Monday, 17 September 2018

Predicting Child Maltreatment – it just ain’t that simple

It is interesting to read in the Guardian that some English local authorities are working to develop a predictive model for their children’s services teams. The plan seems to be to apply algorithms to big data sets in order to predict which children and families are at risk. The Guardian article notes that these initiatives may be a response to financial pressures on local councils as a result of austerity policies. Presumably the thought is that services could be targeted more accurately.

But predictive analytics are not as straightforward as they might seem. Any attempt to predict which groups might be at risk of disease or injury or other unwanted outcomes will involve making both correct and incorrect predictions about individuals. In addition to forecasting true positives and true negatives, systems will also forecast false positives and false negatives. The trick, of course, is to devise ways of reducing the numbers of false positives and false negatives, but even fairly accurate predictors can generate quite a lot. And that raises important practical and ethical questions about how to treat ‘at risk’ groups where a sizeable proportion of members are not actually at risk. If we could be sure of predicting all and only those children who would be abused or neglected, then we could justify strong intrusive interventions to stop maltreatment occurring, but we cannot justify doing that to families who have just been caught up because a predictive system is not very accurate.

Studies of risk prediction models for child maltreatment indicate that some can be effective in identifying at risk groups, but some predictive models have been found to be much more accurate than others (Begle et al 2010). A recent meta-analysis (van der Put et al 2017) concludes that twenty seven different risk assessment instruments have been found to have “a moderate predictive accuracy”. Analysis also revealed that the instruments were better at predicting the onset of maltreatment than its recurrence. 

A New Zealand study (Vaithianathan et al, 2012) found that the use of a predictive algorithm (PRM) applied to children under age of two had fair-to-good, strength in predicting maltreatment by age five, which compared with the predictive strength of mammograms (screening) for detecting breast cancer in the general population. But the authors note that were PRM used to identify families requiring preventive treatment, twenty-seven families would need to take up a the programme in order to avoid one child experiencing maltreatment. They conclude that a full ethical evaluation of the model would be necessary before implementation. They also believe that there is a need for extreme caution before implementing mandatory policies for high risk families and that it is preferable if scores are used to engage high risk families in voluntary rather than mandatory services.

Similar points are made by Dr Art Caplan, head of the Division of Medical Ethics at the NYU School of Medicine. In addition he stresses that unless there is an effective program to help parents learn how not to be abusive, then simply forecasting the likelihood of maltreatment will bring “stigma and penalty” to the children and families involved without bringing help. He argues that it does no good  to have knowledge of a bad outcome unless something effective can be done to prevent it. 

I am not completely against developing predictive instruments, but I am completely against developing them behind closed doors and without the proper analytical and ethical scrutiny that is required to justify their use. No predictive model should be used without a public audit of its accuracy. And no predictive model should be used behind closed doors without being subject to the oversight of an ethical committee. 

Local authorities and their private sector contractors should not be allowed to spend large sums of public money on systems of this type without being prepared to demonstrate publicly that they do more good than harm. 

Monday, 27 August 2018

More fiddling while Rome burns

They say that the Roman emperor Nero played his fiddle while the city burned. The phrase ‘fiddling while Rome burns’ means doing something ineffectual at a time of great crisis. Somebody certainly seems to have been playing a fiddle while the cash-strapped Northamptonshire County Council has been edging closer to collapse. 

An article in Children and Young People Now details a sorry story of messing about with plans to establish a limited company, to be called Children's First Northamptonshire, to deliver children’s services. This idea has now been scrapped because of uncertainty about the future arrangements for local government in Northamptonshire with the possibility of two new unitary authorities being created. How much time and effort and money has been frittered away, I wonder, in planning for this outsourcing only for it all to be put on hold.

Not that putting outsourcing on hold is altogether a bad idea. I have a lot of sympathy with the Unison Northamptonshire branch secretary, Penny Smith, who is quoted by Children and Young People Now as saying that outsourcing is unpopular with staff and that adding yet another layer of responsibility is not good for the children who are receiving services.

Messing about with structures and flirting with outsourcings and privatisations can squander time and money to no good end. And it focuses attention in the wrong place. Good high quality services don’t miraculously come about because governance arrangements are altered to reflect the ideologies of leaders. They come about because careful detailed attention is given to understanding the causes of poor quality and service failures and empowering staff at all levels to make the necessary improvements. 

Big plans often end in tears. On the other hand, frequent small changes, based on the knowledge and experience of frontline workers, can cumulate quickly to improve continuously the quality of services. Let’s hope that what happens next in Northamptonshire is based on a sensible improvement strategy; not an ideological pipe dream. 

Sunday, 26 August 2018

Act in haste ….

“Act in haste, repent at leisure” – so says the old proverb. But acting in haste appears to be what failing local authority children’s services in England are being required to do by the inspectorate, Ofsted, and by central government, in the shape of the Department for Education, which is responsible for child protection policy.

An article in Children and Young People Now reports that Ofsted is to require failing councils to produce a draft improvement plan within 20 days, as opposed to the existing arrangement of 70 days.

To some that may sound like good news, because prompt action sounds business-like. But to my mind it is likely to encourage a rush to judgement and even more top-down imposition of so-called ‘improvements’. 

When things go wrong in an organisation, and the quality of its services declines, the first thing to do is to put in hand activities which will establish what has gone wrong and why. That’s what I call ‘analysis’ – understanding the extent and causes of poor quality. Now whatever else it is, analysis is not easy. It requires reflection and self-criticism and insight. It requires data collection and probing and evaluation. It requires thought – lots of it. And it requires time.

Shooting from the hip happens when management reacts to a situation too rapidly: quick, we need to act, do something. Nearly always shooting from the hip leads to more problems than it solves. There is one thing worse than not tackling a problem; it is tackling the wrong problem. 

Twenty days is a very short period of time – less than three weeks. I would guess that rapidly composed improvement plans will be disproportionately influenced by senior managers, because there will not be time to include people across the organisation in a rush to get the plan agreed. That means that it is likely that the people who know most about the extent and causes of poor quality – those who work at the front line of service provision – will not be involved. And when senior managers begin to implement their plan it is more likely than not that it will not be received with enthusiasm by practitioners. It is likely to appear to them as being off-target and unrealistic. 

The key to better children’s services is not flash-in-the-pan rapid reaction. It is systematic, careful and insightful analysis. Somehow I don’t think that Ofsted and the Government have learnt that yet.

Monday, 6 August 2018

Worcestershire - musical chairs?

I struggle to see why transferring children’s services from Worcestershire Council to a company wholly owned by Worcestershire Council is likely to have much impact other than making governance more complex. 

The Government seems preoccupied with issues of ownership and organisation, which seem to me to be only indirectly related to improvement. You don’t get better services by changing ownership arrangements or by reorganising or by adopting a new name.

You do get better services by gaining a full objective understanding of how current services fall short and by putting in place arrangements for everybody to be involved in continuous improvement. 

Saturday, 4 August 2018

Northamptonshire … and the rest

With English local councils such as Northamptonshire and East Sussex succumbing to the long-term impact of austerity and embarking on savage cuts and major reductions in their services, it is only right for England’s Children Commissioner, Anne Longfield, to issue a dire warning about the impact of sustained shortfalls in funding on the extent and quality of services to vulnerable children. 

A key part of her analysis is that available funds are being increasingly concentrated on children with extremely high needs, leaving little for anyone else. Research by the Institute for Fiscal Studies has shown that approximately 50% of spending on children’s services in England is devoted to the 70,000 children who are in care and a further 30% goes to children for whom there is a child protection plan. That leaves only 20% for preventative work and early intervention. And now authorities like Northamptonshire are struggling to maintain even the core work. In short, they are teetering on the cliff edge.

Ministers appear bizarrely sanguine about this dire state of affairs. They have been told for years that the rising workload of children’s services combined with austerity funding is a recipe of eventual meltdown. And they have just sat there and done very little.

Thursday, 26 July 2018

No Blame Culture

Explaining why Bolton Children’s Services received a ‘good’ inspection report from Ofsted recently, assistant director Bernie Brown is reported in Community Care as saying that the council’s success was due to having social workers who “… are well supported, have regular supervision that is meaningful, and an organisation that doesn’t run a blame culture”. 

An organisation that doesn’t run a blame culture sounds very good to me. People can’t do complex and challenging work with a sword of Damocles hanging over their heads. And not having a blame culture is the first necessary step towards creating an organisation which can learn.  People learn from their mistakes and from identifying weak points in the service the organisation provides. Not blaming people is essential if people are to speak openly about the things that go wrong.

I would like to see every Ofsted report examine the extent to which local authorities don’t run blame cultures and examine the effectiveness of corporate learning. To do that Ofsted, itself, needs to think itself out of a blame culture. Maybe supporting improvement rather than judging, naming and shaming would be a good start.

Tuesday, 24 July 2018

The Care Crisis

Produced by the Family Rights Group, the Care Crisis Review is described as “an inclusive listening exercise” involving more than 2,000 respondents in England and Wales. 

The review comprised a rapid survey of the academic literature, roundtable discussions, conferences, small-group discussions, online surveys, focus groups, filmed interviews and meetings with organisations and individuals. The findings are helpfully summarised in Section 2 of the report (pp. 16 – 18).

The review sets out the background of the relentless rise in care proceedings and numbers of looked after children between 2007 and 2017 and it notes the substantial reductions in spending on preventative services in England (but not in Wales) since 2010. 

But in my view, one of the most important, and starkest, findings of the review is that:

“Many contributors expressed a strong sense of unease about a culture of blame, shame and fear affecting those working within the child welfare and family justice system, as well as children and families who are reliant upon it, often fuelled by media reports or interventions by politicians. Contributions to the Review highlighted that this was resulting in a growing sense of mistrust between those working at all levels, and between families and professionals.” (Paragraph 2.8, page 18)

So, the report reveals a “triple whammy” of crisis – increased demand coupled with decreased resources; and toxic organisations which are ill-placed to respond to the challenges. 

Meanwhile the Children’s Minister, Nadhim Zahawi, is reported as saying that “throwing money” at the situation will not work.

Children and Young People Now quotes him arguing that government spending on early support for families should not be increased. Instead he appears to put faith in the Government’s What Works Centre for Children's Social Care (expected to launch in 2020) which is tasked with promoting evidence-based practice and which, he says, will spread evidence of schemes that reduce the number of children in care. 

‘Clutching at straws’ is a phrase that comes to mind. I’m sure that the What Works Centre will produce some interesting and valuable ideas which may result in practice improvements. What I am sure it will not do is to make up for chronic under-funding of services. 

And I don’t think it will have much impact on a toxic culture of blame and fear which the Government just appears to ignore.