Distinguishing Between Poor/Dysfunctional Parenting and Child Emotional Maltreatment - Conclusions and Recommendations

Conclusions and Recommendations

The developmental perspective described herein views poor parenting and child emotional maltreatment in the context of the parent-child relationship, which has major implications for defining and addressing these issues. Rather than focusing on parental actions alone, this perspective is bi-directional and takes into consideration the relative risk of harm to the child. Therefore, acts of emotional maltreatment may differ in form or intensity in accordance with a child's age or special needs. Because of this variability and the relational context in which parental actions occur, it is deemed necessary to include dual criteria for CEM pertaining to 1) specific parental behaviours shown, and 2) their potential impact on the child. Furthermore, whereas specific criteria are necessary for child welfare decisions relating to allegations of CEM, meeting specific criteria may not be necessary for determining poor/dysfunctional parenting (unless it is needed to obtain services or other assistance).

Poor/dysfunctional parenting methods occupy a wide range along our hypothetical continuum of positive- to-negative parenting behaviours, whereas emotionally abusive or neglectful methods warrant a qualitative distinction from the other methods. In light of this distinction, poor parenting methods fall within a population health mandate: most parents need to receive some level of assistance, education, and awareness to maximize their important role and reduce all forms of child abuse and neglect (Butchart et al., 2004). In contrast, CEM more closely aligns with an intervention (disease) model, in that it stands out as qualitatively more extreme and potentially more harmful than poor parenting and affects a relatively small percent of the population. The different criteria for CEM relating to parental acts and child outcomes can be reliably applied in suspected child welfare cases, facilitating targeted resources and interventions. Implications for these distinctions are highlighted in the following recommendations:

Adopt a Categorical Definition of Child Emotional Maltreatment

The research of Heyman and Slep has shed considerable light on the benefits and utility of applying a categorical, empirically-validated approach to CEM. This approach has shown strong reliability and validity in the field, and may be perceived as more "fair" and objective from a child welfare perspective in which parental rights are at stake. For example, the assessment process is objective and thorough in that it involves a full description of the event(s), context, and risks observed or described. The findings are then provided in written form to a committee to review, reducing the burden on the case manager for making the final determination as well as possible bias. Because child welfare and legal matters must have clear guidelines and definitions, a categorical approach based on scientific evidence is most appropriate for CEM. This approach seems worthwhile for field studies in Canada.

Adopt a Continuum Approach to Defining Poor Parenting

Poor parenting methods are wide-ranging, and require a definition that is of most assistance to public education and awareness (as opposed to child welfare action). As noted by the Think Tank participants, "It is important that the tools exist to identify the more extreme cases for intervention by the child protection system, but public health interventions might be most effective in addressing the more moderate instances (i.e., parenting problems) and preventing emotional abuse or neglect from occurring" (page 17). Although a diagnostic approach can be applied to poor parenting methods, such an approach has relevance mostly for directing clinical intervention (rather than child protection). From a population health perspective, parents need to be informed of "good" and "bad" childrearing methods in a manner that is constructive and educational. A continuum model allows parents to identify the boundaries of appropriate and inappropriate childrearing methods, with a greater focus on healthy strategies and less emphasis on child welfare violations.

Address Gaps in Training

There is an absence of consistent guidelines for training in child welfare and public health approaches to family support. Training guidelines should be introduced for distinguishing CEM (and related forms of maltreatment) from poor parenting, similar to those developed by Heyman and Slep. Training should ensure that all community professionals can reliably distinguish acts requiring child protection investigations from those requiring family or parent-support services. This training could be blended with in-service and continuing professional education and training on child physical abuse, witnessing domestic violence, and similar important topics. Field trials of a diagnostic approach to child welfare investigations can be more readily conducted once training is widespread.

Expand Public Health Strategies to Promote Healthy, Positive Parenting

The conclusions of this report point to the benefits of a public health model for reducing the overall incidence of parenting disorders and emotional maltreatment. Such a strategy requires fewer resources per child and is typically more effective than those relying on detection and protection alone. A public health emphasis involves increasing protective factors such as parental awareness of childrearing options, improved childrearing skills, community-based support during early years of parenting, school involvement, and many others. A public health model emphasizes healthy, positive parent-child relationships by informing the public what positive parenting involves and why healthy child development is important. For example, the continuum model could be used as an educational tool for parents by designing posters for community settings emphasizing positive childrearing methods. Community efforts promoting authoritative parenting methods can be readily adopted from evidence-based programs (noted below).

The need for the 'diagnostic-intervention' corrective/protective approach should/could be significantly reduced if the public health approach is strong and true. Because CEM is complicated and has so many shades of meaning, forms, and impact, and because it is so widespread, with relatively little corrective interventions in place, it may provide just the right opportunity for moving primary prevention and positive childrearing promotion to the top of the child protection priority list (Hart & Brassard, personal communication, February 8, 2010).

Adopt a Children'S Rights Approach to Child Protection and Public Health Education

The UN Convention on the Rights of the Child [particularly article 6 (survival and development), article 5 (parental rights and responsibilities), and article 19 (protection from all forms of violence and maltreatment "while in the care of parents, legal guardians, … and the expectation of a protection and prevention approach as well as an intervention approach"] offers a sound basis for establishing universal-international principles and standards to which Canada has committed. A child rights approach supports primary prevention and education for healthy, positive childrearing methods noted herein, and is well-suited to an overall public health strategy. For example, the best interests of the child are defined and detailed conceptually and operationally in child rights terms, assuring fulfillment of the child's needs and realization of the child's potentials (Bennett, Hart, & Svevo-Cianci, 2009).

Address Gaps in Research and Evidence-Based Interventions

Further studies are needed to distinguish poor parenting and CEM empirically. One example would involve comparing parents identified on the basis of the criteria noted herein (i.e., poor parenting and CEM) with a normal comparison group, in terms of parenting methods and individual, family, and community factors. An additional research priority involves randomized controlled trials of prevention and intervention approaches with parents identified as emotionally maltreating their children.

Studies on effective interventions for parents identified as emotionally maltreating can select families requiring such action based on categorical (diagnostic) criteria noted herein. These families could receive interventions that have shown efficacy with other maltreating or high-risk populations and that might be suitable with this identified group (e.g., The Triple P Positive Parenting Program: Prinz et al., 2009; Prinz & Sanders, 2007; Nurse Home-Visiting Programs: MacMillan et al., 2009; parenting interventions focusing on negative parental cognitions: Bugental & Schwartz, 2009). Population-based interventions could also be delivered to emphasize reduction in risk factors pertaining to both CEM and poor parenting, such as maternal/paternal insensitivity, disciplinary methods, access to community health and family services, etc. (e.g., The Incredible Years program: Reid, Webster-Stratton, & Hammond, 2007; Webster-Stratton, Reid, & Stoolmiller, 2008).