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Social Work Practice with Children
By Nancy Boyd Webb The Guilford Press
Copyright © 2003 The Guilford Press
All right reserved. ISBN: 1-57230-886-9
Chapter One
Children's Problems and Needs The birth of a child sets in motion a chain of inevitable responsibilities for the parents, the rest of the family, and even the community, because all at some future time will be expected to provide in varying ways for this dependent and growing new life. When the parents cannot care for their child, relatives may do so; and when the extended family is unavailable, the state steps in. Society therefore maintains a vested interest in the adequacy with which families meet children's needs.
THE SOCIAL CONTEXT OF CHILDREN'S LIVES
Garbarino, Stott, and Associates (1989) list the basic needs of children as nurturance, responsiveness, predictability, support, and guidance. Meeting these needs may be extremely difficult for unmarried mothers and others living below the poverty line.
The incidence of children under age 18 living in a one-parent family in 1990 was 25%, as compared with 10% in 1960. By 1999, 45% lived in female-headed households, and this number increased to 59% in 2000 (Children's Defense Fund, 2000). In addition, the number of children entering foster care doubled between 1987 and 1991 and increased 35% during the 1990s (Children's Defense Fund, 2000). In 1998 nearly one out of every fivechildren in the United States lived in poverty. Almost half of these children lived with their single mothers, who were three times as likely to be poor as other adults (Children's Defense Fund, 2000).
What is the impact on children of living in impoverished environments that are characterized by unemployment, pervasive substance abuse, inadequate health care, poor-quality childcare, and high levels of child abuse and neglect? Some studies have found that these socioeconomic disadvantages can contribute to higher incidences of impairment in children's social, behavioral, and academic functioning (Achenbach, Howell, Quay, & Conners, 1991; Duncan, Brook-Gunn, Klebanov, 1994; Institute of Medicine, 1989; Schteingart, Molnar, Klein, Lowe, & Hartman, 1995). Obviously, poverty is a serious social and personal crisis, and interventions to help poor children and families will require broad-based efforts that press for political and economic remedies, in addition to helping children with their emotional-behavioral difficulties.
In the first edition of this book, I mentioned the efforts of the American Bar Association to call attention to the need for legal reform to assist U.S. children at risk (American Bar Association Working Group, 1993). This document addressed children's essential needs in the areas of income, housing, education, health, juvenile justice, and child welfare. Similarly, the Children's Defense Fund (1992, 2000, 2001) issues annual reports on the state of U.S. children and argues for political agendas targeting the well-being of children and families. Unfortunately, the hoped-for political pressure for action has been overshadowed in recent years by economic and national and global defense concerns. Significant improvement in the quality of life for families and children at risk remains a future goal. Meanwhile, children are responding with self-destructive and antisocial behaviors that echo the frustrations and conflicts of their parents and communities.
This book focuses on methods for helping children with mental, emotional, and behavioral problems and their families. Because of the interplay of influences between children and their social environments, it is essential to consider simultaneously a troubled child's biological/ temperamental/developmental status, the surrounding familial cultural context, and the physical and social environment (see Figure 1.1). Although political advocacy may be essential for long-term improvement of the insidious effects of poverty, substance abuse/dependence, and violence, immediate supportive assistance must be offered to children and their families who live in the midst of these conditions. Children demonstrating troubled and troubling behaviors require prompt, direct services, even when these are provided in less than ideal social environments.
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THE CASE OF JACOB, AGE 10, AND DAMIEN, AGE 14
This information is taken from a front-page article in The New York Times (Wilkerson, 1994). In preparing the second edition of this book I wondered if this case would seem out of date 8 years later. Sadly, it is not; the situation of urban children who live in high-crime, drug-infested neighborhoods is as bad as ever.
Presenting Problem
Damien, age 14, and Jacob, age 10, were arrested for armed robbery in the shooting death of a pregnant woman who refused to hand over money she had withdrawn from an automated teller machine. Jacob gave the go-ahead signal for the robbery, and Damien, a drug dealer who was trying to obtain money to pay drug debts, carried out the shooting. Damien pleaded guilty to second-degree murder, and both boys received the maximum sentence for juveniles-remaining in state custody until the age of 21.
Family Information
Both boys were born to mothers on welfare, each of whom had first given birth at age 14. Damien's father had abandoned his family, and Jacob's father was shot to death in a bar fight when the boy was 4 or 5 years old. Both boys grew up in an atmosphere of physical abuse; Jacob's father used to beat his mother, and Damien said that he ran away from home because his mother beat him. Both boys lived in crack houses, and Jacob's mother had a history of alcohol and crack dependence.
Jacob was the youngest of eight children, in a family in which he saw relatives and friends use guns to settle disputes. He saw his sister shot in the face when he was 4 or 5. Another sister introduced him to marijuana when he was 9. His mother did not appear for Jacob's first court hearing on the armed robbery charge, and when she subsequently came to testify, she was drunk and could not remember Jacob's birthday.
Damien dropped out of school after the seventh grade and went to live with an older teenage brother, who was a drug dealer and who initiated him into the drug trade. (Damien had earlier been a ward of the court after his mother was accused of beating one of his brothers. He apparently had no contact with his father.) Damien took the gun used in the robbery/murder from his brother's house; in preparation for the attack, in Jacob's presence, Damien sharpened the bullets.
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Discussion
It is not difficult to identify the familial and social factors that coalesced in the behaviors resulting in this tragic murder. An overview of the information available in this case summary reveals the presence of the following negative influences in the lives of these boys:
Family disintegration:
Female-headed households Absent fathers (Jacob's was killed; Damien's abandoned the family) Youthful runaway behavior (Damien)
Poverty (both families were supported on welfare)
Exposure to violence and abuse:
Witness to spouse abuse (between parents-Jacob) Witness to child abuse (parental abuse of sibling-Damien) Personal experience of child abuse (Damien) Witness of gun fights within family (Jacob)
Exposure to substance abuse:
Residence in crack houses Parental alcohol and crack dependence (Jacob) Sibling drug dealing (Damien) Drug abuse/dependence in the neighborhood Encouragement to use drugs
Jacob's lawyer summarized his young client's situation by stating that "Jake is the product of his environment. He comes from a dysfunctional family. The older neighborhood boys were his heroes. They sold drugs. They had guns. They were his role models. He wanted to be like them" (quoted in Wilkerson, 1994, p. A-14).
Charles Patrick Ewing, a lawyer and forensic psychologist, comments in his book Kids Who Kill (1990): "Juvenile killers are not born but made.... Virtually all juvenile killers have been significantly influenced in their homicidal behavior by one or more of a handful of known factors: child abuse, poverty, substance abuse, and access to guns" (p. 157). Certainly these conditions do not always produce child killers; many youngsters manage to survive the ravages of noxious familial and social environments without succumbing to antisocial acts. Some even achieve great success, against all odds (Anthony & Cohler, 1987). Nonetheless, when the cards are stacked so heavily against healthy development, as they were for both Jacob and Damien, the outcome in terms of antisocial behavior is understandable. Furthermore, in addition to Ewing's list of factors contributing to homicidal behavior, we should consider the possibility that Jacob may have been born with fetal alcohol syndrome and/or the effects of his mother's crack addiction, and that Damien may have suffered head injuries as a result of the serious and repeated beatings he received. In addition, both boys' seeming lack of empathy may be related to insecure attachment due to the abuse and neglect they both suffered in the first 2 years of their lives (Karr-Morse & Wiley, 1997; Perry, 1997). We know nothing about either boy's academic performance-possible learning or hyperactivity problems or individual areas of achievement.
This case illustrates how the cumulative influence of individual, familial, and social factors can culminate in juvenile criminal behaviors. Even when social and familial factors appear to predominate as causal, however, remediation will necessitate intensive work with such youths on an individual basis. It is likely that after years of abuse and neglect, youngsters such as Damien and Jacob internalized and then replicated the dysfunctional behavior they witnessed and experienced during their formative years. Rehabilitation will require more than environmental change to significantly alter such youngsters' sense of personal identity, their sense of self-respect and competence, and their views about future goals for their lives. I wrote to the New York Times reporter who wrote this feature article (Wilkerson, 1994), suggesting that she do a follow-up article on how the boys had responded to their respective treatment programs. Unfortunately, she did not respond. At this writing, 8 years after the original report, Damien would now be 22 years old and presumably no longer in state custody, and Jacob would be 18, with 3 more years of custody. Hopefully, they have received some intensive treatment during the 8 years, and we will not see their names on the front page of our newspapers again. Chapter 14 discusses the treatment of children who witness family and community violence.
INCREASED RATES OF EMOTIONAL AND BEHAVIORAL PROBLEMS
There is a growing perception, both among the general public and in the professional literature, that children's problems are getting worse. LeCroy and Ryan (1993) state that "severe emotional disturbance in children and adolescents is a national problem requiring immediate action" (p. 318). Knitzer (1982) and Hewlett (1991) have documented the adverse effects of deteriorating social conditions on children's emotional and physical well-being. Special concern relates to children's exposure to violence in their homes, communities, and the media (Osofsky, 1997).
In an attempt to answer the question "Are American children's problems getting worse?", Achenbach and Howell (1993) compared scores on the Child Behavior Checklist (CBCL) from 3 different years: 1976, 1981, and 1989. The CBCL (Achenbach & Edelbrock, 1983) is the most widely used measure of its kind in the world for documenting children's everyday problems, according to Goleman (1993). In each of the 3 years, a random sample of more than 2,000 children from 7 to 16 years of age was rated. Achenbach and Howell (1993) found that, in 1989, problem scores were somewhat higher on the 118 items describing behavioral and emotional problems and competence scores were lower than they had been in the earlier assessments. Teachers' ratings agreed with those of parents in showing small increases in problem scores and decreases in competence scores. Therefore, Achenbach and Howell (1993) answered "Yes" to the question, although they could not determine why this was so. No significant differences to explain the findings could be attributed to age, gender, socioeconomic status, or black-white ethnicity.
Another important finding among Achenbach and Howell's 1989 sample was a significant rise in the proportion of children scoring in a range indicative of a need for clinical services (18.2%), despite the exclusion from this sample of 8.3% who had already received mental health services in the preceding year. Children in foster care showed rates of significant problem behaviors that were 3 to 4 times higher than the rate of 10% expected in the general population of children, and children in residential treatment showed as much as twice the rates of disturbance (Shennum, Moreno, & Caywood, 1998).
Specific Problem Syndromes
The following groupings of problems, derived from parent, teacher, and self-report forms of the CBCL as administered to the 1989 sample, were presented in The New York Times (Goleman, 1993). Each specific item appears on the CBCL.
Withdrawn or social problems:
Would rather be alone Is secretive Sulks a lot Lacks energy Is unhappy Is too dependent Prefers to play with younger kids
Attention or thought problems:
Can't concentrate Can't sit still Acts without thinking Is too nervous to concentrate Does poorly on schoolwork Can't get mind off certain thoughts
Delinquency or aggression:
Hangs around kids who get into trouble Lies and cheats Argues a lot Is mean to other people Demands attention Destroys other people's things Disobeys at home and at school Is stubborn and moody Talks too much Teases a lot Has hot temper
Anxiety and depression:
Is lonely Has many fears and worries Needs to be perfect Feels unloved Feels nervous Feels sad and depressed
All of these behaviors worsened over the 13-year period from 1976 to 1989. Achenbach stated that "it's not the magnitude of the changes, but the consistency that is so significant" (quoted in Goleman, 1993, p. C-16). He went on to suggest that multiple factors probably contribute to such widespread increases in children's problems.
Continues...
Excerpted from Social Work Practice with Children by Nancy Boyd Webb Copyright © 2003 by The Guilford Press. Excerpted by permission.
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