Family Engagement in the PerinatalPeriod and Infant Rights

The meaning of human rights for children isa contested issue; the notion of rights forunborn babies poses additional complexity.Drawing on data from a prospective casestudy of a specialist drug and alcohol obstet-ric provider and the statutory child protectionservice, this article discusses family engage-ment within a child-rights framework, anddemonstrates how adherence to the best

interests principle, in the absence of an appropriate serviceprovision, excludes vulnerable mother/infant dyads from draw-ing on extended family support.

Menka TsantefskiUniversity of Melbourne

Cathy HumphreysUniversity of Melbourne

Alun C. JacksonUniversity of Melbourne

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Harm associated with parental substance misuse is a major child-rights issue (Reading, Bissell, Goldhagen, Harwin, Masson,Moynihan, Parton, Santos Pais, Thoburn, & Webb, 2009). The UnitedNations Convention on the Rights of the Child (CRC) refers to chil-drens right to protection from violence and illicit use of narcotic drugsand psychotropic substances, rather than family violence or substanceuse by parents per se; yet much of the CRC specifically addressesadverse outcomes and statutory interventions that arise in responseto these frequently co-occurring parental factors of high prevalenceamong child protection (CP) samples internationally (Forrester &Harwin, 2006; Kelly & Mullender, 2000). Childrens exposure to sub-stance use often begins during pregnancy and generally continues inan altered form in the postnatal period (Dunn, Tarter, Mezzich,Vanyukov, Kirisci, & Kirillova, 2002). Pregnancy is the first time manywomen seek drug and alcohol treatment (Butler, 2007). Womenengaged with services early in pregnancy are more able to disclosesubstance-use, more likely to seek information and referral and to beinvolved with services in a supportive role without mandated inter-vention (Macrory & Harbin, 2000).

Taking one specialist drug and alcohol obstetric provider as a casestudy, this article addresses engagement of substance-dependentwomen in the perinatal period, a time of heightened infant risk andvulnerability, within a child-rights framework. Three parties, eachwith rights and/or responsibilities, are mentioned in the CRC: thechild; his or her parents or legal guardians; and the state. It is arguedthat without consideration of the interrelatedness of articles, adichotomy emerges between childrens and parents rights, while thechilds right to provision for those who care for him or her and thefamilys right to participation in decision-making are overlooked.

Rights of the Unborn and the InfantThe CRC does not specify the age at which childhood begins andis unclear whether the rights aorded to children are extended to the

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Acknowledgment: The invaluable contribution by Dr. Lynda Campbell toward this study is gratefully acknowledged.

unborn. Much of the literature on the rights of the unborn refers tothe right to life of the fetus ( Janoff, 2004). There is also a body ofliterature from the U.S. discussing criminal prosecution of substance-using women (Fentiman, 2009). What links these contentious, butseparate, debates is the balance between the rights of the unborn andthose of the pregnant woman (Campbell, 2005). Childrens rightsare sometimes discussed in terms of their needs, particularly amonginfants and young children (Schoeman, 1980); however, children areincreasingly defined as bearers of human rights, not merely recipi-ents of welfare and protection (Bessell & Gal, 2009; Wall, 2008). TheCRC provides a framework for understanding and responding tochildrens needs at the individual, institutional and societal level inwhich rights of participation and provision are as important as rightsof protection. These rights are universal, interdependent, indivisible,and without hierarchy (Reading etal., 2009; Tobin, 2008).

The infants right to protection and safety, and the parents rightto have guardianship and custody of their child, are often perceivedto be in conflict (Connolly, 2006b; Connolly & Ward, 2008; Mathews,2008; Seneviratne, Conroy, & Marks, 2003). Adherence to Article3(1) requires this conflict be resolved according to the childs bestinterests. However, critique of the CRC largely centers on the bestinterests principle, which currently dominates the discourse on CP,but is open to interpretation and dicult to implement in practice(Bessell & Gal, 2009; Musgrove & Swain, 2010). The other area ofcontention is the issue of autonomy rights, which recognize the childas an agent (Freeman, 2007) with interests separate to the family(Schoeman, 1980). Clearly, the infants capacity to exercise agency isdevelopmentally limited. In the context of CP, a viable means of oper-ationalizing infant participation is through engagement with thosecharged with his or her care and protection: the family and the state.

Family Engagement and ParticipationWhile family engagement oers a viable means of representing theinfants interests, it is contingent on engagement with CP services(Connolly & Smith, 2010; Darlington, Healy, & Feeney, 2010; Davies

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& Krane, 2006; Gockel, Russell, & Harris, 2008). Yatchmeno (2005)identifies positive and negative aspects of engagement: receptivity,expectancy, investment, working relationship, and mistrust. A produc-tive relationship between parent and worker is a prerequisite for soundassessment and good therapeutic outcomes (Howe, 2010). A relation-ship of openness and trust permits the worker to take risk and to con-front child abuse (Bell, 1999; Connolly & Smith, 2010; van Nijnatten,Hoogsteder, & Suurmond, 2001) but fear of judgment and gravity ofconsequences pose significant barriers to family engagement with serv-ice providers (Walsh & Douglas, 2009), particularly between substance-dependent parents, concerned with the risk of child removal, andservice providers often subjected to hostility by substance-aected, anx-ious parents (Buchanan & Corby, 2005; Forrester & Harwin, 2008;Taylor & Kroll, 2004). Participation by reluctant, substance-dependentparents therefore remains a major challenge in child welfare practice.

Family group conferences (FGC), which originated in NewZealand, operationalize concepts of partnership and empowermentby bringing together the extended family and professionals, includingdisparate services that typically operate in isolation, for example,domestic violence (Pennell & Burford, 2000) and drug and alcoholtreatment services (Weigensberg, Barth, & Guo, 2009), in a family-led decision-making forum to address issues of concern (Connolly,2006a; Morris & Connolly, 2010; Pennell, 2006; Pennell, Edwards, &Burford, 2010). FGC have been mandatory practice in New Zealandsince 1989 (Connolly, 2006b); in other countries, they are largely atthe discretion of CP workers (Sundell, Vinnerl jung, & Ryburn, 2001).Despite significant benefits, there is evidence of resistance to partici-patory practice with families among CP practitioners (Morris &Connolly, 2010), with low uptake of the model and low referral ratesin Sweden (Sundell etal., 2001), the United Kingdom (Brown, 2007;Sundell etal., 2001), and Australia (Harris, 2008).

The Legislative Context of This StudyAustralian CP laws come under the jurisdiction of individual statesand territories; with one exception, all have implemented or

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conducted trials of FGC, with significant variation in implemen-tation. In the state of Victoria, where the present study was located,FGC have been policy when there is risk of child placement since1992, yet are rarely held. While evidence suggests an increase infamily conferencing, the extent of use and program fidelity to theNew Zealand model are unknown due to variations between regionsand decentralized management. The terminology suggests usingFGC; however, the model does not fulfill the same function, is usedon a nonlegislative basis, and is reliant, in part, on enthusiasm atthe ground level (Harris, 2008, p. 9). The present study was con-ducted under the legislative framework of the Children and YoungPersons Act 1989. At the commencement of the study, referrals forinfants were accepted in the pre- or postnatal period. With no legalmandate supporting intervention with unborn babies, prebirth noti-fications were historically received as reports, rather than notifica-tions per se, and were responded to in an ad hoc manner acrossregions. The Children, Youth, and Families Act 2005 (introducedin 2007), legitimated prebirth notifications and intervention withunborn babies. The act also emphasizes using Aboriginal familydecision-making but does not provide specific details about imple-mentation; no reference is made to family decision-making princi-ples for nonindigenous children.

As signatory to the CRC, the best interests principle is en -trenched in various Australian state and territory legislative and pol-icy contexts (Tobin, 2008), including Victoria; some provide for thechild in utero, the remainder ex utero. In the former instance, theunborn infant is not considered a legal entity until born alive.Australian policymakers and researchers have not actively engagedwith the debate on prosecution or protective custody of substance-dependent women (Butler, 2007; Kelly, Davis, & Henschke, 2000),and the terms fetus, unborn child, and unborn infant are used inter-changeably, except for specific areas of law (Stewart & Stuhmcke,2008), not applicable to the current study. While duty of care remainsimperative, concern must be for the infants well-being after birth.The expressed intention is early intervention to reduce the risk ofpostnatal harm and the need for tertiary involvement through

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supports and services to the pregnant woman (Mathews, 2008).Despite legal sanction for intervention with unborn babies in somejurisdictions, the infants of substance-dependent women continue tobe overrepresented in CP samples nationally, to comprise a signifi-cant number of children in out-of-home care, and to remain in carelonger (Australian Institute of Health and Welfare, 2007). Thus, sub-stance use by pregnant women is of increasing concern for the toll itexacts not only from the individual and family, but also from societymore broadly (Kelly etal., 2000).

As the major provider of obstetric services to substance-depen-dent women in the state of Victoria, the Womens Alcohol andDrug Service (Womens ADS), at the Royal Womens Hospital, iswell-placed to reduce maternal vulnerability and to enhance infantwell-being through identification and monitoring of risk and pro-tective factors in the perinatal period. A major task facing theWomens ADS is activation of the formal service system to supportwomen in the care of their infants while either using substances orreceiving treatment for substance use. The service aims to create amutually trusting relationship in which women can disclose sub-stance-use; there is no mandatory system of reporting newborninfants to CP (Phillips, Thomas, Cox, Ricciardelli, Ogle, Love, &Steele, 2007). When the informal network and/or community-based agencies are unable to provide the level or type of supportrequired to assist women and protect infants, a notification is madeto CP. Until the present study, the Womens ADS did not have dataon the outcome of its notifications to CP and wanted to know ifthese were considered appropriate by CP, what actions were takenas a result of prebirth notifications, a contentious issue, and thosemade in the postnatal period.

MethodArising from the previously mentioned context, a practice-based casestudy (Yin, 2003) was undertaken. In light of the reported signifi-cance of social support to outcomes among substance-dependentwomen and their infants and children (Hogan, 1998; James, 2004),

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the study aimed to describe how formal and informal networks sup-port substance-dependent women in the first year of their infantslives and to understand mothers experiences of the provision of sup-port. There were two units of analysis: (1) communication and col-laboration between the Womens ADS and CP; and (2) individualwomen accessing the Womens ADS.

Structured interviews were held with Womens ADS sta mem-bers to report on risk assessment and referrals made for each partic-ipating mother/infant dyad at infant age 6 weeks. Structuredinterviews were held with CP sta to report families progress throughthe CP system from notification and screening through to the mak-ing of Court Orders in cases of substantiated abuse and/or neglect atinfant age 6 weeks, 6 months, and 12 months. CP sta members werealso asked to report referrals made on behalf of each family includ-ing the purpose of the referral. Both the Womens ADS and CP stawere asked to report the extent and quality of collaboration betweenservices. Participating women were interviewed to examine how sub-stance-dependent mothers evaluate their sources of informal help andformal support from the perinatal period through to the end of theinfants first year. Interviews with mothers were conducted at infantage 6 weeks, 6 months, and 12 months.

The Womens ADS Client Assessment Tool provided descriptivevariables for each mother/infant dyad. Structured interviews withWomens ADS counselors and CP sta members were used to ana-lyze the service response to risk in infancy. Semistructured interviewswith mothers conducted face-to-face were tape-recorded, transcribed,and manually thematically analyzed by coding and sorting intophrases, patterns and themes to produce a set of generalizations thatanswered the questions posed by the study (Yin, 2003).

During the recruitment period, which extended from July toDecember 2003, 51 women attended the Womens ADS. A total of29 women were introduced to the researcher. Of these, 22 agreedto take part, and 7 declined. Interview data were not available for2 women who were lost to follow-up prior to the first interview. The22 women in the study ranged in age from 23 to 37 years with a meanage of 30 years. Of the women, 16 were Australian of non-Indigenous

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origin, 1 was Australian of Indigenous origin, 2 were Asian, and3 were European born. All women were English speaking.

Additional ethics requirements applied in this study due to inclu-sion of participants likely to be aected by substances or to disclosechild abuse and/or neglect. Furthermore, invitation to contribute toa study that includes CP services was potentially stigmatizing as itdrew attention to the fact that a professional judgment may havebeen made that the infant was at risk of abuse and neglect. Womenwere introduced to the researcher, who was on site during the recruit-ment period, by Womens ADS sta, only if they did not present asintoxicated or suered a serious mental illness that would deem themunsuitable as research participants. The duty to warn of limits to con-fidentiality was particularly pertinent. The study was approved byseveral Human Research Ethics Committees, including Departmentof Human Services, Royal Womens Hospital, Department of Justice,and the University of Melbourne.

The small sample size and qualitative methodology restrict theability to generalize these findings; however, comparison of demo-graphics and descriptive variables with previous research indicatesthis was a highly representative sample of women accessing theWomens ADS (Kelly etal., 2000). While the study was conductedduring an overhaul of legislation in Victoria, recent national researchindicates consistency in practice across time, regardless of the legalframework for intervention with families, including large numbersof infants in CP samples and in out-of-home care, and minimal useof FGC (Harris, 2008).

FindingsFamily Engagement in the Perinatal PeriodThe Womens ADS made two prenatal and eight postnatal notifi-cations to CP. Although somewhat contradictory, four pre-birthmeetings were held between mothers, the Womens ADS and CP.The discrepancy was due to a formality. Media attention to the issueof pre-birth notifications prior to changes in legislation may haveled to greater caution in terminology among CP staff. Womens

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ADS counselors and CP staff attended planning meetings for allbut two infants (n 18). Mothers were present at all meetings;fathers were present in only three. Three grandparents attendedmeetings for three individual infants. Representation by community-based agencies was minimal. FGC were not held for any of the infantsprior to infant discharge from hospital, although these are meant tobe scheduled when there is likelihood of infant or child placement,as previously noted.

The Womens ADS and CP reported productive collaborationthat enabled early planning to reduce crisis-driven intervention.Prebirth notifications were preferred by both service providers andservice users as these were seen to allow sucient time to engagemothers and the extended family in the development of safety plans.Several parents reported a marked dierence in the experience of theWomens ADS in the pre- and postnatal periods with greater satis-faction reported in the prenatal period when the mother/infant dyadis inseparable. In the postnatal period, when the infants best inter-ests rose to the fore, some parents perceived the Womens ADS towield coercive power through connection to CP.

My initial reaction was that they didnt trust me alone withthe baby, but I thought, its my baby, you know. What are theygoing to do, take it away? (Lena)

Most women developed a trusting relationship with Womens ADScounselors. Engagement began to fragment when mothers realizedthey could not participate as equal partners in decisions that aectedtheir families after notification to CP. However, many women, includ-ing some notified to CP, expressed disappointment that involvementwith the Womens ADS could not endure, indicating that engage-ment had been established in the critical perinatal period when infantvulnerability is high prior to discharge from hospital.Family Engagement with CPMothers understood that the primary role of CP is to ensure the bestinterests of infants and children and most were not theoreticallyopposed to involvement. The complexity of the cases, the dicultyCP faced establishing honest engagement with parents fearful of

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infant removal, and the challenge in engaging men and workingwith whole families, was increasingly apparent at each consecutivephase of the study as more infants were brought into the CP andout-of-home care systems. At the end of 12 months, 14 infantswere subject to notification, approximately half of whom were nolonger in the legal care of their mothers. Women, including thosenotified prenatally, called for even earlier involvement by CP to pre-pare for the infants discharge from hospital, engage men and sup-port both parents.

They [CP] should have come in and started helping us a bitearlier. They might have helped Mick [father] a bit better,cause they say they dont help them until the babys born(Natasha).

Women were initially prepared to work with CP to improve out-comes for themselves, their infants and families, but argued that con-tinuous monitoring and assessment did not lead to the provision ofactual support, which was a serious impediment to engagement witha service that was seen as potentially beneficial. Mothers called fortransparency in practice, mutual trust and the adoption of a strengths-based approach with feedback from CP, particularly that compliancewith directives would result in maintaining the infant in their care orthe return of an infant who had been removed. Engagement betweenparents and CP was associated with the degree of trust engendered.Several women commented on unpredictable behavior by CP work-ers who could suddenly flip. They also described repeated unsuc-cessful attempts at engagement with fathers by CP with minimalor outward compliance by men. Barriers to eective partnershipbetween parents and CP included fear of infant removal, whichdeterred women from honest engagement; woman-centered ratherthan family-focused practice; and poor communication between par-ents and CP and between CP and other service providers, with theexception of the Womens ADS. While women were able to articu-late the important role CP has in safeguarding infants and children,some argued that intervention was destructive of family relations andresulted in loss of valuable support from partners when directed toseparate from the fathers of their infants, or loss of the infant to a

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grandparents care, or when no family member was available to pro-vide alternative care, loss of the infant to foster care. Of note wasthe minimal use of FGC to link mandated intervention with thesupportive potential of the kinship network: only one FGC was heldin phase two.Family Engagement with the Wider Service SectorThe pattern of service use evident in this study was variable; the dom-inant pattern was continuous engagement with universal, medicallyoriented providers (the Maternal and Child Health Service and gen-eral practitioners), with virtually no engagement in alcohol or otherdrug treatment or domestic violence counseling, minimal engage-ment with family support and some use of housing services, partic-ularly during pregnancy and the postnatal period. Four men weredirected by CP to attend mens behavior modification programs;not one man engaged with these services beyond initial assessment.With the exception of women with active CP involvement, familysupport services were either unavailable due to lengthy waiting peri-ods, were considered unnecessary by service providers and mothers,or were shunned by parents. No use was made of intensive familypreservation programs to assist reunification of infants to maternalcare. Mistrust of CP and the risk of infant removal were primarymotivating factors for most parentsnot only those involved withCPto actively resist, disengage, or not make adequate use of avail-able support. Many women expressed a preference for informalsources of support; most support was indeed provided by partnersand womens own mothers.

DiscussionThe CRC draws attention to the need to protect infants from illicituse of narcotic drugs and psychedelic substances and violence (Article33); the parental factors most prevalent among CP samples interna-tionally (Forrester & Harwin, 2006; Hogan, 1998). Article 3(1) ofthe CRC states that the best interests principle is a primary con-sideration; it does not state that it should be the only consideration

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in decisions or actions concerning children. Given the vulnerabil-ity of infancy, and the infants lack of agency to make decisions ortake actions, it does seem reasonable that it be the guiding principle,particularly in reference to Article 19 which draws attention to thechilds right to protection from all forms of abuse while in the careof parents, legal guardians or others who have the care of the child.However, adherence to Article 3(1), in isolation of the Articles inwhich it is embedded, distorts the integrity of the CRC. Article 3(2)refers to the rights and duties of parents and legal guardians; Article3(3) specifically mentions the provision of institutions, services andfacilities for the care and protection of children. Also expressed, butoften overlooked, are the childs rights to social programs to providenecessary support for the child and for those who care for him or her(19.2) and to the childs right to noninterference in the family unlesshis or her best interests are not met (Article 16.1). Human rights areinterdependent and indivisible. The convergence of Articles is neededto maximize the likelihood of infants and children remaining safelyin parental care, or when this is not possible, to ensure they areremoved in a timely manner and placed in an appropriate family envi-ronment (Reading etal., 2009).

In the context of the present study, professional adherence to Article3.1, in isolation of the broader framework in which the best interestsprinciple is embedded, determined organizational practices which,in turn, influenced maternal behavior with profound implicationsfor infant outcomes. New legislation clarified and formalized incon-sistent policy and program responses to unborn babies deemed to beat risk of harm. There is no doubt that decisions made at the notifica-tion/intake stage were critical in determining the type and extent ofservice provision available to women and their infants in the perinatalperiod. Lack of engagement with community-based service providersindicates that decision-making did not adequately impact on the eec-tiveness of the child welfare system as a whole; nor did it result in har-nessing of the strength of the informal network to increase longer termsafety and security for the infant (Connolly & Smith, 2010).

The findings from the present study support the notion thatthere seem to be fairly good systems for identifying concerns around

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babies born to drug-using mothers (Forrester & Harwin, 2006,p. 331). However, women, including those notified prior to the birthof the infant, called for even earlier involvement by CP, particularlyto engage fathers and to secure adequate support services prior tothe infants discharge from hospital. This suggests that much inter-vention is still crisis-driven and reactive, despite legal sanction forprebirth notifications. Mothers, who felt well-supported in preg-nancy, became aware in the postnatal period that the infants andtheir own interests were considered in contest, and that those of theinfant were likely to prevail, causing women to become anxious andavoidant. CP, anxious about infant safety and well-being followingbirth, conducted further assessment and monitoring, but could notprotect infants without the support of the wider service sector and/orparticipation by the extended family. In the absence of adequate pro-fessional or familial support, legal action was taken by CP to securethe infants best interests (protection principle). The exercise ofcoercive power inevitably led to resistance by some parents, further-ing a climate of mutual mistrust, which further increased the prob-ability of avoidable infant placement, thereby violating both thechilds right to be cared for within the family and parental rights toraise the child (Connolly & Ward, 2008).

It is reasonable to expect that assessment and intervention wouldbe more likely to occur when concern for the infant is expressed pre-natally (Macrory & Harbin, 2000; Seneviratne etal., 2003). Prebirthnotifications were preferred by mothers and CP workers, but theimplementation of case plans required resources that were sorely lack-ing. Mothers highlighted the lack of detoxification and rehabilitationprograms or continuity of support for the family unit following infantdischarge from hospital. In the absence of appropriate services (pro-vision principle), surveillance leading to removal is more likely thanfamily support (Walsh & Douglas, 2009). Yet childrens needs and par-ents rights are inextricably linked and take place within policy, serv-ice and practice systems (Connolly & Ward, 2008; Freemen, 2007;Howe, 2010). Lack of resources is a serious problem for CP authori-ties and other service providers (Mathews, 2008) and is recognized assuch by the CRC. The state justification for failing to meet childrens

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needs, and therefore their rights, is typically lack of resources: claimsmade even when budgets are in surplus. Challenging and changingexisting power relations and structures is dicult to achieve (Tobin,2008) and consideration needs to be given to what can and should bedone in the interim to protect infants, promote child rights andincrease familial engagement in child welfare practice.

Inclusion of the extended family increases safe retention of chil-dren in kinship networks, promotes placement stability, and reducesthe time spent out of parental care (Connolly & Smith, 2010; Pennelletal., 2010). Although most of the infants in the present study metthe criteria for a FGC, that is, they were at risk of removal fromparental care by virtue of exposure to continuing parental substanceuse, and in many cases, family violence, it is noteworthy that only oneFGC was held for the 20 infants across a 12-month period. Meetingsheld with mothers and a small number of fathers in the perinatalperiod did not have the formality or decision-making powers of aFGC (Connolly, 2006a). For the women in the present study, discre-tionary use of FGC severely limited engagement of the extendedfamily at a time not only of heightened infant risk, but also increasedmaternal and parental motivation for change; the valuable opportu-nity for early intervention and prevention aorded by prebirth noti-fication was thereby underused. FGC may have reduced CP activity,lowered the rate of substantiated abuse and neglect, resulted in lessemergency visits to families, and allowed a greater number of infantsto remain in maternal care (Pennell & Burford, 2000). Participationin FGC may also have improved provision through connection toparenting, counseling and mental health services (Weigensberg etal.,2009), increased the likelihood of continuous engagement with serv-ices and improved intersectoral collaboration between the disparateservices involved with substance-dependent parents and their chil-dren (Pennell & Burford, 2000).

Concluding CommentsThis case study illustrates the extent to which protection (best inter-ests principle), participation (partnership with parents and legal

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guardians), and provision (a continuum of services) are entwined inpractice. Without appropriate services, or partnership with parents(Reading etal., 2009) and the extended family, the benefits aordedby prenatal notifications were not fully realized. The study demon-strates good professional communication and collaboration in theperinatal period between the major provider of obstetric services tosubstance-dependent women and the statutory CP service, butlimited opportunity for shared decision-making with parents andextended family members. The present study was conducted withina legislative and policy framework, which legitimated interventionwith unborn babies, coupled with a service system, and practices, thatlacked sucient capacity for action. Adherence to policy which spec-ifies use of FGC when infants and children are deemed at risk ofremoval from parental care, as is the case for many infants exposedto substances in pregnancy, should have resulted in increased familyparticipation, which was not the case. Instead, concern for infantstranslated into a statutory response.

Although ratified by Australia in 1990, to date, there has beenminimal use of the CRC to develop, implement, and monitor lawsand policies that aect children (Tobin, 2008). The study findingssuggest FGC may have to be mandated on the premise of commit-ment to participation as a human right (Connolly, 2006b) held bythe infant (through partnership with parents and extended familymembers), prior to court ordered intervention for changes to prac-tice to occur. Policy reliant on the enthusiasm of workers has largelyproven to be ineective in Sweden (Sundell etal., 2001), the UnitedKingdom (Brown, 2007), and Australia (Harris, 2008).

ReferencesAustralian Institute of Health and Welfare. (2007). Child protection Australia 20052006

[Child welfare series no. 40. Cat. No. CWS 28]. Canberra, Australian Capital Territory,Australia: Author.

Bell, M. (1999). Working in partnership in child protection: the conflicts. British Journal ofSocial Work, 29, 437455.

Child WelfareTsantefski et al.

93

Bessell, S., & Gal, T. (2009). Forming partnerships: The human rights of children in need ofcare and protection. International Journal of Childrens Rights, 17, 283298.

Brown, L. (2007). The adaptation and implementation of a service innovation in a social worksetting-a case study of family group conferences in the UK. Social Policy and Society, 63(3),321332.

Buchanan, J., & Corby, B. (2005). Problem drug use and safeguarding children: A multi-agency approach. In R. Carnwell & J. Buchanan (Eds.), Eective practice in health and socialcare: A partnership approach (pp. 163179). Maidenhead, UK: Open University Press.

Butler, M. (2007). Pregnancy: Opportunity or invasion? Of substance, 5(1), 1014.

Campbell, N. D. (2005). The construction of pregnant drug-using women as criminal perpe-trators. The Fordham Urban Law Journal, 33, 463485.

Connolly, M. (2006a). Fifteen years of family group conferences: Coordinators talk abouttheir experiences in Aotearoa New Zealand. British Journal of Social Work, 36, 523540.

Connolly, M. (2006b). Up front and personal: Confronting dynamics in the family group con-ference. Family Process, 45(3), 345357.

Connolly, M., & Smith, R. (2010). Reforming child welfare: An integrated approach. ChildWelfare, 89(3), 931.

Connolly, M., & Ward, T. (2008). Navigating human rights across the life course. Child andFamily Social Work, 13, 348356.

Darlington, Y., Healy, K., & Feeney, J. A. (2010). Challenges in implementing participatorypractice in child protection: A contingency approach. Children and Youth Services Review,32, 10201027.

Davies, L., & Krane, J. (2006). Collaborate with caution: Protecting children, helpingmothers. Critical Social Policy, 26(2), 412425.

Dunn, M., Tarter, R. E., Mezzich, A. C., Vanyukov, M., Kirisci, L., & Kirillova, G. (2002).Origins and consequences of child neglect in substance abuse families. Clinical PsychologyReview, 22, 10631090.

Fentiman, L. C. (2009). In the name of fetal protection: Why American prosecutors pursuepregnant drug users (and other countries dont). Columbia Journal of Gender and Law, 18(2),647669.

Vol. 90, No. 4Child Welfare

94

Forrester, D., & Harwin, J. (2006). Parental substance misuse and child care social work:Findings from the first stage of a study of 100 families. Child and Family Social Work, 11,325335.

Forrester, D., & Harwin, J. (2008). Parental substance misuse and child welfare: Outcomesfor children two years after referral. British Journal of Social Work, 38, 15181535.

Freeman, M. (2007). Why it remains important to take childrens rights seriously. InternationalJournal of Childrens Rights, 15, 523.

Gockel, A., Russell, M., & Harris, B. (2008). Recreating family: Parents identify worker-client relationships as paramount in family preservation programs. Child Welfare, 87(6),91113.

Harris, N. (2008). Family group conferencing in Australia 15 years on. Melbourne, Victoria,Australia: Australian Institute of Family Studies.

Hogan, D. M. (1998). The psychological development and welfare of children of opiate andcocaine users: Review and research needs. Journal of Child Psychology and Psychiatry, 39(5),609620.

Howe, D. (2010). The safety of children and the parent-worker relationship in cases of childabuse and neglect. Child Abuse Review, 19, 330341.

James, S. E. (2004). I couldnt go anywhere: Conceptualizing violence and drug abuse: Asocial network study. Violence Against Women, 10(9), 9911014.

Jano, A. F. (Spring 2004). Rights of the pregnant child vs. rights of the unborn under theconvention on the rights of the child. Boston University International Law Journal, 22(1),163188.

Kelly, J. J., Davis, P. G., & Henschke, P. N. (2000). The drug epidemic: Eects on newborninfants and health resources consumption at a tertiary perinatal centre. Journal of Pediatricsand Child Health, 36(3), 262264.

Kelly, L., & Mullender, A. (2000). Complexities and contradictions: Living with domesticviolence and the UN convention on childrens rights. International Journal of ChildrensRights, 8, 229241.

Macrory, F., & Harbin, F. (2000). Substance misuse and pregnancy. In F. Harbin & M.Murphy (Eds.), Substance misuse and child care (pp. 6777). Dorset, UK: Russell HousePublishing.

Child WelfareTsantefski et al.

95

Mathews, B. (2008). Protecting children from abuse and neglect. In G. Monahan & L. Young(Eds.), Children and the law in Australia. (pp. 204237). Chatswood, New South Wales,Australia: Lexis Nexis.

Morris, K., & Connolly, M. (2010). Family decision making in child welfare: Challengesin developing a knowledge base for practice. Child Abuse Review. Retrieved September20, 2010, from http://onlinelibrary.wiley.com.ezp.lib.unimelb.edu.au/ doi/10.1002/ car.1143/pdf.

Musgrove, N., & Swain, S. (2010). The best interests of the child: Historical perspectives.Children Australia, 35(2), 3537.

Pennell, J. (2006). Restorative practices and child welfare: Toward an inclusive civil society.Journal of Social Issues, 62(2), 259279.

Pennell, J., & Burford, G. (2000). Family group decision making: Protecting children andwomen. Child Welfare, 79(2), 131158.

Pennell, J., Edwards, M., & Burford, G. (2010). Expedited family group engagement andchild permanency. Children and Youth Services Review, 32, 10121019.

Phillips, D., Thomas, K., Cox, H., Ricciardelli, L. A., Ogle, J., Love, V., & Steele, A. (Spring2007). Factors that influence womens disclosures of substance use during pregnancy:A qualitative study of ten midwives and ten pregnant women. Journal of Drug Issues,357375.

Reading, R., Bissell, S., Goldhagen, J., Harwin, J., Masson, J., Moynihan, S., Parton, N., SantosPais, M., Thoburn, J., & Webb, E. (2009). Promotion of childrens rights and preventionof child maltreatment. The Lancet, 373, 332343.

Schoeman, F. (1980). Rights of children, rights of parents and the moral basis of the family.Ethics, 91, 619.

Seneviratne, G., Conroy, S., & Marks, M. (2003). Parenting assessment in a psychiatric motherand baby unit. British Journal of Social Work, 33, 535555.

Stewart, P., & Stuhmcke, A. (2008). The child in utero and ex utero. In G. Monahan & L.Young (Eds.), Children and the law in Australia (pp. 5482). Chatswood, New South Wales,Australia: Lexis Nexis.

Sundell, K., Vinnerljung., B., & Ryburn, M. (2001). Social workers attitudes towards familygroup conferences in Sweden and the UK. Child and Family Social Work, 6, 327336.

Vol. 90, No. 4Child Welfare

96

Taylor, A., & Kroll, B. (2004). Working with parental substance: Dilemmas for practice. BritishJournal of Social Work, 34, 11151132.

Tobin, J. (2008). The development of childrens rights. In G. Monahan & L. Young (Eds.),Children and the law in Australia (pp. 2353). Chatswood, New South Wales, Australia:Lexis Nexis.

van Nijnatten, C., Hoogsteder, M., & Suurmond, J. (2001). Communication in care and coer-cion: Institutional interactions between family supervisors and parents. British Journal ofSocial Work, 31, 705720.

Wall, J. (2008). Human rights in the light of childhood. International Journal of ChildrensRights, 16, 523543.

Walsh, T., & Douglas, H. (2009). Legal responses to child protection, poverty and home-lessness. Journal of Social Welfare and Family Law, 31(2), 133146.

Weigensberg, E. C., Barth, R. P., & Guo, S. (2009). Family group decision making: A pro-gressive score analysis to evaluate child and family services at baseline and after 36-months.Children and Youth Services Review, 31, 383390.

Yatchmeno, D. K. (2005). Measuring client engagement from the clients perspective onnon-voluntary child protective services. Research on Social Work Practice, 15(2), 8496.

Yin, R. K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: SagePublications.

Child WelfareTsantefski et al.

97

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