Mandatory reporting on child abuse and neglect: the consultation

I’ve just responded to the government consultation Reporting and acting on child abuse and neglect which closes on 13 October. It’s prompted some thoughts;

The challenge

Preventing children being harmed. Obviously.   But that’s a pretty broad remit. Local authorities and the agencies they work with have a statutory duty to ‘make arrangements for ensuring that their functions are discharged having regard to the need to safeguard and promote the welfare of children’ (s. 11 Children Act 2004). Basically they should have appropriate procedures in place. That prompted this comment from Eileen Munro in her Review of Child Protection;

‘…instead of “doing things right” (i.e. following procedures) the system needed to be focused on doing the right thing (i.e. checking whether children and young people are being helped)’ (Consultation document para 5)

Since the 2004 Children Act, safeguarding children seems to have had an increasingly high profile; promoting the welfare of children appears to have taken a back seat. Here’s how the current government sees it;

“…Safeguarding children – the action we take to promote the welfare of children and protect them from harm…”(para 2)

In other words the broad duty to promote the welfare of children – with all that that entails – now boils down to protecting children from abuse and neglect.  And the child protection system doesn’t always work. Numerous people have pointed out that no system can guarantee the protection of all children; we don’t have, and never will have, the resources to do that.

The nation has been, understandably, shocked to the core by accounts of the appalling abuse some children have suffered. The news that one child each week is killed on our roads and over 2000 a year are seriously injured in contrast barely makes the headlines; child protection isn’t just about abuse and neglect.  But children are abused and neglected and recent high profile cases have been shocking partly because they’ve highlighted clear failings in the child protection system. The reporting and acting consultation is part of the government’s response.

What the consultation proposes is that reporting and acting on suspected child abuse and neglect is made mandatory for people working in certain organisations. If they don’t report and take appropriate action, they could face serious sanctions. The people include not only those working directly with children but support staff and senior officers. As the consultation document points out, the possibility of sanctions introduces a significant risk of unintended and unwanted outcomes, such as unwarranted intrusion into family life and even more problems with recruitment and retention of social workers.

The evidence

On the face of it, mandatory reporting and acting looks as if it makes sense; if everyone reported and acted on their concerns, surely children would be much safer. But the evidence doesn’t support that reasoning. The evidence shows that when mandatory reporting is introduced the number of referrals increases dramatically (in Australia it doubled), but the proportion of substantiated cases is low (around 20% in several jurisdictions).   As the consultation document itself says:

‘Overall, the literature seems to show that “there remains some question about the efficacy of reporting laws in achieving their ultimate goal: protecting children from harm”’(Annex D p.22).

The causes

Not only does the evidence demonstrate that mandatory reporting doesn’t help, but reporting and acting per se don’t play a major role in the failures of the child protection system to protect children, either. Serious case review after serious case review identifies complex decisions to which there is no obvious right answer, and not following existing procedures properly, as key factors in the failure to protect children from harm. SCRs are littered with accounts of novice social workers being assigned to difficult cases, agency staff unfamiliar with cases, inadequate supervision, lack of understanding of the law and poor communication between agencies – all signs of services that don’t have the capacity to meet demand. In the vast majority of cases, the problem wasn’t that no one had reported their suspicions or failed to act on them.

Given the lack of evidence for the effectiveness of mandatory reporting and acting, and the fact that reporting and acting weren’t the main causal factors of failure, why is the consultation happening at all?

Why consult?

The consultation appears to be have been prompted by some recent high profile cases where abuse and neglect was known about but ignored; the consultation document cites Jimmy Savile’s activities and the sexual exploitation cases in Rotherham, Rochdale and Oxfordshire. Mandatory reporting and acting has been suggested by “MPs, MPs, Peers, campaign groups and members of the public” (consultation document Foreword). But MPs, Peers, campaign groups and members of the public might not be familiar with the evidence for the efficacy of their suggestion.   The way the child protection system is designed isn’t a matter of opinion, it’s a matter of the evidence for what’s effective.

The only reason for consulting that I can think of that is that it’s politically advantageous; the government is seen to be doing something. As the consultation document says “… it is crucial that we do all that we can to strengthen our arrangements to minimise the risks as far as possible” (para 14). Yes, it is, but there’s no evidence to suggest this is the way to do it.

If there are problems with a system, the only way to address them effectively is to identify the root causes of those problems.   SCRs provide a wealth of evidence for those root causes. We need to be looking at them, not quick fixes that we know won’t work and could make things worse.

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.

the claims: NSPCC briefing on home education

logicalincrementalism

The NSPCC briefing Home education: learning from case reviews claims to consist of ‘learning about child protection pulled from the published versions’ of seven Serious Case Reviews (SCRs) published between 2008-2013. In this and subsequent posts, I want to focus on the patterns of events that emerge from the case reviews, but I’ll also refer to examples of what happened to specific families or specific children. I’ve numbered the cases to anonymise the children as much as possible, but have linked to the published versions of the SCRs. I’ve listed brief details of each case below for reference.

Family 1 2007 serious maltreatment of adopted children
Child 2 2008 non-accidental poisoning with prescription drug
Child 3 2009 unexplained death
Child 4 2010 death due to severe malnutrition
Child 5 2011 suicide
Child 6 2012 death due to natural causes
Family 7 2013 neglect, and sexual abuse of adopted child

In…

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NSPCC briefing on home education: the law

logicalincrementalism

In March this year the NSPCC published a briefing entitled Home education: learning from case reviews. It’s based on seven Serious Case Reviews (SCRs) published since 2008 ‘where elective home education was highlighted as a key factor’ and ‘consists of learning about child protection pulled from the published versions of the reports’.

I got the impression from the briefing that the seven cases involved tragic situations in which parents had neglected or abused children and that home education had played a significant role in that neglect and abuse. The picture painted by the SCRs themselves is somewhat different. In only three cases was there unambiguous evidence that parents and carers were directly responsible for the harm the child suffered. In only one case were local authorities unaware of the challenges faced by the families or of the risk to children. There were several examples of healthcare actually contributing to…

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Martin Narey on social worker education

The tragic death of Victoria Climbie in 2000 focussed attention on the effectiveness of social services departments. The Laming reports published in 2003 and 2009 made recommendations for reform, and the 2011 Munro review of child protection referred to gaps in social workers’ expertise. A couple of weeks ago, Sir Martin Narey, fomer CEO of Barnardo’s and previously Director General of the prison service, published his review of the education of social workers. Although Narey recognises the high quality of some social work education, he is generally critical of the admissions criteria, content, quality and regulation of courses and makes a number of recommendations for improvement. What was striking about the report, I felt, was not so much what it said, but what it didn’t say.

Narey opens by directly addressing the fact that his inquiry was a one-man one, that evidence was gathered through private interviews, and says elsewhere that he didn’t have detailed terms of reference. Conducting an inquiry in this way has several advantages; it’s quicker and cheaper, reports are shorter, more focused, and more likely to be read and acted on – and as Narey points out, it encourages contributors to be more candid (p.3). There are also disadvantages; the opinion of a single reviewer is more likely to colour the inquiry’s conclusions and no one else can evaluate the evidence they’re derived from – with the best will in the world, people might misremember or misunderstand the evidence they present.

In addition, in complex systems like education health and social care, all elements of the system are connected, directly or indirectly. This means it’s often cost-effective in the long-term to remove the causes of problems, rather than to keep putting sticking plasters on the problems themselves. (Ten of Narey’s 18 recommendations involve increased regulation, rather than addressing the causes of what’s going wrong.) In an inquiry with narrow terms of reference the primary causes of problems the inquiry has been set up to investigate might actually fall outside its remit and not even get a mention. This is exactly what appears to have happened in the Narey review.

Narey makes it clear that some social workers are very able, are educated to a high standard and have no trouble getting a job when they graduate. But the rest of the picture he paints is a bit bleak. It suggests that school-leavers with low qualifications are being admitted to over-subscribed courses that offer insufficient teaching, inappropriate work placements and that lecturers and supervisors are sometimes under pressure not to fail inadequate students. In 2011 some local authorities had 20% of social worker posts vacant despite nationally almost 30% of Newly Qualified Social Workers (NQSWs) being unemployed; local authorities were clearly reluctant to employ NQSWs perceived as inadequately prepared for the job.

Why on earth would this situation arise? Narey locates the causes primarily in the calibre of applicants for social work courses, the content and quality of courses and the availability and quality of supervised work placements. And he makes a number of recommendations related to these factors. It’s apparent from his report, however, that the long-standing crisis in social worker recruitment might be driven by factors that Narey doesn’t explore in detail, such as the level of social worker qualifications, the reasons for the core content of courses, the regulation of social worker education, and university funding.

Level of qualifications

Throughout the 20th century, the level of qualification required to become a social worker rose steadily. In the 1970s Birmingham University offered a postgraduate diploma, a master’s level qualification and a four-year social work degree. In 1994, the national route to qualification became a postgraduate diploma involving partnership with employer, but during the 1990s there was a significant fall in applications. In response, in 2003 the government introduced a three-year social work BA – a sandwich course that included two work placements – or alternatively a two-year MA for graduates. This means that in the last decade the level of social worker qualification has fallen, something that is likely to have had an impact on the expertise of NQSWs and on the willingness of local authorities to employ them.

Core content of courses

Narey comments in some detail on the content of social worker courses. The original course offered by Birmingham University in 1908/9 consisted of 117 lectures covering topics as diverse as industrial history, law, statistics and sanitation & hygiene, as well as visits to a variety of institutions, and traditionally universities have continued to focus on the principles underpinning social work. But recent complaints from students and employers include challenges about the relevance of the courses including “weeks and weeks…looking at Plato, Socrates and Aristotle etc” rather than “skills relevant to social work” (p.9). Another student complained “ I have so far learned nothing concerning signs of abuse… There is not enough practical experience or theory related to its actual use in practice”(p.9). Narey adds “employers need to be more confident that students at every university will graduate with an adequate grasp of the basics necessary for them to develop into competent and confident children’s social workers.” (p.9)

Narey complains about the current focus of social work on ‘non-oppressive practice’ (or ‘anti-oppressive practice’ – he uses the terms interchangeably). He points out that there is a serious downside to a view that encourages working in partnership with, and the empowerment of, parents whose children are at risk. What he doesn’t seem to fully appreciate is that ‘non-oppressive practice’ is, and always has been, fundamental to the ethos of social work. Of course if anti-oppressive practice is the only theoretical framework presented to aspiring social workers, that does pose a problem that should be addressed. Narey entitles his critique of anti-oppressive practice the politics of social work teaching (p.10). Politics is about the distribution of power, so an anti-oppressive model of social work is in a sense ‘political’, but it’s not clear if Narey is using the term in that way, or if it’s because he suspects that this dominant conceptual model originates with the progressive Left (p.13).

Having debunked one core concept in social work teaching, Narey introduces another. In his own list of what he thinks social workers should understand he includes child development and attachment theory as two separate items (p.10). At first glance this looks like one of the conclusions of the Munro review that refers to social workers needing to know about ‘child development and attachment’ (Munro p.96). The difference is that Munro and the sources she cites could be construed as seeing attachment as one facet of child development, whereas Narey unambiguously presents them as distinct issues. My conclusion in previous posts about attachment theory is that there’s a serious risk of social workers seeing child development not as involving attachment, but solely in terms of attachment, rather than as a highly complex set of interacting biological, social and environmental factors of which attachment is only one. Narey’s suggestion is likely to perpetuate that over-simplification.

Intriguingly, given his focus on conceptual models in social work, Narey says he has never discussed the international definition of social work with the current Secretary of State for education or with any of his predecessors (p.13). It would be interesting to know why.

Narey isn’t the only one to take issue with the content of social worker education. There’s also disagreement between universities and employers, but much of it appears to centre on the difference between education and training. It seems fair to argue that social workers’ education should include statutory frameworks, but it’s debatable whether signs of abuse, a highly specialised skill, should be included in education or be approached via on-the-job training. My guess is that the problem actually boils down to who pays for what. The budgets of universities and local authorities have been under pressure for many years, and it’s understandable why local authorities might want social workers to emerge fully formed from their university courses, but that universities don’t want to broaden what they offer unless they have to. The ultimate losers are, tragically, the most vulnerable members of society that social workers are supposed to support.

Regulation of social worker education

Narey draws attention to the facts that social worker education is regulated by three different bodies and that universities need to consult at least five different source documents to shape the academic content of courses. He observes in respect of the Health and Care Professions Council (HCPC) that social work sits ‘very oddly’ with the list of other professions it regulates (p.21). Social work isn’t the only profession in this situation. In 2009, the HCPC replaced the Council for Professions Supplementary to Medicine (CPSM) set up in 1960, which regulated several professions that fall broadly under the umbrella of medicine. When the HCPC replaced it, the regulatory remit was broadened and practicing psychologists and social workers were added to the mix. This caused some consternation amongst psychologists, previously regulated by their own professional body, many of whom didn’t see themselves as working in professions related to either health or care. Only two of psychology’s protected titles – clinical and health psychology – could be clearly classified as involved in health or care whereas others covered fields as diverse as international educational systems and business management. Doubts were expressed as to whether the HCPC could have the range of expertise required in order to regulate effectively. From what Narey reports, it’s still a relevant question.

University funding

I mentioned earlier the three-year BA in social work introduced in 2003, following a fall in applications for social work courses. Narey doesn’t address the causes of the drop in applications, but it’s worth considering what it they might be.

Prior to 1945, some students from less well-off families could access a university education via much sought-after Board of Education grants, often on condition that they became teachers after graduation. In 1962 student funding by local education authorities became mandatory. A steady increase in student numbers coupled with a policy decision to increase the numbers of graduates and universities, led to the Dearing review of university funding in 1996, which recommended the introduction of an annual contribution of £1000 toward tuition fees, and in 1999 student loans were introduced. That meant that a four-year social work qualification was a relatively expensive way of getting a degree, so it’s hardly surprising that applications fell. In an attempt to boost social worker numbers, the three-year BA was introduced in 2003, accompanied by the offer of a bursary. The bursary, counterintuitively, appears to have had little impact on social worker recruitment, but does appear to have encouraged applicants wanting a low-cost route to a degree (p.28). Subsequent reductions in government funding have resulted in universities becoming increasingly reliant on student fees as a source of income; universities can now charge UK students up to £9000 p.a. and students from overseas usually pay much more. It appears that some universities have adopted a ‘pile ’em high’ approach to social work degrees, attracting large numbers of students but failing to provide them with the qualifications that employers are looking for.

Thinking outside the box

Times change, and social workers are no longer preoccupied by the impact of industrial injuries or poor sanitation as they were in 1908 (although hygiene is still an issue). But as far as I can see the social worker role is fundamentally unchanged; it still has to address the problems people encounter often as a result of societal factors over which they have little control. That doesn’t appear to be how social work is viewed by central or local government, however. In the last three decades, there’s been a noticeable shift from viewing social workers’ clients as people who are primarily victims of circumstance, to viewing their problems as the outcomes of individual choices. Both ways of framing people’s problems are over-simplifications and neither is helpful, because in reality everybody’s problems are due to a complex interaction of systems pressures and individual choices.

Another apparent shift is in respect of the focus of social work. Narey advocates not only restoring the option to specialise in adult or child social care following basic generic tuition, but also suggests the development of children’s social work degrees. Although specialisation seems justified, from the outside it looks as if social work is becoming increasingly polarised, toward care for the elderly at one end of the spectrum and toward children at risk at the other (p.37). In other words, adult social work will be about care of the elderly and children’s social work will be about child protection, as if adults and children had no other issues to deal with.

The location of the source of problems in the individual – or in individual organisations (universities and regulatory bodies in the case of the Narey report) – is an inevitable consequence of successive governments adopting a ‘market’ model for services. This is because the free market model rests on assumptions about the behaviour of individuals; that people make rational decisions, that they have free choices about the goods and services they purchase and that their free, rational choices ensure that competition between suppliers drives up quality. In reality none of these assumptions holds true.

The narrow terms of reference of the inquiry have resulted in the impact of some key systems issues being overlooked. These include; the underlying economic model chosen by government for the delivery of public sector services, the way context and individual behaviour are framed by government, the remit of regulatory bodies, the way the underlying purpose of social work is perceived, and how higher education is funded.

And a shift of the focus of social work from problems at all levels from the individual to the societal, is an inevitable consequence of shrinking the public sector; as a result there will be a tendency to focus on people most at risk, rather than in addressing the underlying systemic causes of a wide range of obstacles that people encounter when they are trying to get on with their lives.

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.

what social workers *really* need to know about child development

In the final report of her review of child protection, one of Eileen Munro’s recommendations is the development of social workers’ expertise, including an understanding of child development and attachment – in relation to which she cites four texts. In my previous post I suggested that the model of child development presented in these texts is normative, over-emphasizes emotional and social development and has an incomplete frame of reference, for two reasons;

It’s policy-based rather than evidence-based – an evidence-based model would give weight to all factors of child development.

It’s based on biological knowledge that pre-dates WWII. Old knowledge isn’t necessarily wrong, but research has moved on since then. The model of child development proposed by the texts doesn’t seem to recognize this. Continue reading