Medical practice and the practice of child welfare continue an integral interaction. The Ministry of Children and Family Development responds regularly to calls requiring intervention into suspected non accidental injuries of children or to calls of neglect of children. When services intervene in the lives of other citizens, they must do so based on best evidence available with regard to the probable consequences of that intervention. Evidence based practice (EBP) is a theme which one can locate readily on the internet. Many professional practices are addressing the need.
Definition: Evidence based practice is the diligent, precise and prudent use of recent best evidence for making clinical practice and policy decisions. It has become unmistakable that current criticisms of certain child protection cases in British Columbia point to the need to prioritize EBP. The Evidence Based and Social Investigation Conference which this blog site has been advertising these past several days will apply that definition to child welfare. Blog Post 545 presented the schedule of experts who will be in attendance to apply this definition.Diligent or conscientious use of current best evidence suggests that practitioners will always maintain an awareness of their moral obligation to enlist all available evidence and to guard against bias and deception. Precise or explicit use of current best evidence requires that practitioners and policy makers are convinced as to the reliability, validity and applicability of evidence that is being used to make decisions and they can convincingly justify their decisions. Prudent or judicious use of current best evidence means that practitioners will use practical reasoning and clinical expertise to assess children’s and families’ unique characteristics, preferences and circumstances as they make case recommendations.
This commitment implies many things. Evidence based practice (EBP) is improving constantly because it is changing, corrective, emendatory. EBP acknowledges that best practice rests fundamentally upon the best available evidence. EBP must therefore be objective and transparent. EBP requires critical thinking and appraisal skills. EBP requires structure and methodology to translate the current best evidence research into practice.
I understand that medical professionals could become convinced that a triad of findings point to shaken baby syndrome which then always implies an abuser of a child that is injured. However, when SBS became such a disputed diagnosis in the medical sciences community, the SBS loyalist became entrenched. What may have occurred is an unwillingness to entertain the possibility that there was current better evidence, that is, other explanations for the triad of symptoms. This is but one example of the need for EBP in the related fields of medicine and child protection. The Paul and Zabeth Bayne case is one such case where their professed innocence was rejected in deference to a medical diagnosis which became the foundation for the Ministry (MCFD) case to take all four children indefinitely, yet the diagnosis has been in dispute and then rejected by the judge and yet the children remain in care even though there is not one iota of evidence to prove that Paul or Zabeth have willfully hurt a child or have been negligent in the care of their children.
. Ron; you raise one of the most important topics today, which as you know, I have frequently addressed in the past. Evidence based on known facts. This is not only supposed to be a pillar of good medical practice, but also one of the main underpinnings of our judicial system. Dare I say that fact based evidence should also be the basis for psychology and social work practice? The fact based evidence leads one to believe that psychologists and social workers prefer abstract and unproven theories for the most part.
ReplyDeleteToday I would like to refer to a related topic. Namely the predictability and reliability of human behaviour. Anyone with social responsibilities needs to understand the topics. Social workers, lawyers and judges, as well as teachers, lawmakers and police. There is overwhelming evidence to show that human behaviour is for the most part reliable and predictable. Without this predictablity, no planes would fly, no buses run and no banks would open on time. We come to rely confidently in the service of others, because the best evidence shows that it is safe to do so. People do not simply start to act out of character for no good reason.
This dependability works both ways. The habitual criminal will continue to steal, the abusive spouse will continue to abuse. The slovenly mother will never clean up and the chronic spendthrift will always be in debt.
Similarly we can see the predictable behaviour of public officials. Many of the protection staff are predictably adversarial. The Fraser Director and his staff are predictably obstructive and wasteful of public funds. Only two percent of foster home closure appeals are successful. This indicates a predictably adversarial stance towards foster homes throughout the province. Ministry bureaucrats can be relied upon never to admit to mistakes, much less correct them. One can depend on them to stonewall evade and obfuscate. Nobody ever gets a straight answer or a satisfactory outcome. There are many, many predictable positive behaviours and an equal number of predictably negative ones. Greed and cruelty are universal, as we all know and these exist side by side with love and self-sacrifice. Just as Finn Jensen made a lot of money out of a case he did not believe in, Doug Christie lost a lot of money doing what he believed in.
The behviour of judges is just as predictable. They will become obsessed with fine legal points and quibbles. They will seek precedents, which may or may not be in the least relevant to the matter in hand, because to them process is everything. They will happily bury everything in process; time, justice and child welfare. You name it. Judges can also reliably be predicted to support the establishment wherever possible. We have seen all these things in the Bayne case. No doubt "for the greater good", Judge Crabtree rescued the ministry from the inevitable dungstorm that would have erupted had he followed the evidence and returned the children.
Another example is that social workers and judges will believe any piece of nonsense presented by a perceived expert. Judges have sent numerous people to prison and families have been broken up on the grounds of evidence given by psychiatrists, psychologists and self-styled therapists who have expounded false theories like recovered memory counselling and allegations of satanic ritual abuse. Shaken baby theory is now half way out the door. Predictably, they never learn and will chase after the next populist belief. Predictably psychologists will always be ready to collect fat fees for catering to these gullible public servants. From the evidence of past behaviour, it is completely predictable that Paul and Zabeth Bayne could not deliberately hurt a child. A fact based profile provides the evidence to make that assessment completely reliable. Of course it is also predictable that Fraser staff will go into denial about that and pass off their responsibilities to a perceived outside expert.
Very astutely written Ray, and depressingly true. It is so much easier to affect a home makeover than a human makeover.
ReplyDeleteThe Fact Based Evidence concept explains why MCFD goes to extraordinary lengths and cost to contract out their skills to such third parties, to give the impression of impartiality and outside, "objective" opinion.
ReplyDeleteA social worker can only bring evidence from point A - through questioning and observation - to point B, into the courtroom.
A social worker's opinion (in Canada, at least) counts for very little in a trial setting, because they cannot be declared an "expert" for court purposes.
The opinion of the same social worker in a different setting, a simple chambers application leading up to a trial, is given enormous weight. These individuals are viewed as impartial officers of the court, viewed as being there without malice and without any personal stake or lack of objectivity.
After all, they do not get paid extra money in their payhceck if they remove twenty children in one month versus just ten. How they benefit is a very different discussion.
This business of "Facts" and "Evidence" is but one strategy for social workers to increase the odds against parents.
One class of "experts" most depended on by child protection social workers are PHd psychologists. A judge cannot ignore their "opinion." A parent cannot easily discredit this expert opinion. The intent is to present a monumental hurdle for parents to overcome. The Baynes are one of the very few families who suceeded in addressing the fallability of these "impartial" quasi-experts used by MCFD.
A doctor is the next best think to an expert. Ostensibly, they do not have a vested interest in the outcome. Yet, their medical reports, with or without their supporting presence, is regarded as evidence by judges in civil child protection cases.
The trend these days is to imbue these quasi-experts with court-ready declarations of not only medical diagnosis, but clear "diagnosis" of guilt or innocence. I gather this is what the main thrust of the conference is about.
It is important to have fact-based evidence, and equally important to uncover falsified, deliberately confusingly presented fact-based evidence obtained by those who have a vested interest "winning" against parents.
What is well hidden is the fact these individuals DO have a vested interest in the outcome. It is exceedingly difficult to explain to casual observers in a few sentences why a social worker would deliberately choose to expended extraordinary effort and cost to warehouse children for as long as possible in the system, rather than offer proper supports to the family.
Abuse specialists who are funded by government funds are another example of highly trained individuals whose livlihood depends on negative findings. If no findings of abuse are found, clearly there is little justification for a specialized abuse infrastructyre and staff to populate the bureaucracy.
New fangled technologies such as penlie testing is a perfect example of a mechanism used to augment "expert" diagnosis which can be used in court. These outcomes can also be used internally to justify continued costly involvment. This "evidence" relieves the judge of having to listen to tedious testimony.
Expert status means that expert does not have to testify to support or defend their diagnosis and written opinion. It can stand alone in court.
Unless, the losing side subpeona's this expensive individual at $250 per hour (at a minimum half day billing increments). One wonders what the shaken baby proponent Randal Alexander charged us taxpayers for his esteemed presence.
All that said, the war of experts on both sides of the fence can learn from such a conference.
Ron I am writing this on June 10th, so please put this in the latest slot.
ReplyDeleteSharon Shoesmith and Ed Balls may be unfamiliar names to most readers. Sharon Shoesmith was the $200,000 a year director of the child welfare authority in Haringey England. There was series of child welfare disasters to rival the cases of Matthew Vaudreuil and Sherry Charly. Repeated complaints and investigations, ending in the death of children, because compelling evidence was ignored.
Ed Balls was the minister responsible for British child welfare under the labour government. He had an inquiry made and when the report came in he found Shoesmith's service to be unfit for purpose and Shoesmith to be unfit for office, so he fired her. Shoesmith filed a suit for wrongful dismissal and after a long court battle, the court ruled in her favour.
The trial judge ruled that the dismissal was unfair, because Balls failed to follow due process. Of course with a name like the minister's, the tabloid press found lots of creative ways of making headlines, but that was just the sideshow. The main reasons were that no opportunity was given to Shoesmith to defend herself. The commissioner who made the inquiry did not discuss anything with Shoesmith and she was given no opportunity to explain anything. The judge declined to get into the issue of whether or not the director was competent, or whether she deserved to be fired, He said that was not his responsibility, but all he had to deal with was the fairness of process and he found the process to be flawed. He ordered her to be reinstated and that she be paid about half a million pounds in back pay, compensation and legal costs.
This is another prime example of how judges are totally immersed in process and outcomes are a nether matter. He was asked to rule on process and that is exactly what he did. It did not matter whether or not the woman was totally incompetent, or whether she thoroughly deserved to be fired. It was not done in the right way and that is all that mattered. There was rejoicing in the Shoesmith camp and also among the social workers. They claimed that they had to do a very difficult job and they could not do it if they were constantly afraid of losing their jobs and this ruling gave them some protection.
Not so fast though. Judges may obsess with process, but politicians obsess with power. What was the reaction of the minister? When the Cameron/Clegg coalition defeated the Blair/Brown labour government, Ed Balls was replaced by a conservative minister. He immediately vowed to appeal the judgement. He reasoned that ministers must be free to run their departments as they see fit and that it is not the prerogative of the courts to tell them how to do it. Lesson to Shoesmith. You may win a battle with the government, but you cannot win the war. They have a lot more money than you and when it comes to a power struggle, you will usually lose.
Lesson for readers of this blog. Even if a child welfare service is as badly run as British Columbia's, it is tough to fire a senior civil servant. Have we heard the last of Leslie Dutoit, or was she paid enough? Joy Rigaux fought and won following Gove. Lesson two, judges care only about process. Child welfare, deserved dismissals and every othe thing on earth are minor matters and process must rule. Crabtree proved the point as well.
Ray Ferris said...
ReplyDeleteRon I am writing this on June 10th, so please put this in the latest slot.
Sharon Shoesmith and Ed Balls may be unfamiliar names to most readers. Sharon Shoesmith was the $200,000 a year director of the child welfare authority in Haringey England. There was series of child welfare disasters to rival the cases of Matthew Vaudreuil and Sherry Charly. Repeated complaints and investigations, ending in the death of children, because compelling evidence was ignored.
Ed Balls was the minister responsible for British child welfare under the labour government. He had an inquiry made and when the report came in he found Shoesmith's service to be unfit for purpose and Shoesmith to be unfit for office, so he fired her. Shoesmith filed a suit for wrongful dismissal and after a long court battle, the court ruled in her favour.
The trial judge ruled that the dismissal was unfair, because Balls failed to follow due process. Of course with a name like the minister's, the tabloid press found lots of creative ways of making headlines, but that was just the sideshow. The main reasons were that no opportunity was given to Shoesmith to defend herself. The commissioner who made the inquiry did not discuss anything with Shoesmith and she was given no opportunity to explain anything. The judge declined to get into the issue of whether or not the director was competent, or whether she deserved to be fired, He said that was not his responsibility, but all he had to deal with was the fairness of process and he found the process to be flawed. He ordered her to be reinstated and that she be paid about half a million pounds in back pay, compensation and legal costs.
This is another prime example of how judges are totally immersed in process and outcomes are a nether matter. He was asked to rule on process and that is exactly what he did. It did not matter whether or not the woman was totally incompetent, or whether she thoroughly deserved to be fired. It was not done in the right way and that is all that mattered. There was rejoicing in the Shoesmith camp and also among the social workers. They claimed that they had to do a very difficult job and they could not do it if they were constantly afraid of losing their jobs and this ruling gave them some protection.
Not so fast though. Judges may obsess with process, but politicians obsess with power. What was the reaction of the minister? When the Cameron/Clegg coalition defeated the Blair/Brown labour government, Ed Balls was replaced by a conservative minister. He immediately vowed to appeal the judgement. He reasoned that ministers must be free to run their departments as they see fit and that it is not the prerogative of the courts to tell them how to do it. Lesson to Shoesmith. You may win a battle with the government, but you cannot win the war. They have a lot more money than you and when it comes to a power struggle, you will usually lose.
Lesson for readers of this blog. Even if a child welfare service is as badly run as British Columbia's, it is tough to fire a senior civil servant. Have we heard the last of Leslie Dutoit, or was she paid enough? Joy Rigaux fought and won following Gove. Lesson two, judges care only about process. Child welfare, deserved dismissals and every othe thing on earth are minor matters and process must rule. Crabtree proved the point as well.
June 10, 2011 5:56 PM
Anon 4:40 "After all, they do not get paid extra money in their payhceck if they remove twenty children in one month versus just ten. How they benefit is a very different discussion."
ReplyDeleteAnd what exactly would that discussion be?
Thank you to give such important information for us
ReplyDelete