The following describes a case study scenario in which I am an experienced, protective services worker about to do the first home visit with a new family. It goes on to speculate what might happen, the families reactions, cultural variations and engagement tools and recommendations.
While many service bureaucracies focus on a single family member as the client or patient, my site visits suggested that the needs of children in particular (and probably other family members as well) may be impossible to solve, and perhaps even to diagnose, if a program’s focus is on the individual child rather than the family. In fact, programs may need to learn a great deal about the family as a whole if they are to diagnose and solve the problems of children. At the simplest level, an example is a problem for a baby that is caused by interaction between a teen mother and her own mother, the baby’s grandmother: [One caseworker:] “Most of the grandparents will tell them, “Don’t hold the baby, you’re going to spoil it.” . . . I spend a lot of time trying to talk to grandparents.” [Another caseworker:] “[You] have to go back to the grandparents. These kids [the teens] — all they hear is ‘You’re stupid. I didn’t do it that way.’ So after a while they figure, ‘If I touch this baby, it’s wrong.’ So, ‘Here, momma, take it’ (Jones, 2004).
Two examples are shown below, to illustrate more fully the way in which children’s needs are nested in a family context and intimately connected with the parents’ and other family members’ own personal well-being. The first example comes from Oklahoma’s Integrated Family Services (IFS) System, which serves multiproblem families:
A seven-year-old boy came to the attention of a school principal because of both physical and emotional health problems. The boy had long been prone to seizures and self-destructive behavior and was just starting to threaten other children. When the principal called IFS, he found that IFS was already working with the family because the mother was on AFDC and herself had multiple problems. The IFS worker called a meeting of all of the agencies who had contact with the family to talk about the child’s needs. As a result, the boy was admitted and sent to a diagnostic center for several months of testing and treatment; the mother received needed services such as mental health treatment and literacy training; and the Child Protective Services worker changed her mind about the possible outcomes for the case and concluded that the mother had the potential to be an adequate parent (Huston, 2003).
In this example, the needs of the child turned out to be related to the needs of the mother — and, perhaps more important for the service delivery system, part of the solution to the child’s needs lay in providing services to the mother so that she could help him. According to an IFS case worker, “What the child really [may] need is a mother who can cope” (Herr, et al 1999). In the second example, in which meeting a child’s needs again depends on an adult’s well-being, serving the child depends critically on the service deliverer’s relationship with the adult. The illustration comes from a site visitor who accompanied a case manager on a home visit:
The case manager made a home visit to a young (18-year-old) mother who had suffered physical and sexual abuse as a child. During the visit, the case manager picked up and played with the young woman’s 8-month-old child and observed how the child responded. Then she asked the mother a specific question about her experience with the child: Did she ever feel as though she were “climbing the walls” and just had to get out of the house when the baby was crying? The young woman said yes, and the case manager asked what she did at such times: Was there anyone she could leave the child with so that she could go on a walk? The teen responded that either she left the baby with her friend downstairs and went for a walk, or she put the child in the crib, closed the door partway, and went into another room. The case manager seemed satisfied with these responses, and she later told the interviewer that, while she has no reason to suspect any abuse or neglect in this case, she realizes that the teen is somewhat unstable and under great stress, so she likes to keep close watch on what is going on (Pelton, 2008).
In this example, the case manager’s key contribution to the child’s wellbeing comes through her attention to and friendship with the mother. Only the case manager’s strong personal relationship with the teen enabled her to keep a constant eye on the case while not being perceived by the teenager as intrusive, only the strong relationship permitted her diagnosis that the child was doing fine, and only the relationship permitted her to provide preventive services in the form of low-key advice. These links between a child’s needs and the well-being of the family as a whole reinforce the conclusion that effective family service deliverers need a trusting relationship with the family and an ability to reach out across systems (Crosson, 2010; pg 12). In particular, the links between child and family well-being suggest that serving children in multiproblem families requires that the service deliverer know both child and family well and be able to reach out across the service system to help all family members.
2.) We shall now discuss the three types of preventions with examples.
Many of the “preventive services” offered by the sites (Wolock, 1984) parenting education and support for parents’ ability to nurture their children-occur not through formal services but through the relationship between the family and the case manager. However, several of the sites also provide more formal services, such as support groups, classes, or workshops. For example, all three of the teen parent programs provide teen support groups that touch on parenting issues as well as other topics such as self-esteem, health and nutrition, and family planning. In addition to knowledge about parenting, these programs generally emphasize providing mothers with the warmth and support that they are seen to need in order to be warm and supportive, in turn, to their children. Some of the programs also emphasize the actual practice of new attitudes and skills in interacting with children (Herr, et al 1999). For example, in the TASA Next Step program, teen parent support groups are paired with on-site child care, and the sessions are planned so that mothers meet without their children for the first portion of the visit and with the children for the second.
What exactly does it mean to serve children through this case management relationship? What does the relationship offer besides referral to specific, functional services like those already discussed? More generally, the family-oriented case managers in the site programs serve children by:
1 Keeping an eye on children themselves and helping families gauge how their children are doing;
2 Providing parents with support and friendship, assistance in improving important family relationships and in dealing differently with their children, and information about parenting or children;
3 Providing friendship, support, and role models for a child directly; and encouraging other service deliverers to respond more effectively to a child’s needs.
In several programs, case managers struggle to bring together their role in relation to a single client, such as a teen mother or a school age child, with their role in relation to the family as a whole. In these successful examples, case managers reported integrating those roles to see the child in a family context rather than advocating for one family member against another, but not all experiences were as successful. In addition, case managers operated with quite different levels of training in child development and family functioning; again, the examples illustrated in this paper show what is possible with training and, in several cases, expert backup support.
3. The following discusses the societal changes that should be made to protect children in the twenty-first century.
Children who are growing up in poverty or other kinds of need are likely to come into contact with other large public agencies besides the welfare system: the public schools, community health clinics or city hospitals, and, perhaps, sadly, the state’s child protective services agency. What are the implications of the findings presented here for the other large public agencies that see poor children and families? To put the question slightly differently, what principles would we apply to each system if we wanted to create a coherent network of services to children? While this study was not designed to investigate other service systems in any detail, the research sites do suggest several intriguing speculations (Crosson, 2010). First, other agencies besides the welfare department can and should consider what it means to be two-generational. As the research sites and the evidence of other researchers suggest, family needs are often intertwined, whereas the services offered by many of the large systems are limited to a single family member (Jones, 2004). A number of program examples from the site visits and other sources illustrate what it means for service providers other than the welfare department to be two-generational in their focus:
â€¢ The PACE program in Kentucky, with its combination of adult literacy and preschool education operates within the public schools. In addition to offering two-generational services to families that are directly enrolled in PACE, the program director sees PACE as a vehicle for changing the thinking of the public schools toward a greater inclusion of parents and other family members.
Child protective services workers in several of the research sites found that working with intensive case managers helped them appreciate the demands on parents that made it difficult for the latter, in turn, to respond to the needs of the child. This insight lies behind a variety of family support and family preservation programs now being deployed as part of the child welfare services continuum in a number of states. The aim of these programs is to offer services to both parent and child to improve family functioning and enable the child to stay in the home (Wolock, 1984). Visiting nurse programs enable health care providers to see parents and children together and serve the whole family. Maternal and child health clinics with other collocated services also offer the opportunity to meet the needs of several family members.
In several locations in New England, Head Start programs are planning or already operating programs jointly with education and training programs for mothers on welfare. These programs include cooperative projects with vocational high schools and with a community training agency. The ways in which welfare agencies have overcome these barriers may well offer insights to other agencies (Jones, 2004). For example, welfare agencies at the successful sites have overcome the limitations of their initial mandate by developing a clear and sustainable mission that makes dear why services to children and families are part of the welfare agency’s job. In order to expand services, schools, health clinics, and child protective services agencies may similarly need to articulate connections between an initial, narrower mission and the broader, family-centered mission that they would like to achieve (Crosson, 2010). Thus, schools may conclude that they cannot teach children without a collaborative relationship with parents, that they cannot teach children without addressing the problems that keep them from being ready to learn, or that they cannot teach teen mothers effectively without addressing their roles as parents as well as students. Child protective services agencies may conclude that functions such as enhancing family stability and averting foster care are more effective over the long run than providing after-the-fact treatment.
4.) Discuss the key similarities and the differences between the residual effects of neglect, physical abuse, and sexual abuse. What implications does this knowledge have for future prevention, intervention and treatment efforts?
While both formal and informal services at the sites are geared to preventing child abuse and neglect, program case managers sometimes find that they need to take stronger, more drastic measures to ensure a child’s safety and well-being. Case managers in a number of the programs call on child protective services workers for informal consultation and help when they are worried about a family, and several said that they had made child protective referrals (hotlined a family) at least once (Pelton, 2008). The informal consultation appears to go both ways: Child protective services workers in several locations reportedly ask the site case managers to keep an eye on families which they worry about but cannot serve themselves, given their caseload of even more urgent crises.
The worker must be able to cross professional boundaries to meet a wide variety of family needs. In order to serve the child, he or she must also develop a relationship with the whole family, since the child’s well-being is often intimately bound up with the well-being of other family members. No agency attempting to move in a two-generational direction should expect the change to be easy (Wolock, 1984). Many of the obstacles experienced by welfare agencies apply just as forcefully to the other large service systems for poor children and families. For example, difficulties of mission plague both schools and child welfare agencies that consider reaching out to parents, just as they hamper welfare agencies that consider reaching out to children. In the school setting, teachers, administrators, and elected overseers may worry that a mission of academic excellence will be compromised by too much attention to the multiple needs that children and their families bring into the classroom. For child welfare agencies, the conflict is even more stark: In an agency whose mission is to protect children, many of whom are in urgent danger, how can it be legitimate to pay comparable attention to their parents? Similarly, each system suffers isolation from other service deliverers and lack of expertise in the multiple problems of families. Each experiences its own set of demands on workers and on the organization as a whole, demands that must be balanced against the needs of families in any successful solution.