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Protecting Children is Everybody’s Business: Investigating the Demand for Service at the Children’s Aid Society of Lond

Protecting Children is Everybody’s Business: Investigating the Demand for Service at the Children’s 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

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Protecting Children is Everybody’s Business: Investigating the Demand for Service at the Children’s Aid Society of Lond

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  1. Protecting Children is Everybody’s Business: Investigating the Demand for Service at the Children’s 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

  2. 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

  3. Goals of Research • To examine factors that could help account for the increase in the demand for service at the Children’s Aid Society of London and Middlesex

  4. Increases in Ontario’s 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)

  5. Ontario’s 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)

  6. The Number of Children Admitted to Care(London and Middlesex CAS (1993-2002)

  7. The Number of Children in Care at Year End

  8. 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

  9. 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

  10. 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

  11. The Risk Assessment Tool • Developed as the Risk Assessment Model for Child Protection in Ontario • Includes22 areas that describe child welfare risk related areas: • Caregiver Influence (Parental capacity) • Child’s Influence (Vulnerability, health status) • Family Influence (Violence, social supports) • Intervention Influence (Motivation, cooperation) • Abuse and Neglect (history and severity)

  12. 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

  13. 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

  14. Policy, Clinical and Systemic Issues Supplementary Reports • Developmentally and medically fragile children • First nations children with the CAS • Community Feedback

  15. 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)

  16. 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

  17. 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

  18. 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

  19. 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 19952001 Average risk score 25.3 29.4

  20. Changing Level of Risk of Children Admitted to Care • If the threshold for admission to care has been lowered, risk scores will be lowerin 1995 relative to 2001 The Outcome • The average cumulative risk score for families is higher in 2001 relative to 1995 19952001 • Average risk score 31.5 34.7

  21. 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

  22. 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 ReferralPercent Parent 20.0 Police 17.9 Family Associate 17.3 Children’s Service Provider 14.6

  23. 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 Referral19952001 Professional 51% 73%

  24. 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

  25. 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

  26. 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

  27. Study #1 Child Maltreatment

  28. 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%

  29. 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

  30. 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

  31. Study #2 Woman Abuse

  32. 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

  33. 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

  34. Woman Abuse Among Caregivers of CAS Children Increase of six percent between 1995 and 2001

  35. Caregivers Experiencing Woman Abuse AbusedNon abused (%) (%) • Major mental disorders 45 37 • Substance abuse 23 12 • Chronic medical condition 20 13

  36. 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

  37. Study #3 Poverty

  38. Rates of Child Poverty • 1996 census: Canada ranks sixth of the world’s twenty five most industrialized countries • National rate of child poverty - 21.1% • Ontario rate of child poverty - 20.3% • 1996 census: Ontario’s child poverty rate increased by 5% relative to 1990 census (largest provincial increase: 390,000 children in Ontario live in poverty)

  39. 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

  40. Children Age 15 and Under Living in Poverty Proportion of London Children Age 15 and Below living in Poverty TotalPoorTotalPoorPoverty 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

  41. 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%

  42. 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%

  43. Differential Contribution to Child Risk • Examination of what contributes to cumulative child risk scores? • Violence • Poverty

  44. Study #4 Maternal Depression and Child Risk

  45. 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

  46. 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

  47. 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%

  48. Study # 5 Parenting Capacity

  49. 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: • Caregiver’s expectation of child • Caregiver’s acceptance of child • Family Identity and Interactions

  50. 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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