Assessing Broken Cups

By Donald E. Baumeister

Recently, the horrific death in August 2016 of an emaciated 11-year-old boy has both the organizations charged with preventing such abuse in Los Angeles County, NASW members, and the public asking a common question: How could this tragedy happen when Yonatan Aguilar’s family had six documented contacts with the Los Angeles Department of Children and Family Services (DCFS) since 2002?

Answers and recommendations to this penetrating question are likely to be varied but predictable from the invested stakeholders:

• Caseloads are too high;
• Training is insufficient;
• Budgets need to be increased;
• Screening tools need improvement;
• A number of child deaths are inevitable.

However, a more fundamental but nuanced answer is not one that is likely to make the typical list. Why? The reason is that public child welfare professionals have effectively eliminated clinical social work as a factor in assisting their workers in case evaluation. The rationale goes something like this: We are tasked with protecting children not providing mental health services to them.

Consequently, let us remain focused on our assigned mission without getting distracted with those “less than evidenced-based” clinical social work practices. We plan on steering a course for what’s best for our clients and we are not really interested in hearing any other explanations.

So, however logical and sound their responses appear, this answer belies the assets of using clinical skills to evaluate families in crisis. These families lie somewhere on the continuum among nicked, broken and shattered cups. These families can only maintain however much of their cup remains following the fractures. This cup is defined by the three rules of clinical practice: 1) Start where the client is; 2) Stay where the client is; and 3) Every strength is a weakness, every weakness is a strength, depends on the circumstances. The cup is also outlined by the four fundamentals of clinical work:

• Adequate assessment (10 minutes to 10 months);
• Therapeutic relationship (warmth, empathy, and genuineness);
• Clinical interventions (remove or remain with services);
• Done at the right time (timing, timing, and timing).

Applying these fundamentals to public child welfare cases takes the understanding that no amount of McGregor’s Theory X style of micro-management administration will create a Theory Y organization that values retaining trusted committed workers, giving them the resources needed to do their jobs, and supporting their clinical efforts.

Why have the current public child welfare professionals not embraced a more clinical approach? The likely answers are many and varied but consistent: teaching and training workers to be credible clinicians in addition to child protectors is just more than they want to do. The DSM suggests that those who possess this Help-rejecting Defense mechanism manage “emotional conflict or internal or external stressors by complaining or making repetitious requests for help that disguise covert feelings of hostility or reproach toward others, which are then expressed by rejecting the suggestions, advice, or help that others offer.”

What might be other examples? It’s an axiom of management from the RAND Corporation that “a problem with no apparent solution (or consensus about a solution) is generally not defined as a problem.” While public child welfare officials certainly understand the “problem” of child deaths,” they seem to have yet to embrace a solution that includes clinical assessments as a necessary and integral aspect of screenings for proper legal interventions.

Nonetheless, the children and families of our community like Yonatan Aguilar will continue to take the brunt of our all-but-clinical responses. Unless we can help these broken cups, they will continue to need better assessment models to help them heal, problem solve, and grow.

Dr. Baumeister is a retired clinical social worker who has worked in a wide variety of setting including public child welfare, mental health, public education, the VA, and numerous public and private universities. He may be contacted at dbaumeistr@verizon.net.