NASW Social Work Talks - EP84: Supporting Families to Prevent Child Abuse and Neglect

Episode Date: April 15, 2022

Our guest Suzin Bartley, is executive director at The Children's Trust, an organization working to stop child abuse in Massachusetts. Their programs partner with parents to help them build the skills and confidence they need to make sure kids have safe and healthy childhoods.  Read the show notes for related resources.  

This episode is sponsored by DSM-5TR Insanely Simplified, a new book from Chiron Publications. Welcome to Social Work Talks. I am Greg Wright. April is National Child Abuse Prevention Month. Did you know that at least one out of seven children in our nation is abused or neglected each year? And that in 2019, more than 1,800 children died from abuse and neglect. But this does not have to be. Today, we are talking to social worker Susan Bartley, executive director of the Children's Trust in Massachusetts. Bartley's organization works to support families so children are never mistreated. Welcome to Social Work Talks, Susan. How are you?

I'm fine, and thank you for having me, Greg. Well, before we get going here, I want to talk about your journey as a social worker. Why did you become one, and also, how did you end up at the Children's Trust? That's taking me back, but let me share with you. I did a lot of community organizing in the early 70s in Dorchester, which is a neighborhood of Boston. And that combined with the women's movement, I thought, gee, I really want to do something different.

So the thought was to get a clinical degree because I'd already had the macro skills and to create a women's mental health collective in Dorchester. The reality hit hard after I graduated and I went to work for a community-based mental health center. So that's how I got here. Gotcha. So I want to look at the word child welfare or the words childlike welfare. You don't like that term. You actually like to use another one.

Tell us all about that, Susan. I think child welfare takes you right down that lane to protective services. And as soon as someone hears protective services, they back right up. I'm not saying that there isn't a role. There is. In fact, there's a huge need for better child protective services. However, I was trained to hunt pathology, find it, diagnose it, and treat it. I think that what we're talking about is doing something a little bit different, which is working upstream before abuse and neglect has to happen.

Traditionally, child welfare, you're dealing with families who have already experienced child abuse and neglect, and you're trying to kind of figure out how to help them overcome those situations and that tendency. With us, I'm not part of child welfare. We are part of family support. We're looking to get to families right from the very beginning. As social workers, we're taught zero to three. That's, you know, actually Margaret Marlowe had me terrified when I first read her about, you know, zero to 18 months and you can have, you know, any number of character disorders, whether it's narcissism. So as a new mom, trust me, I was frightened. But if we know that as social workers, why do we wait until after the damage is done? Rather than getting in there, zero to three is when the bulk of the brain develops. Let's move in. Let's make sure that the foundation of that brain is as stable and as strong and as developed as it can be. I worked in child protective services. I worked for Judge Baker Children's Center prior to coming to the Children's Trust and worked with, you know, child protective families through the Department of Children and Families. I would say even those that I had to recommend termination of parental rights, they loved their children. They just couldn't do it. They hadn't the skills, they hadn't, you know, they had mental health issues. There were a whole host of reasons that they just were

not able to adequately parent their child. But doesn't mean that they didn't love them. And in some cases, that's what I attached you to say, Greg, I know, I know you love this child. And you're going to have to love this child enough to give her up and let someone else do this hard work because you just can't. So how do you find the families to like help them before bad things happen? Like how are they identified? And also how does the trust reach out to them, Susan? We do it in a number of ways. Oh, don't we wish the child abuse and neglect was one simple problem. It isn't. There's a multitude of things that are categories categorized underneath that. So I think you want to look at reaching out to parents to say, Greg, you want to be a good dad.

We have a family center right in your neighborhood. Come on down, bring the baby. You can do playtime. You can find out what existing resources there are. You can meet other dads and other moms. Oh, that that doesn't sound like a bad thing. it sounds like a good thing because every parent I know, including myself, had a lot of questions. So I was lucky with my first child. I came home and my cousin, who was a pediatrician, came immediately afterwards. And then two days later, she's never done it before since she showed up and I had a baby that hadn't pooped. He was making funky sounds and I had never, have never seen a belly button like that before. So, you know, and I'm nervous and I'm tense.

I'm a clinical social worker. Husband is a doctorate in education. You'd think we could handle it. We could, but we needed someone to say, oh, relax. Okay. Don't worry about it. Here's the belly button and we're just going to kind of wolf it up and you're not going to pull it off and he's not going to bleed out. Someone who knew about babies. And I think that's what a newborn home visiting program or an in-home parent coaching program can do. It joins with the parent at the time of birth, hopefully prenatally. We have a program that is universal in Massachusetts for all first-time parents under 23 and under. 90% of those parents that we find accept services. They want to learn more about how to be a good mom or a good dad. When you start to talk to them about brain development and that if you sing or read, I've seen kids who are so depressed, but yet they start to sit up taller because they're talking about, I'm making my baby's brain smarter.

And that's exactly what you want. And you want to keep feeding that. I think it's helping parents connect to existing resources, helping parents to define goals. What do you need to do in order to be a good parent? Now, at first, they're going to say, I want to have a car and a house. That's great. Let's chunk it down and come up with six-month goals that are attainable, that are doable. And oftentimes I hear from the parents themselves that their home visitor believed in them when no one else did. And they kept saying, you can do it, you can do it, you can do it. It is that support that then helps to jettison them forward so that they are doing it. And so Tufts University is our evaluator. And I would love to tell you all the good stuff that

that we've discovered both from a randomized control as well as from a longitudinal study. This works. Yeah, well, I wanted to ask you, at one time, like families like lived closer. So if you had a baby, you had an aunt there, or a grandparent, like families now are more like isolated, they're more single parents now than ever. So are you seeing that there like isn't a support system kind of like built in and that we actually need to like build this support system for folks. Absolutely. Absolutely. You know, I wouldn't want to go back 50 years ago because then I wouldn't be able to be a professional. You know, there are so many advantages to being a woman at this point in the, in the game. However, you move, you're isolated, you're working full

time you're coming in. You may not even be sitting out on the front porch. You don't see people. You don't have those connections. I grew up on a street where, trust me, all the women knew each other and don't think that Mrs. Colleran wouldn't have dropped a dime on me if she needed to. That doesn't exist in the same way. So how do we recreate and wrap the protective quilt of community around parents because it is the toughest job and yet it's the most important job we do and so it's starting there and wrapping that quilt and saying okay how do we bring you together how do you meet other parents because you're going to go on this journey with them you're going to see them on the sidelines you're going to see them at teachers conferences you know pick their brains

and you know what happens parents do that naturally yeah you know they want to know who's Yeah. So there you go. Yeah. So with a pandemic happening, I mean, I've read a lot of articles that it's actually harder now to detect abuse like happening because more families are like isolated. They're not out there and the children aren't either in a daycare or at a school. So a lot of things are falling through the cracks here. And I was wondering, what are you saying? I think we've been very lucky in that we've used technology with the program that I'm talking about, the in-home parent coaching. It's over 20 years old, and we always had a participant data system. So we had to train our paraprofessionals into how to get comfortable with technology. we've had surface pro out there with them so they could bring it to communities where quite frankly

it's not easy not everybody and i live in massachusetts has access to broadband um so they were already prepared we shut down on we knew we were shutting down we shut down on monday and they immediately went to work one of our family centers um put out out on facebook and said, we're going to do a play group. You sign up. They had 25 families sign up. They dropped off the book, the materials that they were using to make whatever they were making that day as the activity. They brought the noisemaker, which I quite frankly would have ditched. And they were able to do it over Facebook. By the end of that day, they had 200 views on their Facebook page. So we knew we were onto something.

I think in some ways, what we've learned from this pandemic is that for some parents coming to a parenting ed program, it may be easier to come and do it virtually versus trying to get the kids out the door, even though we provide food and transportation. It is, you know, it's a crummy day out here today. Who wants to take a baby out in the rain? And you got a million things to do.

So being able to participate and using Zoom was something that we started. We didn't even hesitate. So we closed in March. Between March and June, we had over 11,000 virtual home visits. And what we heard from families was, oh, thank God you're there. You're still here because my childcare is closed. My school is closed. My job is iffy. And I know I can still count on you. We had to pivot and do a lot of basic need connections. Diapers, you know, those kinds of things. Susan, I want you to tell us a bit more about how the Children's Trust was created. How did that idea come up? And also, what kind of an organization are you? Are you like a state

and like private thing mixed up? Let us know. I love that mixed up it is. We are a public private I didn't mean that no but it was good it was good because no we are a public private partnership because sometimes the public side the legislature will say well can't you raise that privately and sometimes the private side will can't you get that publicly so yes it is it can be a kind of a mix um children's trust grew out of um the chem center and someone a physician whose name, I am not remembering, who said, gee, we have trust funds for highways. Why don't we have trust funds for preventing child abuse and neglect? Massachusetts was a little late to the game. And in some ways that was our advantage because we looked at what, how other children's

trusts were created and the enabling statute, which is the law that the Commonwealth passed in 1988, made it wonderful and made it helpful for how we can operate, that we are this public-private partnership. Importantly, that we have to evaluate. Oftentimes, I see things, particularly around child welfare, it's like, well, we saw 1,700 parents. Okay. What happened? Well, we had, you know, 4,000 statewide enrolled in parenting ed. Did they like it? Was it fun? Did they gain anything? Was there a pre or a post? Was there any kind of instrument? You know, it's not enough to offer services. You really need to know whether or not those services are effective and meeting the needs of a variety of people. You and I would not have the same needs.

A man of color, you're going to have to be careful and think about what it is that he's experiencing and what he needs. It's going to be very different than, you know, white girl here. Sorry, it just is. And so being sensitive and careful about that is very important. Yes, to do, like, you think that there's a lack of evidence-based practice in like social work? I mean, are we needing like more of it? Is it lacking? I do think it's lacking. You know, I don't want to go to the extreme, which is you have to evaluate every program and every program needs to be evidence-based. But for larger programs like a Healthy Families, we're investing $18 million. There's no shame in understanding what's working and what's not so you can begin to tinker with it. There is no shame in continuous quality improvement, especially when it benefits the families you're serving. You know, keep your eyes on the prize. It is all about children. And if we're not having an effective impact, then we're not helping them. We're helping ourselves.

Tell us about some of the programs you like offer. I mean, I'm sure there is a plethora of them, but describe some of them. Okay. We talked about the newborn home visiting program. At some point, I do want to be able to tell you about some of the outcomes that Tufts University has documented, like 70% who aren't in school go back to school, 83% graduate and go on to more training or college. By the end of the program, they are twice as likely to have completed a year of college.

Understand these are under 23. So you've had that. They're geared to move forward because they know that they need to be economically self-sufficient. And in fact, they're less likely to be on cash assistance, more likely to be in decent housing, have a medical home, all kinds of wonderful things. I could go on and on. So that's one program. We will, dads, I think any dad that's out there could tell us a couple of stories about how the doctor is looking at the wife or the other partner when they're sitting in there in the ER or in the pediatric office. The teacher is talking to mom. We kind of say,

oh dads why bother with them you know that is particularly heinous in child welfare there are accompanying factors like race and cultural concerns where we don't want to mess with people but we we are a female dominated field and oftentimes when our client comes in and says oh he's awful he's miserable he does this we go oh of course and we take our less than stellar feelings sometimes towards men and we join with them and we pay no attention to dad but what we know is clearly from the research that kids do better when dad's involved and dad does better and i could go through that research but we don't have time i think what's really important is how you work so with the newborn home visiting those young dads we're going to help them negotiate

the maternal family system we're going to help make sure he's on that birth certificate that he has visitation that he is actively involved so he understands just how hot a job it is and also so he falls in love with that baby because once you do that that connection is strong have you heard that a new edition of the dsm-5 was just released dsm-5tr insanely simplified gets you up to speed with the latest changes in the DSM and provides an easy way to understand the spectrum based approach to diagnosis. DSM 5 TR Insanely Simplified provides an overview of the new diagnostic manual. You could buy the thousand page APA publication for $200 or you can buy DSM 5 TR Insanely

Simplified for just $19. To purchase visit ChironPublications.com That's C-H-I-R-O-N Publications dot com. How hard is it, though, to help a father if it's a situation where it's a married couple and the father lives in one place and the mom in another place? How hard is that? what the research will tell you is that for girls even if dad is not physically in the house as long as he stays emotionally connected there you have better mental health outcomes so it is the nature of the relationship the intimacy of that relationship and the consistency of that relationship that's key we understand parents don't always live together we understand that

most of the participants in healthy families are not going to be married but they move into a more safe supportive co-parenting situation and so you want to work on that co-parenting skill set for both mom and dad and help them understand how important both of them are to the to the life of the child um you have um a program that i actually like find quite um interesting and it's helping um a parent if they are incarcerated um i was wondering if you could like tell us a bit more about that, Susan? Sure. We work with the Hampshire House of Corrections. These are the more short-term county jails, as opposed to folks who are in, you know, long-term Department of Corrections. We work primarily, I would say about 95, 98% is dads. And it's a program called the

Nurturing Fathers program, intensive, 13 weeks, to help you look at how were you parented? What was your relationship like with your dad? And really kind of sorting that out. One of my favorite exercises is literally they've got all these boxes in this picture, and they're saying, okay, what do you want to keep that your dad gave you? What do you want to put in this box to give away? And what do you want to create in your own box? And I have watched men who tough, angry, and they just melt because they begin to understand and forgive their own fathers and then work towards trying to work not only with their children's mothers, but also with the children themselves. And I can tell you the recidivism rate has gone down, but I have never

been to a graduation where i don't cry because these are dads talking about finally having this connection how important the child is um yesterday we did a legislative um briefing and one of the dads said who had been raised within the department of children and families i didn't realize that yelling and shouting was not effective. And it scared my kids. It really, this really helped me to think about it. And now my kids can sit and I can listen and they're not scared of me. And then like, for me, that's like such a step in the right direction. It changes men's lives. I think it gives them support, but also affirmation that the role they play can be important and that once they get out, they can make a difference and they can change the way they're parented. And that's

powerful. I think that there's a misconception like out there that a lower income like family has more um issues than like say um higher income ones but i was wondering if you um are seeing that like there are common problems that are across all classes races etc when it comes to this issue yeah i think there are and i think that you know in fact dr jessica price um from florida has done what she would call blind removal yeah i know her set yeah i love her love her work she came up and did it but i think it's important that if i don't know the address that's just a bias that's going to pop up immediately that's a poor community oh that's da da da da oh they've got this that that's that is what gets in our way as social workers. We have a perceived bias. I think what we find is,

let's talk about child sexual abuse. Child sexual abuse does not know any class, any race, it happens. And rather than just saying focused on the signs and symptoms and how to report a child who's been abused and neglected. Not saying that's not important. It is. They deserve help. But how about you come upstream with me and let's focus on the signs and symptoms of a pedophile. We've just finished with the legislative task force on the prevention of child sexual abuse in Massachusetts. We had a beautiful, big, huge, thick binder. Well, I knew where that binder was going to sit, on somebody's shelf. So what we did was we created Safe Kids Thrive. It's a website for child and youth serving institutions.

Let's help you learn how to hire and to screen. Because you wouldn't be surprised to find a drunk in a bar, would you? Not at all. Okay. So why are we surprised to find pedophiles where kids are? We as adults need to get over that. Hiring, screening, codes of conduct, safe environment policies, training, that can all be rolled out. And it not only keeps the staff safer, it keeps the institution from being sued, but ultimately it can really help kids be safe and not be subject to pedophilia. That to me is really important. And that cuts across all kinds of race and class. Shaken Baby, which is now called Abusive Head Trauma. We have a wonderful film called All Babies Cry. 72% of the FaceTime on it is dads. These are real parents with real babies

talking about how to soothe them. And the message continually given is, you know what, Greg? You're not a bad dad. When that baby cries and you can't stop the baby crying, it's not that you can't read her cues. It's that they are in this point where they've just lost it. put them down they're not going to melt because they're crying shut that door and give yourself a break and here are some you know here's here are some things you can do for that break but here are some ways that you can soothe that baby and at the end of the day i love it the parents will say you know what just because it worked yesterday doesn't mean it's going to work today keep trying different you know things well um i have to like tell you um a story when um we were

new parents many many years ago because uh my son is almost like 30 now he was um a colicky baby and so in the um evenings i mean he would be like fed and dry um sung to read to but he was just like cry cry cry cry cry so uh we phoned up my mother um in law and like what are we doing wrong here she said look um is the baby dry yeah yeah is it fed yeah close the door let him cry read like a book have a cup of tea and just like wait and he would fall asleep on his own i mean it was like um a frustration you know he was like working out so um i learned that but then we had um our parents you know helping us um a lot of folks don't so they don't like learn this and it's in a video that you offer that's like awesome that really is right there and um all

babies cry you can look it up and it's you know for anyone in the country just to get that kind of reassurance that this is tough stuff and that baby's going to drive you crazy now. But guess what? I'll tell you a story. My 34 year old, when he was seven, I am, we do an annual conference and I'm up there talking. I say, you know, how many of us are parents? Raise your hands. Cause I want you to keep your parent habit, not just your clinical social work habit. And because I, for example have a seven-year-old who can make me good in nuts in under 60 seconds i repeated that that evening at dinner brian looked right at me and said oh i can do it in less i was terrified because i didn't want him to see my fear okay and and in some ways he can still do

it in less but it's kids can drive us crazy they know when to do it whether it's at six o'clock and they're throwing themselves down on the ground. I mean, as an adjunct at BC School of Social Work, I'm teaching social work students who don't have kids. Well, think about this. Would you continue to date someone who threw themselves down on the grocery floor and screamed for candy at the checkout?

No. You would be out that door so fast, you wouldn't even respond to their texts or phone calls. but we expect parents to pick that baby up and whether it's then or they're you know screaming and carrying on and you can't get that car seat on them or how about a large family gathering where your least favorite sister-in-law is horrified to see what your child is doing i mean those are real time real things that we as parents have to deal with we make it really hard we are not necessarily supportive. And that gets me back to, I was trained to hunt pathology.

I was trained to be judgmental. And one of the ways in which our programs work is to walk in the door and be strength-based. It's not like I'm not going to hear or understand or make note of all of the issues that you're going to need to work through, but that's not my focus. Everybody has strengths. And how do I build those strengths so that you can overcome whatever obstacle it is? It's a different way of doing it. It's paying attention to the five key protective factors, parental resilience, that ability to get back up and do it again.

Social connections. Are you connected? Do you have friends? Do you have neighbors? Do you have family? Concrete help in times of need. That can be as simple as a pan of lasagna or an off at a babysit, or you might need the food pantry. You might need WIC, whatever that is, making it happen.

Knowledge of parenting and child development, helping parents get solid, good facts about what they can do and how they can handle their stress or how they can handle the many challenges that kids confront us with. And finally, social and emotional development of children. Fostering that child's ability to interact positively with others and build their social, emotional health. Those are five key protective factors that, in conjunction with a strength-based approach, I find, and I've got 30 years into this, it really does make a difference. because parents want to join with you around raising their kids because they do love their babies. They love their little ones, even if they drive us a little crazy. We do love them. Yeah, absolutely. Now, there are over, like, 700,000 social workers in our nation.

Out of that, like, one out of, like, five works with children and, like, families. What actually drew you into that one, like, sector of social work, Susan? I made a decision to be clinically trained. So that kind of lends you into that milieu. And working at Judge Baker, one of the things that I did was consult with the local child protective agencies. And I had a case where a woman was an incest survivor. Went through a lot as a child. married someone who will be no surprise sexually abused her two oldest daughters um i worked with

her for several years and i was pretty clear that she was keeping dad away from the kids oh no she wasn't that just blew my mind and i just thought wow there's got to be there's got to be something else that can be done here to prevent this from happening it just it made me crazy and i came home and i said to my significant other i'm not going to do this anymore he said great and he handed me this is how old it was he handed me the um health wanted pages and there it was this little ad child abuse prevention and as a clinician i also had a private practice i sat with adults who would sob who would re-experience childhood

trauma and it always went back to their childhood that's where it started whether it was the alcoholism of their parent whether it was dv it all went back there and i thought well then why am i working back there so it doesn't have to happen why am i waiting to treat it that that doesn't make sense to me um so i was really clear and i was lucky that they hired me wow so um a final question for you um a lot of the um service um agencies um and the social workers who are like there have um heavy uh uh caseloads a lot of them are um underfunded um if you could make if i'm sorry um if you could wave a magic like wand um and make things like better um could you name a few things that would make um um our system a better place for the families and for children

I would say that we should be putting a lot more resources into upstream prevention so that zero to three, the bulk of the brain, they're developed in the way we want. And I'm pretty clear about that, and I'm extremely clear that I've seen that success, both short term, but also the longitudinal outcomes for kids and for families when that happens and when it's done well. because at this point, at least in Massachusetts, and I know it's the same in other states, we get about 130,000 to 145,000 reports every year, and we screen in between 30,000 and 45,000. That's a capacity issue. What does it say to that Delta? What does it say to those families that aren't screened in? What does it say to those mandated reporters who are sufficiently concerned that they've actually made that call. Oh, well, Greg, I think you should break an arm or a leg or maybe be in the car with them and be drinking or smoking or whatever. It creates this

unintended increase in dysfunction in a family before they can get services. That's nuts. There's no other way to put it. That's just crazy. And then we expect a social worker to wave a magic want and make it all better. That's not the way it goes. If we could cut off the spigot and get in and do that early work, you'd lower the number of families that need this. Let me give you an example. In healthy families, 55% of the moms had substantiated cases of child abuse and neglect in this state. I don't know Connecticut. I don't know Rhode Island. Okay. 10 years out after this program, there's a 33% decrease in a report. I'm not talking substantiated because substantiated can vary in terms of what the area or office is doing, the capacity, whatever.

I just want to know, was there sufficient concern that someone made a report? 10 years out, a 32% decrease in a second report. To me, that shows we're strengthening families. We're building families. We're not just waiting to hunt pathology. The other issue, I think, is that when I look at child welfare, inadequate training, lack of consistent supervision and reflective supervision, there's a quality to it that's also missing. It is disorganized and you can't find resources for clients. That is a setup to fail and it makes us feel bad about the work we do and it's not helpful to kids. And if we're really in this work, it's not about us, it's about the children, then we should be able to do a better job.

Thank you. We've had a wonderful conversation. It's really been a pleasure. Susan Bartley, the CEO of Children's Trust in Massachusetts, thank you for being our guest on Social Work Talks. Thank you for having me, Greg. It's been a delight. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org, and don't forget to subscribe to NASW Social Work Talks wherever

you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.