Paradigms in building a trauma-informed, infant-led, relationally reflective system of care: A contemporary exploration of the intersection of the Australian child protection system, the child protection practitioner, and the care of the infant.
Introduction
National child protection data gives evidence of a growing proportion of infants entering out-of-home care (AIHW, 2015). Out-of-home care (OOHC) is a system of care that encompasses short to long-term fostering or kinship care arrangements for children who have been removed from their families due to evidence of severe neglect, harm, or life-threatening risks (Queensland Government, 2019). Across Australia in 2016–17, infants (aged less than 1) were more likely to have received child protection services (37.2 per 1,000) and in the ages 1 – 4 it was around 29 of 1,000 (AIHW, 2018). More specifically, in Queensland as of June 2018, the percentage of substantiated harm (all types) included 7.6% of unborn and 30.5% of 0 – 4 ages (DCSYW, 2019). These findings demonstrate that younger children are more vulnerable, inviting specific protective policies and procedures and an increased national emphasis on early intervention, through assessment and treatment to reduce the adverse effects of trauma and harm and to improve longer-term outcomes (DCSYW, 2019). Considerable research in this field identifies an increased risk of problems with physical health, developmental delays, and relational capacity (Dozier, Bick, and Bernard, 2011; Silver, 2000; Wulczyn, Hislop, and Harden, 2005), due to the infant’s complete dependency on adults who are responsible in attending to their needs (Zhou and Chilvers, 2008). When the parent or carer cannot be considered appropriately cared for, child protection authorities must intervene to safeguard the infant’s wellbeing (McIntosh, 2008).
Increasingly, the research addresses the role of the Child Protection Practitioner (CPP) within the Child Protection System (CPS) that aims to keep these young children safe. There are a great many complexities to consider around the challenges that CPPs face within their practice, within the system, and with the interaction with families, foster carers, and non-government departments (Ferguson, 2017). This research shows concerns regarding the capacity and decision-making ability (Gillingham, 2017), appropriate levels of support (Hunt, Goddard, Cooper, Littlechild, & Wild, 2016), and the ongoing education for CPPs to undertake this very complex role. Nevertheless, limited research has been undertaken concerning the intersubjective nature of the CPP, the system, and the infant in OOHC in Queensland (QLD), in Australia, or internationally. Whilst it is important to continue to develop research in all areas of the infant in OOHC; enhancing a local knowledge base to support the CPP, the child protection system, and policy developments in QLD are warranted. An anticipated outcome of this research is a critical understanding of the nature of systemic intersubjectivity (Helm, 2016) within the complexity of the relationship between the infant, their carers, the CPP, and the CPS. This critical systemic intersubjectivity may then translate into the holistic care of the infant in OOHC through policies, procedures, and targeted training for practitioners to directly address matters confronted by these young children. Understanding the relationship of these roles and care systems through an infant-led, trauma-informed lens (Bloom and Farragher, 2013) is required to explore how to support the complex intersubjective relationship of infants the CPP, and the care system. According to Bunston (2018), an infant-led approach reflects the experience of the infant, as being a dynamic member in the process of any potential growth or change. Working then from the infant and child viewpoint rather than the adults invites a more robust way of approaching thought and intervention (Bunston, 2018). Conversely, it is equally important to consider the needs of the worker and the carers, for if the managers of systems cannot respond to the safety needs of the workers then how can the workers be empowered to see all the safety needs of the linguistically limited infant (Bloom, 1998).
The Child Protection System in Australia
In Australia, child welfare legislation and service provision are the responsibility of the community services department in each State and Territory. In the state of QLD, the responsible government body at the time of this research is the Department of Child Safety, Youth and Women. The evolving nature of the child protection system within the Australian context has been central to much controversy over its lifetime as well as being hybridized through many political changes (Fernandez and Atwool, 2013). However, there has developed a lasting impact through the lens of the stolen generation with a pervasive and transgenerational impact on Aboriginal and Torres Strait Islander communities (Home, 1997). This transgenerational trauma experienced through the loss of connection to country (land), family, and community has translated to an ongoing disadvantage (Dudgeon, Watson, and Holland, 2017). Statistics for 2016-17 outline that Indigenous children were 7 times more likely than non-Indigenous children to receive child protection services, which equated to 164.3 per 1,000 children, next to 22.3 per 1,000 for non-Indigenous children (AIHW, 2018). This is further evidenced through the over-representation within systems such as the juvenile and adult justice systems (Grace, Knight, McMahon, McDonald, and Comino, 2017). There exists an intergenerational progression of trauma through the historical events of colonization to increases in family violence, child sexual abuse, and family breakdown (Dudgeon, Watson, and Holland, 2017). Holding ethical regard for all infants in OOHC and connecting to this country demands an ongoing deeper exploration and understanding of the child protection system.
The Research Aims and Questions
There are three core aims within this research; Firstly, an infant-led contemporary exploration into the nature of a child-centered and trauma-informed practice that is pivotal for the mental health and wellbeing of the infant in out-of-home care. Secondly, to seek a deeper understanding of the critical systemic intersubjectivity of contemporary social work practice (CPP) within the public child protection system in QLD, Australia. Then, thirdly, to crystallize the role of child protection policies and practices in relation to early mental health intervention support and approaches for infants in out-of-home care.
The main research question asks;
What is the nature of the current model of mental health early intervention for infants in out-of-home care that can strengthen social work practitioners' attention and skills in a child-centered, trauma-informed approach, which simultaneously mirrors a trauma-informed system of care that supports practitioners?
There are also several sub-questions asking;
What is the nature of contemporary social work practice in the public child protection system in Australia?
What does the research data and best practice evidence suggest needs to be included in a proactive, child-centered, and trauma-informed mental health intervention model?
What refinements are suggested to the model after an engagement of child protection workers in trialing it in their practice? And lastly, what recommendations arise from the research to influence government policies and practices in relation to early mental health intervention approaches for infants in out-of-home care?
Methodology
Critique of research paradigm elements with reference to theorists and exemplar papers.
A research paradigm is made up of ontology, epistemology, methodology, and axiology. Ontology can be described as your way of being or what you believe is real in the world; Epistemology, as how you think about that reality; Research methodology, is how you are going to use your ways of thinking to gain more knowledge about your reality; and the axiology, as a set of morals or ethics (Wilson, 2001).
Critical methodological approaches will direct the core paradigm that informs the current directions in this research. Through this perspective, it is anticipated that the researcher can begin to deconstruct and reconstruct assumptions influencing a deeper investigation within the research design (Hickson, 2016). Fook and Gardner (2007) explain that critical reflection can be used as a framework for approaching research or it can be used to supplement other research approaches. However, according to Hickson (2016) using qualitative research methodology can inform an interpretive and subjectively constructed approach to inform the ultimate design of the research study. Therefore, the end design will also hold an Interpretivist lens, because as a researcher the goal is to seek an understanding around one’s own and another’s meaning as constructed within and of their experiences, interpretations, and perceptions. This meaning-making concept leads into the intersubjective angle of the research and brings to attention a key infant-focused lens of felt relationships (Fonagy, 2010; Siegal, 2016).
According to Wilson (2001), critical theorists align with a single reality, but that it is fluid and contingent on gender, culture, and social class. The influence of these factors are connected to the individual’s experience and identity that are changeable and impactable, suggesting the epistemology is contextually based, meaning a situation impacts your idea of reality. The critical theory it could be said is working toward social change with the goal of improving the current reality through a deeper exploration and understanding (Wilson, 2001). According to Denzin (2017), there is an increasing need for the critical qualitative inquiry to attend to matters in the public arena and calls for interpretive, critical, performative qualitative research that matters in the lives of those who daily experience social injustice. Foucault (1990) articulated that societal-level power relations both shape and are shaped by concrete small-scale action and that they permeate our lives, and of how ‘power passes through individuals’ (Foucault, 2003, p. 29). Making sense of these socially organized hierarchies takes place through critical investigation for potential action which opens up for those positioned on the bottom of whichever hierarchy being explored (Chapman, 2011). The infant in OOHC it could be argued being quite possibly the most vulnerable within any hierarchy. Whilst these hierarchies intersect in complex ways through a critical lens we must see ourselves within this web and occupying a power differential. We, therefore, need to reflexively navigate how power is passing through us (Chapman, 2011), as a concept to understand how to experience the power differential for the infant and therefore the CPP within the hierarchy of Child Protection.
Furthering this idea of complex hierarchy through the critical lens can be done by assuming an analytical position known as ‘intersectionality’. This is a paradigm that allows researchers to further analyze identity and oppression. This can further challenge the hierarchical and complex nature that exists among the interrelatedness of social systems, considering how an intersectional perspective can shape and better inform the role of the CPP at the micro, mezzo, and macro levels (Mattsson, 2014). Bronfenbrenner’s (2018) ‘ecological systems model’ now known as the ‘bioecological model’ brings these complexities into the conversation for children as those crucial political, economic, and social factors that impact on their development emphasise the wider environmental issues uniquely layered. Mattsson (2014) argues that an intersectional approach, focussing on the interplay and complexity between gender, sexuality, class, and race, critical reflection allows ongoing attention to core power relations.
Critical intersectionality will be overlayed with intersubjective systems theory, coming together to form a deeper critical perspective that lends itself to the interactions that take place in between all dimensions of the infant’s experience; the carer, the CPP, and the child protection system.
Application of the research paradigm to the proposed research project.
The research design intention lies then in an intersectional angle of the critical paradigm along with an intersubjective understanding that can be guided by a Critical Narrativist approach (Hickson, 2016). This critically reflective approach can then be used to deconstruct the participants’ stories to question the construction of knowledge, power, and reality, as the researcher then reflexively attunes to implicit and explicit influences on the research. The practical design will be through participant observation utilizing an Infant Observation as a Research Approach (Rustin, 2006) which is ethnographic in nature. Through a critical ethnographic interchange with Infant observation there is a critically reflexive connection; an intersubjectivity of felt relationship enabling the researcher to share in the experience of the researchee. Infant Observation being a naturalistic participant observation approach aims is to observe as much as possible, be responsive as required, without initiating interaction or giving advice, staying present to the intersubjectivity and the researcher’s emotional responses to what is being seen and felt in the development of the baby, or in this case the CPP, over time (Wakelyn, 2011). Ingold (2014) highlights that there can be no observation without the participation and that there is always an intimate connection, in perception and action, of the observer and observed inviting an ontological commitment of involvement and formation of shared experience and knowledge.
The method or steps in the research will seek to invite CPPs from three Child Safety Service Centres on the Sunshine Coast who currently have at least one infant (0 – 2) on their caseload they are actively involved with. The general steps seek to include: a) a pre-questionnaire of current knowledge around infant mental health; identifying baseline care practices and needs in the infant, b) a narrative semi-structured interview of CPP's experience within CPS and what drew them to this work; c) then undertake at least one home visit with each CPP, to observe the interactions either using a checklist; Such as the Mental Health Screening Tool (Brown et al, 2000), as a guide. The last step, d) will consider the benefit of a post-observation questionnaire or semi-structured interview either individually or as a group, using reflective supervision practices. A reflective supervision model requires the CPP to pay explicit attention to the emotional and relational aspects of their work with families. Through this exploration, the CPP can have an opportunity for open dialogue and a safe place to express and explore their feelings thus modeling what is asked of them in their relationship with the infant and their family (Gatti, Watson, and Siegal, 2011).
An alternate paradigm: Indigenous Methodology
In keeping with this researcher’s inquiry into issues within child protection and hierarchy the second key paradigm investigated is Indigenous Methodology. This was chosen for a number of reasons including but not limited to; the transgenerational trauma impacting the Aboriginal and Torres Strait Islander peoples (Grace, et, al., 2017); the increasing call to relationship focus in social work (Howe, Kohli, Smith, Parkinson, McMahon, Solomon, and Walsh, 2018); the need for increased attention to post-colonial discourse (West, Stewart, Foster and Usher, 2012) and a growing sense of being limited to a worldview through a modern critical lens (Wilson, 2001) and the desire for a deeper understanding for this research.
Habermas (1984) outlines that one of the consequences of colonization is the impact on intersubjectivity, or how individuals relate to each other, in particular around the establishment of mutual understanding. Indigenism is a term defined by indigenous scholars conceptualizing methodological reform drawing on approaches that are compatible with the experience and interests of indigenous people (West, et. al., 2012). Wilson (2001) explores Indigenous methodology as an approach to dialogue about relational accountability and that the researcher is accountable to all relations when doing research. This approach whilst incorporating moves beyond a critical paradigm in that the goal is not in answering questions of what is valid or reliable nor is it about making judgments of what is best but instead the call is to connect in relationship with the world around you (Wilson, 2001). Whilst indigenist research has its origins in critical theory, Denzin and Lincoln (2008) highlight that critical theory will not encapsulate the indigenous experience unless it is localized and grounded in the unique meanings, traditions, customs, and community connections. These research methodologies then are required to reflect researcher reflexivity and encompass an ethical, critical, deeply respectful, and humbled approach (Denzin & Lincoln, 2008).
Indigenous methodology in moving forward is required to evolve into a new anticolonial epistemology and methodological paradigm carrying within them the potential to fortify the struggle for cultural liberation from subjugation. West et, al, (2012) bring to the conversation specifically Dadirri*, to represent elements of the critical paradigm which can reflect an indigenous way of life. ‘Ungunmerr-Baumann (2002), a distinguished Aboriginal educator and artist from Daly River, described the importance of Dadirri for both indigenous and nonindigenous people’ (West, et, al, 2012, p.1584). Reflexivity is represented through this paradigm as pivotal in that, “Dadirri means listening to and observing the self as well as, and in relationship with, others” (Atkinson, 2002, p. 19). West et. al (2012) claim that Dadirri can stand alone as a methodological approach and a critical lens for data analysis. Dadirri considers; knowledge and consideration of the community; diversity and uniqueness each individual brings to the community; ways of relating and acting within the community; nonintrusive observation, or quiet, aware, watching; deeply listening; reflective, nonjudgmental consideration of what is, and what is heard; based on what is learned from listening informed by wisdom and the responsibility that comes with knowledge (West, et, al, 2012). Kovach (2009) states that any such research, whether it is ‘positivist, constructivist or transformative, is still researching us’ (p. 29). Kovach (2009) also highlights that there is an ongoing need for united approaches to research that take a relational stand to support Indigenous methodologies to flourish.
“In this contested space between the two knowledge systems, the cultural interface, things are not clearly black or white, Indigenous or Western. In this space are histories, politics, economics, multiple and interconnected discourses, social practices, and knowledge technologies that condition how we all come to look at the world, how we come to know and understand our changing realities in the everyday, and how and what knowledge we operationalize in our daily lives” (Nakata, 2007, p. 9).
This research’s methodology asks different questions which are focussed on relationships rather than asking about validity or reliability, the researcher will also ask ‘how am I fulfilling my role in this research relationship? And What are my obligations in this relationship?’. This axiology or morals according to an indigenous methodology need to be an integral part so that when the researcher is gaining knowledge, this is not just an abstract pursuit but one that the researcher is responsible for upholding their end of the research relationship (Wilson, 2001). This becomes an Indigenous methodology, by looking at relational accountability or being accountable to all my relations.
In seeking the narrative of CPPs around their relationship with the infants in their charge, and their experience within child protection services, the research, and the researcher is entering a sensitive and complex world. Whilst it is important to hold a critical paradigm in this work and in the preliminary exploration of these complex systems, it could be said that the storytelling and methods of personal narrative fit an indigenous epistemology because when relating a personal narrative, there exists a relationship with someone (Wilson, 2001; West, et. al, 2012). Wilson (2012) explains that participatory action research is useful for Indigenous people because it aligns with axiological beliefs and whilst action research may have its roots in constructivist or critical paradigms, it also fits into an indigenous paradigm because the idea is to improve the reality of the people with whom you work.
Conclusion
Through a critical and systemic intersubjective lens; which is now influenced by the relationally based indigenous methodology, the research will seek to address the complexity of the relationship from the infant’s experience and need to the CPP experience and need to the capacity of the system and the gaps in knowledge and skill to relate to the whole system of care. Reflexively speaking and in with the impact of indigenous methodology supporting the CPP to see through the eyes of the infant will require that the researcher investigates through the eyes of the CPP. This research then will be presented through a critical paradigm and an indigenous narrative approach, with the intention of increasing the reflective capacity of the infant’s system of care.
*N.B, permission was not sought for the use of Dadirri at this time, however, is referenced accordingly, for any future use or publications permission will be sought.