Child protection is a complex, delicate and sensitive subject, for which it is very difficult to keep hindsight when faced with situations that constantly question the ethical and deontological positioning of professionals.
Here is the story of Juliet and Malo (the names have been changed to ensure confidentiality and anonymity):
Juliet was admitted to the mother-child unit in October 2020, following an altercation with Romeo, her partner, which resulted in the police intervening and Juliet filing a complaint against him for domestic violence. As Romeo was already on probation for similar acts against former partners, he was placed in pre-trial detention.
Juliet arrived at the mother-child unit, seven months pregnant, completely alone and disorientated. At only twenty years of age, Juliet’s life had already been marked by abuse and deprivation, from her mother’s rejection to her father’s alcoholism, which led her to attempt to end her life at a very early age, an attempt that was repeated many times during her childhood and adolescence and which reflected the psychological disorders from which this young woman suffered.
The end of Juliet’s pregnancy was stormy, relations with the staff and the other users were tense and the atmosphere increasingly unhealthy. Totally overwhelmed by various preoccupations (her very unstable relationship with Romeo, the father’s baby who’s in jail, waiting for his judgement, the dog that needs to be rehoused, etc.), she didn’t invest in her pregnancy and even went so far as to reject her baby and to verbally and physically attack him, insulting him or pushing and hitting on her belly.
Malo was born on January 2021 and showed early signs of suffering. He was crying a lot, including in Juliette’s arms, whose gestures were not adapted, with a very insecure carrying style, sudden movements, a loud voice that she didn’t modulate in the presence of her son. Malo’s face was very tense, his eyes and hands wide open, and he calmed down more often in the professionals’ arms than in his mother’s, who provided him with very random care and relied heavily on the team to know when he had eaten or if he needed to be changed. He was an unrewarding baby, who was giving her the impression that he didn’t love her and who calmed down better with the professionals.
Malo’s numerous signs of suffering alerted the team and the Baby Distress Alarm Scale was completed at a multidisciplinary meeting (ADBB, Guedeney et al., 2001). My tutor suggested that I write the report of this assessment, which I gave her with some reservations about the ethical framework in which this report would be situated and the use that would be made of it. This scale is normally intended for babies of at least two months of age, but Malo was only 17 days old when it was filled in, which made me very cautious.
I saw Juliet one last time on February, as my last day of training was scheduled for the following Thursday. She confided in me that she was very distrustful of the team of educators and obviously preferred to entrust Malo to me rather than to them. She told me about her worries for the future and her feeling of having been duped about the help that the services could give her. She expected to be supported in her administrative procedures, in finding accommodation or getting her driving licence, and the constraints imposed on her, the conflicting relationships and the cut-off point of a possible decision to place Malo undermined trust and dialogue with the team. She had an appointment that evening with the head of the department and I learned the following week that Malo’s placement had been announced during this meeting, which had resulted in Juliet’s emergency hospitalisation in a psychiatric unit, as this decision was impossible for her to bear. Malo was 5 weeks old.
In order to draw lessons from these experiences for my future practice, I felt it was important to examine several questions. One of these questions concerns the psychologist’s position when practising in an institution. The principle of responsibility and autonomy in the psychologist’s code of ethics (Principle 3) states that “the psychologist decides and is personally responsible for the choice and application of the methods and techniques he/she designs and implements and for the advice he/she gives”. In practice, however, the psychologist’s autonomy is variable, since it necessarily falls within a framework that limits the scope of possibilities. In Juliette’s situation, although the psychologist is personally responsible for the advice he gives, he cannot be fully responsible for the use made of it by the institution. This puts the principle of respect for the assigned purpose (principle 6) to the test. The psychologist must take into account the use that may be made of his or her interventions by third parties, while remaining as impartial as possible. He must therefore be aware of this limitation and be cautious in the opinions he issues. This caution is clearly advocated by the principle of competence (principle 2), according to which “each psychologist is the guarantor of his or her particular qualifications by defining his or her own limits and refusing to intervene when he or she knows that he or she does not have the required competence. For this reason, all the writings I produced during my internship were proofread and corrected by my tutor before being sent to the team or to the parents.
The second important question is about the use of the Baby Distress Alarm Scale to assess Malo’s relational withdrawal behaviour. Article 24 of the psychologist’s code of ethics requires the psychologist to use scientifically validated and up-to-date assessment techniques, but article 23 specifies that “the psychologist’s practice is not limited to the methods and techniques used. It is inseparable from a critical appreciation and theoretical perspective of these techniques”. This suggests that the use of standardised tests outside the framework provided by the test (in this case the age of the child) can be done as long as the psychologist can justify his or her choices.
A valid argument in Malo’s case is that there is no other tool available to assess the suffering of such young babies, and it was difficult to wait two months to get an idea of his psychological well-being as the first weeks of life are crucial for the development of the child. This scale provided us with clinical elements giving an overview of Malo’s state of suffering and could also have allowed us to observe his evolution. Indeed, in the weeks following the Baby Distress Alarm Scale, we could notice a progression in Malo’s behaviour, who was gradually opening up to the world even if he often remained tense, and I would have been curious to compare the Baby Distress Alarm Scale responses at 15 days and at one month, before Juliet’s departure, in order to determine which part of these behaviours was due to the child’s age. Unfortunately, Juliet left the structure before a second assessment could be offered for Malo. Hir condition improved afterwards, and we will never know how much of this improvement was due to the separation from an insecure mother and how much was due to the child’s natural development. Nevertheless, I noticed that the professionals were convinced that Malo was better because he was away from his mother. The obvious relief in the team following Juliet’s departure may explain this feeling and have had an impact on Malo’s behaviour. I also think that people working in child protection are so often confronted with adversity that they need to hold on to the positive. Juliet’s departure was very difficult to live for those around her in the institution and it was comforting to know that it gave at least some benefits for the child.