The Prevalence of Child Abuse and Neglect in Britain

The NSPCC’s survey of the prevalence of child maltreatment is most welcome. (Child cruelty in the UK 2011 An NSPCC study into childhood abuse and neglect over the past 30 years February 2011 - http://www.nspcc.org.uk/news-and-views/our-news/nspcc-news/11-02-15-report-launch/nspcc-stats-launch-event_wda80813.html )

At this stage only an executive summary is available. Even a careful reading of this left me a bit confused about the main implications. It is, however, clear that this study, like its 1999 predecessor (also conducted by the NSPCC), is a very important piece of research that must be studied carefully by professionals and policy makers.

One in seven of the young adults surveyed (14.5%) reported that they had been severely maltreated by a parent or guardian during childhood.

This is, of course, a shocking figure, but a problem is that studies like this are, of necessity, studies of prevalence not incidence. In other words they survey a random sample of the population to determine if they have ever been victims of child abuse and neglect. Turning the findings into estimates of incidence (i.e. how many children and young people are being abused and neglected at any one time) is not easy. But by any standards it seems hard to reconcile the relatively small numbers of children subject to child protection plans (less than 50,000) with the main findings of this research, suggesting that under-reporting of abuse and neglect remains a serious problem.

I am looking forward to being able to dig down into the detail of this study when the full findings are released. Of particular importance will be information relating to the sub-group of those reporting persistent maltreatment and any information about the extent to which they received (or did not receive) help from statutory services.

ICS and the Mountain

I was struck by the following comment in Molly Garboden’s piece in Community Care yesterday (“Munro's 'ideal' vision of child protection social work” Monday 07 February 2011 - http://www.communitycare.co.uk/Articles/2011/02/07/116232/munros-ideal-vision-of-child-protection-social-work.htm )

“There is much less in the latest report than in her (Munro’s) first installment, however, about ICS becoming an intuitive decision-making tool similar to those used in the airline industry and medicine. It seems likely that, even in an ideal world, Munro recognised that there is a pretty big mountain for ICS to climb.” (my underlining)

If this is an accurate prediction of what the review will ultimately recommend   – and hopefully it is not - then it is sad. In my view no amount of remedial work is going to make the Integrated Children’s System (ICS) fit for purpose. That is because it is misconceived. Rather than supporting the professional work that child protection social workers do, ICS imposes an unrealistic model of practice. Completing all the forms and ticking all the boxes doesn’t result in better decision-making. In fact it impedes it, not only because is it time consuming, but also because frequently it is not possible to gather good quality data. The results are thousands upon thousands of yes/no boxes checked on which people do not (and should not) rely when making their decisions.

The purpose of child protection social work is not completing assessments. Assessments are only useful if they accurately inform decisions about whether or not, and how, to intervene in the life of a child. In order to have useful IT in child protection, it is necessary to begin by building an accurate understanding of how sound decisions are taken and what support social workers need in taking them.

Management accountants have an old – but precious – adage: sunk costs are history. Just because a lot of money, time and effort have been spent on something in the past has no bearing on whether it makes sense to continue spending money, time and effort on it in the future.

To borrow Molly’s metaphor: I don’t want to see ICS climbing any mountains. It’s best discarded at base camp. Otherwise its weight and cumbersomeness will cause climbers to lose their footings and bring the whole expedition to a sorry end.

The Tragedy of Alex Sutherland

The executive summary of the Serious Case Review report concerning the death of “Child T” (Alex Sutherland) is generally clearly written and provides sufficient information to see the basic facts of the case (http://www.manchesterscb.org.uk/prof-scr.asp ). But I began to get depressed when I reached the conclusions and recommendations.

The report casts the net of responsibility for the failings widely:

“The Panel considered that no single agency was responsible for failing to protect Child T from the chronic neglect which he suffered at the hands of his mother, but rather he was the victim of the multiple failures of all those agencies with whom he was involved (with the exception of GMP) to recognise the risks to which he was exposed and to take appropriate protective action.” (para 7.2, page 23).

The report then goes on to blame a combination of “single agency failings” and “generally poor inter-agency communication and collaborative working’, without engaging in any rigorous systematic analysis of the causes of the disaster. The result is a series of recommendations that seems to me unlikely to make any serious contribution to improving the safety of child protection services in Manchester or elsewhere. Two that struck me as being particularly weak were the following:

(For University Hospitals of South Manchester) “All patients attending the trust to be asked routinely about dependants that they are responsible for.”

(For Manchester Children’s Social Care) “Revise procedures to ensure social workers speak directly to family members as part of assessments.”

Resisting the temptation to fulminate - or even to wonder what people having in-growing toe nails removed in South Manchester will think when they are given the third degree about who are their nearest and dearest – I will swiftly move on to the crux of the issue which goes something like this.

Alex Sutherland suffered neglect as a result of his mother’s alcoholism. From the first involvement of statutory services to the last, it seems clear that the primary focus of all the agencies involved was concern for Alex’s care as a result of his mother’s drinking. Not only that but several referrals from members of the public also cited maternal drinking and consequent neglect. Yet having initially embarked on a child protection approach to Alex’s case, Manchester children’s services subsequently produced a Child in Need plan (instead of a Child Protection Plan) and then continued to work with Alex and his mother on the basis that he was a child in need but not in need of protection.

In view of what is known about Alex’s condition and the facts of the case, that decision – not to hold a child protection conference that would probably have resulted in a Child Protection Plan – seems to me to have been the crucial mistake. But it is not addressed in the Serious Case Review Executive Summary. Nor does it receive any attention in the press coverage.

Recognising this error is the beginning, not the end, of a proper analysis of what went wrong in this case. Bad decisions of this sort are not usually a matter of individual failings. They are normally the product a complex matrix of environmental, organisational and inter-organisational factors that result in individuals loosing situational awareness. One might speculate that staff and other resource shortages, and local and national procedures and policies, may have contributed to a climate in which an apparently clear case of child neglect was not treated as such. But it seems we shall never know.

Good news from Munro

Eileen Munro’s review seems to be developing on the right lines. On the BBC’s Today programme this morning she told John Humphrys that more rules do not make children safer and that social workers trying to protect children are often distracted by filling forms and following procedures. She argued that professionals should be spending more time working directly with children, trying to understand how they feel and what they want to happen.

These are conclusions with which it is difficult to disagree. Child protection social work must be child centred. And procedures need to support good practice, not impede it. There is mounting evidence that huge procedural manuals and data driven recording systems, such as ICS, are obstacles to getting the job done and barriers to meeting children's needs.

The BBC also reports that Munro believes that formal time scales can distract social workers from making sound decisions. (http://www.bbc.co.uk/news/education-12323806)

Again this is good common sense. Completing an assessment before some vital piece of information can be made available is actually a waste of time – because the assessment may have to be revisited. Holding a child protection conference on a date within the required timescales, but on which key participants are not available to attend, is equally counter-productive.