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Study of the Mother-Child Program

Part Three: Prevention: An Objective to Pursue

A. The Concept of Neglect
B. The Different Types of Neglect
C. Identifying Situations of Neglect
D. The Causes of Neglect
E. Models of Treatment and Services

As we have seen, the process of development of the child between zero and six years of age is a "complex" phenomenon. There are many theories in this field, and none is really comprehensive (Cloutier and Renaud, 1990).

A basic question must be asked in this regard. How can we make sure that children between zero and six years will be able to develop their physical, cognitive, emotional and social abilities in a normal way? This question is fundamental not only for all parents, but also for all educators or people working with young children, regardless of the "life situation" of those children. The question takes on a particular connotation when the intention is to replace the family environment with a child care environment in rehabilitation institutions, such as those operated by CSC. How can the child be helped to develop normally when he or she is separated from the environment in which most children have been traditionally looked after, namely the natural family setting?

The issue of caring for children in substitute environments (nurseries, child care services, foster homes, etc.), and of the effects of these environments on a child’s development, especially in regard to social development and adaptation, has given rise to a number of questions and to many controversies. The results of studies in this field are inconsistent and remain hard to interpret, especially where effects on the child are concerned (Crombrugge and Vandemeulebroecke, 1994). "This is surprising", the authors note, "because the negative effects on social development are most obvious when children are placed in a nursery." The authors base their remarks on a very interesting study by Belsky (1988) concerning the limited network of contacts for children in such a setting. Here again, there is no consensus on what is "truly good" for a child in these circumstances.

Despite differences of opinion, authors of studies in this area agree at least on one thing : prevention of negligence and abuse. "Prevention makes it possible to reduce deficits and delays in the child" (Turisse and Blouin, 1994). The authors emphasize the role of parents in this process, noting "parents must remain front-line educators; they must also know how to identify problems before they become too serious."

A number of questions have been raised about the risks of negligence and abuse directed at children, particularly children between two and five years of age living in high-risk environments. Studies that have raised these kinds of questions are abundantly quoted in textbooks on the psychology of child development. Many authors have examined the problems, particularly problems relating to emotional neglect, which is more difficult to assess and to reveal.

Because of the small amount of information available, we are not yet able to state with certainty that keeping a child with his or her mother in a facility may have a harmful effect on the child’s development and lead to negligent patterns of behaviour. However, more research should be done in this area. Nonetheless, a number of aspects of this situation have been identified as risk factors. These concern both the personal characteristics of the mothers and children, and the characteristics of the situational context. In this connection, there have been a number of programs over the last two decades. Generally speaking, these programs are designed to be applied in a family setting. They increasingly take the form of non-professional social support for parents, especially mothers. The objectives of these interventions are to support the mother in her parental role, to prevent the development of all kinds of problems in the child, and to foster the development of the parent-child relationship.

This social interest in prevention of child neglect and abuse in high-risk environments requires that we pay special attention to it here. It will then be up to correctional services to be vigilant in regard to this problem, to intervene if problems exist, and, above all, to put everything in place in order to prevent them.

This section of our study is therefore designed to identify the nature of this problem and the means that are currently available to minimize the negative impact of an environment both on the child and on the mother-child relationship.

 

A. The Concept of Neglect

[ The data presented in sections A, B, C, D, and E are taken from the document Rapport d’évaluation du projet "Connexion" , by Labreque, R., Guédon, M.C., Bérubé, D. (1995) et Guédon, Bélanger, Bérubé, Rousseau (1989).]

Neglect of children is one of those realities that we can easily appreciate through common sense, but that defy any precise definition when one seeks to operationalize them objectively, for the purposes of intervention or prevention. The authors who have examined these problems emphasize all of the difficulties inherent in identifying and assessing neglect. These include Coulborn-Faller (1981), Giovannoni and Becerra (1979), Helfer (1987), Maidman (1984), Mayer-Renaud and Berthiaume (1986), and Polansky et al. (1981).

In the opinion of several specialists, one of the best definitions of neglect is that proposed by Polansky and his team. These authors describe neglect as follows:

Neglect is a situation in which the parent or the individual responsible for the child, either deliberately or through extreme lack of attention or ignorance, allows the child to suffer an existing condition from which the child could be removed and/or does not provide the child with the elements deemed essential for the development of the child’s physical, intellectual and emotional abilities (Polansky et al., 1981).

Neglect is thus defined with reference to the child and to the circumstances in which the child is required to live, and is also defined in terms of a lack, rather than in relation to the motives or traits of the persons responsible for the child (usually the parents).

Many authors do not make a clear distinction between neglect and abuse, and combine the two in the same problem area of mistreatment of children.

However, there is a semantic distinction between these two concepts. For example, it is generally acknowledged that neglect involves the omission of care, while abuse refers to the commission of acts harmful to the child, in particular violence. Moreover, there are indications that the two problems have a different etiology. A number of authors, including Kadushin (1974), are of the opinion that neglect is more often associated with external stress factors than is abuse, while abuse is brought about more by factors of internal stress. As has been noted by the experts of the recent commission of inquiry on health services and social services in Quebec (the Rochon Commission), the debate on this issue has not yet been settled (file on children 0 to 11 years of age, 1986). While some situations are clearly attributable to one problem or the other, other situations are much more ambiguous. Neglect and abuse sometimes overlap, and some situations of neglect could easily be interpreted as disguised forms of abuse directed against the child. In practice, however, we shall speak of neglect rather than abuse whenever lack of care is not accompanied by active violence towards the child.

 

B. The Different Types of Neglect

As a rule, a distinction is made between several types of neglect, on the basis of the areas affected by the lack of care. Having conducted a survey of the documentation available on the subject, Mayer-Renaud and Berthiaume (1985) have established the following categories:

Physical neglect: Inadequate food (with delayed growth in the young child), clothing, hygiene and housing, lack of supervision, lack of safety.

Medical neglect: When the child does not receive the medical care he or she needs.

Emotional neglect: Coldness, lack of interaction between parents and children, lack of interest in the child, lack of attention and stimulation, primarily negative interaction.

Educational neglect: This is primarily characterized by insufficient attention to the imperatives of school attendance.

Institutional or community neglect: This type of neglect is situated at another level, because it relates to situations that do not fall within the responsibilities of the child’s family.

Two major categories emerge: physical neglect and emotional neglect. The second frequently accompanies the first (Coulborn-Faller, 1981; Kempe, 1987; Maidman, 1984; Polansky et al., (1981). However, emotional neglect can also be found in its pure state, and it is much more difficult to assess and to reveal (Cantwell, 1980; Cruickshank, 1985; Giovannoni and Becerra, 1979; Mayhall and Norgad, 1983). Despite the seriousness of the consequences for the development of the child, it is difficult to use emotional neglect as a basis for judicial intervention (Boehm, 1970).

 

C. Identifying Situations of Neglect

Except in extreme cases, the identification and assessment of situations of neglect for the purposes of intervention involves delicate issues, because of the variability of the factors involved. Intervention is only justified if there are sound reasons for believing that the observed lack of care is harming or is likely to harm the child’s development. However, making a judgment in this regard is fraught with uncertainty:

• At the present time, we do not know enough about what is really necessary for the development of the child to be able to establish definite criteria in this area.

• On the subject of how to raise children, information regarding what is desirable varies from one culture to another, and even from one era to another within a given culture (Korbin, 1987).

• Because of individual differences, it is difficult to predict the impact of a given situation on a particular child, and especially to develop general standards in this respect.

In our society, there are characteristic signs that make it possible to recognize a situation of neglect. It must, however, be admitted that judgments in respect of negligence are based on a social consensus regarding what is desirable for the welfare of the child, a consensus that is not necessarily shared by all parents. Questions of values and of culture are of great importance in this area (Gilles and Lancaster, 1987; Giovannoni and Becerra, 1979; Korbin, 1987). In Quebec, section 38 of the Youth Protection Act contains a number of provisions on lack of care, from various points of view: physical and psychological care, material living conditions, safety and supervision, school attendance, etc. According to the investigators of the Rochon Commission, the interpretation of these provisions is not uniform, but varies with individual directors of the Youth Protection Program (files on children 0 to 11 years of age, 1986).

 

D. The Causes of Neglect

Several factors have been associated with conditions that can lead to neglect of children. These factors include poverty, religious fanaticism, ignorance of the care that children require, physical or mental health problems, problems of alcoholism or drug addiction, lack of emotional maturity on the part of the parent, particular values regarding the education of children, poor quality of the surrounding social environment, etc. Generally speaking, it is agreed that neglectful behaviours result from both internal and external factors, or psychological and environmental factors, with different emphases on these factors depending on individual situations.

 

E. Models of Treatment and Services

An examination of the available documentation makes it possible to identify various types of interventions designed to prevent neglect. These interventions are not mutually exclusive, and can be undertaken simultaneously. Simultaneous action is indeed recommended by many authors, who note that the gravity of the situation in some cases requires that several problems be addressed. We shall make a distinction here between three categories of interventions, depending upon whether one first deals with the child, with the family or with the environment. All these actions may be described as preventive in that they seek to avoid situations that are harmful to the child’s normal development. We shall conclude this section by looking at the intervention and service model employed by the Rosalie Jetté Centre.

1. Removal of the child, and placement in a substitute environment

When the parents of a child seem incapable of looking after the child properly, it may be considered appropriate to remove this child from his or her parents, and to place the child in a setting that is more likely to meet his or her needs. In the past, this was the most common solution. In Quebec, for example, "a majority of children were taken away from their parents in a virtually irreversible manner" (Zeller, 1987).

At the present time, actions in this area tend to favour keeping the child with his or her parents, with the appropriate measures of support. Placement of children in a substitute environment is no longer regarded as a valid solution unless it is definitive. Consequently, it must now be regarded only as a last resort, when all other means have been exhausted. All the authors who have looked at this subject emphasize the strong attachment that most children feel towards their biological parents, even where serious family problems exist, and the heartbreak that separation from the "real family" represents for them. It seems that nothing can really heal the profound psychological wounds suffered by children who are abandoned by their parents.

2. Family-centred interventions

Given this current policy of keeping children in their family environment, interventions designed to improve the quality of life of families have acquired special importance. The approaches that can be used for this purpose vary according to individual situations and the major causes to which neglectful behaviours can be attributed. These include therapeutic approaches (individual, marital, family-centred), where the behaviours are associated with psychological factors (mental illness, emotional immaturity, substance abuse, rejection of the child, etc.), educational approaches, where the neglect is attributable primarily to ignorance regarding the care that children require (especially in the area of nutrition), and, finally, material or instrumental aid when the situation primarily depends upon material problems or organizational problems. Depending on the case involved, various types of resources may be brought in: professionals in health or human sciences, educators, community groups, homemakers, non-professional helpers, day centres, child care centres.

3. Community-centred interventions

Community-centred interventions have shown that the quality of the surrounding social environment, in particular its capacity for providing support in regard to the stress experienced, plays a determining role in the course of events. In this area, problems seem to appear due to a combination of stress and of lack of social support. Authors who have considered this matter have stressed social isolation or the inefficiency of the social network in providing support.

On the basis of this observation, many specialists have recommended that, in environments identified as being at risk, the quality of the social fabric and of support networks be improved in order to prevent or reduce the incidence of abuse and neglect. According to Frenette (1983), for example, parents will more easily adapt to their role if there is social support in four specific areas:

• Acquisition of knowledge and skills required for taking care of a child.

• Validation of the parents’ way of being and acting with the child.

• Sharing the various intense, and sometimes unexpected, emotions that may possess the parents.

• Access to material and human resources suited to their personal situation.

Frenette relates these four specific areas to five support functions: information support, feedback, emotional support, material support and physical assistance. Lepage and Guay (1984) emphasize that in order to plan a type of intervention that is truly appropriate for the personal situation of the parents, one has to be able to complement the five levels of support with interventions in relation to the network. Lepage and Guay suggest that the support networks of families be analyzed on the following six levels:

1. Determining whether the parents have a network of social support.

2. Identifying the type of support that the parents receive:

• from their sources of informal assistance (relatives, friends, neighbours, etc.)

• from their sources of formal assistance (professionals, social services centres [CSS], local community services centre [CLSC], etc.).

3. Determining whether the parents are satisfied with the support they receive from their formal and informal networks.

4. Identifying the needs of the parents that are not being met by their networks.

5. Determining whether the parents are using their potential resources for assistance.

6. Identifying the type of support that the parents wish to receive and the formal or informal resources they wish to use.

According to Lepage and Guay (1985), this type of analysis makes it possible to identify the parents’ needs for support, the assistance to which they have access, and the means they wish to employ in order to meet their needs. It thus becomes easier to plan an intervention that is truly appropriate for the personal circumstances of the parents.

This document is particularly important because it presents the factors that are today deemed essential to the development of an environmental approach to the parents’ role, and that are used in most evaluative studies. These factors are provision of information and of emotional, instrumental or physical support, socialization and interventions in relation to the network, the concepts of social network and support network, etc. The authors discuss the types of support in depth, in order to help workers to support parents in improving their parenting skills and to intervene in relation to the network. The authors also present Barrera’s ASSIS (Arizona Social Support Interview Schedule, 1981), a validated instrument for measuring the social support network. Lepage (1984) has translated this instrument and adapted it for Quebec. The document also discusses the use of non-professional help, the types of intervention that can be directed at the network, the creation of a new social network, and the use of community and volunteer resources. Today, this research perspective is reflected in various programs of intervention that have been applied over the last few years. These programs include the following:

The "De la visite " (visiting) project, aimed at a clientele of new parents living in settings identified as "at risk" (primary prevention). While enhancing the dynamism of the family’s support network, the worker tries to develop the mother’s parenting skills. The intervention of visiting mothers, evaluated by Durand et al. (1988), is characterized by the five types of support already mentioned: emotional support, information, instrumental support, physical support and interventions in relation to the network. This type of intervention has had a positive impact on the mother-child relationship, on the mother’s emotional or physical state, and on the relationship of the couple.

To improve the quality of the social fabric and the support networks for groups at risk, one can develop community projects by creating either self-help groups or various mechanisms to foster interpersonal relationships. It is hoped that violence will be prevented or that its incidence will be reduced through work not only on the family, but also on the social environment.

"La Parentèle" (parent group) pilot project was designed to foster the optimal development of parent-child dyads and to encourage the involvement of families in their respective communities. The evaluation was conducted by Beaudry et al. (1992). This assessment showed that this non-professional intervention made it possible to improve parent-child relationships, to avoid placements, to overcome the isolation of mothers, and to integrate immigrant families into Quebec society.

The "Marrainage" (godmothering) project, which also adopts a non-professional approach, is characterized by the five above-mentioned support functions: material support and physical assistance, feedback, socialization, and emotional and informational supports. This type of intervention, evaluated by Moreault et al. (1992), made it possible to improve the family situation in 54 % of cases. The observed effects are: improvement of parenting skills; greater psychological well-being among mothers; better knowledge and better use of community resources; improvement of the marital relationship; and finally, enhancement of the physical environment (support relationships).

Some observations suggested that the important factor here is not so much the quality of the social environment as the quality of the ties that the parents maintain with that environment. The research work of Polansky et al. (1981), in particular, refers to the "profound solitude" of neglectful parents. The parents are isolated, but not necessarily because the environment does not have the desired potential in terms of social support. Another, more important cause appears to be that these parents maintain this isolation through their particular mode of operation and their inability to foster satisfactory social relationships (Polansky et al., 1981, 1985; Seagull, 1987).

At other times, isolation appears to be one of the consequences of the mode of operation underlying neglect, in particular problems with interpersonal relationships. Consequently, the problem cannot simply be reduced by enriching the social environment. One also has to try to improve the dynamics of interpersonal relationships and the quality of the interactions in the primary networks of the families concerned. This is why an approach like network intervention is advantageous.

4. Network interventions

Network intervention is a relatively recent practice in Quebec. A number of adaptations of the original model of Speck et al. (1973) have given rise to various types of interventions employed in different contexts, in mental health (Blanchet, 1992) or in social work (Brodeur and Rousseau, 1984). The model we shall describe here is that of Brodeur and Rousseau (1984).

The basic principles of this mode of intervention are as follows:

Primary networks - that is, informal groups made up of individuals who are significant to each other (relatives, neighbours, friends, etc.), are of primary importance in the etiology of psycho-social problems and in the solution of these problems.

Symptoms of mental illness or maladjustment that may appear in an individual in fact reflect the dysfunction of the collective entity (primary network) to which the individual belongs, in other words, the inability of the members of this collective entity to maintain among themselves a type of relationship suited to enhancing each person’s well-being.

An intervention directed towards the establishment of this functioning may allow the members of a network to take collective responsibility for their problems and to find solutions suited to their "internal culture". The intervention thus has two aims: reconstruction or consolidation of the collective entity ("collectivization"), and expression of this collective entity’s capacity for taking charge of itself ("creation of autonomy").

The role of the worker, in this context, is situated halfway between clinical and community practice. By being regularly in the presence of the parents and by practising active listening, the worker attempts to highlight the collective aspect of the problems mentioned, to clarify the interplay of relationships among the members of the family, to improve the quality of the interactions, and possibly to foster greater openness towards other members. The worker also tries to encourage initiatives for redefining the problems and developing solutions that respect the culture. The worker does not focus on the symptoms identified initially, but rather on the quality of the network’s functioning and on the way in which the network meets its members’ needs. Finally, the worker plays a consultative role with a family, working as well on his or her own development.

Applied to the context of preventing neglect, this intervention is based on the assumption that the problem of inadequate care of children reflects dysfunction in the whole primary network of the family in question. The intervention thus focuses on identifying this network, on making interactions between the individuals within it more dynamic, and in getting the network to develop solutions.

However, existing social networks are not always able to ensure the well-being of their members (Auslander and Litwin, 1987; Blanchet, 1982; Gorlick, 1988; McIntyre, 1986; Pancoast, 1981; Schilling, 1987; Van Meter et al., 1987). In the process described above, one may be dealing with a number of situations that might be regarded at first glance as obstacles to network intervention. In fact, these situations above all require specific strategy choices:

• The support network may be extremely limited or virtually non-existent, reflecting the observations concerning the isolation of families at risk and their great mobility. The intervention will then seek to actualize the potential network and to stimulate the development of new relationships.

• The existing network, especially if it is a network of relatives, may have a negative effect on the situation and contribute to keeping the problems alive. The intervention will then acquire its full meaning, precisely because it is designed to foster a more positive functioning of the network, if necessary by encouraging it to open up to external elements.

• Neglectful behaviours may not be associated with an inadequate internal functioning of the network, but may rather reflect a lifestyle consistent with the network. They may reflect, for example, particular values relating to the education of children. In such a case, the intervention will aim at clarifying the fundamental choices, comparing these choices with the dominant social values and getting the network to define solutions to resolve potential conflicts (this may go as far as accepting definitive placement for the children).

The "Connexion" (connection) project is a network intervention that also favours a non-professional approach. The evaluation by Labrecque and Guédon (1994) has shown that this type of intervention produced the following results among mothers:

• A significant improvement in interpersonal relations.

• A great improvement in physical fitness.

• Improvement in self-esteem, greater self-confidence, more affirmation, and establishment of personal plans.

• Significant progress was noted, particularly in terms of submissive and aggressive behaviours among the mothers. There was more stability and less manipulation.

Social isolation:

• A greater openness towards using the available resources in the environment (natural, institutional and community resources) was observed. Greater satisfaction in terms of the assistance received was also observed.

• A significant improvement in the mother-child relationship was observed.

• There was significant improvement in the situation of neglect.

5. Intervention and rehabilitation

a. Model of the Rosalie Jetté Centre

The Rosalie Jetté Centre is one of Quebec’s four rehabilitation centres for mothers with problems. The centre is located in Montreal, and has been in existence for several years. It has considerable expertise in the field of adaptation to the parental role. Within the continuum of services offered by the local community services centres (CLSCs) and other partners, the Centre offers rehabilitation services to mothers struggling with serious problems of adaptation to the parental role. The general objectives of the centre are to allow the mother to pursue or resume her development, while letting her assume her parental role adequately and collaborating in the social integration of the mother and child. The centre offers four types of rehabilitation services, two internal and two external.

The internal services are group homes and individualized living units. The group homes are facilities for mothers and children that provide an environment that both stimulates and creates a feeling of security. The physical organization of the homes provides an appropriate structure for the mother and her child. The individualized living units provide a physical setting and a mode of living for the mother and child that is similar to apartment living. External services are offered in the form of follow-up at home or in a day services centre. The major activities are regular visits to the home of the parents, supervised visits aimed at assessing parenting skills, activities to encourage the development of parenting skills, individual follow-up, and a child care centre.

The Centre also offers indirect services designed to support public or community agencies: assessment and referral, vocational training, counselling services, and research interventions aimed at taking action. All of the professional services are offered within five umbrella programs:

1. Adaptation to pregnancy and maternity.

2. Development of ability to parent.

3. Existence of a significant emotional network.

4. Personal development of the client.

5. Social and occupational integration.

As in all programs based on interventions affecting the setting, the Centre’s action takes the environment into account. While working to develop a network of social support, the Centre tries to develop parenting skills and to establish the mother-child relationship.

The process of planning the Centre’s actions is articulated around two important theoretical concepts: mother-child attachment and parenting skills. The Centre has a number of validated assessment tools relating to the technical concepts, including Q-SORT on mother-child attachment (Waters & Deane, 1985), Q-SORT on maternal behaviours (Pederson & Moran, 1990), and the Child Well-Being scales (Magura and Beth S. Moses, 1986) concerning the well-being of children in relation to the exercise of parental responsibilities. The experience acquired and the skills of the staff have made it possible to develop a matrix for interpreting the mother-child attachment.

The clinical and legal conditions on which the intervention is based need to be considered.

b. Clinical conditions

• Given the important place occupied by parents and their responsibility in the development of the child, the services must be organized in such a way as to provide support and reinforcement for the mother-child relationship.

• Because the many physical, cognitive, social and emotional needs may interfere with the mother-child relationship, the plan must make it possible to provide services in a personalized way. This second clinical condition assumes a particular importance when it is necessary, for example, to assess the relevance of accommodating a child on a full-time or part-time basis.

c. Legal conditions

• The Centre takes action only within the framework of legislation.

• The Centre receives its mandate through an application by parents (mother and/or father), a decision by the Youth Protection Division or a decision of the Youth Court.

• In carrying out its action, the Centre takes into account the rules and provisions contained in this legislation (Health Services and Social Services Act, Youth Protection Act, Young Offenders Act).

We wish to thank Ms. Micheline Vallières-Joly of the Rosalie Jetté Centre, who gave us permission to reproduce an overview of the three umbrella programs concerned with developing parenting skills. This overview is taken from the document produced by the Centre (June 1992), and is an important resource for the mother-child program for federally sentenced women.

d. Overview of three umbrella programs of the Rosalie Jetté Centre

1. Umbtella Program

"Adaptation to Pregnancy and Maternity"

This umbrella program groups together various programs, all of which are designed to encourage the client to take charge of her personal life in the context of her pregnancy and maternity. These programs are:

1.1 Prenatal intervention.

1.2 Postnatal intervention.

1.3 Becoming a mother.

1.1 PRENATAL INTERVENTION

This program is designed to prepare the mother-to-be for the birth and for the integration of the baby into the mother’s life. This program comprises a set of activities, including:

• Information on pregnancy, birth and breathing exercises.

• A visit to the delivery room.

• Dialogue regarding the physical, psychological and emotional experience of pregnancy and birth.

1.2 POSTNATAL INTERVENTION

This program is designed to support the mother so that she will be able to meet the needs of the infant adequately, providing proper food, necessary care, emotional security and a stimulating, safe environment.

This response to the needs of her child should establish a new balance between her own needs and those of the child. The activities relate directly to the care and feeding of the baby and to the care that the mother should take of herself and the mother’s diet.

1.3 BECOMING A MOTHER

This program is designed to transform the mother’s desire to become pregnant into a genuine desire for a child, to ensure that the mother recognizes her child as a separate and autonomous individual, and to ensure that there is established, for the mother, a proper focus regarding:

• the delicate balance between her own needs for dependence and her aspirations to independence;

• integration of a body image that reflects quite closely her image of herself as a woman;

• her conscious and unconscious relationship with her parents, and the parental images that have arisen from it.

This questioning (therapeutic process) is carried out in accompaniment meetings provided for in the process of planning the intervention.

2. Umbrella Program

"Development of Ability to Parent"

This umbrella program brings together various programs which are all designed to foster, in the client of the Rosalie Jetté Centre, an ability to take charge of her personal life through the development of her ability to look after her child and to assume her responsibility as a parent. These programs are:

2.1 Care of child and child’s development.

2.2 The mother-child relationship (attachment).

2.3 The life planned for the child (adoption).

2.4 Assessment of ability to parent.

2.5 Development of ability to parent.

2.1 CARE OF CHILD AND CHILD’S DEVELOPMENT

This program is designed to provide the mother who is having problems with the means required to enable her to give her child the care the child needs for his or her security and development. This program involves a group of activities, including:

• Information concerning the needs of a child and child safety.

• Acquisition of the knowledge required to adapt care to the needs of the child, in order to allow for the biological, psychological and social development of the child.

• The child’s learning of language.

• The child’s learning of socialization.

• Acquisition of the skills required to guarantee the stability and safety of a child (child care).

2.2 THE MOTHER-CHILD RELATIONSHIP (ATTACHMENT)

This program is designed to help the mother who is having problems to develop a secure bond with her child. It leads her to invest in the relationship with the child. This program involves a group of activities, including:

• Learning to observe the child.

• Development of the attitudes that foster a secure bond with the child.

• Learning how to play with the child.

• Organizing the day-to-day routine of living with the child.

• Development of the mother’s tools for mental imaging in relation to the child.

• Imposition of reasonable limits on the child, or the management of discipline.

• Management of crises, of "no", of undesirable behaviour patterns and of the "agitated" child.

• Workshops to stimulate the young child and his or her mother.

• Management of the arrival of the second child.

• Respite activities offered to the mother.

• Swimming pool activities.

2.3 THE LIFE PLANNED FOR THE CHILD (ADOPTION)

This program is designed to favour the mother’s voluntary consent for adoption of the child, when the mother is unable to take proper responsibility for her child, and adoption is viewed as a means of dealing with an emotional deficiency. This program involves a number of activities, including:

• The mother’s becoming aware of her problems in assuming responsibility for her child.

• Voluntary request to make the child available for adoption.

• Taking charge exercises, intended to make the mother realize that she cannot look after the child and that she loves the child for himself or herself.

• Specific activities of support and accompaniment offered to the mother who is having her child adopted or upon whom adoption is imposed by the court.

2.4 ASSESSMENT OF ABILITY TO PARENT

This program is designed to evaluate the attributes of the mother or future mother as a parent responsible for her child. It establishes a reliable starting point for the work of developing the ability to parent. This program involves various activities, including:

• Observation of the mother’s behaviour with the child.

• The formal report to the court.

• Exploratory meetings.

• Supervised visits.

• Programmed activities.

2.5 DEVELOPMENT OF ABILITY TO PARENT

This program is designed to enable the mother to acquire the skills, attitudes, and, if necessary, the knowledge required to assume various parental responsibilities such as protection, authority, affection, education, and identification models for the child. This program involves various activities, including:

• Providing information to the mother regarding her behaviour with her child.

• Exploratory meetings.

• Role playing.

• Parenting support.

3. Umbrella Program

"Existence of a Significant Emotional Network (family or other)"

The aim of this umbrella program is to help the client to regain control of her personal life by creating or regenerating ties with her family, by creating her own family network, and by developing a significant emotional network. These programs are:

3.1 The relationship within the couple.

3.2 The relationship with the family.

3.3 Relationships with the broader network.

3.1 THE RELATIONSHIP WITHIN THE COUPLE

This program enables the mother to see herself as a woman and as a lover in relationship to a spouse, and as a person who is involved in her life plan with a child, in order to guarantee the well-being and security of herself and of her child. This program involves various activities, including:

• Meetings with educators.

• Thinking about the existing relationship with the spouse.

• Integration of the spouse into the mother’s intervention plan.

3.2 THE RELATIONSHIP WITH THE FAMILY

This program enables the mother to situate herself with her child in a broader parental setting, where she can find support and assistance. This program involves a range of activities, including:

• Relationships with the client’s parents (grandparents of the child).

• Relationships with the parents-in-law.

• Information on the rights of parents and of grandparents.

• The role of grandparents in providing support for the child’s development.

• Support for grandparents in their efforts to draw closer to their daughter or grandchild.

3.3 RELATIONSHIPS WITH THE BROADER NETWORK

This program is designed to help the mother develop positive contacts with her environment, by using and the resources in that environment and making appropriate referrals to them. This leads to the creation of a support network in a natural setting.

This program involves, among other things, activities focusing on relationships with neighbours, friends, the child care centre, and the members of community organizations.