Should At Risk Children Be Removed From the Home?

The debate presented is should children who are at risk for abuse remain with their families? This is a difficult dilemma and does not allow for a universal position. Unfortunately, there are many factors which influence the predicament. For example, considerations must be given to whether the family is at risk for abuse, or if abuse has occurred. Also, the professional advocates must look at the developmental stage of the child in determining whether more harm is likely to come to the child, and if that harm is greater than that of removing the child from the home. Furthermore, the type of abuse must be examined to determine whether it is neglect, physical abuse, sexual abuse, or psychological abuse. The professional must further examine what the likely outcomes for the child will be. Will the child be placed in a foster care or institutional setting? Will reunification with the family be the likely plan or will permanency in an alternative setting be the hope for the child? Availability of the resources in the community must also be examined. Finally, the objective must remain clear that the child is the point of interest, not political agenda’s, parental bias, and racial or cultural discrimination.

The position this writer takes in the debate of child abuse and reunification with the family is that each specific case must be looked at individually by trained professionals with experience and knowledge in the area of child maltreatment and the outcomes. The influential indicators for each individual decision must include the chronological and developmental age of the child, the ability of the community and professionals to provide intense intervention, the occurrence or risk of the abuse, and the likelihood that the perpetrator of the abuse can alter their behavior. A family simply being “at risk” for child abuse is not enough to justify removal from their home, however, previous occurrences of abuse, neglect, or maltreatment to the child question or siblings does justify immediate action by the professionals, community, and advocacy agencies.

Certain premises have to be universally understood and accepted by advocacy agencies and society to promote and accept the interventions required to adequately address the cataclysm of child maltreatment. In 2006 the United Nations and World Health Organization recognized child abuse and neglect as a major public health issue (Giardino, 2008). Paolo Sergio PinheriroGiardino, 2008). Pinheriro further suggested that a child is dependent on adults completely; therefore more protection should be available, not less, as many private sectors suggest that the government is too interfering with personal family units (Giardino, 2008). As of 2006, in the United States, nine hundred five thousand children were maltreated with sixty three percent of these cases being substantiated neglect, sixteen percent were deemed physical abuse, eight percent classified as sexual abuse and six percent presented as psychological abuse (Giardino, 2008). Furthermore, according to the National Center on Child Abuse Prevention Research, in 2006 One thousand five hundred thirty children died as a result of abuse and neglect (Giardino, 2008). Seventy eight percent of these children were under the age of three (Giardino, 2008). These numbers would suggest that the national plan to address abuse and neglect is not working. Similar to the United Nations, the United States needs to address child maltreatment as a public health issue with funding for research and prevention, intervention, and adequate services to meet the needs of these children. Furthermore, the largest percentage of abuse is in the form of neglect and the largest mortality rate is with children under age three, therefore specific measures need to address and follow the family after the birth of a child to age three.

General understanding of the cycle of abuse is critical to prevention and intervention. Child maltreatment can be recognized in four specific forms, including physical abuse, sexual abuse, neglect and emotional abuse (Child Welfare Information Gateway). The impact of neglect may not be apparent in early stages, but as the child develops it impairs the health and physical development, intellectual development, emotional development and social or behavioral development (Child Welfare Information Gateway). The impact of maltreatment is also dependent upon the child age, presence of adults and services that provide protection or security, the frequency, duration and severity of the neglect, along with the relationship of the child to caregiver (Child Welfare Information Gateway). Early maltreatment impairs the ability of attachment for the child, which has longstanding adverse outcomes (Child Welfare Information Gateway). Furthermore, research finds the first few years of life are sensitive periods for cognitive growth as neural synapses are formed at a high rate (Child Welfare Information Gateway). Research has show that maltreated children have increased rates of cognitive deficits, language delays, and increased rate of later diagnosis of mental retardation (Child Welfare Information Gateway).

The outcomes for maltreated children are devastating and have the potential to be lifelong. A major component of emotional and psychosocial development is the ability to attach to a primary caregiver in the first year of life (Child Welfare Information Gateway). It is estimated that seventy to one hundred percent of maltreated infants form insecure attachments (Child Welfare Information Gateway). Attachment disorders result from attempts to attach by the infant that are met with unresponsive, painful interactions (Ziegler). The attachment dysfunction manifests as an adaption or coping mechanism of the child (Ziegler). Most of these adaptations occur pre-cognitively, therefore become ingrained in the child’s personality unconsciously (Ziegler). Typically, individual therapy, cognitive interventions, and insight can not overcome attachment problems as a form of treatment (Ziegler).

Disorganized attachments are highly correlated to maltreated children (Berk, 2008). These children show contradictory behavior, flat affect, depression, etc. (Berk, 2008). This type of attachment is related to internalizing situations with fear, anxiety and other crisis emotions, and displaying externalized behaviors such as aggression (Berk, 2008). The situation may not be hopeless, however. The continuity of caregiving determines the extent to which the attachment may or may not impair later life (Berk, 2008). If negative caregiving persists, research indicates the likelihood of disorganized later behavior and developmental impairments (Berk, 2008). Research of infant subjects in a Romanian orphanage found that babies placed in a loving home after age four were still able to develop positive emotional relationships and bonds with the caregiver, thus it appears attachment can occur up to age six (Berk, 2008).

A fundamental acceptance of the impact of maltreatment can assist professionals in their pursuit of appropriate placement of the child. Depending upon the age of the child, the severity of the maltreatment, and the likelihood of successful intervention or continued parental offenses must all be taken into account. Foster care is not a permanent solution; rather it is a temporary service responding to a crisis situation (Barbell & Freundlich, 2001). The ultimate objective is to find a safe permanent placement in a safe loving environment (Barbell & Freundlich, 2001). The factors that increase the risk of abuse and neglect include poverty, homelessness, drug and alcohol abuse, and declining community and family support (Barbell & Freundlich, 2001). While the need for these services increases, the availability of these services to meet the needs declines (Barbell & Freundlich, 2001). Many opponents of the interference of state advocacy agencies claim that the foster care system is already overburdened and should not focus on intervention and only interfere with the most severe cases. This is true; the service agencies are stretched thin with little hopes of more funding coming soon. Between 1984 and 1995 foster care placement increased sixty five percent while the available foster parents dropped by four percent (Barbell & Freundlich, 2001). Several changes in policy have occurred in the past twenty years. One significant event is the Adoption Assistance and Child Welfare Act of 1980 which stated that reasonable effort to keep families together be promoted, but alternative permanency solutions need to be created quickly in situations where reunification would not be an option (Barbell & Freundlich, 2001). Again, the foster parent is not a replacement for permanency. The objectives for children where reunification is not possible include adoption and kinship placement (Barbell & Freundlich, 2001). Recently, guardianship has become a viable permanency option for children facing foster care (Barbell & Freundlich, 2001). In 2000, forty three percent of children in foster care were slated for reunification with family, and sixty percent actually returned home (Barbell & Freundlich, 2001).

When consideration is given to remove a child from the home, the actual resources and availability of a safe residential setting has to be considered. There are many placement options, including foster care, kinship care, adoption, and institutionalization. However, each individual case needs to be examined to determine if the harm at the current home setting is greater than the harm at the placement options. For example, if the only available placement option for a 3month old infant is institutionalization, but the form of maltreatment occurring at home is malnutrition, than obviously the risks for cognitive, social and emotional development from disrupted attachment in the institutional setting far outweigh the cost of immediate intervention in the home to teach the parent health and nutrition skills. Yet, if the malnutrition is simply an indicator of far worse neglect and abusive acts such as physical abuse, emotional detachment from the infant, severe emotional neglect, etc. than the temporary placement in an institutional setting may be appropriate with the hopes of obtaining an alternative setting in the near future, such as foster care or a placement with a relative.
In theory, maltreatment in any form is unacceptable. However, reality concedes that there are not enough adequate alternative placements for children who suffer maltreatment. The ultimate goal has to consider whether the family situation is open and receptive to intervention, training, and learning a new form of parenting and caregiver response. If this is possible, than intervention is the choice. If the family dysfunction is so great that the likelihood the abuse will continue or present again in the future, than alternative placement must be sought.

The key to the crisis of child maltreatment must focus on prevention. Strategies need to not only recognize the factors that increase the likelihood of maltreatment, but have the resources to support the at risk family during the sensitive periods of child development. Recognition fact that reoccurrence is high with many forms of maltreatment, especially those that are psychologically derived such as sexual abuse, should indicate an immediate and required intervention for specific at risk populations. In these specific situations, reunification should never be an option. The focus must remain on the child and the child’s ability and potential for healthy development when services are required to intervene. Sensitivity and trust are likely absent in these children’s working models of the world around them, so it is the community and agency’s responsibility to introduce these concepts. Once intervention has concluded, follow up services must be continued along with supports within the immediate environment to ensure a safe haven for the child’s development.

A 2006 report to the United Nations in which he proclaimed that no violence against children can be justified, yet all violence against children is preventable. In conclusion, the debate over removing children at high risk for maltreatment must be individualized to the unique situation of the family and the child. The developmental and chronological age must guide the appropriate interventions with special attention given to the critical formation of healthy attachments. Removal of a child should not be an automatic response, but if the child is in a life threatening situation, victim of sexual or physical abuse, immediate action must be taken. Simultaneously, the risk factors associated with the likelihood of maltreatment must be addressed by the community and social services, with adequate funding and support to ensure that children have a safe haven. Finally, when children are removed, a thorough investigation of the allegations, as well as, a review of the current developmental abilities of the child should be reviewed to determine the impact of the maltreatment.











References:
Barbell, K., & Freundlich, M. (2001). Foster Care Today. Washington DC: Casey Family Program National Center for Resource Family Support.

Berk, L. (2008). Infants, Children and Adolescents. Boston: Pearson.

Child Welfare Information Gateway. (n.d.). Understanding the Causes of Neglect. Retrieved August 14, 2008, from Not Alone: http:www.enotalone.com/article/9889.html

Giardino, A. P. (2008). child maltreatment: Is the glass half full yet? Journal of Forensic Nursing , 1-3.

Ziegler, D. P. (n.d.). Understanding and treating attachment problems in children. Retrieved February 5, 2010, from Attachment Disorders: http://www.addictionrecov.org/paradigm/P_PR_F98/Attachment_Di...



Take a minute and share your thoughts or your story with us... Should a child be removed if they are at risk? What severity of abuse or neglect requires a child be removed? Thoughts, ideas, etc....

The Birthing Process- Your choices and Infant Mortality? What can we do?

Discussion 4-1

The process of birth occurs in three stages. The first of these processes is the dilation of the cervix and transition of the contractions to reach their optimal level (Berk, 2008). This is followed by the birthing process which includes the pushing of the baby down the canal and the emergence of the body (Berk, 2008). Finally, the placenta is delivered, marking the end of the process (Berk, 2008). Although, in a normal delivery, all of these processes occur in the same sequence, cultures define the environment and methods used to assist in the process.
Prior to the 1800’s in the Western Cultures, most births took place in the home (Berk, 2008). However, as risks increased and the industrial revolution brought more medical and professional services to urban areas, hospitals with doctors became the choice setting for birth (Berk, 2008). It is important to remember, however, in the hospital settings; during those times sanitary conditions and standards were low, which possibly increased the potential for harm to the mother and newborn.
Between the 1950’s and 1960’s a Natural child birth Movement emerged in which mothers opted for a more relaxed setting within the hospital, so birth centers were created (Berk, 2008). These allowed for members of the family to participate in the process, the declined use of pain medications occurred, and the onset of practices which assisted the mother in the birthing processes such as relaxation techniques, position and Lamaze (Berk, 2008). This allowed for the mother to have a choice in how the birth of her child would be conducted. Proponents Natural Child birth claimed to reduce pain and reduce anxiety (Berk, 2008). The Natural birth Process included classes about the process to decrease fear, breathing and relaxation techniques, and a coach to assist with the labor by offering encouragement and assisting with the techniques learned throughout the training (Berk, 2008).
Free standing birthing centers also became an option for the mothers. Free standing birthing centers allowed for the mother to choose the position, the environment, and allow whom she chooses into the delivery process (Berk, 2008). Positions included sitting upright or using a special birthing stool which allegedly led to decreased labor and increased oxygen to the baby; Water births in which the water supports the weight of the mother and thus allowing her to move into comfortable positions during the process (Berk, 2008).
During the 1970’s and 1980’s, Home Deliveries became more common. Home Delivery has historically been the preference in countries like England, Netherlands, and Switzerland, but in the Western culture it began to emerge as a choice for women who were at decreased risk for complications (Berk, 2008).
It is important to note that in all cases, there is a risk of complication during the delivery. However, even in hospital setting with a physician standing by, some of these complications cannot be corrected. Once the birth is complete, the risks for the newborn do not end. In fact, depending upon culture, socioeconomic standards, and available support systems, the risk may increase.
Unfortunately the greatest risk for infant mortality occurs with poor ethnic minorities (Gross, 2008). African American and Native American infants are twice as likely to die in the first year, while Canada has the greatest survival rate (Gross, 2008). The infant mortality is linked to physical defects and low birth weight (Gross, 2008). The numbers are actually staggering for the first month of life, with 67% of infant deaths in the United States (Gross, 2008).
Many countries have significantly lower rates of infant mortality in comparison to the United States. Research indicates that this likely due to health care and support that is universal to all who need it in these countries (Gross, 2008). Furthermore, these countries take a proactive approach in offering nutrition, medical care, and social economic supports to the new mothers (Gross, 2008). Western European countries, for example, offer low cost or free prenatal care, home based health services, follow up to the new mother and infant after birth, counseling, and ongoing medical services to the infant (Gross, 2008).
Post Natal development is critical to the survival of the infant. Many countries with high mortality rates lack clean drinking water, immunizations, are in desperate poverty, and have inadequate medical supports (Gross, 2008). Besides these basic needs, the physical contact from the mother is critical. Research indicates that infants who are deprived of comforting physical touch experience higher rates of failure to thrive (Gross, 2008).
So, although history shows progress in the actual birthing process, the post natal care and treatment services available still pose a huge threat to the survival of the infant.

Valerie Poling

References:
Berk, L. E. (2008). Foundations of Development. In L. E. Berk, Infants, Children and Adolescents (pp. 129-145). Allyn and Bacon.
Gross, D. (2008). Physical Growth Health and Nutrition. In D. Gross, Infancy: Development from Birth to Age 3 (pp. 141-174). Pearson Education, Inc: Allyn and Bacon.



Now, after reading that... I am curious, what do you think we should do? 67% of infants die during their first month in the Western Culture? how Can that be? With all the advances in medical technology that we have? yet, those advances are not freely accessible to the poor, uneducated, and those in certain outlying areas...
Is universal health care the solution? Or is this simply going to decrease the available services?

I would love to get a real conversation going on this one... hear your thoughts, see it from a different perspective... So, share here!