Invisible children? Professional bricolage in child protection

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Invisiblechildren?Professionalbricolageinchildprotection

RESEARCH·AUGUST2015

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LarsAlberth

LeibnizUniversitätHannover

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DorisBühler-Niederberger

BergischeUniversitätWuppertal

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Invisible children? Professional bricolage in child protection

Lars Alberth, Doris Buhler-Niederberger

PII: S0190-7409(15)30038-4DOI: doi: 10.1016/j.childyouth.2015.08.008Reference: CYSR 2751

To appear in: Children and Youth Services Review

Received date: 5 February 2015Revised date: 13 August 2015Accepted date: 13 August 2015

Please cite this article as: Alberth, L. & Buhler-Niederberger, D., Invisible children?Professional bricolage in child protection, Children and Youth Services Review (2015), doi:10.1016/j.childyouth.2015.08.008

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Invisible children? Professional bricolage in child protection

Lars Alberth, Doris Bühler-Niederberger

Lars Alberth, Leibniz University Hannover, Institute of Sociology, Im Moore 21, 30167

Hannover, [email protected] (+ 49 511 267 2997)

Doris Bühler-Niederberger, University of Wuppertal, Department of Sociology, Gaußstraße

20, 42097 Wuppertal, [email protected] (+ 49 202 439 22 83)

Abstract

In the last decades, child protection has been heavily criticized in many countries as fatal

cases have caused public debates and political revisions. A study on the child protection

system in Germany is presented. Responding to public criticism of fatal cases, new laws

aimed for a stronger involvement of further professions beyond social workers who are

traditionally holding the main responsibility. The study enquires in how far these revisions

allow for a higher level of attention given to the children’s conditions and sufferings. Data

was gathered in five communities by interviewing practitioners of the social work profession,

pediatric medicine, and midwifery on recent cases. By applying concepts of interpretive

sociology of professions, 93 cases were systematically reconstructed. A typology of the

different “mandates” of the occupations was developed, referring to the practitioners’

interpretation of their main tasks in their case work. Validation of the qualitative analysis was

sought by quantifying important characteristics of case trajectories. The results show that a

mere addition of professional groups does not lead to a comprehensive consideration of the

child’s situation. The three professions only take specific aspects of children and according to

their ‘mandates’ into account. Furthermore, social workers, having the competence of case

coordination, occasionally exclude the knowledge of other professions from further

proceedings.

Keywords: child protection; child maltreatment and neglect; professions; sociology of

professions; professional mandates.

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1. - Introduction: Fatal cases and systematic biases in child protection

Child protection system has been fiercely discussed in the last decades as to its reliability, its

quality and to put it in a nutshell: as to its alleged failure. In many countries this became an

important issue of scientific analysis, but of public discourses as well and thus, it was put

prominently on political agendas.1

Such critique gave special attention to cases in which

families already had a history with child protection services, but their child came to death all

the same. In mass media, in reports into the deaths of these children, and in political reactions

such fatal issues appeared to be proof of severe shortages of child protection systems as a

whole. Stricter control, more formalization, and additional recommendations are needed

according to this critique from outside. In contrast, the comments of social work scientists and

thought leaders of child protection criticize such propositions and their gradual

implementation as a (false) belief in control and managerialism, as bringing about a process of

de-professionalization, and at any rate a waste of time which might be dedicated to the child

otherwise (Ayre, 2001; Munro, 2005; Shaw et al., 2009). Such is the critique from within and

more or less explicitly it argues that fatal case stories are not least due to this inadequate

intervening into the child protection system.2 The discussion was particularly intensive and

most consequential in UK, but of the same tenor in other countries, for example, in Germany

(Fegert, Ziegenhain, & Fangerau, 2010; Wolff, Flick, Ackermann, & Biesel, 2013).

While the reconstruction of such fatal cases may be seen as an important approach among

others to the quality management in child protection, it cannot be the approach to make valid

judgments on the quality of child protection as a whole, its overall strengths or weaknesses

(Parton, 2014). Firstly, the goal to guarantee the child’s safety in each and every case will

never be realized; the privacy of the family is all in all the most violent realm of society,

1 To mention some examples: Speech of the Education Secretary in UK, the Rt Hon Michael Gove MP,

https://www.gov.uk/government/people/michael-gove; The American Statesman analysis of child fatality reports in 2015: http://projects.statesman.com/news/cps-missed-signs/main.html 2 For a position in between these two stances, see Corby, Shemmings, and Wilkin (2012).

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especially young children becoming victims (Finkelhor, 2008). Secondly, these often

atrocious cases of child abuse and neglect which are discussed to give evidence of child

protection’s “failure” may result from exceptional case constellations.

However, there are quite some studies analyzing and criticizing processes of child protection

beyond dramatic cases and based on a larger data basis. They give evidence of systematic

biases in decisions of child protection agencies, compromising the quality of child protection.

These studies focus on the process of substantiation of reported cases. They show that most of

the cases reported to child protection agencies do not become registered at all. Such

calculations are only possible for US, Canada, Australia, and England, as these are the only

countries where the necessary data are collected systematically. Only about twenty percent of

referred cases are substantiated and this percentage is even smaller in England (Creighton,

2004; English & the Longscan Investigators, 1997; Gilbert et al., 2009). Often, such decisions

to discharge referrals – which in about fifty percent are made by other professionals – or to

end child protection measures turn out to be fatal. Jonson-Reid, Chance, and Drake (2007) in

a longitudinal study of children who were reported to child protection agencies found a

mortality rate which was twice as high as for a control group of not referred children living in

comparable social circumstances. The median time between first referral and death was only

nine months, however, only a very small number of children who deceased had still been

under the control of the agency or even benefitting from a child protection measure at the time

of death. Using information from 4,515 children from a national probability study of children

investigated for maltreatment, Cross and Casanueva (2009) analyzed the process of

substantiation more thoroughly. In almost ten percent of the cases there was no substantiation

despite caseworkers’ judgement that there was middle or severe harm and risk given in this

case. The study concludes that substantiation is a ‘flawed measure’ of child maltreatment and

needs a “fresh appraisal by state child welfare service agencies” (p. 38).

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Taken together, the studies mentioned above give evidence, that decisions in child protection

exclude too many reported cases from protective measures. This insight – if interpreted in

isolation – might simply be attributed to a shortage of resources and therefore correspond

partly to the critique from within. But, there is some evidence for a second bias: The

substantiation process is influenced by considerations other than the judgements of risk and

harm to which the child is exposed. Several studies shed light onto something which might be

called a “proper family-bias”, a stronger importance given to a well-functioning family than

to the sufferings of the child in assessing and handling the case.

King and Scott (2014) found that cases of child maltreatment reported by school professionals

are much less often substantiated in the subsequent investigation of child protective services

than cases reported by other professionals. However, the cases the schools reported were

severe, but contained more child risk factors (e.g., child emotional and behavioral problems)

and fewer caregiver and family risk factors than the cases reported by other professionals.

Corby (2003) re-analyzed case histories in UK and found that in about ten percent of cases

there had been too much concentration for too long a time on giving help to the family instead

of using authority to protect the child, what would have been indicated in certain cases. His

judgment was validated by negative outcomes in these cases; meanwhile a premature

authoritarian intervention was extremely rare. Holland (2001) found a minimal range of child

related documentation in British assessment centers, mostly copying standard textbook

phrases compared to a rich and lively vocabulary on the parents. This does not change, even if

practitioners commit to learning about children’s lives: the vocabulary in which the child is

displayed then turns to rather negative aspects of children’s identities (Thomas & Holland,

2010). Several ethnographic studies from Finland reported a minor role of children in child

protection practices (Forsberg, 1998), and a lack of documentation (Törrönen & Mäenpää,

1995). Pösö (2001) found that the problems of children were constantly framed as deviancy

by the Finnish welfare state, taking to the concept of the child as a trouble maker or

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‘rebellious child’ (Best, 1994). Another evidence of the family as the key object of concern is

given by Eriksson and Näsman (2008). They found in interviews with children who had

participated in family law proceedings on parental custody that they were actively persuaded

by the professionals to keep in contact with the violent father, even if the child declared to

feel sick after meeting him.

Several studies of mostly North American origin offer evidence that professional practices are

influenced by the everyday knowledge the professional shares with any member of society,

and in this way the “folk concept” of a “proper family” is intertwined with categories of

stigmatization, mainly race and class. Jenny, Hymel, Ritzen, Reinert, and Hay (1999) found in

an analysis of hospital files that about one third of cases of head trauma were mistakenly not

diagnosed as due to maltreatment. Missed cases were significantly more frequent in the group

of white children from two-parent families. Wood et al. (2010) conducted a study in 39

hospitals where they analyzed the data of infants who were admitted from 2004 to 2008. They

found considerable biases in the evaluation for abusive head trauma eliciting concern for

over-evaluation in some infants (black or publicly insured/uninsured) or under-evaluation in

others (white or privately insured). Biases of race and class were found in many studies and

several countries (Benbenishty et al., 2014; Drake, Lee, & Jonson-Reid, 2009; Gelles, 1996;

Lau et al., 2006; McRoy, 2002; Rhee, Chang, Weavere, & Wong, 2008, Roberts, 2003; van

Krieken, 2010).

For Germany there is no data available giving insight into the substantiation process and its

biases. Until 2012, there was not even a national statistic on cases existing. But, very much

like in other countries, German social services had been under attack for providing ineffective

work and this was due to fatal cases: young children coming to death due to maltreatment and

neglect although the family had been under close supervision of child protection services.

Among others, the death of two year old boy “Kevin” in Bremen revealed a tremendous

imbalance between the administrative efforts and protective outcomes (Büchner, 2011).

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Media presented a series of fatal cases, in which social services were unable to prevent the

worst. Several political consequences were found. They mainly consisted of involving new

professional groups more strongly into the child protection processes. This article on child

protection in Germany is based on an empirical study of how these different professional

groups routinely perform in cases of (suspected) child neglect or maltreatment, of how their

work is coordinated and in how far this assemblage of different professional programs might

cope with the biases of child protection processes.

2. Child protection in Germany – history and recent revisions

To contextualize the empirical study, we will provide a short historical development of the

child protection system in Germany, which is embedded in the German welfare system, as

well as recent political and legal developments.

2.1 Rise and dominance of social work – from parents as offenders to parents as clients

Historically, public child protection in Germany is closely tied to welfare services delivered to

poor families and by that a form of policing and normalizing families. From 1922 on, the task

to exercise the state’s control on families which were considered improper and therefore

offending the social order (Müller, 2013) was delegated to the “Jugendamt” (youth welfare

office). The main rationale of interventions was to discipline families in order to prevent

young people from showing deviant behavior in public, such as drinking, loitering, smoking,

violence or theft. There was a clear focus on social order: to generate self-reliant, future

oriented and morally responsible and productive citizens (Donzelot, 1979; Kessl, 2005).

To achieve these goals, the youth welfare office started to incorporate social workers as

assisting workforce (Sachße, 2002). Their number was steadily rising. Recent statistics on the

professional composition of the workforce employed in Germany’s 658 youth welfare offices

give evidence on that: out of the 34,797 pedagogical and administrative staffers counted on

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December 31st, 2010, 18,651 employees held a university degree in social work or social

pedagogy, while the second largest group, clerks of public administration comprised 4,117

persons (Statistisches Bundesamt, 2012). Although psychologists, members of several

therapeutic occupations, attorneys and even two physicians can be found on the youth welfare

offices’ rosters, social work has managed to establish itself as the dominant profession at the

center of this organization.

And it is the youth welfare office, where the different threads of public responses to child

abuse and neglect come together: it is the social workers who record allegations of abuse and

neglect, manage and carry out risk assessments and protective responses, decide on and

supervise services (usually carried out by further public and private organizations), prepare

court hearings on parental rights, and hold the general steering function and responsibility for

case management as laid down in Book VIII of the German Social Code (SGB VIII).

Establishing the youth welfare office as child protection’s central body of authority and social

work as its dominant profession may be seen as the latter’s main success.

This success is reflected in the law. In the late 19th

and early 20th

century law allowed the

punishment of parents when a child was “neglected” or visibly maltreated, it assumed a clear

perpetrator-victim-constellation. Katz and Hetherington (2006) call this a (dualistic) child-

focused model (see Richter, 2011). The newer model of social work turned towards a client-,

hence adult-centered model, in which services to and preservation of families became of

utmost concern for the social workers. From 1980 on, § 1666 of the German Civil Code

(Bürgerliches Gesetzbuch, BGB) highlights the parents’ responsibility to avert dangers to the

child’s weal, subsuming parental violence under the notion of the parents’ inability or missing

will to protect their children from harm, which are now the legitimate reasons for

interventions in cases of child maltreatment and neglect. In its current version, §1666 I BGB

states: “If the physical or mental weal or the wealth of the child is threatened, and the parents

are unwilling or unable to avert such threat, the family court has to take the measures

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necessary to avert the threat” (Deutscher Bundestag, 2008, p. 1188). In this legal definition, it

is assumed that child abuse and neglect are rather omissions than commissions.

2.2 Involvement of pediatricians and midwives: recent political revisions

Parallel and in response to the reported public debates on the efficiency of the German child

protection system, legal responses started to regulate the professional responsibilities in two

ways: Firstly, already established professions delivering services according to Book VIII of

the Social Code (e.g., social workers, kindergarten teachers, and pedagogues) faced specific

rules for proceeding suspicions of abuse and neglect. And secondly, further professions were

included for diagnostic purposes and low-threshold services. In effect, this led to a stronger

involvement of pediatricians and midwives.

In 2005, the new §8a of the Book VIII of the Social Code established a mandatory

two-man-rule for both social workers at the youth welfare office and further social

services when confronted with a case of suspected maltreatment and neglect. Now,

every case has to be scrutinized by at least two professionals. The same paragraph also

obliged kindergarten teachers, social workers at centers for counseling and school

teachers to seek counsel with an external expert before reporting any suspicions

directly to the youth welfare office (Deutscher Bundestag, 2005, p. 3134).

Since the discovery of the child-battered syndrome in the 1960s, pediatricians have

been consulted to identify physical and sexual abuse. But there is neither a mandatory

reporting for pediatricians nor any involvement beyond diagnostics. However, a law

from 2012 (Deutscher Bundestag, 2011, p. 2975) loosened the doctor-patient-

confidentiality for suspicions of abuse and neglect, which is considered to ease

probable conflicts of conscience (Bundesärztekammer, n.d.). Also, efforts were made

to use the pediatricians’ developmental screenings to systematically detect further

incidences of maltreatment and neglect. Such screenings are due to fixed dates in the

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child’s growth and are financed by public health insurances. Since 2005, 12 of the 14

federal states (the so-called “Bundesländer”) oblige pediatricians to report every single

screening to a control agency, which is often the public health department. If families

recurrently fail to meet their appointments, they will be reported to the local youth

welfare office. In this way, the involvement of pediatricians may be considered an

indirect reporting system.

The very same law from 2012 sought to strengthen a multi-professional approach.

Following the buzzword of “early intervention” – and building on already running

programs –, new “early intervention networks” are established as well as provided

with a regular funding of 51 million Euro p.a. from 2015 onwards. Central to this new

approach are midwives, who already became valorized as a professional group in child

protection. Equipped with a new extended vocational training, midwives are now paid

for up to one year after the child’s birth (instead of eight weeks) to accompany very

young mothers or mothers in “multi-problematic” families. However, this

occupational group is tied to the youth welfare office which decides on the midwives’

installment. Even if a midwife suspects maltreatment or neglect, she has no power to

intervene, but instead reports her suspicion to her principal: the youth welfare office.

The recent legal developments aimed at a multi-professional restructuring of the child

protection system in Germany with a new weight given to medical professions. However,

these revisions refrained from touching the central position of the youth welfare office and its

social workers, even with the introduction of the two-man-principle.

3. Empirical study on child protection in Germany

3.1 Study questions and theoretical base

Our study raises the question how the child protection system in Germany works after these

revisions. What are the approaches of the members of different professional groups now being

involved in child protection, that is, social workers, pediatricians, and midwives, how are

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these approaches integrated and what about (remaining) biases and blind spots due to which

some children might be insufficiently protected?

The theoretical framework for our empirical study takes the specific situation in Germany into

account, which may be characterized as a weakly coordinated addition of occupational

groups. A theory of professions is indicated, giving weight to the specific ways in which

occupational groups define the social world. We refer to the interactionist tradition of the

sociology of professions. In the sociological approach of symbolic interactionism actors give

meaning to objects, to processes, and to themselves and such interpretations are orienting and

re-orienting interactions. The concepts of “mandate” and “licence”, which Hughes (1958)

developed for the sociology of professions, were coined in this theoretical perspective.

Mandate refers to the members’ shared definition of “proper conduct” towards a problem at

hand and in general: the mandate determines what to do and how to do it (Hughes, 1958, p.

78). The mandate is, therefore, the self-perception of the members and it may be publicly and

legally recognized to different degrees. Such recognition is not simply grounded in a

superiority of the occupational group or an effective technology – and by no means

automatically results from such superiority. It is rather grounded in a successful professional

project, a skillful or solitary appearance on a “market” of occupational groups, where they

acquire a licence, a monopoly to solve a problem by delivering their services, acknowledged

by political elites and employers (Hughes, 1971; Johnson, 1972; Larson, 1977).

Furthermore, an interpretative perspective towards professions makes aware that professional

groups do not just process social problems as they are defined by public opinion, by

politicians or even by law. They actually define social problems they gained responsibility for

or for which they claim responsibility (Blumer, 1971; Spector & Kitsuse, 1973): they can

make the public aware of the existence of a problem in the first place (e.g., the battered-child

syndrome by the pediatric radiologist Henry Kempe in 1962, see Pfohl (1977)), but it

generally implies that they apply patterns of interpretation specific to their occupation.

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While professionals apply these patterns on the level of their everyday work they engage in

social problems work (Holstein & Miller, 2003). This includes the ascription of a client status

to persons (Hall, Juhili, Parton, & Pösö, 2003), whose problems have to be identified

individually and sorted along existing categories at the discretion of the professional in street-

level bureaucracies (Lipsky, 1980). However, street level determination of the actual clients

and their needs may range considerably – for child protection, this may either be the child,

one or both parents, or the family (Vesneski, 2009) – and may be deeply grounded in the

everyday routines and the professional’s belief of who is worthy of services to be delivered

(Maynard-Moody & Musheno, 2003). Križ and Skivenez (2014) found that practitioners adapt

selectively to the normative aims of their national child welfare systems, for example,

preferring family reunification over stable foster home placement when aiming at stability and

Marinetto (2011) argues that this might also lead to child protection failures.

All these case-by-case definitions and hence decisions are closely tied to the profession’s

mandate as it may even be officially declared. But, we have to be mindful that a professional

group is not a monolithic block. Some of its members are on an academic level, doing

research and teaching, and some are doing the front-line case work, with many graduations in

between. Similar to Lipsky’s organizational concept of street-level bureaucracy, but better

fitting into a consistent framework of an interactionist theory of professions, Freidson’s

concept of “transformation of knowledge” (1986) takes such differences into account.

Freidson shows, that the knowledge as produced by academic professionals regularly

undergoes a further transformation when handed down to and applied by practitioners of the

same profession. In general, this transformation of knowledge caters to the employers,

administration, political elites, but to everyday exigencies of the practitioner as well. The

problem of knowledge transformation lies at the heart of debates on the knowledge base of

decision-making in child protection (Gambrill & Shlonsky, 2000; Gillingham & Humphreys,

2010; Munro, 1998; Taylor, 2012) and the effectiveness of assessment tools (Johnson, 2011),

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check lists or clinical experience (Bastian, 2011; van de Luitgaarden, 2011). Gilbert et al.

(2009) complain about a very fundamental transformation of academic knowledge on child

maltreatment and neglect when they say that the problem is considerably underestimated on

the level of social policy measures and professional services for children in regard to its

frequency as well as to its disastrous consequences.

Out of these conceptual instruments our study uses the concepts of “mandate”, “licence” and

“transformation of knowledge”. They are systematically connected to the empirical material

in order to describe and distinguish the approaches of different professional groups and to

assess their relevance in child protections processes.

3.2 Study Design

3.2.1 Sample and units of analysis

The research was conducted in five communities in Germany, differing on being either urban

or rural, on their geographical location,3 as well as on their financial situation and the

economic situation of their respective population. Early intervention programs were already

running in all five communities at the time of the interviewing. We conducted 81 interviews

with social workers (N=62), pediatricians (N=11; in this group we include 3 forensic

specialists, who were all members of the medical professions), midwives (N=8) and 12

observations of case conferences. We chose an empirical approach as close as possible to the

actual case proceeding – instead of, for example, an analysis of professional regulations,

opinions and doctrines, or mere case outcomes – because of our theoretical assumption of a

transformation of knowledge in actual case-work. In this way we aimed at the reconstruction

of cases of child maltreatment or neglect which made up our units of analysis. Out of the

almost 200 cases presented in the interviews and conferences we reconstructed 93 cases of

children aged 0-6 years, while excluding cases of sexual abuse only, cases of children older

3 Geographical location implicates in Germany the East-West dimension, that is, a different political history of

GDR and FRG. Two of our communities were in the Eastern part. However, twenty years after reunion, the findings for East and West did not differ.

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than six years, and cases for which only little information was given. Most of the

reconstructed cases stemmed from social workers as showed in table 1.

(Insert table 1 about here)

3.2.2 Data collection

The interviews (lasting 60 to 90 minutes) combined a narrative approach with additional

semi-structured parts. The question to stimulate narrations was: “Could you tell us about your

recent case of maltreatment or neglect of a child not older than 6 years?”4 This incited the

interviewees’ accounting of cases, that is, they offered presentations, interpretations and

legitimations of case trajectories. The semi-structured part of the interview aimed at

completing information on the cases: on actual events, that is, measures, turning points of the

proceeding, on cooperation with other professionals, on duration, and on outcome or current

state of the intervention. Subsequent questions aimed at the reconstruction of additional cases

contrasting – in the view of the interviewees – to the ones that they had just described. On the

basis of the practices and routines, presented, interpreted and legitimated in the case

narrations of the practitioners, we were able to assess their mandates over different steps of

analysis.

3.2.3 Steps of analysis

The data analysis followed mainly a qualitative model of research. Qualitative research is not

characterized by an orderly process of different and separable steps. Rather, a back and forth

of theorizing and data collection is required, Strauss and Corbin (1990) call this a process of

“coding” and “memoing”. Nevertheless, we attempt to make our work process as transparent

as possible. In the first step we wrote case plots, summaries of the cases which we gained in

the interviews or observations. Case plots are depicting (1) the trajectories and (2) the way

4 In German, the exact wording of the question was for the last case of “Kindeswohlgefährdung oder Verdacht

auf Kindeswohlgefährdung” which means translated “endangerment of the child's weal or suspicion of such endangerment”.

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they were presented and interpreted by the interviewees as well; the two aspects cannot be

separated as the research aims at professional perspectives. By comparing these case plots for

the professional groups we found “types” of professional approaches to child protection cases,

a first still unsystematic classification (Lazarsfeld & Barton, 1951).

In the second step – partly based on the orientation which we gained in the first step and

partly in a timely overlap – we specified the theoretical concepts (see 3.1) which had been

guiding our research in a sensitizing way. In this step we followed a “grounded theory”

approach (Strauss & Corbin, 1990): The development of theoretical codes (i.e., the “coding”

and “memoing”) continuously accompanied the data collection. The three categories which

we found appropriate to grasp the particularities of the approaches of the three professional

groups were the following: “definition of responsibility”, “relationship with the client”, and

“applied knowledge”. (1) By definition of responsibility we mean that practitioners of

different professional groups have specific concepts of what they should do and how they

should do it if involved in a case of child maltreatment or neglect or suspicion of such

incidence. (2) Relationship with the client means the intensity of contact, but also the

strategies which are used to involve the client. (3) When assessing the applied knowledge we

consider the information which is used to judge on the case and to decide on the next steps.

Such knowledge may be considered a selection and transformation of the academic

knowledge on child maltreatment and neglect. – These three categories proved to be

empirically observable indicators of our most important theoretical concept of the “mandate”

and include the concept of “transformation of knowledge”.

In the third step of the analysis, data was systematically sorted by the now generated codes

with the help of MAXQDA software. This step was extremely time-consuming as – due to the

overlapping of steps of analysis – the codes might still be redefined while already entering the

data for MAXQDA, consequentially data had to be sorted again. However, this allowed for a

quantification of some findings. Results of this step are the quantifications in regard to the

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category “applied knowledge” and the final “classification of case narrations” assigning all

93 cases to one of five classes according to a) the reasoning given for interventions and b) the

events which are mentioned as turning points for the work on this case.

The coding process in qualitative research is – this became already evident – different from

the coding process in a quantitative approach. It does not consist in the attribution of material

to predefined codes, therefore, it cannot be delegated to raters. It is the group of researchers

which is involved in this process of continual working out of codes and interpretation of

material, during coding sessions which are recorded in theoretical memos. Accordingly, the

quality of the coding process is not assessed by calculating an inter-rater reliability. The

quality of the coding process is strived for in what we may call a discursive validation of the

interpretation in the research team (Corbin & Strauss, 1990). We were three researchers in our

group – for the first half of the cases the coding process was done by all three researchers

together, in the second half we worked in teams of two researchers.

4. Results – child maltreatment and neglect as professional construction

We present our results in four sections: the “case plots” allow first insights into the definitions

of the mandates (see 4.1); they are followed by an elaboration of the categories and their

attributes, which can be put together in a systematic classification of the different professional

mandates (see 4.2). This typology is then validated by systematically categorizing all 93 cases

according to the type of “case narration” (see 4.3). Finally, we further scrutinize the

modalities of cooperation (see 4.4).

4.1 Three “typical” case plots – a first access

The three cases below are taken to be typical in the way the member of the professional

groups developed their narrations and this assumption will be confirmed by results in the

following sections. Further quotes in the plots are taken from the respective interview.

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Social worker. The narration starts with a single mother who was already in contact with the

authorities and who finds herself in a situation which somehow got out of hand:

A mother with three kids (1, 3 and 4 years old) was referred to the social service. Multiple

allegations were put forward: intimate partner violence, neglected and maltreated children,

a pedophile recurrently visiting the family. The youth welfare office issued orders of

restraint for the pedophile and the ex-partner, but they were not followed. The kids were

locked up at night and the door handles were screwed off. The social worker visiting them

at home ought to “take the mother by the hand”, “but couldn’t reach the mother in a way,

which would result in an inner change”. After a further incident (shards in the bath tub, the

baby got cut) the children were taken into custody. The social worker focuses his case

narration on the mother’s lack of insight and motivation to cooperate. He legitimates the

intervention by referring to the mother’s way of life and her lack of compliance.

Afterwards, the social worker and the mother keep in contact due to the latter’s wish. She

wants counseling regarding the contact with her children. (plot, case #12)

The narrator is concerned with the mother’s lack of will to abide agreements and change her

own life. This was crucial for the evolvement of the case. Although the baby was wounded by

shards of glass in the bathtub, the incident served as an opportunity for the practitioner’s

decision to take the children into custody, not as a reason. The removal of the child from the

family was not the end of the story: Both, the case-worker and the parents strive for a return

of the child and therefore the intervention continues by working with the parents. The second

problem, which the social work mandate is concerned with, is the moral life of the client,

his/her inability or unwillingness to lead a proper, organized life. In our final classification

(see 4.4) of case narrations we will categorize this as a compliance and life management story.

Pediatricians. The story of the pediatrician starts with the examination of a physical symptom

which may or may not be caused by the parents:

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During an examination, a six week old girl is diagnosed with a broken femur. The

information is provided by the father (“Would you take a look, please. She moves her leg

so strangely”). The parents are questioned on the possible cause, but they have no

explanation. Later, they provide insufficient explanatory attempts (e.g., the siblings sat on

the leg). To be sure, the records were sent to a forensics specialist at the university who

substantiated the suspicion of maltreatment: such a break can only result from an external

source and a relatively high exertion of physical force. Therefore, the parental narration is

not believed and the youth welfare office is informed. The girl is placed in a foster family.

(plot, case # 80)

Contact with the parents is minimal and serves the ascertainment of the causality for the

physical symptoms, that is, the occurrence of violence. The explanations of the parents are

taken for true, as long as they don’t contradict the patterns of injuries of the child’s body. We

often found that pediatricians include colleagues in cases when they are unsure in their own

diagnosis. The diagnosis of violence is the basis for a transfer to the youth welfare office,

which then holds the main authority for the further proceedings, whereas the pediatrician

dismisses any further responsibility. In the classification of case narrations we will categorize

this as a family violence story.

Midwives. The story of the midwife is strongly focused on the practical care of the mother for

her very young child and the baby’s development:

The baby doesn‘t gain any weight. The father is always asleep during home visits, the

mother is barely able to read and doesn‘t have a water boiler. The midwife trains the

mother in preparing the bottle, which bugs the father. At a coincidental meeting with the

social worker (who works on this case, too) at a home visit, the midwife detects bruises

which “couldn‘t be caused by lying on the pacifier”. The youth welfare office takes the

child into custody and the mother is presented with three alternatives: a separation from her

husband, admission into a mother-child-institution or placement of the baby in a foster

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family. The mother decides to go to the mother-child-institution. The midwife can‘t tell,

how the case further evolved and if physical maltreatment was substantiated. (plot, case

#72)

This case started – typical for the midwives approach – as a care story. The midwife takes the

role of the experienced counselor or sage woman; she trains the mother’s caring behavior by

showing and then observing and correcting the mother’s execution of a proper care. However,

this story was finally categorized as a family violence story: the discovery of the bruises in the

course of the midwife’s demonstration of adequate care for the baby changed the previous

approach to handle this case; it became the decisive turning point and was declared to be the

reason for new measures. The midwife discovered these symptoms of violence not while

looking systematically for maltreatment, but rather incidentally. She has the baby’s body

under her watchful eye as she is observing mother’s care.

4.2 Towards a typology of professional mandates

While the case plots presented above gave a first impression of the different approaches of the

three professional groups, this section will now present selected parts of our material,

structured along the three categories of the professional mandates: “definition of

responsibility”, “relationship with client” and “applied knowledge” (see 3.2.3 for their

definition).

4.2.1 Social work’s “mission”: converting the client

Definition of responsibility: Social workers define their responsibility in relation to the

parents and their moral life. The following case illustrates this professional responsibility:

A mother returns from prison (she was there because of narcotic offence) and takes up the

care for her children again. A home visiting social worker is trying to support the mother.

The kindergarten reports on the youngest to have lice. The social worker’s primary goal is

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to build a relationship of trust with the depressive mother, achieving small steps towards a

proper life management, illustrated by the provision of adequate furniture. The case isn’t

closed at the time of the interview. The intervention logic of the social worker becomes

evident when he says: “Of course this has to stop with the lice and all. Maybe in three or

four weeks or in five weeks (…) or she won’t open the door anymore. The mother was

very depressed at that time. She didn’t move anymore.” (plot, case # 19)

The main responsibility of the social worker lies on the mother’s insight, her making up her

mind to actively change things in her life. Confronted with the demand to stop the child’s

infestation with vermin, the social worker chooses to stick to her parental focus; to gain the

client’s inner conviction to change behavior is ranking above the child’s status.

Relationship with the client: For the social workers it is especially challenging to establish a

“normative compliance pattern” (Etzioni, 1964) with their clients, that is, they want to limit

their organizational power if possible to norms and values that are transmitted to the client

and they aim at a corresponding intrinsic involvement of the client. Most parents, however,

are either unwilling or unable to comply in this way with the social service and the

professionals seek to establish a relationship of trust – a lot of energy and time is invested in

bringing the client up to scratch. The intervention is always taken to be threatened by a break-

up of the fragile professional-client relationship especially if the social worker resorts to

control.

“Control always makes it harder to build trustful relationships with the mothers and

fathers. If mothers know, that she (the social worker) just visits and checks whether

everything is in order, and the mothers want to keep their children, then they won’t

confront their problems openly, but say: ‘yeah, everything’s okay.’ Or the dresser is

cleaned up, but just for the day and any other time it’s not. Due to that, it is very important

to us to build a fundament of trust.” (social worker # 121)

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Applied knowledge: For social work their “definition of responsibility” and “relationship with

the clients” enforce considerable selections and transformations of the academic stock of

knowledge in regard to child maltreatment and neglect.

A first systematic transformation of knowledge may be termed “parent-centeredness” or

“mother-centeredness”. Different quantified indicators give evidence of this transformation:

Narrative introduction. Out of the 58 cases, 30 were initiated with the phrase “there is

this mother…” (52%). In further 21% (n=12), cases started with “there is this

family…” and only 16 cases (27%) referred to the child first, which was always asked

for in the interviewer’s question.

Quantity of vocabulary. The amount of words used for the description of parents and

the child was distributed unequally. In a random sample of 20 of our social work

cases, 8691 words referred to the parents (among them 4770 on parental compliance

alone) and only 4880 on children.

Structure of coding. Confirmation was also found in the distribution of the parent-

related coding in the case narrations. In our 58 cases there were all in all 745

statements on parents, identified as a unit of meaning. 46% referred to parental

“compliance”, 37% to “parental behavior” (20% to ‘life management” and 17% to

“parenting”), 13% to “parental attributes” esp. “psychological illness”,

“traumatization” or “overly stressed”, 4% to “character traits” of the parents. While

the dominance of compliance and life management is evident, the distribution of the

parental attributes indicates a professional construction of parents as unable to cope

due to too much stress or traumatization. Especially mothers were described in this

way. The interviewed social workers defined the problem of child maltreatment and

neglect as a problem of a reduced capacity of non-compliant or traumatized mothers.

Less consideration of the child is a logical implication of the parent-centeredness of

knowledge transformation. But this omission of the child is so impressive that we interpret

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it to be a real rejection of any specific knowledge of the child and as such to be a second

systematic transformation:

This is mirrored in the techniques, social workers used for gathering information

on the child. In only 17 cases (29%) the child was reported as a relevant source of

information, whether the social workers saw the child, talked to it or at least to the

kindergarten staff. In 12 cases (21%), the interviewers explicitly stated that they

were unable to see or talk to the child or they even argued that the child would

disturb their work. However, in 29 cases (50%) no information on the child as a

source of information was given.

Consequently, the information given on the child in the case narration provides

little information concerning effects of maltreatment and neglect (see table 2). In

9% of the cases there was no information on the child at all. The rest of the cases is

dominated by (a) superficial information: 85% mentioned the age of the child and

50% the sex of the child. (b) A considerable amount of information omits the

victimhood of the child, as 38% of the cases presented children as disturbing or

“displaying behavioral problems”. (c) Rather a non-professional language was

used for the children’s behavior, they were “lively”, “nerving”, “a sack full of fleas

to guard”; “displaying behavioral problems” was the only professional code used

by social workers and it is clearly a code which signifies a deviant or malicious

rather than a victimized child. the 27% of the cases including information on the

child’s state of nourishment or care and 38% referring to the child’s experience or

suffering48 % of cases fell in either of these two categories).

(Insert table 2 about here)

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4.2.2 Pediatricians: investigating the corpus delicti

Definition of responsibility: Pediatricians define their responsibility in child protection

primarily as the investigation of physical injuries. The ascertainment of facts concerning

injuries and possible offences makes the core of their mandate. After delivering the diagnosis,

they usually refer the cases back to the youth welfare office:

A baby (6-10 months) with bruises, looking like bite wounds and hand prints. Although the

youth welfare office already works with the family, it didn’t notice the injuries. Instead,

they were noticed during the routinized developmental scrutiny. The mother argues that the

baby had inflicted the injuries himself. The pediatrician consults her boss. The

investigation leads to the conclusion of an external force as the cause. The child is admitted

to the ward. X-rays are taken and sent to forensics. There, maltreatment is substantiated.

The case goes to the youth welfare office. The legal procedure continues. (plot, case #38)

In the interviews with five free pediatricians, two of them were unable to report cases of

maltreatment and neglect. Their licence to detect such cases was recently enforced by making

developmental screenings mandatory for every child (see 2.2). However, these screenings

focus on deviations from expected cognitive abilities, motor skills, weight and height, and the

time investment reimbursed by the public health insurances takes this and nothing else into

account, as one of the free pediatricians explained in the interview. This renders the detection

of maltreatment and neglect by free pediatricians to a matter of chance.

Relationship with the client: The contact with the parents is minimized; its main function is to

get the parents’ explanation for the child’s physical state. This explanation makes part of the

investigation; it is evidence for or against a verdict (Timmermans, 2006).

For both groups, free pediatricians and those in hospitals, responsibility for any further

involvement is rejected. A forensic specialist explained:

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“I just got a report on that case: Shaken baby syndrome. The child has been shaken two

times. There’s the medical report from another neurologist (…) and she said: ‘The report I

wrote is shit’– not literally, but something like that and that the abuse can’t be

substantiated. Her report states: ‘Could have been this and that’ and my report didn’t take

the compliance of the parents into account, the milieu, the parents’ occupation, the

impressions of the midwife. Of course I didn’t. This is a medical report and I don’t give,

sorry for the expression, a shit, if the parents are mayors or pope or the emperor of China. I

have an injury and I have what has happened according to the parents. And I compare.

That is all. That’s my advantage.” (forensic specialist #135)

The child figures as a corpus delicti, an object of information. The child’s body displays

patterns of symptoms which have to be explained as being of either violent origin or not. The

pediatricians limit their responsibility to their diagnostic work, and the professional program

is not geared towards long term interventions.

Applied knowledge: The essence of transformation lies in the reduction of the academic

knowledge to a physical cause-effect-sequence. The free pediatricians might have opened this

narrow focus, as they encounter more intensive and long-termed relationships with their

patients, but they are constrained by the institutional conditions. By the highly specific

clinical gaze, the situation of violence is redefined in a way which erases both the agency of

the perpetrator and the victimhood of the child as the latter is reduced to a mere body of

evidence. While the medical profession claims to identify the causes of physical injuries and

signs of neglect, it doesn’t demand any professional responsibility for the treatment of

maltreatment and neglect beyond the subsequent treatment of an already injured body.

The case narrations give clear evidence of this transformation:

In 80% of the pediatricians’ cases, we find precise information on bodily injuries

and symptoms. In contrast, there are only two cases (10%), in which information

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on the child’s behavior is reported and no cases at all contain references to the

child’s experience.

As to the parents, we find a general remark on their compliance in three cases

(15%), life management comes up in four cases (20%), whereas character traits are

mentioned in one case only (5%).

We even find an explicit refusal to consider any such knowledge as the reported

interview has shown.

4.2.3 Midwives: counseling and control

Definition of responsibility: Midwives, who traditionally care for the mother in the immediate

birth situation and in puerperium, have acquired a new market in “early intervention”, while

free midwives increasingly refrain from their core license, giving birth, as the insurances are

too expensive. In child protection, they define their mandate in advising and helping the

mothers in order to prevent any form of neglect. They advise mothers on proper techniques of

care, for example, feeding or bathing the child, how to stimulate it and how to recognize the

child’s needs.

A single mother is unable to care for her eight week old child. The youth welfare

office employs a midwife. She dictates, trains, and controls a detailed diet regime for

the baby. Attempts of bargaining by the mother are refuted rigorously: “No, water

simply boils at 100 degrees.” This is the midwife’s response to the baby food prepared

lukewarm and mother’s attempt of defense. Reports on a lack of care accumulate and

the child does not gain weight. The mother refuses to move into a mother-child-

institution. The baby is placed in a foster family. (plot, case #36)

Relationship with the client: As midwives define child maltreatment and neglect as a lack of

care, the mother is addressed as the person who has to take care for the child. In her natural

authority, midwives control the adaptation to advices by the mother and refuse to negotiate

on the right way to do things. In contrast to the social workers, the midwife in the presented

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case clearly dismisses any trial of the mother to explain, that she would have prepared the

food properly. Still, if the mother is not compliant or the child does not develop as expected,

midwives rely on the youth welfare office.

Applied knowledge: Midwives adapt to the knowledge on child maltreatment and neglect by

applying and hence reducing it to familiar situations of care and bodily development of the

child as both presented plots for the cases #36 and #72 (see 4.1) showed. To some degree, this

allows them to detect signs of family violence as the body of the very young child is given the

primary attention. However, this detection happens more or less accidentally: it is neither

systematically looked for, nor can midwives deal with this information in any other way than

referring cases back to the social workers of the youth welfare office.

In eight of the 15 midwives’ cases, the professional attention was strictly limited to questions

of care. Midwives knowledge, however, tends to undergo a process of hybridization between

their own genuine mandate and the perspectives and interpretations of a social worker.

Midwives in early intervention face situations alien to their usual approach, for which they

have restricted knowledge: they deal with older children and different problems of care

compared to the first weeks after birth, which traditionally comprise the timeframe for

midwives’ involvement. They often have to take part in educative programs, based on typical

social work knowledge. In effect, some of such “family midwives” incorporate these stocks of

knowledge and apply it to their work. Some of them import the vocabulary on compliance and

life management into their case narrations (see table 3).

4.3 Classification of case narrations

We use a classification of case narrations to test the quality of our typology of professional

mandates. We assign all 93 cases to five classes based on the professionals’ reasoning and on

crucial turning points that were mentioned (see 3.2.3 for definition, and 4.1. for illustration).

The cases are classified as either centered on family violence, on care for the children, on

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parental compliance, or on the parental management of their everyday lives; a fifth class

contains residual cases for which several logics of narrations were combined.

Table 3 shows the distribution of those types for all three professions.

(Insert table 3 about here)

Social work cases either evolved around the topic of compliance or parental life management

(n=47), while only six cases bore family violence as the leading theme. Five cases pertained

to different logics but all of those showed elements of either the compliance or the life

management type. On the other hand, pediatricians were concerned with family violence

(n=12) and to some lesser extent with caring behavior (n=6). The midwives told us mainly

care stories (8), while three cases could be classified as of the family violence type. Four of

the 15 cases were narrated in the style we found in social work, supporting our hypothesis of

hybridization. These results on case narrations mirror the results on professional mandates.

4.4 Coordination of different mandates

The main responsibility for intervention remains with social work, legally and actually, they

are clearly the main licence holder. Therefore, it is up to social work to consider or reject

knowledge of child maltreatment and neglect as it may be brought up by the members of the

other professional groups in favor of its own parent-centered approach. This leads to two

more transformations of knowledge: (1) the professional knowledge on cases is downplayed

by the social workers, if it challenges the dominant program; (2) professional differences tend

to vanish.

Downplaying professional knowledge. As the pediatricians restrict themselves to diagnostic

interventions and refer the cases back to the youth welfare office, the program of social work

takes over: For the case-workers, medical knowledge is just one impression amongst others,

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which they compare with their own assessment. In such a situation, a diagnosis by a

pediatrician may be rejected. It is what the complaint of the forensic specialist #135 (see

4.2.2) showed, when an additional medical report was requested for the case to be

substantiated by the youth welfare office. We find further evidence in the following case:

The violent father, who should not be living with the family, is recurrently present at

unannounced visits of the social worker. Until the end of the case, the intervention aims at

the parental compliance. Seemingly successful bargains on foster-care placement of the

four year old son are cancelled last minute by the mother. After admission to hospital due

to beatings, the boy is taken into custody and placed in a foster family against the parents’

will. At the court proceedings, a solution is sought for keeping the child in the family.

(plot, case #27)

The social worker argued that the occurrence of violence towards children would not

automatically indicate a necessity to separate the child from the parents:

“My principle for the social work: I want to have the opportunity to take a second look, as

long as it is possible, even if the parents flip out or something. As long as it is not

specifically life threatening, I should be able to try – in a latent situation of threat, and

talking about physical violence – I should be able to try reflecting on it together with the

parents (…) and always weighing up, is it still okay, is there a basis to let the child be and

work ambulatory or is it a situation in which I can’t stand it anymore, in which I can’t

guarantee that something doesn’t happen to the child or they are protected.” (social

worker #221).

The social worker clarifies that maltreatment is always weighed up against the preservation of

the family. He strengthens his point in the specific case and plays down the hospital’s

diagnosis and treatment of the injuries:

“Okay, in the beginning it was a bruise. I saw it myself. I was there, when the child was in

the A+E unit. I took a look at him. And that was really important, as the hospital wanted to

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make it really clear, a proper bandage to show all parties concerned that it was something

fierce. But I saw it the day after.” (social worker #221 #27)

The interviewee claims to know better while the hospital staff is portrayed as following

illegitimate interests of accusing parents, which would not be in the interest of the case.

Vanishing of professional differences. If the pediatric knowledge is always reevaluated by the

dominant group, midwives face an even more serious challenge. The already mentioned

“hybridiziation” may lead to a vanishing of the midwives original knowledge and actual

work. In a way, they might become social workers, who work with a specific group of clients:

young mothers with very young children. Midwives are often paid by the youth welfare

office, making it even more difficult to stick to their mandate. Such a case was told by a social

worker administering the cases of early intervention who decided to finance a midwife for a

family.

A father of two children contacts the youth welfare office to report his newly pregnant ex-

wife. The social worker visits the mother at home and involves the early intervention

department. After stocktaking of the risk factors and resources, the mother is motivated to

take up therapy. The mother is attested a high compliance and a midwife is paid to

accompany the mother. She helps with administrative communication, the determination of

the educatory rights vis-à-vis the father and organizes free baby food for a year. The recent

state of the case is justified with compliance. (plot, case #52)

In this case, the midwife takes over a job which is typical for social work. The mother is

helped in tasks of everyday life management instead of being controlled in her caring

behavior. The midwife applies foreign knowledge. The hope of broadening the angles to

combat child maltreatment and neglect may be effectively counteracted by this deployment.

5. Discussion

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None of the three professional groups we studied defines its mandate with regard to child

maltreatment and neglect in a way that this might be considered a comprehensive approach to

the problem. This is the main result from our reconstruction of 93 cases of child maltreatment

and neglect or respective suspicions and the logic in which they were handled by social

workers, pediatricians of midwives. Each professional group defines its own fragmentary

approach to the problem and adding up the fragments may lack coordination.

Social work focuses on parents. They aim at parents’ insight and inner motivation for a joint

effort to manage family affairs and to enhance the quality of family life. While this is for sure

relevant for handling cases of child maltreatment and neglect, it is only one aspect among

others and one which doesn’t promise an immediate protection of the child’s wellbeing. The

knowledge on children, which is applied in the actual case-work, is limited. This is not to say

that social workers would not dispose of such knowledge, but they seem to use it rather

marginally: they do not present their cases in the light of such knowledge, they do not

legitimate their decisions on the basis of such knowledge, and if ever they describe the

children’s state and suffering, they do so in an everyday language. Meanwhile, pediatricians

limit their mandate clearly to the child’s body, injuries which may be caused by maltreatment

and which they investigate and cure. Midwifes who are quite newly involved in cases of child

protection limit their mandate to the aspect of care for very young children and may detect

cases of maltreatment rather accidentally. Both, pediatricians as well as midwifes, have to

involve the youth welfare office if they have suspicions or evidence of maltreatment and/or

neglect. It is up to the social workers there to take the next steps and the members of the

medical professions mostly do not even know what these steps will be like in the cases they

reported. From the case narrations of the social workers, we learn that they occasionally

question or skip this knowledge of the medical professions. In sum, we cannot speak of a

multi-professional approach, rather of a bricolage of different mandates, due to a very strong

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licence of social work and a lack of an institutionalized coordination. Such fragmentary

approaches and their uncoordinated addition might in their consequence produce exactly the

biases that we mentioned in our introduction: a trivialization and therefore exclusion of

serious cases and a “proper-family bias” in the selection of cases which are substantiated and

benefitting from a child protection measure. Only cases which end up in family court allow

for a multi-professional evaluation, as the youth welfare office merely remains a party among

others.

The “critique from inside” explains such biases with scarcity of timely resources, rendering

careful case work impossible. However, our reconstruction of social work cases challenges

this explanation: for none of the 53 cases that were presented by social workers such shortage

was mentioned as having impaired the work on this case. And what’s more, all cases were

presented in a way that the case-worker had done the job to his/her best of knowledge and

belief. We therefore conclude that this parent-centered approach, in which knowledge on the

child is of minor importance, is in accordance with the professions’ own definition of what to

do and how to do it on the level of the actual case-work, in short: with its mandate.

Pediatricians find themselves in a different situation. Free pediatricians explicitly mentioned

that their conditions of work – the reimbursement by health insurances – did not allow them

to give attention to possible maltreatment. However, until today it has not been a discernible

attempt of professional policy to change such regulations of health insurances and include a

systematic and even comprehensive handling of child maltreatment and neglect into the

mandate of pediatricians. As to the midwives, their approach to cases of child maltreatment

and neglect happens mainly under the aegis of the youth welfare office. They have defined

their mandate – as our cases mostly showed – close to what has been midwives’ traditional

work with young mothers. But, the youth welfare office may decide on their work differently

and the education programs they visit may orient them towards other responsibilities. In this

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way, their child-orientation, while already quite limited, runs the risk of getting lost

completely, not due to their mandate, but due to conditions which impede this mandate.

We have to mention clear limits of our study. The number of cases is rather small and even

smaller is the number of professionals from which we collected these cases. In the group of

pediatricians there were only nine pediatricians who presented cases, as two of the free

pediatricians said that due to their conditions of work they did not have such cases at all. Also,

the number of midwives was very small with eight interviewees. So the study may be

considered more valid for the social workers. It would have been good as well to follow some

cases in the real handling and not only in the narration of the interviewees. Maybe there is a

sort of “practical knowledge” which is relevant, but not verbalized. While this may still be

considered a problem, as professions need to verbalize their approach in a professional

vocabulary and discourse, it might, however, adjust some of our conclusions.

Perhaps the most severe limit is that we have no answer to the burning question: Why is there

no professional group that makes a comprehensive approach to child maltreatment and

neglect the core of its mandate? In the theoretical approach of an interpretative sociology of

professions, we may suggest both a partial and provisional answer. According to this

approach, professions do not define themselves along the lines of the society’s problem

definitions. We have to conceive of them as social groups with their own interests of

achieving recognition as a professional group and a share on the market of professions. And

the material on the midwives in the field of child protection may have shown that a

professional group has a real problem without such a professional standing. Due to their own

interests and logic, professions do not submit to society’s problem definitions, rather it is the

other way around: professions define society’s problems and make the public aware of the

existence of such problems. To place child maltreatment and neglect on the top of social

problems, however, had been a lay endeavor, a consequence of a higher valorization of

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children and of children’s rights which happened in the last decades. As far as children’s

rights are concerned, it was the international organizations which fought for these issues in the

last decades (Therborn, 1996). Evidently, they found enough members of society who

followed them as in some countries corporal punishment became forbidden by law,

ombudsmen for children became institutionalized and there is a growing field of research on

children’s wellbeing (Ben-Arieh, 2008). But, until today, and in the field of child protection,

professional groups did not change their mandates according to this new public sensitivity for

reasons we can’t identify up to now.

Acknowledgements

The study was funded by the Deutsche Forschungs Gemeinschaft (DFG) from February 2010

until January 2013 (BRN: BU 1034/8-1).

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table 1: reconstructed cases

Profession N

Social workers 58

Pediatricians 20

Midwives 15

Total (N) 93

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table 2: information1 given on the child

1 Cases contain multiple information

38

27

38

50

85

9

0 20 40 60 80 100

% of cases per type of information (N=58)

no information

age

sex

behavioral problems

state of nourishment/care

experience/suffering

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table 3: classification of case narrations (N=93)

Narration centered on: Social worker

(58)

Pediatricians(20) Midwives

(15)

family violence 6 12 3

care for the children 0 6 8

parents’ compliance 29 0 2

parents’ life management 18 0 2

several logics combined 5 2 0

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Highlights

• Germany’s child protection legislation enforced the involvement of midwives and

pediatricians, but social work remains to be the main holder of intervention license.

• Social workers approach cases of child protection as a problem of parental compliance and

morality, and very rarely as a problem of violence. This is their “mandate”, the professional

group’s shared definition of how the problem has to be perceived, what has to be done and

how it has to be done.

• There is a lack of coordination between the different professional approaches. Due to social

work’s “licence” of intervention, knowledge on children provided by pediatricians and

midwives might be downplayed.

• As a result of this professional bricolage – an uncoordinated adding of professional

approaches – the actual state of the children is the blind spot of child protection services.