Transcript for Episode 84: Supporting Families To Prevent Child Abuse and Neglect

NASW Social Work Talks Podcast

Announcer:
This episode is sponsored by "DSM-5-TR Insanely Simplified," a new book from Chiron Publications.

Greg Wright
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 1800 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?

Suzin Bartley
I'm fine, and thank you for having me, Greg.

Greg Wright
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?

Suzin Bartley
That's taking me back, but let me share with you. I did a lot of community organizing in the early seventies 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.

Greg Wright
Got you. So I want to look at the word "Child welfare", or the words, "Child welfare". You don't like that term, you actually like to use another one. Tell us all about that, Susan.

Suzin Bartley
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 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 are taught, zero to three, that's... Actually Margaret Malow had me terrified when I first read her about zero to 18 months. And you can have any number of character disorders, whether it's narcissism.

Suzin Bartley
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 child protective families through the department of children and families.

Suzin Bartley
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 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 to, to say Greg, 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.

Greg Wright
So how do you find the families to help them before bad things happen? How are they identified, and also how does the trust reach out to them, Susan?

Suzin Bartley
We do it in a number of ways, oh, don't we wish that child abuse and neglect was one simple problem. It isn't, there's a multitude of things that are 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 play time, you can find out what existing resources there are. You can meet other dads and other moms". Oh, 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.

Suzin Bartley
And then two days later, she's never done it before or since, she showed up and I had a baby that hadn't pooped, he was making funky sounds, and I had never, never seen a belly button like that before, whoa, whoa, whoa, whoa. 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 woof 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 23 and under. 90 percent of those parents that we find accept services, they want to learn more about how to be a good mom or a good dad.

Suzin Bartley
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".

Suzin Bartley
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 we've discovered both from a randomized control as well as from a longitudinal study, this works.

Greg Wright
Yeah. Well, I wanted to ask you, at one time, families lived closer, so if you had a baby, you had an aunt there or a grandparent. Families now are more isolated, there are more single parents now than ever. So are you seeing that there isn't a support system built in and that we actually need to build this support system for folks.

Suzin Bartley
Absolutely, absolutely. I wouldn't want to go back 50 years ago because then I wouldn't be able to be a professional, there are so many advantages to being a woman at this point 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. [Kolwein 00:09:30] 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. Pick their brains. And you know what happens? Parents do that naturally.

Greg Wright
Yeah. Yeah. Absolutely.

Suzin Bartley
They want to know who's... Yeah, so there you go.

Greg Wright
Yeah. So with a pandemic happening, I've read a lot of articles that it's actually harder now to detect abuse happening because more families are 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?

Suzin Bartley
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 Service 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. So they were already prepared. We knew we were shutting down, we shut down on Monday, and they immediately went to work. One of our family centers put that out on Facebook and said, "we're going to do a playgroup, 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.

Suzin Bartley
They brought the noise maker, which I quite frankly would've ditched, but... 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'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 in using Zoom was something that we started, we didn't even hesitate.

Suzin Bartley
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 are 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, those kinds of things.

Greg Wright
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 a state and private thing mixed up? Let us know.

Suzin Bartley
I love that, mixed up, it is. We are a public private partnership.

Greg Wright
I didn't mean that.

Suzin Bartley
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 can be a mix. Children's Trust grew out of the [Chem 00:13:42] 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 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.

Suzin Bartley
Oftentimes I see things, particularly around child welfare. It's like, well, we saw 1700 parents. Okay. What happened? Well, we had 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? 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 White girl here. Sorry. It just is. And so being sensitive and careful about that is very important.

Greg Wright
Yes. So do you think that there's a lack of evidence based practice in social work? Are we needing more of it? Is it lacking?

Suzin Bartley
I do think it's lacking. 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. Keep your eyes on the prize. It is all about children. And if we are not having an effective impact, then we're not helping them, we're helping ourselves.

Greg Wright
Tell us about some of the programs you offer. I'm sure there is a plethora of them, but-.

Suzin Bartley
Yes, there are.

Greg Wright
... describe some of them.

Suzin Bartley
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 percent who want in school, go back to school, 83 percent 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 we'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. 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 say, oh, dads, why bother with them?

Suzin Bartley
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 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.

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Greg Wright
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?

Suzin Bartley
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, that 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 skillset for both mom and dad, and help them understand how important both of them are to the life of the child.

Greg Wright
You have a program that I actually find quite interesting, and it's helping a parent if they are incarcerated. I was wondering if you could tell us a bit more about that, Susan.

Suzin Bartley
Sure. We work with the Hampshire House of Corrections, these are the more short term county jails, as opposed to folks who are in long term department of corrections. We work primarily, I would say about 95, 98 percent is dads. And it's a program called a nurturing father's program, intensive 13 weeks to help you look at how were you parented? What was your relationship like with your dad? And really 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.

Suzin Bartley
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. Yesterday we did a legislative 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. 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, for me, that's 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've parented. And that's powerful.

Greg Wright
I think that there's a misconception out there that a lower income life family has more issues than say higher income ones. But I was wondering if you are seeing that there are common problems that are across all classes, races, et cetera, when it comes to this issue?

Suzin Bartley
Yeah. I think there are. And I think that, in fact, Dr. Jessica Price from Florida has done what she would call blind removal-.

Greg Wright
Yeah. I know.

Suzin Bartley
... that looks at... Love her.

Greg Wright
Yeah.

Suzin Bartley
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 dah, dah, dah, dah. Oh, they've got this. That is what gets in our way, is 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 staying 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.

Suzin Bartley
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?

Greg Wright
Not at all.

Suzin Bartley
Okay. So why are we surprised to find pedophiles were 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, or which is now called abusive head trauma. We have a wonderful film called All Babies Cry. 72 percent of the FaceTime on it is dads. These are real parents with real babies talking about how to soothe them.

Suzin Bartley
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 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 things.

Greg Wright
Well, I have to tell you a story. When we were new parents many, many years ago, because my son is almost 30 now. He was a colicky baby. And so in the evenings, he would be fed and dry, sung to, read to, but he would just cry, cry, cry, cry, cry. So we phoned up my mother in-law and, what are we doing wrong here? She said, look, is the baby dry? Yeah. Yeah. Is it fed? Yeah. Close the door. Let him cry, read a book, have a cup of tea and just wait. And he would fall asleep on his own. It was a frustration he was working out. So I learned that, but then we had our parents helping us, a lot of folks don't. So they don't learn this. And it's in a video that you offer. That's awesome.

Suzin Bartley
It is.

Greg Wright
That really is.

Suzin Bartley
It is right there. And All Babies Cry, you can look it up and it's for anyone in the country, just to get that 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, we do an annual conference, and I'm up there talking and I say, how many of us are parents? Raise your hands. Because I want you to keep your parent hat on, not just your clinical social work hat on. And because I, for example, have a seven year old who can make me good and nuts in under 60 seconds. I repeated that, that evening at dinner, Brian looked right at me and said, oh, I can do it less.

Suzin Bartley
I was terrified, because I didn't want him to see my fear. Okay. And in some ways he can still do it 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. As a 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 screen 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 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.

Suzin Bartley
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's 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 offer to babysit, or you might need the food pantry. You might need [WIC 00:30:54], whatever that is, making it happen.

Suzin Bartley
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 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.

Greg Wright
Yeah, absolutely. Now there are over 700,000 social workers in our nation. Out of that, one out of five works with children and families. What actually drew you into that one sector of social work, Susan?

Suzin Bartley
I made a decision to be clinically trained. So that 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. I worked with her for several 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 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, ah, 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 Help Wanted pages.

Suzin Bartley
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 reexperience 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 aren't I working back there so it doesn't have to happen? Why am I waiting to treat it? That doesn't make sense to me. So I was really clear and I was lucky that they hired me.

Greg Wright
Wow. So a final question for you. A lot of the service agencies and the social workers who are there have heavy caseloads, a lot of them are underfunded. I'm sorry, if you could wave a magic like wand and make things better, could you name a few things that would make our system a better place for the families and for children?

Suzin Bartley
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 a 130,000 to 145,000 reports every year. And we screen in between 30 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.

Suzin Bartley
And then we expect a social worker to waive a magic wand 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 percent 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 is a 33 percent decrease in a report. I'm not talking substantiated, because substantiated can vary in terms of what the area office is doing, the capacity, whatever. I just want to know what's their sufficient concern that someone made a report. 10 years out of 32 percent decrease in a second report, to me that shows we are strengthening families. We're building families. We're not just waiting to hunt pathology.

Suzin Bartley
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.

Greg Wright
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.

Suzin Bartley
Thank you for having me, Greg, it's been a delight.

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