Transcript Dorothy Scott - Fragile Families - Department of Education and Early

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 Recommendations
1.
2.
3.
4.
5.
6.
7.
Prevention
Early Intervention
Statutory child protection services
Aboriginal children and young people
The law and the courts
Workforce Development
System governance
How might we
take the first step?
Prevention
Child 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 risks
A 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
Domestic Violence
Parental mental health problems
69.4%
65.2%
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.
Targeted Prevention
and Intervention for
Vulnerable Families
Universal Prevention for all
Children/Families
Families
at risk of
violence
Disability
Mental Health
IServices
Children in
need
of placement
Correctional services
Homelessness
services
Child Protection Intervention
Drug and
alcohol
services
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’)
Three levels of service reform
Service Providers
Organisational Setting
Policy Context
The triangle of values, knowledge
and skills
Values for working with
vulnerable families: ERGO
Empathy
Respect
Genuineness
Optimism
What we know about ‘the therapeutic
relationship’
Client factors and
environmental factors
(eg. social support)
30%
Qualities of the
therapeutic
relationship
40%
15%
15%
Hope and expectancy
of positive outcome
Specific intervention
of technique
From The Handbook of Psychology Integration by
M.J. Lambert, 1992, P97.
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 vocation
which sustains us
in working with
vulnerable
families
References
Dawe, 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 wellbeing 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.au
Scott, 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
[email protected]
www.unisa.edu.au/childprotection