Protection Clarification - The Florida Network of Children`s Advocacy

Report
The Protection Clarification
Strengthening the Role and Responsibility
of the Non-Offending Caregiver in the
Outcome for Child Victims
Presented by:
Rachael J. Garrett, LMSW
The Dee Norton Lowcountry Children’s Center
Charleston, SC
Objectives
1.
2.
3.
4.
Participants will:
Learn the importance of caregiver engagement.
Learn to identify potential barriers for nonoffending caregivers to be a protective resource
for the abused child.
Learn interventions to overcome these barriers.
Understand the role of the caregiver in evidence
based treatment interventions.
Importance of the Caregiver
• Role of protective caregiver in outcome for
the child victim
– The degree of maternal support at the time of
disclosure impacts the victim’s adjustment.
– Lack of support is associated with greater
psychopathology for the victim and higher rates of
out of home placement (Everson, et.al., 1999).
Identify Barriers to Protection
• Motivation of caregiver (focus, impact, cost)
• Internal barriers (cognitive capacity, mental health
status, medical/physical conditions, impact of
substance abuse)
• External barriers (maintain a safe environment by
restricting contact with the offender, emotional and
physical support of child, financial resources,
transportation, time, lack of support system)
• Child Characteristics (impact of abuse on child,
premorbid issues, behavior management issues)
Types of Barriers
• Instrumental/Tangible (what they may tell us
as to why they are not coming)
- Transportation, location, cost, job conflicts
• Perceptual/Psychological (the real reason
why they are not coming)
- Stigma, fear, shame, stereotypes, trust,
cultural, denial, hopelessness, family,
education, past experience, religion,
substances
(information from Dr. Rochelle Hanson, MUSC Crime Victims Center)
Why focus on barriers?
• Barriers to participation in treatment are significantly
associated with therapeutic change (Kazdin &
Wassell, 2000).
• Perceived barriers matter!
- most salient predictor of adherence to tx
recommendations (MacNaughton, 2001)
• What does this mean?
- continuity of care may be seriously
compromised if the perception of barriers by
families is high.
(information from Dr. Rochelle Hanson, MUSC Crime Victims Center)
Interventions
• Interventions are developed by the team of
professionals who work in partnership with
the Children’s Advocacy Center.
• Evidence based practice is utilized to reduce
risk and increase child safety.
Intervention: Clarification
• Evaluated as one of sixteen intervention models that
is supported and acceptable treatment for child
physical and sexual abuse.
• Was designed for use in a coordinated
multidisciplinary community response to allegations
of child abuse and neglect (CAC systems integration
model).
• Integrates the mandate of child protection, family
preservation and offender accountability.
• Creates a partnership between the family and the
treatment provider/community response system.
Clarification: Theory and Rational
• Goals to identify and reduce barriers to child safety and
protection following the identification of abuse; to reduce
any negative effects of abuse; to prevent future abuse
• Based on the guiding principles from the empirical
literature on child maltreatment, child protection state
and federal mandates, and supports the overarching goal
of family preservation or reunification with preconditions
of child safety.
• A uniform and comprehensive clinical assessment of the
non-offending caregiver and child based on APSAC
guidelines provides a baseline of history and experience
of the child and family.
Engaging the Caregiver
The Clarification Process
Clarification is a Process aimed at:
• Empowering the caregiver vs. blaming
• Caregiver shift toward child focus
• Caregiver shift toward active protection
Modeling Appropriate Support
and Protection Behaviors
The therapist has the opportunity to:
- provide information
- provide empathy and emotional support
- address the caregiver’s safety
- address the caregiver’s basic needs
- help the caregiver identify other supportive
individuals and systems
- help caregiver identify needs from community
system
- identify the importance of the caregiver in the child’s
safety and wellbeing
Basis of Protection Clarification
• Child’s view of adults as responsible caregivers
disrupted
• Developmental Issues
- Child believes parents know what child
knows.
• Roles and Responsibilities must be realigned.
• Relationship between maternal support
and positive child outcomes
• Supports child’s disclosure of risk.
Protective Caregiver
• When the caregiver is willing and able to be a
protective resource, the protection
clarification can take place immediately.
• This outcome supports the child protective
services mandate for family preservation.
• It also protects the child from placement away
from a supportive family.
Non-Protective Caregiver
• When the caregiver is unwilling or unable to
be a protective resource immediately, family
preservation becomes secondary to child
protection and the child must be placed
outside of the care of the non-offending and
now non-protective caregiver.
The Clarification Process
Protection Clarification
Completed by a non-offending caregiver.
Assigns responsibility for protecting the child.
A precondition for safety and treatment
Addresses the child’s need to have their reality
affirmed regarding the abuse and failed
protection.
• Provides a safety plan for the present.
•
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Introducing Clarification to Caregivers
• Identify the caregiver as the expert on the child.
• Focus on the child and meeting child’s needs.
• Help caregiver be specific regarding the child’s report
of abuse.
• Help caregiver identify what she wishes she had been
able to do to protect the child.
• Help the caregiver appreciate the child’s reporting.
• Identify the therapist as a consultant to this process.
Four Steps of The Clarification Process
Define abusive
behaviors as wrong.
Acknowledge that
abuse happened.
CHILD FOCUS
Assign responsibility
for abuse and it’s
consequences to
offender.
Assign responsibility
for protection to nonoffending caregiver.
Define behaviors/actions
that will be put in place to
minimize risk.
The Clarification Process
First Order
Verbal
• Child has NOT been removed
• Caregiver initially child focused
• Caregiver acknowledges
responsibility
• Caregiver is actively protective
• Child has been removed
• Caregiver acknowledges reasons
for removal
Written • Caregiver acknowledges need for
Letter
change but has not affected change
• Caregiver may need treatment in
order to assume responsibility
Second Order
• Child has NOT been removed
• Caregiver’s initial presentation may be
ambivalent, not child focused, does not
fully acknowledge abuse
• Following immediate intervention,
caregiver is able to shift focus on child’s
needs
• Child has been removed
• Caregiver initially not able to
acknowledge abuse has engaged in and/or
completed recommended treatment and
taken actions necessary to provide safety
for child
• Caregiver able to demonstrate shift of
focus during letter writing/revising
process
Protection Clarification
Assessment
• Determine appropriate clarification based on
child’s needs/caregiver’s responses.
• What does the child need to hear from the
caregiver in order to help the child feel safe
and affirm the child’s reality?
• What does the caregiver need to ensure that
the information delivered to the child is
appropriate and child focused?
Protection Clarification
Process
• The protection clarification process involves
the therapist working with the non-offending
parent(s)/caregiver(s) to identify specific
information regarding responsibility for protection
and responsibility for the abuse to the child
through a clarification conference.
Protection Clarification
Information
• The information to be identified is elicited
through the assessment and developed in the
initial stages of treatment.
• The information is written in a letter form to
the child victim to ensure the non-offending
parent/caregiver remains child-focused.
Issues to be Covered in
Protection Clarification Letter
• Acknowledge awareness of what happened
(using the child’s words).
• Empathy for what the child has experienced;
the focus is to be on the child and not on the
parent(s)/caregiver(s) own feelings.
Issues to be Covered in
Protection Clarification Letter
• Acknowledge that the offender is responsible
for the abuse and any disruptions following
disclosure.
• Acknowledge any attempts made by the child
to disclose.
• Acknowledge that it is the parent’s
responsibility to protect and care for their
child.
Issues to be Covered in
Protection Clarification Letter
• Describe what did happen regarding
protection.
• Acknowledge any failure to know or question
about the abuse.
• Describe what actions the protective
parent(s)/caregiver(s) wish they had taken.
Issues to be Covered in
Protection Clarification Letter
• Set up a safety plan to include how to
communicate and what to expect for
protection.
• Commit to the best interest of the child.
Protection Clarification
Letter is a Process
• Address issues to be covered.
• Discuss in group and with therapist.
• Write initial letter – can start with what the
caregiver thinks the child needs to hear.
• Review and revise as many times as necessary
in conjunction with additional feedback from
child’s therapist.
Protection Clarification
Letter is a Process
• The letter is reviewed by the therapist who
provides feedback to the non-offending
caregiver to address any subtle shifts of
responsibility, and to ensure that it is complete
and accurate.
Delivering the Protection Clarification
Letter
• When letter is ready…
- Have caregiver write a final letter without
benefit of earlier letter.
- Caregiver reads and is given feedback.
- Child’s therapist reviews drafts of letters
with feedback.
- Rehearsal helps caregiver manage emotions.
- Incorporate feedback from child’s therapist
and from rehearsal into letter.
Delivering the Protection Clarification
Letter
• Issues that must be revised are “grist for the
treatment mill.”
• Address barriers to believing, supporting, and
protecting.
• Caregiver reads letter to therapist at every session.
• Can be helpful to read line by line and ask what the
child would hear.
• Write in age and developmentally appropriate
language.
Clarification Conference
• Explain rules to child/parent prior to conference.
• Caregiver reads letter to the child in the presence of
child’s therapist and other supportive adult.
• Parent’s therapist is present for support.
• Therapist orchestrates the session.
• Process is stopped as necessary.
• Child has opportunity to ask questions.
• Child is given the letter.
Clarification Conference
• Siblings of the index victim are included
individually and the caregiver shares the letter
developed for each.
• Same process of questions and answers
• No expectations of affection
• No expectation of forgiveness
• Ways to give child control in the process
• Therapist can ask questions if child doesn’t.
Desired Outcome
• The child understands why he or she was
removed from the family.
• Caregiver accepts responsibility for protection.
• Child’s reality of the abuse and failed protection
is acknowledged.
• Commitment to future protective behaviors is
clearly defined and stated.
• Caregiver commits to providing emotional
support and following through with treatment
for self and for the child.
Desired Outcome
• If the child’s caregiver is unable to complete
clarification in a timely manner, the therapist,
CPS worker or foster parent can clarify
around the reasons for placement.
• When the caregiver moves to a position of
being able to be protective, the caregiver then
presents the Protection Clarification.
Measurable Behavioral Change
• Although there is no guarantee of any
protective interventions, the Protection
Clarification provides clear behavioral
responses by the caregiver that are specifically
designed to protect the child
• Past barriers to child safety have been
identified and interventions have been made
to overcome those barriers and to reduce risk
to the child.
Measurable Behavioral Change
• New behaviors have been identified, discussed and
implemented prior to the child returning home with
the now protective caregiver
• New rules, boundaries, roles and responsibilities are
identified and implemented by the caregiver
• Methods developed for the child to share future
information regarding risk leads to increased
communication and safety
Measurable Behavioral Change
• The behavioral changes identified through
treatment and then communicated to the
child/children in the clarification are
monitored by individual/family therapy
providers
• Family therapy offers an opportunity for both
monitoring change and offering additional
interventions for change as required
Additional Uses of
Clarification Intervention
• Although this intervention model was designed for
use in child sexual abuse cases it is also appropriate
for other typologies of abuse or neglect including
abuse perpetrated by offenders out of family
• Caregivers participate in the same process to
appropriately assign responsibility for the abuse and
to provide their child with information about what
the caregiver will do in the future to protect the
child
Additional Uses of
Clarification Intervention
• Child Protective Service professionals and
treatment providers are often asked to
provide recommendations regarding the safety
of children who have been abused
• This intervention provides observable
behavioral indicators of change in support
of child safety
Additional Uses of
Clarification Intervention
• The Protection Clarification process focuses
specifically on caregiver protective behaviors
• The successful completion of the Protection
Clarification can be utilized as a precondition for
family preservation, for visitation and/or family
reunification
Questions and Comments
For more information please contact:
The Dee Norton Lowcountry Children’s Center
843-723-3600
Rachael Garrett [email protected]

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