Protecting Children is Everybodys Business: Investigating the Demand for Service at the Childrens Ai

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Protecting Children is Everybodys Business
Investigating the Demand for Service at the
Childrens Aid Society of London and Middlesex

• Research Team Alan W. Leschied, Paul C.
  Whitehead, Dermot Hurley and Debbie Chiodo
• The University of Western Ontario, London,
  Ontario CANADA
• October, 2003
• This research was funded by the United Way of
  London Middlesex, The City of London, The
  County of Middlesex
• and an anonymous donor

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• Perhaps we will always live in a world where
  children suffer,
• But we can reduce the number of suffering
  children.
• And if you do not help us in this pursuit my
  friend,
• Who in this world will help us do this?
• Robert
  F. Kennedy

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Goals of Research

• To examine factors that could help account for
  the increase in the demand for service at the
  Childrens Aid Society of London and Middlesex

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Increases in Ontarios Cases of Abuse and Neglect
(Rivers, Trocme, Goodman Marwah, 2002 )

• Children suspected of abuse or neglect rises by
  44 (1993- 1998)
• Investigations for neglect increases from 4,400
  to 8,900 children (1993-1998)

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Ontarios Admissions to Care (Rivers, Trocme,
Goodman Marwah, 2002 )

• The number of children admitted to care increases
  by 51.7 (1996-2001)
• Children admitted to care increases from 10,419
  to 15,792 children (1996-2001)

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The Number of Children Admitted to Care (London
and Middlesex CAS (1993-2002)
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The Number of Children in Care at Year End
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Research Informed by

• Extensive review of the literature
• other jurisdictions experiencing similar
  increases
• Identified most frequently cited hypotheses for
  increases
• clinical reasons explaining referrals to CAS and
  admissions to care
• Focus groups at the CAS of London and Middlesex
• Expertise of the community advisory committee
• Consultation with leading researchers in child
  welfare

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The Focus Groups Told Us

• 1995 is seen as a pivotal year in charting the
  increase
• No single reason should be isolated as the factor
  accounting for the increase
• Multicausal factors should include
• policy changes in child welfare
• legislative changes in child welfare
• social, psychological, economic changes impacting
  on children and families in London and Middlesex

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The Method

• Random sample of cases opened at London CAS in
  1995 and 2001 examined on a broad range of
  factors - 1042 out of a possible 2316 cases
• 1995 - 450 children (176 in care and 274 not in
  care)
• 2001 - 592 children (381 in care and 211 not in
  care)
• Six trained researchers completed the review of
  files in the summer of 2002
• Raters trained to understand the Child Protection
  Risk Assessment Model

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The Risk Assessment Tool

• Developed as the Risk Assessment Model for Child
  Protection in Ontario
• Includes 22 areas that describe child welfare
  risk related areas
• Caregiver Influence (Parental capacity)
• Childs Influence (Vulnerability, health status)
• Family Influence (Violence, social supports)
• Intervention Influence (Motivation, cooperation)
• Abuse and Neglect (history and severity)

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Cumulative Risk Assessment Score

• Risk assessments done by the trained researchers
  is based on a cumulative risk assessment score
  comprised of a total score of the 22 individual
  risk elements
• The application of the Risk Assessment Tool
  completed by child protection workers does not
  include a cumulative risk assessment score
• The cumulative risk assessment score was
  completed independent of the child protection
  worker rating that was included in the case file

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Policy, Clinical and Systemic Issues

• Issues of Policy Relevance
• Changing pattern and source of referrals
• Changing standard of risk in admissions to care
• Estimates of risk by less experienced case
  managers
• Issues of Clinical Relevance
• Child maltreatment
• Woman abuse
• Parenting capacity
• Maternal depression
• Previous history with CAS
• Issues of Systemic Relevance
• Poverty

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Policy, Clinical and Systemic Issues

• Supplementary Reports
• Developmentally and medically fragile children
• First nations children with the CAS
• Community Feedback

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1990 Events that Influenced Ontario Child
Welfare Policy

• Ontario Child Mortality Task Force
• Investigating deaths of children known to CAS
• 16 recommendations to improve Ontario child
  welfare system
• Child Protection Review
• 87 of CASs were in compliance with MCSS
  Standards for investigating child abuse cases
• Conformity with MCSS standards for case
  management and record keeping was a concern
• Child Welfare Accountability Review
• Called for revisions by the Ontario Ministry of
  Community and Social Services in the areas of
  setting goals and expectations, contracting,
  monitoring and follow-up in their relationship
  with CAS
• Protecting Vulnerable Children
• Recommendations to amend the Child and Family
  Services Act (CFSA)

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Bill 6Amendments to the CFSA

• Represented the most substantial change to the
  Child and Family Services Act (CFSA) in almost
  two decades
• The primary goal was to increase protection for
  children considered at risk for abuse or neglect

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Bill 6Amendments to the CFSA

• Purpose of the Act
• Grounds for determining whether a child is in
  need of protection
• Inclusion of past evidence of parenting in child
  welfare proceedings
• Clarified and expanded the duty to report child
  maltreatment
• Addressed timelines relating to society wardship
  and permanency planning
• Improved CAS access to information
• Clarified family access to children in care
• Mandated a regular review of the Act

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Testing Five Hypotheses

• Changing level of risk of children and families
  referred to the CAS from 1995 - 2001
• Changing level of risk of children admitted to
  care to the CAS from 1995 - 2001
• Change in the length of time children remained in
  care
• Change in the patterns of the sources of referral
• Risk estimates comparing more and less
  experienced child protection workers

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Changing Level of Risk of Children and Families

• With the expanded definition of a child in need
  of protection, one would expect lower risk scores
  for children and families in 2001 relative to
  1995
• The Outcome
• Cumulative risk scores are actually higher in
  2001 relative to 1995
• 1995
  2001
• Average risk score 25.3
  29.4

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Changing Level of Risk of Children Admitted to
Care

• If the threshold for admission to care has been
  lowered, risk scores will be lower in 1995
  relative to 2001
• The Outcome
• The average cumulative risk score for families is
  higher in 2001 relative to 1995
• 1995
  2001
• Average risk score 31.5
  34.7

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Change in the Length of Time Children Remain in
Care

• Are children remaining in care longer in 2001
  relative to 1995?
• The Outcome
• Children do not spend greater lengths of time in
  care in 2001

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Change in the Patterns of the Sources of
Referral

• Is there a change in referral patterns between
  1995 and 2001?
• The Outcomes
• Patterns of referrals across the years is
  consistent
• Source of Referral Percent
• Parent 20.0
• Police 17.9
• Family Associate 17.3
• Childrens Service Provider 14.6

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Change in the Patterns of the Sources of Referral

• Is there a shift in sources of referral for
  neglect cases?
• The Outcome
• Referrals for neglect proportionally remain the
  same across both years
• Professionals are more likely in 2001 to be the
  source of referral for cases of neglect
• Source of Referral 1995
  2001
• Professional 51 73

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Risk Estimates Related to Experience of Workers

• Do less experienced case workers rate risks to
  children higher than more experienced case
  workers?
• The Outcome
• Less experienced case workers do not rate risk
  higher than more experienced case workers

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Training of Workers

• Mandatory new worker training and supervisory
  consultation on all admissions to CAS care has
  offset the effects of inexperience of child
  protection workers

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Relevant Findings

• The degree of risk of children referred to and
  admitted to care is higher in 2001 compared to
  1995
• All referral sources are equally increasing their
  rate of referrals to the CAS the most likely
  sources of referral are parents, children service
  professionals and police officers
• No one type of child maltreatment is
  disproportionately driving the increase of
  children in care in 2001
• Inexperienced CAS workers are no more likely to
  rate children as higher risk compared to more
  experienced workers and neither are they more
  likely to recommend that a child be taken into
  care

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Study 1

• Child Maltreatment

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Child Maltreatment

• Ontario Incidence Study
• Rates of substantiated maltreatment between 1993
  and 1998 have doubled.
• Exposure to domestic violence nine-fold increase
• Neglect and Physical Abuse Doubled
• Sexual Abuse Decreased by 44

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Frequency of Substantiated Maltreatment

• Major increase in cases of physical abuse
• Three times the rate in 2001 over 1995
• Proportion of cases of sexual abuse, emotional
  abuse, and neglect do not differ across years
• Reported in percent

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Children in Care

• Significant increase in
• CAS admissions to care of maltreated children in
• 2001 compared to 1995
• (71 vs. 44)
• The proportion of
• substantiated cases of
• neglect, physical, sexual,
• and emotional abuse do
• not differ across years

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Study 2

• Woman Abuse

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Woman Abuse

• Exposure to woman abuse is associated with poor
  child outcomes similar to the effects of physical
  abuse
• Exposure to woman abuse and physical abuse is
  associated with higher levels of poor child
  outcomes compared to either experience alone

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Woman Abuse

• The Outcomes
• In only two outcomes do physically abused
  children differ from children exposed to women
  abuse high degree of similarity between
  children
• Conclusions from children experiencing two forms
  of violence (physical and exposure to violence)
• children exposed to woman abuse and physically
  maltreated
• higher rates of ADHD
• higher rates of cumulative child welfare risk

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Woman Abuse Among Caregivers of CAS Children

• Increase of six percent between 1995 and 2001

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Caregivers Experiencing Woman Abuse

• 
  Abused Non abused
• 
  () ()
• Major mental disorders 45 37
• Substance abuse 23 12
• Chronic medical condition 20 13

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Families Where Woman Abuse is Present

• More likely to be on social assistance/welfare
  (66 vs. 44)
• More likely to be unemployed (69 vs. 59)
• More likely to have less reliable and useful
  social supports
• More likely to have experienced abuse as children

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Study 3

• Poverty

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Rates of Child Poverty

• 1996 census Canada ranks sixth of the worlds
  twenty five most industrialized countries
• National rate of child poverty - 21.1
• Ontario rate of child poverty - 20.3
• 1996 census Ontarios child poverty rate
  increased by 5 relative to 1990 census (largest
  provincial increase 390,000 children in Ontario
  live in poverty)

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Family and Child Poverty in Canada, Ontario and
London/Middlesex

• Rates of Child Poverty
• Canada 21.1
• Ontario 20.3
• London 18.8
• London and Middlesex 17.1
• Canada and Ontario relates to child poverty
• London and London and Middlesex relates to family
  poverty

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Children Age 15 and Under Living in Poverty

• Proportion of London Children Age 15 and Below
• living in Poverty
• Total Poor Total
  Poor Poverty Rate ()
• All Cities 2,325,000 693,700
  19.1 23.3 29.8
• London 66,200 16,100
  20.6 26.6 24.5

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Poverty and CAS Involvement

• Rate of families on social assistance open to CAS
  remains consistent
• 1995 - 65 2001 - 64
• Evidence that those on social assistance are not
  doing as well in 2001
• Families on social assistance seen at the CAS
  with children in care
• 1995 - 48 2001 - 80
• Single mothers on social assistance with children
  seen at the CAS
• 1995 - 71 2001 - 83

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Poverty and Neglect

• Children living with single moms in 2001 more
  likely to suffer from neglect
• Children of families on social assistance in 2001
  are more likely to suffer from neglect and
  emotional abuse
• Increases in rate of single mothers on social
  assistance experiencing violence
• 1995 - 63 2001 - 84

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Differential Contribution to Child Risk

• Examination of what contributes to cumulative
  child risk scores?
• Violence
• Poverty

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Study 4

• Maternal Depression and Child Risk

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Increase in Rates of Maternal Depression in
Children Admitted to Care

• Identifies formal diagnosis of depression or
  identification of depression as interfering with
  parenting capacity
• 15 of cases in 1995 had mothers diagnosed with
  depression as compared to 29 in 2001

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Child Outcomes Related to Maternal Depression

• Children more likely to
• Be diagnosed with ADHD
• Receive medication for an adjustment disorder
• Have higher cumulative risk scores
• Be suspended from school more often

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Cumulative Risk Score Higher for Child/families
with Depressed Mothers

• Overall risk score
• Presence of maternal depression 33.2
• Absence of maternal depression 28.0

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Study 5

• Parenting Capacity

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Tracking Parenting Capacity

• Nico Trocmé of the Bell Center of Excellence in
  Child Welfare Research suggests that the Ontario
  Risk Assessment (ORAM) tool provides an
  acceptable measure for tracking parenting
  capacity
• Three items from the ORAM refer directly to
  parenting
• Caregivers expectation of child
• Caregivers acceptance of child
• Family Identity and Interactions

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Parenting Capacity Scores

• All caregivers received a score of parenting
  capacity ability based on the three risk
  assessment item scores from the ORAM
• Impaired parenting capacity scores reflect
• caregivers with unrealistic expectations and
  angry conflicts with child
• caregivers who disapprove, reject and are
  indifferent to child
• family interactions are generally negative or
  inconsistent

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Parenting Capacity Scores

• Caregivers in 2001 had higher scores on parenting
  capacity compared to caregivers in 1995
• Parents are
• more likely to have unrealistic expectations of
  their child
• emotionally indifferent to their child, and
• family interactions are generally more negative
  and hostile.
• (higher scores denote poor parenting capacity)

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Impaired Parenting Capacity Results in

• The diagnosis of children with ADHD
• The diagnosis of children with conduct disorder
• The likelihood that a child is or was previously
  on medication for an adjustment-related disorder
• Children receiving suspensions from school
• Children experiencing chronic truancy

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Impaired Parenting Capacity in Adults is Related
to

• Caregiver diagnosed with major mental illness
• Caregiver diagnosed with depression

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Impaired Parenting Capacity for Families is
Related to

• Homelessness
• Unemployment
• Receipt of social assistance and welfare
• Woman Abuse

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Study 6

• Intergenerational CAS Involvement

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Intergenerational CAS Involvement

• The Question
• What are the long term outcomes for adults who
  had previous involvement with CAS?

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Children with Families with Previous CAS Contact

• 
  
• Children Served in the Community
• 1995 2001
• 26 35
• Children in Care
• 1995 2001
• 36 42

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Impact of Previous CAS Contact

• Overall risk for children is higher for those
  with caregivers with previous CAS contact
• And this finding consists primarily of risk
  related to parent factors
• Caregiver influence (abuse and neglect)
• Caregiver influence / alcohol and drug use
• Caregivers motivation for seeking intervention
• Severity of abuse / neglect

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Caregivers with Previous CAS Contact

• Caregivers previously involved with CAS
• more likely diagnosed with depression
• more likely diagnosed with major mental illness
• involved with woman abuse
• children exposed to woman abuse
• unemployed
• on social assistance
• score higher in the severity of their mental,
  emotional and intellectual capacity to care for
  children

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Protecting Children is Everybodys Business
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Key Findings

• Violence against children
• 7 out of 10 children were admitted to CAS care in
  2001 for reasons of abuse and neglect, up from 4
  out of 10 in 1995
• The rate of children admitted to CAS care for
  reasons of physical abuse tripled from 1995 to
  2001

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Key Findings

• Woman abuse
• Witnessing abuse is as detrimental to a child as
  being physically abused
• The combination of both witnessing abuse and
  being physically abused is more devastating than
  either one alone
• By 2001, more than half of the mothers of
  children with open cases with CAS were victims of
  woman abuse
• 45 of them suffered from a mental health
  disorder
• 23 of them had a substance abuse
• 20 experienced a chronic medical condition

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Key Findings

• Poverty
• Almost double the number of children who were
  admitted to CAS care in 2001 were living in
  poverty as compared to 1995

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Key Findings

• Mental Health
• The number of depressed mothers receiving service
  from CAS almost doubled from 1995 to 2001
• The children of depressed mothers are twice as
  likely to experience a mental health disorder as
  compared to children of non-depressed mothers

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Key Findings

• Impaired Parenting Capacity
• Parents receiving services from CAS have less
  effective parenting skills in 2001 as compared to
  1995

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Key Findings

• Intergenerational CAS involvement
• 4 out of 10 children admitted to care in 2001 had
  a parent who was involved with CAS as a child
• The number has grown and continues to grow since
  2001

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Protecting Children is Everybodys Business

• We cannot leave it to the child welfare system
  alone
• (Allen, 2002)
• The problem is too large
• Its impact is too far reaching
• Its causes are too complex
• Necessary solutions are too comprehensive

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• Protecting Children is
• Everybodys Business