Title: Protecting Children is Everybodys Business: Investigating the Demand for Service at the Childrens Ai
1Protecting Children is Everybodys Business
Investigating the Demand for Service at the
Childrens Aid Society of London and Middlesex
- Research Team Alan W. Leschied, Paul C.
Whitehead, Dermot Hurley and Debbie Chiodo - The University of Western Ontario, London,
Ontario CANADA - October, 2003
- This research was funded by the United Way of
London Middlesex, The City of London, The
County of Middlesex - and an anonymous donor
2- Perhaps we will always live in a world where
children suffer, - But we can reduce the number of suffering
children. - And if you do not help us in this pursuit my
friend, - Who in this world will help us do this?
- Robert
F. Kennedy
3Goals of Research
- To examine factors that could help account for
the increase in the demand for service at the
Childrens Aid Society of London and Middlesex
4Increases in Ontarios Cases of Abuse and Neglect
(Rivers, Trocme, Goodman Marwah, 2002 )
- Children suspected of abuse or neglect rises by
44 (1993- 1998) - Investigations for neglect increases from 4,400
to 8,900 children (1993-1998)
5Ontarios Admissions to Care (Rivers, Trocme,
Goodman Marwah, 2002 )
- The number of children admitted to care increases
by 51.7 (1996-2001) - Children admitted to care increases from 10,419
to 15,792 children (1996-2001)
6The Number of Children Admitted to Care (London
and Middlesex CAS (1993-2002)
7The Number of Children in Care at Year End
8Research Informed by
- Extensive review of the literature
- other jurisdictions experiencing similar
increases - Identified most frequently cited hypotheses for
increases - clinical reasons explaining referrals to CAS and
admissions to care - Focus groups at the CAS of London and Middlesex
- Expertise of the community advisory committee
- Consultation with leading researchers in child
welfare
9The Focus Groups Told Us
- 1995 is seen as a pivotal year in charting the
increase - No single reason should be isolated as the factor
accounting for the increase - Multicausal factors should include
- policy changes in child welfare
- legislative changes in child welfare
- social, psychological, economic changes impacting
on children and families in London and Middlesex
10The Method
- Random sample of cases opened at London CAS in
1995 and 2001 examined on a broad range of
factors - 1042 out of a possible 2316 cases - 1995 - 450 children (176 in care and 274 not in
care) - 2001 - 592 children (381 in care and 211 not in
care) - Six trained researchers completed the review of
files in the summer of 2002 - Raters trained to understand the Child Protection
Risk Assessment Model
11The Risk Assessment Tool
- Developed as the Risk Assessment Model for Child
Protection in Ontario - Includes 22 areas that describe child welfare
risk related areas - Caregiver Influence (Parental capacity)
- Childs Influence (Vulnerability, health status)
- Family Influence (Violence, social supports)
- Intervention Influence (Motivation, cooperation)
- Abuse and Neglect (history and severity)
12Cumulative Risk Assessment Score
- Risk assessments done by the trained researchers
is based on a cumulative risk assessment score
comprised of a total score of the 22 individual
risk elements - The application of the Risk Assessment Tool
completed by child protection workers does not
include a cumulative risk assessment score - The cumulative risk assessment score was
completed independent of the child protection
worker rating that was included in the case file
13Policy, Clinical and Systemic Issues
- Issues of Policy Relevance
- Changing pattern and source of referrals
- Changing standard of risk in admissions to care
- Estimates of risk by less experienced case
managers - Issues of Clinical Relevance
- Child maltreatment
- Woman abuse
- Parenting capacity
- Maternal depression
- Previous history with CAS
- Issues of Systemic Relevance
- Poverty
14Policy, Clinical and Systemic Issues
- Supplementary Reports
- Developmentally and medically fragile children
- First nations children with the CAS
- Community Feedback
151990 Events that Influenced Ontario Child
Welfare Policy
- Ontario Child Mortality Task Force
- Investigating deaths of children known to CAS
- 16 recommendations to improve Ontario child
welfare system - Child Protection Review
- 87 of CASs were in compliance with MCSS
Standards for investigating child abuse cases - Conformity with MCSS standards for case
management and record keeping was a concern - Child Welfare Accountability Review
- Called for revisions by the Ontario Ministry of
Community and Social Services in the areas of
setting goals and expectations, contracting,
monitoring and follow-up in their relationship
with CAS - Protecting Vulnerable Children
- Recommendations to amend the Child and Family
Services Act (CFSA)
16Bill 6Amendments to the CFSA
- Represented the most substantial change to the
Child and Family Services Act (CFSA) in almost
two decades - The primary goal was to increase protection for
children considered at risk for abuse or neglect
17Bill 6Amendments to the CFSA
- Purpose of the Act
- Grounds for determining whether a child is in
need of protection - Inclusion of past evidence of parenting in child
welfare proceedings - Clarified and expanded the duty to report child
maltreatment - Addressed timelines relating to society wardship
and permanency planning - Improved CAS access to information
- Clarified family access to children in care
- Mandated a regular review of the Act
18Testing Five Hypotheses
- Changing level of risk of children and families
referred to the CAS from 1995 - 2001 - Changing level of risk of children admitted to
care to the CAS from 1995 - 2001 - Change in the length of time children remained in
care - Change in the patterns of the sources of referral
- Risk estimates comparing more and less
experienced child protection workers
19Changing Level of Risk of Children and Families
- With the expanded definition of a child in need
of protection, one would expect lower risk scores
for children and families in 2001 relative to
1995 - The Outcome
- Cumulative risk scores are actually higher in
2001 relative to 1995 - 1995
2001 - Average risk score 25.3
29.4
20Changing Level of Risk of Children Admitted to
Care
- If the threshold for admission to care has been
lowered, risk scores will be lower in 1995
relative to 2001 - The Outcome
- The average cumulative risk score for families is
higher in 2001 relative to 1995 - 1995
2001 - Average risk score 31.5
34.7
21Change in the Length of Time Children Remain in
Care
- Are children remaining in care longer in 2001
relative to 1995? - The Outcome
- Children do not spend greater lengths of time in
care in 2001
22Change in the Patterns of the Sources of
Referral
- Is there a change in referral patterns between
1995 and 2001? - The Outcomes
- Patterns of referrals across the years is
consistent - Source of Referral Percent
- Parent 20.0
- Police 17.9
- Family Associate 17.3
- Childrens Service Provider 14.6
23Change in the Patterns of the Sources of Referral
- Is there a shift in sources of referral for
neglect cases? - The Outcome
- Referrals for neglect proportionally remain the
same across both years - Professionals are more likely in 2001 to be the
source of referral for cases of neglect - Source of Referral 1995
2001 - Professional 51 73
24Risk Estimates Related to Experience of Workers
- Do less experienced case workers rate risks to
children higher than more experienced case
workers? - The Outcome
- Less experienced case workers do not rate risk
higher than more experienced case workers
25Training of Workers
- Mandatory new worker training and supervisory
consultation on all admissions to CAS care has
offset the effects of inexperience of child
protection workers
26Relevant Findings
- The degree of risk of children referred to and
admitted to care is higher in 2001 compared to
1995 - All referral sources are equally increasing their
rate of referrals to the CAS the most likely
sources of referral are parents, children service
professionals and police officers - No one type of child maltreatment is
disproportionately driving the increase of
children in care in 2001 - Inexperienced CAS workers are no more likely to
rate children as higher risk compared to more
experienced workers and neither are they more
likely to recommend that a child be taken into
care
27Study 1
28Child Maltreatment
- Ontario Incidence Study
- Rates of substantiated maltreatment between 1993
and 1998 have doubled. - Exposure to domestic violence nine-fold increase
- Neglect and Physical Abuse Doubled
- Sexual Abuse Decreased by 44
29Frequency of Substantiated Maltreatment
- Major increase in cases of physical abuse
- Three times the rate in 2001 over 1995
- Proportion of cases of sexual abuse, emotional
abuse, and neglect do not differ across years - Reported in percent
30Children in Care
- Significant increase in
- CAS admissions to care of maltreated children in
- 2001 compared to 1995
- (71 vs. 44)
- The proportion of
- substantiated cases of
- neglect, physical, sexual,
- and emotional abuse do
- not differ across years
31Study 2
32Woman Abuse
- Exposure to woman abuse is associated with poor
child outcomes similar to the effects of physical
abuse - Exposure to woman abuse and physical abuse is
associated with higher levels of poor child
outcomes compared to either experience alone
33Woman Abuse
- The Outcomes
- In only two outcomes do physically abused
children differ from children exposed to women
abuse high degree of similarity between
children - Conclusions from children experiencing two forms
of violence (physical and exposure to violence) - children exposed to woman abuse and physically
maltreated - higher rates of ADHD
- higher rates of cumulative child welfare risk
34Woman Abuse Among Caregivers of CAS Children
- Increase of six percent between 1995 and 2001
35Caregivers Experiencing Woman Abuse
-
Abused Non abused -
() () - Major mental disorders 45 37
- Substance abuse 23 12
- Chronic medical condition 20 13
36Families Where Woman Abuse is Present
- More likely to be on social assistance/welfare
(66 vs. 44) - More likely to be unemployed (69 vs. 59)
- More likely to have less reliable and useful
social supports - More likely to have experienced abuse as children
37Study 3
38Rates of Child Poverty
- 1996 census Canada ranks sixth of the worlds
twenty five most industrialized countries - National rate of child poverty - 21.1
- Ontario rate of child poverty - 20.3
- 1996 census Ontarios child poverty rate
increased by 5 relative to 1990 census (largest
provincial increase 390,000 children in Ontario
live in poverty)
39Family and Child Poverty in Canada, Ontario and
London/Middlesex
- Rates of Child Poverty
- Canada 21.1
- Ontario 20.3
- London 18.8
- London and Middlesex 17.1
- Canada and Ontario relates to child poverty
- London and London and Middlesex relates to family
poverty
40Children Age 15 and Under Living in Poverty
- Proportion of London Children Age 15 and Below
- living in Poverty
-
- Total Poor Total
Poor Poverty Rate () - All Cities 2,325,000 693,700
19.1 23.3 29.8 - London 66,200 16,100
20.6 26.6 24.5
41Poverty and CAS Involvement
- Rate of families on social assistance open to CAS
remains consistent - 1995 - 65 2001 - 64
- Evidence that those on social assistance are not
doing as well in 2001 - Families on social assistance seen at the CAS
with children in care - 1995 - 48 2001 - 80
- Single mothers on social assistance with children
seen at the CAS - 1995 - 71 2001 - 83
42Poverty and Neglect
- Children living with single moms in 2001 more
likely to suffer from neglect - Children of families on social assistance in 2001
are more likely to suffer from neglect and
emotional abuse - Increases in rate of single mothers on social
assistance experiencing violence - 1995 - 63 2001 - 84
43Differential Contribution to Child Risk
- Examination of what contributes to cumulative
child risk scores? - Violence
- Poverty
44Study 4
- Maternal Depression and Child Risk
45Increase in Rates of Maternal Depression in
Children Admitted to Care
- Identifies formal diagnosis of depression or
identification of depression as interfering with
parenting capacity - 15 of cases in 1995 had mothers diagnosed with
depression as compared to 29 in 2001
46Child Outcomes Related to Maternal Depression
- Children more likely to
- Be diagnosed with ADHD
- Receive medication for an adjustment disorder
- Have higher cumulative risk scores
- Be suspended from school more often
47Cumulative Risk Score Higher for Child/families
with Depressed Mothers
- Overall risk score
- Presence of maternal depression 33.2
- Absence of maternal depression 28.0
48Study 5
49Tracking Parenting Capacity
- Nico Trocmé of the Bell Center of Excellence in
Child Welfare Research suggests that the Ontario
Risk Assessment (ORAM) tool provides an
acceptable measure for tracking parenting
capacity - Three items from the ORAM refer directly to
parenting - Caregivers expectation of child
- Caregivers acceptance of child
- Family Identity and Interactions
50Parenting Capacity Scores
- All caregivers received a score of parenting
capacity ability based on the three risk
assessment item scores from the ORAM - Impaired parenting capacity scores reflect
- caregivers with unrealistic expectations and
angry conflicts with child - caregivers who disapprove, reject and are
indifferent to child - family interactions are generally negative or
inconsistent
51Parenting Capacity Scores
- Caregivers in 2001 had higher scores on parenting
capacity compared to caregivers in 1995 - Parents are
- more likely to have unrealistic expectations of
their child - emotionally indifferent to their child, and
- family interactions are generally more negative
and hostile. - (higher scores denote poor parenting capacity)
52Impaired Parenting Capacity Results in
- The diagnosis of children with ADHD
- The diagnosis of children with conduct disorder
- The likelihood that a child is or was previously
on medication for an adjustment-related disorder - Children receiving suspensions from school
- Children experiencing chronic truancy
53Impaired Parenting Capacity in Adults is Related
to
- Caregiver diagnosed with major mental illness
- Caregiver diagnosed with depression
54Impaired Parenting Capacity for Families is
Related to
- Homelessness
- Unemployment
- Receipt of social assistance and welfare
- Woman Abuse
55Study 6
- Intergenerational CAS Involvement
56Intergenerational CAS Involvement
- The Question
- What are the long term outcomes for adults who
had previous involvement with CAS?
57Children with Families with Previous CAS Contact
-
- Children Served in the Community
- 1995 2001
- 26 35
-
- Children in Care
- 1995 2001
- 36 42
58Impact of Previous CAS Contact
- Overall risk for children is higher for those
with caregivers with previous CAS contact - And this finding consists primarily of risk
related to parent factors - Caregiver influence (abuse and neglect)
- Caregiver influence / alcohol and drug use
- Caregivers motivation for seeking intervention
- Severity of abuse / neglect
59Caregivers with Previous CAS Contact
- Caregivers previously involved with CAS
- more likely diagnosed with depression
- more likely diagnosed with major mental illness
- involved with woman abuse
- children exposed to woman abuse
- unemployed
- on social assistance
- score higher in the severity of their mental,
emotional and intellectual capacity to care for
children
60Protecting Children is Everybodys Business
61Key Findings
- Violence against children
- 7 out of 10 children were admitted to CAS care in
2001 for reasons of abuse and neglect, up from 4
out of 10 in 1995 - The rate of children admitted to CAS care for
reasons of physical abuse tripled from 1995 to
2001
62Key Findings
- Woman abuse
- Witnessing abuse is as detrimental to a child as
being physically abused - The combination of both witnessing abuse and
being physically abused is more devastating than
either one alone - By 2001, more than half of the mothers of
children with open cases with CAS were victims of
woman abuse - 45 of them suffered from a mental health
disorder - 23 of them had a substance abuse
- 20 experienced a chronic medical condition
63Key Findings
- Poverty
- Almost double the number of children who were
admitted to CAS care in 2001 were living in
poverty as compared to 1995
64Key Findings
- Mental Health
- The number of depressed mothers receiving service
from CAS almost doubled from 1995 to 2001 - The children of depressed mothers are twice as
likely to experience a mental health disorder as
compared to children of non-depressed mothers
65Key Findings
- Impaired Parenting Capacity
- Parents receiving services from CAS have less
effective parenting skills in 2001 as compared to
1995
66Key Findings
- Intergenerational CAS involvement
- 4 out of 10 children admitted to care in 2001 had
a parent who was involved with CAS as a child - The number has grown and continues to grow since
2001
67Protecting Children is Everybodys Business
- We cannot leave it to the child welfare system
alone - (Allen, 2002)
- The problem is too large
- Its impact is too far reaching
- Its causes are too complex
- Necessary solutions are too comprehensive
68- Protecting Children is
- Everybodys Business