The ‘Baby P effect’ and home education

In August 2007, a toddler living in the London Borough of Haringey died. 18 months later on 11 November 2008 his mother, her boyfriend and her boyfriend’s brother were convicted of causing or allowing the child’s death. The toddler was Baby P, eventually named as Peter Connelly.

Media interest was intense. On the day of the conviction, Sharon Shoesmith, director of Haringey’s children’s services, and Jane Collins, CEO of Great Ormond Street Hospital (GOSH) held a press briefing that mentioned the disciplinary proceedings against individual social workers finding no evidence of gross misconduct. On the following day, November 12, the Department for Children, Schools and Families (DCSF) issued a press statement condemning the behaviour of those convicted.

Later that day, at Prime Minister’s Questions, Gordon Brown (then PM) appeared to be taken by surprise by David Cameron’s (then Leader of the Opposition) criticism of the way Haringey Council had responded to Peter Connelly’s death. Cameron asked who was taking responsibility and why no one had resigned. He followed up his attack later with an emotive article in the Evening Standard, and the next day with a letter to the Sun. The Sun launched a petition calling for Sharon Shoesmith, the social workers involved, and a paediatrician at GOSH to be sacked, and by the weekend could claim the petition had 1.4 million signatures. The Government’s reaction triggered a chain of events culminating in a ‘perfect storm’ that had significant, far-reaching repercussions for national and local government, the news media, social work as a profession, children’s services, individual social workers and vulnerable children.

The Government response

The Government’s response to the criticisms was swift and robust. A press officer was sent to Haringey Council and on 1 December the Council leader George Meehan and the cabinet member for children and young people Liz Santry, resigned. Ed Balls, Secretary of State for Children, Schools and Families announced in a press conference that he was replacing Sharon Shoesmith with John Coughlan, then director of children’s services in Hampshire, and appointed Graham Badman, previously director of children’s services in Kent, as chair of Haringey’s Local Safeguarding Children Board. A week later, Shoesmith was formally dismissed by Haringey Council.

Shoesmith didn’t take her sacking lying down. She appealed and in 2011 the High Court ruled that Ed Balls and Haringey Council acted unlawfully in dismissing her. In 2015, she completed a PhD through which she had tried to understand the psychosocial factors involved in the aftermath of Peter Connelly’s death. A couple of weeks ago, she published Learning from Baby P, which draws on her research. In the book, she notes some of the factors that prompted the government to act as it did. Shoesmith’s analysis is well worth reading; it’s incisive and insightful. My only quibble is that she appears to accept some conceptual frameworks uncritically, such as the feminist, psychoanalytic and medical models.

Shoesmith points out that by late 2008, the ‘New Labour project was running into trouble’ (pp.123-127). Gordon Brown had taken over from Tony Blair as PM the previous summer, but in May 2008 Labour had had its worst local government election results for 35 years and Labour’s attempts to reduce child poverty were faltering. In October 2008 the Healthcare Commission’s investigation into the Mid-Staffs scandal was completed revealing significant failings, and the global financial crisis prompted a £500bn rescue package for UK banks.

Cameron’s framing of Peter Connelly’s death in political terms had significant implications for the Labour government. Their flagship strategy Every Child Matters couldn’t be seen to fail, nor could Ed Balls, who had been Brown’s chief economic adviser until Brown became PM. Then there was Haringey. Haringey had high levels of deprivation and a history of what Shoesmith calls ‘defining events’. It had witnessed the Broadwater Farm riots in 1985 during which PC Keith Blakelock had been murdered, and the death of Victoria Climbié in 2000 that had led to the Laming Inquiry and significant changes in child protection policy. In addition, Haringey Council had long been perceived as hailing from the ‘loony left’; understandably a centre-left government might want to distance itself. Lastly, the government felt compelled to align its narrative with that adopted by large sections of the public and press – that public sector services should to be seen to take responsibility for Peter Connelly’s death.

All three key political figures – Cameron, Brown and Balls – used the press directly to manage the political narrative.  It could be argued that the press used politicians to the same end. In July 2007, six months after he’d resigned as editor of the News of the World following the conviction of two reporters in the phone hacking scandal, the Conservative Party had appointed Andy Coulson as its director of communications. The Sun, another News International paper, had a history of campaigning for changes in the law as a result of high profile child abuse cases; for longer sentences following the death of James Bulger in 1993, and for disclosure of previous sex offences following the death of Sarah Payne in 2000. During the Leveson Inquiry into phone hacking, it was suggested that after the Baby P trial the Sun put pressure on Ed Balls to order resignations (p.183).  The press narrative in the Baby P case centred around calls for the resignation of professionals involved with Peter Connelly. Shoesmith explains her reasons for not offering to resign, but I think the issue of resignation warrants further comment.

It’s a resigning matter

Traditionally, tendering your resignation if something goes wrong is seen as an honourable thing do to – even if no one believes you’re responsible for what went wrong and your resignation isn’t accepted. A resignation symbolises acceptance of responsibility and would have been one factor in the calls for resignations over the Baby P case. But Shoesmith makes it clear in Learning from Baby P that she saw voluntary resignation as an admission of responsibility for Peter’s death, an impression she wanted to avoid – understandably given the introduction of the offence of ‘causing or allowing the death of a child or vulnerable adult’ in 2004 to close a legal loophole. Although the offence can be committed only by people living in the same household as the victim, its title begs the question of who else might be responsible for causing or allowing a death of a child by, for example, neglecting their professional duty. Police officers, social workers or paediatricians might be brought into the frame, something that could be inferred from David Cameron’s Evening Standard article (p.144).

But there’s another factor involved in the calls for sackings; it’s the assumption that if a public sector worker failed to prevent the death of child, they would have been able to prevent it if they’d acted differently. That’s nonsense of course. Even if a child were taken into care or a social worker were to live with the family, no child can be totally protected from harm. But the idea that children can be fully protected persists. Cameron, Brown and Balls all vowed to ensure that nothing like Peter Connelly’s death happened again (p.178) – even though, in reality, such promises are meaningless.

Child protection had become a political football and government, opposition and the media were vying for control of the ball. Ironically, the outcomes had significant negative repercussions for vulnerable children. Directors of social services became very nervous about their jobs, and social worker recruitment and retention, already under strain, became even more challenging, further increasing the vulnerability of the children social workers were dealing with. Local authorities made sure they erred on the side of caution; between October 2008 and March 2012 the number of applications for care proceedings increased by 79% (p.19).

Elective home education and the Badman review

The ‘Baby P effect’ rippled out to another group of children Shoesmith doesn’t mention – those educated at home. English law gives parents a duty to cause their child to receive an education suitable to their age, ability, aptitude and any special educational needs they may have (s.7 Education Act 1996). Local authorities can intervene if it appears a child is not receiving a suitable education (s.437(1) Education Act 1996). The law, rightly, puts the individual child at the heart of the education, and sensibly, gives final responsibility for the child’s education to parents. Some parents make a complete hash of bringing up their children, but historically they’ve done a much better job than the state. Home education has been a contentious issue however, and in 2007 Alan Johnson, Ed Balls’ predecessor at the then Department of Education and Skills, published a set of guidelines for local authorities about elective home education.

In January 2009, Ed Balls announced a review of elective home education. Home educating parents were perplexed, not least because the guidelines had been issued only a year or so earlier. Also, the review was framed in terms of home educated children being ‘hidden’ and home education being used as a cover for child abuse, even though there appeared to be no robust evidence of this actually happening.   In addition, the review conflated education and welfare, which are treated as distinct issues by the law.

The review was led by Graham Badman, introduced as the former director of children’s services at Kent County Council. A month earlier, Balls had appointed Badman as chair of Haringey LCSB, but unless they’d been following the news closely, most home educating parents wouldn’t have made a connection with the Baby P case. They would also have been unaware that in May 2008, seven year-old Khyra Ishaq had starved to death at her home in Birmingham. She had been educated at home for the previous six months. Khyra’s death came to public attention only in June 2009, when the trial of her mother and her mother’s partner began. Her death was presented as reinforcing the government’s call for reforming the law relating to home education, rather than as a trigger for the review happening in the first place.

In 2009 Graham Badman was busy. In November 2008 he’d set up an education consultancy, Nektus, that carried out two local authority progress reviews in its first year.  In December he’d been appointed Chair of Haringey LCSB, to oversee the aftermath of a very high profile child protection case.   In January 2009 had become a visiting professor at the Institute of Education, and Acting Chair of BECTA – being appointed Chair on 1 May. He became a Trustee and Board member of UNICEF in July. His elective home education report was published on 11 June, and his recommendations accepted in full the same day by Ed Balls. Given all these commitments, it’s not surprising that more than one organisation complained that Badman’s account of what they said to him wasn’t quite what they recalled saying, and that Graham Stuart MP, a member of the Children, Schools and Families Select Committee felt obliged to point out that Badman had made a significant sampling error in his assessment of the risk to home educated children.

Badman made 28 recommendations, including giving local authority officers the right to enter the homes of home educated children, to interview them alone and to assess their educational progress.  A public consultation on Badman’s proposals followed, with a record number of responses. The full government response to the Badman report wasn’t published until October 2009, towards the end of the consultation period, so many people who responded to the consultation wouldn’t have seen it. Throughout the review, I got the strong impression that the Government didn’t see those who disagreed with the proposals as citizens expressing their opinions, but as political opponents. The Government planned to include the Badman proposals in the Children, Schools and Families Act 2010, but many were abandoned in the ‘wash up’ prior to the 2010 General Election, due to opposition from other parties. Conservative MPs had, not surprisingly given the political overtones of the review, been quite supportive of home educating parents. In December 2009, a record number of petitions protesting against the proposed changes to the law were presented to Parliament, a strategy initiated by Graham Stuart.

Learning from the Baby P effect

The primary task of government, national and local, is to protect the population to allow us – all of us – to go about our lawful business without let or hindrance. Obviously, there are going to be instances where legislation that protects one group of people inconveniences another – the law has to weigh up the interests of different parties. On the face of it, it looked as if that the actions of government, opposition and press in the wake of Peter Connolly’s death could result only in beneficial outcomes for vulnerable children. But their focus was on only one aspect of child protection and other aspects got completely overlooked, including local authority priorities (disabled children are also children in need but LA thresholds for support are set so high many disabled children get no social care support), social worker recruitment and retention and the consequent impact on vulnerable children, and children being taken into care unnecessarily. The proposals for home educated children, such as social workers being entitled to enter the family home and to interview children alone had significant implications for a number of important legislative principles.

Government, opposition and the press framed child protection solely in terms of the behaviour of individuals, whether they were adults who might harm children directly, social workers who might fail to prevent harm, or elected members of local government responsible for implementing national policies. Little attention was paid to the effectiveness of legislation, key legislative principles, local authority resources, the impact of the government’s action on social workers and on children deemed to be at risk when they weren’t. Good legislation requires careful thought and wide consultation, not a knee-jerk response to a party political attack. If government is seen as a party political project, rather than an institution that exists to serve the population, it puts everyone’s welfare in jeopardy, not least that of vulnerable children.

Reference

Shoesmith, S (2016).  Learning from Baby P.  Jessica Kingsley Publishers

Updated 4 September 2016 with minor corrections.

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protecting disabled children: systems maltreatment and neglect

Ofsted’s assumptions in their report Protecting disabled children: thematic inspection that “risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe” appear to be based on some rather unreliable data. That doesn’t mean Ofsted wasted its time doing an inspection. But what concerned me about the report – in addition to the statistical analysis that triggered it – wasn’t so much what was said, as what wasn’t said about the risks to disabled children and support for them.

If we had robust data I’d be surprised if they didn’t show disabled children to be at an increased risk of maltreatment or neglect. That’s because of the risk factors involved. Many disabilities have a genetic component, meaning that other family members are more likely to have health or disability issues. Add to that the challenge of looking after a disabled child, the impact on siblings, the likelihood of a reduced income with increased expenditure and you have a situation where all those directly involved are likely to be vulnerable. But some protection from those risks can be offered by the community. Appropriate support from relatives, friends, neighbours and the local authority can make a big difference to families’ quality of life and thus reduce the risk of maltreatment or neglect.

Ofsted’s inspection focused on safeguarding and looked after children services in relation to disabled children. Nothing wrong with that focus, per se. But Ofsted also refers to more general support services that could have an impact on the safety and wellbeing of disabled children. In this post I want to examine some of the wider issues relating to child protection and support services for disabled children.

What does child protection mean?

‘Child protection’ is a term commonly used to refer to the protection of children from maltreatment and neglect by people they know well, like family members. There’s no doubt that children are most at risk from people they know well. That’s not because people who know children well are inherently more evil than people who don’t; it’s partly because not everyone who brings up a child is good at doing so, but also because children spend a great deal more time with people they know well, as distinct from with people they don’t. When that situation is reversed, historical evidence from children’s institutions suggests that the main source of risk to children changes accordingly.

‘Child protection’ can also refer to protection from people who work with children (hence Criminal Record Bureau checks), from strangers (hence ‘stranger danger’ warnings), and sometimes from other children (hence anti-bullying policies in schools). But ‘child protection’ is rarely used in the context of what the Australian government calls ‘systems abuse’, defined as:

preventable harm [that] is done to children in the context of policies or programs which are designed to provide care or protection. The child’s welfare, development or security are undermined by the actions of individuals or by the lack of suitable policies, practices or procedures within systems or institutions.

I’d broaden this definition by omitting the words ‘which are designed to provide care or protection’, since children can experience collateral damage from policies of any sort.

An example of what I mean was featured in a recent documentary shown on BBC 4 (unfortunately not currently viewable) entitled ‘Growing children: autism’. The last part of the programme shows footage of two young brothers, Jake and Zaine, both on the autistic spectrum. Their behaviour results in their mother spending much of her time protecting her shins. Zaine explains very clearly and persuasively why he doesn’t want to attend school (the people, the noise) but it’s no use, he has to go to school. (I’m not blaming his mother, incidentally, because her options might have been limited.) If a child had behaved like that at the end of the school day, rather than at the beginning, and said those things about going home, my guess is that social services would have been contacted. But despite much rhetoric about listening to the voice of the child (and s.17. 4(A) of the Children Act 1989 requiring the wishes and feelings of children in need to be ascertained in respect of service provision), the impact of some policies and programmes on children is simply ignored regardless of the distress and harm it causes, as many parents of children with disabilities and those children themselves can testify.

This is what Bronfenbrenner’s ecological systems theory highlighted; that children are most strongly influenced by people they come into direct contact with (for obvious reasons), but that the actions of people they never meet, such as decision-makers in organizations and national and international governments, can have a significant influence too – for good or ill. This brings me to the point about support services.

Support services

The Ofsted inspection involved 12 local authorities – that’s fewer than 10% of the total in England. Of the 12, seven had been judged ‘good’ and five ‘satisfactory’ in previous inspections of safeguarding and looked after children services (p.9). Ofsted wanted to look in detail at the ‘child’s journey through the system’, so it made sense to investigate authorities that were following procedures fairly closely, in order to identify shortcomings resulting from the design of the system rather than because of failures in implementation. Inspectors also met with “18 parents, 10 of whom had disabled children with child in need plans and eight of whom had children subject to child protection plans” (p.9). I couldn’t discover how many families were represented, but at best it was obviously a very small sample, an average of 1.5 per local authority inspected.

Ofsted’s focus is on safeguarding and looked after children services but several references are made to universal services. The introduction (p.7) begins:

When the national Aiming High for Disabled Children programme was being developed in 2007 by the previous government it was estimated that there were 570,000 disabled children in England. This programme put in place a range of support for disabled children and their families.”

Aiming high for disabled children

Let’s take a closer look at the Aiming High programme, as described in Aiming high for disabled children: better support for families, published jointly by HM Treasury and the Department of Education and Skills in May 2007 and signed off by Ed Balls, then Economic Secretary to HM Treasury and Andrew Adonis, then Parliamentary Under-Secretary of State for Schools. The Aiming High programme was the outcome of the Disabled Children Review, one strand of a Review of Children and Young People, in turn part of a Comprehensive Spending Review (CSR), undertaken by the previous Labour government. The CSR set government departmental spending plans and priorities for 2008-2011. (Aiming High p.10)

So what is the ‘range of support for disabled children and their families’ that the Aiming High programme put in place? The Aiming High report identifies three core areas, which I’ve summarized for brevity. You can read them in full on pp. 6-8 of the document.

Empowering disabled children, young people and their families

• a “core offer“ to make it clear what entitlements and services disabled children, young people and their families can expect

• piloting individual budgets

• spreading good practice on engagement such as parents’ forums

Promoting more responsive services and timely support

• a national disabled children indicator

• evaluation and benchmarking good practice on early intervention

• Local Authorities and PCTs will improve their data collection

• continuing the Early Support Programme

• a Transition Support Programme

Boosting provision of vital public services

• provision of short breaks for disabled children

• a childcare accessibility project

• a radical reform of community equipment and wheelchair provision and

• research the skills and behaviours required by the workforce and to identify gaps.

Funding was allocated to some of these areas and funding for short breaks and parent forums, for example, has been maintained by the coalition government. But how much of this actually constitutes ‘support’? And how much support is on offer? Feedback from parent groups and voluntary sector organisations suggests that parents who can access short breaks, specialist childcare and individual budgets value these services, but that provision varies and access is often limited. And although the Aiming High document repeatedly refers to improvements in educational provision, the Education and Skills Select Committee report on Special Educational Needs, published less than a year earlier, had described the SEN system as ‘not fit for purpose’. Little mention is made in the Aiming High document of medical provision except in the context of improving workforce skills and behaviours. More recent reports on the state of healthcare (Kennedy), social care (Munro) and education (Lamb) suggest that there is still considerable scope for improvement in terms of universal services for children with disabilities. This is somewhat at odds with the overall impression I got from the Ofsted report that despite some weaknesses in the system around prevention of maltreatment and neglect by parents and carers (paras. 104-8), most local authorities had good information about disabled children, a high level of commitment to supporting them, and offered a wide range of early support services (para. 15).

Clearly the quality of healthcare, social care and education services has a disproportionate effect on the development of children with disabilities and the functioning of their families. But the home is not the only source of child maltreatment and neglect. It could be argued that disabled children in England have always been subject to systems maltreatment and neglect because they have never had access to consistently high quality support that’s timely, appropriate and effective. Ofsted’s focus was on safeguarding and looked after children services. But a narrow view of what constitutes child protection, overlooking concerns about universal services raised in recent high-profile reports, and basing statistical analyses on assumptions and unreliable data doesn’t help to paint an accurate picture of the real level of risk to disabled children.

A fundamental principle of democracy is that everyone matters. A key indicator of the health of a democratic society is how it treats its most vulnerable members, and disabled children constitute one of the most vulnerable groups in our society. Disability can strike anyone at any time, which is why it’s so important to have timely, appropriate and effective interventions available. Such interventions can optimise the quality of life of disabled people and their families as well as increasing the likelihood that the disabled person and their carers will be able to work and reducing the cost of support and the interventions that are too little too late – outcomes dear to the heart of the current government.

Despite its obvious concerns about the wellbeing of disabled children, I felt the Ofsted report perpetuated their marginalisation by failing to consider the wider failings of systems that are supposed to offer support.

what is it about child protection plans and statistics?

Ofsted warns of abuse risks to disabled children” says the BBC headline about the report entitled Protecting disabled children; thematic inspection published last week. And indeed the report opens by reminding us that research “indicates that disabled children are more at risk of being abused than non-disabled children”. It goes on:

However, they are less likely than other children in need to become the subject of child protection plans. This suggests either that risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe.

The thematic inspection was undertaken to find out more. I’ll come back to the findings later, but in this post I want to take a closer look at the data about risk that appear to have prompted Ofsted’s interest. The research cited in support of Ofsted’s opening claim consists of one paper (Sullivan and Knutson, 2000) describing a large-scale study of children in Omaha, Nebraska during 1994-95. Disabled children were found to be 3.4 times more likely to have experienced maltreatment than non-disabled children.

By contrast, Ofsted points out;

The children in need census as at 31 March 2011 showed that there were 382,400 children in need in England of whom 54,100 (14.2%) were recorded as having a disability. At that time 42,700 (11%) children were subject to a child protection plan of whom 1,600 (3.8%) were recorded as having a disability. Children with a recorded disability were therefore less likely to be the subject of a child protection plan than other children in need.” (p.8)

If I’ve understood this correctly, it’s saying that if disabled children are at a higher risk of maltreatment than non-disabled children, you’d expect to see a higher rate of child protection plans (CPPs) amongst disabled children. But the frequency of CPPs amongst disabled children is lower (3.8% as compared to 11%), prompting concerns about children falling through the net.

There was something that didn’t look quite right about Ofsted’s analysis and I think I’ve figured out what it is. (I should point out that statistical analysis isn’t my forte, so please let me know if I’ve got it wrong.) I think there are three problems with Ofsted’s data;

– the level of risk to disabled children is based on an assumption
– the figures for children in need and disabled children are unreliable
– the level of risk and level of CPPs are derived from qualitatively different populations.

Assumptions about disabled children and the risk of maltreatment

First, let’s look at the figures for the risk of maltreatment. Little relevant research has been undertaken. Sullivan and Knutson’s study did indeed find that disabled children were 3.4 times more likely than non-disabled children to experience maltreatment. But they also cite an earlier finding that the risk was 1.7 times higher (p.1258). It’s clear from previous research that determining the prevalence of maltreatment is dependent on factors such as the quality of available data, quality of support services, definitions of disability and maltreatment, and whether disability has led to maltreatment or maltreatment has led to disability. This means that the prevalence of maltreatment is likely to vary widely between communities. The figure Ofsted took as its baseline for England was one that emerged from data gathered almost 20 years ago and 5,000 miles away in a community with a very different healthcare system. We don’t actually know the risk of maltreatment for disabled children in England.

Who qualifies as a child in need or a disabled child?

Let’s assume for the moment that disabled children are at a higher risk of maltreatment than non-disabled children. Whatever the level of increased risk, we’re still left with the question of the lower proportion of disabled children with a CPP.

Sullivan and Knutson’s sample consisted of 50,278 children enrolled in the Public (OPS) and Archdiocese schools of Omaha, Nebraska during the 1994–95 school year. It included children in other educational programmes and therefore covered an age range between 0-21. So the sample represented almost all children in a specific geographical area. But the sample Ofsted refers to consists, not of all children in a geographical area (in this case England), but of children in need in that location.

Section 17 (10) of the 1989 Children Act defines children in need as follows:

“For the purposes of this Part a child shall be taken to be in need if—
(a) he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority under this Part;
(b) his health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or
(c) he is disabled”

and s. 17 (11) defines ‘disabled’ as;

For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed; and in this Part—
* “development” means physical, intellectual, emotional, social or behavioural development; and
* “health” means physical or mental health.”

The first problem that arises is one of classification. The Children Act appears to class all disabled children as ‘children in need’, whether or not they are considered to be otherwise at risk. But local authorities don’t necessarily do that. DirectGov site says ‘local councils must identify the extent of need in their area and make decisions about levels of service they provide’, and it’s clear from local authority websites that their criteria for ‘children in need’ and criteria for ‘disabled children’ vary somewhat. One local authority officer told me that her LA classifies all disabled children as children in need whereas Cheshire East, for example, carries out an assessment to determine whether a disabled child qualifies as a child in need.

Then there’s the issue of the reliability of local authority records. The Citizen’s Advice Bureau tells us that ‘the local authority must keep a register of children with disabilities in its area but does not have to keep a register of all children in need’. Local authorities might be required to keep a register of children with disabilities, but that doesn’t mean that all children with disabilities will be registered. A recurring complaint from my own local authority is that although they have a register, it’s perpetually out of date and incomplete. In short, if LAs are unclear about how many disabled children and how many children in need are living in their area, the census data cited by Ofsted might not be entirely reliable. I did try to find out what data were collected by the census, but failed. If you can figure it out, let me know.

Qualitatively different populations

A key problem with Ofsted’s data is that if some LAs are treating all disabled children as children in need, but are treating non-disabled children as children in need only if their health or development is at risk, this would result in non-disabled-children-in-need being at a higher risk of maltreatment than non-disabled children-in-the-general-population. Ofsted is comparing data drawn from two qualitatively different populations – the general population vs children in need.

Child protection plans

What difference does that make to Ofsted’s concern about CPPs? It means that you’d expect non-disabled-children-in-need to have a disproportionately high level of CPPs compared to non-disabled-children-overall. That would widen the gap between CPPs for non-disabled children and CPPs for disabled children, making the proportion of CPPs for disabled children look disproportionately low. Some calculations might clarify the point:

Sullivan and Knutson set out their data (for all children) in a 2 x 2 matrix as shown below:

If Ofsted’s data (for children in need) are set out in the same way, they look like this:

In Table 2, the proportion of non-disabled children with CPPs is 4 times the proportion of disabled children with CPPs, exactly the opposite of Sullivan and Knutson’s trend, and that’s what Ofsted is concerned about.

But Sullivan and Knutson’s finding was based on data from all children in a location, not just children in need. If we put Ofsted’s figures into the context of all children in a location (in this case, England), a different picture emerges. (The total figures for all children and for all disabled children are estimates – the figure for disabled children is the Aiming High estimate).

If my calculations are correct, the proportion of non-disabled children with CPPs in the whole population of non-disabled children is only 0.39%, whereas the proportion of disabled children with CPPs in the whole population of disabled children is slightly lower at 0.28%, considerably less than the 4-fold ratio if children in need only are taken into consideration. When the population differences are corrected for (as far as is possible with the data provided), the discrepancy between CPP rates for disabled and non-disabled children almost disappears.

*********

There’s something about child protection plans that seems to have an adverse effect on statistical analysis. UK readers who were home-educating their children during the Badman review in 2009 will probably recall the disagreement between Graham Badman and Graham Stuart (later to become Chair of the Education Select Committee) about the proportion of home-educated children subject to CPPs. The central issue was that the total number of home-educated children in the UK was unknown; estimates had varied between 20,000 and 150,000. You can read the full account here, but I thought it was worth reproducing some of the exchange in full:

Graham Badman: I reflected a great deal on our exchange of views, I promise you. I did go back and look at the figures and I came up with exactly the same conclusion. In fact, if you want me to qualify it, when surveying the number of child protection plans in the authorities that we covered in the last survey, we came up with a figure of 0.4 per cent., which is double that within the normal population. In fact, that figure could be fractionally higher, because we discounted any child protection plan that was there as a consequence of disability. I know you argued that because I did not know about the other half, that therefore negated it and made it even again. My argument in return, as you will recall, was that because we did not know about the other half, that did not mean to say that they were all safe either. It could be exactly the same figure or more.

Q 86Mr. Stuart: May I interrupt you there? The question was not about the letter to the Select Committee in which you suggested that I had said that any child who was not known about was automatically safe. I said no such thing, so you have your facts wrong there—again. What we were establishing was the rate of child protection plans in the home-educating community. We went through it slowly, and you want to rehearse it, so I will rehearse it.

If you have a child protection plan, automatically you are known to the local authority, so children previously not known to the local authority who become subject to a child protection plan are then known to the local authority. It does not by any means guarantee that children who are not known to the local authority and do not have a child protection plan are necessarily safe. But what you do know is that every child with a child protection plan is known to the local authority, and you claimed, completely erroneously—and although you have been corrected, here you are months later still getting it wrong, which is pretty frightening—that the percentage of children who are home educated who have a child protection plan is double the national average, when your own report suggests that the numbers are at least double the 20,000, which is the number registered with the local authority, and the Secretary of State said on Second Reading that the Government estimated the number was 70,000. They do not know for sure, but they think it is 70,000.

If you take the number of home-educated children with a child protection plan and you see that as a percentage of 70,000, it comes out at a great deal less than the average for the population, and that I believe is the definitive statement of what we know. It does not tell us everything we need to know, which is why I would not overstate my reliance on it. Could you please comment on whether you believe that we can truly say, as you have repeatedly said, that there is double the rate of the most serious level of child protection plan among children who are home educated?

Graham Badman: I fear we are in danger of going round in the same circle. I am afraid I fundamentally disagree with you. You think I am wrong; I think you are wrong.

Mr. Stuart: It is maths.

Graham Badman: Well, fine; we might want to debate that later—perhaps you went to a better school than me. The fact remains that I do not agree with your assumptions. On the basis of the data collected from the local authorities and from two surveys that have been validated by DCSF statisticians, I believe that we are quite safe in saying that on the basis of the child protection plan analysis that they carried out, there are twice as many young people on a child protection plan known to local authorities within that population as are within the general population. That is a fact. I am sorry that you do not agree with me, but we could go on for ever disagreeing.

I also have concerns about other aspects of the report, which I’ll discuss in the next post.

Reference

Sullivan, P.M & Knutson, J.F (2000). Maltreatment and disabilities: A population based epidemiological study. Child Abuse & Neglect, 24, 1257–1273,

the assessment framework for children in need

In September last year I attended a presentation by a local authority on the way they plan to assess the needs of children with disabilities. They intended to use this framework;

I couldn’t see how the framework would help other than to remind LA staff of different areas of need, since many of the needs of children with disabilities and their families involve ‘health’ – only one of seven types of developmental need, and not mentioned at all in relation to parenting capacity or environmental factors. The framework doesn’t unpack any of the factors into their component parts, even though the health issues of children with disabilities and their families are many and varied. In addition, some needs have arisen only because of service inadequacies; e.g. problems getting a diagnosis, a wheelchair, sufficient nappies, a suitable education or respite care. It seemed a bit pointless to be developing a comprehensive assessment framework when known needs couldn’t be met anyway.

I’ve since discovered that the local authority in question didn’t devise this assessment framework. It was proposed by the Department of Health (DH), Department for Education and Employment and the Home Office in a document published by the DH in 2000 called Framework for the Assessment of Children in Need and their Families. The document is largely about the circumstances in which the framework should be used and who should use it. A companion document was also produced by the DH in 2000. It’s called Assessing Children in Need and their Families: Practice Guidance. I hoped it would explain how the Assessment Framework works in practice, which it does to some extent. The Practice Guidance contains four chapters. The first introduces the Framework, chapters 2 and 3 are dedicated to assessing the needs of ‘black’ and ‘disabled’ children respectively and the fourth is about resources.

Chapter 1 sets out a now-familiar model of child development in terms of milestones and ‘optimal’ outcomes (1.4), but doesn’t explain how the concept of ‘optimal’ is arrived at. It sees children’s development at different ages as predominantly physical (infancy to preschool), social and academic (middle childhood) and social and emotional (adolescence) (1.4), despite physical, cognitive, social and emotional changes being important features of each period of development. Experience in infancy is framed in terms of attachment (1.5), attachment theory is presented as ‘relatively new’ (1.8) despite being developed in the post-war period, and there are claims for a ‘wealth of research’ into it (1.11) despite Barth et al finding only four evaluations of the theory in the social science literature since 1996. Child development is grounded in psychodynamic theory (1.12) and learning theory prior to 1980 (1.13). References to ecology of the child tend to refer to social ecology only (1.50).

In my previous comments on this model of child development, I’ve pointed out that recent research in molecular and developmental biology doesn’t support a normative pathway for development; children have many similarities, certainly, but each child is developmentally unique. Physical, cognitive, social and emotional factors interact throughout development, implying that no aspect can be isolated from the others and that a model of child development grounded only in attachment theory is incomplete. The biological knowledge underlying psychodynamic theory has been superseded by a much more accurate understanding of the interactions between genes and the environment, and recent work in the neurosciences has made sense of earlier rather disjointed learning theories. But recent biological research isn’t reflected in the model of child development set out here.

In this post I want to make four observations about the model of child development set out in the Practice Guide and the Assessment Framework that’s based on it;

• a normative model of child development poses problems that those working with children then have to resolve

• a normative model of child development runs counter to the social model of disability

• the Assessment Framework is descriptive rather than explanatory

• the model of child development presented and the Assessment Framework are policy-based rather than evidence-based.

OK, now to explain those points.

a normative model of child development sets up problems that those working with children then have to resolve

In 2000, the Department of Health would probably have justified the inclusion of chapters dedicated to ‘black’ children and ‘disabled’ children on the grounds that their needs have been consistently marginalized for a long time. Although that is undoubtedly true, I would argue that a normative model of child development by definition creates demographic groups that don’t conform to the developmental pathway of a hypothetical average child. A normative pathway is challenged by any child who in any respect falls outside the normal range. Children and young people from ethnic minorities, whose first language isn’t English, who don’t fall into neat categories in terms of gender or sexual orientation, have minority religious or philosophical beliefs or unusual lifestyles, are chronically sick, have long-term functional impairments, minor problems with motor control, speech or attention or who have specific learning difficulties are all unlikely to meet their developmental milestones. This poses a problem for anyone assessing a child’s needs according to a normative developmental pathway because they have to figure out which exceptions are acceptable and which aren’t.

For example, Figure 2 in the Practice Guidance is a table of developmental ‘tasks’ relevant to different age groups (1.4). I understand the meaning of the word ‘tasks’ in the behavioural sciences, but it strikes me that here the word ‘duties’ could be easily substituted. The developmental tasks include school attendance and appropriate conduct, learning to read and do arithmetic, following the rules of society and involvement in extra-curricular activities. In addition to being about school, rather than about development per se, all of these ‘tasks’ could pose significant problems for a disabled child. Can allowances be made for children with disabilities? Apparently not. Paragraph 3.4 informs us that:

Disabled children and young people need to complete the same tasks of emotional development as all children: early attachments are just as important for disabled babies and children, and the development of relationships, self-confidence and sexuality are just as important for young disabled people.”

The big problem with a normative model of development is that services based on it are designed to meet the needs of a hypothetical average child, not the needs of all children. As a consequence, frontline practitioners such as GPs, teachers and social workers have been trained to address the needs of children following an average developmental pathway, but not the needs of all children. Another consequence is that all exceptions to the average pathway have to be treated as special cases, so we have ‘black’, ‘disabled’ and ‘poor’ children and those with ‘special educational needs’, for each of whom special provision has to be made. Special provision comes with a price tag, and a price tag attached to a specific demographic group is politically vulnerable. The group itself becomes vulnerable if children within it or their families are seen as being unwilling to achieve the milestones they are supposed to aspire to. By contrast, a model of child development that recognizes the inherent natural variation between children in different aspects of development would be more likely to result in services designed to meet the needs of all children, with professionals receiving appropriate training, and wouldn’t generate a plethora of special cases.

a normative model of child development runs counter to the social model of disability

The social model of disability locates disabilities in their societal context. In other words, someone might have what’s described as a ‘functional impairment’, but what actually prevents them leading what most people would consider a normal life isn’t the functional impairment itself, but barriers to leading a normal life that society imposes or fails to remove. Say for example, Mrs A is unable to work because she’s severely short-sighted, but because she can’t get a job she can’t afford the spectacles that would give her 20/20 vision. Mrs A’s problem would be resolved by giving her access to affordable spectacles. That particular scenario isn’t currently a problem the UK, mainly because so many people have impaired vision, but it illustrates the point. Viewing phenomena in their societal context is a powerful analytical tool, because it enables us to see relevant factors that are sometimes invisible when we take the societal framework for granted.

As human beings we tend to prefer people who are similar to ourselves – in appearance, beliefs, values and lifestyles. (Note that this is a tendency, not a hard-and-fast rule.) As a consequence we assign others to ingroups – people we feel comfortable with and/or approve of, and outgroups – people we don’t feel comfortable with or disapprove of. Often our perceptions of outgroups are over-simplified (stereotyped) because we don’t know much about them. The social model of disability addresses the tendency of the non-disabled majority to make the implicit assumption that everybody is non-disabled like them, and to ignore (accidentally or deliberately) the needs of the whole community. In other words, the able-bodied majority, as a whole, holds a normative model of human functioning that implies that everyone can or should function like the able-bodied majority.

A normative model of child development is in serious danger of creating precisely the kind of situation that the social model of disability has been developed to address; that a majority group assumes that everybody is like them or should be like them (or as is often the case, a group with resources decides how groups without resources should behave). Just as this assumption creates disabilities that wouldn’t exist in a society that actively addressed the needs of all its members, so a normative model of child development creates problems for children who can’t or don’t want to conform to the developmental pathway of the hypothetical average child.

The Practice Guidance takes a social model of disability perspective (3.10). But what seems to have happened to the social model of disability in relation to public policy is that a subtle change in understanding of the model has occurred. Instead of it being seen as explaining one of the causal factors for disabilities, there has been a shift to disability being seen only in social terms. Paragraph 3.10 says;

This guidance is informed by an understanding of the ‘social model’ of disability, which uses the term disability not to refer to impairment (functional limitations) but rather to describe the effects of prejudice and discrimination: the social factors which create barriers, deny opportunities, and thereby dis-able people…” (3.10)

There is no mention of the systemic factors that arise not so much from prejudice and discrimination but rather from poor planning, inadequate funding or patchy data. Viewing disabilities primarily in social terms risks marginalizing the causes of functional impairments. Paragraph 3.10 goes on to say;

Children’s impairments can of course create genuine difficulties in their lives. However, many of the problems faced by disabled children are not caused by their conditions or impairments, but by societal values, service structures, or adult behaviour…

That’s certainly true, but tends to belittle the effect that ‘impairments’ can have. Most people would think it unacceptable if someone couldn’t obtain spectacles that corrected a visual impairment, or crutches if they had broken a leg, but it’s currently very difficult to obtain comprehensive assessments, never mind treatments, for impairments that cause significant sensory, attentional, communication or mobility problems for children. Framing disabilities only in terms of social factors and failing to give GPs, teachers and social workers adequate training with regard to functional impairments, has, I suggest, resulted in some of the service structure failings paragraph 3.10 refers to.

the Assessment Framework is descriptive rather than explanatory

The DH describes the Framework as ‘systematic’ (Framework p.viii). I think what it really means is ‘comprehensive and consistent’, because the Framework isn’t actually systematic, but instead provides a checklist (albeit one divided into different domains and arranged in the form of a triangle) that helps identify the kinds of needs children have. The defining feature of a system is that it has interacting component parts, so for the Assessment Framework to be systematic it would need to show how its components interacted. As the Framework is presented, it’s just a list.

One thing it doesn’t do is help identify the ultimate, rather than immediate causes of children’s needs. Obviously, if a child has serious immediate needs those will take priority, but identifying ultimate causes is essential if needs are to be met effectively over the long term. Nor does the framework indicate how needs and/or their causes interact – essential if appropriate services are to be provided in a timely and cost-effective manner. I agree with the DH (Framework p.ix) that those assessing children and families shouldn’t be expected to follow a manual and should instead should use their professional judgement, but some indication in the Framework of the ultimate causes of children’s needs and the way factors interact would have been helpful, especially given the inadequacies in training highlighted recently.

The failure to present the Framework in systems terms means there’s a risk of several causal factors for children’s needs being overlooked;

• low-level causes such as health issues that aren’t immediately obvious
• high-level causes such as unwanted and unintended outcomes of social policy or legislation
• systemic causes such as different services having conflicting goals or competing for funding

However accurately those working with children identify the types of need they have, unless the causes of the needs are accurately identified as well, it will be impossible to prevent the needs arising.

the model of child development and the Assessment Framework are policy-based rather than evidence-based

The Practice Guidance places a strong emphasis on evidence-based practice and contrasts this with the use of evidence in judicial processes, quoting from a 1991 DH publication Patterns and Outcomes in Child Placement;

Social workers tend to think of evidence in terms of court hearings and reports, but evidence in the sense of ‘facts which lead to conclusions’ must be at the heart of every decision..” (1.62)

Evidence is used in many domains to inform decision-making. The aim, whether the decision relates to guilt or innocence, right or wrong, or the validity of a scientific theory, is to evaluate all available relevant evidence, so the decision best reflects the situation in the real world – what actually happened or happens. In the judicial system a judge or jury does the evaluating, in a formal debate it’s the audience, in government it’s parliament and in science it’s scientists. In the judicial system, debating and politics, each party involved cites evidence that supports their case and downplays evidence that doesn’t. Scrutiny by the opposing party is supposed to expose any flaws in reasoning. But people working in those domains aren’t usually the ones doing the evaluating so there’s a risk of them losing sight of the importance of taking into account all the evidence and instead to focus on evidence that supports a particular case.

Scientists, however, do evaluate evidence. A scientist would tackle an issue like children’s needs by first examining all the data. Any framework for assessing children’s needs would then be based on the data – addressing the most frequently occurring or serious needs, their causes and what interventions were most effective. Contradictory and inconclusive evidence would be included so that those using the assessment framework would be aware of its strengths and weaknesses and could apply their professional judgement accordingly. But in the case of the Assessment Framework, the evidence doesn’t appear to have been approached in that way. The Framework document opens with this statement;

Securing the wellbeing of children by protecting them from all forms of harm and ensuring their developmental needs are responded to appropriately and the duty of Local authority social services departments working with health authorities to safeguard and promote the welfare of children in their area who are in need and to promote the upbringing of such children, wherever possible by their families, through providing an appropriate range of services…

and sets the Framework in the context of national and international policy (p.viii). In other words, the starting point isn’t data on children in need, but government policy in relation to them. Supporting evidence for the policy is then cited in the form of a model of child development that’s based on partial and out-of-date information. Recent findings from molecular and developmental biology aren’t mentioned, nor is the policy framework itself critiqued (see for example Garrett, 2003). This isn’t surprising since it’s a government publication, but it’s not evidence-based in the scientific sense.

What summed up these documents, for me, was this from the Practice Guidance;

Recent empirical research, for example, has suggested connections between biological and other areas of development. The development of the infant brain mirrors developmental experience in general. It is argued by Perry (1993) that the brains of developing infants react to the quality and nature of sensory information…” (1.6)

The fact that biological factors are presented as a novel area of research and that only Perry’s work (of which more in a future post) is cited in relation to sensory information and brain development suggests that the authors of this chapter are less than familiar with the vast biological literature on this subject.

This brings us back to the comparison I made in another post, between Leo Kanner and Bruno Bettelheim regarding their level of expertise and the way they handled evidence in relation to children with autism. Kanner was up to speed with developmental biology, and used contemporary theory to develop hypotheses, which he then tested against data. As the data changed, so did his conclusions. Bettelheim knew about psychoanalysis and philosophy but didn’t have a biological background. He decided from the outset what was causing the children’s unusual behaviour and cited supporting evidence only. The outcomes of their work were very different; Kanner’s highlighted the developmental problems of a large group of children, Bettelheim’s resulted in needless guilt and misery for many parents and quite possibly wasted a substantial research grant from the Ford Foundation. In the case of the Assessment Framework, it’s difficult to avoid the conclusion that the Department of Health, bizarrely, doesn’t appear to know anything about research in developmental biology or genetics since the 1950s, nor much about how systems work or what expertise is necessary in order to identify children’s needs.

Some years ago, I complained to a government department that I couldn’t trace documents cited as evidence in a Green Paper because the references to them weren’t detailed enough. The minister concerned responded, rather tartly I felt, that the Green Paper wasn’t an academic paper. The implication was that academics might have to subject their evidence to public scrutiny, but government wasn’t obliged to do so. Personally, I don’t doubt that the intention of the previous UK government in relation to children’s needs was benign. Unfortunately, in order to be effective policy has to reflect the real world, not just part of it, and has to take into account the actual causes of those needs whether they are located in individuals or in flawed social policy, legislation or service delivery. A scientific approach to evidence stands a better chance of doing that than offering only evidence that supports what’s ultimately a nice idea. Science, like democracy, might not be perfect, but, also like democracy, it’s the best system we’ve found to do the job.

References

Barth, R.P, Crea, T.M., John, K, Thoburn, J. & Quinton, D (2005). Beyond attachment theory and therapy: Towards sensitive and evidence-based interventions with foster and adoptive families in distress, Child and Family Social Work, 10, 257–268.

Department of Health (2000). Assessing Children in Need and their Families: Practice Guidance. London, TSO.

Department of Health, Department for Education and Employment and the Home Office (2000). Framework for the Assessment of Children in Need and their Families. London, TSO.

Garrett, P.M. (2003). Swimming with dolphins: The assessment framework, new Labour and new tools for social work with children and families, British Journal of Social Work, 33, 441-463.