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Are the social workers prepared to assist a changing population of dysfunctional parents in Sweden?
ARE THE SOCIAL WORKERS PREPARED TO ASSIST A CHANGING POPULATION OF DYSFUNCTIONAL PARENTS IN SWEDEN? GUNILLA
LARSSON,
Department
DR.
of Psychiatry.
MED.
SC., GUNILLA
Karolinska
EKENSTEIN,
RASCH,
M.S.W.
Institute.
Huddinge
Hospital.
M.S.W.,
AND
S-141 86 Huddinge.
Sweden
EWA
Abstract-Whztkind of support
can an affluent society as the Swedish offer dysfunctional parents in order to give the infants an optimal start in life? The purpose of the present study was to analyze the social situation in families precipitating the admission of infants to institutional care in 1970. 1975 and 1980. The results show that in 1980 more complex forms of parental dysfunction were common including mental disorders. criminality. abuse of alcohol and drug addiction. The reported incidence of domestic violence had increased significantly from 1970 to 1980 as well as the number of maltreated infants. The social welfare agencies had greater difficulties and to a larger extent lacked adequate methods of providing assistance to the dysfunctional parents in 1980 than in 1970. &V Wards-Infants.
Institutional
care. Social assistance.
Family
dysfunction.
R&me-En 1970. une femme qui etait connue des services sociaux pour son incapacitk personnelle, socio-izconomique ou psychiatrique. d’elever son enfant. le confiait facilement auxdits services pour adoption. En 1980. la situation a chang6 radicalement, la plupart des mtres d&rent garder leur enfant. alors m&me que les problemes sociaux. socio-tconomiques et psychiatriques. de toxicomanie et de criminalitt, ont B la fois augmentt et sont mieux dipis&. Trts souvent. des enfants nouveau-nCs sont confits g leur mere. alors qu’il est prizvisible que l’enfant court des risques. et on doit alors intervenir plus tard et en catastrophe pour placer I’enfant une fois que les mauvais traitements ou la nkgligence sont devenus patents. Ceci fait que, pratiquement, le nombre des enfants qui ont dO Otre placirs aprks coup a beaucoup augmenti: en 1980 par rapport g 1970. Si I’on veut continuer cette politique respectant les droits des parents, il faudrait en meme temps leur faire accepter et leur olTrir d’emblCe le soutien psychiatrique et I’appui familial necessaires.
INTRODUCTION DURING THE LAST DECADE there has been a nationwide concern in Sweden about the battered or neglected child. A tremendous amount of attention has been focused on prevention of child abuse and on early detection of the maltreated child. In general, Sweden has a comparatively high standard of living and a well-developed system of social security. Thus it is of great interest to examine the present methods of providing services for children at high risk of maltreatment and for their families. During the last decade in Sweden an increasing number of infants have been separated from their parents and committed to institutional or foster care [l, 21. The change in criteria for admission of infants to institutional care during the last decade has already been reported [3]. The purpose of the present study was to analyze the social situation in the families which precipitated the placement of the infants in the institutions and the extent to which the families had obtained assistance from the social welfare agencies. Presented
at the Fourth
International
Congress
on Child Abuse and Neglect. 9
Paris. September
1982
IO
Muterial
Gunilla
Larson.
Gunilla
Ekensteln.
and E\\\a Rasch
md Methods
The study includes all infants (337) admitted for institutional care in the metropolitan area of Stockholm during three periods with the following distribution: 150 infants in 1970: 92 infants in 1975 and 95 infants in 1980. Psychosocial characteristics of the mothers at the time of admission of the infants had changed markedly during the ten years studied [3]. There ~vas a significant decrease @ < 0.01) in mothers who were teenagers, single and/or primapara. In 1980 a larger number of mothers already had other children in foster care. The number of alien mothers had doubled in 1980. compared to 1970. The records of the social welfare authorities were studied according to a structured scheme. with special regard to the social condition Y in the family the year before and during the placement of the infant in institutional care. Recorded information concerning the family and assistance offered by the social welfare authorities was also studied. There were very few notes in the records regarding the fathers. Consequently, this study reflects the circumstances pertaining to the mothers and their infants. Statistical ditrerences between the groups were determined by the chi-square test or Fisher’s exact test. The study was approved by the Ethical Committee of the Karolinska Institute. It was authorized by grants from the Save the Children Fund. Results In 1980 86% of the families, compared to 50% in 1970. were already on the records of the Social Welfare Department before the current commitment of the infants to institutional care. The social welfare register contains notations of the type of measure eRected according to either the Social Welfare Act. the Child Welfare Act or the Temperance Act. The majority of the families were on the records under the Social Welfare Act. which means that they had received financial aid (Table I). There has been an increasing tendency. however. to register these cases under the Child Welfare and Temperance Acts. In the analyses of the parental problems displayed during contacts with the social workers. regardless of the law under which the families were registered, the situation is quite direrent (Table 2). During the three periods studied there was a significant increase in parents with
Table
I.
Families on the Records of the Social Welfare Admission of rhe infant for Institutional
Social Welfare Act Child Welfare Act Temperance Act
49 (72%) 37 (479’) x (12%)
Department Care
45 (X5?) ‘4 (457 I? (257)
)
Before the
70 (97”;I** 42 (SSP; I 70 (16%)*
Frequencies tn 1970 tested against 19X0. *p<0.05: **p
Table 2. Analyses of Adverse Home Conditions Recorded by the Social Welfare Departmenls Before Current Admission of the Infant for Institutional Care I970
I975
(II =6x)
01=531
Alcohol or drug dependence Mental cl~wrder Crlmlnality Mental retardation Frcqucncles tn lY70 tatal xgaln\t 1475 and/or ‘,“_ 0.05: **/+ 0.01 : ***ps O.OOI.
19x0
Iuxo III 176)
A changing
population
of dyafunctlonal
II
parenla in Sweden
documented alcohol and/or drug abuse, mental disorders and criminality. Although the families were registered under the Social Welfare Act. there was usually ic much more complex dysfunction than that ascribable to financial problems. There was a significant increase @ < 0.001) in the reported incidence of domestic violence. predominantly battered women, from 1970 (5%) to 1980 (39%). Furthermore. the number of reported infants who had been maltreated prior to placement in the institution increased significantlv i (p < 0.001) from 4% to 29% during the period studied. The majority of these reports to the social agencies were made by the police although all health and school personnel are obliged to report suspected child abuse. Extent
of Social Intervention
The social agencies had provided various kinds of services to the families before the infant was committed to institutional care. Financial aid was the most common social measure during the three different years, with a marked increase in 1980 (Table 3). A frequent service in 1980. provided for parental relief. was to place older children of the family in a day nursery. An explanation of the low level of assistance offered to the families in 1970 is the comparatively large percentage of mothers (21%) who had decided to place the newborn baby in the institution while awaiting adoption. Interinstitutional
Consultations
The number of consultations between the social agencies and other institutions concerning the parental capability and the situation of the infant are shown in Table 4. The increasing degree of collaboration between the social welfare department and psychiatric care institutions. as well as the police, is in accord with the growing number of parents with mental disorders, dependecny problems and criminality. The pediatric departments were mainly consulted when the newborns were separated from their mothers immediately after birth and discharged from the maternity clinic for institutional care while awaiting an investigation according to the Child Welfare Act.
Table
3.
Extent of Social Intervention 1970 (n=68)
Previous children placed in day nursery Lay worker Present child on probation Social welfare
2 6 10 39
Frequencies in 1970 tested against *p
Table
(3%) (8%) (15%) (58%)
4 8 8 41
(8%) (15%) (15%) (77%)
1980 (n=76)
17 27 20 68
(22%)* (36’S)* (27%) (892Y’
1980.
4.
Tvw
of Consultation
1970 (n= 150) Addiction centres Psychiatric care Police Department of paechatrics Child guidance climes Frequencies in 1970 tested against *p
1975 (n=53)
4 (3%) 6 (5%) 2 (2%) 4 (3%) I(]%) 1980
1975 (n=92) 8 7 3 10 7
(10%) (8%) (4%) (12%) (8%)
1980 (n=95) IO 15 20 15 4
(I 1%) (178) (23%)” (17%)’ (5%)
12
Gunilla
Admission for Institutional
Larson.
Gundla
Ekenstein.
and Ewa Raach
Cure
The majority (66%) of the placements in 1970 appears to have been planned b! the >ocial agencies in agreement with the parents. Thus the purpose of the admission and the destination of the infant after the institutional care was already settled in advance. At that time most mothers asked for, or at least consented, to the placement of their child [3]. This is in sharp contrast with the situation in 1980 when the majority of the parents did not consent to the commitment of their babies to institutional care. As most of the mothers had already been on the records before the birth of the child, the social workers were aware of the fact that the home environments were unsatisfactory for an infant. but they were unable to oKer the parents adequate assistance. Some parents were openly hostile and antagonistic to e\‘erg form of assistance and others. though pleasant, were uncommunicative. The social agencies pursued a wait-and-see policy until they had evidence that the child was maltreated or was not cared for in an acceptable manner. The incidence of revocation of maternal custody after the placement of the infant in institutional care under the Child Welfare Act was significantly higher in 1980 than in 1970 (Table 5). As reported elsewhere [3], the most noticeable diEerence between the three years studied concerning the destination of the infants after institutional care was that in 1970 only 14% were committed to foster care, while 21% were adopted and the rest were returned to their biological parents. On the other hand, in 1980 46% were placed under foster care. none were adopted and the rest returned to their natural homes.
DISCUSSION The social conditions in the families which precipitated the commitment of the infants to institutional care during the period studied differed significantly. A growing number of parents from 1970 to 1980 were already on the social welfare records long before the infant in question was born. Comparatively speaking, the parents in 1980 were caught up in a much more complex web of social isolation and dysfunction than those in 1970. Most families had financial problems and were on the records according to the Social Welfare Act. Although there was some recognition of alcohol and drug abuse in 1980. the social workers .seemed to be hesitant to register the parents under the Temperance and/or the Child Welfare Act. Only a small number of the addicted parents were registered under the Temperance Act. Approximately half of the children were on the records according to the Child Welfare Act. Lvhich. especially in 1980, is an underestimate of the infants’ situation as they were cared for in highrisk environments, including parental dru, 0 and/or alcohol addiction and mental disorder. The present study clearly indicates that registration under the Social Welfare Act does ~:ot only imply financial problems but serious disabling parental handicaps as well. Since individuals who need assistance from the community often have accumulated psychosocial prob-
Table
5.
Admission
for Institutional Cnre and Result Child WelCare Act
of Investi@ons
I Y70
lY75
(II = 150)
or= 92)
Unplanned committals to institutional care Withdrawal of maternal custodv Frequencies in I970 tebted agalnht 197.5 and/or ‘p
IYXO.
under the
I9XO (,r-Y5)
A changing population
of dysfunctional
parents in Sweden
I3
lems. it would have a deleterious effect on preventive social work simply to send a monthly pay cheque, as has been proposed in a legislative bill. Our findings are in accord with earlier reports [4-81 that parental maladjustment, involving mental disorders and excessive use of alcohol and drugs, is a frequent element in maltreatment of children. The increasing incidence of reported family violence from 1970 to 1980 involving child abuse as well as mothers battered by their male partners reflects the increase in alcoholism during the ten-year period studied. Domestic violence leads to a general inability to function socially and mental stress. There is a vast amount of documentation [9-l I] that lends credence to the notion that such high-risk environments have a negative effect on the lives of children. The number of infants with parents who were aliens nearly doubled from 1970 to 1980. The majority of the parents with foreign citizenship were Finnish and most of them had already had financial as well as alcohol problems in their home country. In Sweden their inability to function socially was even more manifest. A characteristic of these parents was that they were socially impoverished families in which the parent-child relationship was devoid of enduring supportive relationships. They were deprived of both nurturance and feedback, the essential elements of supportive systems [ 12, 131. Most of them appeared to be extremely isolated from sources of comfort and help. During the last five years there has been a fierce debate in Sweden about the deleterious long-term effects on the child of the disruption of affectional bonds when the child is separated from its mother. This view held by many social workers and lawyers before the court partly explains why so many newborns, particularly in 1980, were discharged from the maternity clinic to the care of incapable mothers. Instead of revoking parental custody after childbirth, the infants were left in the mother’s custody a few months under poor conditions and then admitted to institutional care as an emergency. The evidence suggesting that the syndrome of distress in children is probably partly due to a disruption of the bonding process. that the bonding need not necessarily be with the biological mother, and that the distress arises from distortion of firmly established relationships, is denied in the public debate [14]. In practice. collaboration between services has proved to be difficult [ 15, 161, but still it is necessary for the benefit of dysfunctional families, as these families often seek help from different authorities. Approximately one-third of the mothers had documented psychiatric insufficiency. but psychiatric care was rare. This lack of coordination between services gives rise to serious concern because, to a high extent, the psychiatric care and social welfare authorities have to deal with the same individuals [8]. As a consequence of the increasingly common family violence, there was an increase in consultations between the police and the social welfare authorities. In contrast with most social workers in Sweden, the police are available on a 24-hour basis and frequently accumulate a great deal of information about domestic disturbances. parental drinking and troubled children. The high number of infants placed under institutional care as an emergency measure in 1980 did not necessarily mean that the social welfare authorities had not offered the families assistance. The conventional social work methods were not appropriate to repair the harm done. in some cases. to prevent further deterioration of the families. According to the involvement continuum described by Kempe [17], the interventions in the present study occurred mostly at a very low level. The assistance mainly concerned the parents. However, after the admission of the infant. the involvement comprised protection of the child on an involuntary basis and no other meaningful therapeutic intervention occurred on behalf of the parents. The etiology of the parental dysfunction was different in 1970 atid the needs of the parents could often be met with usual social work methods.
14
Gunilla
Larsson.
Gtmilla
Ekenstein.
and Ewa Rasch
SUMMARY Compared with the living conditions of the families in 1970. there has been a change from more conventional social problems to severe parental handicaps in 1980. In 1970 just half of the total number of parents were on the social welfare records before the admission of their infant for institutional care, compared to the majority of parents in 1980. Most of the child rearing environments in 1980 included either parental drug or alcoholic addiction. psychiatric insufficiency, or family violence. These circumstances must be considered to have had a destructive influence on the development of the child even when specific acts of abuse did not occur. The social security system in Sweden is, in general. well developed but lacks adequate methods of providing services for maltreated children and their families.
REFERENCES 1. Starisrlcal Abstract of Sweden 66 ( 1979). 2. Srarisrical Abstract of Sweden 68 (198 1). 3. LARSSON G.and EKENSTEIN, G.. Institutional care of infants in Sweden: Criteria for admission in 1970. 1975 and 1980. ChildAbuse& Neglecf 7:11-16 (1983). 4. MAYER. J. and BLACK. R.. Child abuse and neglect in families with alcohol or opiate addicted parents. Cltrld Abuse & Neglect 1:85 (1977). 5. BEHLING. D. W., Alcohol abuse as encountered in 51 instances of reported child abuse. Clin~crrl Pedrarrrcs 18:87 (1979). 6. LAGERBERG. D.. NILSSON. K. and SUNDELIN. C., Life style patterns in families with neglected children. Child Abuse & Neglect 3:483 (1979). 7. OPPENHEIMER. R.. At risk: Children of female psychiatric inpatients. Chrld Abuse & Yegiecr 5: 117-122 (1981). 8. LARSSON. G. and LARSSON, A.. Health of children whose parents seek psychiatric care. Acra Psychlar. &and. 66:154-162 (1982). 9. PARKER, B. and SCHUMACHER, D. N.. The battered wife syndrome and violence in the nuclear famrly of origin: A controlled pilot study. Amencan Journal of Public Health 67:760-76 I ( 1977). 10. BURGESS, R. T. and CONGER, R. D.. Family interaction in abusive. neglectful and normal families. Chrld Development 49: 1163-1173 ( 1978). 1I. STRAUS. M. A.. Social stress and marital violence in a national sample of American families. Atrn. J. Acad. Srr. 347:229-250 (1980). 12. CAPLAN, G.. Support Systems and Communifv Mental Health. Behavioural Publications. New York. (1974). 13. GARBARINO, J. and SHERMAN. D. High-risk neighborhoods and high-risk families: The human ecology of child maltreatment. Child Development 51: 188-189 (1980). 14. RUTTER. M., Maternal deprivation reconsidered. J. Psychosom. Res. 16:241 (1972). 15. GUSTAFSSON. L. H., LAGERBERG. D., LARSSON. B. and SUNDELIN. C.. Collaboration in practice. rlcra Paediarr. Scund.. 275: 126- 13 I ( 1979). 16. LARSSON, G.. Amphetamine addiction and pregnancy. IV. Analysis of basic information concerning measures taken by social welfare agencies. Child Abuse & Neglect 4:89-99 (1980). 17. KEMPE. C. H. and HELFER. R. E., Helping rhe Barrered Child and HIS Farnd~~.J. B. Lippincott Company. Philadelphia and Toronto ( 1972).
LARSSON,
Department
DR.
of Psychiatry.
MED.
SC., GUNILLA
Karolinska
EKENSTEIN,
RASCH,
M.S.W.
Institute.
Huddinge
Hospital.
M.S.W.,
AND
S-141 86 Huddinge.
Sweden
EWA
Abstract-Whztkind of support
can an affluent society as the Swedish offer dysfunctional parents in order to give the infants an optimal start in life? The purpose of the present study was to analyze the social situation in families precipitating the admission of infants to institutional care in 1970. 1975 and 1980. The results show that in 1980 more complex forms of parental dysfunction were common including mental disorders. criminality. abuse of alcohol and drug addiction. The reported incidence of domestic violence had increased significantly from 1970 to 1980 as well as the number of maltreated infants. The social welfare agencies had greater difficulties and to a larger extent lacked adequate methods of providing assistance to the dysfunctional parents in 1980 than in 1970. &V Wards-Infants.
Institutional
care. Social assistance.
Family
dysfunction.
R&me-En 1970. une femme qui etait connue des services sociaux pour son incapacitk personnelle, socio-izconomique ou psychiatrique. d’elever son enfant. le confiait facilement auxdits services pour adoption. En 1980. la situation a chang6 radicalement, la plupart des mtres d&rent garder leur enfant. alors m&me que les problemes sociaux. socio-tconomiques et psychiatriques. de toxicomanie et de criminalitt, ont B la fois augmentt et sont mieux dipis&. Trts souvent. des enfants nouveau-nCs sont confits g leur mere. alors qu’il est prizvisible que l’enfant court des risques. et on doit alors intervenir plus tard et en catastrophe pour placer I’enfant une fois que les mauvais traitements ou la nkgligence sont devenus patents. Ceci fait que, pratiquement, le nombre des enfants qui ont dO Otre placirs aprks coup a beaucoup augmenti: en 1980 par rapport g 1970. Si I’on veut continuer cette politique respectant les droits des parents, il faudrait en meme temps leur faire accepter et leur olTrir d’emblCe le soutien psychiatrique et I’appui familial necessaires.
INTRODUCTION DURING THE LAST DECADE there has been a nationwide concern in Sweden about the battered or neglected child. A tremendous amount of attention has been focused on prevention of child abuse and on early detection of the maltreated child. In general, Sweden has a comparatively high standard of living and a well-developed system of social security. Thus it is of great interest to examine the present methods of providing services for children at high risk of maltreatment and for their families. During the last decade in Sweden an increasing number of infants have been separated from their parents and committed to institutional or foster care [l, 21. The change in criteria for admission of infants to institutional care during the last decade has already been reported [3]. The purpose of the present study was to analyze the social situation in the families which precipitated the placement of the infants in the institutions and the extent to which the families had obtained assistance from the social welfare agencies. Presented
at the Fourth
International
Congress
on Child Abuse and Neglect. 9
Paris. September
1982
IO
Muterial
Gunilla
Larson.
Gunilla
Ekensteln.
and E\\\a Rasch
md Methods
The study includes all infants (337) admitted for institutional care in the metropolitan area of Stockholm during three periods with the following distribution: 150 infants in 1970: 92 infants in 1975 and 95 infants in 1980. Psychosocial characteristics of the mothers at the time of admission of the infants had changed markedly during the ten years studied [3]. There ~vas a significant decrease @ < 0.01) in mothers who were teenagers, single and/or primapara. In 1980 a larger number of mothers already had other children in foster care. The number of alien mothers had doubled in 1980. compared to 1970. The records of the social welfare authorities were studied according to a structured scheme. with special regard to the social condition Y in the family the year before and during the placement of the infant in institutional care. Recorded information concerning the family and assistance offered by the social welfare authorities was also studied. There were very few notes in the records regarding the fathers. Consequently, this study reflects the circumstances pertaining to the mothers and their infants. Statistical ditrerences between the groups were determined by the chi-square test or Fisher’s exact test. The study was approved by the Ethical Committee of the Karolinska Institute. It was authorized by grants from the Save the Children Fund. Results In 1980 86% of the families, compared to 50% in 1970. were already on the records of the Social Welfare Department before the current commitment of the infants to institutional care. The social welfare register contains notations of the type of measure eRected according to either the Social Welfare Act. the Child Welfare Act or the Temperance Act. The majority of the families were on the records under the Social Welfare Act. which means that they had received financial aid (Table I). There has been an increasing tendency. however. to register these cases under the Child Welfare and Temperance Acts. In the analyses of the parental problems displayed during contacts with the social workers. regardless of the law under which the families were registered, the situation is quite direrent (Table 2). During the three periods studied there was a significant increase in parents with
Table
I.
Families on the Records of the Social Welfare Admission of rhe infant for Institutional
Social Welfare Act Child Welfare Act Temperance Act
49 (72%) 37 (479’) x (12%)
Department Care
45 (X5?) ‘4 (457 I? (257)
)
Before the
70 (97”;I** 42 (SSP; I 70 (16%)*
Frequencies tn 1970 tested against 19X0. *p<0.05: **p
Table 2. Analyses of Adverse Home Conditions Recorded by the Social Welfare Departmenls Before Current Admission of the Infant for Institutional Care I970
I975
(II =6x)
01=531
Alcohol or drug dependence Mental cl~wrder Crlmlnality Mental retardation Frcqucncles tn lY70 tatal xgaln\t 1475 and/or ‘,“_ 0.05: **/+ 0.01 : ***ps O.OOI.
19x0
Iuxo III 176)
A changing
population
of dyafunctlonal
II
parenla in Sweden
documented alcohol and/or drug abuse, mental disorders and criminality. Although the families were registered under the Social Welfare Act. there was usually ic much more complex dysfunction than that ascribable to financial problems. There was a significant increase @ < 0.001) in the reported incidence of domestic violence. predominantly battered women, from 1970 (5%) to 1980 (39%). Furthermore. the number of reported infants who had been maltreated prior to placement in the institution increased significantlv i (p < 0.001) from 4% to 29% during the period studied. The majority of these reports to the social agencies were made by the police although all health and school personnel are obliged to report suspected child abuse. Extent
of Social Intervention
The social agencies had provided various kinds of services to the families before the infant was committed to institutional care. Financial aid was the most common social measure during the three different years, with a marked increase in 1980 (Table 3). A frequent service in 1980. provided for parental relief. was to place older children of the family in a day nursery. An explanation of the low level of assistance offered to the families in 1970 is the comparatively large percentage of mothers (21%) who had decided to place the newborn baby in the institution while awaiting adoption. Interinstitutional
Consultations
The number of consultations between the social agencies and other institutions concerning the parental capability and the situation of the infant are shown in Table 4. The increasing degree of collaboration between the social welfare department and psychiatric care institutions. as well as the police, is in accord with the growing number of parents with mental disorders, dependecny problems and criminality. The pediatric departments were mainly consulted when the newborns were separated from their mothers immediately after birth and discharged from the maternity clinic for institutional care while awaiting an investigation according to the Child Welfare Act.
Table
3.
Extent of Social Intervention 1970 (n=68)
Previous children placed in day nursery Lay worker Present child on probation Social welfare
2 6 10 39
Frequencies in 1970 tested against *p
Table
(3%) (8%) (15%) (58%)
4 8 8 41
(8%) (15%) (15%) (77%)
1980 (n=76)
17 27 20 68
(22%)* (36’S)* (27%) (892Y’
1980.
4.
Tvw
of Consultation
1970 (n= 150) Addiction centres Psychiatric care Police Department of paechatrics Child guidance climes Frequencies in 1970 tested against *p
1975 (n=53)
4 (3%) 6 (5%) 2 (2%) 4 (3%) I(]%) 1980
1975 (n=92) 8 7 3 10 7
(10%) (8%) (4%) (12%) (8%)
1980 (n=95) IO 15 20 15 4
(I 1%) (178) (23%)” (17%)’ (5%)
12
Gunilla
Admission for Institutional
Larson.
Gundla
Ekenstein.
and Ewa Raach
Cure
The majority (66%) of the placements in 1970 appears to have been planned b! the >ocial agencies in agreement with the parents. Thus the purpose of the admission and the destination of the infant after the institutional care was already settled in advance. At that time most mothers asked for, or at least consented, to the placement of their child [3]. This is in sharp contrast with the situation in 1980 when the majority of the parents did not consent to the commitment of their babies to institutional care. As most of the mothers had already been on the records before the birth of the child, the social workers were aware of the fact that the home environments were unsatisfactory for an infant. but they were unable to oKer the parents adequate assistance. Some parents were openly hostile and antagonistic to e\‘erg form of assistance and others. though pleasant, were uncommunicative. The social agencies pursued a wait-and-see policy until they had evidence that the child was maltreated or was not cared for in an acceptable manner. The incidence of revocation of maternal custody after the placement of the infant in institutional care under the Child Welfare Act was significantly higher in 1980 than in 1970 (Table 5). As reported elsewhere [3], the most noticeable diEerence between the three years studied concerning the destination of the infants after institutional care was that in 1970 only 14% were committed to foster care, while 21% were adopted and the rest were returned to their biological parents. On the other hand, in 1980 46% were placed under foster care. none were adopted and the rest returned to their natural homes.
DISCUSSION The social conditions in the families which precipitated the commitment of the infants to institutional care during the period studied differed significantly. A growing number of parents from 1970 to 1980 were already on the social welfare records long before the infant in question was born. Comparatively speaking, the parents in 1980 were caught up in a much more complex web of social isolation and dysfunction than those in 1970. Most families had financial problems and were on the records according to the Social Welfare Act. Although there was some recognition of alcohol and drug abuse in 1980. the social workers .seemed to be hesitant to register the parents under the Temperance and/or the Child Welfare Act. Only a small number of the addicted parents were registered under the Temperance Act. Approximately half of the children were on the records according to the Child Welfare Act. Lvhich. especially in 1980, is an underestimate of the infants’ situation as they were cared for in highrisk environments, including parental dru, 0 and/or alcohol addiction and mental disorder. The present study clearly indicates that registration under the Social Welfare Act does ~:ot only imply financial problems but serious disabling parental handicaps as well. Since individuals who need assistance from the community often have accumulated psychosocial prob-
Table
5.
Admission
for Institutional Cnre and Result Child WelCare Act
of Investi@ons
I Y70
lY75
(II = 150)
or= 92)
Unplanned committals to institutional care Withdrawal of maternal custodv Frequencies in I970 tebted agalnht 197.5 and/or ‘p
IYXO.
under the
I9XO (,r-Y5)
A changing population
of dysfunctional
parents in Sweden
I3
lems. it would have a deleterious effect on preventive social work simply to send a monthly pay cheque, as has been proposed in a legislative bill. Our findings are in accord with earlier reports [4-81 that parental maladjustment, involving mental disorders and excessive use of alcohol and drugs, is a frequent element in maltreatment of children. The increasing incidence of reported family violence from 1970 to 1980 involving child abuse as well as mothers battered by their male partners reflects the increase in alcoholism during the ten-year period studied. Domestic violence leads to a general inability to function socially and mental stress. There is a vast amount of documentation [9-l I] that lends credence to the notion that such high-risk environments have a negative effect on the lives of children. The number of infants with parents who were aliens nearly doubled from 1970 to 1980. The majority of the parents with foreign citizenship were Finnish and most of them had already had financial as well as alcohol problems in their home country. In Sweden their inability to function socially was even more manifest. A characteristic of these parents was that they were socially impoverished families in which the parent-child relationship was devoid of enduring supportive relationships. They were deprived of both nurturance and feedback, the essential elements of supportive systems [ 12, 131. Most of them appeared to be extremely isolated from sources of comfort and help. During the last five years there has been a fierce debate in Sweden about the deleterious long-term effects on the child of the disruption of affectional bonds when the child is separated from its mother. This view held by many social workers and lawyers before the court partly explains why so many newborns, particularly in 1980, were discharged from the maternity clinic to the care of incapable mothers. Instead of revoking parental custody after childbirth, the infants were left in the mother’s custody a few months under poor conditions and then admitted to institutional care as an emergency. The evidence suggesting that the syndrome of distress in children is probably partly due to a disruption of the bonding process. that the bonding need not necessarily be with the biological mother, and that the distress arises from distortion of firmly established relationships, is denied in the public debate [14]. In practice. collaboration between services has proved to be difficult [ 15, 161, but still it is necessary for the benefit of dysfunctional families, as these families often seek help from different authorities. Approximately one-third of the mothers had documented psychiatric insufficiency. but psychiatric care was rare. This lack of coordination between services gives rise to serious concern because, to a high extent, the psychiatric care and social welfare authorities have to deal with the same individuals [8]. As a consequence of the increasingly common family violence, there was an increase in consultations between the police and the social welfare authorities. In contrast with most social workers in Sweden, the police are available on a 24-hour basis and frequently accumulate a great deal of information about domestic disturbances. parental drinking and troubled children. The high number of infants placed under institutional care as an emergency measure in 1980 did not necessarily mean that the social welfare authorities had not offered the families assistance. The conventional social work methods were not appropriate to repair the harm done. in some cases. to prevent further deterioration of the families. According to the involvement continuum described by Kempe [17], the interventions in the present study occurred mostly at a very low level. The assistance mainly concerned the parents. However, after the admission of the infant. the involvement comprised protection of the child on an involuntary basis and no other meaningful therapeutic intervention occurred on behalf of the parents. The etiology of the parental dysfunction was different in 1970 atid the needs of the parents could often be met with usual social work methods.
14
Gunilla
Larsson.
Gtmilla
Ekenstein.
and Ewa Rasch
SUMMARY Compared with the living conditions of the families in 1970. there has been a change from more conventional social problems to severe parental handicaps in 1980. In 1970 just half of the total number of parents were on the social welfare records before the admission of their infant for institutional care, compared to the majority of parents in 1980. Most of the child rearing environments in 1980 included either parental drug or alcoholic addiction. psychiatric insufficiency, or family violence. These circumstances must be considered to have had a destructive influence on the development of the child even when specific acts of abuse did not occur. The social security system in Sweden is, in general. well developed but lacks adequate methods of providing services for maltreated children and their families.
REFERENCES 1. Starisrlcal Abstract of Sweden 66 ( 1979). 2. Srarisrical Abstract of Sweden 68 (198 1). 3. LARSSON G.and EKENSTEIN, G.. Institutional care of infants in Sweden: Criteria for admission in 1970. 1975 and 1980. ChildAbuse& Neglecf 7:11-16 (1983). 4. MAYER. J. and BLACK. R.. Child abuse and neglect in families with alcohol or opiate addicted parents. Cltrld Abuse & Neglect 1:85 (1977). 5. BEHLING. D. W., Alcohol abuse as encountered in 51 instances of reported child abuse. Clin~crrl Pedrarrrcs 18:87 (1979). 6. LAGERBERG. D.. NILSSON. K. and SUNDELIN. C., Life style patterns in families with neglected children. Child Abuse & Neglect 3:483 (1979). 7. OPPENHEIMER. R.. At risk: Children of female psychiatric inpatients. Chrld Abuse & Yegiecr 5: 117-122 (1981). 8. LARSSON. G. and LARSSON, A.. Health of children whose parents seek psychiatric care. Acra Psychlar. &and. 66:154-162 (1982). 9. PARKER, B. and SCHUMACHER, D. N.. The battered wife syndrome and violence in the nuclear famrly of origin: A controlled pilot study. Amencan Journal of Public Health 67:760-76 I ( 1977). 10. BURGESS, R. T. and CONGER, R. D.. Family interaction in abusive. neglectful and normal families. Chrld Development 49: 1163-1173 ( 1978). 1I. STRAUS. M. A.. Social stress and marital violence in a national sample of American families. Atrn. J. Acad. Srr. 347:229-250 (1980). 12. CAPLAN, G.. Support Systems and Communifv Mental Health. Behavioural Publications. New York. (1974). 13. GARBARINO, J. and SHERMAN. D. High-risk neighborhoods and high-risk families: The human ecology of child maltreatment. Child Development 51: 188-189 (1980). 14. RUTTER. M., Maternal deprivation reconsidered. J. Psychosom. Res. 16:241 (1972). 15. GUSTAFSSON. L. H., LAGERBERG. D., LARSSON. B. and SUNDELIN. C.. Collaboration in practice. rlcra Paediarr. Scund.. 275: 126- 13 I ( 1979). 16. LARSSON, G.. Amphetamine addiction and pregnancy. IV. Analysis of basic information concerning measures taken by social welfare agencies. Child Abuse & Neglect 4:89-99 (1980). 17. KEMPE. C. H. and HELFER. R. E., Helping rhe Barrered Child and HIS Farnd~~.J. B. Lippincott Company. Philadelphia and Toronto ( 1972).