Child Abuse Detection, Reporting and Treatment > Chapter 12 - Case Management

Chapter 12: Case Management

CASE MANAGEMENT

Successful intervention in the lives of abused and neglected children and their families requires the concurrent involvement of many different systems. Interventions aimed exclusively at the individual victim often ignore or underutilize the family and the environmental resources available to the child. This approach can perpetuate the child’s experience of isolation and exacerbate his/her victimization.

A time-limited, hourly therapeutic session with a child will not guarantee his/her safety nor will it guarantee successful interactions in his/her home, school, or community. Careful assessment and utilization of family members and caregivers as well as liaison with school personnel, law enforcement and court-related personnel,and child welfare agencies increases the likelihood that the child will benefit from treatment, remain safe, and promote healthy relationships with others.

[QN.No.22.A good case management includes:]

FAMILY MEMBERS

Inherent in good case management is the principle that the therapist must have a parent or guardian consent and sign a release of information form that gives the therapist permission to contact the appropriate parties whether they be friends, relatives, acquaintances, or professionals. The parent has the right to be informed of the purpose of each contact and the information received from the contact. The child has the right to be informed about how information is obtained and shared.

Parents

Parents of abused and neglected children can be their child’s strongest ally or most serious detractor in the process of therapy. In order for the child to benefit from therapy, his/her parents need to support the use of therapy and be willing to provide the time and effort necessary to help the child maintain the therapeutic relationship.

For most children, the ability to use therapy depends on their parents’ understanding of the therapeutic process and their parents’ willingness to support and follow through with established goals and objectives. The therapist needs to engage the parents’ cooperation, use the parents’ strengths, and when necessary, advocate for appropriate resources to meet the parents’ physical and emotional needs.

Parents often need information about the effects of abuse and neglect and the signs and symptoms that indicate that their child may need therapy. Parents need encouragement for facilitating their child’s participation in therapy and ongoing support when the child’s progress is slow or difficult. Many parents who have unresolved feelings related to their own history of child abuse, neglect, or abandonment need additional attention to help resolve some of their feelings before they can fully address the needs of their child. Parents who understand the therapeutic process and have reasonable expectations regarding the outcome of therapy are more supportive and practical about their child’s feelings and behaviors. Parents who have a fairly objective perspective and a sense of hopefulness about recovery are more helpful to their children.

Siblings

Case management includes advocating for siblings in the family. Often, siblings benefit from services to help them understand the ramifications of abuse and neglect. It is also important to rule out any chance that they have also been victimized. Siblings often need help addressing the following issues:
  • fear and heightened sense of vulnerability;
  • confusion, guilt, or envy (“why not me?”), or self-blame for failing to protect the victim;
  • embarrassment or shame; and
  • misunderstandings regarding the abuse of children, including blaming the victim, scapegoating the victim, sexualizing the sexual abuse victim.
When the perpetrator is a family member, especially a parent, the siblings, as well as the primary victim, will need services to address the following:
  • changes that may have occurred in the family;
  • divided loyalty;
  • anger at the victim for disclosing abuse; and
  • learned behavior, including victimization of younger siblings, inappropriate problem-solving skills, and issues related to gender and the use of power.

Relatives

Relatives can be very helpful or harmful to a child or family that is attempting to resolve issues related to abuse or neglect. Relatives can be an important resource for overburdened and exhausted parents. They can offer comfort, support, and child care for parents who need a respite from the tasks of parenting.

However, relatives need to be screened for their ability to respond appropriately to the child and parent; they should be carefully evaluated for any history of inappropriate behavior that could suggest a propensity to abusive or neglectful behavior. Parents who were abused as children by a family member, including a mother or father, should be strongly advised against seeking care for their child from that family member. Sometimes, a parent will need to explore his/her own history of victimization before being able to understand the ramifications of continuing to socialize or depend on a family member with a history of victimizing children.

If a relative is to be considered as a possible placement for a child who has been removed from parental care, it is important that relative’s motives for caring for the child be evaluated. The relative’s desire to take care of the child may emanate from a sense of obligation or guilt rather than from a real interest in protecting and parenting the child. This can contribute to confusion and perhaps feelings of rejection in the child. The relative must be evaluated to determine his/her understanding of the abuse or neglect. The relative must be able to clearly understand the responsibility for the abuse and place this responsibility with the perpetrator. Any anger or confusion regarding the child’s disclosure needs to be clarified and corrected. Blaming the child for disrupting the family or generating a criminal prosecution will be damaging to the child and increase the child’s fear and anxiety and possibly symptom formation.

On the other hand, relatives need to understand the importance of the child’s relationship with a parent or parent figure and refrain from denigrating the parent to the child. The relative should be evaluated to determine his/her willingness to utilize outside resources including social service caseworkers and therapists. The relative’s willingness and ability to be more alert to family problems and make any changes necessary to address the problems needs to be explored. Most importantly, the relative’s style of discipline needs to be explored and evaluated because family members often learn and use similar childrearing and disciplinary techniques.

A child who is placed with a relative needs to recognize and acknowledge the family connection and have some relationship with the intended caregiver. When a child is placed with an unfamiliar relative, conditions similar to foster placement may apply. The child who will reside with a relative needs to feel that he/she can discuss his/her feelings about the abuse or neglect, the absent parent(s), or changes in the family situation, including the placement with the relative without fearing repercussions or that he/she is jeopardizing his/her place in the family.


SCHOOL

Good case management includes liaison with school personnel, including the child’s teacher, principal, school counselor, and school psychologist. School personnel have the daily responsibility of educating the child; they are a primary source of information about the child’s social and educational skills. The school can be a “safe haven” and is often referred to by abused and neglected children as the one constant and predictable environment in which they felt competent and safe. School can also be “torture” when a child is teased and ostracized because his/her behavior is inappropriate or different from that of other children. Working together with school personnel can add important information to the overall assessment of the child’s behavior and allows the therapist to utilize a support system that is already in place.

[QN.No.23.A primary source of information about the child’s social and educational skills is:]

Teacher

The teacher is an important source of information about the child’s social abilities and relationships. Many abused or neglected children have conflict-ridden or difficult interpersonal relationships. The teacher can provide selective and unique information about a child’s behavior and can be engaged as a support person for changing problematic behaviors. The therapist can address social skills and behavior management techniques in therapy and reinforce successful mastery only with accurate information from reliable sources. Explaining to a teacher that the child is receiving therapy for issues related to abuse or neglect can help the teacher understand any problematic behavior the child may be demonstrating in class. Consistent discipline techniques and responses to the child establish a familiar pattern of interaction with adults that helps the child learn to manage problematic behavior.

School Counselor

The school counselor can offer onsite support for emotional or behavioral problems. Coordination with school counseling services can assure that the child receives appropriate and consistent intervention. It can eliminate duplication of services while generating a “team” approach to intervention with children. School counselors are often available on an emergency basis and can intervene in problematic behavior as it occurs. This timely response and ability to modify behavior problems before they escalate can decrease some of the stigma often generated by abuse or neglect. A child who complains of being teased or bullied on the school grounds can seek protection, and a child who behaves in a threatening or intimidating manner can be monitored and limited in his/her acting out behavior. An accurate report from the school counselor about the child’s academic and behavioral performance can enhance the therapist’s awareness of the child’s strengths and needs and help him/her plan useful interventions.

School Psychologist

A school psychologist can be particularly useful in developing an educational plan that addresses the abused or neglected child’s academic performance. Academic testing and individualized educational plans can help assure that the child does not lose the benefits of a positive educational experience. It is helpful and important to explain to school personnel that the experience of child abuse or neglect can impair a child’s cognitive functioning. This kind of information can help the school teacher, counselor, and psychologist consider learning plans that take into account the stress and anxiety the child may be experiencing from addressing emotional issues related to abuse or neglect.


CHILD WELFARE AGENCIES

It is incumbent on the therapist to work as part of a team with the child welfare caseworkers in order to ensure the safety and protection of the child. A positive and cooperative effort on the part of the therapist enables him/her to better advocate for the needs of the child, including the implementation of optimal, permanent plans. Child welfare caseworkers typically coordinate all of the services provided to abused and neglected children and their families and are responsible for ensuring that effective and timely decisions are made in a case. This decision making can be influenced by the knowledge and opinion of the therapist, but only if the therapist has a good working relationship with the agency. To this end, it is important that the therapist maintains clear and accurate notes describing therapy sessions. The therapist is often called on to provide written opinions about issues (e.g., placement, custody, or need for ongoing therapy) involving his/her clients. Consistent documentation, that is, the keeping of progress notes or client session notes, facilitates the decision-making process and offers objective information to support recommendations made to the child welfare agency.


JUVENILE COURT

The therapist needs to be familiar with the juvenile court system that makes decisions about the safety and protection of children. Placement decisions, visitation policies, and criteria for termination of parental rights are all important concepts that may need to be explained to the child. The therapist may be asked to make reports (i.e., recommendations for placement or visitation) to the juvenile court. These reports often help the child welfare caseworker make decisions that are in the child’s best interest. It is often useful to inform the child that the therapist does not get to “tell” the child welfare caseworker or juvenile court what to do. It is important that the child realize that the judge has the ultimate responsibility for any decisions about the child’s living arrangement.

Substitute Care Placement

When a child is removed from his/her family and is placed in substitute care, he/she has many needs that must be met. The therapist can advocate for the child’s experience to continue to be as safe, familiar, and as “normal” as possible in order to decrease the stress and anxiety generated by the move. The therapist needs to be aware of the child’s social, emotional, and educational needs in order to advocate for a setting that will be suitable for the child. The therapist advocates for the child’s social needs by sharing information about the child’s style of interacting and skill at joining with adults and peers. The therapist can offer suggestions for helping the child feel comfortable negotiating for attention and resources. Finally, the therapist can help the child’s caregivers interpret and respond to the child’s behavior in a consistent and productive manner. Information about the child’s educational abilities and extracurricular activities need to be available to the child’s welfare caseworker and caregivers in order to ensure some feeling of continuity, predictability, and access to esteem-building activities. At times, the therapist may need to advocate for a more intensive level of care for the child. The therapist may need to negotiate with the child welfare caseworker to have a psychiatric evaluation conducted if the child’s emotional state or behavior warrants medication or hospitalization, a psychological evaluation if additional diagnostic information is necessary, or a medical evaluation if any physical problems seem to interfere with the child’s stability and well-being.

The child welfare caseworker should always be notified if the child is a danger to self or others. Any suicidal or homicidal ideation or plans need to be passed on to the child welfare caseworker who has responsibility for the child. However, in such instances, the therapist has responsibility for facilitating hospitalization of the child (when appropriate) and for continuing involvement in the case.

Visitation

The therapist is often asked to make recommendations regarding visitation with noncustodial parents or caretakers. The child’s needs and wishes must be considered as primary information. The child’s concerns regarding safety and protection, feelings about the parent and the visits, and the child’s interest and willingness to interact with the parent seeking visitation need to be considered. Again, a multidisciplinary approach that elicits information from the parents, the parents’ attorneys, the parents’ advocate or therapist if possible, and the child welfare agency is important.

Reunification

When reunification with the parents is a consideration, the therapist needs to be in close contact with the child welfare caseworker in order to relay information about the child’s progress in treatment and to gain information to help prepare the child for changes in visitation or living arrangements. Recommendations regarding reunification, including information about the child’s ability to trust the parent and feel safe and protected, need to be relayed to the child welfare caseworker. The therapist should advocate for appropriate departure from the foster home and a reasonable transition to termination of child welfare services.

Conjoint sessions with parents and child are useful at this time. During these sessions, the course of events can be reviewed, changes discussed, and parental responsibility verbalized and processed. The sessions also offer a forum for the child to share his/her concerns and for the parents to make a commitment to protect the child from further harm.

It is often useful to continue the child’s therapy through the reunification process in order for the child to have a place to discuss adjustment to living with his/her family again and explore solutions to any problems that may arise.

Law Enforcement

When the child is involved in a criminal investigation, it is often helpful to advocate for timely and sensitive intervention with law enforcement personnel. The therapist can help the child feel comfortable about the interview by providing some pertinent details about the experience. Providing the officer’s name and time of visit can help the child feel the officer is a somewhat familiar figure. Identifying the officer as a friend and a person who helps children can also ease some of the child’s discomfort.

Educating officers regarding developmental considerations, including the use of language, skills that facilitate memory and recall, as well as personal skills that help the child feel comfortable and safe are important.

Encouraging the officer to explain to the child the process of investigating a case can help the child feel that he/she has not been forgotten or that his/her case was not important. For more information on the law enforcement officer’s role, the interested reader is referred to The Role of Law Enforcement in the Response to Child Abuse and Neglect, another manual in this series.

Prosecution

Testifying in criminal court can be such a stressful experience that it keeps the child focused on the outcome of the criminal proceeding and deters resolution of the issues related to the abuse or neglect. Schetky and Green note that the fears expressed by child witnesses include:222
  • the fear of retaliation by the defendant, particularly if the defendant has made threats to the child in the past;
  • the fear that he/she will not be believed;
  • feeling as if he/she (the child) is on trial, often reinforced by aggressive cross-examination, or guilt if the child blames him/herself for what happened; and
  • humiliation and embarrassment from the nature of questions asked and the presence of the jury and press.
The child and family need to develop coping responses that ameliorate these fears. The therapist can help the family remain realistic about the criminal proceedings and can prepare them for the possible outcomes. Praising the child’s effort, without emphasizing the content or outcome of the criminal court proceedings, can enhance the child’s self-esteem and positive feelings about the experience. The therapist may need to advocate with the attorney prosecuting the case for the child who is expected to participate in a criminal proceeding. For a description of preparing a child for testifying in court, the reader is referred to another manual in this series entitled Working With the Courts in Child Protection.
 
Child Abuse Detection, Reporting and Treatment > Chapter 12 - Case Management
Page Last Modified On: September 6, 2014, 10:08 PM