Work Practice for Children and Families - Case Study Example

Work Practice for Children and Families. INTRODUCTION: Historically, social workers have played a key role in the child welfare system by protecting children at risk and supporting families in need. Indeed, the social work profession is strongly rooted in the tradition of social reform, much of which was directed toward alleviating the problems of children in postindustrial society. Family health social work practice is focused on nurturing and strengthening the family unit. It is based on systems and ecological concepts, and the principles of individual and family development. This approach is multidisciplinary in nature and uses variety of techniques to help the family unit. Family-centered practice is a way of working with families, using both formal and informal ways so as to help them to care for and protect their children. It focuses on the needs and welfare of children within the context of their families and communities. This practice analyzes the strengths and weaknesses of family relationships and tries to build on the strengths to achieve the required outputs. It tries to minimize or workaround the weaknesses and provide necessary support to overcome them. Family-centered practice helps families by advocating for improvement in their living conditions, by providing them the necessary support, stabilizing those in crisis, reunifying those who are separated, building new families, and connecting families to the resources that will sustain them in the future. Basically, this practice form is based on the premise that the best place for children to grow up is in families and providing services that engage, involve, strengthen, and support families is the most effective approach to ensuring children's safety, permanency, and well-being. (Tollefson, 1999) A successful practice requires mutual trust, respect, honesty, and open communication between parents and family support workers. Families should be involved in the development of policy, program design, and evaluation, and they should be encouraged to make their own decisions in selecting services for themselves and their children. Family and child assessment is strengths-based and solution-focused. Services are community-based and build upon informal supports and resources. Family-centered and community-based principles are at the heart of a number of practice approaches being implemented across program areas and service systems. These approaches are used at different points in the helping process for purposes of assessment, case planning, and decision-making, and to address identified needs and concerns. Some are developed to address a specific population, such as substance-involved families or families of prisoners. The Key components of family-centered practice include: Strengthening the capacity of families to function effectively Providing specific and individualized, flexible, and relevant services for each family depending on their unique needs. Support the family by helping them make conscious and wise decisions for the betterment of their condition. Ensuring the safety and well-being of all family members by understanding and helping them meet their specific needs. Providing help and support by linking them with community-based networks of supports and services which are comprehensive and culturally relevant. APPROACHES TO FAMILY CENTRIC PRACTICE Some of the important approaches to family oriented practice are : 1. Family group decision-making --- This approach requires that all the family members are brought together to discuss and make suggestions and make decisions about how to care for their children and develop a plan which is most suitable for their children and family. It is a well known fact that people participate in any process only when they are genuinely interested or when they are the part of decision making process. Thus it is very important to allow the family to make their own conscious decisions rather than imposing any decisions on them. 2. Family-Centered, Neighborhood-Based Foster Care : This approach is based on the focusing on strengths of the family. It is culturally sensitive and based on neighbor to neighbor, neighbor to family, and family to family approach. The focus is on the provision of foster care services and the support of community and networks for families. 3. Alternative Response as a Family-Centered Approach : Traditional response to any child neglect or abuse report is the investigation and putting approprotae intervention in place. But now most of the child welfare agencies are moving towards and adopting family centered approach called alternative response, differential response, or multiple response. In these models, the family support providers assess the needs and requirements of the family and child and try to ensure the child's safety, without requiring a determination regarding maltreatment. Families may receive services through diversion to community agencies. 4. Shared Family Care :In Shared Family Care (SFC), parents and children are placed together in the home of a host family who is trained to mentor and support the parents as they develop skills and supports necessary to care for their children independently. This is used as an option against out-of-home placement and to provide reunification options to families that have been separated. 5. Family Mediation : Family mediation is also known as alternative dispute resolution, collaborative negotiation, conflict resolution, or conflict intervention. It is used in making child protection, child placement, and permanency decisions for children. This is different to the traditional approach of decision making process and it involves close cooperation between court and community based mediators with the family to resolve the conflicts. 6. Mother/Child Residential Substance Abuse Treatment :Traditional models of substance abuse treatment have relied on residential programs in which the user is separated from his or her family. During this period, the children are place din foster care and thus it is not possible for children and parents form or maintain a strong attachment. In this family centric approach, children are allowed to live with their parents, usually the mother, in a facility that provides services related to both substance abuse and parenting CASE STUDY In our case study, the most important aspect is that of Child neglect. All the children - Sean, Marie , Ronan and Roisin are neglected children. Previous research ahs shown that the neglect was distinguishable from abuse and conceptualized it as a failure by emotionally needy mothers to provide adequate care (however unintentional) (Rose & Meezan, 1993, pp. 280_281). As with other forms of child maltreatment, child neglect research has many grey areas and it is characterized by a widespread lack of consensus. The family support workers do not have much time think about these differentiation. Thus, they mostly rely on personal discretion and professional judgement. CHILD NEGLECT Child neglect can thus be defined as a condition in which a caretaker responsible for the child, either deliberately or by extraordinary inattentiveness, permits the child to experience avoidable present suffering and/or fails to provide one or more of the ingredients generally deemed essential for developing a person's physical, intellectual, and emotional capacities (Gaudin, 1993a, pp. 3_4). It is the term used to describe parents' or caretakers' failure to provide basic physical health care, supervision, nutrition, personal hygiene, emotional nurturing, education, or safe housing. It also includes child abandonment or expulsion, and custody-related forms of inattention to the child's needs (Gaudin, 1993b, p. 67). These parents do not provide for their children's needs resulting in adverse affects on the child's health and development. These parents do not feel guilty and are unable to foresee the harmful consequences of the chronic neglected state of their children (Hall et al., 1982, p. 6), (Swift, 1995a, pp. 70_71). It has been proven that the incidence of neglect is more prevalent in areas of extreme poverty. But this does not mean that all children living in such conditions are neglected. There are variety of reasons why child neglect may occur and poverty is definitely one of the important reason. In a study published in 1993, Giovannoni found that the main criterion used in defining whether abuse or neglect existed was the seriousness of impact upon the child, and that this criterion was fairly consistent across groups. The other problems that may be prevalent in such families are the adults having minimal exposure to knowledge, skills and tangible resources. Dubowitz et al. (1993) noted that although estimates of severity are typically based on the degree of harm involved, this is not always immediately apparent and/or easy to assess. There have been a wide range of different subtypes of child neglect. Rose and Meezan, and Swift have noted that physical neglect has always been the first concern of the social welfare workers. As per Swift (1995a) this concern is mirrored in practice as the traditional physical signs of neglect predominate in both case records and in workers' talk about neglect (p. 72).Besides physical neglect, there are emotional as well as medical neglect. Emotional neglect generally happens when the parents are ignorant and unaware of their child's needs. It is also due to depressive moods, chaotic life-styles, poverty, lack of support, and lack of appropriate child-rearing models (often based on parental childhood experiences), unwittingly impairing child-development and well-being (Iwaniec, 1995, p. 5). While the failure to thrive is the medical neglect of the child. And it refers to chronic and severe undernutrition of an infant. As we can now readily see that Ronan and Roisin are victims of medical neglect while the older kids Sean and Marie have unfulfilled emotional needs besides the physical neglect which is more due to poverty than anything else. MODELS OF CHILD NEGLECT AND OUR CASE STUDY We will now consider the models of child neglect study. And try to fit in our case study within these frameworks. The medical diagnostic approach to child maltreatment is the oldest model of child neglect. This model is limited to the most severe instances of child maltreatment, (D. Barnett et al., 1993, p. 18). And it involves emphasis on treating a disorder afflicting the parent. It is a highly individualistic approach, based on a view of neglect as a disease entity in need of a cure. Sociological models of child maltreatment (e.g., Gelles, Giovannoni and Becerra) define child maltreatment in terms of a social judgement of parental acts that are deemed inappropriate by cultural standards and practices. They concentrate on factors such as poverty, that give rise to mal-treatment. Legal models of child maltreatment (e.g., Wald) establish clear guidelines regarding parental actions justifying court action. These models aim to provide national standards for judicial decisions about maltreatment. Ecological models (e.g., Bronfenbrenner, Belsky, Garbarino, Starr, Zuravin) place equal emphasis on environmental and familial contributions to maltreatment. These models maintain that society as a whole shares responsibility for child protection (D. Barnett et al., 1993, pp. 18_19). The new approach is more child-focused than the parent focused one. And it tries to deal with the effects of neglectful behavior on the child. This became necessary because in parent focus approaches, the social workers were placing children in foster homes thereby disrupting a very biological bond between parents and children and most of the times there was no substantial risk of harm to the child.(Rose & Meezan, 1993, p. 284). Thus coming back to our case study, we can actually use a framework of two approaches - one where there is a need for urgent medical attention for the two young kids roisin and ronan. Theirs is a case where the physical neglect is more significant at this stage of their lives and they are both dependent on their parents for their physical needs. But to be fair, this neglect is more due to the abject state of poverty in which the Barlow family finds itself. Though this is not conclusively established, but financial assistance may be the key to their immediate problems. The problems of the older kids are also due to poverty but there is an aspect of emotional neglect here. As earlier workers have pointed out, the mother Tracey expects these two children to take care of themselves at such a tender age. This is due to her own inability to cope with the pressures of raising four children as well as her lack of learning ability. And her apparent lack of resources to do anything about her situation. CLL SCALE IN OUR CASE STUDY There are several measures that can be used to assist in assessing the existence of child neglect. The most commonly used is the Childhood Level of Living (CLL) Scale, which grew out of Polansky et al.'s 1967 research of neglectful mothers in rural Appalachia. The CLL Scale was designed to examine specific elements of care along a continuum from poor to excellent, in the arenas of physical, emotional, and cognitive care. This allows for deficits in one area to be compensated for by strengths in another and for patterns of good as well as poor care to be identified (Swift, 1995a, p. 69). The CLL presents nine descriptive categories, five of which assess physical care and four the emotional, cognitive, or psychological factors. Under physical care, consideration is given to such facts as meal planning, medical care, safety issues, leaving the child alone, house or shelter adequacy and safety, appropriateness of sleeping and living conditions, and cleanliness. The psychological assessment considers the type of stimulation the child is given, the parents' emotional availability to the child, quality of discipline, the mother's concern for the child, and her own stability (Hally, and Polansky, 1980) (Hanson, 1993, p. 96). Using this CLL scale in our case study we can easily say that both the physical and psychological factors seem to be on the negative side showing a definite neglect in the family. But there has been one positive point which is that all the children seem to be fond of their parents and thus moving them to foster care or out of home does not look to be a viable option for now. Thus besides poverty, it seems that Adrian's unemployment has also caused a state of despondency in the family. He seems to be having a drinking problem and Tracey is a chain smoker, thus both the parents are showing substance abuse and are depressed. Moreover, their problems seem to be increasing with the addition of more children. In such conditions, they are probably unaware of the needs of their children. Crittenden (1993) looked at cognitive theory on information processing and identified four states at which parents could fail to respond to signs by their children. According to her parents fail to respond to children's need for care because "they did not perceive the signal, interpreted the signal as not requiring a parental response, knew that a response was needed but did not have a response available, or selected a response but failed to implement it" (p. 27). As were have seen now that Adrian has lost his job and the family is currently facing financial problems, it may be a good idea to introduce Adrian to other employment opportunities in his neighborhood such that he could take care of his family. Sometimes, people are unduly biased against poor families and this might be the case here as well. It is seen that some workers may harbor, wittingly or unwittingly, a less sympathetic view toward the poor (Piven & Cloward, 1971). Low-income families may be held largely accountable for their circumstances and professionals may be reluctant to become involved in financial issues. INTERVENTIONS AND TREATMENT PLANS Till now, there is no definite criteria about which intervention targets should be used to prevent or correct child maltreatment or which are most easily or effectively modified (Belsky, 1993, p. 413). Researchers have proposed few interventions unique to child neglect. The most effective interventions are comprehensive and relatively long term (Gaudin, 1993) (Erickson & Egeland, 1996, p. 16). The findings showed that cases where focus was on skill-training such as home management and social skills, parent education and support groups, family counseling, home-based counseling to remediate daily living skills deficits, and the use of lay counselors gave positive outcomes while those using traditional approaches of parent-focused interventions and casework, were associated with the poorest outcomes (Becker et al., 1995, p. 37). Thus it is very clear that family centric approach would be best in this case. The idea would be try to provide employment to Adrian and some home based work to Tracey such that they are able to have a sustained family monthly income to provide decent meals to their children. The other need is to provide information on handling kids or helping them become better parents by becoming responsive to the needs of their children. Coohey (1996) recommended a variety of interventions which focused on providing a network of people who can provide emotional support to parents of such families. The intervention should aim at helping and guiding them towards increasing institutional resources such as adequate education and employment. Thus a combination of parenting groups, intensive in-home counseling and supportive interventions should be used for helping Adrian and Tracey cope with their circumstances. It is necessary to provide interventions suited and individualized to the needs of the particular Family. (Dubowitz et al.,1993). For poor families, the financial support or Improved housing conditions play an important role in improving their circumstances (Belsky, 1993). Since poverty is a major contributing factor to child neglect, the interventions should include guaranteed minimal incomes, child allowances, and housing benefits to Barlow family. The treatment goals must include the nurturing of the neglecting parents (Adrian and Tracey) in order to enhance their self-esteem and self-efficacy. The interventions should be parent friendly and assume that parents want to improve the quality of care for their children (Gaudin, 1993b). This will help in reinforcing the parents' hidden strengths. We should try to set realistic and achievable treatment goals. If required, we will exercise legal authority to overcome any denial or apathy. And last but not the least, we have to ensure that the treatment lasts at least 12 months. We will create a program that would use in-home behavioral training to teach Adrian and Tracey shopping and menu-planning skills so as to able to provide a nutritious and balanced meal to the kids. The training program should include the basic skills to improve the cleanliness in the home and to remedy specific safety hazards and to identify the children's illness symptoms. Both the parents and children (specially Sean and Marie) will need to learn the behavior modification techniques and positive reinforcement to remedy specific skill deficits and environmental conditions (Barone et al.) (Gaudin, 1993b, p. 74). To conclude, the Barlow family needs a comprehensive training and skill development module specifically made for them to undergo the required transformation in their behaviors. Since they have been floating around in such conditions for so long, it is not going to be easy. Thus regular follow ups along with strict adherence to the plan is a must. We might have to take a legal recourse to help them overcome their initial feras. We are positive that once they actually see the outcome of this treatment, they themselves would like to continue and improve their condition. The two younger children will need intensive care and extra support to come up to the required level. Both Adrian and Tracey should be made aware of their own needs and skill deficits and encouraged to overcome for the betterment of their children and family. Adrian has to be provided an employment opportunity to overcome his apparent lack of concern or frustration. We are sure that once the family has a steady income , they will be able to kick off their lethargic and neglectful attitudes. Thus a comprehensive family centric approach is the way to go for the Barlow family. REFERENCES 1. Barnett, D., J. T. Manly; D. Cicchetti., (1993) "Defining Child Maltreatment: The Interface Between Policy and Research." In D. Cicchetti and S. L. Toth (eds.), Child Abuse, Child Development, and Social Policy, 7_73. Norwood, N.J.: Ablex Publishing, 2. Barnett, D; J. I. Vondra; S. M. Shonk., (1996) "Self-Perceptions, Motivation, and School Functioning of Low-Income Maltreated and Comparison Children." Child Abuse and Neglect 20(5) : 397_410. 3. Belsky, J.,(1993) "Etiology of Child Maltreatment: A Developmental-Ecological Analysis." In Psychological Bulletin 114(3) : 413_434. 4. Becker, Judith; J. L. Alpert; D. S. BigFoot; B. L. Bonner et al.(1995) "Empirical Research on Child Abuse Treatment: Report by the Child Abuse and Neglect Treatment Working Group, American Psychological Association." Journal of Clinical Child Psychology 24 (Suppl.) : 23_46. 5. Coohey, C., (1994) "Neglectful Mothers, Their Mothers, and Partners: The Significance of Mutual Aid." Child Abuse and Neglect 19(8) : 885_895. 6 .Coohey, C. (1996) "Child Maltreatment: Testing the Social Isolation Hypothesis." Child Abuse and Neglect 20(3) : 241_254. 7. Crittenden, Patricia M. , (1993)"An Information-Processing Perspective on the Behaviour of Neglectful Parents." Criminal Justice and Behaviour 20(1) : 27_48. 8. Dubowitz, H; M. Black; R. H. Starr; S. Zuravin.(1993) "A Conceptual Definition of Child Neglect." Criminal Justice and Behaviour 20(1) : 8_26. 9. Dubowitz, H., (1994) "Neglecting the Neglect of Neglect." Journal of Interpersonal Violence 9(4) : 556_560. 10. Dubowitz, Howard; M. Black., (1994) "Medical Neglect." In J. Briere et al. (eds.), The APSAC Handbook on Child Maltreatment, 227_241. Thousand Oaks, Calif.: Sage. 11. Erickson, Martha; B. Egeland. (1996) "Child Neglect." In J. Briere et al. (eds.), The APSAC Handbook on Child Maltreatment, 4_20. Thousand Oaks, Calif.: Sage. 12. Gaudin, James Jr., (1993a) Child Neglect: A Guide for Intervention. Washington: U.S. Department of Health and Human Services. 13. Gaudin, James M. (1993b)"Effective Intervention with Neglectful Families." Criminal Justice and Behaviour 20(1) : 66_89. 14. Gaudin, James M.; N. A. Polansky; A. C. Kilpatrick; P. Shilton. (1993)"Loneliness, depression, Stress, and Social Supports in Neglectful Families." American Journal of Orthopsychiatry 63(4) : 597_605. 15. Gaudin, James M.; N. A. Polansky; A. C. Kilpatrick; P. Shilton., (1996) "Family Functioning in Neglectful Families." Child Abuse and Neglect 20(4) : 363_377. 16. Giovannoni, Jeanne M.(1993) "A Child Centered Resolution." In Chronic Neglect Symposium Proceedings, 1993, 8_10. National Center on Child Abuse and Neglect. Washington: U.S. Department of Health and Human Services. 17. Hanson, K, (1993) "The Neglect of Children." In Understanding Child Abuse and Neglect, 95_122. Needham Heights, Mass.: Allyn and Bacon. 18. Iwaniec, D., (1995) The Emotionally Abused and Neglected Child. Chichester, Eng.: Wiley. 19. Iwaniec, D.,(1997) "Evaluating Parent Training for Emotionally Abusive and Neglectful Parents: Comparing Individual Versus Individual and Group Intervention." Research on Social Work Practice 7(3) : 329_349. 20. Tollefson, (1999). Family-Centered Child Welfare Practice: A Resource Manual for Child Welfare Workers, Administrators, and Educators 21. Rose, Susan J.; W. Meezan.(1993) "Defining Child Neglect: Evolution, Influences, and Issues." Social Service Review 67(2) : 279_293. 22. Rose, Susan J.; W. Meezan., (1996) "Variations in Perceptions of Child Neglect." Child Welfare 75(2) : 139_160. 23. Sullivan, S., (1998) Child Neglect: Current Definitions and Models: A review of child neglect research, 1993_1998, Family Violence Prevention Unit, Health Canada. 24. Swift, Karen J., (1995a) Manufacturing "Bad Mothers": A Critical Perspective on Child Neglect. Toronto: University of Toronto Press. 25. Swift, Karen J. (1995b) "An Outrage to Common Decency: Historical Perspectives on Child Neglect." Child Welfare 74(1) : 71_91. Read More