Title: Ethical Responses for Vulnerable Children and Families
1Ethical Responses for Vulnerable Children and
Families
- Dr Leah Bromfield
- Manager
- National Child Protection Clearinghouse
2The ACCFPP Conference 2008
- In explaining the theme for this conference, the
organisers state - As debates continue within the child and family
welfare system about the effectiveness of
strategies to support vulnerable children, the
professions are instead struggling to reconcile
the need for appropriate supportive relationships
with clients against ever increasing compliance
bureaucracy
3What does it mean to be ethically responsive?
- Integrity
- Respect
- Partnership
- Empowerment
- Empathy
- Forensically astute
- Childs best interests
- Meeting needs
- Timely
- Quality
- For me, it conjures concepts such as
4Overview
- Child and family protection systems
- Evaluation evidence-informed policy and practice
- Intervening early in the life of the problem
- The right service at the right time
- Child and family protection practice
- Risk assessments and risk aversion
- Engaging families
5- Ethically responsive policy and practice is
evidence-informed
6Ethically responsive services
- Ethically responsive services
- Do no harm
- Provide high quality services
- Improve outcomes for children and families
- The best way to achieve this is through
evidence-informed policy and practice
7Good ideas dont always result in good outcomes
- Personal safety programs for children
- Theory Increasing childrens knowledge about
concepts such as good touch-bad touch will help
prevent child sexual abuse - Evaluations show mixed results
- Some success - increased disclosure
- No evidence that personal safety programs prevent
a child from experiencing child sexual abuse - May have unintended consequences (gt anxiety)
8NCPC Audit of prevention programs
- Audit of all Australian child abuse prevention
programs - Research undertaken in 1999
- Prevention programs classified according to
target group - Children (Personal Safety)
- Families (Parenting Education Home Visiting
Family Preservation) - Community (Community Education)
- Many programs (n 1762)
- Majority had some form of evaluation - mainly
process - Insufficient evidence base to determine what
works
Tomison Poole, 2000
9Child abuse prevention programs A review of the
evidence
- Reviewed evaluations of child abuse prevention
programs to find out what works - Australian and international research
- Outcome evaluations only
- 52 published evaluations identified with search
criteria - Only 5 of 52 evaluations identified were for
Australian programs
Richardson et al., 2005
10Evidence-informed policy practice
- Evaluation is essential to determine if a program
works - Can explain why some programs work and others do
not - Limited pool of money for child welfare programs
- Growing demand for programs to be evaluated to
secure ongoing funding - Abused and neglected children are among the most
vulnerable in our community - Vital that interventions are accountable, that
they actually work and that they do no further
harm
Holzer et al., 2006
11Essential elements of a rigorous evaluation
- Impact and/or outcome measures
- Impact - direct effect of a program according to
its aims and objectives - Outcome - assumptions underlying the direct aims
of the program - Pre- and post-test design (change?)
- Comparison group (better than nothing?)
- Follow-up (long-term effects change?)
Holzer et al., 2006
12Implications
- There is a critical need for rigorous program
evaluations to show - programs that are effective in improving client
outcomes - core components of effective programs
- Is there evidence that the program
- does no harm?
- improves outcomes for children and families?
- Can you provide a plausible theoretical and
empirical rationale for the program?
13- Ethically responsive service systems intervene
early in the life of the problem with the aim of
preventing children from being harmed and family
problems becoming entrenched
14Case Study
- This case study illustrates a pattern of chronic
maltreatment and the cumulative effects if
maltreatment persists - 22 notifications 4 substantiations over 8yrs
- Underlying issue in majority of notifications
- poor parenting capacity
- psychological maltreatment by mother
Bromfield, Gillingham Higgins (2007)
15Case Study
- Notifications fell into 5 groups of 2-3
notifications per group - The notifications within each group were all
essentially regarding the same set of concerns - Physical abuse
- Emotional abuse (esp. verbal abuse and rejection)
- Exposure to family violence
- Neglect
Bromfield, Gillingham Higgins (2007)
16What is cumulative harm?
- Cumulative harm may be caused by an accumulation
of a single adverse circumstance or event, or by
multiple different circumstances and events - The unremitting daily impact of these experiences
on the child can be profound and exponential, and
diminish a childs sense of safety, stability and
wellbeing
Bromfield Miller (2007)
17Notification One05-Oct-1994 to 06-Oct-1994
- Grandparent saw mother kick walker with 8mth old
son, Jarrod sitting in it. Pulled Jarrod up off
couch by one arm. Mother no diagnosed mental
illness, but severe mood swings and previous
psychiatric care. Mother receiving support from
MCHN and FS - Outcome Insufficient info to warrant
involvement, especially given involvement of
local support agency.
Bromfield, Gillingham Higgins (2007)
18Cumulative harm analysis
- No previous child protection involvement for this
or any other child in mothers care. Does not
reach threshold for involvement
Bromfield, Gillingham Higgins (2007)
19Notification Three04-May-1995 to 05-May-1995
- Aunt alleging loud verbal arguments in front of
15mth old Jarrod, Father punches walls, Mother
verbally abusive of Jarrod and is becoming
increasingly aggressive towards him. Mother
giving Jarrod stronger doses of prescribed
medication to get him to sleep. Family Support
Worker only sees parents in office. - Outcome Notification raising similar issues also
received from Grandparents.
Bromfield, Gillingham Higgins (2007)
20Cumulative harm analysis
- No previous child protection involvement for this
or any other child in mothers care. Does not
reach threshold for involvement - 3rd notification for same issues. 2 different
notifiers. Increasing verbal and physical
aggression towards child.
Bromfield, Gillingham Higgins (2007)
21Notification Eleven15-Oct-1997 to 15-Oct-1997
- Notification from worker at Family Welfare
Agency. Mother came into service requesting a
washing machine (note parents now separated). - While at the agency Mother continually yelled at
3 year old Jarrod for misbehaviour. In workers
opinion, child was not behaving inappropriately. - Worker told Mother that yelling at child was not
acceptable. Mother verbally abusive towards
worker and left. - Outcome Assessed no protective concerns
Bromfield, Gillingham Higgins (2007)
22Cumulative harm analysis
- No previous child protection involvement for this
or any other child in mothers care. Does not
reach threshold for involvement - 3rd notification for same issues. 2 different
notifiers. Increasing verbal and physical
aggression towards child. - 11th not. for same issues from 7 different
sources. 2 prior substantiations. Professional
notifier. Behaviour observed in public parental
behaviour in private?
Bromfield, Gillingham Higgins (2007)
23Cumulative harm analysis
- One month laterGP stated 3 year old Jarrod was
severely traumatised following overnight access
with mother and further contact with mother
should not be permitted
Bromfield, Gillingham Higgins (2007)
24Systemic barriers to recognising cumulative harm
- Research, policy and practice treat maltreatment
as an isolated event - Because each involvement treated as a discrete
event - Information not accumulated from one report to
the next - Information lost over time
- Assumption that problems presented in previous
involvements are resolved at case closure - Files are not scrutinised for pattern of chronic
maltreatment and cumulative harm
Bromfield, Gillingham Higgins (2007)
25Implications for policy
- Recognise and address systemic barriers to
identifying cumulative harm - Intervene early in the life of the problem to
help prevent - children from being harmed
- family problems becoming entrenched
- families subsequently requiring child protection
services
26Implications for practice
- Unlikely to receive a report explicitly due to
cumulative harm - The majority of children who experience
maltreatment experience - multiple incidents and
- multiple types
- Need to be alert to possibility of cumulative
harm in all reports
Bromfield Miller (2007)
27Indicators of cumulative harm in the case history
- Be alert if there are
- Multiple reports
- Previous substantiations
- Multiple sources alleging similar problems
- Reports from professionals
- Evidence of children not meeting developmental
milestones - Allegations of inappropriate parenting in public
Bromfield, Gillingham Higgins (2007)
28- Ethically responsive service systems provide the
right service at the right time
29Changing social context
- Internationally, developments over the past 30
years have resulted in very high demand on child
protection services - Key developments have included
- Increased public awareness of child maltreatment
and its effects - Broadened scope of what constitutes child
protection - Changing thresholds for interventions
Bromfield Holzer, 2008
30Ethically responsive service system
- One of the critical challenges for creating an
ethically responsive service system is creating
pathways to services for families in need that
do not require them to first be referred to child
protection services
Bromfield Holzer, 2008
31Child protection and families in need
- High numbers of notifications
- Large administrative burden for processing these
- Total reports comprise relatively small number of
children who need a child protection response - Only 1 in 5 notifications are substantiated
(approx.) - Majority of families reported are in need and
likely to be re-referred if no preventive action
is taken
Bromfield Holzer, 2008
32External
Public Health Approach
Bromfield Holzer, 2008
33- Ethically responsive child and family protection
practitioners put children at the centre of
assessments
34Risk assessment and risk aversion
- Risk, rather than being a neutral term to
describe statistical probability, is value-laden
and implies heightened risk - Risk to children is considered to be measurable
and manageable. - Implication - harm to children both can and
should be prevented - If not, then someone is to blame
Bromfield Holzer, 2008
35Risk assessment and risk aversion
- Negative media attention when the wrong
decision is perceived to have been made - In response to negative attention, process of
assessments, as well as general child protection
practices, have become increasingly risk-averse
Bromfield Holzer, 2008
36Risk assessment and risk aversion
- Risk assessment in child protection involves an
additional un-stated dimension - risk to the
individual or organisation of making the wrong
decision - High-profile child death reviews and the media
response to them have reinforced increasingly
risk-averse practice in recent years
Bromfield Holzer, 2008
37Implication for policy and practice
- Critical challenge, in a highly politicised
context, is maintaining sight of the childs best
interests as the central issue in assessing risk
Bromfield Holzer, 2008
38- Ethically responsive child and family protection
practitioners engage families to meet their needs
39Practice in a statutory environment
- Child protection practitioners work in a
statutory environment in which - they must comply with their obligations under
legislation and - with agency policy and practice directives
40Autonomy over relationships
- Due to the proceduralised nature of child
protection, staff have limited autonomy - However, they still have a large degree of
autonomy in their relationships with children and
families and in the way in which they choose to
engage them
Connolly, 2007 in Bromfield, 2008
41Importance of relationships
- Relative contribution of different factors in
psychotherapy outcomes showed - therapeutic relationship contributed to 30 of
change - compared with only 15 contribution for the
specific intervention technique - Suggests relationships between practitioners and
families may have a greater impact on outcomes
than the structure of the service systems
Scott, 2007 in Bromfield, 2008
42Changing organisational culture
- In my PhD research, I concluded that
- Organisational culture change may need to occur
along with a re-clarification of the role of
statutory child protection services to address
the preoccupation with risk management that
appeared to preclude practitioners from engaging
with families
Bromfield, 2005
43Role of individual practitiones
- Need to encourage and acknowledge the difference
individual practitioners can make from the ground
up through relationships based on - Empathy
- Respect
- Genuineness, and
- Optimism
Scott, 2007 in Bromfield, 2008
44Implications for practice
- Challenge is for practitioners to reflect on the
most effective way to engage their clients - Individuals have the power to make a difference
- Harness the power of therapeutic relationships to
assist families to change
45Conclusion
- Ethically responsive child and family protection
services - Are evidence-informed
- Intervene early in the life of the problem
- Enable families to access the right service at
the right time - Ethically responsive child and family protection
practitioners - Put children at the centre of assessments
- Engage families to meet their needs
46National Child Protection Clearinghouse
- Australian Institute of Family Studies
- Level 20, 485 La Trobe Street Melbourne
- 03 9214 7888
- www.aifs.gov.au/nch
- This presentation can be downloaded
fromwww.aifs.gov.au/nch/pubs/presentations/diary
47References
- Bromfield, L.M. (2008). Editorial. Child Abuse
Prevention Newsletter, 16(1), pp.1-2. - Bromfield, L. M. (2005). Chronic Child
Maltreatment in an Australian Statutory Child
Protection Sample. Unpublished PhD thesis, Deakin
University, Geelong. - Bromfield, L. M., Higgins, D. J. (2005).
Chronic and isolated maltreatment in a child
protection sample. Family Matters, 70(38-45).
48References
- Bromfield, L.M., Holzer, P.J. (2008).
Australian Institute of Family Studies Submission
to the Special Commission of Inquiry into Child
Protection in NSW. Melbourne Australian
Institute of Family Studies. Available from
www.aifs.gov.au/nch/pubs/submissions - Bromfield, L. M., Miller, R. (2007). Specialist
Practice Guide Cumulative Harm. Melbourne
Victorian Government Department of Human
Services, available from www.aifs.gov.au/nch/resea
rch/menu.html
49References
- Bromfield, L. M., Gillingham, P., Higgins, D.J.
(2007). Cumulative harm and chronic child
maltreatment. Developing Practice, 19, 34-42. - Holzer, P. J., Higgins, J., Bromfield, L. M.,
Richardson, N., Higgins, D. J. (2006). The
effectiveness of parent education and home
visiting child maltreatment prevention programs.
Child Abuse Prevention Issues, 24.
50References
- Richardson, N., Higgins, D. J., Bromfield, L.
M. (2005). Making the right choices about child
protection Programs and services. Paper
presented at the Healthy Solutions for Children
Making the Right Choice, 10th National Conference
of the Association for the Welfare of Child
Health. - Tomison, A., Poole, L. (2000). Preventing child
abuse and neglect Findings from an Australian
audit of prevention programs. Melbourne,
Australia Australian Institute of Family
Studies.