Transcript Bromfield - Association of Children`s Welfare Agencies

Families with Multiple and Complex Problems
and Child Protection Services
Key Issues for Practice
Leah Bromfield
ACWA Conference, Sydney, August 2010
Acknowledgments
• Australian Institute of Family Studies
• Victorian Government, Department of
Human Services
• AIFS co-authors: Alister Lamont, Robyn
Parker and Briony Horsfall
• DHS co-authors: Karen Sutherland and
Robyn Miller
Overview
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Definitions & prevalence
Key issues for assessment
Key issues for planning
Implications for interventions
Families with multiple and complex
problems are:
• Families with multiple, chronic, and interrelated problems, the constellation of
which can result in children’s needs being
unmet, and children being at heightened
risk of abuse and neglect (Cleaver et al.
2007; Cleaver et al. 1999)
Why focus on families with multiple
and complex problems?
• The primary problems of families involved
with child protection services are
– parental substance misuse
– domestic violence
– parental mental health problems
• Data shows that the co-occurrence of
these problems are the norm
• NSW Reports (Wood, 2008)
– 3 most common features of reports were DV
(31%), D&A (20%); Mental Health (14%)
• Vic Investigations (Allen Consulting, 2002)
– 4 most frequent ‘concerning characteristics’
were DV (40%); Drugs (25%); Alcohol (21%);
Psych (15%)
– Average no. of problems increased over 5-yrs
• SA Children in Care (Jeffreys et al., 2009)
– of the children entering care due to a parental
D&A, 69% of parents also exp. DV and 65%
had mental health problems
– Authors concluded “the picture that emerges
is one of poverty, violence, unpredictability
and high risk”
Key issue
• Families with multiple and complex problems
are not a marginal group, in fact they have
become the primary client group of
contemporary child protection services
Why do problems frequently cooccur?
• Problems themselves are inter-related
– Frequently pre-cursor or consequence of another
problem
• Can be consequence of parent’s own traumatic
history
- PTSD = multiple & complex problems
• Symptomatic of concentrated disadvantage
– (e.g. poverty, homelessness, unsafe neighbourhoods,
unemployment, poor health, isolation)
Key issues for assessment
• Not enough to note the presence or
absence of problems
• How do the most commonly presenting
parental problems impact parenting?
• 3 issues often confounded in literature
•impact on individual
•impact on parenting
•risk of abuse and neglect
Substance misuse
• Misuse of licit (alcohol, prescription medications)
or illicit (opioids, amphetamines, psychoactive)
substances
• Effects of intoxication:
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Senses, perception, motor skills, speech, judgment
Heighten responsiveness or flatten it
Induce violence or paranoia
Cause lethargy, loss of consciousness, coma, death
• Withdrawal hurts: anxiety, irritability, disturbed
sleep, depression, vomiting, paranoia
• Link to risky and/or illegal activities
Parenting impacts of substance
misuse
• Being intoxicated or in withdrawal associated
with
– lack of routine, poor nutrition, being emotional
unavailable, financial difficulties, unpredictable
moods, inconsistent & negative parenting & discipline,
verbal aggression, inattentiveness, secrecy, and
blurring of parent-child roles
Risks of abuse & neglect associated
with parental substance misuse
• Heightened risk of all abuse and neglect
– High risk of neglect, emotional abuse - inadequate supervision,
inattention to emotional, developmental, nutritional, hygiene,
routines, and sleep needs
– Risk of physical abuse - if parent violent, reactive or punitive
– Increased risk of sexual abuse while parent intoxicated if parent
predisposed
– Heightened risk of sexual abuse by other perpetrators due to
inadequate supervision
• Exposure to drug use, dealing, criminal activity
• Deep-seated fear of discovery, parental imprisonment,
being removed from family, removal from support
network
Domestic violence
• When a family member, partner or ex-partner
attempts to physically or psychologically
dominate or harm the other. Includes: physical
violence, sexual abuse, emotional abuse,
intimidation, economic deprivation or threats of
violence
• Assessment must consider victim/survivor &
perpetrator
• Gendered
Domestic violence individual
impacts: Perpetrators
• Perpetrators frequently exhibit following
characteristics towards their partners
– Controlling, sense of entitlement & superiority, selfish,
self-centred, possessiveness, confuse love & abuse,
manipulative, externalise responsibility, denial,
minimise effects on victim, blame victim (Bancroft &
Silverman, 2002)
• Post-separation: may experience homelessness,
housing instability, loss of r’ship with partner &
children, criminal charges
Domestic violence Individual
impacts: Survivors
• Effects include:
– Injuries ranging from bruising to broken bones
– Reduced mobility, disability, miscarriage, sexual &
reproductive health problems
– Linked to mental health problems - incl depression,
anxiety, trauma, self-harming, suicide
– Linked to substance misuse - avoidance, selfmedicate
– Post-separation: homelessness, housing instability,
financial insecurity, poverty
Domestic violence - fathering
impacts
• Bancroft & Silverman (2002)
• Common characteristics of father-child
interactions where fathers perpetrate DV
– Inappropriate expectations of child
– Generally under-involved & low physical
affection but may have episodes of strong
presence in child’s life
– Authoritarian, rigid & physical discipline
– Want to be centre of attention & jealous if not
Domestic violence - fathering
impacts
– Physically & verbally undermine mother
– Manipulate perception of situation to shift
blame
– Disconnect between professed emotions &
actual behaviour
Domestic violence - mothering
impacts
Fear, anxiety, anger, distress may lead to
emotional distance/unavailability
 Injuries may lead to absences, reduced mobility
 Violence may lead to emergence of other
problems for mothers, which impact parenting
capacity
 Survival strategies to avoid violence may affect
parenting
 Less able to exercise authority or control
over child

Risks of abuse & neglect associated
with domestic violence
• Effects age-dependent (e.g. in utero; younger likely to be
target, older hurt when intervening)
• Psychological effects of witnessing/living with violence toxic stress & trauma = abuse
• High risk of physical abuse
• Risk of sexual abuse
• Can act out, become violent or aggressive, regress
developmentally, become withdrawn
• May lose parent through separation, death
• Escape may lead to homelessness, inadequate housing,
loss of social networks, the familiar
Mental illness
• Mental illness refers to a diagnosed disorder;
mental health problems have less impact on
daily functioning (Huntsman, 2008)
• 6 main disorders in child & family welfare clients:
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Depression
Bipolar disorder
Schizophrenia
Post-traumatic stress syndrome
Borderline personality disorder (mothers)
Anti-social personality disorder (fathers)
Mental illness impacts
• Depression
– Sadness,
emptiness
– Disturbed sleep
– Lack interest,
energy, motivation
– Poor concentration
affecting
interaction with
others, making
decisions
– Suicidal thoughts
or intentions
• Bipolar disorder
– Extreme highs &
lows - prolonged
– Mania - euphoric,
high self esteem,
talkative, sleep
little, distractable,
make rash
decisions
– Depressed, plus
consequences of
mania can trigger
Mental illness impacts
• Schizophrenia
– Psychosis emerging in
adolescence or early
adulthood
– Can be a response to
stress
– Experience delusions,
hallucinations;
disorganised
– Flattened emotions
– Poor social skills
• Borderline personality
disorder:
– Common in females,
emerges in
adolescence
– May have c’hood
history of r’ship
instability, abuse,
violence, neglect
– Experience unstable
r’ships, poor sense of
self, impulsiveness,
fear of abandonment
– Symptoms constant,
enduring, widereaching
Mental illness impacts
• Post-traumatic stress disorder:
– A response to an event or circumstance
– May emerge soon after, or many years later
• Symptoms persist if untreated & include:
– Re-living through nightmares, flashbacks, obsessive
thoughts;
– Avoidance of reminders
– Anxiety
– Mental health problems incl disturbed sleep & eating;
amnesia & dissociative disorders
– Depression
Mental illness - parenting impacts
• Parents with a mental illness may
– Have difficulty controlling emotion - tense, irrational,
unhappy
– Withdrawn or unresponsive
– Overly critical
– Inconsistent
– Disorganised
– Lacking in energy, inactivy
– Inward-looking (at expense of child)
Risks of abuse & neglect associated
with parental mental illness
• Parental mental illness does not equal risk of
abuse or neglect
• In some cases, mental illness has been
associated with
– Neglect & emotional abuse - effects of mental illness
prevent parent meeting child’s physical, emotional &
developmental needs
– Physical abuse - if parent violent, reactive or punitive
– Insecure/disorganised attachment
– Parentification - child becomes carer
Key issues for planning
•An effective intervention is planned and
purposeful, and staged to meet the needs and
capacities of each family over time
•Maslow's hierarchy of need
• survival
• safety & security
• belongingness
• self-esteem
• self-actualisation
Key issues for intervention in CP
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Trauma
Parenting
Appropriate referral
Working in partnership
Systems that support practitioners
• Capacity
• Integrated
– no wrong door
– remove 'silos'
• Prevention focussed
Conclusion
• Multiple and complex = primary clients
• Assessment
– identifying problems not enough
– how do they impact individual, parenting and
risks to children
• Purposeful intervention – not a service per
problem
• Evidence-based interventions that target
incapacity to meet children's needs
• Systems designed for multiple problems
A/Prof Leah Bromfield
Deputy Director
Australian Centre for Child Protection
University of South Australia
www.unisa.edu.au/childprotection/
[email protected]
08 8302 2924