Families with Multiple and Complex Problems and Child Protection Services Key Issues for Practice

1. Families with Multiple and Complex Problems and Child Protection ServicesKey Issues for Practice Leah Bromfield ACWA Conference, Sydney, August 2010

2. 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

3. Overview • Definitions & prevalence • Key issues for assessment • Key issues for planning • Implications for interventions

4. Families with multiple and complex problems are: • Families with multiple, chronic, and inter-related 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)

5. 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

6. 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

7. 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”

8. 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

9. Why do problems frequently co-occur? • 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)

10. 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

11. Substance misuse • Misuse of licit (alcohol, prescription medications) or illicit (opioids, amphetamines, psychoactive) substances • Effects of intoxication: • 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

12. 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

13. 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

14. 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

15. 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

16. 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, self-medicate • Post-separation: homelessness, housing instability, financial insecurity, poverty

17. 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

18. Domestic violence - fathering impacts • Physically & verbally undermine mother • Manipulate perception of situation to shift blame • Disconnect between professed emotions & actual behaviour

19. 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

20. 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

21. 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: • Depression • Bipolar disorder • Schizophrenia • Post-traumatic stress syndrome • Borderline personality disorder (mothers) • Anti-social personality disorder (fathers)

22. 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

23. 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, wide-reaching

24. 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

25. 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)

26. 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

27. 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

28. Key issues for intervention in CP • Trauma • Parenting • Appropriate referral • Working in partnership

29. Systems that support practitioners • Capacity • Integrated • no wrong door • remove 'silos' • Prevention focussed

30. 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

31. A/Prof Leah Bromfield Deputy Director Australian Centre for Child Protection University of South Australia www.unisa.edu.au/childprotection/ Leah.Bromfield@unisa.edu.au 08 8302 2924