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Case studies in child welfare

About this guide, child welfare case studies, real-life stories, and scenarios, social services and organizational case studies, other case studies, using case studies.

This guide is intended as a supplementary resource for staff at Children's Aid Societies and Indigenous Well-being Agencies. It is not intended as an authority on social work or legal practice, nor is it meant to be representative of all perspectives in child welfare. Staff are encouraged to think critically when reviewing publications and other materials, and to always confirm practice and policy at their agency.

Case studies and real-life stories can be a powerful tool for teaching and learning about child welfare issues and practice applications. This guide provides access to a variety of sources of social work case studies and scenarios, with a specific focus on child welfare and child welfare organizations.

• Real cases project Three case studies, drawn from the New York City Administration for Children's Services. Website also includes teaching guides
• Protective factors in practice vignettes These vignettes illustrate how multiple protective factors support and strengthen families who are experiencing stress. From the National Child Abuse Prevention Month website
• Child welfare case studies and competencies Each of these cases was developed, in partnership, by a faculty representative from an Alabama college or university social work education program and a social worker, with child welfare experience, from the Alabama Department of Human Resources

• Immigration in the child welfare system: Case studies Case studies related to immigrant children and families in the U.S. from the American Bar Association
• White privilege and racism in child welfare scenarios From the Center for Advanced Studies in Child Welfare more... less... https://web.archive.org/web/20190131213630/https://cascw.umn.edu/wp-content/uploads/2013/12/WhitePrivilegeScenarios.pdf
• You decide: Would you remove these children from their families? Interactive piece from the Australian Broadcasting Corporation featuring cases based on real-life situations
• A case study involving complex trauma This case study complements a series of blog posts dedicated to the topic of complex trauma and how children learn to cope with complex trauma
• Fostering and adoption: Case studies Four case studies from Research in Practice (UK)
• Troubled families case studies This document describes how different families in the UK were helped through family intervention projects
• Parenting case studies From of the Pennsylvania Child Welfare Resource Center's training entitled "Understanding Reactive Attachment Disorder"
• Children’s Social Work Matters: Case studies Collections of narratives and case studies

• Race for Results case studies Series of case studies from the Annie E. Casey Foundation looking at ways of addressing racial inequities and supporting better outcomes for racialized children and communities
• Systems of care implementation case studies This report presents case studies that synthesize the findings, strategies, and approaches used by two grant communities to develop a principle-guided approach to child welfare service delivery for children and families more... less... https://web.archive.org/web/20190108153624/https://www.childwelfare.gov/pubPDFs/ImplementationCaseStudies.pdf
• Child Outcomes Research Consortium: Case studies Case studies from the Child Outcomes Research Consortium, a membership organization in the UK that collects and uses evidence to improve children and young people’s mental health and well-being
• Social work practice with carers: Case studies
• Social Care Institute for Excellence: Case studies
• Learning to address implicit bias towards LGBTQ patients: Case scenarios [2018] more... less... https://web.archive.org/web/20190212165359/https://www.lgbthealtheducation.org/wp-content/uploads/2018/10/Implicit-Bias-Guide-2018_Final.pdf
• Using case studies to teach
• Last Updated: Aug 12, 2022 11:21 AM
• URL: https://oacas.libguides.com/case-studies

Children and the Child Welfare System: Problems, Interventions, and Lessons from Around the World

• Open access
• Published: 30 January 2021
• Volume 38 , pages 127–130, ( 2021 )

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• Jarosław Przeperski   ORCID: orcid.org/0000-0002-5362-4170 1 &
• Samuel A. Owusu 1  

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Securing the welfare of children and the family is an integral part of social work. Modern society has experienced enormous changes that present both opportunities and challenges to the practice of social work to protect the welfare of children. It is thus essential that we understand the experiences of social work practitioners in different parts of the world in order to adapt practice to the changing times. To help achieve this, we present a collection of papers from around the world that presents findings on various aspects of social work research and practice involving children and the potential for improved service delivery.

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Understanding and Promoting Child Wellbeing After Child Welfare System Involvement: Progress Made and Challenges Ahead

Sarah A. Font & John D. Fluke

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The protection of children’s welfare in many parts of the world involve different institutions and professionals ranging from social workers to the police, courts, schools, health centers, among others. In the course of their duties, some form of collaboration to varying degrees occur between these institutions and professionals in order to secure the welfare of children (Lalayants, 2008 ).

The child welfare system and social work particularly, has been observed to have undergone complex changes from its inception till now (Bamford, 2015 ; McNutt, 2013 ; Mendes, 2005 ; Stuart, 2013 ). Historically, the family and the local community were in many societies, solely responsible for a child’s well-being. When in crisis, the family including the wider extended family, was primarily responsible for supporting the child and solving their problems.

In response to wider changes in contemporary society, the child welfare system has increased the involvement of aid institutions protecting the welfare of children while reducing the role of the family. The family as a unit has also undergone changes, from the involvement of a broader network of relatives and the local community to the dominance of the nuclear family. Family ties have been weakened in many societies and the way the family unit functions has changed. Many children experience problems that often exceed the capacity of help available to these nuclear families. This has made it necessary to involve professional institutions (education, health, etc.) to aid in other areas outside of their core mandates to ensure children are secure, healthy, fed, and entertained and also to help families regain their own strength.

Although certain challenges to child welfare have persisted over time, children in contemporary times face some threats to their welfare unique to the times. Advancement in technology on one hand presents novel problems such as internet-use addictions and extensive means of child exploitation whiles on the other hand, these advancements in technology also provide opportunities to reach more clients effectively, gather data for analysis, and monitor and assess the performance of workers as well as the effectiveness of services. Modern ICT tools (such as online platforms and mobile applications) provide more flexibility in engagement between social workers and clients and the frequency of such meetings or engagements. However, an uncritical over-reliance on these tools presents other problems. Some social workers may be prone to avoid difficult situations involving uncooperative or violent families (Cooper, 2005 ) and an over-reliance on online meetings may worsened such cases, leaving vulnerable children unprotected.

All around the world, differences exist in the degree of exposure and the severity of problems facing children based on their age group (infants, toddlers, teens, and, youth), gender, geography, economic background, and culture. For instance, among the genders, differences exist in the probability of falling victim to child sexual abuse (Wellman, 1993 ) and the consequences of such victimization (Asscher, Van der Put, & Stams, 2015 ). Children from poor families are more at risk of being involved with the welfare system in certain countries (Fong, 2017 ) while poor and developing countries lack some resources needed to support children and families compared to more developed and richer countries. In addition, cultural attitudes towards parenting in different parts of the world may exacerbate the problems of child neglect, corporal punishment, and other forms of abuse.

To ensure that social workers are better equipped to deal with the daunting task of protecting the welfare of children, reforms have been proposed which are aimed at improving on the knowledge and skills of social workers, instituting standards of practice based on data, striving for continuous excellence in organizations (Cahalane, 2013 ) among others. The social work interventions aimed at improving the welfare of children of any given society can be affected by political, cultural, and socio-economic factors and this needs to be understood and addressed during the design, implementation, and assessment stages of interventions. Reisch and Jani ( 2012 ) describe how politics affect the development of social programs at the macro and micro levels, workplace decision-making processes, and resource allocation for agencies and clients.

With the aim of understanding the various challenges facing social work and the child welfare system around the world and the existing opportunities to address them, several papers on varying topics related to child welfare have been collated into this special issue. The contributors come from Asia, Africa, North America, and Europe and present the results of research into different areas affecting child welfare, child welfare workers and institutions, and interventions. Many lessons can be learnt from understanding the problems facing children and their families from around the world, the services and interventions instituted to combat such problems, the state of mind of children and their relationships with others, and the potentials of modern tools to improve service delivery in the child welfare sector.

In the special issue, Filippelli, Fallon, Lwin and Gantous ( 2021 ) present the paper, “Infants and Toddlers Investigated by The Child Welfare System: Exploring the Decision to Provide Ongoing Child Welfare Services”. Following the concerns of limited research into decision-making process of young children involved in the welfare system, the authors aimed to contribute to the literature on cases of maltreatment of young children and decisions to address them. The authors sought to answer the questions of the character of investigations of alleged child maltreatment, what factors influence decisions to recommend welfare service provision, and what differences may exist between cases involving infants and toddlers. After reviewing data on investigations into suspected cases of child maltreatment in Canada, it was determined that assessment by welfare workers and the mental health of caregivers are important indicators of decisions to transfer cases for further services. For cases involving infants, results indicate caregiver characteristics and household income are unique factors influencing decision-making while in toddler-involved cases, the toddler and the caregiver characteristics are factors that affect decisions.

Van Dam, Heijmans, and Stams ( 2021 ) aimed to determine the long-term effect of the intervention program, Youth Initiated Mentoring (YIM) organized in the Netherlands. They sought to find out how the mentors and the youth mentees were doing several months or years after the program and their impression of the whole program. In the paper “Youth Initiated Mentoring in Social Work: Sustainable Solution for Youth with Complex Needs?”, they show some findings on the present situation of mentees, the quality and trajectory of mentor–mentee relationships, and the level of support from social workers. Results indicate a sustained relationship between majority of the mentors and mentees and a reduction in the likelihood of out-of-home placement among other long-term benefits. The authors offer some recommendations for future research into Youth Initiated Mentoring.

Mackrill and Svendsen ( 2021 ) in the paper, “Implementing Routine Outcome Monitoring in Statutory Children’s Services” highlights the outcome of a 2-year long study on the effect of implementing a feedback-informed approach to family service provision in Denmark. In the study, they sought to understand how the feedback informed approach assisted in protecting children and families and what gaps exist in the service delivery chain. This involved analyzing by means of a constructivist grounded theory approach, anonymized data derived from field notes and interviews of various stakeholders. They report that the feedback-oriented approach helped service workers to follow legal directives especially in areas of assessment, care planning and follow-up, as well as in their approach to interviewing children. On the other hand, they assert that this approach to service delivery fails to emphasize attention to risk especially within families and the rights of clients to legal advice and recourse, among other issues. They offer some recommendations to address some of the identified challenges.

In order to understand the perceptions of the youth about older people with regards to healthcare and social help so that resources to address any existing negative stereotypes can be identified, Kanios ( 2021 ) surveyed 1084 school-going young people in Poland. Findings of this survey are presented in the paper titled “Beliefs of Secondary School Youth and Higher Education Students About Elderly Persons: A Comparative Survey”. Results show varied beliefs about older people regarding healthcare and social help among Secondary School Youth and Higher Education Students. Most of the respondents from both groups held no stereotypical views of older people. Students in higher education especially were found to maintain a more mature outlook on older people. Kanios concludes the paper with some recommendations of educational interest to combat existing negative stereotypes of older people.

Frimpong-Manso ( 2021 ) aimed to understand the views of social workers in Ghana on the benefits of intervention programs that strengthen families and to identify any existing barriers to their successful implementation in his paper, “Family Support Services in The Context of Child Care Reform: Perspectives of Ghanaian Social Workers”. Qualitative data derived from interviews with social workers point to some benefits of the existing family support services such as capacity building and wellbeing promotion of the families. Some identified challenges to success include inadequate funding and poor interagency cooperation.

Odrowąż-Coates and Kostrzewska ( 2021 ) from Poland present an analysis of the indicators of successful and fulfilling teenage motherhood in their paper titled “A Retrospective on Teenage Pregnancy in Poland. Focusing on Empowerment and Support Variables to Challenge Stereotyping in the Context of Social Work”. With the aim of showcasing positive cases of teenage motherhood as a means of empowerment and a way to tackle stereotypes in Poland, the authors utilized data from interviews and field practice notes involving teenage mothers and family court curators. Findings from this study show these teenage mothers to be empowered, independent, persevering, and with agency. Resources available through social work interventions and other support systems are also highlighted. The authors emphasize the need to show the positive life experiences of teenage mothers and the social work programs that contribute towards that in order to dispel existing stereotypes.

Abu Bakar Ah et al. ( 2021 ) in their paper, “Material Deprivation Status of Malaysian Children from Low-Income Families” relied on data from a self-reported survey of 360 poor children in Malaysia to determine their level of material deprivation. Results indicate a low level of material deprivation among poor Malaysian children. The authors include some recommendations to improve on the well-being of children in Malaysia.

With the hypothesis that the quality and quantity of placement of children with their kin depend on social workers, managers, and some organizational factors, Rasmussen and Jæger ( 2021 ) present a case study of social workers and their field practices related to kinship care in Denmark. Their paper, “The Emotional and Other Barriers to Kinship Care in Denmark: A case study in two Danish municipalities” contains analysis of the findings of their study. Through a mixed method approach of analyzing documents, interviews, observations, and dialogue meetings, data on placement into kinship care in two municipalities in Denmark were gathered. Among all the cases selected for the study, they reported a reasonable level of satisfaction among all parties involved. However, the authors indicate a hesitation among social workers to enter emotionally-charged familial situations which affects their decisions on kinship placement. The paper also points to the non-involvement of families in a systematic manner in placement decisions as another factor that affects placement decisions.

Grządzielewska ( 2021 ) from Poland, reviews how machine-learning can be applied as a tool to predict burnout among social work employees in the paper, “Using Machine Learning in Burnout Prediction: A Survey”. The ability to analyze and interpret large amount of data makes the tools of machine learning very useful. The paper attempts to compare traditional and newer methods of predictive modeling and discusses how different variables affect the choice of appropriate methodologies. It is discussed in this paper how machine-learning algorithms can be incorporated into a burnout monitoring system to create new models of burnout, identify the potential for burnout among new recruits and existing employees, and design appropriate interventions. The author recommends further attention by social work researchers in the study of burnout.

We acknowledge the contributions of the various authors to making this special issue possible by sharing their perspectives on child welfare service delivery.

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Filippelli, J., Fallon, B., Lwin, K., & Gantous, A. (2021). Infants and toddlers investigated by the child welfare system: Exploring the decision to provide ongoing child welfare services. Child and Adolescent Social Work Journal, 11, 1–15.

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Frimpong-Manso, K. (2021). Family support services in the context of child care reform: Perspectives of Ghanaian social workers. Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00729-6 .

Grządzielewska, M. (2021). Using machine learning in burnout prediction: A survey. Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00733-w .

Kanios, A. (2021). Beliefs of secondary school youth and higher education students about elderly persons: A comparative survey. Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00727-8 .

Lalayants, M. (2008). Interagency collaboration approach to service delivery in child abuse and neglect: perceptions of professionals. International Journal of Interdisciplinary Social Sciences, 3, 225–336.

Mackrill, T., & Svendsen, I. L. (2021). Implementing routine outcome monitoring in statutory children’s services. Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00734-9 .

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Odrowąż-Coates, A., & Kostrzewska, D. (2021). A retrospective on teenage pregnancy in Poland: Focusing on empowerment and support variables to challenge stereotyping in the context of social work. Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00735 .

Rasmussen, B. M., & Jæger, S. (2021). The emotional and other barriers to kinship care in Denmark: A case study in two Danish municipalities. Child and Adolescent Social Work Journal.

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van Dam, L., Heijmans, L., & Stams, G. J. (2021). Youth initiated mentoring in social work: Sustainable solution for youth with complex needs? Child and Adolescent Social Work Journal . https://doi.org/10.1007/s10560-020-00730-z .

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Przeperski, J., Owusu, S.A. Children and the Child Welfare System: Problems, Interventions, and Lessons from Around the World. Child Adolesc Soc Work J 38 , 127–130 (2021). https://doi.org/10.1007/s10560-021-00740-5

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Evaluating Child Labor Programs: Uncovering How Local Norms Impact Field-Level Relationships Between Farmers, Workers and Children

This is a case study of how Philip Morris International (PMI), used participatory evaluation tools to gather information in order to address the “root causes of the most prevalent and persistent issues that keep surfacing” – specifically child labor in their agricultural supply chain.

Using participatory evaluation to address the root causes of an issue

This case study is part of a collection developed under the Quality of Relationships stream of Shift’s Valuing Respect Project . It explores how Philip Morris International (PMI) , a global tobacco company, used participatory evaluation tools to gather information in order to address the “root causes of the most prevalent and persistent issues that keep surfacing” – specifically child labor in their agricultural supply chain. 

December 2020 |

Assessing whether behavior change training can improve relationships between supervisors and workers.

Over the years, PMI has been gathering data through regular assessments and farm visits, which help the company to monitor the implementation of its labor standards, including zero child labor. However, it is its latest strategy, Step Change , that has provided complementary information about local awareness challenges, customs and societal attitudes that normalized children working on tobacco-growing farms. In driving this change, PMI has set itself an ambitious target to eliminate child labor from its leaf supply chain by 2025. Addressing incidences of child labor is important due to the hazardous nature of the agricultural work, which can pose increased health and safety risk to children. This case study describes how a combination of participatory methods allowed local and affected people to express in their own terms any local realities that run counter to the company’s efforts to reduce the use of child labor on farms.  

Specifically, the evaluation uncovered that:

• workers are more accepting of children working on farms than farmers; 
• child labor is seen as part of a widespread societal norm of communal work; and 
• strong cultural beliefs ingrained in the society including of some local leaders, educators and community representatives weakening the company’s messaging about child labor. 

“ We asked ourselves: ‘Why aren’t we seeing positive change?’ That is when we decided to take a deep dive, speak to the farmers and workers directly to uncover root causes which were preventing us from achieving desired outcomes.”  “ JOANNE LE PATOUREL, MANAGER SOCIAL SUSTAINABILITY LEAF, PMI

QUALITY OF RELATIONSHIPS SERIES

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ABOUT THE VALUING RESPECT PROJECT

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This resource was published by shift project on february 07, 2021, related work to evaluating child labor programs: uncovering how local norms impact field-level relationships between farmers, workers and children.

August 2021 |

Red flag 24. aggressive tax-minimization strategies.

Red Flag 23. Markets where regulations fall below human rights standards

Red Flag 22. Sales-maximizing incentives that put consumers at risk

Red Flag 21. Automation at speed or scale that leaves workers little chance to adapt

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Exploring the health of child protection workers: A call to action

Javier f. boyas.

1 Troy University, School of Social Work and Human Services, 112A Wright Hall, Troy, AL, 36082, USA

Debra Moore

Maritza y. duran.

2 University of Georgia, School of Social Work, 279 Williams St., Athens, GA, 30602, USA

Jacqueline Fuentes

Jana woodiwiss, antonella cirino.

Background: This exploratory study determined if a relationship exists between secondary traumatic stress (STS) related to health status, health outcomes, and health practices among child protection workers in a Southern state.

Methods: This study used a cross-sectional survey research design that included a non-probability sample of child protection workers (N=196). Data were collected face-to-face and online between April 2018 and November 2019 from multiple county agencies. A self-administered questionnaire was completed focused on various health behaviors, outcomes, and workplace perceptions.

Results: Results of the zero-order correlations suggest that higher levels of STS were significantly associated with not having visited a doctor for a routine checkup ( r =-0.17, P =0.04), more trips to see a doctor ( r =0.16, P =0.01), and increased number of visits to emergency room (ER) ( r =0.20, P =0.01). Lower levels of STS were associated with better self-rated health (SRH) ( r =-0.32, P ≤0.001), higher perceptions of health promotion at work ( r =-0.29, P ≤0.001), frequent exercise ( r =-0.21, P =0.01), and by avoiding salt ( r =-0.20, P ≤0.031). T-test results suggest that workers who did not have children (µ=45.85, SD=14.02, P =0.01) and non-Hispanic white workers (µ=51.79, SD=11.62, P ≤0.001) reported significantly higher STS levels than workers who had children (µ=39.73, SD=14.58) and self-identified as Black (µ=39.01, SD=14.38).

Conclusion: Findings show that increased interpersonal trauma was linked to unhealthy eating, general physical health problems, and health care utilization. If not addressed, both STS and poor health and health outcomes can have unfavorable employee outcomes, such as poor service delivery.

Introduction

Child protection is one of the more challenging and taxing human service occupations. The nature and organization of the work make child protection inherently strenuous, such as high work demands, low salaries, excessive caseloads, risky and unpredictable case situations, changing policies and standards, on-call duties, understaffed work environments, persistent emergencies, and arduous work schedules. 1 - 4 Child protection workers often face the apprehension of making abrupt decisions on complicated cases, sometimes with little to no background information. Such fast-paced decision-making does not always end in selecting the safest option, which has resulted in continuous public and media scrutiny. 5 It is clear, though, that child protection workers’ decisions are vital, given they are the first line of defense when there is suspicion of child abuse or neglect and effective interventions when cases of abuse or neglect are indicated. Additionally, listening to children talk about traumatic experiences while trying to work in a demanding, challenging, and commonly “insensitive” child welfare structure can potentially put a child protection worker at heightened risk of developing emotional and psychological problems. 6 - 10 Thus, for child protection workers to provide quality services to vulnerable populations, they must be mentally, physically, and emotionally prepared.

Given the magnitude of what is at stake and the number of job-related stressors, it is not surprising that many child protection workers suffer from mental health problems. Such suffering has often resulted in the genesis of adverse occupational stress reactions, such as job stress, burnout, and vicarious trauma. 6 - 10 One of the concerning occupational hazards faced by child protection work relates to the increased susceptibility to experiencing vicarious trauma, often recognized as secondary traumatic stress (STS). It has been estimated that as many as 70% of social workers experience STS. 11 That is because of the multiple times child protection workers are exposed to indirect trauma through a client’s narrative and distressing description of a traumatic event, such as hearing accounts of acts of cruelty, medical neglect, emotional, physical, sexual, and psychological abuse. 12 , 13 They also hear and read disturbing content discussed in case reviews and case recordings. 14 Since so many of their clients are survivors of trauma, child protection workers provide empathy for their clients by providing ongoing listening, supporting, and providing various levels of continuing care, which can leave them vulnerable to absorbing the anguish their clients experience. 15 Not surprisingly, child protection workers too are likely to show stress symptoms of primary trauma. 16 , 17 STS is thus viewed as a psychological reaction to a stressor encountered in the workplace associated with the many traumatic accounts shared by trauma survivors. 18 It is well established that STS can manifest on three levels: physical, behavioral, and psychological/emotional. 19

Although researchers have documented the psychosocial stress reactions associated with child protection, such as STS, very few studies have explored whether child protection workers’ levels of STS are associated with health status, health practices, and health outcomes. Existing research highlights the relationship between interpersonal trauma exposure and adverse physical health outcomes. 20 , 21 Furthermore, several studies sampling vulnerable occupational groups revealed that occupational stress can manifest and result in psychosomatic symptoms. 22 - 26

This relationship has been explained by asserting that trauma activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous systems, which prompts an overreaction in the immune system. 27 , 28 This physiological response is attributed to increased ill health and a debilitated immune system. 29

We maintain that investigating the global health of this occupational group is highly relevant because, historically, child protection workers hardly ever benefit from organizational health and well-being training. Very few organizations have invested in promoting health and well-being among their workforce. While some child protection organizations have started to introduce programming to address mental health concerns, the same cannot be said about physical health, despite the growing number of studies that underscore the health concerns raised by child protection workers. 30 - 32 Current research suggests that child protection workers develop unhealthy behaviors due to the stress and demands of child protection practice, which include unhealthy eating, substance abuse, self-neglect, and lack of exercise. 30 , 33 Thus, child protection workers’ health behaviors and health status should be investigated, given the work conditions they experience. Health is not only a key indicator of social wellness, but it is also essential to the work performance of child protection workers. 34 Ignoring child protection workers’ health could put the entire child welfare system at risk. 15 , 35 There is very little information in the literature related to how much health is discussed within child welfare organizations or discussion of the nutritional eating habits of child protection workers. Additionally, although many studies suggest that many child protection workers suffer from STS, 36 , 37 few studies have explored whether a correlation exists with health status, health practices, and health outcomes among this vulnerable occupational group. This study’s first aim was to identify child protection workers’ health practices and health status in a Southern state. The second aim was to determine if a significant correlation exists between STS, health behaviors, and health outcomes.

Materials and Methods

Research design and sampling.

This study used a cross-sectional, retrospective research design. A non-probability sample of child protection workers was recruited to participate in this study using a combination of convenience and snowball sampling techniques. The study eligibility criteria were: (1) be at least 18 years of age, (2) be employed in a child protection public agency in a specific Southern state and (3) have no cognitive limitations. Participants were excluded if they worked for a private child protection agency or were public child protection in other neighboring states. No potential participant was left out due to exclusion criteria.

Participants were recruited via Facebook, word of mouth, and at trainings targeting child protection workers. Data were collected face-to-face and online from April 2018 through October 2019 from various county agencies across one state. A self-administered questionnaire took approximately 30 minutes to complete. In all, 40 persons opted to complete the survey online, whereas the other 158 participants completed their surveys face-to-face. No significant differences in health and health outcomes were identified between respondents who completed the survey online compared to those who completed the survey in person. Pilot testing with 15 possible participants was conducted to further maximize the face validity of the questionnaire. Their responses were not included in the current analysis. As a result of feedback gained from the pilot testing, the final instrument was abbreviated to reduce the possibility of the participants experiencing mental fatigue. Written informed consent was obtained from all participants. Participants were not given a research honorarium. The Institutional Review Board at the University of Mississippi approved the protocols (protocol number: 18x-288)used in the present study to ensure minimal risk to participants.

Instrumentation

The STS symptoms scale 36 is a self-report questionnaire consisting of 17 items. Responses are based on a 5-point Likert-type scale (1 = never to 5 = very often). The STS includes three subscales: intrusion (5 items), avoidance (7 items) and arousal (5 items). Items were summed to create a total score, with higher scores indicating a higher level of STS. A total score of 38 or higher indicates STS. 36 The STS scale had a high internal consistency in the present study (Cronbach’s alpha = 0.89).

Self-rated health (SRH) continues to be widely used in health surveys because it is considered a robust global measure of general health status in epidemiological studies and an independent predictor of morbidity and mortality. 38 , 39 SRH was a single item that asked respondents to answer the question, “How would you describe your overall state of health these days?” SRH was measured as a five-category ordinal variable: poor = 0 to excellent = 4.

Several measures were included to determine child welfare workers’ health status, health practices, and health outcomes. Chronic health conditions were an eight-item measurement in which workers were asked to report the chronic conditions they were experiencing. Workers were asked if they had been diagnosed with the following conditions: diabetes, heart disease, obesity, asthma, hypertension, cancer, stroke, and liver disease. Each question was a dichotomous variable, indicating either presence (= 1), or absence (= 0) of the diagnosis in question.

Exercise activity was a single item measure that asked participants how often they managed to get the recommended amount of exercise: 1 = never to 3 = three times a week. Body mass index was calculated by height and weight of respondents. Smoking was a five-item measure that captured participants’ smoking status, how many cigarettes they smoked daily, weekly, and monthly, and if they began smoking as a result of their job. Smoking status was captured as a dichotomized measure: no = 0, yes = 1.

Nutritional eating was an eight-item measure that asked participants how often they engaged in healthy eating by eating fruit, eating vegetables, eating healthy options, avoiding salt, eating bran, avoiding fried food, avoiding desserts, and avoiding sugary drinks. Each nutritional eating question was an ordinal variable that was measured as Never/rarely = 1, A few times per week = 2, Once a day/every meal = 3.

The following individual and demographic data were collected: race/ethnicity, age, education level, job titles, marital status, and children. Race/ethnicity was a single item that asked participants to state with which ethnic group they identify. The original options included Caucasian, African American/Non-Hispanic Black, Hispanic/Latino, Asian American/Asian, Native American/Alaskan Native, Hawaiian or Pacific Islander, or not listed. However, since the sample was mostly homogenous, this variable was dichotomized: 0 = non-Hispanic White, 1 = African American/Black. Age was a continuous measure. Educational degree was a nominal measure: Bachelor = 1, Bachelor’s in Social Work = 2, Master’s in Social Work = 3, Master’s in Psychology = 4, Ph.D. = 5, Psy D. = 6, JD = 7, Other = 8. Licensure was dichotomized: No = 0, Yes = 1. Furthermore, job titles were nominal measures: Manager/ Supervisor = 1, Frontline worker = 2, Staff = 3, Legal staff = 4. Marital status: single = 1, married = 2, separated = 3, divorced = 4, widowed = 5. Having children were captured as a dichotomized measure: No = 0, Yes = 1.

Team health promotion was measured by the Team Health Climate instrument developed by Sonnentag and Pundt. 40 Three Likert-scale items were used to assess if workers were asked if the topic of health was included in their work meetings, if it was expected within their workplace that they take care of their health, and if there were any exchanges in ideas about healthy living. Child welfare workers responded using a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). All 3 items were aggregated to create the scale, with higher scores representing better perceptions of team health promotion. Previous research of the team health climate scales showed acceptable levels of internal consistency (Cronbach’s alpha = 0.71). 41 In the present study, Cronbach’s alpha for this scale was 0.86.

Health care utilization was a five-item measurement. Workers were first asked if they had one person they thought of as their personal doctor or health care provider (1 = Yes, only one, 2 = More than one, and 3 = No, I do not have a personal doctor or health care provider). They were then asked about how long it had been since they last visited a doctor for a routine checkup; this was a Likert scale measure that ranged from 1 = Within the past year to 6 = Never had a routine checkup. The health care utilization measures were three single items previously used in the National Health Interview Survey. 42 Each item asked participants to report how many times they had visited a health clinic, doctor, and emergency room (ER) in the past 12 months.

Data analysis

Univariate statistics were used to discern the study sample in terms of sociodemographic characteristics. Bivariate analyses included zero-order correlations to determine if multicollinearity was an issue and identify the strength between STS and independent variables. T -tests were also used to identify group mean differences by sex and race/ethnicity. Statistical significance was measured at the 95% confidence interval level ( P ≤ 0.05). All statistical analyses were conducted using IBM SPSS version 25 (IBM Corp., Armonk, NY, USA).

Descriptive sample information

The majority of the child protection workers in the sample were Black/African American ( n  = 152; 77%), followed by non-Hispanic White/Caucasian ( n  = 44; 22%). The sample participants identified primarily as female ( n = 197, 97.5%). The median age of the respondents was 36.86 (SD = 10.34) years old. In terms of marital status, most of the respondents indicated being single ( n  = 93; 46%), followed by those who were married ( n  = 84; 42%). Many respondents reported having children 73.8% ( n = 149). In terms of job tenure, respondents reported a mean average of 68.73 months, or 5.72 years of working for the child protection agency. Most respondents were frontline workers ( n  = 136; 67%), whereas the remaining were in managerial and supervisory positions ( n  = 42; 20%). Most respondents held a Bachelor’s in Social Work (BSW) ( n  = 123; 61%), while 50 (25%) reported possessing an master of social work (MSW). Only 33.7% of respondents ( n  = 68) were Licensed Social Workers. Respondents indicated that 63.4% ( n = 128) worked in a rural community, followed by 22.3% ( n = 45) of workers who worked in a semi-rural community.

Health status and health behaviors

In terms of health status, 62% of respondents indicated having either poor or fair health. Respondents reported having been diagnosed with the following chronic health conditions: diabetes 18% ( n  = 37), heart disease 4.5% ( n  = 9), obesity 28.7% ( n  = 19), hypertension 28.7% ( n  = 58), asthma 6.4% ( n  = 13), cancer 1.5 % ( n  = 3), stroke 1% ( n  = 2) and liver disease.5% ( n  = 1). Among the respondents, 29% reported having at least one chronic condition, 13% reported having two conditions, while 8% reported having 3 chronic conditions. Most of the respondents did not smoke cigarettes ( n  = 93%). Seven respondents stated that they started smoking as a result of working at the agency. The mean average body mass index (BMI) of survey respondents was 31.64 (SD = 8.34).

Participants were asked if they managed to get the recommended amount of exercise per week which is at least 30 minutes three times per week. The majority of respondents (55.4%; n = 112) indicated they rarely/occasionally exercised the recommended amount, while 33.7% ( n = 68), indicated that they never exercised the recommended amount. Only 10.4% ( n = 21) of the respondents indicated they exercised the sufficient amount/got sufficient physical activity in their work.

Nutritional eating

In terms of healthy eating, 22.8% ( n = 46) of the participants indicated that they never/rarely engaged in eating fruits, while 68.4% ( n = 128) indicated that they engaged in eating fruits a few times per week. Only 12.4% ( n = 25) indicated that that they engaged in eating fruits with every meal. Regarding engaging in eating vegetables, participants indicated 22% ( n  = 10.9) never/rarely, while 56.9% ( n = 115) indicated a few times per week, and 29.7% ( n = 60) indicated eating vegetables once a day/every meal. In terms of avoiding salt, 53.5% ( n = 108) of participants indicated never/rarely, 31.7% ( n = 64) indicated a few times per week, 12.4% ( n = 25) indicated avoiding salt once a day/every meal. Participants were asked how often they ate bran: 57.9% ( n = 117) indicated never/rarely; 33.7% ( n = 68) indicated a few times per week; 3% ( n = 6) indicated once a day/every meal. Participants were also asked how often they avoided fried food, and 39.1% ( n = 79) reported never/rarely avoiding fried food; 46% ( n = 93) avoided fried food a few times a week; and 11.9% ( n = 24) avoided fried food once a day/every meal. Furthermore, 42.6% of participants never/rarely avoided sugary drinks; 39.6% ( n = 86) avoided sugar drinks a few times per week and 15.8% ( n = 32) avoided sugary drinks once a day/every meal.

Health-seeking behaviors

In terms of having a personal care provider, 61% of the respondents reported having one person they considered their personal doctor or health care provider, whereas 14% did not have one person they considered their personal care provider. The majority of respondents, 75%, reported visiting the doctor for a routine doctor visit that did not include an exam for a specific injury, illness, or condition in the past year, while another 13% visited the doctor for a routine visit within the past two years. In terms of health care utilization, respondents were asked how many times they visited a health clinic, a doctor’s office, and the ER. Twenty percent of respondents did not visit the doctor for a routine doctor visit. On average, respondents average 3.39 (SD = 3.85) visits to a doctor’s office, 2.95 (SD = 3.37) visits to a health clinic, and.55 visits to the ER in the past 12 months. Roughly 33% of the respondents reported needing to go to see a doctor but did not do so because of cost.

Health promotion in the workplace

Participants were surveyed about how much health is discussed within their team meetings and other team events. Roughly 46% either strongly disagreed or disagreed that the topic of health is discussed within their team. Moreover, 41% strongly disagreed or disagreed that they exchanged ideas about healthy living within their team. However, 54% strongly agreed or agreed that it is expected that they take care of their health.

Bivariate results

Results of the zero-order correlation suggest that STS is significantly associated with healthy eating by avoiding salt, frequency of exercise, team health climate, frequency of routine check, number of visits to the doctor, number of visits to ER, and SRH. Results of the t test suggest that having children and race were significantly associated with STS. In terms of health status, respondents who reported poorer health also reported higher levels of STS ( r  = -0.32, P  ≤ 0.001). In terms of health behaviors, respondents that did not exercise 30 minutes 3 times weekly reported significantly higher levels of STS ( r  = -0.21, P  ≤ 0.01). Respondents who reported not avoiding eating salt also reported higher levels of STS ( r  = -0.20, P  ≤ 0.05). In terms of the workplace, respondents who perceived higher perception of health being promoted amongst their team also reported lower levels of STS ( r  = -0.29, P  ≤ 0.001). Turning to healthcare utilization, respondents who made more trips to see a doctor ( r  = 0.16, P  ≤ 0.05) and the ER ( r  = 0.20, P  = 0.01) also reported higher levels of STS. However, respondents who have not visited a doctor for a routine checkup in a while reported significantly higher levels of STS ( r = 0.17, P  = < 0.05). Demographically, t test results suggest that workers who had children (µ = 39.73, SD = 14.58) reported significantly lower levels of STS than workers without children (µ = 45.85, SD = 14.02). African American child protection workers (µ = 39.01, SD = 14.38) reported significantly lower levels of STS compared to non-Hispanic White workers (µ = 51.79, SD = 11.62).

Child protection workers work in highly stressful work environments and are regularly exposed to emotional duress indirectly, which may result in the genesis of interpersonal trauma. The present study sought to explore how STS was associated with multiple health outcomes among child protection workers in a southern state. Among a sample of child protection workers, 57.7% of respondents in the present study reported STS scores of 38 or more. This finding is concerning, given that interpersonal trauma has been linked to somatic symptoms and general physical health problems. 43 If not addressed, STS and poor health can have unfavorable employee outcomes, such as poor service delivery. Thus, if child welfare outcomes are going to improve, improving child protection workers’ health and mental health will be critical.

Health status was significantly associated with STS. In the present study, results indicate that STS was significantly associated with SRH. In fact, SRH shared the strongest relationship with STS. Consistent with existing studies, poorer health perceptions were significantly associated with increased levels of STS among child protection workers. 21 , 32 , 44 This finding may be related to the correlation between health outcomes and the clustering of avoidance and hyperarousal symptoms that underly STS, resulting in a potentially cumulative adverse impact on health. 32 , 45 , 46 One study suggests that child protection workers’ stress contributes to unhealthy eating habits, disturbed sleep, and substance use and poor health, such as high blood pressure, weight gain, and fatigue. 30 Other studies suggest that secondary stress among social workers was associated with sleep disturbance, sexual difficulties, poor eating habits, and elevated blood pressure. 26

Health practices were found to be correlated with STS. The observed relationship between STS and lack of exercise among child protection workers is indicative of literature illustrating the impact of mental health distress on disengaging from physical activity. 30 , 47 In one study, child protection workers noted having “no energy” or “being too tired” to engage in physical activity after work, highlighting the emotional exhaustion of STS leading to bodily fatigue. 15 This finding is consistent among first responders who also report lower levels of physical activity when having higher levels of STS. 48 Moreover, this finding affirms the consequences of trauma on the physical health of child protection workers.

The present study revealed that respondents who reported not avoiding eating salt also reported higher levels of STS. There currently needs to be more research examining how limiting salt can curtail STS. While it has been noted that psychological dysregulations ensue as a result of normal homeostatic functioning being shifted towards abnormal ranges due to prolonged secretion of stress hormones, 49 the connections between behaviors associated with these dysregulations as it relates to STS and salt intake have not been established. Furthermore, psychosocial stimulation associated defense responses (stress) have been shown to induce an increase in salt appetite. 50 - 52 One suggestion to this occurrence may be that after prolonged salt intake to ameliorate stress activation, individuals may lean on salt to manage stressful situations and become less able to deal with consistent stress, such as work-related stress or STS. More research is needed that elucidates the workings of this relationship.

Limited literature also exists regarding the association between child protection workers and their participation in routine check-ups and ER visits and doctor visits. Some literature suggests child protection workers miss appointments or come to work sick due to time constraints with their work schedule and fear falling behind on their existing workload. 30 , 33 One study suggests child welfare workers directly referenced not feeling they had time to attend routine check-ups due to overwhelming workloads and described preventative care becoming an added stressor. 30

Turning to sociodemographics, two were significantly associated with STS. Findings suggest a significant relationship exists between having children and lower STS scores. This may be the case because having loving and supportive relationships with friends and family may increase child protection workers’ capacity to manage different types of stress. 53 For child protection workers without children, it is reasonable to assume that the absence of psychosocial resources, such as children, does not allow these workers to find the fortification and inner strength to realize mental equilibrium or emotional permanence, which can increase the onset of distress. 54 Essentially, the missing support from personal resources, such as those with children, can lead to poorer individual coping. 55 , 56 However, our results contradict the existing literature, which implies that STS levels are higher among child protection workers who reported having children. 31 , 57 One of STS’s notable consequences is strain and withdrawal from personal relationships as a defense mechanism against traumatic experiences shared by clients. 31 Several participants in James’study 31 reported experiencing STS had impacted their relationships because of feeling beleaguered by constant distractions and lower moods. Respondents noted their stress levels increased because of not having enough time with family and friends and missing their children’s school events. Still, more research is needed that elucidates possible explanations as to why child protection workers without children suffer from higher levels of STS.

In this study, race mattered. The racial identity of child protection workers was found to predict increased levels of STS, specifically among White child protection workers. While there is not literature to help explain this finding due to mostly white samples in child welfare studies, 58 several interpretations can be advanced. This finding could relate to the context of the workers, which is the southern state itself, where data were collected. Historically, and even today, this state’s quest for full integration continues to be a struggle. This is a state with a deep history of enslavement, sharecropping, racial exclusion separation, hate group participation, and aggressive anti-Black activism. This history allowed many Whites to experience life in a cultural vacuum where they were surrounded by white peers. 59 Understanding this backdrop, it may be that what White child protection workers in this study heard traumatic narratives that they have never heard of or experienced directly. It could be argued that the life experiences by Whites in this Southern state are radically different from the many families of color, and rural populations who receive child protection services. According to constructivist self-development theory, a person constructs their realities based on self-perceptions and schemas, influenced by their lived experiences, that stem from interpersonal, intrapsychic, familial, cultural and social experiences. 19 , 60 Black child protection workers in this Southern state may have experienced lower incidences of vicarious trauma because they have been already exposed to accounts of traumatic experiences of child abuse and neglect that fit all too well with their reality. Because of their lived experience, Black child protection workers had already confronted the damage generated by intergenerational trauma, which may have lessened the pain of hearing accounts of trauma among their clients. The traumatic narratives heard by Black child protection workers may have altered their cognitions and worldview in ways that did not materialize for non-Hispanic White child protection workers, who may have never been exposed to the trauma they heard from clients.

It can also be hypothesized that the deflated account of STS among Black child welfare workers can be attributed to the Black Superwoman Schema (the overwhelming majority of Black respondents were women), which posits that Black women are less likely to report STS due to their socialization, which is linked to racial and gendered schema that includes displaying strength to overcome racial adversity. 61 , 62 Watson and Hunter 63 expand on how this multidimensional construct is characterized as an “obligation to manifest strength, emotional inhibition, resistance to utilize mental health self-care resources, rejection of dependence on others, determination to succeed, and caretaking” 63 (p. 445). Qualitative findings suggest Black women, particularly professionals, resist showing vulnerability because they do not want to give their counterparts a sense that they could not do the work, even when working with limited resources, 62 as is often the case in child protection work.

Team health climate was also examined in this study, which revealed thatchild protection workers reported lower levels of STS when they perceived working in an environment where team health was being promoted. To the best knowledge of the authors, no other study has examined if a relationship exists between STS and team health climate. One study found that team health climate was generally associated with positive health and mental health. 41 The results are consistent with broader research suggesting that health climate is a milieu source that enables health-related outcomes among workers. 41 , 64 This finding underscores the importance that an organization’s climate can have on serving as a social cue to trigger desired and rewarded health behaviors that safeguard child protection workers from ill health. 64

Implications

Child welfare workers experience elevated rates, such as 80% mild, 47% moderate, and 22% full STS severity levels. 65 Due to current reports of STS rates among child protection workers, exploration of how STS impacts the health of child protection workers, as evidenced by the proven association between STS and ER visits, doctor visits, and routine checks, may assist with developing better support systems for this strained workforce that is a crucial base in supporting families and children in need. Child welfare organizations are primed to become distal antecedents for employee health and well-being. To mitigate the genesis of STS, organizations can be intentional about emphasizing concern, care, and consideration about favorable employee health- and mental health-related outcomes. This can be accomplished through using health promotion advocacy to encourage self-care practices among its employees by “maintaining a healthy diet, physical exercise, balancing work and play, rest, spiritual replenishment, and building social networks”. 31 The National Association of Social Workers (NASW) 66 supports organizational policies that promote self-care, including a healthy diet, adequate sleep, physical activity, health care, and vacations to prevent STS. 67 This is important given that empirical evidence exists that links self-care practices with more favorable perceptions of health among child protection workers. 68

Given the number of poor health habits (e.g., poor nutritional eating habits, low exercise activity levels) reported by child protection workers in this study, child welfare organizations must begin to consider the health status of their workforce. Most of the workers in the present study reported poor or fair health, almost 30% reported suffering from at least one chronic condition, many had very high BMI counts, and over 60% did not have someone they considered their personal doctor or health care provider. Thus, it would be prudent for organizations to take on the role and responsibility of promoting the well-being of their employees. 69 It has been argued that a positive organizational climate is one that provides learning opportunities and rewards. 64 Child welfare administrators should consider encouraging teams within the agency to discuss health matters and provide them with health and mental-related information and practical support, 41 such as trauma-specific workshops or contract or partner with community clinics to host on-site monthly health checkups for the employees. This partnership is germane for child protection staff, given that many respondents stated they could not take time away from work to tend to their medical needs.

To mitigate the negative impacts of STS, child welfare agency administrative responses should integrate trauma-informed child welfare practices into their organizational culture. 68 Trauma-informed child welfare practices by staff concede how traumatic events could influence children, families, and child protection professionals who serve them. Still, such an approach should also acknowledge how the workers might suffer from the various traumatic narratives they have encountered while working in child protection. 70 For example, normalizing the experience of secondary trauma among workers is essential in considering trauma as an underlying explanation for behavioral and emotional distress. 70 Such a perspective may change the deficit approach child protection workers are met with by their colleagues. The conversation may shift from asking, “What’s wrong with you?” to “What happened to you?” 70 (p. 6).

Another implication of this study’s findings is the potential that child protection workers’ consumption of salt to manage stress may cause increased tolerance, rendering this coping mechanism less and less effective even with increased intake over time. Once an individual cannot cope with daily life stressors, an allostatic overload can occur. 71 Allostatic load refers to the cumulative burden of chronic stress and life events. 71 “Chronic stress and allostatic load shift the operating range of numerous biological systems” 49 (p. 798). These shifts in biology could also play a role in how workers engage with salt intake and utilize salt and nutrition as mitigating factors in coping with chronic stress, job burnout, and STS. 49 More attention should be given to the allostatic load count of child protection workers due to the connection of chronic stress and allostatic load on the biological makeup of individuals exposed to consistently stressful work environments; the impact of stress on this vulnerable occupational group could dramatically alter their health trajectories in terms of comorbid conditions. This is further evidenced by the vast number of comorbid conditions reported by participants in the current study, such as obesity, hypertension, and diabetes stemming from chronic physical inactivity and heavier salt consumption. Future longitudinal research should be carried out that examines allostatic load counts among child protection workers to determine if the workplace stressors have created significant wear and tear on their bodies since joining the child protection workforce.

Despite being one of the few studies exploring child protection workers’ health and health outcomes, several limitations should be acknowledged. First, the cross-sectional survey research design does not allow for any causal inferences. Second, it is unknown how many of the workers experienced a personal traumatic event(s) prior to working in these roles. Some research suggests helping professionals have a higher prevalence of individual trauma than other professionals, which may worsen what is experienced in the workplace. 72 Third, given the topic explored in this study, there is a potential for a self-selection bias. It is possible that the propensity for participating in this investigation was related to a participant’s greater interest in, or direct experience, with personal trauma. Fourth, the sample was somewhat homogeneous because it was predominantly female respondents and primarily African American. Other genders’ and racial/ethnic groups’ perspectives were not captured. Fifth, the generalizability of results are limited due to the convenience sampling methods used within the current study. Last, data were collected from a single southern state, which may not be representative of patterns of STS experienced nationally.

The present study underscores the extent to which STS is associated with multiple health behaviors among child protection workers in a southern state. There does appear to be a significant correlation between STS levels, SRH, lack of exercise, salt intake, and healthcare utilization. Moreover, we found that STS levels were lower among child protection workers who believed health promotion was stressed in their team environment. These results underscore the importance of how physical health relates to a worker’s inward dynamics. Thus, more research is needed to identify how public child welfare workers cope with STS to ensure they do not develop unhealthy health habits that can contribute to or expand health disparities among this vulnerable work group. More importantly, public child protection workers who unsuccessfully abate the deleterious consequences of their work on themselves can harm them and place their clients at further injury by not knowing how to respond and redirect their client’s set of circumstances appropriately. 72 Such oversight has the potential to significantly diminish the service delivery received by the children and families in the child welfare system. As the current study unveils, uncovering the adverse outcomes associated with child protection work becomes critical. It identifies that in our effort as a society to create positive change, we may be establishing a system of oppression under the guise of professionalism and humanitarian effort that disenfranchises a vulnerable work group that is protecting an even more vulnerable population.

Author Contributions

Conceptualization: Javier F. Boyas.

Data curation: J avier F. Boyas, Debra Moore, Maritza Y. Duran.

Formal Analysis: Javier F. Boyas, Debra Moore, Maritza Y. Duran.

Investigation: Javier F. Boyas, Debra Moore.

Methodology: Javier F. Boyas, Debra Moore.

Project administration: Javier F. Boyas.

Resources: Javier F. Boyas, Debra Moore.

Supervision: Javier F. Boyas.

Validation: Javier F. Boyas.

Visualization: Javier F. Boyas, Jacqueline Fuentes, Jana Woodwiss, Leah McCoy.

Writing – original draft: Javier F. Boyas, Debra Moore, Maritza Y. Duran, Jacqueline Fuentes, Jana Woodiwiss, Leah McCoy, Antonella Cirino.

Writing – review & editing: Javier F. Boyas, Debra Moore, Maritza Y. Duran, Jacqueline Fuentes, Jana Woodiwiss, Leah McCoy, Antonella Cirino.

No external funding was obtained for the current study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The procedures carried out in this research were approved by the University of Mississippi’s ethics committee.

Competing Interest

The authors declare no conflicts or competing interests.

• Case report
• Open access
• Published: 11 September 2017

A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy

• Magdalena Romanowicz   ORCID: orcid.org/0000-0002-4916-0625 1 ,
• Alastair J. McKean 1 &
• Jennifer Vande Voort 1  

BMC Psychiatry volume  17 , Article number:  330 ( 2017 ) Cite this article

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Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment.

Case presentation

A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.

Conclusions

The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

Peer Review reports

There is a paucity of studies that address long-term effects of deprivation, trauma and neglect in early life, with what little data is available coming from institutionalized children [ 1 ]. Rutter [ 2 ], who studied formerly-institutionalized Romanian children adopted into UK families, found that this group exhibited prominent attachment disturbances, attention-deficit/hyperactivity disorder (ADHD), quasi-autistic features and cognitive delays. Interestingly, no other increases in psychopathology were noted [ 2 ].

Even more challenging to properly diagnose and treat are so called sub-threshold presentations of children with histories of early trauma [ 3 ]. Pincus, McQueen, & Elinson [ 4 ] described a group of children who presented with a combination of co-morbid symptoms of various diagnoses such as conduct disorder, ADHD, post-traumatic stress disorder (PTSD), depression and anxiety. As per Shankman et al. [ 5 ], these patients may escalate to fulfill the criteria for these disorders. The lack of proper diagnosis imposes significant challenges in terms of management [ 3 ].

J is a 4-year-old adopted Caucasian male who at the age of 2 years and 4 months was brought by his adoptive mother to primary care with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. J was given diagnoses of reactive attachment disorder (RAD) and ADHD. No medications were recommended at that time and a referral was made for behavioral therapy.

She subsequently took him to two different child psychiatrists who diagnosed disruptive mood dysregulation disorder (DMDD), PTSD, anxiety and a mood disorder. To help with mood and inattention symptoms, guanfacine, fluoxetine, methylphenidate and amphetamine salts were all prescribed without significant improvement. Later quetiapine, aripiprazole and thioridazine were tried consecutively without behavioral improvement (please see Table  1 for details).

No significant drug/substance interactions were noted (Table 1 ). There were no concerns regarding adherence and serum drug concentrations were not ordered. On review of patient’s history of medication trials guanfacine and methylphenidate seemed to have no effect on J’s hyperactive and impulsive behavior as well as his lack of focus. Amphetamine salts that were initiated during hospitalization were stopped by the patient’s mother due to significant increase in aggressive behaviors and irritability. Aripiprazole was tried for a brief period of time and seemed to have no effect. Quetiapine was initially helpful at 150 mg (50 mg three times a day), unfortunately its effects wore off quickly and increase in dose to 300 mg (100 mg three times a day) did not seem to make a difference. Fluoxetine that was tried for anxiety did not seem to improve the behaviors and was stopped after less than a month on mother’s request.

J’s condition continued to deteriorate and his primary care provider started risperidone. While initially helpful, escalating doses were required until he was on 6 mg daily. In spite of this treatment, J attempted to stab a girl at preschool with scissors necessitating emergent evaluation, whereupon he was admitted to inpatient care for safety and observation. Risperidone was discontinued and J was referred to outpatient psychiatry for continuing medical monitoring and therapy.

Little is known about J’s early history. There is suspicion that his mother was neglectful with feeding and frequently left him crying, unattended or with strangers. He was taken away from his mother’s care at 7 months due to neglect and placed with his aunt. After 1 month, his aunt declined to collect him from daycare, deciding she was unable to manage him. The owner of the daycare called Child Services and offered to care for J, eventually becoming his present adoptive parent.

J was a very needy baby who would wake screaming and was hard to console. More recently he wakes in the mornings anxious and agitated. He is often indiscriminate and inappropriate interpersonally, unable to play with other children. When in significant distress he regresses, and behaves as a cat, meowing and scratching the floor. Though J bonded with his adoptive mother well and was able to express affection towards her, his affection is frequently indiscriminate and he rarely shows any signs of separation anxiety.

At the age of 2 years and 8 months there was a suspicion for speech delay and J was evaluated by a speech pathologist who concluded that J was exhibiting speech and language skills that were solidly in the average range for age, with developmental speech errors that should be monitored over time. They did not think that issues with communication contributed significantly to his behavioral difficulties. Assessment of intellectual functioning was performed at the age of 2 years and 5 months by a special education teacher. Based on Bailey Infant and Toddler Development Scale, fine and gross motor, cognitive and social communication were all within normal range.

J’s adoptive mother and in-home therapist expressed significant concerns in regards to his appetite. She reports that J’s biological father would come and visit him infrequently, but always with food and sweets. J often eats to the point of throwing up and there have been occasions where he has eaten his own vomit and dog feces. Mother noticed there is an association between his mood and eating behaviors. J’s episodes of insatiable and indiscriminate hunger frequently co-occur with increased energy, diminished need for sleep, and increased speech. This typically lasts a few days to a week and is followed by a period of reduced appetite, low energy, hypersomnia, tearfulness, sadness, rocking behavior and slurred speech. Those episodes last for one to 3 days. Additionally, there are times when his symptomatology seems to be more manageable with fewer outbursts and less difficulty regarding food behaviors.

J’s family history is poorly understood, with his biological mother having a personality disorder and ADHD, and a biological father with substance abuse. Both maternally and paternally there is concern for bipolar disorder.

J has a clear history of disrupted attachment. He is somewhat indiscriminate in his relationship to strangers and struggles with impulsivity, aggression, sleep and feeding issues. In addition to early life neglect and possible trauma, J has a strong family history of psychiatric illness. His mood, anxiety and sleep issues might suggest underlying PTSD. His prominent hyperactivity could be due to trauma or related to ADHD. With his history of neglect, indiscrimination towards strangers, mood liability, attention difficulties, and heightened emotional state, the possibility of Disinhibited Social Engagement Disorder (DSED) is likely. J’s prominent mood lability, irritability and family history of bipolar disorder, are concerning for what future mood diagnosis this portends.

As evidenced above, J presents as a diagnostic conundrum suffering from a combination of transdiagnostic symptoms that broadly impact his functioning. Unfortunately, although various diagnoses such as ADHD, PTSD, Depression, DMDD or DSED may be entertained, the patient does not fall neatly into any of the categories.

This is a case report that describes a diagnostic conundrum in a young boy with prominent early life deprivation who presented with multidimensional symptoms managed with polypharmacy.

A sub-threshold presentation in this patient partially explains difficulties with diagnosis. There is no doubt that negative effects of early childhood deprivation had significant impact on developmental outcomes in this patient, but the mechanisms that could explain the associations are still widely unknown. Significant family history of mental illness also predisposes him to early challenges. The clinical picture is further complicated by the potential dynamic factors that could explain some of the patient’s behaviors. Careful examination of J’s early life history would suggest such a pattern of being able to engage with his biological caregivers, being given food, being tended to; followed by periods of neglect where he would withdraw, regress and engage in rocking as a self-soothing behavior. His adoptive mother observed that visitations with his biological father were accompanied by being given a lot of food. It is also possible that when he was under the care of his biological mother, he was either attended to with access to food or neglected, left hungry and screaming for hours.

The current healthcare model, being centered on obtaining accurate diagnosis, poses difficulties for treatment in these patients. Given the complicated transdiagnostic symptomatology, clear guidelines surrounding treatment are unavailable. To date, there have been no psychopharmacological intervention trials for attachment issues. In patients with disordered attachment, pharmacologic treatment is typically focused on co-morbid disorders, even with sub-threshold presentations, with the goal of symptom reduction [ 6 ]. A study by dosReis [ 7 ] found that psychotropic usage in community foster care patients ranged from 14% to 30%, going to 67% in therapeutic foster care and as high as 77% in group homes. Another study by Breland-Noble [ 8 ] showed that many children receive more than one psychotropic medication, with 22% using two medications from the same class.

It is important to note that our patient received four different neuroleptic medications (quetiapine, aripiprazole, risperidone and thioridazine) for disruptive behaviors and impulsivity at a very young age. Olfson et al. [ 9 ] noted that between 1999 and 2007 there has been a significant increase in the use of neuroleptics for very young children who present with difficult behaviors. A preliminary study by Ercan et al. [ 10 ] showed promising results with the use of risperidone in preschool children with behavioral dyscontrol. Review by Memarzia et al. [ 11 ] suggested that risperidone decreased behavioral problems and improved cognitive-motor functions in preschoolers. The study also raised concerns in regards to side effects from neuroleptic medications in such a vulnerable patient population. Younger children seemed to be much more susceptible to side effects in comparison to older children and adults with weight gain being the most common. Weight gain associated with risperidone was most pronounced in pre-adolescents (Safer) [ 12 ]. Quetiapine and aripiprazole were also associated with higher rates of weight gain (Correll et al.) [ 13 ].

Pharmacokinetics of medications is difficult to assess in very young children with ongoing development of the liver and the kidneys. It has been observed that psychotropic medications in children have shorter half-lives (Kearns et al.) [ 14 ], which would require use of higher doses for body weight in comparison to adults for same plasma level. Unfortunately, that in turn significantly increases the likelihood and severity of potential side effects.

There is also a question on effects of early exposure to antipsychotics on neurodevelopment. In particular in the first 3 years of life there are many changes in developing brains, such as increase in synaptic density, pruning and increase in neuronal myelination to list just a few [ 11 ]. Unfortunately at this point in time there is a significant paucity of data that would allow drawing any conclusions.

Our case report presents a preschool patient with history of adoption, early life abuse and neglect who exhibited significant behavioral challenges and was treated with various psychotropic medications with limited results. It is important to emphasize that subthreshold presentation and poor diagnostic clarity leads to dangerous and excessive medication regimens that, as evidenced above is fairly common in this patient population.

Neglect and/or abuse experienced early in life is a risk factor for mental health problems even after adoption. Differences in genetic risk, epigenetics, prenatal factors (e.g., malnutrition or poor nutrition), exposure to stress and/or substances, and parent-child interactions may explain the diversity of outcomes among these individuals, both in terms of mood and behavioral patterns [ 15 , 16 , 17 ]. Considering that these children often present with significant functional impairment and a wide variety of symptoms, further studies are needed regarding diagnosis and treatment.

Abbreviations

Attention-Deficit/Hyperactivity Disorder

Disruptive Mood Dysregulation Disorder

Disinhibited Social Engagement Disorder

Post-Traumatic Stress Disorder

Reactive Attachment disorder

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Romanowicz, M., McKean, A.J. & Vande Voort, J. A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. BMC Psychiatry 17 , 330 (2017). https://doi.org/10.1186/s12888-017-1492-y

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FORCED LABOUR IN BANGLADESH: A CASE STUDY OF CHILD DOMESTIC WORKERS IN CHITTAGONG.

2019, International Journal of Advanced Research (IJAR)

In the age of human rights, it is quite surprising to think about forced labour or slavery-like practices. But, millions of people around the world are victims of forced labour and number is increasing quite significantly. In Bangladesh, thousands of children are working as domestic workers living inside the walls devoid of rights and privileges. In addition to this, often, they become victims of physical and mental harassment by their employers. There is no limited working hour for them with poor payment and other facilities. There is strict control over their movement inside and outside the house. Altogether, their life is dominated by employers and there is nothing they can do about it. Most of them are isolated from their families and have limited connections with them. All these situations indicate a strong case of forced labour and the response from the authority is not a strong one.

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Bangladesh&#39;s socioeconomic realities include the problem of child labor. This is a huge problem that cannot be overlooked. In this study, I looked at the elements that contribute to child labor in Bangladesh. Poverty is the primary cause of children working as child laborers. The issue of child labor has become one of the most prominent challenges in developing countries. To put an end to this, societies and governments must act together. The government, in particular, must ensure that citizens&#39; basic rights are protected. Following that, the implementation of child labor legislation and a social boycott of child work would be an effective remedy.

H M Shahriar Parvez

Perspective of our country for children is different than other country. We are not considering our future power in proper way. Sometimes children is used to work as a labor and forcing them to do risky jobs. Day by day the number of influence in child laboring is increasing in an alarming rate. But the people of concerned and conscious society want to get rid of it. This proportion of people in our society are trying hard to find out the reason of involvement in child labor and its solution.

Md. Kamruzzaman

Child labor is a common practice in developing countries. Child labor is defined as work that deprives children of their childhood, their potential and dignity as an emerging social threat increasing at an alarming rate. The statistical secondary data analysis method was used in this study to estimate the causes and different types of victimization trend on child at workplace in Bangladesh. The authors have experienced that the child are now working in multidimensional sectors like agriculture, service sector, industry, construction, domestic work, transport etc for their hand to mouth. They are forced to perform more than one shift duty a day keeping contradiction with the ILO regulations in this connection. They are on the different kinds of workplace victimization where physical abuse, health injury, economical exploitation and sexual abuse are on the top rank. There is no headache on their educational deprivation in our ongoing society.

Child labor is an international concern which is swelling day by day linked with poverty, inadequate educational prospects, gender inequity, and a lot of health hazards. The child labor issue has become one of the most remarkable matters in the developing countries as like Bangladesh. After independence, Bangladesh has since suffered military unrest, overpopulation, poverty, and natural disasters and the child labor issue is enormous and cannot be overlooked. Child labor practices were humiliated by social reformers because it was harmful to the health as well as children’s wellbeing and happiness. Children of Bangladesh are now working in multidimensional sectors like agriculture, service sector, steel industry, ship breaking, construction, domestic work, transport, etc. for themselves and their family. This study indicates the child labor increase in a developing country like Bangladesh and the negative effects of child labor on society. The purpose of this article is to present the socio-economic scenario of child labor in Bangladesh based on a review of existing literature and secondary data analysis.

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Child labour, particularly in its worst forms, harms the health and general welfare of children. It is considered to be a decisive impediment to the development efforts of developing countries. Working children drop out of school early and the resulting comparative lack of knowledge and skills decreases their chances to find well-paid employment in the future. International legal documents, most prominently in the United Nations Convention on the Rights of the Child (UN CRC) and Conventions by the International Labour Organization (ILO), address the problem of child labour and call for an elimination of its worst forms. Despite efforts made at the international and national level child labour remains a common, and often socially accepted, scenario particularly in some developing countries. Bangladesh is one of the countries that still face the challenge of having a large number of children that are working under conditions considered as child labour. The prime reason is poverty. In ...

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Article Contents

Literature review, alive program, implications for school social work practice.

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Trauma and Early Adolescent Development: Case Examples from a Trauma-Informed Public Health Middle School Program

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Jason Scott Frydman, Christine Mayor, Trauma and Early Adolescent Development: Case Examples from a Trauma-Informed Public Health Middle School Program, Children & Schools , Volume 39, Issue 4, October 2017, Pages 238–247, https://doi.org/10.1093/cs/cdx017

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Middle-school-age children are faced with a variety of developmental tasks, including the beginning phases of individuation from the family, building peer groups, social and emotional transitions, and cognitive shifts associated with the maturation process. This article summarizes how traumatic events impair and complicate these developmental tasks, which can lead to disruptive behaviors in the school setting. Following the call by Walkley and Cox for more attention to be given to trauma-informed schools, this article provides detailed information about the Animating Learning by Integrating and Validating Experience program: a school-based, trauma-informed intervention for middle school students. This public health model uses psychoeducation, cognitive differentiation, and brief stress reduction counseling sessions to facilitate socioemotional development and academic progress. Case examples from the authors’ clinical work in the New Haven, Connecticut, urban public school system are provided.

Within the U.S. school system there is growing awareness of how traumatic experience negatively affects early adolescent development and functioning ( Chanmugam & Teasley, 2014 ; Perfect, Turley, Carlson, Yohannan, & Gilles, 2016 ; Porche, Costello, & Rosen-Reynoso, 2016 ; Sibinga, Webb, Ghazarian, & Ellen, 2016 ; Turner, Shattuck, Finkelhor, & Hamby, 2017 ; Woodbridge et al., 2016 ). The manifested trauma symptoms of these students have been widely documented and include self-isolation, aggression, and attentional deficit and hyperactivity, producing individual and schoolwide difficulties ( Cook et al., 2005 ; Iachini, Petiwala, & DeHart, 2016 ; Oehlberg, 2008 ; Sajnani, Jewers-Dailley, Brillante, Puglisi, & Johnson, 2014 ). To address this vulnerability, school social workers should be aware of public health models promoting prevention, data-driven investigation, and broad-based trauma interventions ( Chafouleas, Johnson, Overstreet, & Santos, 2016 ; Johnson, 2012 ; Moon, Williford, & Mendenhall, 2017 ; Overstreet & Chafouleas, 2016 ; Overstreet & Matthews, 2011 ). Without comprehensive and effective interventions in the school setting, seminal adolescent developmental tasks are at risk.

This article follows the twofold call by Walkley and Cox (2013) for school social workers to develop a heightened awareness of trauma exposure's impact on childhood development and to highlight trauma-informed practices in the school setting. In reference to the former, this article will not focus on the general impact of toxic stress, or chronic trauma, on early adolescents in the school setting, as this work has been widely documented. Rather, it begins with a synthesis of how exposure to trauma impairs early adolescent developmental tasks. As to the latter, we will outline and discuss the Animating Learning by Integrating and Validating Experience (ALIVE) program, a school-based, trauma-informed intervention that is grounded in a public health framework. The model uses psychoeducation, cognitive differentiation, and brief stress reduction sessions to promote socioemotional development and academic progress. We present two clinical cases as examples of trauma-informed, school-based practice, and then apply their experience working in an urban, public middle school to explicate intervention theory and practice for school social workers.

Impact of Trauma Exposure on Early Adolescent Developmental Tasks

Social development.

Impact of Trauma on Early Adolescent Development

Traumatic experiences may create difficulty with developing and differentiating another person's point of view (that is, mentalization) due to the formation of rigid cognitive schemas that dictate notions of self, others, and the external world ( Frydman & McLellan, 2014 ). For early adolescents, the ability to diversify a single perspective with complexity is central to modulating affective experience. Without the capacity to diversify one's perspective, there is often difficulty differentiating between a nonthreatening current situation that may harbor reminders of the traumatic experience and actual traumatic events. Incumbent on the school social worker is the need to help students understand how these conflicts may trigger a memory of harm, abandonment, or loss and how to differentiate these past memories from the present conflict. This is of particular concern when these reactions are conflated with more common middle school behaviors such as withdrawing, blaming, criticizing, and gossiping ( Card, Stucky, Sawalani, & Little, 2008 ).

Encouraging cognitive discrimination is particularly meaningful given that the second social developmental task for early adolescents is the re-orientation of their primary relationships with family toward peers ( Henderson & Thompson, 2010 ). This shift may become complicated for students facing traumatic stress, resulting in a stunted movement away from familiar connections or a displacement of dysfunctional family relationships onto peers. For example, in the former, a student who has witnessed and intervened to protect his mother from severe domestic violence might believe he needs to sacrifice himself and be available to his mother, forgoing typical peer interactions. In the latter, a student who was beaten when a loud, intoxicated family member came home might become enraged, anxious, or anticipate violence when other students raise their voices.

Cognitive Development and Emotional Regulation

During normative early adolescent development, the prefrontal cortex undergoes maturational shifts in cognitive and emotional functioning, including increased impulse control and affect regulation ( Wigfield, Lutz, & Wagner, 2005 ). However, these developmental tasks can be negatively affected by chronic exposure to traumatic events. Stressful situations often evoke a fear response, which inhibits executive functioning and commonly results in a fight-flight-freeze reaction. If a student does not possess strong anxiety management skills to cope with reminders of the trauma, the student is prone to further emotional dysregulation, lowered frustration tolerance, and increased behavioral problems and depressive symptoms ( Iachini et al., 2016 ; Saltzman, Steinberg, Layne, Aisenberg, & Pynoos, 2001 ).

Typical cognitive development in early adolescence is defined by the ambiguity of a transitional stage between childhood remedial capacity and adult refinement ( Casey & Caudle, 2013 ; Van Duijvenvoorde & Crone, 2013 ). Casey and Caudle (2013) found that although adolescents performed equally as well as, if not better than, adults on a self-control task when no emotional information was present, the introduction of affectively laden social cues resulted in diminished performance. The developmental challenge for the early adolescent then is to facilitate the coordination of this ever-shifting dynamic between cognition and affect. Although early adolescents may display efficient and logically informed behaviors, they may struggle to sustain these behaviors, especially in the presence of emotional stimuli ( Casey & Caudle, 2013 ; Van Duijvenvoorde & Crone, 2013 ). Because trauma often evokes an emotional response ( Johnson & Lubin, 2015 ), these findings insinuate that those early adolescents who are chronically exposed will have ongoing regulation difficulties. Further empirical findings considering the cognitive effects of trauma exposure on the adolescent brain have highlighted detriments in working memory, inhibition, memory, and planning ability ( Moradi, Neshat Doost, Taghavi, Yule, & Dalgleish, 1999 ).

Using a Public Health Framework for School-Based, Trauma-Informed Services

The need for a more informed and comprehensive approach to addressing trauma within the schools has been widely articulated ( Chafouleas et al., 2016 ; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011 ; Jaycox, Kataoka, Stein, Langley, & Wong, 2012 ; Overstreet & Chafouleas, 2016 ; Perry & Daniels, 2016 ). Overstreet and Matthews (2011) suggested that using a public health model to address trauma in schools will promote prevention, early identification, and data-driven investigation and yield broad-based intervention on a policy and communitywide level. A public health approach focuses on developing interventions that address the underlying causal processes that lead to social, emotional, and cognitive maladjustment. Opening the dialogue to the entire student body, as well as teachers and administrators, promotes inclusion and provides a comprehensive foundation for psychoeducation, assessment, and prevention.

ALIVE: A Comprehensive Public Health Intervention for Middle School Students

Note: ALIVE = Animating Learning by Integrating and Validating Experience.

Psychoeducation

The classroom is a place traditionally dedicated to academic pursuits; however, it also serves as an indicator of trauma's impact on cognitive functioning evidenced by poor grades, behavioral dysregulation, and social turbulence. ALIVE practitioners conduct weekly trauma-focused dialogues in the classroom to normalize conversations addressing trauma, to recruit and rehearse more adaptive cognitive skills, and to engage in an insight-oriented process ( Sajnani et al., 2014 ).

Using a parable as a projective tool for identification and connection, the model helps students tolerate direct discussions about adverse experiences. The ALIVE practitioner begins each academic year by telling the parable of a woman named Miss Kendra, who struggled to cope with the loss of her 10-year-old child. Miss Kendra is able to make meaning out of her loss by providing support for schoolchildren who have encountered adverse experiences, serving as a reminder of the strength it takes to press forward after a traumatic event. The intention of this parable is to establish a metaphor for survival and strength to fortify the coping skills already held by trauma-exposed middle school students. Furthermore, Miss Kendra offers early adolescents an opportunity to project their own needs onto the story, creating a personalized figure who embodies support for socioemotional growth.

Following this parable, the students’ attention is directed toward Miss Kendra's List, a poster that is permanently displayed in the classroom. The list includes a series of statements against adolescent maltreatment, comprehensively identifying various traumatic stressors such as witnessing domestic violence; being physically, verbally, or sexually abused; and losing a loved one to neighborhood violence. The second section of the list identifies what may happen to early adolescents when they experience trauma from emotional, social, and academic perspectives. The practitioner uses this list to provide information about the nature and impact of trauma, while modeling for students and staff the ability to discuss difficult experiences as a way of connecting with one another with a sense of hope and strength.

Furthermore, creating a dialogue about these issues with early adolescents facilitates a culture of acceptance, tolerance, and understanding, engendering empathy and identification among students. This fostering of interpersonal connection provides a reparative and differentiated experience to trauma ( Hartling & Sparks, 2008 ; Henderson & Thompson, 2010 ; Johnson & Lubin, 2015 ) and is particularly important given the peer-focused developmental tasks of early adolescence. The positive feelings evoked through classroom-based conversation are predicated on empathic identification among the students and an accompanying sense of relief in understanding the scope of trauma's impact. Furthermore, the consistent appearance of and engagement by the ALIVE practitioner, and the continual presence of Miss Kendra's list, effectively counters traumatically informed expectations of abandonment and loss while aligning with a public health model that attends to the impact of trauma on a regular, systemwide basis.

Participatory and Somatic Indicators for Informal Assessment during the Psychoeducation Component of the ALIVE Intervention

Notes: ALIVE = Animating Learning by Integrating and Validating Experience. Examples are derived from authors’ clinical experiences.

In addition to behavioral symptoms, the content of conversation is considered. All practitioners in the ALIVE program are mandated reporters, and any content presented that meets criteria for suspicion of child maltreatment is brought to the attention of the school leadership and ALIVE director. According to Johnson (2012) , reports of child maltreatment to the Connecticut Department of Child and Family Services have actually decreased in the schools where the program has been implemented “because [the ALIVE program is] catching problems well before they have risen to the severity that would require reporting” (p. 17).

Case Example 1

The following demonstrates a middle school classroom psychoeducation session and assessment facilitated by an ALIVE practitioner (the first author). All names and identifying characteristics have been changed to protect confidentiality.

Ms. Skylar's seventh grade class comprised many students living in low-income housing or in a neighborhood characterized by high poverty and frequent criminal activity. During the second week of school, I introduced myself as a practitioner who was here to speak directly about difficult experiences and how these instances might affect academic functioning and students’ thoughts about themselves, others, and their environment.

After sharing the Miss Kendra parable and list, I invited the students to share their thoughts about Miss Kendra and her journey. Tyreke began the conversation by wondering whether Miss Kendra lost her child to gun violence, exploring the connection between the list and the story and his own frequent exposure to neighborhood shootings. To transition a singular connection to a communal one, I asked the students if this was a shared experience. The majority of students nodded in agreement. I referred the students back to the list and asked them to identify how someone's school functioning or mood may be affected by ongoing neighborhood gun violence. While the students read the list, I actively monitored reactions and scanned for inattention and active avoidance. Performing both active facilitation of discussion and monitoring students’ reactions is critical in accomplishing the goals of providing quality psychoeducation and identifying at-risk students for intervention.

After inspection, Cleo remarked that, contrary to a listed outcome on Miss Kendra's list, neighborhood gun violence does not make him feel lonely; rather, he “doesn't care about it.” Slumped down in his chair, head resting on his crossed arms on the desk in front of him, Cleo's body language suggested a somatized disengagement. I invited other students to share their individual reactions. Tyreke agreed that loneliness is not the identified affective experience; rather, for him, it's feeling “mad or scared.” Immediately, Greg concurred, expressing that “it makes me more mad, and I think about my family.”

Encouraging a variety of viewpoints, I stated, “It sounds like it might make you mad, scared, and may even bring up thoughts about your family. I wonder why people have different reactions?” Doing so moved the conversation into a phase of deeper reflection, simultaneously honoring the students’ voiced experience while encouraging critical thinking. A number of students responded by offering connections to their lives, some indicating they had difficulty identifying feelings. I reflected back, “Sometimes people feel something, but can't really put their finger on it, and sometimes they know exactly how they feel or who it makes them think about.”

I followed with a question: “How do you think it affects your schoolwork or feelings when you're in school?” Greg and Natalia both offered that sometimes difficult or confusing thoughts can consume their whole day, even while in class. Sharon began to offer a related comment when Cleo interrupted by speaking at an elevated volume to his desk partner, Tyreke. The two began to snicker and pull focus. By the time they gained the class's full attention, Cleo was openly laughing and pushing his chair back, stating, “No way! She DID!? That's crazy”; he began to stand up, enlisting Tyreke in the process. While this disruption may be viewed as a challenge to the discussion, it is essential to understand all behavior in context of the session's trauma content. Therefore, Cleo's outburst was interpreted as a potential avenue for further exploration of the topic regarding gun violence and difficulties concentrating. In turn, I posed this question to the class: “Should we talk about this stuff? I wonder if sometimes people have a hard time tolerating it. Can anybody think of why it might be important? Sharon, I think you were saying something about this.” While Sharon continued to share, Cleo and Tyreke gradually shifted their attention back to the conversation. I noted the importance of an individual follow-up with Cleo.

Natalia jumped back in the conversation, stating, “I think we talk about stuff like this so we know about it and can help people with it.” I checked in with the rest of the class about this strategy for coping with the impact of trauma exposure on school functioning: “So it sounds like these thoughts have a pretty big impact on your day. If that's the case, how do you feel less worried or mad or scared?” Marta quickly responded, “You could talk to someone.” I responded, “Part of my job here is to be a person to talk to one-on-one about these things. Hopefully, it will help you feel better to get some of that stuff off your chest.” The students nodded, acknowledging that I would return to discuss other items on the list and that there would be opportunities to check in with me individually if needed.

On reflection, Cleo's disruption in the discussion may be attributed to his personal difficulty emotionally managing intrusive thoughts while in school. This clinical assumption was not explicitly named in the moment, but was noted as information for further individual follow-up. When I met individually with Cleo, Cleo reported that his cousin had been shot a month ago, causing him to feel confused and angry. I continued to work with him individually, which resulted in a reduction of behavioral disruptions in the classroom.

In the preceding case example, the practitioner performed a variety of public health tasks. Foremost was the introduction of how traumatic experience may affect individuals and their relationships with others and their role as a student. Second, the practitioner used Miss Kendra and her list as a foundational mechanism to ground the conversation and serve as a reference point for the students’ experience. Finally, the practitioner actively monitored individual responses to the material as a means of identifying students who may require more support. All three of these processes are supported within the public health framework as a means toward assessment and early intervention for early adolescents who may be exposed to trauma.

Individualized Stress Reduction Intervention

Students are seen for individualized support if they display significant externalizing or internalizing trauma-related behavior. Students are either self-referred; referred by a teacher, administrator, or staff member; or identified by an ALIVE practitioner. Following the principle of immediate engagement based on emergent traumatic material, individual sessions are brief, lasting only 15 to 20 minutes. Using trauma-centered psychotherapy ( Johnson & Lubin, 2015 ), a brief inquiry addressing the current problem is conducted to identify the trauma trigger connected to the original harm, fostering cognitive discrimination. Conversation about the adverse experience proceeds in a calm, direct way focusing on differentiating between intrusive memories and the current situation at school ( Sajnani et al., 2014 ). Once the student exhibits greater emotional regulation, the ALIVE practitioner returns the student to the classroom in a timely manner and may provide either brief follow-up sessions for preventive purposes or, when appropriate, refer the student to more regular, clinical support in or out of the school.

Case Example 2

The following case example is representative of the brief, immediate, and open engagement with traumatic material and encouragement of cognitive discrimination. This intervention was conducted with a sixth grade student, Jacob (name and identifying information changed to ensure confidentiality), by an ALIVE practitioner (the second author).

I found Jacob in the hallway violently shaking a trash can, kicking the classroom door, and slamming his hands into the wall and locker. His teacher was standing at the door, distressed, stating, “Jacob, you need to calm down and go to the office, or I'm calling home!” Jacob yelled, “It's not fair, it was him, not me! I'm gonna fight him!” As I approached, I asked what was making him so angry, but he said, “I don't want to talk about it.” Rather than asking him to calm down or stop slamming objects, I instead approached the potential memory agitating him, stating, “My guess is that you are angry for a very good reason.” Upon this simple connection, he sighed and stopped kicking the trash can and slamming the wall. Jacob continued to demonstrate physical and emotional activation, pacing the hallway and making a fist; however, he was able to recount putting trash in the trash can when a peer pushed him from behind, causing him to yell. Jacob explained that his teacher heard him yelling and scolded him, making him more mad. Jacob stated, “She didn't even know what happened and she blamed me. I was trying to help her by taking out all of our breakfast trash. It's not fair.”

The ALIVE practitioner listens to students’ complaints with two ears, one for the current complaint and one for affect-laden details that may be connected to the original trauma to inquire further into the source of the trigger. Affect-laden details in case example 2 include Jacob's anger about being blamed (rather than toward the student who pushed him), his original intention to help, and his repetition of the phrase “it's not fair.” Having met with Jacob previously, I was aware that his mother suffers from physical and mental health difficulties. When his mother is not doing well, he (as the parentified child) typically takes care of the household, performing tasks like cooking, cleaning, and helping with his two younger siblings and older autistic brother. In the past, Jacob has discussed both idealizing his mother and holding internalized anger that he rarely expresses at home because he worries his anger will “make her sick.”

I know sometimes when you are trying to help mom, there are times she gets upset with you for not doing it exactly right, or when your brothers start something, she will blame you. What just happened sounds familiar—you were trying to help your teacher by taking out the garbage when another student pushed you, and then you were the one who got in trouble.

Jacob nodded his head and explained that he was simply trying to help.

I moved into a more detailed inquiry, to see if there was a more recent stressor I was unaware of. When I asked how his mother was doing this week, Jacob revealed that his mother's health had deteriorated and his aunt had temporarily moved in. Jacob told me that he had been yelled at by both his mother and his aunt that morning, when his younger brother was not ready for school. I asked, “I wonder if when the student pushed you it reminded you of getting into trouble because of something your little brother did this morning?” Jacob nodded. The displacement was clear: He had been reminded of this incident at school and was reacting with anger based on his family dynamic, and worries connected to his mother.

My guess is that you were a mix of both worried and angry by the time you got to school, with what's happening at home. You were trying to help with the garbage like you try to help mom when she isn't doing well, so when you got pushed it was like your brother being late, and then when you got blamed by your teacher it was like your mom and aunt yelling, and it all came flooding back in. The problem is, you let out those feelings here. Even though there are some similar things, it's not totally the same, right? Can you tell me what is different?

Jacob nodded and was able to explain that the other student was probably just playing and did not mean to get him into trouble, and that his teacher did not usually yell at him or make him worried. Highlighting this important differentiation, I replied, “Right—and fighting the student or yelling at the teacher isn't going to solve this, but more importantly, it isn't going to make your mom better or have your family go any easier on you either.” Jacob stated that he knew this was true.

I reassured Jacob that I could help him let out those feelings of worry and anger connected to home so they did not explode out at school and planned to meet again. Jacob confirmed that he was willing to do that. He was able to return to the classroom without incident, with the entire intervention lasting less than 15 minutes.

In case example 2, the practitioner was available for an immediate engagement with disturbing behaviors as they were happening by listening for similarities between the current incident and traumatic stressors; asking for specific details to more effectively help Jacob understand how he was being triggered in school; providing psychoeducation about how these two events had become confused and aiding him in cognitively differentiating between the two; and, last, offering to provide further support to reduce future incidents.

Germane to the practice of school social work is the ability to work flexibly within a public health model to attend to trauma within the school setting. First, we suggest that a primary implication for school social workers is not to wait for explicit problems related to known traumatic experiences to emerge before addressing trauma in the school, but, rather, to follow a model of prevention-assessment-intervention. School social workers are in a unique position within the school system to disseminate trauma-informed material to both students and staff in a preventive capacity. Facilitating this implementation will help to establish a tone and sharpened focus within the school community, norming the process of articulating and engaging with traumatic material. In the aforementioned classroom case example, we have provided a sample of how school social workers might work with entire classrooms on a preventive basis regarding trauma, rather than waiting for individual referrals.

Second, in addition to functional behavior assessments and behavior intervention plans, school social workers maintain a keen eye for qualitative behavioral assessment ( National Association of Social Workers, 2012 ). Using this skill set within a trauma-informed model will help to identify those students in need who may be reluctant or resistant to explicitly ask for help. As called for by Walkley and Cox (2013) , we suggest that using the information presented in Table 1 will help school social workers understand, identify, and assess the impact of trauma on early adolescent developmental tasks. If school social workers engage on a classroom level in trauma psychoeducation and conversations, the information in Table 3 may assist with assessment of children and provide a basis for checking in individually with students as warranted.

Third, school social workers are well positioned to provide individual targeted, trauma-informed interventions based on previous knowledge of individual trauma and through widespread assessment ( Walkley & Cox, 2013 ). The individual case example provides one way of immediately engaging with students who are demonstrating trauma-based behaviors. In this model, school social workers engage in a brief inquiry addressing the current trauma to identify the trauma trigger, discuss the adverse experience in a calm but direct way, and help to differentiate between intrusive memories and the current situation at school. For this latter component, the focus is on cognitive discrimination and emotional regulation so that students can reengage in the classroom within a short time frame.

Fourth, given social work's roots in collaboration and community work, school social workers are encouraged to use a systems-based approach in partnering with allied practitioners and institutions ( D'Agostino, 2013 ), thus supporting the public health tenet of establishing and maintaining a link to the wider community. This may include referring students to regular clinical support in or out of the school. Although the implementation of a trauma-informed program will vary across schools, we suggest that school social workers have the capacity to use a public health school intervention model to ecologically address the psychosocial and behavioral issues stemming from trauma exposure.

As increasing attention is being given to adverse childhood experiences, a tiered approach that uses a public health framework in the schools is necessitated. Nevertheless, there are some limitations to this approach. First, although the interventions outlined here are rooted in prevention and early intervention, there are times when formal, intensive treatment outside of the school setting is warranted. Second, the ALIVE program has primarily been implemented by ALIVE practitioners; the results from piloting this public health framework in other school settings with existing school personnel, such as school social workers, will be necessary before widespread replication.

The public health framework of prevention-assessment-intervention promotes continual engagement with middle school students’ chronic exposure to traumatic stress. There is a need to provide both broad-based and individualized support that seeks to comprehensively ameliorate the social, emotional, and cognitive consequences on early adolescent developmental milestones associated with traumatic experiences. We contend that school social workers are well positioned to address this critical public health issue through proactive and widespread psychoeducation and assessment in the schools, and we have provided case examples to demonstrate one model of doing this work within the school day. We hope that this article inspires future writing about how school social workers individually and systemically address trauma in the school system. In alignment with Walkley and Cox (2013) , we encourage others to highlight their practice in incorporating trauma-informed, school-based programming in an effort to increase awareness of effective interventions.

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Real Case Studies in Social Work Education

The central elements of the Real Cases Project curriculum integration effort are three case studies, drawn from the ChildStat Initiative—an innovative, agency-wide case review process of New York City’s Administration for Children’s Services. As documented in Brenda McGowan’s introduction to the case studies and their development, we went through a rigorous selection process to insure that the cases would be diverse, engaging, and useful in meeting the objectives of the Real Cases Project . The overview of the case studies, by Tatyana Gimein, (Co-Chair of the Project before her retirement from ACS), highlights key elements of each case study, and the profound challenges facing the families, staff and communities involved.

The decision to use real case studies in a curriculum integration effort was adopted after an extensive assessment phase. In 2004, the Planning Committee initially began the case selection process, focusing on cases drawn from the ACS Accountability Review Process. An expert panel convened by the Committee narrowed the selection to one case. After recruitment and preliminary work by faculty on individual teaching guides, this case became unavailable. The ChildStat approach was then proposed and access to cases was granted, resulting in the selection of the three cases in this document. Faculty authors adopted these three cases as framing elements in their teaching guides. The three case studies collectively raise critical issues in public child welfare practice today, show a diverse range of practices, family issues, and populations, as well as showcase the ChildStat Initiative.

The Real Cases Project is part of the social work tradition of case study education. During our profession’s history, social work educators have used case studies in the classroom to teach particular course content (Richmond, 1897; Towle, 1954), drawing vignettes from students’ work in the field (Reynolds, 1965; Wolfer & Gray, 2007), published case studies and cases from their own practice (Cohen, 1995). The case study approach appears to be experiencing resurgence, as indicated by the number of published books of cases and suggestions for their use in the classroom (Fauri, Wernet & Netting, 2007; Haulotte & Kretzschmar, 2001; Hull & Mokuau, 1994; LeCroy, 1999; Rivas & Hull, 2000; Stromm-Gottfried, 1998; Wolfer & Scales, 2006). Even with its widespread use, the efficacy of the case study approach for learning specific content or integrating multiple content areas has not been extensively tested and remains a fruitful area for inquiry.

Case studies are especially useful for training professionals in disciplines as social work, where critical thinking and problem solving skills are necessities (Ross & Wright, 2001). Case studies are often utilized in professional social work education in order to provide students with a real life example on which to practice their skills of critical analysis and assessment. In addition to practicing a particular skill set, case studies also allow faculty to assist students in their application of theory into practice. In addition, when used properly, case studies can provide students an opportunity to accept responsibility for their own learning (Armisted, 1984).

This Project contributes to the growing literature on using child welfare case studies in social work education (Brown, 2002; Johnson & Grant, 2005). We advance this effort, especially considering that the cases are drawn from a public child welfare agency and are accompanied by teaching guides that demonstrate how the cases can be used successfully in different courses across the curriculum. The Real Cases Project does not suggest that the cases supplant the content of a particular course. Rather, the cases can be used to illuminate and expand course content. While students may become familiar with the cases in more than one class, the teaching guides will insure that the use of the cases is not redundant, and is appropriate to each course in the curriculum. Thus, both the individual courses and the understanding of child welfare as a part of social work are enriched.

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Blog The Education Hub

https://educationhub.blog.gov.uk/2024/03/15/how-to-claim-15-hours-free-childcare-code/

How to claim 15 hours free childcare including how to get your code

We’re making the  biggest investment  by a UK government into childcare in history, doubling the amount we expect to spend over the next few years from around £4 billion to around £8 billion each year.  

• Currently, eligible working parents of 3 and 4-year-olds can access 30 hours of childcare support.  
• From  April 2024 , eligible working parents of 2-year-olds will be able to access 15 hours childcare support.  
• From  September 2024 , 15 hours childcare support will be extended to eligible working parents with a child from 9-months-old.  
• From  September 2025 , support will reach 30 hours for eligible working parents with a child from 9-months-old up to school age.  

When can I apply?  

Applications are open until 31 March for eligible working parents of 2-year-olds to receive 15 hours free childcare starting from April 2024.  

From 1 April, eligible working parents whose children will be 2 or older by the 31 August, can apply to receive 15 hours childcare starting from September 2024.   

And from 12 May, eligible working parents whose children will be aged between 9- and 23-months old on 31st August, can apply to receive 15 hours childcare starting from September 2024.  

It’s important to remember that codes need to be renewed every three months, so parents applying close to 12 May will need to renew their code prior to the offer starting in September.  

How do I apply?   

You apply online here on   Gov.uk once you have checked our  eligibility criteria .  

You’ll need to make sure you have the following information to hand before starting the application:  

• your national insurance number (or unique taxpayer reference if you are self-employed)  
• the date you started or are due to start work  
• details of any government support or benefits you receive  
• the UK birth certificate reference number (if you have one) for your child.  

You may find out if you’re eligible straight away, but it can take up to 7 days.  

Once your application has been approved, you’ll get a code to give to your childcare provider.  

Eligible parents are also able to access Tax-Free Childcare through the same application system. You can apply for Tax-Free Childcare at any time. However, you don't need to apply for Tax-Free Childcare to be eligible to apply for the 15 hours childcare scheme.   

What happens once I receive my code?  

Once you receive your code, you’ll need to take it to your childcare provider, along with your National Insurance number and your child’s date of birth.  

Your childcare provider will process the code to provide your place.  

Places will be available for September in every area of the country, but a significant minority of settings hold waiting lists of over six months. If you have a preferred nursery for September, you should reach out now to secure a place for your child ahead of receiving your code.  

Your local authority can provide support for finding a government-funded place in your area.  

What if I’m already registered for Tax Free Childcare?  

Parents must reconfirm that they are still eligible for Tax-Free Childcare every 3 months.  

Parents who are already claiming Tax-Free Childcare and need to reconfirm their eligibility between 1 April and 12 May will be automatically issued a code in the post from HMRC soon after the 12 May.   

This is to ensure every parent can give their code to their provider in good time. This code will be valid to apply for 15 hours of government-funded childcare from September.   

If I receive a code in a letter from HMRC, does this make my code on my Childcare Account invalid?  

No. Both codes will be valid.   

Do I need to wait for my reconfirmation window to add another child to my account?  

A parent who is already using the childcare service for another child can add a new child to their account at any time.  

Your reconfirmation cycle for your current Tax-Free Childcare will not affect this.  

How are you making sure there will be enough childcare places for eligible parents?  

Parents that have a preferred place for September should reach out now to their local provider to secure a physical place for their child ahead of time.  

To make sure there are enough places available, we’re investing over £400 million in 2024-25 to increase the hourly rates paid to local authorities.  

The Institute for Fiscal Studies has independently reported that the average funding rates for two-year-olds and under 2s paid by government from April 2024 are projected to be substantially higher than the market rate paid by parents last year, and we have committed to further increases to provider rates for the next two years.  

We have also committed to increasing hourly funding rates over the next two years by an estimated £500 million, to make sure providers can increase places at each phase of the rollout.    

You may also be interested in:

• Budget 2023: Everything you need to know about childcare support
• Before and after school childcare: Everything you need to know about wraparound care
• Free childcare: How we are tackling the cost of childcare

Tags: 15 hours free childcare , Applying for 15 hours free childcare , Childcare , Free childcare 2024 , Free childcare eligibility , tax-free childcare , When to apply for 15 hour free childcare

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Ruby Franke case: Police records, personal journal detailing child abuse released

The records also include witness statements from franke and jodi hildebrandt’s august arrest..

(Santa Clara-Ivins Police Department) Police body camera footage shows officers preparing to enter the home of Jodi Hildebrandt on Aug. 30, 2023. Washington County prosecutors released a slew of records Friday from Hildebrandt and Ruby Franke's child abuse case.

Washington County prosecutors released a slew of records Friday detailing the “horrific abuse” Utah parenting influencer Ruby Franke and former mental health counselor Jodi Hildebrandt inflicted last summer on two of Franke’s young children.

The records include police reports, witness statements and more than 30 body camera and surveillance videos showing Franke, Hildebrandt and the children interacting with authorities.

Also included in the records is a handwritten journal that Franke kept, according to the Washington County attorney’s office. It documents a timeline of the children’s abuse as well as Franke’s apparent musings of “religious extremism” that prosecutors say motivated the women to harm the kids.

(Utah 5th District Court) Ruby Franke and Jodi Hildebrandt appear in 5th District Court in St. George, Friday, Sept. 8, 2023. Washington County prosecutors released a slew of records Friday from their child abuse case.

The children were regularly denied food and water as well as beds to sleep in, prosecutors have said. They were forced to lift and carry boxes up and down stairs, perform wall sits for hours, and do manual labor outside in the “extreme summer heat” without shoes or socks, among other forms of abuse.

“If you can engage a weak minded soul in a physical activity of obedience you can begin to break the bond Satan made w/ the weak,” one entry from Franke’s journal states.

The women were arrested Aug. 30 after Franke’s 12-year-old “emaciated” son escaped Hildebrandt’s Ivins home and asked a neighbor for help. Security footage released Friday from the neighbor’s home showed the boy knocking on their door.

Responding officers soon found Franke’s 10-year-old daughter inside a bathroom closet within Hildebrandt’s home. Body camera footage shows authorities giving the malnourished girl pizza to coax her out, promising to help her like they helped her brother.

In the videos, both children appears thin and dazed, moving slowly. Their answers to police questions are redacted. In one video, a paramedic outside Hildebrandt’s house tells an officer, “I’m crying.”

“I know,” he responds. “That’s why I have my shades on.”

[Read more: Ruby Franke videos: What police saw after Franke’s son escaped Hildebrandt’s home ]

Franke and Hildebrandt each pleaded guilty to four counts of aggravated child abuse in December. Both were sentenced in February to at least four years in prison.

The records shared Friday also included Washington County jail phone calls from both Franke and Hildebrandt, in which they discuss “their guilt, perceived innocence, and motives for the crimes they were convicted of,” prosecutors said in a news release.

A police report taken after the children were hospitalized noted the Division of Child and Family Services told authorities they already had “several other cases” involving the Franke family “up north.” Franke’s primary residence was located in Springville.

“The women appeared to fully believe that the abuse they inflicted was necessary to teach the children how to properly repent for imagined ‘sins’ and to cast the evil spirits out of their bodies,” the news release states. It adds that the children suffered emotional abuse “to the extent that they came to believe that they deserved the [physical] abuse.”

‘He doesn’t even know what month it is’

(Santa Clara-Ivins Police Department) Police body camera footage shows first responders treating a child outside a home near Jodi Hildebrandt's house on Aug. 30, 2023.

When prosecutors on Friday identified “religious extremism” as the motivation behind Franke and Hildebrandt’s abuse, they did not specify what church the women affiliate with or attend.

The first unredacted entry in Franke’s journal, however, notes Hildebrandt received a blessing May 21 from a person she identifies as a local Latter-day Saint temple president.

About three weeks later, Franke’s journal indicated, Hildebrandt also traveled to Salt Lake City on June 13 to meet with two leaders from The Church of Jesus Christ of Latter-day Saints.

The faith does not advise or support practices such as restraining children or withholding food as punishment. The church did not immediately comment Friday on the released records or Franke’s journal.

The journal entries that stretch until Aug. 27 otherwise focus on Franke’s two youngest children, who she accuses of “deviant behavior.”

[Read more: Ruby Franke case: A timeline of events ]

“These selfish selfish children who only desire to take, lie [and] attack have zero understanding of God’s love for them,” she wrote.

At one point in July, Franke wrote that her son refused to do any more “work” and began screaming. In response, his hair was shaved off. The next day, she wrote, the boy attempted to run away.

“It is [the boy’s 12th] birthday and he doesn’t even know what month it is,” Franke wrote on July 10. “... I told [the boy] that he emulates a snake. He slithers and sneaks around looking for opportunities when no one is watching.”

(Santa Clara-Ivins Police Department) Police body camera footage shows officers taking handcuffs and rope from the home of Jodi Hildebrandt on Aug. 30, 2023.

Franke continues to demean the children throughout the journal, calling her son a compulsive liar and writing that she “never would have suspected the cold, dead heart [he] has.”

She describes her daughter as manipulative and at one point cut off all the girl’s long hair — “no more distracting with long hair,” Franke wrote in the entry.

“‘My mom starves me and calls it fasting,’” Franke recalled her daughter saying in one entry. “‘If I can’t go home, then what’s the point in being obedient?’”

The boy repeatedly begged his mother for basic care, such as water or air conditioning, according to the entries. The average June temperature in Ivins is about 80 degrees, with an average high of about 91 degrees, according to climate-data.org .

On July 11, the boy told Franke that he wanted to go to jail, according to the journal.

“[He] doesn’t actually know what ‘jail’ means,” Franke wrote. “He has no comprehension what throwing your life away means. He just wants the immediate gratification of sitting in an air conditioned car ride to juvie.”

A plan to move to ‘open land’ where the children ‘can work’

(Santa Clara-Ivins Police Department) Police body camera footage shows Ruby Franke after she was taken into custody on Aug. 30, 2023.

Throughout the entries, Franke states that Hildebrandt was searching for property with “open land” to buy in Arizona “where these two can work.”

The women planned to move forward with financing the property quickly, the entries indicate.

“They will think they won,” Franke wrote of her children. “They will think they got what they wanted. They will relax. Then... POP!!! We will drop them like hot potatoes out in the desert. Their new home!”

Franke said this “new home,” later described as a 500-acre plot that Hildebrandt found, would have room for them to build a ranch, so the children could experience “natural outcomes” — like a kick from a horse or cactus to run into.

“The devil does not want us to take [the children] out of society,” Franke wrote. “He did not want Jodi finding this property. He wanted Jodi and I down at the police station... not discovering a place to bring intervention to his entanglement of my children.”

By Aug. 27, it appears Franke was preparing her kids for a move — she wrote that she packed 20 boxes and put them in a storage shed, and that one of her older daughters in Springville gave her job two weeks’ notice.

Three days later, the boy managed to make it to the neighbor’s front door, his wrists and ankles wrapped in duct tape that covered open wounds, asking for help.

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‘Quiet on Set’ Directors Explain How They Uncovered Stars’ Secret Support for Pedophile Brian Peck and Whether Kids Are Safe on Set Post-Dan Schneider’s Nickelodeon Reign

By Emily Longeretta

Emily Longeretta

• Dan Schneider Denies ‘Sexualizing’ Child Stars on Nickelodeon: ‘Some Adults Project Their Adult Minds Onto Kids’ Shows’ 6 days ago
• ‘Quiet on Set’ Directors Explain How They Uncovered Stars’ Secret Support for Pedophile Brian Peck and Whether Kids Are Safe on Set Post-Dan Schneider’s Nickelodeon Reign 1 week ago
• ‘Love Is Blind’ Reunion: Nick Lachey Kicks One Cast Member Off Stage and Clay Admits Regrets to AD 2 weeks ago

For the first time, the so-called toxic environment at the cable channel Nickelodeon in the late ’90s and early aughts is being exposed on screen, in ID’s “ Quiet on Set: The Dark Side of Kids TV ” docuseries. For years, directors Mary Robertson and Emma Schwartz worked to make sources comfortable with the idea of talking about their experiences, sharing allegations of abuse, sexism, racism and inappropriate dynamics on sets — mostly under creator Dan Schneider .

For the four-part ID documentary, cast members and crew who worked alongside Schneider — the creator of “All That,” “The Amanda Show,” “iCarly,” “Victorious,” “Sam & Cat” and many other massive Nickelodeon hits — shared their experiences. The documentary explores what type of behavior was allowed on the sets of children’s television shows, including women writers who claimed they were forced to accept half the salaries their male counterparts made.

Variety contacted Schneider — who says he hasn’t seen “Quiet on Set” yet — to comment on the docuseries’ allegations. About the salary claims, Schneider’s representative says: “‘The Amanda Show’ was produced by a different company (Tollin/Robbins) not Dan. Additionally, Dan was not involved in writers’ salaries, they were controlled by the network and also by the WGA, not by Dan even on shows he did create.”

The doc also features crew members alleging they were asked continuously to massage Schneider on set. “Dan deeply regrets asking anyone for neck massages,” his representative says in response. “Though they happened in public settings, he knows this was highly inappropriate and would never happen again.”

Variety also reached out to Nickelodeon about the claims made about the network in “Quiet on Set,” and a spokesperson wrote in part: “Our highest priorities are the well-being and best interests not just of our employees, casts and crew, but of all children, and we have adopted numerous safeguards over the years to help ensure we are living up to our own high standards and the expectations of our audience.” (The full statement, which is also about Bell, is at the bottom of the post.)

In this interview, directors Mary Robertson and Emma Schwartz about the process of learning Bell was the victim, unsealing the documents and more. “Quiet on Set” airs over two nights on ID at 9 p.m. on Sunday, March 17 and Monday, March 18. Episodes will also be s treaming on Max.

Why did you decide to tell this story now?

Mary Robertson: Several years ago, we noticed some videos online that perhaps you’ve seen yourself —compilations of clips from some of these shows that Dan presided over, some of these clips featured Ariana Grande lying on the side of a bed pouring water on herself in a manner that arguably is sexual . We also in those clips, girls appearing on Dan’s shows would receive a squirt of a viscous liquid on their face. There were a lot of questions that were circulating online certainly around the conditions under which these videos were made. Certainly, we had our own curiosity, and thought it was a really meaningful and worthy subject. And then we read an article that Kate Taylor wrote in Business Insider that we think really advanced the reporting on Dan Schneider and his influence at Nickelodeon. There were more than 12 anonymous sources, who were offering quotes and insight into what was really happening behind the scenes. And we wrote Kate a letter, and said we’d love to partner on this and move forward. Then we began the work of trying to convert these anonymous sources into sources who would appear on camera and feel comfortable sharing their stories in this environment and were eventually able to build upon that.

Emma Schwartz: The more we dug in, the more we talked to people because really, a lot of the folks that we have on “Quiet on Set” had never spoken before and had never actually spoken for the Business Insider piece. There was a much bigger story and a story that hadn’t been told about these environments. Many people, even people who didn’t want to speak publicly would say, “I’m really glad you’re doing this. I think this deserves attention.”

There is a lot of talent shown in this, including Grande, Victoria Justice, Jamie Lynn Spears and Amanda Bynes. Did you reach out to all of them to see if they’d like to participate?

Robertson: We’re really proud of and excited by the fact that we’re bringing forward more than a dozen sources who have never shared their stories publicly before. And if Ariana Grande or anyone else who was in this universe wants to share more with us, we’re very interested. We reached out to everyone that you might expect for comment and beyond.

How much did you guys engage with Dan Schneider throughout this process?

Schwartz: We reached out to Dan, we asked for his participation. He declined to participate on camera and we sent him a list of questions and incorporated his responses into the project.

What was the process of learning that Drake Bell was the victim in the Brian Peck case, and then getting him to come forward and share his story?

Schwartz: Pretty early in the process, we learned that there have been several people who’ve been arrested and convicted of child sex abuse at Nickelodeon. We began to hear whispers that the person who was the victim in Brian Peck’s case was Drake Bell, but we wanted to be really careful and really thoughtful approaching someone who is a survivor of child sex abuse, especially someone who has, at that point, clearly remained very private about that. But at a certain juncture, when we were pretty certain it was him, I wrote a letter and that letter began a back and forth and a conversation that eventually led to his willingness to sit down on camera. Just sitting down on camera wasn’t easy. It wasn’t as if he went home that day and said, “Oh, that was the greatest decision I made.” It’s been a process and a journey, trying to sort of heal from the trauma that he experienced more than two decades ago.

How did he feel once he watched it?

Schwartz: I think the thing he said to me: that finally, he felt like a weight had been lifted. He’s been carrying and, he’ll carry it for the rest of his life, but there’s a certain levity in finally knowing you don’t have to hold it as a secret. And perhaps in shining light, you can help other people.

So what happened after getting Drake Bell on board? The case was sealed and the letters were sealed, so were you able to unseal them after getting his OK?

Robertson: I think it arguably influences the way in which one perceives and understands Drake’s experience too. And perhaps it helps us understand a little bit of what he might have felt when he walked into the courtroom, as he describes in the film and sees that Brian Peck’s side of the courtroom is full right. I don’t think, at the time, he felt as though he had many allies.

Schwartz: I think he expected to have support and then realized that he essentially walked into a room and was sort of re-traumatized.

Dan has responded in multiple statements. Did you have any contact at all with Brian Peck?

Schwartz: He is certainly aware that we unsealed those letters.

Peck was hired again by “Suite Life of Zack and Cody” after he got out of prison, which there were rumors about but it hadn’t been confirmed. Did you discuss that decision with the Disney Channel?

(After a long pause) Schwartz: Like you said, it’s been out there that he had continued to work in the industry and had worked on another children’s show. And that was certainly something that, a lot of people that we spoke with, were very curious about.

( Variety confirmed Peck performed voiceover work on three episodes of “Suite Life,” and was never on set. He had zero interaction with any cast or crew. Once the network learned of his conviction, he was immediately terminated and his credits on the three episodes were replaced. )

How much participation did you have overall from Nickelodeon while making this? We have the blanket statement in each episode, but other than that?

Schwartz: We also reached out and asked them if they wanted to have someone participate on camera. They declined. We sent them a series of questions. That statement was what we got back from them. We certainly reached out to lots of people who had been in and around Nickelodeon, and we tried to learn as much as we could.

There’s a big question now about how kids are protected now on set — what protocols are on set, what has changed, etc. Did you look into that?

Schwartz: Well they did expand their background checks to include freelancers, meaning the production companies, after these cases had come up. As far as I understand, there’s not uniform rules that say, like there are at schools, that say, you cannot have a child sex offender anywhere near a set. That’s something that, for instance, Kyle [Sullivan], who is in the program, is very concerned about. He certainly believes that that’s not enough protection, that things can slip through the cracks.

Fundamentally, what we were trying to do with “Quiet on Set” is scrutinize these power dynamics between kids and adults, between the parents and the crew and the showrunner, and really sort of peel back the curtain on this world.

After the amount of research you’ve done through this, do you feel personally, that children are protected on sets now?

There’s always work to do. What was the toughest part for you guys during this process?

Schwartz: I think just for me personally, it was working with Drake in his decision to come forward. That’s not easy. It takes a lot of courage. And it was a process and I think, a unique process to go through that with somebody.

Robertson: I think listening to Joe, Drake’s dad, share his account. Listening to him and thinking carefully about how to create a safe environment for him to be vulnerable and share experiences that he felt were really upsetting. I think that that was hard, but it also felt important.

This could really start more conversations — if more people come forward with stories to tell, would you guys be interested in doing more episodes of this?

Robertson: Absolutely. We have so many questions. We are here to listen, and we hope that others who have similar, adjacent, related meaningful experiences in this realm come forward to us.

Schwartz: I’d say one of the goals is to elevate and help create that conversation and the more people who can come forward, the more we can have a thoughtful conversation.

Here is the full statement from Nickelodeon: “Though we cannot corroborate or negate allegations of behaviors from productions decades ago, Nickelodeon as a matter of policy investigates all formal complaints as part of our commitment to fostering a safe and professional workplace environment free of harassment or other kinds of inappropriate conduct. Our highest priorities are the well-being and best interests not just of our employees, casts and crew, but of all children, and we have adopted numerous safeguards over the years to help ensure we are living up to our own high standards and the expectations of our audience.”

Here is the full statement from a spokesperson for Schneider: Everything that happened on the shows Dan ran was carefully scrutinized by dozens of involved adults, and approved by the network. If there was an actual problem with the scenes that some people, now years later are “sexualizing”, they would be taken down, but they are not, they are aired constantly all over the world today still, enjoyed by both kids and parents.

Remember, all stories, dialogue, costumes, and makeup were fully approved by network executives on two coasts. A standards and practices group read and ultimately approved every script, and programming executives reviewed and approved all episodes. In addition, every day on every set, there were always parents and caregivers and their friends watching filming and rehearsals. Had there been any scenes or outfits that were inappropriate in any way, they would have been flagged and blocked by this multilayered scrutiny.

Unfortunately, some adults project their adult minds onto kids’ shows, drawing false conclusions about them.

This interview has been edited and condensed.

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Opinion The case for a 32-hour workweek with no loss in pay

Bernie Sanders, an independent, represents Vermont in the U.S. Senate. Shawn Fain is president of the United Auto Workers.

Although it is rarely discussed in the media, the Senate overwhelmingly passed legislation to establish a 30-hour workweek in 1933. While that legislation ultimately failed because of intense opposition from corporate America, a few years later President Franklin D. Roosevelt signed the Fair Labor Standards Act into law and a 40-hour workweek was established in 1940.

Unbelievably, 84 years later, despite massive growth in technology and worker productivity, nothing has changed.

Today, American workers are more than 400 percent more productive than they were in the 1940s. And yet, despite this fact, millions of our people are working longer hours for lower wages. In fact, 28.5 million Americans now work over 60 hours a week, and more than half of full-time employees work more than 40 hours a week.

The sad reality is, Americans work more hours than the people of most other wealthy nations. In 2022, U.S. workers logged 204 more hours a year than employees in Japan, 279 more hours than those in the United Kingdom and 470 more hours than those in Germany.

Despite these long hours, the average worker in America makes almost $50 a week less than he or she did 50 years ago, after adjusting for inflation.

Let that sink in for a moment. In a 1974 office, there were no computers, email, cellphones, conference calling or Zoom. In factories and warehouses, there were no robots or sophisticated machinery, no cloud computing. In grocery stores and shops of all kinds, there were no checkout counters using bar codes.

Think about all the incredible advancements in technology — computers, robotics, artificial intelligence — and the huge increase in worker productivity that has been achieved. What have been the results of these changes for working people? Almost all the economic gains have gone straight to the top, while wages for workers are stagnant or worse.

While CEOs are making nearly 400 times as much as their average employees, many workers are seeing their family lives fall apart, missing their children’s birthday parties and Little League Baseball games, as they are forced to spend more time at work. What stresses them out even further is that many still do not have enough money to pay rent, put food on the table and send their kids to college without going deeply into debt.

This should not be happening in the United States of America in 2024. It’s time for a 32-hour workweek with no loss in pay.

Let’s be clear. This is not a radical idea: Belgium has already adopted a four-day workweek. Other developed countries are moving toward this model, such as France (35-hour workweek and considering reducing to 32) and Norway and Denmark (roughly 37-hour workweeks). In 2019, Microsoft tested a four-day workweek in Japan and reported a 40 percent increase in productivity.

Last year, the United Kingdom conducted a four-day workweek pilot program of 3,000 workers at more than 60 companies, and it was a huge success for both workers and employers. Over 73 percent of workers who participated in this program reported greater satisfaction with their work. Businesses that participated in this program saw a 35 percent average increase in revenue, and 91 percent of businesses opted to continue a four-day workweek after the study concluded.

Studies have shown that workers are either equally or more productive during a four-day workweek — one study found that worker productivity rose , with 55 percent saying their ability at work increased after companies adopted this new schedule. In addition, 57 percent of workers in companies that have moved to a four-day workweek have indicated that they are less likely to quit their jobs.

Moreover, at a time when so many of our people are struggling with their mental health, 71 percent of workers in companies that have moved to a four-day workweek report feeling less burnout, 39 percent reported feeling less stress and 46 percent reported feeling less fatigued .

Even Bill Gates, the founder of Microsoft, and Jamie Dimon, CEO of JPMorgan Chase, predicted last year that advancements in technology could lead to a three- or 3½-day workweek.

The question is: Who will benefit from this transformation? Will it be the billionaire class or workers? In our view, the choice is obvious. At a time of massive income and wealth inequality and huge increases in productivity, the financial gains from new technology must go to workers, not just to the people on top.

As part of their historic contract negotiations with the Big Three automakers — General Motors, Ford Motor Co. and Stellantis (formerly Chrysler) — the United Auto Workers called for the introduction of a four-day, 32-hour workweek at the same rate of pay and overtime pay for anything beyond that.

Despite significant gains for workers in their new contract, they were not successful in winning that demand. The struggle continues.

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Crime and Public Safety | Blame game? Santa Clara County lawyer…

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Crime and Public Safety

Subscriber only, crime and public safety | blame game santa clara county lawyer reassigned after child abuse interview scandal, latest controversy raises ‘honesty’ concerns at department of family and children’s services.

Santa Clara County’s child welfare agency is once again mired in a contentious blame game, as social workers say department leaders are scapegoating an attorney for a controversial practice that the county recently abandoned: inviting parents to attend child abuse interviews, even when the parent is the one suspected of abuse.

The attorney, Bhavit Madhvani, was reassigned from his position in recent days shortly after the Bay Area News Group reported he provided training that instructed about 45 staff members to “ignore” a state penal code that gives children the right to be interviewed about abuse in private. County leaders wouldn’t comment on Madhvani’s job status, calling it a personnel matter.

But social workers and their supervisors — long at odds with the county counsel office’s outsized role in Santa Clara County child abuse investigations — are coming to Madhvani’s defense, saying it is unlikely he would have provided such extraordinary guidance without the approval of his superiors. Even one of the county’s elected leaders is calling into question the honesty of department heads.

Alex Lesniak, a social worker and union steward, summed up the sentiment.

“We workers know what his chain-of-command is, and workers know it’s not just” a county lawyer making decisions, she said. “It’s not fair to Madhvani.”

Madhvani declined to comment to the Bay Area News Group, citing attorney-client privilege.

The showdown is the latest upheaval in Santa Clara County’s child welfare system, which has been under fire in recent months for its mishandling of the case of 3-month-old Phoenix Castro, who died from fentanyl poisoning after being allowed to go home with her drug-abusing father.

Revelations from the Bay Area News Group’s ongoing investigation into Phoenix’s death led to a series of reforms and calls for an overhaul of the county’s child welfare system. Critics have flagged a number of parent-friendly policies introduced in recent years as the county embraced the goal of keeping troubled families together and kids out of foster care. Some child welfare advocates fear the county’s mission is endangering at-risk children.

The new controversy raises additional questions about transparency among the county’s top executives.

Earlier this month, hours before the publication of a Bay Area News Group report on the practice, Santa Clara County announced it would give social workers the green light to bar parents from child interviews when court orders were obtained.

On Friday, the Bay Area News Group asked county leaders whether Department of Family and Children’s Services Director Damion Wright; his boss, Social Services Agency Director Dan Little; or County Executive James Williams, who formerly served as County Counsel, were aware of the guidance on child-abuse interviews before this news organization began reporting on the issue in mid-February.

The response from a county spokesman: “The answer to your questions as to each of the individuals is no.”

But Lesniak, the union steward, said that in a meeting Wednesday between social worker supervisors and department higher-ups, Wright acknowledged that many people in the department knew about the guidance on abuse interviews.

“I am hearing that it was discussed, it was admitted, and that staff have been lifting up these concerns since December,” Lesniak said.

A county spokesman on Friday called the claim about Wright’s acknowledgment “inaccurate.”

As it turns out, the concerns were delivered to county leaders as early as February 2023. A state report on a dramatic drop in child removals from Santa Clara County homes stated that “Social Workers are no longer able to interview children at school without a parent’s permission. Interviews at school are often the only time social workers report being able to interview a child without concerns of coaching or being altered due to a parent’s presence.”

Santa Clara County Supervisor Sylvia Arenas, who has been leading the charge to overhaul the department, said she was dubious that Wright has been upfront about the controversy, especially after County Counsel Tony LoPresti came forward to acknowledge his office “recently became aware” of the interview guidance shortly before the Bay Area News Group broke the story.

“We cannot begin to right this ship until we start meeting basic standards of honesty with the public and the Board of Supervisors,” Arenas said last week.

In a statement Wednesday, Williams also said that county leadership “recently became aware” that legal advice was being provided to social workers that was not in alignment with the county’s legal or policy positions. He said that county lawyers and welfare workers will conduct a review of presentations, policies and other materials “to ensure they align with the law, reflect best practices, and are grounded in prioritizing the safety of our most vulnerable children.”

Social workers say county lawyers have also blocked them from getting court orders to enter homes without a parent’s consent to investigate child abuse.

Veteran Oceanside family and parental rights attorney Donnie Cox said that he knows of “no other county who claims that they can’t get an order to go into a home … with probable cause.”

“For them to say that there’s no way they can get a warrant or they can’t get an (entry) order and are telling their social workers not to go get an order, is a cop-out — a serious cop-out,” Cox said.

This week, within a day of this news organization contacting county officials about those concerns, Wright released a memo telling the staff that they “are permitted to request entry orders in the investigatory process when needed to interview children.”

Even Cox, who has established seminal case law in California on behalf of parents and families, questioned Santa Clara County’s deference to parents’ rights.

“We don’t want them to stop protecting kids,” he said. “We just want them to follow the Constitution while they’re doing it.”

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An Introvert’s Guide to Visibility in the Workplace

• Melody Wilding

You don’t have to be a loud, outgoing personality to have your contributions recognized.

Visibility in the workplace isn’t nice to have, it’s a necessity. Being seen and recognized for your work can open doors to new opportunities and propel your career forward. But that doesn’t have to come at the cost of becoming someone you’re not. Even as an introvert, you can find ways to play to your strengths. In this article, the author outlines five strategies to boost your visibility: 1) Speak up early in meetings. 2) Take the pressure off. 3) Ditch self-deprecation. 4) Leverage async methods of communication. 5) Show gratitude.

A reader recently told me, “I prefer to be brilliant behind the scenes.” If you’re an introvert — someone who’s more comfortable focusing on their inner thoughts and who tends to recharge in solitude — then you may relate to this sentiment. Many introverts value depth and thoughtfulness in their work over noise and showmanship. They’re content to contribute without constant recognition or the spotlight. 

• Melody Wilding , LMSW is an  executive coach  and author of  Trust Yourself: Stop Overthinking and Channel Your Emotions for Success at Work . Get a free copy of Chapter One here .

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