Co-operating to protect children -shifting the thresholds

It is now 30 years since Kempe delivered his watershed address to the American Academy of Paediatricians graphically describing the battered child syndrome. In the 30 years that followed elaborate child protection procedures, supported by strong legal powers, have developed not only in the UK and the USA but also in may countries around the world. In the last 5 years or so, however, there has been another great watershed. Independently in both the USA and in the UK, evidence has accumulated which is questioning the efficacy of our elaborate child protection systems. For social workers in the UK the history is familiar; the child abuse inquiries leading on to the Cleveland Inquiry, on going scandals in residential care and concern about the outcomes for children in the public care system, and, finally, the recent message from the Department of Health in 1995 “Child Protection - Messages from Research”. Less familiar will be the concerns which emerged in the USA. There, following the introduction of mandatory reporting which in some states is mandatory even for civil citizens, there was a huge rise in the number of children reported (3 million reported in 1992 of which less than half were substantiated). This largely incapacitated the child protection agencies and led to large numbers of children being admitted into the public care. In 1990 the US Advisory Board on Child Abuse and Neglect concluded that there was an urgent need to develop new approaches.

The answer put forward in this country and the USA has been the rediscovery of targeted preventive approaches. Central to these approaches is what we call family support and what is called social support in the USA.

Child protection is an important and demanding activity

- research and our own limited local information does pose serious questions about the efficacy of the process;

- this points to the need for reviews by area child protection committees;

- research also tells us important things about the characteristics of families involved especially about their social and economic circumstances. These need to be addressed.

Addressing these needs requires several things

- a good individual assessment and population assessment to plan appropriate services;

- a sound interagency/multiprofessional approach;

- maximising all the resource options and taking a broader view of the task - as well as mainstream services as currently arranged, we need to embrace a community development approach and to view die families involved in terms of their inclusion or exclusion from society and address these shortfalls.

We are only at the threshold of the implementation of the Order and we need to approach it with a broad vision.     

South Australian Parents want Child Protection Programs to be offered in Schools and PreSchools

It is now widely realized that child sexual abuse is an all too common crime against children, resulting in long term damage to victims and heavy costs to the community. It is also realized that much abuse could have been prevented if children had been given basic information about acceptable and unacceptable touching, secrecy about touching and norms of adult-child behaviour.

Parents representing 250 families, caring for 565 children aged 3-12 were interviewed to find out what parents tell their children to protect them from sexual molestation.

Three quarters of all parents told their children nothing and most of those who thought that they had given information had only given hints. Furthermore, this “information” was passed on only after a traumatic event had already occurred.

Parents revealed an inadequate knowledge of the dangers to children and a desire for school and preschool programs to remedy the deficit.     

The paradox of “wonderful children”: The case of child abuse

In our society young children are generally considered to be “wonderful”. This dominant concept pervades not only parental thinking, but professional thinking as well. In the case of child abuse, however, profound contradictions can arise as a result. Professionals are primarily focused on children's welfare, while parents' views are much more ambiguous.

In our example of a Family Centre these contradictions are clearly illustrated, and we hope to draw conclusions as to what change in theory and practice could result from an analysis of contradictions.     

Integration: Quality in care and education for the young disabled child

The presentation aims to examine the criteria of quality for care and education programmes for young disabled children in integrated early childhood settings. The conceptual and practical issues which influence quality programmes will be discussed with particular reference to the Integration Programmes operated throughout South Australia in early childhood centres.

The Integration Programmes, developed to enable and support the integrated or normalised development of young children has as its specific 'target' group individual children who are 'too delayed or disabled' to be able to fully participate or participate without direct assistance in community based early childhood programmes. Some of these children are extremely disabled and others' handicapping conditions are exacerbated by severe lack of other available community resources, isolation and other factors.

Integration is more than 'being there'—it is a complex process based upon the recognition of human value and human rights. For greater insight into the Integration Programmes an appraisal of the following aspects will be provided.

• the principles of integration

• the goals of integration

• the dimensions of integration.

The dimensions of integration will be placed in relation to the indicators of quality in early childhood programmes. The juxtaposing of these parameters of quality will lead to the emergence of guidelines for practical goalsetting and evaluation hallmarks of excellence in integration.     

The efficacy of the parent-teacher “partnership” of the 1990s

The 1990s are times of rapid social and technological change. There are many unknowns that face both adults and children. We all have problems that need resolution. The time when adults “knew” the answers and children learned by “watching” echo faintly in the whirl of scientific change which is impacting on most aspects of our daily life. As early childhood teachers we have to learn to enquire, to listen, to think together with children, their families and society. The concept of negotiation is central to communication while the basic tenet of the process focusses not on the person but the issue. It is in these times of rapid change that we need to deepen our understanding of the family and further our professional insights by “tapping” the wealth of crucial kndowledge that parents have about their children. Hurst asserts that the partnership of parents in issues of their children's education:

“is probably the greatest single opportunity for educational advance open to teachers today”.

Hurst: 1987; 109     

Ethical and practical considerations in palliative child care and the support needs of parents and siblings

Death is one of the few certainties in life and yet it is the one event that most people avoid contemplating until forced to do so. When considering death and dying it is assumed by most to occur in old age and in hospital. The death of a child is a devastating loss which can cause the most distressing and long lasting grief (Davey, 1995). According to “Childhood cancer UK” the number of children developing cancer in the United Kingdom has remained constant over the past 30 years (about 1300 new cases each year), with only two-thirds of children with the disease being treated successfully. In Britain 32 per cent of cancer deaths occur at home (Bean, 1994) however only a small proportion of these will be children. Despite the deaths of children at home being a statistically small group it must not be ignored due to the great emotional impact it has on the individual, family, health workers and often local community.

The changing status of children in the UK means that health care professionals must uphold childrens' rights whilst working in partnership with parents. A balance must be found between the traditional protectionist and paternalistic attitude of care and the liberationist approach. This can only be achieved through communication and collaboration between families and members of the multi-disciplinary team allowing the promotion of constructive problem solving

The key aim of palliative care is to give the child as good a quality of life as possible in the time remaining with freedom from distressing symptoms including pain. Every health professional working with a dying child who has pain should give consideration to the complexity of pain, it's unique and diverse effects and engage the entire family and health care team in planning interventions and providing support to the child and to each family member (Graner, 1976).

Siblings, parents and health professionals may be profoundly affected by the experience of the death of the child, therefore, each multi-disciplinary team must develop formal coping strategies to deal with the possible psychological disturbance and to facilitate adjustment after the death of the child.

Martinson, writes of her greatest encouragement which came from the parent of a dying child;

“No matter if it culminates a full life or a life shortened much too soon, does death have to be terrorising? There are many to rejoice and aid in the event of birth, as with the patient that can be helped, but for those going through the frustration of 'not getting better' when science and the masses, sometimes even family and friends who can no longer face them, have deserted, could there be a greater challenge or more considerable need for help?”

(1976, p. 13)

This is a powerful message for health professionals caring for children in the end stages of a terminal illness. It is at this time that the family and dying child are in most need of the consistent, expert and humane relationships provided by the caring professions. The challenges are immense but great reward lies in the privilege of being intimately involved in this final rite of passage through life.     

“Missing Milestones”

Missing milestones are known to be a normal variant of development. The purpose of our study is to find if missing milestones always lead to normal development?

METHODS

This is a prospective case study on seven patients referred for motor developmental problems from July 1997 to February 1998 and then followed over a 2-year period. On each attendance, the multi-disciplinary team assessed children

RESULTS

We present a case series of seven children with “missing motor milestones”. Six of the seven, had tactile defensiveness but absent parachute reflexes on presentation

At the end of the two year period, 3 infants had normal development (Group I). One was discharged after 7 months. The second one had speech problems most likely secondary to her bilateral serous otitis media, with no other developmental problems. The third child acquired age appropriate milestones before the care was transferred to another hospital. Of the four in Group II, three developed global developmental delay and the fourth was diagnosed to have multiple cavernous haemangiomata in the brain. The pre-school alert panel was alerted for two of them possibly needing future help in school

Five of the seven children in our study were still being followed up after two years

CONCLUSIONS

Missing milestones in a subject can be a benign variation of normal motor development. However, they may also be the first sign to appear in children with neuro-developmental disorders

Tactile defensiveness may be the most useful early sign to enable the early diagnosis of non-weight bearing children with 'missing milestones'     

Forms of knowledge, the curriculum and the young child

Children need to learn many matters, but not all their learning is of the same epistemological kind.There are something like eight fundamental and fundamentally different ways in which human beings encounter the world: Knowledge of Mathematics and Logic, Empiricist Knowledge, Scientific Knowledge, Knowledge of Persons and their Minds, Moral Knowledge, Knowledge and Experience in the Aesthetic Domain, Religion, Philosophy. These Forms structure children's learning, understanding, and experience both formal and informal, at all ages.Moreover they structure not just “scholarly knowledge and experience”, but also, “commonsense knowledge and experience”.

A suitable curriculum will be one which in one way or another provides diverse experiences of these Forms. Because there is no “transfer of training” between Forms as such, children need to be introduced to them all and to be shown how they differ. To say this is not to beg any questions about the best way in which to teach young children: no matter how we decide to organize a curriculum,we are still able to use a range of modern methods.

Although much learning in pre-school and early elementary school ought not to be directly concerned for the deliberate acquisition of the Forms as such, much of the casual learning in schools (and outside them) does indeed involve the Forms-with examples drawn from the child world.

In introducing children to the Forms, those who care for and who teach young children have an enormous responsibility.     

Recovery work with child victims of sexual abuse: A framework for intervention

With each high profile case of sexual assault perpetrated against a child there generally follows a media driven reaction narrowly focusing on stranger danger or paedophile activity The difficulty is that this can present the false impression that therein lies the greatest danger to our children.

The situation with which parentdcarers, and professionals, are faced with in dealing with cases of child sexual abuse is much more complex for a variety of reasons. These include the fact that such abuse is mostly perpetrated by a member of the family or a close friend of the family or child; there are many cases of crossgenerational and sibling abuse; there is often fragmentation of families following disclosure; the immense challenge to strongly held beliefs regarding familv, society and religious values; and thaf a child's coping strategies often involves blocking out the abuse, disassociation and extreme forms of self-harm.

Much good literature exists on the phenomenon of child sexual abuse. However, there is a lack of written material on models of therapeutic intervention, and to engage in this area of work in the absence of a well thought-out framework for intervention would be highly irresponsible and dangerous. The purpose of this paper is to discuss the issue of intervention and in setting out a framework for intervention, the premise is followed that the child is not abused in isolation, but within a family and community context. For this reason theoretical considerations relating to victim impact, family functioning, social learning and developmental stages will be viewed as underpinning practice.     

Building a Comprehensive School-based Drug/Alcohol Prevention Program

Concerned educators trying to help students who abuse alcohol and drugs want assurances that the process they use does work. They ask, “How are we doing? Are we making a difference in the lives of our students?”

Unfortunately, there often is no one person or group they can call on for a quick answer. The district personnel directing the prevention and intervention program, as well as trained outsiders, struggle to determine whether progress is being made. Self-made assessment tools can become subjective and selective.

Schools are struggling to find effective, cost-efficient programs that reduce drug use. Building a comprehensive Drug/Alcohol program is one of the most important tasks administrators can face.     

Children first: Protection & prevention in services for disabled children part II

SYNOPSIS

This paper is written in two parts.

Part I outlined the legislative and social economic contexts. A framework for analysing prevention and protection services for handicapped children was then presented. This framework was illustrated in relation to services at four levels of intervention: populations, early risks, significant harm and children already abused or “looked after”.     

A Shoestring Operation for Sexually Abused Children

The title of this paper refers to how resources were gathered to provide a therapy group for latency aged children who had been sexually abused. In one way it is a sad commentary on how society treats children who have been victimized; on the other hand, this account shows how volunteers with a will can harness the energies of social agencies to help provide a needed service that was not yet established. The history of social work is replete with accounts of generous individuals who stepped forward to do the necessary. Social work, like nursing, had its origins in volunteerism.¹ Even today lacunae in public welfare are filled by volunteers, and while not all efforts become institutionalized the trend toward innovation and compassion is still strong in contemporary society (Newsweek, “A 51 Gun Salute to Everyday heroes” pp 62-79 July 6 1987).

Within the profession, there are always fields of service that are on the cutting edge of human needs—witness industrial social work, divorce mediation, services to lesbian/gay clients, AlDs victims, etc. Often these special programs, or the recognition of special populations within an agency's service area are first made by employed professionals within the agency. If the innovative professional has success, the program or method is gradually extended to other agencies and finally adopted by the government. While the connection between individual innovation and public policy is too complex to be described here, it is sufficient to say that the current American program of AFDC had its origins from the experience of juvenile court judges who were faced with the prospect of removing dependent children from their widowed mother. The common sense of these officials and other child advocates saw the wisdom of preserving the family at state expense (Trattner, 1974, pp 185-186).

Whether the situation is that of orphaned or abused children, the process is slow that defines the fact into a social problem. Sometimes, without much fanfare or rhetoric, an individual professional or a volunteer will attempt a remedy either with spontaneous effort or a small scale program. These small efforts can emerge despite the bureauracy that controls the bulk of public welfare; sometimes the new remedy becomes part of received wisdom and public policy. Whether it is continued or not the program has responded to human need in a changing world. Social work in industry, among refugees, displaced homemakers, gay people are some of the instances in which small scale operations came before “public” help.

The problem of sexually abused children has been around a long time; any kind of sexual activity with a child is harmful (Conte 1981, pp 601-602.). An unknown number of child victims grow up without psychological help that could prevent painful memories as an adult. It was to prevent this emotional scaring that the “shoestring operation” was launched.     

Some implications for the child's educational potential of recent investigations into early childhood interaction

The primary object of this paper is to suggest that recent investigations into early childhood, and particularly those concerned with adult-child interaction, are indicating what amounts to a new view of the cognitive nature of the young child. The paper will also begin to examine some of the evidence which may link this view with the development of his educational potential.

Babies are born, it seems, with highly developed perceptual systems and with inherited propensities to take part in interaction with other humans, especially the principal caring adult (who, for convenience is referred to as “the mother” throughout the paper). They can time their behaviour so as to interact in complex sequences. Moreover the baby displays initiative in interaction and by this means sets about learning about his world, especially the meaning of his social world.

Because this interaction is dependent on complex signalling, including the synchronisation of sequences of behaviour with those of others, it is probable that it can be very easily disrupted. Such disruption can occur in many ways: for instance physiologically, by minor brain damage, or socially, by the child trying to interact with an unresponsive depressed mother. Most easily lost would be the child's initiative and hence the power to direct the interaction process in his quest to make sense of his world.

It may be on this level that a child's cognitive potential is reduced. Perhaps the child's loss of initiative is a connecting factor between educational handicap and the social-cultural correlates variously identified within an extensive literature.     

The Role and Responsibility of Teachers and Child Care Workers in Identifying and Reporting Child Abuse and Neglect

Because of their daily interactions with young children, teachers and child care workers play a central role in the prevention, identification, and treatment of child abuse and neglect. In most states in the United States, teachers or other school personnel are legally mandated to report any suspected cases of abuse and neglect.

This article provides a brief summary of the role and responsibility of the teacher in the prevention and identification process.     

“caught in the middle” exploring children and young people's experience of domestic violence

This document seeks to explore children's experiences of domestic violence and the effects such violence may have on their lives, both in the short term and in the long term. It draws on the conclusions of various studies in this area which have been carried out in America and the United Kingdom. It aims to raise awareness of the complexity of this issue and to highlight the importance of support for both women and children who may be survivors of domestic violence. The document highlights a number of issues, namely

How children and young people may experience domestic violence;

Identification of links between domestic violence and child abuse;

The impact domestic violence may have on mothering;

The effects domestic violence may have on children and young people's lives;

The legitimacy of the cycle of violence theory;

Issues to be considered when assessing the possible impact of domestic violence on children and young people.     

International year of the family 1994: Family and gender equity in education

“Building the smallest democracy at the heart of society,” is the motto of the International Year of the Family being celebrated during 1994. The year 1994 has been designated by the United Nations to highlight issues concerning families locally, nationally, and globally during the year and to suggest recommendations for changes in policies and programs.

Since 1975, when the world celebrated International Women's Year, and again, in 1979 during International Year of the Child, evidence has been accruing regarding gender disparities in all countries. It is discouraging, yet perhaps not surprising, that in 1994 the world still awaits gender equity, even though a considerable amount of progress has been made since 1975.     

Group treatment work with parents/carers of young people who have sexually abused children and others

This article reflects on group work with parents/carers of young people who have sexually abused children and others. It highlights the paucity of relevant literature and outlines the context, format and goals of a support group for parents/carers.

Recurring themes observed over a four year period are examined in detail. Three key areas are discussed :-

1. Emotional reactions of the parents /carers to the disclosure of the sexual abuse.

2. Lack of resources to facilitate/ accommodate the special needs of this population of parents/carers.

3. The parents'/carers' need to be aware of, understand and, where possible, facilitate the treatment programme of the young person who sexually abused.

Results from the evaluation of the four groups support the conclusion that parents are an important part of the treatment programme of young people who sexually abuse, and should be viewed as 'gate-keepers' in sustaining and monitoring relapse prevention plans.     

Research Note: Unmet Needs for Education of Primary School Children in Nigeria

According to the Convention on the rights of the Child, every child is entitled to receive compulsory basic education, and no child should suffer any discrimination irrespective of origin, birth, colour, sex, social beliefs, status or disability.

Bearing in mind these stated objectives of this Convention, three hundred children and three hundred teachers from twenty public schools in Lagos were the subjects of a survey carried out to Identify the unmet needs for education of Nigerian children.

About 90% of the teachers surveyed, admitted that the quality of education was poor and deteriorating on a daily basis. Reasons given were for the poor condition of services, poor teacher morale due to poor condition of service, lack of parental cooperation and general lack of interest among the children.

An observation of the children in the school showed that about 60% of the children had chronic malnutrition with ravages of diseases such as malaria, cough, catarrh, diarrhoea, and skin rashes. Many of the children complained of lack of adequate supply of water and electricity at home for several weeks. A large number (70%) were also found to be unkempt, without decent uniforms and textbooks.

Suggestions were made for proper teacher training, remuneration and more parental concern and involvement for the proper education of their children.     

Working with a child exposed to community and domestic violence in Northern Ireland: an illustrated case example

The focus of this paper is on the author's multi-modal therapeutic practice with a 7-year-old boy referred to the Family Trauma Centre, following paramilitary assaults on his father. The work also addresses the boy's experience of domestic violence.

The work is contextualised in terms of the “Peace Process” in Northern Ireland, including the establishment of the Family Trauma Centre as a response to the needs of victims of the Troubles. A rationale for working with children using a multi-modal approach is presented.     

Data on gross motor development of the infant

The author presents a study of motor development in the Institute under her direction. Under the conditions created in the Institute, the children's motor activity is continually ensured throughout the period of motor development. The most recent research tends to show that it is precisely the motor and other kinesthetic activities carried out by the child himself on his own initiative which are most important for the development of the mental functions. It is on the basis of these facts- by comparing the usual, typical motor development, directly influenced by adults, with that not under direct influence but in contact with environmental factors (material and people), that we can consider the most physiological side of this development.

Due to the fact that the children are more independent and therefore less in need of adult help, the course of motor development exercises a positive influence on calm, well-balanced child-adult relationships, which are most important in institutions, and of considerable interest at home as well.

Mothers and child nurses thus economize time, which they can. put to good use by applying useful and necessary ideas for the education of their children or of the children they have in custody.