Dilemmas in planning for the protection of children and youths in residential facilities

Protection of children and youths after placement must be given increased emphasis because deinstitutionalized care is itself not harm-free and also because the needs of many children for care, control, and treatment are likely to be met in residential facilities for the foreseeable future. However, the diverse and often incompatible views of advocates and providers of child care about the issues affecting the protection of residents in institutions loom as obstacles to planning for the protection of children and youths after placement. Both of the extreme views of institutional abuse and neglect issues deny the need for child protection after placement. The first holds that since the child or youth is being protected and/or treated, no ongoing child protection is necessary. The other view holds that any child protection effort short of closing residential facilities is futile and therefore without merit. Underreporting of abuse or neglect is widespread; accountability of facilities for the protection of residents is, as a result, unevenly established. These conditions are attributable in part to the inadequate statutory base for protecting children in institutions. At the same time, because of the lack of a planned approach to protection within facilities, and between facilities and child protection agencies, residential facilities are likely to suffer negative public exposure when moderate or serious incidents of maltreatment become public. The absence of procedures for facilities themselves to recognize abuse and neglect invites exposure of incidents by staff and residents. The ad hoc manner in which incidents are managed by external agencies often inflicts unwarranted costs on the reputations of residential facilities that in many cases may have only one or two serious incidents a year. Finally, the use of "last resort" placements may be putting some children and youths into situations of unacceptable risk. Despite the existence of differing views in the residential care field, we have identified areas of agreement between the child protection agencies and residential facilities upon which public policy might build. The problem may not be so much that these attitudes exist, as that the states have not responded in a planned and credible way to the problem of institutional abuse and neglect. Nevertheless, development of a planned and credible approach must deal with these areas of difference if protection of children after placement is to be improved.     

Medical examinations for child sexual abuse in Scotland: good enough practice?

This questionnaire survey of a representative sample of practitioners in Scotland sought to establish speci?cally how widely guidance on child protection issued by the Scottish Executive Health Department was being followed by practitioners, NHS Trusts and health boards. It aimed to identify the medical practitioners involved and the range of current practice in child sexual abuse examinations throughout Scotland. The results suggest that the medical assessment of children who disclose sexual abuse is a low‐volume, highly specialized activity, practised by about one in ?ve paediatricians and forensic medical examiners in Scotland. Most (79%) are aged between 41 and 60 years; 59.8% have less than 10 years' experience in the ?eld; and the majority (86.3%) perform fewer than two examinations per week. Available guidance is comprehensive and uniform, highlighting the importance of joint specialist working, use of the colposcope for photodocumentation, training and continuing professional development in this specialized area of work. Despite this, the results of our survey of practitioners show that throughout Scotland, the care offered to children and the service provided to the courts are suboptimal. Copyright © 2004 John Wiley & Sons, Ltd.     

Beyond the state: Conceptualizing protection in community settings

In the last two decades, the child welfare system has undergone a series of dramatic changes. We have moved from a broad concern for the social welfare of children and families to a restricted focus on detecting, investigating and assessing instances of child physical and sexual abuse and neglect. Spiraling reports of suspected or actual abuse and neglect, higher caseloads, reduced resources and lack of support for both families and workers, have all contributed to narrowing the focus of contemporary child welfare to one more aptly characterized as child protection. Child protection discourse is concerned with the nature and extent of state intervention into family life for the purpose of protecting children at risk of harm. While much attention has been given to boundaries and procedures for state intervention, it is less common to critically examine the actual activities involved in protection of children. An exception to this is the feminist scholarship on the topic, illustrating that protection is very much a gendered activity entailing the scrutiny of women's mothering practices and often associated with mother-blame. In this paper, another dimension to protection activity is explicated, namely that which occurs in a community setting. Drawing on a qualitative case study of a community agency that serves young mothers, we document its implications in 'child protection' processes and its markedly different approach to protection from formal child welfare agencies. Given the community agency's emphasis on supportive services to mothers, we turn a critical eye on usual conceptions of protection, where it occurs, and how it is accomplished.     

Child protection: a new approach in South Australia

This paper argues the case for an integrated approach to child protection services, embracing children's safety, risk and needs and incorporating formal assessment instruments. It then provides a brief overview of the new child protection system in South Australia. The steady rise in child abuse/neglect reports raises questions about how best to provide child protection services. Analysis of South Australian data suggests that much of the rise can be attributed to an increase in reports of neglect and emotional abuse and an increase in re‐notifications. This in turn raises questions about the traditional investigative approach. In 1995 Messages from Research advocated that agencies re‐focus on children's needs and concentrate less on investigations into safety and risk. The critical question is how to distinguish families requiring investigation from those needing support. The latest research suggests that such decision‐making in child protection is generally inconsistent and unreliable. This paper argues that statutory agencies should use formal assessment tools to determine the level and nature of their interventions. These arguments have been critical in the development of the new child protection model in SA, which relies on a centralized intake, differential response to reports and the structured decision‐making system. Initial evaluation of the new model indicates improvements in consistency of initial screening and responses to children in danger. Copyright © 1999 John Wiley & Sons, Ltd.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.     

Responding to child deaths: the work of Australia's Victorian Child Death Review Committee

The Victorian Child Death Review Committee (VCDRC) in Australia is a multidisciplinary Ministerial Advisory Committee established to review the deaths of children either currently child protection clients or known to the statutory child protection system. The Committee provides advice about each child death as well as insights into what are the surrounding patterns and issues. Key to this role is examining the contribution of the service sectors to the protection of children and the routine practices that are in place to respond to children and vulnerability. This paper provides a snapshot of the cases referred to the VCDRC and the key messages for practice drawn from them. What emerges is that often the threshold for when statutory child protection services must be involved in child and family matters can be ambiguous and that agreement about intervention, the level and nature of need or risk, and when cumulative harm and neglect require statutory responses are not always shared between agencies. It is clear that the lack of common frameworks about what constitutes child protection intervention challenges services. It is recommended that there be and used agreed definitions and frameworks to ensure shared understandings and collaborative responses across the service and legal systems.     

Early indicators of child abuse and neglect: a multi‐professional Delphi study

Through the application of the Delphi technique, this study draws on the expertise of British child protection academics and practitioners from a wide range of disciplines in seeking to develop a consensus opinion on possible early indicators of child abuse and neglect. The search for early indicators is described in the context of a secondary preventative approach to the problem of child maltreatment. A very tentative conclusion arising from the study is that the early indicators of child abuse and neglect that achieved consensus of agreement may help in diagnosing child abuse and neglect at an earlier stage, although they are not necessarily diagnostic. Alternative explanations, differential diagnoses and information‐gathering are paramount, as is a willingness and ability to act on concerns. Although great caution is urged, it is suggested that the findings from the study are credible and of interest to those who are working towards more timely recognition and referral of abused and neglected children. Copyright © 2003 John Wiley & Sons, Ltd.     

Prevention of child abuse and neglect and improvements in child development

The aim of the study was to evaluate the implementation of a section in the Danish Social Assistance Act which encourages local authorities to offer families services in order to support children at risk of child maltreatment. The specific purpose of the present paper is to answer the question: Will the socio‐psychological development of children known to social services be improved when abuse and neglect are reduced? A sample of 1,138 children was drawn at random from new social services cases starting in 1998. Subsequently, about 80 per cent were evaluated by local caseworkers on the basis of a standardised questionnaire covering a period of four years. The most damaging family conditions seemed to be psychological maltreatment, physical/sexual abuse and neglect. Maltreated children were more often in a depressed state, unhappy, socially isolated, or they had an eating disorder, inadequate or under‐nutrition, suicidal tendencies, lack of concentration, or disturbed behaviour, compared to those children who were not exposed to abuse and neglect. If parental behaviour improved, effects on children's well‐being were also observed and positive changes in children's socio‐psychological development were identified. The questionnaire explored the impact of various interventions, including services geared to strengthen the child's network, but results indicated that the child displayed reduced risk of reactive symptoms only when parental behaviour improved and abuse and neglect were reduced. Copyright © 2009 John Wiley & Sons, Ltd.     

Child Abuse and Neglect inChina: What the Papers Say

In order to gain an insight into attitudes towards child abuse in China, a review of a number of newspapers for a period of 3 months was carried out. There was a dearth of relevant stories in national papers, but more in the local type of newspaper read by the majority of Chinese. Overall there were few reports relating to child abuse, especially in the intrafamilial setting. Of particular note is the number of reports of neglect of children following divorce. Violence towards students by teachers also features prominently. But by far the most reported issue is the damaging effect on children resulting from pressures for good academic performance in a highly competitive society.     

Where now for ‘child protection’ in Scotland?

In common with the rest of the UK, child care and protection practice in Scotland has undergone unprecedented change over the last ten years, including a wide‐ranging three‐year Child Protection Reform Programme. In 2006, The University of Dundee's Centre for Child Care and Protection and Barnardo's Scotland Research and Development team were commissioned by the then Scottish Executive to undertake a process review of the Child Protection Reform Programme (Daniel et al., 2007 ). Drawing on findings from the process review, this article considers the impact of the Child Protection Reform Programme. The process review concluded that, in the view of the respondents, the Child Protection Reform Programme made a substantive contribution towards the improvement and delivery of child protection services in Scotland, particularly in terms of raising awareness and increased multi‐agency working. It was beyond the scope of the review to measure outcomes for children as a result of the reforms. Since the completion of the Child Protection Reform Programme, national policy emphasis has broadened from ‘child protection’ towards integrated support for children under the Getting it Right for Every Child reforms of children's services. The paper concludes with a discussion around where ‘child protection’ now fits within this context of universal support for children and argues that there is a need to ensure that the valuable work which was done to improve child protection services in Scotland under the Child Protection Reform Programme is not lost. Copyright © 2010 John Wiley & Sons, Ltd.     

Significant harm: making professional judgements

Judging whether a child is suffering or is likely to suffer significant harm has become a critical task for professionals working with children and their families in England and Wales. Yet little guidance is available about what the phrase means in its entirety and how it should be applied in practice. This study set out to examine how the phrase was used in practice by a selected sample of experienced health and social work staff. The evidence collected suggests flaws in the general approach adopted by professionals to identification and assessment in child protection cases. The data indicate a heavy concentration of attention on the weaknesses of families being assessed rather than their strengths and on parents rather than children. Problems are identified in responding effectively to long-term, chronic abuse such as emotional abuse and neglect. The study recommends changes in practice based on these findings which have been implemented by a wide range of practice agencies within the study area. © 1998 John Wiley & Sons, Ltd.     

The Child's Voice in Service Evaluation: Ethical and Methodological Issues

This paper examines the ethical issues which arose as part of a qualitative study with children who had experienced sexual abuse and the implications of these ethical issues for the methodology and conduct of the study. The ethical dimensions addressed include protection of the therapeutic relationship, anonymity, confidentiality, safeguarding (child protection), consideration of the sensitivity of the issue, informed consent, the right to withdraw and storage of data. The study formed one component of a service evaluation of a network of therapeutic projects provided by Action for Children, offering interventions for trauma following child sexual abuse. Children and young people's perspectives were collected using a child‐friendly activity book designed to elicit their views on the service. The paper highlights the importance of conducting research which adheres to ethical guidelines and reflects upon the process of designing a study which incorporates them. The research was funded by Action for Children and managed by a steering group comprising managers from the organisation. Copyright © 2010 John Wiley & Sons, Ltd.     

The prevalence and nature of abuse and neglect in children under four: a national survey

This paper reports the results from a Danish national survey of child abuse and neglect. Data were obtained by a written questionnaire sent to all home health visitors. All newborn Danish children receive visits by a home health visitor several times during their first year of life. For children in need of special care for social reasons the visits may continue until school age (at 6 or 7 years). The questionnaire included four checklists of signs of abuse and neglect. The home health visitors were asked to record what they had actually observed visiting the children in their homes. Eighty‐three per cent (covering about 80% of all newborns) answered the questionnaire. The objective was to establish a scientific based framework that could be used to guide preventive efforts. Ten per cent of all children under 1 year of age may be characterized as children in need of special care for social reasons, the most frequent single reason being reliance on social assistance, alcohol abuse or violence against the mother. A minimum of 4% of infants are subjected to broadly defined abuse or neglect from one or more of the four categories: physical abuse, physical neglect, emotional abuse and emotional neglect, physical and emotional neglect being the most frequent and physical maltreatment the most rare. Copyright © 1999 John Wiley & Sons, Ltd.     

Cross cultural transferability in child protection: challenges and opportunities

The paper uses the experience of working in Bolivia in the ?eld of child protection to discuss the usage of international contributions and cooperation in the implementation of child protection measures. The challenges and opportunities involved in the implementation of child protection policy and practice in Bolivia are discussed in the context of the realities faced in many countries of South America. The paper describes how a systemic approach was used to provoke change, to maximize the effectiveness of what resources and capabilities already existed and to promote continuing improvement in multidisciplinary cooperation. Where resources are not available for an integrated multisectorial approach dedicated to child abuse and neglect (CAN), leadership and capacity‐building in this way may be used to enable practitioners to transform the challenges of implementation into opportunities for learning and better practice. Copyright © 2003 John Wiley & Sons, Ltd.     

Evaluation of the Children’s Advocacy Center Model: Efficiency,Legal and Revictimization Outcomes

This study compares the Children’s Advocacy Center (CAC) model with more traditional child protection services on several important outcomes such as substantiation of abuse, arrest and prosecution of the perpetrator, the efficiency of the multidisciplinary process and child revictimization rates. One hundred and eighty-four child abuse and neglect cases from a large metropolitan area in Florida comprised the sample. Cases were selected over a five year-period from three different modes of child protection services including a CAC. Similar outcomes were found between the CAC model and the Child Protection Team (CPT), a multidisciplinary model, which was first developed in Florida in 1978. In comparison with traditional child protective investigation, these models were associated with improved substantiation rates and investigation efficiency. Results are discussed in terms of the utility of CACs above and beyond the aspect of multidisciplinary coordination and whether the goals of the CAC model need to be redefined. Recommendations for further research in the areas of multidisciplinary team decision–making, the long-term impact of the CACs and the role of supportive professionals on the multidisciplinary team were made.     

A Critical Review of the Empirical Literature: Identifying Correlates of Child Neglect

More than half the children in the United States who were victims of maltreatment in 2000 were victims of neglect (USDHHS, 2002). The majority of all child maltreatment related fatalities in 2000 were the result of neglect (USDHHS, 2002), and 27.8% of these fatalities were associated with both physical abuse and neglect (USDHH, 2002). Neglected children are more likely to be younger children (USDHHS, 2000), and the highest rate of child fatality due to maltreatment is between the ages of zero and five (Petit & Curtis, 1997; Gustavsson & Segal, 1994; USDHHS, 1999). The purpose of this article is to present the findings of a systematic review of the research on child neglect from 1990 to 2002. The review critiques method and synthesizes of the current body of knowledge on child neglect.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

The role of communities in safeguarding children and young people

Historically, children's safeguarding policy and practice in the UK have focused on individual and family‐level explanations of abuse and neglect, with relatively little attention given to children's overall well‐being or the role played by neighbourhood conditions in shaping it. As a result, community‐oriented practice, designed to improve the neighbourhood conditions in which many of the families who come to the attention of child welfare agencies live, has largely remained on the margins of mainstream provision for safeguarding children and young people. However, more recent policy developments, including Every Child Matters and the Children's Plan, do highlight the influence of children's wider circumstances on their well‐being, providing the foundations for more holistic approaches to service provision. Nevertheless, it is argued that these policy developments are unlikely to be successful unless they are accompanied by fundamental changes within the culture of many agencies and professions. Using a combination of ecological theory and practice examples, some of the main strands of the changes required (developing a culture of listening to children and adults; recognising and supporting the safeguarding activities of local people; and promoting partnership approaches to extending local provision) are critically examined. Copyright © 2009 John Wiley & Sons, Ltd.     

Understanding and responding to chronic neglect: A mixed methods case record examination

Neglect is the most prevalent form of maltreatment, and thus comprises the bulk of cases for Child Protective Service (CPS) agencies, yet it remains under-studied. Cases in which children experience repeated or “chronic” neglect are particularly concerning. A growing body of research indicates that the effects of chronic neglect create a harmful accumulation of problems for child well-being, including detrimental impact on early brain development, emotional regulation, and cognitive development. The aim of this retrospective case record review study was to examine risk and protective factors of chronic neglect and relevant CPS agency responses and practices. Results demonstrated that families experiencing chronic neglect had multiple significant stressors (four or more stressors for all families in this study), such as domestic violence, poverty, children with behavioral problems, and/or substance abuse, indicating chaotic and toxic living environments. Key implications are outlined for strengthening CPS response to cases of chronic neglect, including the need for comprehensive assessment of families, more effective and consistent use of standardized risk assessment tools, and better recognition of past patterns of neglect to mitigate the risk of accumulation of harm.