Think Child, Think Family, Think Community Enhancing the Capacity of Adult Services to Protect and Promote the Well-being of Vulnerable Children Professor Dorothy Scott

Enhancing the Capacity of Adult Services to Protect and Promote the Well-being of Vulnerable Children

Professor Dorothy Scott

Enhancing the life chances of Australia’s most vulnerable children through: research and strategic evaluation professional education communication and advocacy

Enhancing the life chances of Australia’s most vulnerable children through:

research and strategic evaluation

professional education

communication and advocacy

History of Child Protection First wave – nineteenth century “child savers” began the “child rescue movement” for destitute and physically abused children Second wave – 1960s ‘discovery’ of ‘battered baby syndrome’ and 1980s ‘discovery’ of child sexual abuse leading to investigation focus and mandatory reporting laws .. and the Third Wave? – a twenty-first century public health approach to prevention and remediation?

First wave – nineteenth century “child savers” began the “child rescue movement” for destitute and physically abused children

Second wave – 1960s ‘discovery’ of ‘battered baby syndrome’ and 1980s ‘discovery’ of child sexual abuse leading to investigation focus and mandatory reporting laws

.. and the Third Wave? – a twenty-first century public health approach to prevention and remediation?

Australian reports of child abuse

Primary Maltreatment Type, Australian Substantiated Cases 2006/07 Australian Institute of Health and Welfare, 2008

Parental Characteristics Department of Human Services (Vic) data 2000-01, substantiated cases: Domestic violence 52% Substance Abuse 33% Alcohol abuse 31% Psychiatric Disability 19% (sums to more than 100% due to some parents having more than one characteristic)

Department of Human Services (Vic) data 2000-01, substantiated cases:

Domestic violence 52%

Substance Abuse 33%

Alcohol abuse 31%

Psychiatric Disability 19%

(sums to more than 100% due to some parents having more than one characteristic)

Queensland In over one third of child protection case files, 2 or more domestic violence incidents recorded in the past year. In over one half of child protection case files parental alcohol abuse is recorded. (Dept of Child Safety, Qld, 2008)

In over one third of child protection case files, 2 or more domestic violence incidents recorded in the past year.

In over one half of child protection case files parental alcohol abuse is recorded.

(Dept of Child Safety, Qld, 2008)

Parental Alcohol and Drug Abuse 13.2% of Australian children live in households where an adult is regularly drunk (Dawe et al, 2007) Parental alcohol and/or drug abuse is present in the cases of half to two thirds of children in State care

13.2% of Australian children live in households where an adult is regularly drunk (Dawe et al, 2007)

Parental alcohol and/or drug abuse is present in the cases of half to two thirds of children in State care

Systems under siege … In NSW in 2007 one in fifteen children was notified to Dept of Community Services In SA one in five children has been notified to Families SA by age 16 Victoria has instituted promising legal and policy reforms, and has a much lower notification rate and the lowest rate of children in State care, but the system is still under great pressure

In NSW in 2007 one in fifteen children was notified to Dept of Community Services

In SA one in five children has been notified to Families SA by age 16

Victoria has instituted promising legal and policy reforms, and has a much lower notification rate and the lowest rate of children in State care, but the system is still under great pressure

The ‘cure’ may be hurting children Rubin, O’Reilly, Luan & Localio (2007) followed 729 children for first 18 months in foster care. Found a high level of placement instability. This was strongly associated with a child’s behavioural problems at 18 months, regardless of the level of behavioural problems on entering care. Our current system may thus be causing harm to many children.

Rubin, O’Reilly, Luan & Localio (2007) followed 729 children for first 18 months in foster care. Found a high level of placement instability. This was strongly associated with a child’s behavioural problems at 18 months, regardless of the level of behavioural problems on entering care. Our current system may thus be causing harm to many children.

Data linkage study of 45,000 Illinois child protection cases matched for later offending behaviour. Compared cases of similar risk level where some children were placed in care and others remained at home. School aged children on margin of placement had lower adult arrest rates when they remained at home. National Bureau of Economic Research, 2007 ... and hurting the community

Data linkage study of 45,000 Illinois child protection cases matched for later offending behaviour. Compared cases of similar risk level where some children were placed in care and others remained at home. School aged children on margin of placement had lower adult arrest rates when they remained at home.

National Bureau of Economic Research, 2007

A Public Health Approach Whole of (and inter) government Population based Integrated primary, secondary and tertiary prevention strategies Ecological Evidence-based Family centred Ref: 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

Whole of (and inter) government

Population based

Integrated primary, secondary and tertiary prevention strategies

Ecological

Evidence-based

Family centred

Ref: 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

Families at risk of breakdown Disability Complex health needs Behavioual Problems Special Educational Needs Mental Health Issues Children in need of placement Child Protection Intervention Universal Prevention for all Children/Families Targeted Prevention and Intervention for Vulnerable Families

Key Elements 1. Broadening universal child-focussed services so that they are family centred eg. Maternal and child health services, early childhood education and care services, primary schools 2. Broadening targetted adult-focussed services so they are family centred eg Drug and alcohol, corrections, family violence, mental health, disability, homelessness, refugee services etc

1. Broadening universal child-focussed services so that they are family centred

eg. Maternal and child health services, early childhood education and care services, primary schools

2. Broadening targetted adult-focussed services so they are family centred

eg Drug and alcohol, corrections, family violence, mental health, disability, homelessness, refugee services etc

UK Policy Directions ‘ Child protection cannot be separated from policies to improve children’s needs as a whole’. UK Green Paper, 2003, Every Child Matters

‘ Child protection cannot be separated from policies to improve children’s needs as a whole’.

UK Green Paper, 2003,

Every Child Matters

English Initiatives “ Sure Start” Major anti-poverty strategies and early childhood interventions in high need neighbourhoods “ Every Child Matters” Legal requirement on agencies to work together, common assessment framework, common performance indicators, pooling of budgets, Children’s Trusts in LGAs, inspectorate model of accountability “ Think Family” Both adult and children’s services focus on the needs of the whole family

“ Sure Start”

Major anti-poverty strategies and early childhood interventions in high need neighbourhoods

“ Every Child Matters”

Legal requirement on agencies to work together, common assessment framework, common performance indicators, pooling of budgets, Children’s Trusts in LGAs, inspectorate model of accountability

“ Think Family”

Both adult and children’s services focus on the needs of the whole family

‘ Think Family’ Core Elements No ‘wrong door’ (contact with any service offers an open door to joined up support) Look at the whole family (services take into account family circumstances and adult services consider clients as parents) Build on family strengths (relationship and strength based engagement) Provide support tailored to need (not one size fits all)

No ‘wrong door’ (contact with any service offers an open door to joined up support)

Look at the whole family (services take into account family circumstances and adult services consider clients as parents)

Build on family strengths (relationship and strength based engagement)

Provide support tailored to need (not one size fits all)

Fields explored in UK lit review Mental health Drug and alcohol Young carers Child welfare Youth justice Disability Housing Domestic violence Cabinet Office Social Exclusion Task Force (2008), ‘Think Family: a literature review of whole family approaches’,

Mental health

Drug and alcohol

Young carers

Child welfare

Youth justice

Disability

Housing

Domestic violence

Cabinet Office Social Exclusion Task Force (2008), ‘Think Family: a literature review of whole family approaches’,

From ‘Family Aware’ to ‘Family Focus’ Working with family members to support the service user (dominant focus to date) Identifying and addressing the needs of individual family members as well (examples of this especially in relation to young carers and to parents of children with disabilities). Whole family support (emerging models of this in a number of fields eg family group conferencing, multi-systemic therapy)

Working with family members to support the service user (dominant focus to date)

Identifying and addressing the needs of individual family members as well (examples of this especially in relation to young carers and to parents of children with disabilities).

Whole family support (emerging models of this in a number of fields eg family group conferencing, multi-systemic therapy)

Family Intervention Projects For families with serious anti-social behaviour in public housing estates, a new service with core elements: Dedicated key worker Whole family assessment Contract re behaviour expected Intensive and structured support Integrated response to multiple needs

For families with serious anti-social behaviour in public housing estates, a new service with core elements:

Dedicated key worker

Whole family assessment

Contract re behaviour expected

Intensive and structured support

Integrated response to multiple needs

Family Nurse Partnerships (Olds) Dedicated family nurse for vulnerable parents with engagement in pregnancy Nurse taking responsibility for multiple needs rather than just ‘referring on’ Preventive, strengths based Tools and confidence for practitioners Methods that enhance capacity of parents to provide positive care of children

Dedicated family nurse for vulnerable parents with engagement in pregnancy

Nurse taking responsibility for multiple needs rather than just ‘referring on’

Preventive, strengths based

Tools and confidence for practitioners

Methods that enhance capacity of parents to provide positive care of children

Reflections on two examples of shifting to ‘thinking child and parent ’ From adult to parent and child: shift from focus on ‘maternal mental state’ to ‘mother-infant dyad’ in Queen Victoria Medical Centre Department of Family Psychiatry, mid 1970s From child to parent and child: shift in focus from paediatric surveillance (measure and monitor child health and development) to maternal and child health and well-being, in the then Victorian ‘infant welfare service’ (now ‘maternal and child health service’), early 1980s

From adult to parent and child: shift from focus on ‘maternal mental state’ to ‘mother-infant dyad’ in Queen Victoria Medical Centre Department of Family Psychiatry, mid 1970s

From child to parent and child: shift in focus from paediatric surveillance (measure and monitor child health and development) to maternal and child health and well-being, in the then Victorian ‘infant welfare service’ (now ‘maternal and child health service’), early 1980s

Preconditions of broadening service provider role Low conflict with other aspects of role Flexible inter-professional role boundaries Professional knowledge and skills Resources (time) to perform broader role Consumer acceptance of broader role Scott, D, (1992) Reaching vulnerable populations, American Journal of Orthopsychiatry, 62, 332-341

Low conflict with other aspects of role

Flexible inter-professional role boundaries

Professional knowledge and skills

Resources (time) to perform broader role

Consumer acceptance of broader role

Scott, D, (1992) Reaching vulnerable populations, American Journal of Orthopsychiatry, 62, 332-341

Factors to Consider Policy Context Organisational Setting Individual Practitioner

Roles are defined by institutions and service providers (and clients?) ‘… core responsibilities are defined by society’s central institutions, and these institutions possess powerful sanctions to ensure that they are fulfilled … beyond the core are marginal areas in which much more variation is possible. The occupant of the role may … limit his work to his core responsibilities or extend his involvement with clients to include other aspects of their situation.’ (McCaughey et al, 1977, 166)

‘… core responsibilities are defined by society’s central institutions, and these institutions possess powerful sanctions to ensure that they are fulfilled … beyond the core are marginal areas in which much more variation is possible. The occupant of the role may … limit his work to his core responsibilities or extend his involvement with clients to include other aspects of their situation.’ (McCaughey et al, 1977, 166)

Role definition: narrow to broad 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’)

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’)

Possible Organisational Factors Size of caseload – throughput pressure Agency philosophy/ideology Narrow/broad performance indicators Degree of defensiveness in practice Level of professional autonomy Supervisory style Organisational culture and climate

Size of caseload – throughput pressure

Agency philosophy/ideology

Narrow/broad performance indicators

Degree of defensiveness in practice

Level of professional autonomy

Supervisory style

Organisational culture and climate

Possible Policy Context Factors Legal constraints and ethical challenges Single input services based on categorical funding Goodness of fit between portfolio priorities Output or outcome funding focus Level of competition for scarce resources Strength of centralised reform drivers Lack of good cost-effectiveness data

Legal constraints and ethical challenges

Single input services based on categorical funding

Goodness of fit between portfolio priorities

Output or outcome funding focus

Level of competition for scarce resources

Strength of centralised reform drivers

Lack of good cost-effectiveness data

“ Joined up Government” Challenges Jurisdiction/domain disputes : Response: elevate ownership of the problem Unrealistic Time Scales : Response: develop interim performance measures rather than rigid outcomes Silo Budget Process : Response: multi-lateral budget bids, budget pooling, outcome not output focus (Adam Graycar, Public Policy: Core Business and By-Products, Public Administration Today, July-September 2006, p.6-1)

Jurisdiction/domain disputes :

Response: elevate ownership of the problem

Unrealistic Time Scales :

Response: develop interim performance measures rather than rigid outcomes

Silo Budget Process :

Response: multi-lateral budget bids, budget pooling, outcome not output focus

(Adam Graycar, Public Policy: Core Business and By-Products, Public Administration Today, July-September 2006, p.6-1)

Some key ‘adult focussed’ sectors in relation to vulnerable children Adult mental health Drug and alcohol Corrections Homelessness Disability Family violence Refugee resettlement services Aboriginal Health Services Income security

Adult mental health

Drug and alcohol

Corrections

Homelessness

Disability

Family violence

Refugee resettlement services

Aboriginal Health Services

Income security

Measuring ‘family focus’ Intake (are children known, are immediate parenting needs considered? ) Assessment (are parenting roles and children’s needs central in assessment?) Intervention (is intervention individually tailored to family needs; does it strengthen parent-child relationship; are children ‘seen and heard’?) Outcomes – do service outcomes relate to parental roles and well-being of children? Inter-agency networks – are there good links with child and family services?

Intake (are children known, are immediate parenting needs considered? )

Assessment (are parenting roles and children’s needs central in assessment?)

Intervention (is intervention individually tailored to family needs; does it strengthen parent-child relationship; are children ‘seen and heard’?)

Outcomes – do service outcomes relate to parental roles and well-being of children?

Inter-agency networks – are there good links with child and family services?

Examples in Drug and Alcohol Field Family Alcohol Service (London) Odyssey House, Vic Cyrennian House, Perth Parenting Under Pressure (PUPS), Brisbane Wooraninta Play Group, Coopers Cottage and Uniting Care Burnside, Sydney

Family Alcohol Service (London)

Odyssey House, Vic

Cyrennian House, Perth

Parenting Under Pressure (PUPS), Brisbane

Wooraninta Play Group, Coopers Cottage and Uniting Care Burnside, Sydney

To scale up or not to scale up : that is the question Is it effective and if so, how? Is it cost-effective, and if so, in the short term and/or long term? Is it transferable across contexts? Is it sustainable?

Is it effective and if so, how?

Is it cost-effective, and if so, in the short term and/or long term?

Is it transferable across contexts?

Is it sustainable?

To scale up programs or principles: that is another question It may not be possible to replicate or ‘adopt’ programs in their ‘pure’ form across different contexts, but it may be possible, and sometimes preferable, to transplant the principles of successful or promising programs or practices to other contexts, with careful assessment of the effect of adapting any original elements.

It may not be possible to replicate or ‘adopt’ programs in their ‘pure’ form across different contexts, but it may be possible, and sometimes preferable, to transplant the principles of successful or promising programs or practices to other contexts, with careful assessment of the effect of adapting any original elements.

National Child Protection Framework Provides some opportunities for: Supporting Centrelink to facilitate early intervention and referral with vulnerable families Creating Children’s Workers in some adult specialist services Professional workforce development strategies, especially Indigenous staff Potential to link with other federal initiatives eg homelessness, early childhood education and care.

Provides some opportunities for:

Supporting Centrelink to facilitate early intervention and referral with vulnerable families

Creating Children’s Workers in some adult specialist services

Professional workforce development strategies, especially Indigenous staff

Potential to link with other federal initiatives eg homelessness, early childhood education and care.

References Cabinet Office Social Exclusion Task Force (2008), ‘Think Family: a literature review of whole family approaches’, London. Dawe, S. et al (2006) Drug Use in the Family: impacts and implications for children. Australian National Council on Drugs Doyle, (2007) “Child Protection and Child Outcomes: Measuring the Effects of Foster Care” American Economic Review, 97(5). December : 1583-1610. Graycar, A. (2006) Public Policy: Core Business and By-Products, Public Administration Today , July-September, pp.6-1 McCaughey, J. et al, (1977) Who Cares? Family Problems, Community Links and Helping Services, Melbourne, Sun Books Middlebrooks, J.S, Audage N.C., The Effects of Childhood Stress on Health Across the Lifespan. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2007

Cabinet Office Social Exclusion Task Force (2008), ‘Think Family: a literature review of whole family approaches’, London.

Dawe, S. et al (2006) Drug Use in the Family: impacts and implications for children. Australian National Council on Drugs

Doyle, (2007) “Child Protection and Child Outcomes: Measuring the Effects of Foster Care” American Economic Review, 97(5). December : 1583-1610.

Graycar, A. (2006) Public Policy: Core Business and By-Products, Public Administration Today , July-September, pp.6-1

McCaughey, J. et al, (1977) Who Cares? Family Problems, Community Links and Helping Services, Melbourne, Sun Books

Middlebrooks, J.S, Audage N.C., The Effects of Childhood Stress on Health Across the Lifespan. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2007

References (continued) Rubin, D., O’Reilly, A., Luan, X., & Localio, R. (2007) The impact of placement instability on behavioral well-being 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 Scott, D, (1992) Reaching vulnerable populations: framework for primary service provision, American Journal of Orthopsychiatry, 62,332-341 Useful website: http://www.cabinetoffice.gov.uk/social _exclusion_task_force/families_at_risk.aspx

Rubin, D., O’Reilly, A., Luan, X., & Localio, R. (2007) The impact of placement instability on behavioral well-being 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

Scott, D, (1992) Reaching vulnerable populations: framework for primary service provision, American Journal of Orthopsychiatry, 62,332-341

Useful website: http://www.cabinetoffice.gov.uk/social _exclusion_task_force/families_at_risk.aspx