Slide outline: A practical approach to child protection and supervisory neglect

CFCA webinar - 11 December 2012

  1. Applying a systems approach to the child protection context of supervisory neglect....
    • Debbie Scott (AIFS)
    • Daryl Higgins (AIFS)
  2. Acknowledgements:
    • Ruth Walker (UQ)
    • Richard Franklin (JCU)
    • Commission for Children and Young People and Child Guardian
  3. Disclaimer
    • The Australian Institute of Family Studies (AIFS) is committed to the creation and dissemination of research-based information on family functioning and wellbeing.
      Views expressed here are those of individual authors and may not reflect those of the Australian Institute of Family Studies or the Australian Government.
  4. Setting the scene
    • Injury leadingcause of death in Australian 1-44 year olds
    • Varies by age group:
      • Children: transport, drowning, assault/homicide
      • More vulnerable than adults
    • (image - Toddler pulling over chest of drawers.)
  5. Injury Prevention
    • Preventable
    • Interventions
      • Environmental – pool fencing
      • Legislation – use of car restraints
      • Education – safe sleeping techniques
      • Engineering – reversing sensors in cars
      • Behaviour – wearing of mouth guards
  6. Common ground between accidental and inflicted injury
    • Low socio-economic status
    • Chaotic/noisy households
    • Crowded home environment
    • Highly mobile families
    • Lack of access to services
    • Parental substance abuse/ mental health issues
  7. Grey area
    • No intent to actually HARM, but harm has occurred
    • (images - Plastic baby walker; Old fashioned illustration of mother smacking child on bottom; Illustration of a busy mother with a vacuum cleaner in one hand and a telephone in the other. She is in the kitchen where a young child is playing with blocks at her feet and a baby is in a high chair. in the background there is a fridge, a full laundry basket and a table with a computer and hot cup of coffee; Illustration of girl leaning to reach a ball floating in a swimming pool. Behind her we see the gate of the pool fence has been left open; Young child holding a ball, squatting behind a car in a driveway.)
  8. Supervision
    • Injury prevention strategy?
      • Ideal world vs real world
    • Adequate supervision
      • Risk recognition
      • Capacity to intervene
      • Environment
      • Activity
      • Personality
    • (image - Parental supervision means watching.)
  9. Neglect
    • Australia2010-2011 = 29% of substantiated maltreatment
    • Lack of parental control over some risk factors
      • Poverty
    • Access to services
      • None available
      • Failure of services
  10. Definition of neglect
    • Varies by purpose and jurisdiction
      • Research
      • Practice - harm
    • Generally includes:
      • Failure on behalf of caregiver or parent
      • Provision of requirements for wellbeing and/or development
  11. Definition of Neglect
    • May include:
      • Consideration of cultural expectations
      • Parental circumstances
        • where they are in a position to do so
        • deliberate or through extraordinary inattentiveness
    • ‘Good enough’ parenting
    • Societal neglect
  12. Muddy waters
    • Different types of abuse = different considerations
      • severity
      • chronicity
      • measurement affected
      • criminal prosecution varies
    • Sexual abuse vs emotional neglect
      • supervisory neglect very murky
  13. Supervisory neglect
    • Of all neglect in Canadian Incidence Study
      • 44% = classed as supervisory
    • Of all supervisory neglect cases
      • 2% had physical injury (only ½ required medical treatment)
      • 2% other physical conditions
      • 26% signs of mental or emotional harm
      • Physical harm most common in toddlers and adolescents (compared to 3-11 year olds)
    • Source: Ruiz-Casares M, Trocme N, and Fallon B. (2012) Supervisory neglect and risk of harm: Evidence from the Canadian Welfare System. Child Abuse and Neglect, 36 (6) 471-480
  14. Influences on supervisory neglect
    • Child
      • Decision making ability
        Knowledge of emergency numbers
      • Accessibility to a caregiver
      • Age
      • Activity
      • Comfort
      • Ability
    • Other
      • Time of day
      • Length of time
      • Caregiver reasoning/understanding
      • Environmental risk
      • Previous neglect/abuse
      • Caregiver ability to care for child
      • Number of other children
    • Source: Hymel K and Committee on Child Abuse and Neglect (2006). When is lack of supervision neglect? Pediatrics, 118, 1296- 1299
  15. This study:
    • AIM: to understand definitional differences in supervisory neglect develop a ‘workable’ definition
    • DATA: 100 randomly selected scenarios of deaths of Queensland children under 18 years provided by CCYPCG
    • METHODS: blind review and classification by 5 professionals with experience in child protection, public health, injury prevention, law and child death review
  16. Sample (n=100)
    • 62% male
    • Largest proportion under 12 months (36%), smallest 5-12 years (12%)
    • 20% Aboriginal or Torres Strait Islander
    • 7% CALD
    • 65% not known to child protection authorities at time of death
  17. Causes of death research category
    • Causes of death research category
      Cause of death %
      Transport 41
      SIDS and SUDI* 24
      Diseases and morbid conditions 17
      Drowning 9
      Accidental 6
      Undetermined or unknown 3
      Total 100
    • * Sudden infant death syndrome or Sudden unexplained death of an infant
  18. Classifications
    • Possible:
      • Definitely not/not supervisory neglect
      • Possible supervisory neglect
      • Probable supervisory neglect
      • Insufficient information
    • Logic behind each decision
  19. Results
    • RESULTS Injury Prevention Legal Child Protection Child Death Review Public Health
      Not supervisory neglect 31 25 45* 16 28
      Possible/probably supervisory neglect 62 49 52 64 66*
      Insufficient information 7 26* 3 20 6

      *highlighted field

  20. Medical neglect
    • Agreement
      • Risk Factor
        • Lack of assertiveness
        • Unclear professional advice
        • Lack of support for parents to ask question
      • Protective
        • Med care sought
    • Disagreement
      • Risk Factor
        • Condition worsening and no help sought
        • Did not follow medical advice
      • Protective
        • Med care sought but too late
        • Condition of child not obviously life threatening
  21. Safe Sleeping
    • Agreement
      • Risk
        • Co-sleeping
        • Alcohol or drug
        • Sleep position
      • Protective
        • Fell asleep with bub
        • No evidence alcohol
    • Disagreement
      • Risk
        • Co-sleeping
        • Alcohol or drug
        • Sleep position
        • Length of time
        • Family history
      • Protective
        • Sleep position
        • Own bed
        • No evidence alcohol
  22. Parental ‘Line of sight’
    • Agreement
      • Risk
        • Alcohol/drugs
        • DV or CP history
        • Clarity of supervisor role
        • Child in unsafe area
        • Age
      • Protective
        • Recognition of dangerous environment
        • Age
    • Disagreement
      • Risk
        • Length of time
      • Protective
        • Age
  23. Adolescent Independence
    • Agreement
      • Risk factors
        • Time of day
        • Activity type
        • Length of time
        • Illegal/risky behaviour
      • Protective
        • Age appropriate
        • Parent ‘permission’
    • Disagreement
      • Risk factors
        • Peers
        • Illegal/risky behaviour
        • Parent knowledge of previous risky behaviour
      • Protective
        • Age (older)
        • Time
        • Use of protective equipment
        • Sport
  24. Transport
    • Agreement
      • Risk
        • Drinking
        • Speeding
        • Unrestrained
      • Protective
        • Age
        • No evidence of illegal behaviours
        • Age
    • Disagreement
      • Risk
        • Drinking
        • Drugs
      • Protective
        • Driver fatigue
        • Age
        • P plates
        • History of ‘troubled’ life
  25. Findings
    • Child death review/Public health
      • More weight to risk factors
      • Low burden of proof
      • Focus – primary/prevention
    • Law/Child protection
      • More weight to protective factors
      • High burden of proof
      • Focus – tertiary/response
  26. And so
    • Weighing up of risk and protective factors
    • No formula - risk might also be protective
    • Considered:
      • Environment
      • Age and child characteristics
      • Social norms
      • Parent capacity
  27. Layers of protection
    • (image - 4 rings sitting inside one another. The first, smallest ring is labelled 'Individual', the second ring is labelled 'Relationship', the third 'Community' and the fourth, outer ring is 'Society'. )
    • This diagram is from: Krug, E., et al., eds. World report on violence and health. ed. WHO, 2002, WHO: Geneva. (page 12).
  28. Systems Approach
    • (image - Four slices of Swiss cheese and an arrow showing where the holes line up illustrating Reason's 'Swiss Cheese' model.)
    • Reason, J. BMJ;320:768-770
  29. Beyond the theoretical
    • Consider:
      • Risks
      • Protective factors
      • ‘Systems’ at various ecological levels that can be implemented
      • Evaluate
      • Modify
  30. The big picture
    • Situational crime prevention model
      • Child-safe organisations/communities…
        • Not risky people vs safe people
    • Public health model
      • Universal (population) services
      • More focus where risk is higher
    • Collective responsibility
  31. "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear." Nelson Mandela

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