CAN administrative surveillance in CAN administrative surveillance in EuropeEurope

George Nikolaidis1

1Department of Mental Health and Social Welfare, Institute of Child Health, Greece

The Iceberg of CANThe Iceberg of CAN

Epidemiological tools and Epidemiological tools and their clinical usefulnesstheir clinical usefulness

Mapping: representing as much accurately as possible the extent and features of the characteristic under investigation, viz. CANMonitoring: Ongoing recording and supervision of development and trends of the given characteristic (CAN) both aggregative and on an individual basis Surveillance: Permanent mechanisms for detection of hazardous trends on the overall development of the given characteristic (CAN) or on a particular instantiation of it (e.g. on a certain individual or group of individuals) – usually accompanied by mechanisms of early intervention to prevent increase of risk

Monitoring on CAN: two distinct Monitoring on CAN: two distinct conceptualizationsconceptualizations

Monitoring of the enactment of the U.N.-C.R.C. as well as of protecting children in overall in a given societyMonitoring on an individuated basis as in registering all and every cases of children’s rights’ violation as well as improving recording techniques and procedures

By and large both aspects seem necessary and socially beneficial regardless of their diverse orientation

WHO & ISPCAN, WHO & ISPCAN, (2006)(2006):: “Preventing “Preventing child maltreatment: child maltreatment:

a guide to taking a guide to taking action and action and generating generating evidence”evidence”•Recommendations for Recommendations for

international international comparisons’ appropriate comparisons’ appropriate

tools such astools such as::ICAST ICAST (-CH, -CW/I, -P, -R)(-CH, -CW/I, -P, -R)

ACE ACE (Adverse Childhood (Adverse Childhood Experiences)Experiences)

CTS CTS (Parent–Child Conflict (Parent–Child Conflict Tactic Scale)Tactic Scale)

LVS LVS (Lifetime Victimization (Lifetime Victimization Screening)Screening)

CHILDONEUROPE, CHILDONEUROPE, (2009)(2009):: “Guidelines on “Guidelines on

Data Collection and Data Collection and Monitoring Systems on Monitoring Systems on

Child Abuse”Child Abuse”

•Specification among Specification among others of Guidelines others of Guidelines

forfor::Administrative CAN-Administrative CAN-

related Data Collectionrelated Data Collection

The challengeThe challengeHarmonization and unification of procedures and recording practices on CAN casesCurrent situation: fragmentation and incompleteness of existing resourcesProblems to be tackled:

Different legal frameworks dictating different definitions of a “CAN-case”Different “systems” involved in CAN-related data collection with diverse focus and functional proceduresDifferent orientation towards (a) the case, (b) the child, (c) the family, (d) the perpetrator etc

A realistic approach: small steps towards upgrading comparability and compatibility of pre-existing national and regional resources Potential threats: personal sensitive data protection issues and controversial debates on creating a pan-European “big brother”

What is at stake in a What is at stake in a nutshellnutshell

To have aggregative and reliable data on trends of the CAN phenomenon To maintain individualized files/records/archives for cases/children/families/crimes to facilitate continuity of monitoring (as well as to introduce multiplicity as a parameter in CAN inquiries)To provide real-time interactive feedback in producing indicators/thresholds augmenting clinical decision making

Example of current fragmentation Example of current fragmentation on CAN surveillance: the Balkan on CAN surveillance: the Balkan

countriescountriesIn Albania, Greece, and Turkey, currently neither central authorities where CAN cases can be reported nor unified databases of CAN cases exist; instead, cases are reported to a range of different agencies. In FYROM a new surveillance system is being developed by the Institute of Social Work a few years ago but to this date it remains in a preparatory stage. Despite the fact that there is a surveillance system in place exclusively for cases of sexual abuse, the existing mechanism may not be used to identify CAN cases concerning other child adversities or cases of domestic violence.

Example of current fragmentation Example of current fragmentation on CAN surveillance: the Balkan on CAN surveillance: the Balkan

countriescountriesIn Serbia since 2005, when a new Family Law and the amendments of the Criminal Law were adopted, referral of all CAN cases to one out of the 132 Centers for Social Work (CSW), which are public governmental institutions under the central governance and financing of the Ministry of Labor and Social Policy, has been mandatory. CSWs are also the main statutory agencies responsible for further investigation and management of CAN cases. Health, education and police services, even NGOs, are obliged to report to CSWs if they have any information or concern that a child has been abused or neglected or it is at risk of CAN. CSWs keep a common archive of all CAN cases, which means that each child and his/her family have their own file. Since 2009, CSWs have been using a common CAN record form but descriptive data still predominate in those records. However, there is still no individuated database on CAN cases in CSWs. The only data reported annually by the CSWs are the data on the number and type of CAN cases and the services provided.

Example of current fragmentation Example of current fragmentation on CAN surveillance: the Balkan on CAN surveillance: the Balkan

countriescountriesIn Bulgaria since 2001, the State Agency for Child Protection collects data about cases of abused children from regional departments for child protection, police, prosecutors’ offices and related NGOs. This surveillance system, however, needs improvement in terms of methodology and enrichment of the recorded variables.In Bosnia & Herzegovina, the “Council for Children in BH” is the governmental institution, which maintains a CAN surveillance system at a national level. This Council is the advisory body to the government on child rights issues and responsible for monitoring the implementation of the National Action Plan (2002-2010) for Children in BH and the National Strategy (2007–2010) for combating violence against children. According to the Council's Report, it collects data from different sources (education, health, welfare and justice sectors).

Example of current fragmentation Example of current fragmentation on CAN surveillance: the Balkan on CAN surveillance: the Balkan

countriescountriesIn Romania there is CAN surveillance system operating within the National Authority for the Protection of Child’s Rights, General Direction for Social Assistance and Child Protection.In Croatia, the system for social care has authority over all cases of abuse and neglect of children. The Centers for social care are governed by Ministry of Health and Social Care. 115 Centers are distributed across the country and one center can cover several municipalities. As it is proscribed in the Family Act (Article 108) and in the Rules of Procedure in Cases of Family Violence, issued by the Ministry of Family, Veterans’ Affairs and Intergenerational Solidarity, all the information and knowledge about violence and abuse and/or neglect of children should be reported to the Centers for Social Care, who are obligated to immediately investigate the case and take measures to protect the child.

ConclusionsConclusionsSome countries have a centrally governed structure, some have regional authorities, some have none… Some countries base their surveillance policies to social/welfare sector, some in justice or police sector, some in whoever is willing to collect such data (e.g. N.G.O.s etc)Moreover, some countries nominally have a “system” but it doesn’t seem to fulfill its functions and purposeNaturally, all the aforementioned “systems” do not communicate or are compatible between one another even in nearby countriesThat is extremely burdensome since given the labor mobility around Balkan countries in the last 2 decades, there are nowadays a lot of issues of international jurisdiction concerning child custody, offenders’ prosecution but also clinical continuity and monitoring

What’s next?What’s next? Contemporary challenges Contemporary challenges

Undertaking initiatives to improve: CAN related data collection (in the first place!)Compatibility of existing resourcesIndividuation of existing databases

Additionally, some pan-European “fast-track” mechanism might be useful especially in cases of cross-national interest (custody, jurisdiction but also child trafficking etc) Also, it seems essential to focus on promoting the daily usage/usefulness of data in clinical practice:

Data used to produce evidence-based clinical indicators and thresholds to “feed-back” clinical practiceData used as a pool of information for (classified and partially restricted) access to clinical professionals