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    History Really Does Matter in Child Protection

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    It was several years ago that I was watching the Canadian Broadcasting Corporation program, The Fifth Estate, and its story on the death of Jeffrey Baldwin. As the CBC out it, Jeffrey died of starvation at the hands of his grandparents in one of the world’s richest cities, while those who could have stopped it did not.

    Like all cases where a child dies with child protection involvement, there were many factors at play. One was certainly information that was buried in child protection files about past convictions for child abuse involving both grandparents. In addition, there had been some form of parenting capacity assessment that had apparently concluded that the grandmother was unfit to parent.

    “No matter what he does, every person on earth plays a central role in the history of the world. And normally he doesn't know it.”I was reminded of this as I read an excellent review from Child Family Community Australia titled Rarely and Isolated Incident which made several conclusions including the following:

    Practice and policy responses to children who experience single maltreatment events should be different to those for children who experience multiple maltreatment events. Survivors of multiple maltreatment events are more likely to experience complex trauma and the negative effects of cumulative harm, both of which require more comprehensive intervention and treatment.

    They note that there is a lack of success in interventions with children when maltreatment or abuse are seen as isolated or single events. They identify that research shows quite the opposite – that the majority of children experience multiple events and often in multiple forms. They also note that children who have these experiences inside a family are also quite vulnerable to experiencing them outside the family as well.

    Drawing upon a wide body of research, the authors take time to share with the reader the various important categories that child protection workers must consider when assessing the histories of children:

    • multiple type maltreatment which would include sexual abuse, physical abuse, psychological maltreatment, neglect along with witnessing domestic violence;
    • poly-victimisation which outlines how a child may have various sources of maltreatment within the family and the community (including bullying);
    • complex trauma which is greater than presently thought of through the lens of Post Traumatic Stress Disorder (PTSD)

    It involves disturbances to the cognitive, affective, and behavioral dimensions of a person’s life. This reflects the prolonged nature of the disturbance and the impact on multi-factorial functioning on into adult life. Psychological and physical health are impacted. This is combined with high rates of subsequent victimization in adulthood; Cumulative harm describes both the cumulative harm of multi-victimization along with the multiple harms of multiple types of maltreatment from multiple sources. However, cumulative harm can also occur with multiple victimizations to single perpetrator events in which the victims of Ariel Castro come to mind.

    The implications for practice are profound, not the least of which is that, given the high probability that single maltreatment events are low, that investigation should seek to consider a longitudinal view of the child and family. Maltreatment should not be seen as a discrete event. That a previous complaint led to investigation, services and file closure should not suggest that this meant the issues were resolved. Research keeps telling us that many of the interventions used in child protection are not leading to long-term changes in many families.

    For clinicians, this also means that there is a need to think about the ways in which therapy is approached. Psychological, behavioral as well as developmental concerns are likely requiring attention in the recovery process. My own work with assessing and treating those with addiction, both in and out of the child protection system, speaks to the validity of seeing these four categories as extremely relevant to our work.

    Reference:

    Price-Robertson, R., Rush, P., Wall, L. & Higgins, D. (2013). Rarely and isolated incident: Acknowledging the interrelatedness of child maltreatment, victimization and trauma. Melbourne: Australian Institute of Family Studies

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    Dr. Peter Choate is a Registered Social Worker and Member of the Clinical Registry and Approved Clinical Supervisor for the Alberta College of Registered Social Workers. He is an Assistant Professor at Mount Royal University in the Faculty of Social Work and Disability Studies and a Professional Development Instructor at the University of Calgary. His particular emphasis is on parenting capacity as well child and adolescent mental health including maltreatment, neglect and abuse (physical, sexual, emotional) and these issues within family systems.

    Mental Health

    When Giving Thanks, Don’t Forget Yourself

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    As we give thanks at the holidays, it’s easy to overlook someone important: your past self.

    While it’s well documented that gratitude toward others can improve wellbeing, two University of Florida scientists find that gratitude toward your past self also has benefits.

    Does thanking yourself seem a bit…selfish? The researchers, UF psychology professor Matt Baldwin, Ph.D., and undergraduate student Samantha Zaw, think not.

    “Despite the fact that past gratitude is self-focused, it reminds people that they’re part of a bigger story and that they have the power to grow,” Baldwin said. “It’s possible this promotes a pay-it-forward type of mentality.”

    Gratitude is what psychologists call a self-transcendent emotion, one that lifts us out of the everyday and expands our perspective, which can help us get along with each other better. In a recent experiment, Baldwin and Zaw asked participants to write brief gratitude letters. The first group thanked someone else, the second thanked themselves, while a third, the control condition, wrote about a positive experience they’d had. Zaw and Baldwin then surveyed the participants about their self-perception after writing the letter. Although the results are not yet published, early analysis shows that the exercise gave the other- and self-focused gratitude groups a sense of redemption and helped them feel they were morally good people. However, the group that wrote to themselves scored higher on both measures.

    The past-self group also saw a benefit the others didn’t: an increase in the self-awareness measures of clarity, authenticity and connectedness.

    “Unlike gratitude toward others, being appreciative of ourselves carries an added benefit of truly understanding who we are and feeling connected to ourselves,” said Zaw, a McNair Scholar who has been working with Baldwin since her freshman year as part of UF’s Emerging Scholars Program.

    Zaw and Baldwin’s research — the first known data gathered on past-self gratitude — was inspired by a Reese’s cup. When Baldwin’s co-worker, boredom researcher Erin Westgate, returned to the office after pandemic lockdown, she was delighted to discover a peanut butter cup she had squirreled away in her desk.

    “She texted me like, ‘Oh my gosh, my past self left my future self a Reese’s,’” Baldwin recalled. “I was like, ‘Wait a second. You’re expressing gratitude towards something your past self had done. We have to study this.’”

    As Zaw and Baldwin dug into previous studies, they found plenty on gratitude toward others and a few on self-compassion, but nothing on past-self gratitude. They designed the letter-writing experiment to test its effects, presenting their findings at the Society of Southeastern Social Psychologists in October and at the upcoming meeting of the Society for Personality and Social Psychology in February.

    If you’re curious about the benefits of self-gratitude, Zaw offered a way to try the experiment at home, maybe as a new Thanksgiving tradition. Take a few minutes to write a thank you message to someone else, and another to yourself for something you did in the past. Sharing what you wrote could foster connections between loved ones, she said, but the exercise can also pay dividends if you try it on your own.

    “At Thanksgiving and Christmas, we focus on other people, but self-care is really needed too, especially if we want to feel more clear about ourselves,” she said. “Maybe it can even lead to a better vision for ourselves for the next year.”

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    Mental Health

    A Lifeline for Primary Care Amid a Crisis in Youth Mental Health

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    Most mental health care in America doesn’t happen in psychiatrists’ offices – especially when it comes to children, teens and young adults.

    Instead, young people with depression, anxiety and more turn to the same people they already go to for all kinds of other health issues: their pediatricians, family doctors, school-based clinics and other primary care providers.

    But where do those providers turn when they need more help in handling the mental health concerns of their patients – especially more serious issues that they’re not trained to handle?

    If they’re anywhere in Michigan, they can turn to the team at MC3.

    For nearly a decade, the MC3 program has helped thousands of primary care providers throughout the state care for the mental health needs of young people up to age 26. It also aids providers caring for pregnant women and new mothers of any age who have mental health needs.

    More than 16,000 times since 2012, MC3’s psychiatrists and pediatric behavior specialists from the University of Michigan have connected directly with more than 1,800 primary care providers by phone, for consultations about their patients.

    Together, they’ve mapped out plans for handling ADHD in young children, suicide-prevention safety planning for teens and symptoms that might signal schizophrenia in young adults.

    There’s no charge to providers or their patients, thanks to the program’s funding from state and federal grants.

    For providers whose patients recently had a mental health emergency or are waiting for an appointment with a child psychiatrist or a psychiatric inpatient bed, the service can literally be a lifeline: one in five of the consults involve a patient who has expressed suicidal thoughts or harmed themselves.

    How it Works

    MC3 also offers video-based telehealth appointments to connect patients of participating providers with psychiatrists. U-M and Michigan State University experts have also created a wide range of training options for professionals available on the MC3 website.

    Though the demand has grown in recent years thanks to the pandemic, the program has room for more Michigan providers to join the network and get access to its services.

    Each connection starts by contacting one of the trained professionals in MC3’s network of Behavioral Health Consultants, located throughout the state. MC3 also works closely with the state-funded Community Mental Health agencies across the state.

    “Only about 3% of the children, teens, young adults and moms that our participating providers have consulted with us about are in treatment with a psychiatrist. We’re providing access to specialist-informed care to young people who wouldn’t otherwise have it,” said Sheila Marcus, M.D., who heads the pediatric component of MC3 and is a professor of psychiatry at Michigan Medicine, the University of Michigan’s academic medical center.

    “The reality is that no matter where they live and no matter what their family’s income level, most of these patients would not have easy access to a specialist because of the critical shortage of such providers,” she added. “In some counties, there are no local providers trained to provide this level of care.”

    Primary care providers inside and outside Michigan can also access MC3’s free online resources, even if they’re not enrolled in the program.

    These include prescribing guides for mental health medications and online provider education, to equip them to provide diagnosis and care that might not have been part of their formal professional training. Much of that training offers continuing education credits that can help physicians, nurse practitioners, physician assistants and certified nurse midwives keep up their license.

    “For me, MC3 has been a game changer,” said Lia Gaggino, M.D., who first interacted with the MC3 team through her pediatrics practice in Portage, Michigan and now is the team’s consulting pediatrician. “Since its inception I have used their services for children and teens who presented with very complicated mental health concerns. I wished I had had a psychiatrist to help me and then MC3 appeared and offered me a lifeline. Their services changed my prescribing practices and improved my skills and I am so grateful for their advice and support. I encourage my colleagues to sign up and call –MC3 is there to help us!”

    Local Care Amid a National Emergency

    As the nation grapples with a national emergency of rising mental health concerns among young people, MC3 and similar programs in other states are expanding access to critical psychiatric services at a time when demand is soaring.

    The national organizations that declared that emergency in October called for more support of mental health care in primary care settings, as well as efforts to overcome the national shortage of mental health specialists for young people, especially in rural and low-income areas.

    That shortage is what drove the creation of MC3 in the first place.

    Michigan is third from the bottom among all states in supply of mental health professionals for young people. Only Washtenaw County, where the University of Michigan is located, meets national population-based criteria for having enough mental health providers specializing in children and teens.

    The pandemic has made matters worse across Michigan and the United States. A national report from November 2020 showed that anxiety and depression in pregnant women have more than doubled, and emergency department visits for mental health concerns in children had risen by double digits since the pandemic began.

    Joanna Quigley, M.D., another MC3 consulting psychiatrist from Michigan Medicine, recently presented data at a national meeting showing that 30% of MC3 consults during 2020 focused on pandemic-related concerns.  

    The pandemic has prompted MC3’s team to plan to offer extra training to help providers identify the needs and handle the concerns of children traumatized by experiences they or their families have had during COVID-19.

    Trauma-informed care is also important for children who even before the pandemic experienced very disruptive life events.

    Terri Rosel, NP-C, a nurse practitioner at Cherry Health in northern Michigan, wrote to the MC3 team: “I work in a small student health center in Cedar Springs and am the sole provider in the office. Since starting this job four years ago I have had the pleasure of seeing so many students with mental health concerns. I felt ill-equipped at times to help them with my degree as a family practice nurse practitioner. I would utilize MC3 often to help with treatment plans for these wonderful kids who needed help but could not get into psychiatric services soon enough.”

    As the program continues to grow, it will partner more with schools through a direct connection with the TRAILS program that offers mental health awareness and support services.

    Positive Feedback from Providers

    The MC3 team has surveyed participating providers and found that 99% agreed with the statement that “following phone consultation(s) I felt more confident that I could effectively treat patients’ behavioral health problems.”

    The team published other findings from its survey of providers, and responded to feedback by making changes.

    The quotes they received from providers are equally compelling.

    “This service has been absolutely ‘practice- changing’,” said one. “As we have more and more patients with mental health issues and limited local resources- we are essentially the only option for these kids. Having MC3 support helps us make good treatment decisions and is also ‘on the job training’ which we can apply to future patients.”

    In fact, MC3 data show that 25% of the interactions help the patient avoid a higher-level of care that may be difficult to access, such as a psychiatric hospital bed or emergency psychiatric visit.

    One of the maternal health providers who joined MC3 recently said, “I can’t even express how this service has enhanced the care I can provide. In the past, we’d screen and diagnose and then send moms out. We’d place referrals and hope that folks could navigate the complex system. Now, with MC3, I can collaborate with psychiatry, start meds or treatment, and access community resources that I am confident they will be able to access. It’s really been invaluable.”

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    Culture

    America Has an Anger Problem – Can Better “Mental Nutrition” Fix It?

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    America is a pretty angry place these days. Formerly respectful spaces like school board meetings have become bitter battlegrounds. Some people are harassing healthcare workers and threatening restaurant staff for enforcing COVID protocols. Others are openly furious with the vaccine-hesitant. Everyone, wherever they stand on the (deeply divided) political playing field, is outraged about something.

    Sure, anger is part of the human condition, but have things always been this bad? Elaine Parke thinks not—and she has a plan to get America the anger management tools it needs.

    “We’ve stopped listening to one another because we’ve become addicted to our own narrow and sometimes selfish points of view,” says Parke, author of “The Habits of Unity: 12 Months to a Stronger America…one citizen at a time” (Outskirts Press, 2021, ISBN: 978-1-9772-4276-1, $21.95, www.12habits4allofus.org). “And we seem to have lost sight of the notion that we’re personally responsible for our own behavior.

    “It’s way past time for us to take a collective deep breath and treat others with dignity, respect, and civility—and listen to them—whether we agree or not,” she adds. “It’s urgent that we make this shift now.”

    Dialing down our ire is easier said than done. We are living in extraordinarily stressful times. But there’s more at play. Parke says we are shaped by the messages we consistently consume—and in today’s connected world, a lot of those messages come from our digital diet.

    “Social media isn’t solely to blame for stoking our emotional flames—in fact, it was designed to be a source of information and to bring people together,” Parke clarifies. “But if your newsfeed is making you an angrier person, it’s on you to either log off for a few days or reassess the kind of content you’re engaging with. When we choose to focus on stories that are positive and nourishing, we go a long way toward resetting our emotional equilibrium.”

    Parke’s “The Habits of Unity” is her attempt to help people take charge of what she calls their “Mental Nutrition.” Much in the same way that we (hopefully) approach the food we eat, we need to develop the discipline to make more nutritious mental choices every day. Her book’s 365 “one-magic-minute-a-day” motivationals make it easy to hardwire these choices into habit.

    With her simple, doable framework for uplifting ourselves, boosting our mental health, and practicing unity, Parke hopes to get everyone focused on the same branded behavior each month. The idea is that the sheer force of all that concentrated positive energy sparks a unity revolution that rises from the ground up and sweeps the nation.

    Yet, until that happens, we can leverage the power of  “The Habits of Unity” on a personal level by forming one good habit per month:

    January: Help Others

    February: You Count

    March: Resolve Conflicts

    April: Take Care of Our Environment

    May: Be Grateful

    June: Reach Higher

    July: Become Involved

    August: Know Who You Are

    September: Do Your Best

    October: Be Patient and Listen

    November: Show a Positive Attitude

    December: Celebrate Community, Family, and Friends

    Those who’ve tried it say the plan is easy to put into practice. It feels good, so you’ll want to keep doing it. And there’s a ripple effect. As you become more positive, centered, and respectful, others will be drawn to you and your relationships will improve.

    “As these ripples expand, they will improve the emotional climate in our country and make it easier to seek common ground, instead of lashing out,” says Parke. “But we can’t sit around waiting for others to take action. Each American must recommit to making our country a welcoming, affirming melting pot—instead of a stewing pot.”

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