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Research on Social Work Practice

http://rsw.sagepub.com Developing Evidence-Based Child Protection Practice: A View From Germany

Heinz Kindler Research on Social Work Practice 2008; 18; 319 originally published online Nov 6, 2007; DOI: 10.1177/1049731507308997 The online version of this article can be found at: http://rsw.sagepub.com/cgi/content/abstract/18/4/319

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Developing Evidence-Based Child Protection Practice: A View From Germany

Heinz Kindler
German Youth Institute, Munich, Germany

The child welfare system in Germany has been described as family service-oriented because families in need are entitled to request family support services. If there is any form of child maltreatment, there may be some kind of mandatory state intervention to protect the child. Using trends in the number of children affected by maltreatment, the rate of maltreated children noted by the child protection system, and safety, permanency, and well-being of children after a maltreatment report as outcome indicators, there are hardly any data on the effectiveness of the German child protection system. Moreover, there are no studies examining the validity of risk assessment procedures or the effects of different interventions in child protection cases. However the situation is changing, with international research becoming more accessible, and with the publication of more relevant studies. Keywords: Germany; Child Welfare; evidence-based practice; child maltreatment

In Germany as in other countries, current social work practice in the child protection area has been highly controversial. Comparable to the Victoria Climbi case in Great Britain (Lord Laming, 2003), the Daniel Valerio case in Australia (Community Services Victoria, 1991; Goddard & Liddell, 2002), or several similar child protection scandals in the United States (e.g., Gelles, 1996; Wilson, 1989), inquiries into cases of fatal child neglect or abuse revealed a number of problems including invalid risk assessment procedures, risk communication failures, ineffective or delayed responses of the child protection system, and a high workload for professionals involved in the child protection system. These problems have caused public concern beyond individual child protection tragedies. Generally, stakes are high in child protection as inappropriate assessment and intervention may leave children without protection, result in unnecessary child-parent separations, or lead to serious violations of childrens and parents rights. In response to this situation, support for the development of evidence-based practice has been quite strong in the child protection field (e.g., Macmillan et al., 2007; World Health Organization, 2006), with Germany being
Authors Note: Portions of this paper were previously presented at the conference titled What Works? Modernizing the Knowledge Base of Social Work, sponsored by the University of Bielefeld, Germany, on 10-12 November 2005. Correspondence concerning this article may be addressed to Heinz Kindler, Ph.D., German Youth Institute, Nockherst 2, D-81541, Munich, Germany, or via email using kindler@dji.de. This article was invited and accepted by the editor. Research on Social Work Practice, Vol. 18 No. 4, July 2008 319-324 DOI: 10.1177/1049731507308997 2008 Sage Publications

no exception to the rule. However, interest in building an empirical research program aimed to create an evidence base for child protection practice has grown only recently in Germany. This article gives a short overview of where we stand now. First, a quick introduction into the German child protection system is given. Second, the existing evidence base is reviewed, and finally, obstacles to the development of evidence-based child protection practice are discussed. Child Protection in Germany Germany is a federal republic composed of municipalities, districts, federal states, and a central federal government. There is a federal family law regulating mandatory state intervention by family courts in families, and there is a federal social code regulating duties and rights of the children and youth authority (Jugendamt), including the obligation to offer a range of services for families in need and to investigate child maltreatment reports. Children and youth authorities are mostly organized on a district level. They have the right to temporarily remove children from their parents in cases of emergency. Besides emergency situations, mandatory state intervention in families can take place only if a family court decides that there is a situation to be judged as child endangerment (Kindeswohlgefhrdung) and if the parents are unable or unwilling to improve the childs situation. Child endangerment has been defined as a present danger that will lead with high probability to severe impairment of the childs well-being and development if no action is

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taken. Mandatory state intervention can lead to childparent separation if and only if there is no other way to improve the childs situation. That is to say, even in cases of child endangerment, family counseling and support services are a preferred option if there is no immediate danger to a child. Family counseling and support services can be delivered by the children and youth authority, or by private, mostly non-profit, child welfare organizations, which are widespread in Germany. There is no comprehensive mandatory reporting system, although there are some exceptions for schoolteachers in several federal states. If a private organization providing family services comes across a case of possible child maltreatment, it is obliged to do a comprehensive risk assessment and offer additional help to the family if necessary. If no risk assessment can be done or if help is rejected, the children and youth authority has to be informed. Otherwise, there is no obligation to make a report. Compared to data from the United States, Canada, and Australia (American Public Human Services Association, 2005; Bromfield, 2006; Fallon et al., 2003), the workforce level of academic qualification in the German child protection system is quite high. An overwhelming majority of all workers have studied at least 4 years at a university for applied sciences and have earned a social work degree. Child protection issues, however, are rarely addressed at the university. The philosophy of the German child protection system has been described as family service oriented and holistic (Gilbert, 1997; Hetherington, 2006) because families are entitled to request support services at an early stage before child endangerment is present and because there is no organizational divide between family support and child protection services. Like other continental West European child protection regimes, the German system sometimes has been portrayed very positively in the Anglo-American literature (e.g., Hill, Stafford, & Green Lister, 2002). However, as no analysis of child protection outcomes was provided, there may be confusion between child protection rhetoric and fact.
Child Protection Outcomes in Germany

Unfortunately, the question of how effective the German child protection system is, as a whole, could not be answered until now. Unlike many other countries (e.g., United States: Sedlak & Broadhurst, 1996; the Netherlands: Van Ijzendoorn et al., 2007), Germany has not used sentinel methodology to estimate the number of children experiencing maltreatment. There is one representative retrospective questionnaire study regarding physical and sexual child abuse (Wetzels, 1997).

However, this study excludes child neglect, which is likely to be the most common form of child maltreatment. Despite the World Health Organizations call that governments should monitor the number of child maltreatment cases (World Health Organization, 2002), no data on child maltreatment reports received by children and youth authorities are collected at a state or federal level. Therefore, we do not know how many children experience maltreatment in Germany, nor do we know how many of these children come into the focus of the child protection system. As a consequence, we are also ignorant about trends in the number of children affected by neglect or abuse. Child safety and permanency after a maltreatment report has been received are used as official key child protection outcome indicators in several countries on a national level (e.g., United States: Childrens Bureau, 2006) or regional level (e.g., England: Department of Health & Department for Education, 2007). Moreover, some additional independent studies using the same criteria but different methodologies contribute to the knowledge base (e.g., Jonson-Reid, Chance, & Drake, 2007; Jonson-Reid et al., 2003). In Germany, until now not a single study has looked at child maltreatment recurrence. Regarding permanency, there are several data sets on children in out-of-home placement, but only one study of our own research group (Thrum, in press) has reported data for a large group of foster children with a maltreatment history, showing that more than 40% of the children experience two or more major separations. As the rate of reunification of foster children with birth parents generally is quite low in Germany (e.g., at a certain point in time reunification was planned for less than 10% of our foster children sample), the instability experienced by foster children with a maltreatment history mainly is a function of their behavior problems and insufficient support for foster carers. Achieving child well-being (e.g., good mental and physical health, positive self-esteem, good educational progress) repeatedly has been named as another key child protection outcome indicator. Although multiple studies with different outcome variables, methodologies, and time frames are needed to form a comprehensive picture, long-term studies following children for whom there was a substantiated maltreatment reported into adolescence and young adulthood are especially informative. Available studies from Sweden, the United States, and Great Britain (e.g., Gibbons et al., 1995; Horwitz et al., 2001; Perez & Widom, 1994; Vinnerljung et al., 2006) have raised considerable doubts as to whether existing child protections systems are already effective enough to support long-term child wellbeing. In Germany, no such study has been done until

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now. However, two studies using the Child Behavior Checklist with children in foster and residential care of whom a majority have experienced maltreatment do not leave much room for the assumption that the German child protection system is especially successful (Kindler, 2006; Schmid, 2007). Moreover, as in other countries (Barth & Ferguson, 2004), data on the educational progress of children in out-of-home care are not very encouraging (Kindler, 2006). This does not mean that out-of-home care and family support as used in Germany are on average unhelpful. At least two large-scale studies (Baur et al., 1998; Schmidt et al., 2002) show that the majority of participating children and their families experience some relief and reduction in childrens behavior problems. However, as both studies are short term and control groups are lacking, it is impossible to know whether effects can be distinguished from regression to the mean effects or if they are sustained in the long run. Moreover, both studies do not look at children with confirmed child endangerment separately. In summary, regarding its own effectiveness, the German child protection system is pretty much in a situation like an airplane flying in the fog. Although lacking information per se is no proof that a system is failing, there are at least some indicators that the child protection system is in trouble. For example, studies repeatedly found that judges and social workers both believe that they are not well trained and informed regarding child protection cases (Mnder, Mutke, & Schone, 2000; Rosenboom, 2006). Moreover, it is alarming that in an international comparison on the number of fatalities due to child neglect and abuse, Germanydespite its very cost-intensive child welfare systemscored only in the middle range (UNICEF, 2003).

DEVELOPING EVIDENCE-BASED CHILD PROTECTION PRACTICE IN GERMANY: CHANCES AND OBSTACLES Knowledge about system outcome indicators is important for evidence-based policy making (Pawson, 2006), but it does not answer workers questions about how to proceed with a concrete case. For supporting frontline child protection workers, a different kind of research studies evaluating and comparing different approaches to risk assessment, relationship building, and intervention is needed. Fortunately, the Federal Ministry for Family Affairs, Senior Citizens, Women, and Youth enabled us to form a work group at the German Youth Institute aimed to make relevant research available for child protection

workers in Germany. However, conducting a literature search for high quality studies, defined as research that takes into consideration at least some possible threats to validity (Shadish, Cook, & Campbell, 2002), we were unable to locate any relevant German studies. Therefore, we had to turn to the international literature and discuss the results with colleagues from the field to make sure that they could understand and use our suggestions. For example, we used group discussion to develop a taxonomy of diagnostic tasks child protection workers have to accomplish. Next we did a systematic literature review on these different tasks (e.g., safety assessment, parenting capacity assessment, child abuse and neglect risk assessment) and tried to distill the results to some core points that might work in Germany as well. Thinking about what might work in Germany, we used several criteria as an orientation (e.g., whether a prognostic factor or assessment instrument had shown prognostic validity in different cultural groups or countries). We generally were impressed by the highquality research that has been done in several countries around the world. For example, there were several instruments with some prognostic validity in assessing the risk of recurrent physical abuse or neglect, most of them developed at the Childrens Research Center in Madison, Wisconsin, United States (for reviews, see DAndrade, Benton, & Austin, 2005; Rycus & Hughes, 2003). Using parenting capacity assessments as another example, substantial work has been done in Canada and England (e.g., Reder, Duncan, & Lucey, 2003; Steinhauer, 1991). Based on our research review, we finally suggested eight types of risk factors that German colleagues doing frontline child protection work might want to consider when assessing abuse or neglect risks. We also suggested four parenting capacity dimensions (care and safety, attachment, socialization, and stimulation), each with several indicators as a background model for parenting capacity assessments. As a result of our project, we published a handbook for child protection practice (Kindler et al., 2006). Inspired by the American Handbook for Child Protection Practice (Dubowitz & DePanfilis, 2000) we collected concrete questions from frontline workers and tried to organize and answer them in short chapters (6-7 pages). The Federal Ministry and we are distributing the handbook in print, on CD, and on the Web. Now we are conducting an initial first reliability and validity study with a widely used German risk assessment instrument. In another project, we are undertaking a systematic review on risk screening procedures for families with newborns and infants. All in all, it is clear that we are still at the beginning of the development of evidence-based child protection

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practice in Germany. For example, we did a systematic review on in-home interventions in child protection cases (Kindler & Spangler, 2005) and found that interventions with the best available evidence were not very common in Germany. Given the fact that some other nations began the process of developing evidence-based child protection practice somewhat earlier (for reviews, see MacDonald, 2001; Munro, 2002), one might ask why Germany is lagging behind. I would like to offer three possible explanations, a philosophical one, a pragmatic one, and a political one. First, there is a deep-rooted tradition of idealistic philosophical thought in Germany. The influence of this tradition has vanished in most university departments, but it is definitely alive in some schools of social work. Idealistic philosophy in social work, ranging from phenomenology (for an introduction, see Anderson, 2003) to so-called critical theory (for an introduction, see Rush, 2004), exhibits a wide variety of positions, but generally, the empowerment of professionals by helping them to understand and reflect upon important ideas, experiences, societal developments, and their clients position within this processes are considered central. There is a lot of mistrust against instrumental reason and methodologies that should help to approach objective knowledge because a critical reflection on the aims, uses, and underlying basic categories is not automatically included in this research (for an English example of this line of thought, see Spratt & Houston, 1999). Sometimes there is a call for empirical research but, in effect, practitioners are seen as able to reflect upon their experience even in the absence of reference points in empirical research. As a result, the time-consuming, cost-intensive, and empirical study of narrow concrete problems (e.g., how to work with a neglectful family) is not valued very much. Second, more pragmatically, among German professors of social work there are not many who have ever done and published a high-quality empirical study. For example, we (Liel & Kindler, 2006) did a methodological review of all articles published over a five-year period in five German social work journals classifying all empirical articles into one of five categories. Three of these categories had also been used by Rosen, Proctor, and Staudt (1999): descriptive (studies assessing the central tendencies or distribution characteristics of variables), explanatory (studies examining relationships among two or more variables), and controlled (studies examining the effect of interventions). We added two more categories: illustrative (empirical study is used to illustrate a theoretical statement, central elements of the methodology are not reported) and systematic review. In effect, within

more than 500 articles, we did not find a single systematic review, only 2 controlled studies and only 4 explanatory studies. Most empirical studies were coded as illustrative (n = 46) or descriptive (n = 39). That means empirical research as it is published at the moment in Germany simply does not examine effects of social work, and although there may be a lot of hidden talent, most of the people doing social work research may not be prepared to understand and use more advanced empirical methods. Third, strong and consistent political support for the development of evidence-based child protection practice has been missing in Germany until now. Doing a comparative analysis of central policy documents with relevance to child protection in Germany and several other countries (e.g., England: Department for Education and Skills, 2003; New Zealand: Ministry of Social Development, 2002; Australia: Department of Human Services, 2002), we (Kindler, 2007) found that in the material from Germany, nearly no reference was made to empirical research, outcome criteria, and evidence-based practice. This clearly was not the case in the policy documents from most other countries. But the situation may be changing in Germany. The most recent federal document on the development of programs to prevent abuse and neglect during early childhood explicitly states that scientific research on the effects of early prevention should be conducted, and at least one randomized controlled trial has already started. This, of course, is encouraging. CONCLUSION Dealing with these obstacles, it is necessary to convince scientific colleagues and policy makers that evidence-based child protection practice can and should be developed in Germany. Moreover, it is useful to try to involve colleagues from other, more empirically sophisticated, advanced fields (e.g., pediatricians). It is central, however, to stay in touch with frontline workers and families because their needs legitimize our work. Looking back on the last years, it was important to learn from high-quality research that is done all over the world. In the next years, I hope that we can give something back to the international scientific community that is working on child protection issues. REFERENCES
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