8 September 2010
Current Trends in child abuse and neglect in the United States: What might Australians learn and disregard from this evidence base?
Abstract, slides and audio of presentation
Edited transcript
The following audio presentation is brought to you by the Australian Institute of Family Studies as part of our monthly seminar series in which we showcase national and international research related to the family.
The seminars are designed to promote a forum for discussion and debate. They are open to the public and free of charge.
Seminar facilitated & speaker introduced by Dr Daryl Higgins.
Professor Marianne Berry:
Good morning. It's a delight to be here, truly. Been in Australia - this is my fifth week on the job as the director of the Australian Centre for Child Protection at the University of South Australia. It's my seventh week in Australia. I came here - first of all I want to acknowledge the traditional owners of the land on which we meet today, the Wurundjeri people of the Kulin nations and pay my respects to elders past and present. I also want to express my gratitude to the Australian Institute of Family Studies and to the organisers of Child Protection Week. We have no such week in the US and so it's very impressive to me. I wish that someone here had told me back in July that my fifth week on the job here would have been Child Protection Week, when all the phone calls started coming in last week, being the director of the Centre for Child Protection. A little warning would've been nice, so we've been a bit scrambling in the office to make profound statements about child protection. It's an honour to be part of the event, Child Protection Week.
For me it's also an honour to be here as a recent migrant to this country and the new director of the Australian Centre for Child Protection. I know that that's no small measure of the interest in this country for information from a variety of places to inform what you do in practice in Australia. I am deeply humbled by that and intend to remember my place in this country, as the director of the Australian Centre for Child Protection. I emigrated here seven weeks ago from the United States seeking asylum from a country in a political morass. I'm beginning to wonder if I chose correctly.
As I said, I've been at the Centre for Child Protection for about a month now and pleased to be joined by Dr Leah Bromfield over here as the deputy director at the centre, starting at the same time I did. She has a long history with the Australian Centre - I'm sorry, the Australian Institute of Family Studies, and we were very lucky to hire her and bring her to Adelaide. She has been instrumental in helping me get my feet on the ground here, not only in terms of child protection facts, understanding the sector, as I'm learning to say.
She's also teaching me all the acronyms I need to learn, of which there are many. I told someone back in the States recently that I recently went to Alice Springs as a member of ARACY to meet on the APY lands to talk to a member of FaHCSIA about an ARC grant. And I have no idea what that means. So I'm learning.
But I can tell from everything that Leah knows and is able to share with me just off the top of her head about the services in this country, the needs of children and families in this country, that she is a huge gain for us and a huge loss for you at the institute here. So we are very appreciative to her.
People ask me whether I'm experiencing a big culture change in moving from the US to Australia. The longer I live in Adelaide the more I appreciate that perhaps the bigger change was Leah moving from Melbourne to Adelaide. She's getting quite a few comments - oh Melbourne.
One of the reasons I was recruited to the Australian Centre for Child Protection was my knowledge of the evidence base in child and family services, my ability to conduct sound research and to communicate the results of research to a variety of audiences. I hope my talk today will affirm that assessment. There's an evaluation form to let me know if I do. I'll also take this opportunity to emphasise that my experience and expertise is in the area of child protection, children at risk of maltreatment, children and families receiving child protective services, and children in out of home placement. The centre is therefore focusing - and that's Leah's as well. The centre is focusing our efforts on that population of children and families.
I absolutely appreciate that there's a vast array of services and supports in Australia for families across the spectrum of need. I think in Australia there's a much more cohesive and impressive array of prevention services and early intervention services and the collaboration involved. That seems to be working a lot better here than in the US. What that allows us to do at the Australian Centre for Child Protection is indeed focus our efforts on the child protection population. That will be our part in the larger system that you have here in this country.
These are the three things that we intend to do as we frame our vision for the Australian Centre for Child Protection going forward, certainly building on the strong base that Professor Dorothy Scott has laid down in the past five years. So we're moving forward and - moving forward, sorry, I thought we were over that. Providing knowledge and skills for workforce development with high risk communities and everything we do will be based on a sound evidence base.
What I'd like to do today is review the evidence from the US about what's effective with this population, the services that are effective with children at risk of maltreatment, children experiencing maltreatment, children at risk of out of home placement, especially looking at the components of services. I'm not going to be talking about general packaged treatment models. I'm going to be talking about components, what some have called kernels of effective practice elements. I find those much more translatable, much more transportable than entire models, particularly - I'll get to that - then certainly place the evidence that researchers are finding in the US, place that in the Australian context with some questions, basically, about how much of that would translate here and perhaps might not.
I've been coming to Australia for about 10 years now, working with a variety of agencies, doing some keynotes at conferences, but also working closely with agencies in preparing training and doing a bit longer term work. I don't just come here to speak at people, I come here to talk and listen as well. What I have seen in general, not in every instance but in general, there seems to be a hunger to bring models, to bring practices from the UK or from the US because our countries have bigger research budgets typically. We have a lot of research support in those countries and obviously if we've developed this and we've got the evidence to support it, then let's ship it over here and put it in place. And I've seen that happen here, as you have too, with mixed results. I think you absolutely have to take context into account, and not everything is going to translate.
To serve as an academic for a minute, when you measure - I'd like to talk a minute about prevention, having said that the Australian Centre for Child Protection is going to focus on child protection, children at high risk of maltreatment, being maltreated or needing to be removed from home because of maltreatment. Again, we recognise that that takes place in a larger array of services. A big part of that array here is early intervention and prevention services, which is great. To measure - to evaluate that, whether the prevention of harm or the early intervention and the prevention of maltreatment is occurring, you have to decide what it is you're trying to prevent. So we look for signs of the absence of protection, which is typically maltreatment. If the child wasn't protected, if protection wasn't working, prevention wasn't working, then we see signs of abuse.
Now, that's really difficult to measure. As we know, notifications are a measure of who gets reported. Notifications are not a measure of exactly how much maltreatment is occurring in any particular community, it's a measure of how many kids are getting reported. So we know that just going by notifications, from my point of view, is a better measure of how well your notification system is working rather than how much abuse is actually going on in your community. I would like us to be very careful about using abuse numbers, using maltreatment abuse reports as an indicator of effectiveness of prevention.
If your prevention programs are working, your abuse notifications are actually going to increase. If your prevention programs are working, you're going to be identifying more children being abused, and your abuse numbers are going to go up. And it's hard to say this, but that's actually a good thing, and it's really hard to convince politicians of this fact, to expect the numbers to go up. We expect the numbers to go up and then to go down. We want to identify those kids being abused and those families, get the interventions in there and hopefully the interventions will be successful enough that the child will not come back around into the system.
We certainly know that reports are often re-reports. Families keep coming back. They're the same family that keeps showing up in reports from year, to year, to year. So in the early going of good preventive work you're going to identify more kids who are being abused. In the long run you're going to winnow it down because hopefully you're going to be effectively serving these families so that the abuse stops and they don't keep coming back up to the surface. That's going to be a hard pill for politicians to - that is a hard pill for politicians to swallow, particularly those who are focused on short term outcomes. It takes folks in the sector to help people understand that we want to know who those kids are, so therefore identify more of them so that then we can serve them.
There's a short documentary - not documentary, a fictional portrayal showing tomorrow night on ABC TV. It's a part of Child Protection Week called Polly and Me. I assume many of you have heard of it, if not, let me tell you about it. It's going to be on ABC tomorrow night at 9:30 - is that correct - for an hour. The first 25 minutes is Polly and Me which is a fictional film about a child in a high risk family who experiences a variety of types of danger in her family and maltreatment.
It's part of Child Protection Week to increase public awareness about - Polly could be in your neighbourhood. Polly could live down the street. Polly could be a student in your classroom. Polly could be a patient in your medical practice - to help increase awareness. When awareness increases the number of reports is going to go up. So we shouldn't panic when numbers go up, if the system has the capacity to serve those families and those children once they're identified.
I believe that in Australia you have a strong prevention and early intervention network. I don't have a lot of evidence to this effect, I think we're still counting that, or it might be early in the game and I just haven't learned yet about the effectiveness of those programs here. But in the long run the abuse numbers should actually go down.
How do we truly measure if prevention programs are effective? We actually need a national incidence survey. An incidence survey - we've got one in the United States called the National Incidence Survey, it's in its fourth year. It's got folks on the ground in a variety of just normal everyday places where you might see children who have been maltreated but don't typically come to the attention of child protection agencies. That study has got folks all over the country called sentinels who are counting children who have signs of endangerment, that they're in danger harm, and then signs of children who have been harmed. So we have on a much broader population scale level, not just within the protection arena, but across the population we have better counts of how much maltreatment is actually occurring.
What we're seeing in the US - it's now in its fourth wave - the results of the fourth wave just came out in January of this year. What we saw in the fourth wave is that physical abuse, counts of physical abuse in the general population in the US have gone down per capita. They actually are decreasing, which we are taking as a sign of good early intervention effects. You can't draw a direct line but it's nice to know that physical abuse is going down. Neglect is holding steady. Counts of neglect are holding steady.
Given the global financial crisis and given that the US is a really big part of the global financial crisis - I won't take personal responsibility but we are kind of the hub of the whole problem - Wall Street is the hub of the whole problem - it has hit American families particularly hard and we can that in the neglect numbers that are showing up, the economic problems associated with neglect. It's not surprising that the neglect - to me - that the neglect numbers are holding steady.
In Australian you don't have an incidence survey but you have the longitudinal study of Australia's children where you can measure children's developmental, physical and psychological experiences that lead to different experiences growing up within a nationally representative sample. You have a report, you do know how many kids are involved in the child protection system nationwide. So what you can count, what you can measure in Australia at this point, without a national incidence survey, what you can measure is you can look at that population of children within the child protection system who are already identified in the child protection system and have been identified in your prevention programs as being at high risk of maltreatment. So that's great for us 'cause that's where we're going to focus for the Centre for Child Protection because that's where we're going to focus our attention and our efforts.
We know that there are a variety of other institutes, such as you own, such as AIFS, that are attending to a much broader spectrum of need and research. We simply want to take our place in this larger array of services and do the best we can for that population.
So in looking at the evidence base - for this talk I've looked at those programs that work with already identified maltreated children. We know outcomes of recurrence of maltreatment, maltreatment occurring among kids we already know to have been abused. Have we done things that help prevent recurrence of maltreatment, in other words, help the abuse stop, and can we look at lower rates of out of home placement, are we able to keep more children safely at home. Those are the outcomes that I try to count.
As a researcher, I have a bit more confidence in our ability in those numbers in the counts that we have in that fairly well defined population. My confidence in the larger numbers of children being abused is a bit more fuzzy so I'd rather focus - as a researcher I'd rather focus on a population that I can put some parameters around.
That was a long preamble to why we're looking at this population, so let's get to the point. What are the effective components of programs that serve maltreated children and their families in the US evidence. And again, when I talk about the US evidence I do that because I'm from the United States. I have no credibility in talking about the Australian evidence, having been here for seven weeks. I've certainly been reading it for a long time but I also know that you're highly innovative - don't want any controversy about how I say innovative - I'm learning. So when I talk about the US I'm not here to say it's because we do it better in the US, here's what you need to do. All I'm saying is here's what we're learning in the US. Then I'd like to have a little conversation about what do you think about whether that's going to work here or not and share some of my own thoughts about things that would and would not, have and have not worked when translated here.
So what we know from the US research that's looked at a variety of demonstration programs. We have huge federal monies being put into research in the child welfare and child protection arena. We have a lot of research money and we throw a lot of money at researching children and family programs. We are able to do fairly large scale good research on demonstration programs, on evaluation of programs, on some basic research of interventions that work with families and children in the US.
Much of the evidence points to the effectiveness of home based parenting programs, working in the home one on one with families. It works on one on one learning and practising of skills in the home with the family. Modelling skills, practising skills, the worker in the home praising what goes well, helping the parent think of alternatives when things don't go so well, taking apart why a particular parenting practice may or may not be effective in this situation. But again, always building toward gaining a skill. So you have a very clear outcome of what you're working toward, the skill of positive discipline rather than harsh discipline. The skill of establishing authority rather than having the child running the household. The skill of adequate supervision rather than not knowing where your child is, those kinds of things.
Teaching these skills is best done when it's done within a caring relationship between the worker and the carer in the family, the parent typically. These skills are best taught, most effectively taught in a one on one interaction. There is a multitude of research in the US that says that parent training programs done in a group, done didactically, where there's a person talking and there's people texting, doesn't work, it's ineffective. There's very little opportunity for practice. You could be doing all kinds of things out there, reading the [Op-Ed page] which is fairly interesting today, a variety of things. At the end you'll get a certificate that you attended. And if you're a child protection parent you can take that to the judge and say you attended parent training,
There is no evidence that those programs are very effective at all and there's no evidence that those programs have long term enduring effects on actual behaviour. Nonetheless we continue in the US to provide them all the time. They're efficient, you can get a lot of people in the room. You can provide it to a bunch of people all at the same time and that's great, except that it doesn't actually accomplish anything. So the process is nice and cheap but the outcomes are very expensive because you didn't really accomplish anything. People don't like to hear that but I can refer you back to all kinds of evidence that says it doesn't work.
What you need is one on one sharing, learning, practising, the ability to practise these new skills and get all kinds of praise and encouragement when they're done correctly and where the worker can model them with the child. And done within a caring relationship so that people are paying attention. This isn't necessarily a caring relationship, right, you're kind of sitting there saying what does this yahoo from Kansas - you know what a yahoo is? Like a - what's a word - shoot, what's that word, starts with a B - bogan, thank you - what's that bogan doing up there, what does she know about what we're doing here. I love this language. I absolutely love this language. And I'm teaching my staff some interesting language too, I must say.
So there's not this warmth here. There's a lot of sitting there going well, we'll see what you have to say and whether we think you have anything to say or not. When you're one on one in the home - one, there's all kinds of things that you've demonstrated to the family when you come to the home - I'll talk about that in a minute - and the translation and learning and gaining of good skills is much more likely to happen.
Okay, so there's all kinds of opportunities for praise, we know that's critically important. It always surprises me when I praise anyone in my day to day interaction and they're really surprised that they got noticed, that I noticed this little thing. We don't do enough of it. We're too in a hurry, we assume that everybody knows they're good at what they do. But if you tell them you're really good at what you do - really, you think so? Yeah, yeah. And we make the information clear and concise, not lengthy and complicated. So following that advice I'll move on.
The most important element of effective practice in the child protection arena in child protective services is in the engagement of families. No matter what you do with families, the family has got to be on board. And hopefully we've gotten away from the language of non-compliance, resistant, all of those words that we used to use And we recognise now that it is not the family - in the child protection arena, or any arena really, it's not the client, the parents' job to get engaged with us. That is not their job. It is our job to convince them why this is a worthy journey to go on with us - on which to go with us. That's our job. If the family's not on board, what do we need to do differently instead of just criticise the family for being unco-operative. So learning good engagement skills is probably the most important thing that we can do.
Here's a variety of things that you can do to help engage families. I don't know that you do all of these in any particular case but these are the things that in research with families, families have identified when they were asked what was it about this service or this worker or the structure of this program that got you engaged in it, that interested you and kept you come back. Also as workers, what was it that you saw in the family that showed you they were in. What kinds of things were you doing where you saw a response from the - what kind of behaviours were you doing as a worker where you were getting a response from the family that showed you they were in it, they were buying in.
Here's several. It's important to include staff that look like families. For example, you can include community members in recruitment and delivery of services. I'm not an advocate of matching workers to clients based on some arbitrary things like ethnicity, community of origin or anything like that. I think that's dangerous business. However, the evidence is telling us that when the community of helpers has folks in it that represent, that look like the community service recipients, there's much more engagement and there's much more buy in, and much more understanding, ability to form relationships and understanding between both parties.
Workers are effective when they don't judge or blame the parents or the children. They are non-judgmental, they show acceptance, compassion, understanding. If you're a worker you know all this already. But just to confirm that the data is backing you up. Listening without turning against the parents or the children, not becoming adversaries. I think this is particularly important - I think that the whole notion of either working against a family or working with a family - this is an aside.
This is not on the slide but this is an aside. I think that's going to be critically important. It is critically important. The more and more that we talk about interagency - is this working - interagency collaboration, there's more and more talk in the US, here, and in a variety of places about how no one service - that families have multiple and complex needs. No one service can do everything or be expert in the skills and resources and supports that a client or a family needs. So you have your child protection worker or your child and family worker. You also want to link those folks to alcohol and drug services, domestic violence services, mental health services - what am I missing - homelessness services et cetera.
We talk about that a lot. We're talking about that at the Centre for Child Protection, we talked about that in the US a lot. Everyone in this room is involved in efforts at that. What we've seen in the US - I haven't seen it yet - I'm unaware of how well this is going in Australia. I hope it's going better than in the US because what we're seeing in the US is that each of those agencies is taking ownership of their particular client and their particular client's needs. So people who work in domestic violence typically take the mother as their client, and whatever the other agencies who are collaborating would like to do is judged against is this good for my particular client and her goals or not. In alcohol and drug programs the adult in the family is typically the client. And when a child protection worker is saying we want to try to see if we can keep the whole family together, to work together, but because the child's developmental clock is ticking, we don't want to take forever to come to some resolution of these problems, we want to see things happen quickly. The alcohol and drugs people are saying it takes time, there's going to be relapse, this doesn't happen overnight. Kicking an addiction does not happen overnight, you've got to have some patience with this.
So there are these differing philosophies and these differing - they're not just philosophies - understandings of the problems facing any particular person in a family. They absolutely differ. In the US we're seeing a lot of these collaborations turn into somewhat adversarial relationships. As a newcomer to this country, I'm intrigued to see how that plays out here in the communities of service that you have. You have a much more polite society here, you just do, so I'm curious to see. Americans are brash and we love to disagree. That's why we go to court all the time, so we can disagree in public. So I'm really curious to see how that plays out here. That's an aside.
Engagement happens when workers are honest and encouraging, even when the news is less than positive. The number one thing, the number one behaviour that will disengage parents, where parents will turn it off, they will say that's it, I'm done, is when they discover dishonesty, when they discover that someone didn't tell them the truth or someone withheld the truth as to what was actually going to happen. When families go into court, for example, and get blind-sighted by an option that they didn't know was a possibility, that really could've been discussed with them beforehand, or when children are blind-sighted, it's over, the relationship is over, and it's irretrievable. We have got to be able to tell the truth, gently, but the truth. We're not helping anybody.
In the US it's very helpful - one of the big things coming out in the US research is help with concrete needs, like the provision of health care and the provision of financial support, getting families tied into medical care, dental care and all kinds of financial supports, housing, general financial assistance and so on.
Another thing that families and workers both say - particularly families, is that engagement happens when families feel like the worker feels the same sense of urgency to make things happen, to get this case down the road, to get their child back, or to make the family safe, make things safe. On the converse, if the family does not feel like the worker has that same sense of urgency, that is saying yeah, the next time I can be here is in two weeks so we'll see what happens then, or I'm hoping to get a phone call back - no they didn't, I'll try next week, that's when you lose engagement, is when families don't feel like they have the same - that they're worried about this and for the worker it's another case, it's just another case in a very large caseload.
In the US we're finding that it's very important to be able - if you want families to work with you, it's really important to provide all the ancillary services around it, like transportation, child care, the things that make it possible for parents to show up at a service, participate in a service, without having to arrange their own transportation, care of the children, feeding the children et cetera, while they're gone. In the US agencies have been very successful when they have flexible funding to come up with creative solutions to problems, but it's not all categorical, you can only spend money on this spread sheet in this category for this need, for this need, for this need, for this need, and on these services. The agencies that are more effective are when workers can cobble together a creative solution based on thoughts that the family has about what might actually work, or what they actually might need to solve some problems in their family. And then of course meeting with the family in their own home.
Again, if the basis of an effective - if the services that we find are effective in helping families make changes, and if we know that the effective components of that are about working one on one with families to see, model, learn and practise new skills, that can only happen when both parties are engaged in the learning and the practising. So these engagement steps are the critical first step to then making those kinds of interactions possible.
A little bit on - I'm looking at the clock - a little bit on - so what does this mean for Australians. I'm involved in an international group of child protection scholars, there's about 30 of us, and we meet once a year, typically in Italy because that was where the group was founded. We're conducting international research on a variety of topics in small groups of these 30. I had the privilege of directing a research project in most recent years that looked at engagement of families in home based services in eight different case studies in countries around the world, primarily westernised countries. We're still working around language barriers, so just sticking within westernised countries is a good way to go, while I'm still learning Hebrew and Italian and Dutch to help me get through meetings, which is a good by-product.
That started about eight years ago. That's been instrumental in me gaining an understanding of the importance of context to whether services are effective. When I talk about context, I mean social, national, political, cultural. Cultural really comes into effect when you talk about when does the family stop and the community begin. If you think about the different communities that you serve, the boundary between family and folks outside the family can really vary. Sometimes family goes really far out, the sense of family moves way out into the community. For others, Americans, it comes way in to the people that live in my house. We are all about you mind your business and I'll mind mine, and don't be telling me how to raise my family.
In looking at other countries - Israel, Italy, I'm learning about the difference in boundaries - in just the definition of what constitutes family, the importance of religion, the importance of history of a country and what constitutes a helping relationship between outsiders and folks in the family. It's all really critical. And you know this. I've read a lot of your literature about approaching families, working with families in different communities around Australia. You know this. And if you know this, then I'm hoping that you're extending that knowledge too. Therefore don't bring in westernised models that have been proven effective in countries like the US that have very nuclear families that need all kinds of formal help because our informal networks are so small, right? Get that? So you've got to consider context. This is the name of the group that I'm in, by the way.
Let me go back. Here's a point. For example, in Australia - this will be my last comment and then we can take some questions about what this all really means in Australia. For example, in the US we don't - you know this - we don't have universal health care. We have greatly diminished our ability to provide financial assistance to people in poverty. You can receive financial benefits for a total of two years across your entire life - your entire life - from the government.
What that has meant is that as folks have come to the end of their ability to receive financial assistance from the government. They've often moved, because of a definition now of neglect in their family, right - 'cause they're not feeding their children, they're not taking care of the medical needs of their children - they now become a neglect case, they now become a child protection case, primarily for economic reasons - illogical and immoral.
You in Australia have a universal health care system and you have a decent standard of living and you actually have a sense of the need to care for your fellow woman and man. And apologies to Americans in the room, we don't, it's every man for himself. Go west young man, establish your own - pull yourself up by your boot straps et cetera. So just right there you already have a much stronger sense of community and sense of a social safety net than we do. That means that if the US research is showing that what's really critical to effective services and good outcomes for kids, is tying them into medical care and tying them into financial assistance and what we call the provision of concrete needs, that may not be so critical here.
The problem we have in the US is that once kids get into the child welfare system in the US, they're getting health care for the first time in their lives. [Thudding noise]. They're getting health care - did somebody faint? They're getting health care for the first time in their lives. So all kinds of needs, sicknesses, illnesses, disabilities that they had are actually getting treated. So why would we be surprised when we go back to court and we say this family's done, we're ready for this child to go back home and be released - why would we be surprised when the judge says I don't think so, I really like how this kid is doing here. If we set him free, if we send him back, he's going to lose all that medical care, the family's going to lose the financial assistance they've been getting. So let's keep them in a court ordered system so that the court can order that these people are actually treated decently. It's just bizarre. It's illogical. It's bizarre.
So when you look at US models that are built around this array of services that are provided to a family, I really hope that you'll look very carefully at the national and political and social and economic assumptions that are underlying these models and therefore the services that need to happen in these models. What is consistent across models in all countries is the importance of a sound, caring, compassionate, non-judgmental relationship - across the board. There's all kinds of things we can do to make that better in every working relationship that we have.
What is not consistent is the specific elements. And I think what you can do as Australians, and what I hope that we can help you do at the Australian Centre for Child Protection, is identify those pieces, those components, those elements of service that will work well here in different context and in different communities. I don't think there's an Australian model. I think there's community models that will work in different places. And I hope that we can help you determine the most effective, given the risks and needs in the particular population that you are trying to assist. That's the end of my comments. Thank you very much. I appreciate your attention.
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