Mental health professionals in children's advocacy centers: is there role conflict?

Two recent chapters in professional books have criticized children's advocacy centers for creating role conflict for mental health professionals because of their work with criminal justice and child protection professionals in children's advocacy centers as part of a coordinated response to child abuse. This article argues that these critiques misunderstand children's advocacy center practice and overestimate the risk of role conflict. Children's advocacy center standards set a boundary between forensic interviewing and therapy, which in most children's advocacy centers are done by separate professionals and never by the same professional for a given child. Many mental health professionals serve children's advocacy centers as consultants with no treatment role. Children's advocacy center therapists are rarely involved in investigation, and their participation in multidisciplinary teams focuses on children's interests and well-being.     

Working Relationally with Youth in Child Protection Institutions: A Milieu‐Therapy Perspective

Children and youth who have shown serious difficulties or if it is surmised that parents over time will not be able to care for the child or youth, could be placed in a child protection institution. The therapeutic work in such institutions is often described as milieu therapy. There has been little focus on the milieu therapist's relational work in child protection institutions. The research question for this study was: What factors are described by milieu therapists as significant for relational work with youth placed in institutions? To answer this question, we collected data from qualitative semi‐structured interviews with four milieu therapists working in child protection institutions. Interpretative phenomenological analysis helped us identify three overarching categories: (1) structural and personal factors as a basis for relational work; (2) various forms of communication in relational work; and (3) relational work with a starting point in everyday events.     

The ‘Towers of Silence’ Still Stand: Protecting the Perpetrator

This paper explores the idea that professionals in the arena of child sexual abuse can be induced to respond irrationally, through their wish to protect child victims. I examine why child victims of serious sexual assault are treated as the alleged perpetrator should be. That is, when the family unit cannot give the child a safe environment, the child (not the alleged perpetrator) is removed. I argue for a systems focus, examining how each section of the protective industry: lawyers, CSV protective workers, therapists and consultants can contribute to perpetuating and sustaining child abuse. The article is written in a style that plays on the boundaries between academic article and fiction to heighten the effect of my case material.     

Risk Management in Treating Child Sexual Abuse Victims and Adult Survivors

ABSTRACT

Before the 1990s, mental health professionals were rarely sued for “talking cures.” Today, hundreds and hundreds of cases have been brought against therapists working with child sexual abuse issues. Risk management needs to accommodate the current wave of lawsuits so that mental health professionals can avoid litigation. This commentary presents some of the issues involved in these cases, and suggests techniques for therapists to utilize for risk management.     

Child Protection in a Low‐Resource Setting: Experiences From Paediatric Professionals in Kenya

Key Practitioner Messages:

• Child protection is a significant issue in global child health.
• There is an established legal framework for the protection of children globally and in Kenya.
• This study has given an insight into the current experience of child protection amongst healthcare professionals in Kenya.
• There was limited training reported at both undergraduate and postgraduate levels.
• It has highlighted the need and desire for formal child protection training for all professionals working with children.

     

Inter‐professional working in child protection with families with long‐term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with 28 experienced child welfare professionals. It explores their views about families known to the child protection system with long‐term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter‐personal skills and access to specialist therapeutic services if families are to be supported to address their problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Sometimes Words Just Ain't Enough – Enhancing the Contribution of Children in Therapy through Creative Expression

The meaningful inclusion of children in family therapy is an ideal that therapists readily align with and yet struggle to implement effectively. Within a practice that relies heavily on verbal expression, young children provide a unique challenge for therapists, who require developmentally appropriate opportunities for the child to express, document, and share his or her experience in all its richness and colour. In this paper the author utilises art therapy to support greater inclusion of children in family therapy by capitalising on their creative talents and facilitating the child's visual story within the family dialogue. This can assist in the formulation and treatment of systemic issues.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.     

‘I Will Not Leave My Baby Behind’: A Cook Island Māori Family's Experience of New Zealand Māori Traditional Healing

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri ¹ guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings.     

Are the Children Playing Quietly? Integrating Child Psychotherapy and Family Therapy

Over many years, family therapy training programs have not included the engagement of children under seven. John Byng-Hall wrote in 1986 that family therapists could learn about understanding young children from child psychotherapists. It has long been my practice to include young children when working with families. This article describe ways of working that include young children's play as relevant information. I hope to encourage other child psychotherapists and family therapists to find better ways of integrating skills.     

Social Work Intervention in Child Abuse—An Ever-Widening Net?

This paper considers some of the issues concerning the social work response to child protection which are currently being debated by professionals involved in this field. In particular, the paper considers where there is an imbalance in the system, with too much emphasis being placed on child protection at the expense of child welfare. It describes how one authority has sought to focus its child protection investigation system. This has been achieved firstly through the use of management information to measure performance and make comparisons between different areas. This information was then used as the basis of training, encouraging staff to renew their practice and ensure that an appropriate response is made to child care referrals and that children are not drawn into the child protection net inappropriately but are dealt with within a child welfare framework. Examination of a sample of child protection investigations showed that where welfare needs were investigated, attempts were made to use available resources to meet these needs.     

Complex Couples: Multi‐Theoretical Couples Counselling with Traumatised Adults Who have a History of Child Sexual Abuse

One of the major ways child sexual abuse can have an impact on individuals is in their later ability to have and maintain fulfilling couple relationships. Survivors may experience avoidance behaviours that become problematic in their adult intimate relationships. If couple therapists fail to focus on these traumatic imprints, the therapy may founder. This paper proposes that a multi‐theoretical approach enables the couple therapist to deal with the complex problems such couples present including sexuality and intimacy concerns. Such an approach integrates trauma theory, attachment theory, feminist principles, body‐oriented psychotherapy, and systemic couple therapy.     

If Your Worship pleases: an Australian perspective on the role of the magistrate in child protection

This paper examines the hitherto unexplored role of magistrates in child protection. It reports on a series of interviews conducted by one of the authors with magistrates in the Family Division of the Melbourne Children's Court, Victoria (Australia) in 1993–1994. These interviews form part of a current, and larger, study of magistrates' decision-making in child protection. This paper critically examines the role of magistrates in planning for children in need of care and protection. Some of the questions that the paper poses include: do magistrates focus solely on judicial aspects or do they have a role in overall case planning for children? Do they have specific aims or objectives which influence how they deal with children who come before them? Do magistrates mostly agree with the recommendations which social workers put to them? Are magistrates subject to constraints which may not be understood by other professionals? The findings of the paper will assist in clearly defining the role of the magistrate in child protection, which has distinct advantages for all professionals who work in this complex area. The most appropriate outcomes for children can only be achieved when magistrates and other professionals work in partnership. © 1998 John Wiley & Sons, Ltd.     

INFLUENCES ON THEf INCLUSION OF CHILDREN IN FAMILY THERAPY BRIEF REPORT

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two- parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.     

Exploring trends: tracking evaluations data over several months by therapists and parents of children with cerebral palsy

A pilot study was conducted at the outpatient rehabilitation unit of a children's hospital to explore the overall performance trends of children in daily life as perceived by their parents, compared to the evaluations of therapists. A performance goal was set for each child by his/her therapist and parent at an initial consultation. Over a six-month period, data were collected from the parents of children with cerebral palsy (N = 53), and therapists assessed children at each therapy session as well. The evaluations of both parents and therapists showed statistically significant upward trends in performance over several months.     

Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

A case study of failure to thrive and inter‐agency work

Social workers and medical professionals have an ambiguous relationship. Though expected to work together within the child protection regulations of the Children Act 1989, there are many tensions. In general, social workers and health visitors enjoy close working relationships, but tensions are frequently experienced as one proceeds higher up the medical hierarchy. The reasons for this may be numerous, but in practice may obstruct speedy action in detection and prevention of disease which is social in aetiology — yet all professionals have an important role. I hope to demonstrate this in the following case study, where ‘failure to thrive’ took 18 months to evidence but, without inter‐agency working, might have proved fatal to the child. Copyright © 2000 John Wiley & Sons, Ltd.     

Taking a risk and playing it safe: the use of actors in interagency child protection training

Interagency training in child protection is an important part of engaging professionals in a common approach to their collective responsibility for safeguarding children. Training is a key method for empowering professionals to carry out their complex role in child protection with appropriate knowledge, skills and confidence. In Buckinghamshire, experiential learning involving actors has met with some success as part of the interagency child protection training programme. The following paper proposes the argument for using actors, describes how this is done and evaluates its effectiveness for participants, trainers and actors. It is suggested that this method has ample rewards if properly planned, particularly for practitioners in lessons for practice. A close working relationship must be developed between actors and trainers. Scenarios that seem real can be portrayed and skills can then be practised in the knowledge that no one is really being harmed but valuable lessons for real‐life situations can be learned. A central aspect is learning together in a supportive environment away from a blame culture. Copyright © 2005 John Wiley & Sons, Ltd.