.4% vs.45.4%) and a larger proportion with householdincomes greater than $40 000 (38.4% vs. 22.7%).The Mann–Whitney test showed that this was a sta-tistically significant difference (U = 3566.5, Z =-2.005, P = 0.045, n = 188).

Significantly more accessible-site parents (24.7%)than central-site parents (13.2%) perceived that theirhome or building was not safe from crime (c2 [1, n =195] = 4.277, P = 0.039). Almost 26% of parents ataccessible sites reported that there were not enoughsafe places for children to play in their neighbour-hoods compared with 14% of central-site parents(c2 [1, n = 195] = 4.355, P = 0.037). These findingsmight reflect decisions to place accessible sites in com-munities where child welfare involvement had beenhigh. However, when all of the above differencesbetween the accessible and central site samples werecontrolled for statistically in the analyses, each of thedifferences in helping relationships between centraland accessible sites presented in this paper remainedstatistically significant.

Approximately 72% of both parent groups whoresponded to the survey at case opening alsoresponded at follow-up.There were no notable differ-ences between the characteristics of parents whoresponded at follow-up and those who could not befound.

There were some notable differences in the profilesof front-line service providers at the accessible andcentral sites that could have influenced client serviceinvolvement experiences in particular (e.g. a largerproportion of front-line child protection service pro-viders at the accessible sites were older and had socialwork degrees). Service providers also had some dis-cretion in applying to work at central and accessiblesettings. Unfortunately, because this informationcame from a separate employment survey, there wasno possibility of linking it statistically to the data fromparent interviews or agency files to control for thesedifferences.



Strengths and limitations

A limitation of this study is its focus on a limitednumber of child welfare settings in Ontario and therelatively small size of the accessible programmesincluded in this research. We cannot draw confidentconclusions about system-wide applications of suchapproaches nor about their applicability in very differ-ent contexts.

In addition, the study design did not strongly ruleagainst explanations for the observed differences otherthan the investigated central or accessible servicedelivery approaches. For example, differences infront-line child protection staffing may have contrib-uted to these differences.

On the other hand, the differences found betweenaccessible and central service delivery sites were whatwere predicted from their service delivery intentionsand their physical settings. It is not clear how otherobserved differences, such as staffing, could have ledto the particular configurations of outcomes describedin this study.

The robustness of this study’s findings wasstrengthened by the strong convergence of percep-tions and assessments between parents and serviceproviders as well as clear agreements across the dif-ferent types of data (standard measures, file informa-tion and qualitative interviews) gathered in thisresearch. From our perspective, it is probable thatthese results paint a credible portrait of differencesthat existed at these accessible and central servicedelivery settings at the time of the study. Additionalresearch in different settings is needed to confirm thefinding presented in this paper and to confirm thatthe observed differences can confidently be attributedto accessible and central service delivery settingcharacteristics.

RESULTS

Geographic accessibility: serviceproviders’ perceptions

The geographic proximity of child protection front-line service providers to clients was a central consid-eration in creating community and school sites. Forthe central sites, such proximity was not a priority.Central service settings served much larger geo-graphic areas. The accessible service sites servedsmall geographic areas. Service providers at thecentral sites either did not talk much about theirgeographic accessibility to clients or, when they did,

indicated that their central location was not easilyaccessible to families:

Where we were before, we were in a residential area and then

I think there’s something symbolic in a sense that we’re

moving now away from the residential area, a huge building

and it’s almost like we are further out of reach of clients and

their connection with us.You know what I mean? [Central Site

1: Service provider]

Service providers at all of the accessible sites talkeda good deal about the benefits of service providersbeing physically close to families:

I know, I’m just thrilled that I have clients whose home I can

walk to and, you know . . . to teach them what is available in

their community to help them so that we – you know, it’ll

reduce our concerns about the children and it’s just a short

walk over here and I can take them around and introduce

them to all the programs, they can leave with a stack of

information and choices about, you know, child care programs

and parent/child programs and all sort of stuff that’s just a

walk away, and that’s a huge thing, I mean, I just feel like I’ve

made a big difference in a family’s life if I’ve got them con-

nected here. [Accessible Site 1: Service provider]

Relationship building with families was a centralemphasis among service providers at accessible com-munity and school sites. Immersion in the communityor school was described as a primary venue for build-ing rapport with families:

So when I think back that this is somebody who came from a

very adversarial relationship with our agency [at another

setting], but over years of seeing us, getting to know we’re real

people and getting to know us, started to realize how we work

and why and what it’s about, to the point where they’re

seeking us out now and to let us know the significant events in

their life. [Accessible Site 2: Supervisor]

While front-line service providers at the central sitesclearly valued good relationships with families, andtalked about how they were able to establish them,they also were much more likely to describe the bar-riers their physical settings presented to establishingsuch connections.

Frequency of informal contacts: serviceproviders’ perceptions

A major difference between everyday front-line childprotection work at central and accessible sites wasthe amount of unscheduled and informal contactsbetween service providers and clientele. Centralservice providers said that clients very seldomdropped by to see them outside of scheduled inter-views.They also were unlikely to run into parents and



children in the community. Working in a ‘fishbowl’environment was unavoidable at the accessible sites.Parents and children often came into the office hopingto talk with service providers. Meeting parents andchildren on their caseloads in communities andschools was a common experience:

It’s nice when you run into clients that maybe you’re not

working with, or that you are working with, and you know,

they just stop and say ‘hello’.They’re not intimidated to come

up to you in public and speak with you; that it’s more than just

a relationship with an authoritative figure. (Accessible Site 1:

Service provider)

Like they’re there, they pop by, their little eyes are like glued

to my window in my door right so I think they would have an

easier time because they know me, I’m like, you know, some-

body they see you know every day, to knock on the door and

say hi, you know, maybe they’d come in themselves you know

and they wouldn’t have had that opportunity if there hadn’t

have been somebody there. (Accessible Site 3: Service

provider)

Both parents and service providers at the accessiblesites believed that these types of informal contactsoften improved their relationships. Service providersalso believed that these informal contacts improvedthe information available to them about families andhelped them to keep children safer. Service providersalso claimed that these contacts sometimes enabledthem to respond more quickly to families and toresolve more situations informally.

Service providers who were co-located at the twoneighbourhood sites with a variety of other servicesand community associations talked about how thisenhanced their relationship opportunities with clients.This was particularly evident at the following commu-nity site:

SP4: It’s the dropping in at the breakfast club on your way in

to see if any of your kids are there and to say ‘hi’, it’s taking a

few minutes on the exit to the after school clubs or getting to

know the youth service provider or stuff like that that doesn’t,

I don’t think, take that much away from what our workload is

and I think the beauty of this is that this is conducive to that.

If this is the type of work that you like to do, that’s part of who

you are, then you have that option to do it.

. . .

SP6: . . . New Year’s eve day I was working and saw a client

that morning [at the centre]. A new born baby like a week old

and the baby wasn’t nursing well. Mom’s milk hadn’t come in

or so she thought. Anyhow, I was worried you know, very

vulnerable baby. So I come back here to the office and I just

you know, zipped down to the next door, to Public Health.

They sent a public health nurse over right away with a scale

weighed the baby, did some nursing instruction. About an

hour later the public health nurse comes to my office and says

here’s a prescription for Mom. I just went to the community

health clinic, “here’s a prescription for Mom can you fill it and

get it to her.” (Accessible Site 2: Service providers)

Community image of child protection: serviceproviders’ perceptions

Becoming involved with a child protection agency cantrigger parents’ fears of being judged negatively and/orlosing their children. Service providers and theirsupervisors at most of the central sites talked exten-sively about the perceived stigma of being involvedwith their agency:

The bigger community? Well, the reality is that we’re not

viewed in a positive light. We’re not seen as a helping profes-

sion, we’re seen as the agency that goes out there and takes

people’s children away by a lot of – not only our formal

community partners, but by the community as a whole.That’s

an ongoing struggle that my staff have to deal with on a regular

basis. [Central Site 1: Supervisor]

While the stigma and fear of being involved withchild protection services was recognized, there wasdefinitely less discussion about negative communityimages among service providers and supervisors at theaccessible sites:

People get to know, over time, that if they’re treated respect-

fully that they get to hear that, right, from other people. I

mean, I even hear them here when you’ll have somebody

talking about something, ‘well, they’re just going to do this’

and you’ll hear somebody in the community say, ‘no, no, no, I

know that – that’s not what’s going to happen, it’ll only

happen because of this’, with some of our people and I’ve

heard that out here in the community – almost defending what

we do and how we do it. [Accessible Site 2: Supervisor]

Our broader programme of research found thatparents involved with child protective services withinparticular neighbourhoods frequently shared theirexperiences with each other and other families in theneighbourhood. If these parents were more satisfiedwith their involvements with child protection servicessites, this might begin to shape broader communityperceptions of child welfare and people’s willingnessto ask for help when difficulties arise.

Service provider accessibility: parents’ perceptions

Based on the qualitative interviews, more parentsfrom accessible sites felt that their service providerswere more easily available to them than did parents atthe central sites. It was not uncommon for parents ataccessible sites to indicate that they knew when theirservice provider was at the office and likely to be



available. Table 1 shows that, in the qualitative inter-views, accessible-site parents were more likely to talkabout ease of access to service providers by phone anddescribed higher levels of phone and personal contactswith their service providers.

On the other hand, analysis of the data from parentsurveys showed that respondents from both parentgroups had reasonable access by phone to serviceproviders. At case opening, more than 80% of parentsfrom both programme types reported being able totalk with their service provider either the ‘same day’ orwithin the ‘same week’ that they tried to get in touchwith them.

Overall, these findings suggest that parents at theaccessible sites felt that they had easier access to theirchild protection service providers. Parents involvedwith the accessible sites were more likely to knowwhen their service providers were in the office andboth parents and children at the accessible sites weremuch more likely to drop in unannounced. Yet, bothparent groups reported being able to get in touch withtheir child protection service provider within a weekor less if they wanted to do so. Nonetheless, as shownbelow, accessible-site parents were more willingand comfortable getting in touch with their serviceproviders.

Communication, knowledge and trust:parents’ perspectives

In the qualitative interviews, approximately twice theproportion of parents at the accessible sites describedhelping relationships with their child protectionservice providers that they appreciated. In these inter-views, the three dimensions of communication, knowl-edge and trust characterized appreciated helpingrelationships from the parents’ perspectives.

Table 2 provides a general comparison between thecentral and accessible sites on these dimensions. Inthe qualitative interviews, accessible-site parents weremore likely to describe good communications andtrusting relationships with their service providers.They also thought that their service providers knewmore about how to help their families. A caution ininterpreting these qualitative patterns is that the inter-viewers did not probe extensively for informationabout these specific dimensions. It may be that theserelationship characteristics were more common atboth central and accessible service delivery sites thanthis qualitative summary indicates.

These qualitative findings about parents’ percep-tions of service provider knowledge were stronglyechoed by responses to the parent survey. Notably, at

Table 1 Parents’ perceptions of level and ease of contact with service providers

Dimension Central settings (n = 30) Accessible settings (n = 43)

Access by phone More parents reported difficulties reachingservice providers by phone.

Most service providers described as easy toreach and likely to call back quickly. Parentsalso identified multiple methods ofcontacting their service providers (e.g.watching for their cars and walking over tothe office).

Frequency of contact Slightly less frequent contacts/visits describedoverall.

Slightly more frequent contact/visits describedoverall. More examples of service providerswho came over immediately when called.

Table 2 Comparison of qualities that parents appreciated in helping relationships

Central settings (n = 30) Accessible settings (n = 43)

Communication Fewer parents described comfortablecommunication between themselves andtheir service providers.

More parents described service providers whowere easy to talk to, were good listeners andwere ‘like a friend’.

Knowledge About 17% of parents explicitly described theirservice provider as knowledgeable about howto help them.

About 33% of parents explicitly described theirservice provider as knowledgeable about howto help them.

Trust Only one parent talked about feeling that theycould trust in a helping relationship.

Feeling trust in helping relationships wasdescribed by about 25% of parents.



accessible sites, there was a significant improvementfrom case opening to 10-month follow-up in the pro-portion of parents who thought that their service pro-vider ‘knew about what was going on in their family’(Wilcoxon signed-rank: Z = -2.685, P = 0.007). Overthe same period, central-site parents’ assessments ofservice provider knowledge did not change signifi-cantly. At follow-up, 52.6% of parents at accessiblesites compared with 32.5% at the central settingsdescribed their service provider as ‘definitely knowl-edgeable’ about what was going on in their homes.The Mann–Whitney test showed that this differenceapproached statistical significance (U = 1879.5, Z =-1.838, P = 0.066, n = 137). Similarly, at follow-up,more parents at accessible settings (38.6%) thancentral settings (23.6%) reported that their serviceprovider ‘definitely’ knew how to help their family(U = 1867.5, Z = -1.867, P = 0.062, n = 137). Thisdifference also approached statistical significance.

These findings should not be interpreted as indicat-ing that service providers were objectively moreinformed and knowledgeable about how to help fami-lies at the accessible sites than at the central sites.These assessments were based on parents’ serviceinvolvement experiences. From our perspective, theyare likely a function of parents’ overall satisfactionwith their relationships with child protection serviceproviders. They also could be influenced by the lessintimidating physical settings at the accessible sites,more informal contacts with their service providers aswell as access to more local helping resources.

Satisfaction with child welfare services:parents’ perspectives

Based on the parent survey, more parents at accessiblesettings (75.5%) than central settings (53.8%)believed that being involved with the child welfareagency made things at least somewhat better for theirfamilies (U = 1662.0, Z = -2.607, P = 0.009, n = 135).Over 46% of parents at central agencies said that theirchild welfare agency did not help make things betterin their family ‘at all’ compared with 24.5% of those ataccessible sites.

Table 3 shows that at follow-up, parents at acces-sible sites were more satisfied with child welfare ser-vices than were parents at central sites (U = 1721.0,Z = -2.526, P = 0.012, n = 137). One in three parentsat accessible settings (32%) said that they were ‘verysatisfied’ with their child welfare experiences, whereasless than one-fifth of parents at central agencies (18%)were equally satisfied. Looked at another way, almost Ta

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40% of parents at central sites were ‘very unsatisfied’with their involvement, compared with less than 19%of parents at accessible sites. Moreover, parents’assessments of the benefits of service involvements fortheir families and their overall satisfaction with childwelfare experiences improved notably between caseopening and follow-up at accessible sites. In contrast,these parent assessments at central sites were morenegative on these indicators at follow-up than at caseopening.

Willingness to ask for help in the future:parents’ perspectives

An important indicator of parents’ comfort with theirchild welfare involvements is their willingness to askfor help in the future or to recommend that a friendcontact an agency for support. At the onset of thestudy, there was little difference between settings inparents’ beliefs about their willingness to contact achild welfare agency again. However, at follow-up,Table 3 shows that more parents from accessible sites(61.4%) than parents at central sites (41.3%) would‘definitely’ or ‘probably’ contact the child welfareagency again for help for their own families (U =1739.0, Z = -2.446, P = 0.014, n = 137). Similarly, atfollow-up, a significantly greater proportion of parentsat accessible sites (64.9%) than at central sites(39.2%) said that they ‘definitely’ or ‘probably’ wouldsuggest that a friend contact the child welfare agencyfor help (U = 1717.5, Z = -2.447, P = 0.014, n = 136).

DISCUSSION

In understanding these findings, it is essential to stressthat all of the front-line child protection service pro-viders carried out the same state child protectionmandate. They were required to formally investigatefamily circumstances and remove children fromhomes considered to be unsafe. Indeed, about 24% ofthe cases reviewed at both the central and the acces-sible sites had a child placed outside of the home.Service providers at all sites lamented the inordinateamount of work they had to do and quite a fewthought about leaving their jobs. Most spent 60–70%of their time in front of their computers completingrequired documentation of their work (see theexpanded discussion in [Cameron et al. in press;Cameron et al. 2010]). From our perspective, thereare two implications from this reality. First, the ben-efits to helping relationships noted at the accessiblesites in this research were not achieved under special

or enhanced working conditions. Second, if some ofthese contextual realities could be modified, perhapsthe potential of these accessible approaches would begreater than observed in this study.

The results of this study suggest that if we wantmore cooperative relationships with clientele, it can bedone. They suggest that we do not have to compro-mise the safety of children. Certainly in this study, thesame formal procedures for insuring child safetythrough child protection investigation, risk assess-ments and service delivery regulations were followedat central and accessible sites. The file review showedno reasons for greater concern about protecting chil-dren at accessible sites. Indeed, accessible site serviceproviders believed they could keep kids safer becausethey had better information about how they weredoing.

Both the service philosophy or intentions and thephysical settings for delivering child protective ser-vices matter a lot. Service providers at accessiblesites were able to establish a higher proportion ofcooperative and appreciated helping relationshipswith children and parents. Service providers ataccessible sites were more confident about theircapacity to establish cooperative helping relation-ships with families. Parents at accessible sitesreported many more trusting and helpful relation-ships with service providers. Parents at accessiblesites indicated substantially more willingness to askfor help in the future and to tell a friend to contactthe agency for assistance.

It is possible that placing child protection workersin schools or neighbourhood centres would be fright-ening or stigmatizing for children or parents.However, such reactions were not presented by theparents in this study. Obviously, how child protectionservice providers presented themselves would bequite important. This concern merits additionalexploration.

All of these school and community service deliverysites were modest innovations within Ontario’s childprotection system.These were all relatively small pro-grammes. What would happen if locally accessibleservice delivery of child protective services became thegeneral expectation? What if creating cooperativehelping relationship with many or most familiesbecame a central part of what we were trying toaccomplish? What if co-location and shared responsi-bility for protecting and caring for children with otherservices and community associations became centralto the service delivery model?The central point is thatwe have choices and these choices matter. They are



reflected in our policies as well as in how we strive toengage with children, parents, families and servicepartners.

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the impacts of accessible service delivery on front-line helping relationships in child welfare

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