Impact of a multidimensional intervention programme applied to families at risk for child neglect

The purpose of this study is to evaluate the effects of an intervention programme applied to families at risk for child neglect. Twenty‐nine families were recruited through a Local Community Services Centre (LCSC) and were assigned to two groups: (1) the first group participated in a multidimensional eco‐systemic intervention programme called the Personal, Family and Community Help Program (PFCHP); and (2) the second group underwent psychosocial intervention that was provided as part of regular LCSC services and focused mainly on the social worker–family relationship. Pre‐test measures were obtained at the beginning of intervention for both groups and a follow‐up was held 24 months later. Quantitative and qualitative analyses indicated that both forms of intervention were associated with improved parent–child relationship and the reduction of parental stress, depression and the potential for child abuse and neglect. However, PFCHP participants showed multiple indications of improvement in their social and marital relationships, which was not the case for LCSC participants. The conclusion outlines the need for a long‐term intervention process for families at high risk for child neglect and the necessity of addressing multiple dimensions of family life if lasting changes are to be expected. Copyright 2000 John Wiley & Sons, Ltd.     

Parent and Child Therapy (PACT) In Action: An Attachment‐Based Intervention for a Six‐Year‐Old With a Dual Diagnosis

This case study explores Parent and Child Therapy (PACT), an attachment‐based intervention for mothers and children experiencing intractable relationship distress originally developed by Heather Chambers (a Child Psychotherapist and Family Therapist working in New Zealand). We describe the use of PACT with a mother—child dyad presenting a history of severe abuse and neglect. The child had been diagnosed with Conduct Disorder and co‐morbid Attention Deficit Hyperactivity Disorder. We consider the themes arising in the therapy, the emotional process experienced by the mother and child, the initial outcome and 10‐month follow up. The case study indicates that PACT can be learned and used by practitioners outside of the team that conceptualised and developed it. The case highlights the links between externalising difficulties and attachment disorganisation and points to PACT as a promising treatment for the chronic sequelae of early interpersonal childhood trauma. The need for research and possible directions of this research are discussed.     

The Conversational Model and Child and Family Counselling: Treating Chronic Complex Trauma in a Systemic Framework

Child and Family Counselling Teams in NSW Community Health Services are expected to provide therapeutic services to children who have experienced complex trauma. However, parental trauma is often overlooked or referred elsewhere. A systemic perspective informed by attachment theory and trauma theory provides the basis for addressing parental trauma in Child and Family Counselling Teams, thereby improving parenting. The Conversational Model is an evidence‐based intervention for chronic complex trauma. The foundations of the Conversational Model and its brief component, Short Term Intensive Psychodynamic Psychotherapy, are outlined and a case study is given to illustrate the usefulness of the intervention in Child and Family Counselling. Highlighted is the importance of addressing systemic trauma through parenting to improve attachment quality, family relationships, and children's function.     

A family-based, developmental-ecological preventive intervention for high-risk adolescents

Family-based preventive intervention has emerged as a promising modality for preventing antisocial behavior problems in youth. This article introduces an intensive, family-based preventive intervention for high-risk adolescents: Multidimensional Family Prevention. Multidimensional Family Prevention combines the advantages of standard prevention models (curriculum based and protection focused) with those of psychosocial treatment models (assessment based and problem focused). The model's main features are described: theoretical foundations (risk and protection theory, developmental psychopathology, ecological theory), guidelines for constructing a multidomain prevention program (family and peer relationships, school and prosocial activities, drug use and health issues, cultural themes), and strategies for tailoring and implementing five flexible intervention modules (adolescent, parent, interactional, extended family, extrafamilial). Implemented in the family's home, the intervention works to create a resilient family environment that supports the basic adolescent developmental goals of renegotiated attachment bonds within the family and durable connections with prosocial institutions.     

Multi‐type maltreatment and the long‐term adjustment of adults

Multi‐type maltreatment refers to the experience of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence). Researchers have largely ignored the presence of other types of child abuse and neglect when examining the adjustment problems associated with a particular form of maltreatment. The association between ‘multi‐type maltreatment’ and adjustment was explored in the current study. Retrospective data were obtained on (a) the degree to which maltreatment types co‐occurred, (b) childhood family characteristics and (c) adjustment problems in adulthood in an Australian self‐selected community sample (N=175). As hypothesized, a large degree of overlap was reported in the experience of the five types of maltreatment. Family characteristics—particularly family cohesion and adaptability—discriminated between respondents reporting single‐type and multi‐type maltreatment. Greater adjustment problems were associated with reports of a larger number of different maltreatment types. Multi‐type maltreatment should be recognized as a crucial aspect of the nature and impact of child maltreatment and considered in the development of programmes for the prevention and treatment of child abuse and neglect. Copyright © 2000 John Wiley & Sons, Ltd.     

FAMILY SYSTEMS AND THE INDIVIDUAL CHILD

In working with families with symptomatic children, family therapists may be so focused on the systematic aspects of the problem that they inadvertently neglect the child's individual issues. Through the use of a case example, this paper presents a variety of ways in which one can make use of a psychodynamic understanding of the child's issues while continuing to employ brief, action-oriented intervention strategies. A crucial aspect of the approach described is the devising of tasks which address the child's intrapsychic conflicts.     

Poverty and placement outcomes of Intensive Family Preservation Services

It is argued that Intensive Family Preservation Services (IFPS) often fail to prevent the out-of-home placement of children because family poverty impedes long-term effectiveness of the interventions. Current research is examined to demonstrate that families with lower socioeconomic status have higher rates of substitute care placement and that many IFPS families do not have the minimum income commonly assumed necessary to facilitate successful therapeutic interventions. Research also shows that poverty contributes to child abuse and neglect, to mental health problems, and to juvenile delinquency, resulting in a disproportionate representation of poor children in the three child systems. Until family poverty is significantly reduced, IFPS will continue to have disappointing results for a sizeable portion of their clientele.     

An innovative child welfare pilot initiative: Results and outcomes

Successful family reunification is achieved only about 50% of the time when children are in foster care. Parents' ability to access and complete court ordered services are paramount in determining whether the family can achieve reunification. However, the research on how to best facilitate service access and utilization are sparse. A matched sample of 100 families with no prior child welfare involvement and at least one child in out of home care were selected from Department of Children and Family closed administrative case files. This study compared 48 families who received traditional child welfare services to 48 families who received a Family First model intervention (PFFP) from a large urban public child welfare agency. The independent variables were the elements that distinguished the Family First model from traditional child welfare services and included the number of caseworkers for the life of the case, caseload size, and service needs met through community partnerships. The dependent variables were the stability of the children's out of home placement, the time to reunification, the length of agency involvement, the stability of reunification at one year follow up, subsequent substantiated child maltreatment reports one year after the cases were closed, the distance a placement location was from the home of the family at intake, the match between identified needs and the timely access of services. Hierarchal regression and survival models were constructed to examine elements of the intervention for their impact on family outcomes. The results suggested that a community partnership model that incorporated family engagement, enhanced service provider accessibility, reduced caseloads, one caseworker for each family, are associated with successful reunification outcomes. Moreover, the intervention families were more likely to have their needs met with clinical or economic services, experienced fewer days in out-of-home placement, shorter involvement with the agency, reduced placement moves and were more likely to be reunified sooner compared to the group who received standard child welfare services. At one year follow up, the intervention families also had fewer substantiated child maltreatment reports and children were more likely to be living in the parental home. Implications for policy, research and practice are presented.     

A case study: service delivery and parents with disabilities

A Specialized Family Program, through a supervised paraprofessional, provided time-intensive, home-based service to a family in which both parents were deinstitutionalized disabled individuals. Interventive procedures consisted of systematic educational procedures in basic child care and home management and the case management of many active but uncoordinated agencies. Through this case history, the programmatic needs of disabled parents and their families are discussed, with emphasis on (1) an orientation of family support and advocacy; (2) active, home-based intervention; (3) educational methods based on systematic, behaviorally based instruction; (4) coordination of all workers involved; and (5) client control of decisions related to intervention.     

Navigating post-trauma realities in family systems: Applying social constructivism and systems theory to youth and family trauma

Trauma affecting youth and families takes a variety of forms, from random one-time events such as accidents and natural disasters to chronic and highly personal trauma from child abuse or intimate partner violence. Though trauma has received increasing attention in theory and intervention research over the last several decades, the prevailing theories and treatments have limitations due to a linear perspective focused on the trauma problems of the individual. This is particularly concerning given the high dropout rates for trauma-focused treatments and the complexities of intergenerational trauma that cannot be adequately conceptualised at the level of the individual. To inform and improve family-based treatment of youth and family trauma, this paper proposes a theoretical framework informed by social constructivism and systems theory. Social constructivism upholds that reality is constructed through communication as an adaptive process for survival, with multiple potential realities possible. Systems theory promotes a non-linear view of causality within a system, such that the structure and properties of a system determine outcomes more than the inputs that go into the system. Together, the principles of these meta-theories contradict the orthodox focus on traumatic events causing trauma symptoms, and instead imply that family-based treatment should focus on helping families shift assumptions and dynamics that sustain the problem in the present. The joint application of a social constructivism–systems theory framework for trauma introduces several new principles to inform family-based treatment: (a) post-trauma realities; (b) mutual survival; (c) power–justice balance; and (d) adaptive reorganisation. The implications of these principles for youth and family trauma treatment will be discussed. Future intervention development and research should consider these principles in the ongoing effort to improve family therapy for youth and family trauma.     

Why is history important at moments of transition? The case of ‘transformation’ of Irish child welfare via the new Child and Family Agency

This paper provides a critical commentary on researching social work in transition to make the case for why history is important at crucial moments of change. The present transition of child protection and welfare practice from a Health Services Executive Structure to an Independent Child and Family Agency (Tusla) is focused on for illustration. This development signifies a major transition of services within the country influenced by a number of factors, most notably a number of high profile cases of child abuse within institutions in the past and child deaths/neglect cases in the present. In particular, a discourse of prevention, early intervention and the promotion of children's rights are most dominant in light of a quest to purge the mistakes of the past. Supported by a history of the present approach, the author argues that while the existence of a ‘discursive shift’ typified by the establishment of an independent agency is arguably conclusive, the evidence of changes in practice, culture and underpinning analytical approaches is much more vague and complex. The paper concludes with reflections on implications for a wider European and global context and a call for the need for more critically informed approaches to history to inform present transformations.     

Predictors of out-of-home placement following residential treatment

Objective

There is a lack of research examining predictors of out-of-home placement (OOHP) following residential treatment (RT). The current study examined how various child and family factors predict OOHP at discharge and 6-months post-discharge for a RT sample.

Methods

Three hundred and eighty-three children (11.92 years, SD = 2.63, 293 boys) with serious mental health disorders were assessed using the Brief Child and Family Phone Interview (BCFPI) and placement information forms at admission, discharge, and 6-months post-discharge from RT.

Results

OOHP at discharge was predicted by older age, OOHP at admission, child welfare involvement, deliberate self-harm, a history of physical abuse, neglect, witnessed domestic violence, and a poor family situation (p < .05). At 6-months post-discharge, OOHP was predicted by dual diagnosis, OOHP at admission, child welfare involvement, neglect, and witnessed domestic violence (p < .05).

Conclusions

Pre-treatment factors are predictive of OOHP following RT. Identifying these key predictors and developing permanency planning options for children to promote stability and consistency is essential. A systemic evidence-based approach is imperative in promoting resilience for children at risk of OOHP, including family intervention and collaboration with the community.     

Family group decision making: protecting children and women

With rising demands on child welfare, workers need to consider new options, including strategies that promote a collaborative effort of family, community, and government. Family group conferencing integrates efforts to advance child and adult safety and strengthens family unity while expanding its meaning. The conclusions in this article are based on family interviews and child protective services' file comparison from an outcome study of the Family Group Decision Making Project.     

Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka

To date, research on the psychosocial consequences of mass trauma resulting from war and organized violence on children has primarily focused on the individual as the unit of treatment and analysis with particular focus on mental disorders caused by traumatic stress. This body of research has stimulated the development of promising individual-level treatment approaches for addressing psychological trauma. In contrast, there is virtually no literature addressing the effects of mass trauma on the family and community systems. Research conducted in Sri Lanka and Afghanistan, two long-standing war-torn societies, found that in addition to multiple exposure to war or disaster-related traumatic events children also indicated high levels of exposure to family violence. These findings point to the need for conjoint family- and community-based programs of prevention and intervention that are specifically tailored for the context of the affected society. In particular, programs should take issues such as poverty, child labor, and parental alcohol use into account in assessing and treating children in the aftermath of mass trauma.     

The rediscovery of child neglect

The article is a discussion of the construction of child neglect in a child and family social work team in the UK, based on ethnographic research in the social work office. Two influential and contrasting professional discourses on neglect are identified, and it is suggested that the dominant construction of neglect in the team studied is maternal failure to adequately service children's bodies. This construction is discussed in relation to some relevant theoretical insights and in the context of trends in contemporary child protection work.     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.     

The child welfare response to serious nonaccidental head trauma

Serious nonaccidental head trauma (NHT) can leave permanent neurological damage in children who survive abuse. This study reports on child welfare's handling of NHT cases compared with cases of physical abuse and head trauma due to neglect with regard to placement in foster care, reunification with family, and safety issues. The results show that workers placed children with NHT in foster care immediately after the abuse but treated them no differently than other physically abused children regarding reunification.     

Child abuse and neglect in Cambodian refugee families: characteristics and implications for practice

This study examines the characteristics and patterns of child maltreatment among Cambodian refugee families in Los Angeles and assesses the implications for child welfare practice with Cambodian refugee families. Data were extracted from 243 active Cambodian case files maintained by the Los Angeles County Department of Children and Family Services (LAC-DCFS). Some of the major findings include (1) Cambodian child maltreatment cases were most frequently reported to the LAC-DCFS among various Asian Pacific ethnic groups; (2) Cambodian refugee families were more likely to be charged with neglect, while their Asian Pacific counterparts were more likely charged with physical abuse; (3) the circumstances under which maltreatment occurred most frequently were parental substance abuse and mental illness; and (4) while fathers who maltreated their child were likely to use alcohol, mothers were also more likely to have a mental health problem such as depression. This study suggests the importance of collaboration between Child Protective Service agencies, substance abuse programs, traditional healers, mental health services, and other social service agencies for effective child abuse prevention and intervention efforts.     

Giving Voice to the Search for Meaning: An Interview With Ruth Schmidt Neven

Ruth Schmidt Neven is a child and adult psychotherapist who trained at the Tavistock Institute in England. She worked in the UK for over 20 years in child and family mental health services of the NHS. During this time, she was responsible for setting up Exploring Parenthood, an organisation which focused on parenting issues. Since migrating to Australia in 1989, Ruth has remained committed to promoting knowledge and understanding about child and family development in the broader community through her clinical practice, training courses and writing. She is currently the director of the Centre for Child and Family Development in Melbourne.     

Project SAFE: an Armed Forces cooperative initiative for the prevention and treatment of family violence.

About one out of every eight persons residing in the State of Hawaii is either active duty military or a military family member. In the late 1970s, it became apparent that neither the military nor the state could meet a growing obligation to provide responsive protective services to abused and neglected children of military families. Inspired by a first-ever congressional appropriation for the development of military child abuse and neglect and spouse abuse programs, the Department of Defense funded a 3-year joint-Service family violence project. Operational since 1982, Project SAFE (Services Assisting Family Environments) consists of a family violence shelter, clinical outreach teams, and a prenatal prevention project. This paper chronicles the history of Project SAFE, provides retrospective commentary on planning and implementation, and identifies key evaluation questions yet to be answered.