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Child welfare system too geared to rapid intervention to stop physical harm

HELEN BRANSWELL
Canadian Press


Monday, October 27, 2003
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TORONTO (CP) - Child abuse involving severe physical harm makes up a small
proportion - four per cent - of child abuse cases, yet intervention programs in
Canada are primarily designed to respond to these types of incidents, a new
study states.

The authors suggest that by skewing child welfare programs so heavily towards
rapid interventions aimed at preventing physical abuse, the programs may be
failing to meet the needs of the much larger group of children who undergo
intense emotional and psychological abuse on a regular basis.

"There's a minority of cases where urgency is absolutely required," said lead
author Nico Trocme, a professor of social work at the University of Toronto's
centre of excellence for child welfare. "But we don't necessarily need to take
all of the calls that go to the child welfare system through this protective
investigation with very tight time lines.

"For many of the other cases, the focus needs to be much more on a broader
assessment of the child's well-being, of family functioning and then looking at
strategies for intervention that are much more long term, that may or may not
involve removal."

Further, requiring rapid intervention in cases that don't need it may be
clogging up the system, making it harder for case workers to deal expeditiously
with children who are truly at risk of being battered or sexually abused in
their homes, the authors said.

The article, by Trocme and three colleagues from Health Canada, the University
of Toronto and McMaster University in Hamilton, was published Tuesday in the
Canadian Medical Association Journal.

It analysed data compiled by Trocme and colleague Barbara Fallon in the
landmark 1998 Canadian incidence study of reported child abuse and neglect.

Some jurisdictions - Trocme pointed to Alberta - are moving away from this
across-the-board rapid intervention model. But Trocme said so little evaluation
has been done on any of the programs that he can't say which is best. The
authors advocate more study.

A commentary on the study also urged a cautious response, saying that while the
findings are important, new courses cannot be charted based on one study alone.


"As in most fields, it's difficult to draw final conclusions without looking at
an issue from various perspectives," said Dr. Michelle Ward, a pediatrician
from the Children's Hospital of Eastern Ontario and one of two authors of the
commentary.

"We need information from a number of different fields to try and sort out what
the true message is."

Trocme and his colleagues reported that of a sample of nearly 3,800 cases of
maltreatment reported to child welfare authorities, no physical harm was
documented in 82 per cent of the cases. Of the 18 per cent of cases where
physical harm was recorded, bruises, cuts and scrapes made up the bulk of the
injuries.

In four per cent of substantiated cases, the physical harm was severe enough to
require medical attention; in less than one per cent of substantiated cases,
broken bones or head trauma was recorded.

Even Trocme was initially surprised by those numbers. "They were even lower
than I had expected, given some of the other literature," he said in an
interview.

He believes most people - and most policy makers - have an entirely different
picture of the nature of the abuse children face.

"There's a perception I think . . . that the majority of cases of child abuse
and neglect involve children who have been injured in some way. And if we look
at our policies and procedures, they certainly reflect the assumption that the
risk of physical harm is the primary consideration."

While he is aware challenging that perception may provoke controversy, he
believes it must be done.

"We can't keep on working effectively in a situation where the public and
policy makers misunderstand the nature of the work that we do," Trocme
insisted. "Somewhere along the line we do need to have a reasonably honest
discussion and a reasonably public one about the nature of this work."

The authors do not suggest authorities should minimize the danger some children
are in; the system must swing into action as rapidly as possible to protect
those children when their cases come to light, they say.

But by requiring most abuse investigations to be handled in this way,
authorities are depriving the system of resources needed to fund effective
interventions to deal with the problems faced by the larger group of children,
victims of relentless emotional battering or neglect that leaves no physical
marks but sets up a lifetime's worth of problems.

"These are children who are living miserable, miserable lives. But the misery
is not one that is only at the level of the risk of physical harm to them,"
Trocme said. "In fact, the risk to most of these children is with respect to
their psychological and emotional development."

Funding for the Canadian incidence study was provided by Health Canada and the
governments of Quebec, Ontario, British Columbia and Newfoundland and by Bell
Canada. Some of the individual researchers also had career funding from other
agencies such as the Canadian Institutes of Health Research.

© Copyright 2003 The Canadian Press