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Child advocate: Room to improve

  • Moira K. O’Neill

Monitor staff
Published: 4/9/2021 5:04:58 PM

The state’s Office of the Child Advocate reports that New Hampshire has both room for improvement in the process of caring for children and evidence of being “on the right path,” based on a review of four specific incidents involving children who were relying on the state for guardianship, including a near-death injury and a suicide attempt. 

The office provides independent oversight of the child welfare and juvenile justice systems, with the goal of ensuring that all children involved with a state agency are receiving adequate care and services and are being protected from harm.

“It is up to it is up to the child welfare system to soothe family loss, demonstrate accountable standards of practice, deal with political fallout, and cope with the close proximity to tragedy,” said Moira O’Neill, the State Child Advocate.

The four cases in the report were examined in 2020, and the reviews were conducted with New Hampshire Department of Health and Human Services and the Division for Children Youth and Families, or DCYF. For one of the four cases, which involved an unnamed border state, the review included that state’s public child welfare agency.

One of the cases involved a near-death incident in which a young child in a high chair was struck in the chest by his father, causing him to land on the floor and suffer massive head trauma. Another involved a nine-year-old who was in the custody of DCYF and had difficulty adjusting to a long-term foster placement with relatives on two separate occasions.

The other two cases involved teenagers: one of them was in an institution and, following an altercation, was held in a facedown position by staff for 80 minutes until he was arrested. The other teenager was in the system for six years, in which he moved between institutional care and incarceration and attempted suicide multiple times.

These cases led the reviewers to conclude that a central theme centered on a “network of relationships affecting the circumstance and trajectory of the children.” Well-developed relationships are essential, the report said, to child and family wellbeing.

Additionally, they found that some difficulties could be caused by the size of the system. “Implementation of public policy and allotted resources through a complex bureaucracy may lack the sensitivity or fluidity necessary to respond to variations in human conditions,” the report said. More specifically, recent public interest has led to initiatives to promote trauma-sensitive care, but there has not been a similar investment into caring for developmental conditions.

With this, the report stated that New Hampshire was moving in the direction of transforming the system for the better, and that several of their recommendations were in the process of being met. This was partially through a request for proposal that the Division for Children Youth and Families published in December, which represented a re-design of institutional care by calling for, among other things, trauma-informed care and independent oversight of children’s progress. The request also called for treatment providers to determine appropriate care for each individual child, and emphasized the department’s commitment to reducing the use of restraint and seclusion.

However, the advocate’s report cited concern about the length of time it might take to put these changes in place, saying that the longer it took, “the further loss children experience in relationships, development, and wellbeing.”

“Learning about points for improvement in the system is helpful but it also presages more work to bring responsive change,” said the report. “We look forward to collaborating on the next steps.”

O’Neill said her office uses “system learning reviews (SLRs) seek to empower the people who do the work every day to examine events and identify opportunities for system strengthening,” O’Neill said. SLRs, or system learning reviews, engage field staff, supervisors, administrators, and specialists in a case review – a process that was started by OCA in 2019 to examine “critical incidents,” including child fatalities.

The focus with these reviews is on the system and how to improve it, as opposed to laying blame for serious events. “The SLR process represents the OCA’s effort to provide a mechanism for productive examination of where the system might be strengthened and opportunities to better meet children’s needs,” said the report.

O’Neill stressed the tragedy of the incidents being studied, and how that element of the process should not be lost. “In this report and the process that produced it, we seek to honor the children’s adverse experiences by learning and contributing to a system of prevention,” she said. “The personal tragedy of critical incidents and the experiences of staff working with those children can be lost in bureaucratic detachment, blame and shame of state actors, family dysfunction, and politics.”




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