Critical Analysis of the System Changes Needed in the Child Welfare System

The child welfare system coupled with the juvenile and criminal justice systems have ultimately created and perpetuated the systemic constraints and social underpinnings that keep Black families court involved and monitored.

Data reveals that pluralism across systems yields, “much earlier contact with child protection, committing the first offense at least two years earlier than the general population; had been identified with mental health concerns but not referred to treatment; and had complex trauma histories.” This leaves Black women and girls vulnerable to navigate complex, bureaucratic systems that pathologize Black life and culture. Faced with challenges at the intersections of race, gender, and socioeconomic status, support across the economic spectrum is what families need in order to meet their needs and goals.

The US Department of Justice report, in 2015, Exploring the Impact of Criminalizing Policies on African American Women and Girls, highlights “the impact of criminalization policies on African American women and girls who are survivors of domestic and sexual violence, including the impact of arrest, detention, incarceration, and mandatory minimums.” The challenges and plural systems that undermine a family’s ability to meet those needs and goals were also discussed.

While the report centers the discussion on key points and recommendations for policymakers, child welfare, and the juvenile justice systems, it also facilitates the conversation on the “unintended and undesired consequences” affecting black women and girls. This includes the hyper regulation, monitoring, and criminalization of black girls. In order to address some of the gaps identified in the report, it is imperative that a multidisciplinary, multidimensional approach is developed, implemented, and evaluated. The paradox comes in when we consider the challenges of pluralism across systems.

“Criminalization includes state policies and practices that involve the stigmatization, surveillance, and regulation of the poor; that assume a latent criminality among the poor; and that reflect the creep of criminal law and the logics of crime control into other areas of law, including the welfare, systems” – Gustafason

Challenges faced by pluralism across systems

Within these systems, service users’ satisfaction, evidence based practice outcomes and effectiveness, recidivism to programs, etc. are programs which need evaluation and monitoring in order to measure effectiveness and program improvement. Across the board, within human and social services, allocation of funds for monitoring and evaluation of services is an afterthought. Child welfare programming, “specifically child protection services need funding and efforts for comprehensive oversight and evaluation.” Impacting families directly, but specifically, Black girls, program effectiveness and monitoring data analysis are a key foundation for discussions on program development, process improvement, and policy review.

Access to comprehensive training that encompasses the multilayered challenges of Black girls is imperative. These opportunities will provide a space to better equip and broaden understanding of the systemic underpinnings that impede and exacerbate their unique needs. They need professionals at all levels, who will advocate when systemic and bureaucratic injustices attempt to push them to the margins.

While standard operating protocol and procedures are readily available quality, innovation, relevance to demographics of the clientele is varied and unknown for the professionals within these systems, patriarchal, racial and capitalist ideologies are ever present. These ideologies present themselves through variance in child protective case classifications, options for in and out of home placements, length of court involvement, services referred, recommendation for child removal, etc. only to name a few.

Black girls need programming that mirrors the intersectional, co-occurring and multilayered aspects of their lives. Acknowledging and understanding how trauma, “manifests in delinquent behaviors, and how juvenile justice involvement can exacerbate the trauma,” assists in considering the harm in pluralism across systems.

This includes programming that acknowledges the many roles, barriers and systemic challenges that Black girls face in their families and communities. Data analysis and cross system communication and collaboration to identify “repeat families in the child protection system with whom traditional responses do not work” is a step towards programming that supports the Black family as a unit.

Speaking on the social work profession, Iris Carlton-Laney stated,“the profession maintains a discomforting silence when viewing inequalities and social conditions that affect African American families. Where this is true, the social work profession is helping to sustain societal oppression and facilitating the unequal distribution of power and resources.” Specifically, “social workers have a responsibility to intensively examine the ways that gender intersects and shapes” our lived experiences.

Working within child welfare and the juvenile justice system in six, I know that “girls who are in physical confrontations with a parent or guardian or other adult residing in the home are often responding to a failure to be protected from physical, sexual, or emotional harm.” The discomforting silence extends to Black girls and makes you question whether Black girls lives matters to social work.

Special attention should be given to a review of child protection policies, program existence and effectiveness, and referral to culturally relevant, trauma-informed services in an effort to increase outcomes for children and families. Recidivism factors, training resources for juvenile and family court judges, CASA’s involvement and county and statewide data should be continuously monitored and evaluated to increase the effectiveness in the child protection involvement for children of color especially black girls.

In order for collaboration, comprehensive services, and critical policy reform to occur, professionals from child welfare, juvenile justice, in addition to co-occurring (mental health, substance abuse) specialists, need to be at the policy-making table.

To Counter Child Abuse, Administrators and Case Workers Need Support to Implement Evidence-Based Improvements

In 2015, more than 425,000 children were placed in foster care due to incidents of abuse and neglect. But many unsubstantiated cases under investigation divert time and resources from handling cases that warrant close monitoring and attention. According to recent statistics, more than two million reports of child abuse and neglect were accepted for investigation in 2015 – with more than 700,000 of them eventually substantiated as cases of child abuse or neglect.

Imperfect Responses to Harmful Abuse and Neglect

Caseworkers often report that negotiating the multiple demands of their jobs puts them under constant stress. The sheer volume of Child Protective Services reports and investigations, the number of youth in foster care that need to be looked after, and the piles of paperwork that must be filled out to track decision-making – all of these burdens are overwhelming under the best of circumstances.

Faced with such workloads, agencies and caseworkers are ill-equipped to deliver services based on evidence of what works for youth and parents in the foster care system. The current standard of practice, however, leads agencies and caseworkers to engage in practices not supported by research-based evidence. Poorly conceived and delivered services cause considerable harm by failing to limit the incidence and after-effects of abuse and neglect.

Victims of child abuse and neglect are nine times more likely to become involved in crime and 25% more likely to experience teen pregnancy. Such victims also face increased risks of smoking, early-age drinking, suicidal ideation, inter-personal violence, and sexual risk-taking. The sad results become obvious in later years. Two-thirds of adults under treatment for drug abuse report that they were maltreated as children. And similar reports of childhood abuse come from 14% of men in prison along with 36% of incarcerated women. Four-fifths of 21-year-olds who were abused as children show evidence of at least one mental health disorder. And saddest of all, about 30% of child abuse victims will later abuse their own kids.

What Could be Done?

Several steps can be taken to improve responses to child abuse and neglect:

  • Improved, ongoing training and job support for caseworkers and supervisors could ensure that they know the characteristics of the populations they serve and are aware of effective anti-abuse practices and know how to deliver them or help clients find others in the community who can provide optimal help. Front-line workers also need training to monitor client progress and detect when a case warrants more intensive intervention.
  • Enhanced preventive efforts could save lives and money. Research shows that the total cost of new U.S. cases of fatal and nonfatal child maltreatment was approximately $124 billion in 2008. The estimated cost per victim of nonfatal child maltreatment was $210,012 in 2010, including the costs for health care, productivity losses, child welfare services, criminal justice procedures, and special education. In fatal cases, the figure rises to an astonishing $1,272, 900 per death.
  • Resources should be reallocated to areas of greatest need. In addition to redistributing available funding to hire more staff to manage high caseloads, innovative and effective programs and services must be delivered to prevent child maltreatment and fatalities. States should take advantage of funds offered by the federal government to expand evidence-based child welfare interventions that may have previously been underfunded.

Lessons from Philadelphia

A promising model comes from the state of Pennsylvania, which has participated in a federally funded project that allows child welfare agencies to use Title IV-E funds for evidence-based reforms. Philadelphia’s child welfare system has been at the forefront of adopting three evidence-based treatments for children and families that the city was previously unable to implement due to lack of funding. Waiver funds have made it possible to enhance preparation for child welfare caseworkers, develop databases to track outcomes for children and families, and train staff to identify and implement further improvements.

With flexible authority over spending, two child welfare agencies in Philadelphia decided to implement the Positive Parenting Program, an evidence-based approach to preventing child abuse. Although some reallocated resources have been used to train staff, additional funding is needed to discover barriers to effective program implementation and to implement additional steps known to be cost-effective – such as holding weekly consultations and boosting training for current and replacement leaders and caseworkers involved in the new program.

Research could pinpoint which approaches do best at giving various parents and youth access to the positive parenting program. And as parents and their offspring complete the program, further research would ideally track results in areas such as safety, reductions in abuse incidents, and improved parent-child relationships.

Next Steps

The Title IV-E Waiver Demonstration Project was a provision in the U.S. Child and Family Services Improvement and Innovation Act, which Congress reauthorized for five years in 2011. Now that the act is again up for reauthorization, Congress has the ability to implement changes to the way child welfare federal funds are allocated. Advocates for children have an opportunity to contact representatives and senators in Congress to propose that this program should expand to give more states the chance to reallocate funds and improve child safety.

Much remains to be learned about what it takes to carry out evidence-based interventions in the child welfare system, which provides vital help to many endangered children, youth, and families, disproportionately minorities. The federal Waiver Project provides a unique opportunity to observe what happens when system leaders, community partners, and providers mobilize to prevent childhood trauma. Lessons learned will help provide ongoing guidance to federal and state administrators and welfare leaders as they look for the most effective, empirically proven ways to protect children and families under their supervision.

How Do We Measure Therapeutic Outcomes?

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The phrase evidence-based practice is now common parlance in mental health care. The call for using evidence-based practice can be heard across psychology, social work, psychiatry, occupational health, and a range of other professions.

Often, such “evidence” consists of data from randomised controlled trials (RCTs), non-randomised trials, case studies, qualitative focus groups and interviews, and a range of other sources.

Nevertheless, many decisions in mental health care, whilst being informed by such an evidence base, rely heavily on clinical judgment. As noted in Daniel Kahneman’s seminal Thinking, Fast and Slowclinical judgment is often not as reliable as it seems, especially for longer term outcomes.

Then, there is also a need for practice-based evidence or the collection of evidence during on-the-ground work to measure outcomes for the individual client.

Unfortunately, the simple removal of a psychiatric diagnosis (e.g. “You are no longer depressed”) cannot be considered an accurate measure of change for an person. For decades the unreliability of psychiatric diagnosis has been flagged as an issue and unfortunately not much has changed. Indeed, such diagnostic categories are not even considered scientifically valid.

However, a range of scales and measures are available to monitor change for various problems. One example might be the Internal States Scale for someone having problems with fluctuating mood, the Hospital Anxiety and Depression Scale for someone who is feeling low, the Self-Compassion Scale for someone who is trying to develop compassion, or power mapping to measure someone’s level of personal control within their lives. Positive aspects of a person’s life can also be measured, such as user-defined recovery, quality of life, empowerment, and subjective wellbeing to name but a few.

Outcome measures can also be more tailored to the individual. Subjective units of distress, personal goals (with a clear 1-5 scale of how close one is to achieving the goals), subjective blob trees, and six part stories are other ways to measure the impact of interventions. In fact, such personalised measures may be more meaningful than a set of standardised questionnaires, which can often lack context.

Measures can be helpful to see whether an intervention is staying on track, and may give permission to discuss topics that are difficult to bring up (such as sex drive or self-harm). It may be that the professional has missed something in their questioning, which is revealed through outcome measures to be important to the client.

Clients may also value being able to review their progress, and there are some indications that the use of outcome measures can improve therapeutic outcomes. Outcome measures may additionally support the clinician to reflect upon their work, and ensure that the clinician’s views on progress match the client’s reality.

There are, however, some concerns about using outcome measures in clinical practice. This might include burden, time, and paperwork for both client and professional, concerns about relevance and helpfulness of scales, and also concerns that any outcome scores may be misused by others. An over-reliance on scales to measure outcomes may not be helpful or meaningful. Additionally, scales can only see a change in the concept that they are measuring – for example, a mood scale may miss out key components in somebody’s social life.

As such, like any clinical tool, outcome measures should be used in a person-centred fashion. Good clinical practice involves firstly using an outcome measure that is relevant to the individual. If a person who feels tired and low wants to get out more and make new friends, it may be helpful to set goals related to increased activity (rather than, say, simply using a scale of how low the person feels).

Secondly, an outcome measure should be feasible for the person. For some people, an hourly record of their day might be too much to ask, whereas for someone else it may be helpful and motivating. This can be subject to some experimentation and playfulness – the measure does not have to be “right” the first time but can be considered a work-in-progress.

Thirdly, an outcome measure should gather enough information to be useful, and no more. After all, measures take time and effort to fill in, and it is not ethical to ask someone to collect information that will not be used.

Finally, the progress of outcome measures should be shared and discussed with the client. They should not be collected simply for the sake of the professional, or the service, but should be a meaningful addition to any therapeutic intervention.

Therefore, whilst the concept of evidence-based practice is well known in mental health care, there is an important role in collecting outcome measures as part of everyday practice (practice-based-evidence). As long as such measures are focused on outcomes that are meaningful to the client, and are used in an ethical and person-centred fashion, they can prove a valuable – if not integral – part of clinical work.

Genocide Survivors: Contributors not Victims

Polish-born Holocaust survivor Meyer Hack shows his prisoner number tattooed on his arm during a news conference at the Yad Vashem Holocaust Museum in Jerusalem June 15, 2009. A 95-year-old Auschwitz survivor, Hack, donated jewellery he took from the clothing of Jews who were gassed to death at the Nazi camp to Yad Vashem on Monday. Hack, who now lives in Boston, found the gems while sorting the clothing of victims sent to die in the gas chambers, which was his job at the camp where his mother, brother and two sisters perished. REUTERS/Baz Ratner (JERUSALEM CONFLICT SOCIETY) - RTR24OVC
Polish-born Holocaust survivor Meyer Hack shows his prisoner number tattooed on his arm during a news conference at the Yad Vashem Holocaust Museum in Jerusalem June 15, 2009. A 95-year-old Auschwitz survivor, Hack, donated jewellery he took from the clothing of Jews who were gassed to death at the Nazi camp to Yad Vashem on Monday. Hack, who now lives in Boston, found the gems while sorting the clothing of victims sent to die in the gas chambers, which was his job at the camp where his mother, brother and two sisters perished. REUTERS/Baz Ratner (JERUSALEM CONFLICT SOCIETY) – RTR24OVC

Listening directly to survivors and learning from them have provided me with the most powerful, inspirational, and insightful lessons. Individuals who witness the dark side of humanity have much to teach us about coping and adaptation. In the words of Elie Wiesel, Auschwitz survivor and Nobel peace prizewinner, “Listen to survivors, listen to them well. They have more to teach you than you them!”

Unfortunately, genocide and war did not end with the Holocaust. People continue to be displaced by global armed conflict. The United Nations High Commission for Refugees (UNHCR) reports that in 2015, over 60 million people have been displaced. Holocaust survivors are among the oldest living survivor populations of genocide and war. Lessons learned from working with them as they recovered from and transcended victimization can benefit survivors of other mass atrocities around the world who are trying to recover from similar ordeals. It sends a message of hope to these communities that recovery is possible.

In my work, I focus on strengthening and leveraging their coping skills that have remained strong and intact and minimizing limitations and handicaps. Practicing from a strengths perspective begins with the premise that every individual, family, group, and community has strengths (positive attributes and abilities, knowledge, resources) that are mobilized to achieve their goals and visions (Saleebey, 2006). By changing our perceptions, and seeing them as survivors rather than scarred victims, we move away from the traditional deficit model of mental health to one that is competence and strengths based.

When I first started this program 18 years ago many survivors cried when we had entertainers and music. They missed their families during happy occasions. They were still grieving their losses and did not give themselves permission to experience joy because it was difficult to detach from their suffering. Some survivors felt that living with painful memories helped them keep memories of their murdered families and friends alive. They believed letting go of their pain and suffering would betray those who were murdered during the Holocaust.

In recent years, we noticed that group members were able to recover from the after-effects of their horrendous ordeals. They are able to laugh and give themselves permission to have a good time, demonstrating their detachment from their suffering. In fact, they request lighthearted and fun-filled programs so they can enjoy themselves. They are also aware of their needs and are able to modulate their emotions when these are triggered by an external event that reminds them of their war experiences, e.g. terror attacks in the media.

My approach led to the development of a Drop-in Centre for Holocaust Survivors that I refer to as a group trauma recovery model. This program provides a safe environment where survivors interact with their peers and learn coping strategies that include a holistic approach to well-being. They grieve their losses together by participating in commemorative events and creating mourning rituals. They also participate in activities that bring meaning and purpose to their lives such as publishing a book of memoirs and experiencing themselves as “witnesses to history” through intergenerational programs. This program takes place in a community setting and is run in partnership with survivors where they serve as the Board of Management.

As service providers, it is essential to have a theoretical framework for practice to guide our work with individuals and groups. It is imperative we acknowledge survivors’ coping abilities and resilience that co-exist with their post-traumatic symptoms such as intrusive recollections, sleeplessness, anxiety, and depression.

Reference

Saleebey, D. (2006). Introduction: Power in the people. In D. Saleebey (Ed.) The strengths perspective in social work practice 4th ed., 1-24). Boston: Pearson Education.

Leaving Room For Change: Beyond Evidence Based Practice

Those of us in the social work profession have spent at least 4 years at university studying the intricacies of human behaviours, and thousands of hours analysing a myriad of models and theories that claim to provide the “solution” to people problems. Every model taught has undergone rigorous testing by suitably qualified professionals in order to prove validity, and to claim its stake in the world of “best practice” or “evidence based practice”.

We exit university feeling well equipped with an abundance of knowledge and an ability to adapt what we have learnt to any given client situation. Ethically, we’re bound to continue our professional development and keep ourselves up to date on the latest findings that add to, question or replace the strategies we were taught, and have started to use with our client groups.

prescriptiveHeading into the “real world”, we soon realize that the organisation (or its funding body) will regulate which models we will use with our particular client group. This may feel “prescriptive” for a while, but soon we’ll either be convinced, or told, that this is the latest and most effective evidence based method of intervention for your particular client group.  We may sprinkle in a portion of our own personality, and if particularly brave, insert a couple of our own ideas throughout the intervention process.  How and when this sort of “insertion of the worker’s own interpretation” occurs does not appear to be of much (if any) concern in overall evaluations.

The assertive among us may even go so far as to suggest CHANGE to some of the old “tried and true” strategies. But we’ll soon realize that we need a team of researchers and multitudes of clients willing to be guinea pigs, to provide that much-needed “evidence”. Time consuming. Probably cost prohibitive.  We’re probably already overworked and underpaid.  Perhaps it’s best to just stick to the existing  prescription.  After all, the “experts” have stated that all the research points to evidence that this works. Furthermore, organisational managers who have a management perspective (as opposed to a client perspective) start to adapt these models as “evidence”  to show they are following procedures which have a “proven” methodology. Models have measurements to gauge outcomes, and outcomes justify organisational spending.

Here comes the irony. Interestingly, we encourage our clients to embrace change. As social workers, we are often called “change agents”.  How then, can we justify a profession that is becoming “prescriptive” by the very nature of insistence on “evidence based practice”?

Now before I am bombarded by those proponents of evidence based practice who only read part way through a document – I urge you to read on.

changeBy no means am I inferring we do away with tried and tested models of intervention. Nor would the removal of “evidence” of effective practice achieve anything bar chaos. What I am suggesting is that “prescription intervention” has an inherent risk of the helping professional becoming complacent in his/her  practice. Take that complacency to its limits and we may well end up with workers who  place expectations on client responses. After all, if there is a generic “correct” model of intervention, then there must a generic “correct” client response.  Yet nothing could be further from the truth – we all know that client responses are as diverse as client circumstances.

So wherein lies the balance? The balance lies in perspective. It’s about how we view a particular model. The key is this – models are not meant to be prescriptive, they are a guide.  We value individual differences, so leave room in your practice to adapt, to be innovative, to be flexible according to your particular client needs and circumstances. Look beyond the prescription. Best practice is about best outcomes for clients.

Most of all, focus less on the need to be rigidly mindful on a model and start to use creativity, flexibility, authenticity, innovation and adaptability to ensure that any model of intervention remains relevant to client needs.  And if you think perhaps you’ve fallen into the trap of complacency, consider the need for some time out to regain that sense of wonder, intrigue and sense of justice you once had in your early practice years. Why? It is important for social workers to retain the ability to function effectively as a “change agent”.

Let’s just look at those words again – creativity, flexibility, authenticity, innovation, adaptability. A little outside your comfort zone? Not quite sure where these things fit into social work?   Let me remind you of Einstein’s quote “the definition of insanity is repeating the same thing over and over again and expecting different results”.  If you are not creative, flexible, innovative, authentic and adaptable in your own practice, then how can you empower your clients to make change?  If you adopt one particular “modus operandi” in your practice, relying solely on what has been presented to you as “evidence based practice”, then where will new ideas come from?  If you view one particular model as the generic answer to your client group’s issues, how will innovative new practices ever evolve?

It isn’t simply a case of sitting in the status quo of a current model and insisting on its merits because it has “proven results”, or because the company that pays your salary insists that you utilize a particular method. If you see a need for change, then speak out. Act on it. Find others in the helping professions and discuss their experiences.  After all, isn’t that what we encourage our clients to do?

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