Child welfare process and outcomes for children of parents

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Child welfare process and outcomes for children of parents

Transcript Of Child welfare process and outcomes for children of parents

CHILD WELFARE PROCESS AND OUTCOMES FOR CHILDREN OF PARENTS WITH COGNITIVE IMPAIRMENT [II]
Findings from the CIS_2008
David McConnell, PhD Maurice Feldman, PhD Marjorie Aunos, PhD Laura Pacheco, PhD
January 2017

This research was supported by a grant from PolicyWise for

Children and Families, formerly the Alberta Centre for Child,

Family

and

Community

Research
Child welfare

process

and

outcomes

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CONTENTS
EXECUTIVE SUMMARY ........................................................................................................ 1 BACKGROUND .................................................................................................................... 3 METHODS ............................................................................................................................ 9 Data Analysis ...................................................................................................................13 RESULTS: PREVALENCE AND OUTCOMES .......................................................................17 RESULTS: CHILD, CASE, CAREGIVER AND HOUSEHOLD CHARACTERISTICS ...............22 RESULTS: ISOLATING THE MAIN EFFECT OF PRIMARY CAREGIVER CI ........................29 RESULTS: THE MODERATING EFFECT OF PRIMARY CAREGIVER CI..............................32 DISCUSSION .......................................................................................................................36 Study Limitations.............................................................................................................39 Conclusions .......................................................................................................................39 Appendix A i - ‘Substantiation’ regressions .....................................................................41 Appendix A ii - ‘Apprehension’ regressions .....................................................................42 Appendix A iii - ‘Case remains open’ regressions ............................................................43 Appendix A iv - ‘Court application’ regressions...............................................................44 Appendix B - ‘Investigated maltreatment type’ regressions……………………………….45 References ............................................................................................................................46
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LIST OF TABLES
Table 1. Investigation outcomes: summary statistics ............................................................18 Table 2. Case outcomes by suspected and confirmed primary caregiver CI ..........................18 Table 3. ORs for primary caregiver CI by investigation outcome and child age group .........19 Table 4. Primary caregiver CI by child age: interaction effects .............................................19 Table 5. Case outcomes by household type and caregiver CI .................................................21 Table 6. Investigation outcomes regressed on caregiver CI ...................................................21 Table 7. Case characteristics...................................................................................................24 Table 8. Caregiver and household characteristics: summary statistics.................................25 Table 9. Primary caregiver CI: Unadjusted and adjusted odds ratios ...................................30 Table 10. Referrals made in cases kept open for ongoing services.........................................31 Table 11. Interaction effects: Selected predictors by Primary caregiver CI ..........................33 Table 12. ‘Effects’ of select variables on outcomes..................................................................35
LIST OF FIGURES
Figure 1. Flow of cases: no primary caregiver CI ...................................................................15 Figure 2. Flow of cases: Primary caregiver CI........................................................................16 Figure 3. Child age group distributions ..................................................................................17 Figure 4. Association between primary caregiver CI and outcomes by child age group .......20 Figure 5. Child characteristics ................................................................................................23 Figure 6. Primary child protection concerns...........................................................................24 Figure 7. Primary caregiver characteristics ...........................................................................26 Figure 8. Household characteristics........................................................................................26 Figure 9. Association between primary caregiver CI and maltreatment type.......................27 Figure 10. Association between primary caregiver CI and child functioning issues .............28
Child welfare process and outcomes II ii

EXECUTIVE SUMMARY
 Utilizing data from the third Canadian Incidence Study of Reported Child Abuse and Neglect (CIS_2008), this study investigated prevalence and outcomes for children of caregivers with cognitive impairments (CI) subject to child maltreatment investigations.
 The CIS_2008 includes data on a total of 15,980 children 15 years of age or younger subject to a child maltreatment investigation. This dataset includes information on child, case, caregiver and household characteristics, and investigation outcomes.
Selected findings
 Caregiver CI (primary and secondary) was noted in 7.8% of all cases: Children of parents/ caregivers with CI are four to five times more likely than children of parents/ caregivers without CI to be the subject of a child maltreatment investigation.
 The prevalence of caregiver CI varies with child age. Primary caregiver CI was noted in 14.3% of child maltreatment investigations involving infants (< 1 year), and 4.7% of investigations involving teens (13-15 years).
 Three out of four investigations in which primary caregiver CI was noted were opened due to concerns related to neglect or ‘risk of future maltreatment’. Allegations of physical and or sexual abuse are rare in cases featuring primary caregiver CI compared with all other cases.
 While primary caregiver CI was noted in 6.3% of all child maltreatment investigations, it was noted in 18.4% of investigations resulting in child apprehension, and 20.0% of those resulting in child welfare court application.
 The odds of substantiation, child apprehension, the case remaining open for ongoing services and child welfare court application are two to five times higher when primary caregiver CI is noted, compared to when it is not.
 The ‘effect’ of primary caregiver CI on child maltreatment investigation outcomes diminishes as child age increases. For instance, infants and teens of primary caregivers with CI are, respectively, 3.4 times and 2.0 times more likely to be apprehended than their age peers.
 Primary caregiver CI is strongly associated with household material hardship, caregiver social isolation and physical and mental health issues. Between-group differences in such household and caregiver ‘risk and vulnerability’ factors partly (but not fully) explains disparities in investigation outcomes. In other words, parents/caregivers with CI and their children are more likely to be exposed to environmental adversity, and this
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partly explains why cases featuring primary caregiver CI are more likely to result in substantiation, child apprehension, the case remaining open for ongoing services, and child welfare court application.  In cases that were kept open for ongoing services, no large between-group differences were found in rates of referral, which were low overall. One or more family members were referred for parenting education more often than they were referred for material assistance. The pattern of referrals may reflect variation in the availability of services, and or a predisposition to attribute perceived family problems to individual deficiencies rather than environmental pressures.  Primary caregiver CI moderates the effect of case characteristics (e.g., maltreatment exposure, evidence of harm) on child maltreatment investigation outcomes. When primary caregiver CI is noted, many but not all ‘facts of the case’ have little or less bearing on the outcome. The findings suggest that primary caregiver CI may overshadow other considerations, including the child’s experience, in child maltreatment investigations.
Main conclusions  Overall, the findings suggest that environmental adversity and potentially, inadequate
worker training and supervision leading to negative biases, contribute to the high rates of state intervention into families headed by a parent/caregiver with CI, including high rates of child apprehension and child welfare court application.  To meet Canada’s obligations under the United Nations Convention on the Rights of Persons with Disabilities, a national strategy is needed to uncover and eliminate possible discrimination and build systems capacity to render “appropriate assistance” to persons with disabilities in the performance of their child-rearing responsibilities.
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CHILD WELFARE PROCESS AND OUTCOMES FOR CHILDREN OF PARENTS WITH COGNITIVE IMPAIRMENT [II]
Findings from the CIS_2008
The children of parents with cognitive impairments (CI) are many times more likely than their peers to be the subject of a child maltreatment investigation, and parental CI is associated with more intrusive state intervention, including child apprehension (Booth, Booth & McConnell, 2005; Llewellyn, McConnell & Ferronato, 2003; McConnell, Feldman, Aunos & Prasad, 2011). The high rate of child apprehension is assumed by many policy and decision makers to be a sad but unsurprising corollary of parental CI (Booth, Booth and McConnell, 2004). This assumption may explain why few studies to date have investigated the decision-making of child welfare authorities in cases featuring parents or caregivers with CI. Utilizing data from the third Canadian Incidence Study of Reported Child Abuse and Neglect (CIS_2008), this study investigated process and outcomes for children of parents with CI subject to child maltreatment investigations. One objective was to determine whether the observed association between parental CI and investigation outcomes could be explained by a conglomeration of caregiver and household risk and vulnerability factors. Another objective was to determine whether outcomes may be driven, at least in part, by systemic bias against parents with CI, resulting in the child’s experience and other relevant ‘facts of the case’ having less, little or no bearing on the outcome.
BACKGROUND
In the 20th century, many young men and women with cognitive impairments (CI), including those with intellectual disability or borderline intellectual functioning (BIF), were institutionalized and forcibly sterilized, thus preventing them from having children (IASSIDD Special Interest Research Group on Parents and Parenting with Intellectual Disabilities, 2008). In high income countries these practices are no longer routine. Now, with greater opportunity for young men and women with CI to lead more ordinary lives in the community the number entering into relationships and starting a family of their own is thought to be increasing (McConnell, Matthews, Llewellyn, Mildon & Hindmarsh, 2008). Exactly how many children are born each year to men and women with CI in Canada and in other parts of the world is not known. As 2.1% of Canadian adults of child-bearing age (18-49 years) have significant cognitive impairments, as measured by the Health Utilities Index (Statistics Canada, 2011), we extrapolate that approximately 1 to 2% of Canadian children have mothers and or fathers with cognitive impairments characterized by difficulties with learning, remembering and problem-solving.
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Although men and women with CI may have greater opportunity today to form relationships and have children, many who do so will not be permitted to raise them. While estimates vary by country, definition of CI and sampling frame (i.e., clinical or communitybased), researchers have consistently reported rates of child apprehension in the range of 30% to 50% (Cleaver & Nicholson, 2007; Gillberg & Geijer-Karlsson, 2001; Morch, Jens & Andersgard, 1997; Pixa-Kettner, 1998). Over-representation of parents with CI in child welfare court proceedings has also been observed (Llewellyn, et al. 2003; Booth, et al. 2005). In New South Wales, Australia, for instance, Llewellyn, et al. (2003) reviewed child welfare court records and found that parental intellectual disability or BIF was documented in 8.8% of 285 consecutive cases (involving 469 children) instigated by the child welfare authority. Employing similar methods, Booth, et al. (2005) reviewed child welfare court files in the north of England and found that parental intellectual disability or BIF was reported in 19.9% of 437 care matters (involving 828 children). Both studies found that cases featuring parents with intellectual disability or BIF were more likely to result in permanent out-ofhome placement.
There is a dearth of data on prevalence and outcomes for children of parents with CI in Canadian child and youth protection systems. In the only Canadian study to have investigated these statistics, McConnell, et al. (2011) analyzed core data from the second Canadian Incidence Study of Reported Child Abuse and Neglect (CIS_2003). The analysis revealed that parent/caregiver cognitive impairment was noted in 10.1% of all child maltreatment investigations. The prevalence of parent/caregiver CI was particularly high in cases involving infants and young children. Further, compared to cases where the parents/caregivers did not have CI, the study found that cases featuring parent/caregivers with CI were more likely to result in substantiation of maltreatment or maltreatment risk (61% vs. 46% of all other cases); child apprehension (17% vs. 6%); the case remaining open for ongoing services (55% vs. 25%), and to remain open even when maltreatment was not substantiated (30% vs. 12%); and, child welfare court application (10% vs. 3%).
The increased risk associated with parental CI of child welfare intervention is hard to reconcile with evidence showing that (a) the association between parental cognitive functioning, as measured by standardized intelligence tests, and parenting adequacy is weak (Feldman, 2002; IASSIDD Special Interest Research Group on Parents and Parenting with Intellectual Disabilities, 2008); and, (b) that, with appropriate training and support, many parents with CI can acquire parenting skills (Feldman, Case, & Sparks, 1992; Feldman, Sparks & Case, 1993; Wade, Llewellyn, & Matthews, 2008). Feldman (1994), Wade, Llewellyn and Matthews (2008), and Coren, Thomae and Hutchfield (2011) have critically reviewed parenting training research in the field, which now includes over 30 controlled trials. These reviews, and the results of several trials hence (e.g., Gaskin, Lutzker Crimmins & Robinson, 2012; Glazemakers & Deboutte, 2013; Monsen, Sanders, Yu, Radosevich, & Geppert, 2011; Rao, 2013) support the conclusion that interventions matched to the parent’s individual learning needs, and home-based behavioural parenting
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training in particular, are effective in equipping parents with CI with parenting skills, with concomitant benefits to their children.
Plausible explanations for the high level of child welfare intervention into families headed by parents with CI, and the association between parental CI and more intrusive child maltreatment investigation outcomes include:
 between-group differences (i.e., differences between cases featuring parents/caregivers with CI vs. cases featuring parents/caregivers without CI) in child and case characteristics, including but not limited to child age, sex, aboriginal status, functioning issues and maltreatment exposure (e.g. type, duration);
 the clustering of caregiver and household ‘risk and vulnerability’ factors together with parental CI, including but not limited to caregiver social isolation, physical and mental health issues, substance abuse, and household material hardship; and,
 systemic bias against parents with CI based on an erroneous assumption of inherent parental incapacity, including assumed incapacity to learn parenting skills, keep their children safe from harm, and provide a level of care that is acceptable by community standards even if they are given intensive supports.
Child and Case Characteristics
A higher prevalence of disability and/or behaviour problems among children of parents with CI and/or between-group differences in child age may explain why child maltreatment investigations involving children of parents with CI tend to result in more intrusive outcomes. McConnell et al. (2011) found children of parents/caregivers with CI tend to be younger on average. Further they found that 63.8% of children who had a parent/caregiver with CI, compared with 41.7% of all other children subject to a child maltreatment investigations in Canada, had one or more functioning issues such as emotional-behaviour, learning-developmental, physical disability or health conditions. Child disability and behaviour problems are associated with heightened parental stress and depressive symptoms, and risk of maltreatment (Bolourian & Blacher, 2016; Feldman Hancock, Rielly, Minnes, & Cairns, 2000; Feldman et al., 2007; Sullivan & Knutson, 2000). These children might therefore be perceived to be more vulnerable, especially if they are younger, thus warranting differential treatment. Alternatively, or in addition, child functioning issues may be improperly treated as prima facie evidence of maltreatment (McConnell, Llewellyn & Ferronato, 2002, 2006).
Between-group differences in child protection concerns or maltreatment exposure may also explain or contribute to differential outcomes. Previous studies have found that allegations of child neglect are more frequently documented, and allegations of physical or sexual
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abuse are less frequently documented in cases featuring parents/caregivers with CI (Llewellyn, et al., 2003; McConnell, Feldman, Aunos & Prasad, 2010, 2011). For example, McConnell et al. (2011) found that neglect, or the perceived risk thereof, was alleged in 56% and 38.6% of investigations featuring parents/caregivers with and without CI, respectively. In addition, McConnell et al. (2011) found that prior substantiated maltreatment reports were more often noted in investigations featuring parents with CI. If a relationship exists between child protection concerns and child maltreatment investigation outcomes then such between-group differences may explain why children of parents/caregivers with CI are subject to differential outcomes.
Utilizing the CIS_2003, McConnell et al. (2011) tested the hypothesis that parent/caregiver CI predicts child maltreatment investigation outcomes with the effects of child and case characteristics (e.g. child age, functioning issues, maltreatment exposure, evidence of harm) held constant. Although the hypothesis was supported, controlling for between-group differences in child and case characteristics substantially reduced the strength of the association between parent/caregiver CI and child maltreatment investigation outcomes. Specifically, between-group differences in child and case characteristics accounted for 40% of the increased ‘risk’ of substantiation, 53% of the increased ‘risk’ of the case remaining open, and 74% of the increased ‘risk’ of court application associated with parent-caregiver CI.
The Clustering of Perceived Risk and Vulnerability Factors Together with Parental CI
Questions: All else being equal (e.g. child, case, caregiver and household characteristics), does parental CI predict child maltreatment investigation outcomes? Can the association between parental CI and investigation outcomes be explained by a ‘third variable’ (or cluster of variables)?
In community and child welfare samples, previous research has found that parents with CI are more likely than parents without CI to have experienced trauma in their own childhoods; to be single parents, unemployed, living in poor housing and in deprived neighborhoods; to have few social supports; and, to suffer from often unmanaged chronic health conditions and psychopathology (Aunos, Feldman & Goupil, 2008; Emerson & Brigham, 2013; Feldman, McConnell & Aunos, 2012; Llewellyn, McConnell & Mayes, 2003; McGaw, Shaw & Beckley, 2007; McGaw, Scully & Pritchard, 2010). Such adverse life conditions may influence worker perceptions of future maltreatment risk and consequently, child maltreatment investigation outcomes. Poverty, isolation and other deprivations may
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be conceptualised, by child maltreatment investigators, as ‘proof’ of parent dysfunction or incompetence and/or as risk factors with predictive potential, i.e., rather than as explanatory factors or potential targets for intervention (Clarke, 1993; Farmer & Owen, 1998; McConnell & Llewellyn, 2005; Walsh & Douglas, 2009).
Systemic bias toward parents with CI
Questions: Is the child’s experience (e.g. type and duration of maltreatment exposure) weighted differently in cases featuring parents with and without CI? Does parental CI moderate the effect of ‘the child’s experience’ on child maltreatment investigation outcomes?
Another plausible explanation is systemic bias against parents with CI, resulting in the child’s experience (e.g. maltreatment exposure) having less, little or no bearing on the outcome. Scholars have long voiced concerns about the differential treatment of parents with CI in the child welfare system. Hayman (1990, p.1227), for instance, observes that “... the state treats mentally retarded [sic] parents quite differently from non-retarded parents. A discrete sense of difference pervades the process: discrimination begins with the initial decision to intervene, ends in the decision to terminate the relationship, and is manifest in nearly every significant decision along the way.” Later, Levesque (1996, p. 15) argued that the “rights of mentally disabled [sic] parents are, in practice, being terminated when states present evidence which, if used against non-disabled parents, would not be enough to sever the parental relationship”. Similarly, in Australia, Swain and Cameron (2003, p.175) suggested that parents with intellectual disability are likely to “suffer considerable disadvantage in dealing with the child protection and Children’s Court systems” and to “have their capacity to care more harshly judged” than their non-disabled counterparts.
Concerns about the differential treatment of parents with CI have also been raised by empirical studies of decision-making processes and outcomes in child maltreatment investigations. In Australia and England, for example, McConnell and colleagues found that ‘reasonable efforts’ are not always made to support parents with CI and avert the need for child apprehension and court action (Booth, McConnell & Booth, 2006; McConnell, Llewellyn & Ferronato, 2006). One reason for this is a pervasive and prejudicial assumption of inherent and intractable parental incompetence. Another reason is the paucity of evidence-based parenting support/ family preservation options, i.e., services equipped with the knowledge, skills and mandate required to render appropriate assistance to parents with CI (McConnell, et al. 2008; Wade, et al., 2008). Parents with CI may then be referred for parenting training and family support services that are a poor fit for their needs, and blamed when these services fail to elicit the desired changes: Decision-makers are prone to
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