Ireland - should members of the public be able to initiate care proceedings?

I was pleased to see Eilis O’Hanlan in the Sunday Independent strongly challenging the suggestion made by Ireland’s special rapporteur for children's protection, Dr Geoffrey Shannon, that any person should have the right to apply to a court to have a child taken into care.

http://www.independent.ie/opinion/analysis/eilis-ohanlon-vigilante-child-protection-will-put-innocents-at-risk-3182535.html

My view is that allowing any member of the public the right to initiate proceedings would inevitably result in public services having to respond to some cases that should never have been drawn into the care net. That would mean that significant resources (fostering, assessment etc.) were diverted away from more needy children.

Ireland’s child protection institutions have experienced more than their fair share of problems in recent years but a free-for-all in child protection is not the solution. It could have disastrous results.

Eighty Five Children killed by abuse and neglect annually in UK

The latest study of Serious Case Reviews has produced a more accurate estimate of the number of children dying each year as a result of maltreatment.

Eighty five children die as a result of violence or other maltreatment each year.

The study also found that a smaller proportion of children dying in this way during the period 2009-2011 were babies, compared with the period 2007-2009 (36% compared with 46%).

Opposition to draft 'Working Together' regulations

Opposition is beginning to surface to the Government’s draft Working Together regulations. The Every Child in Need Campaign says the proposals are “… wrong-headed, dangerous and will place the most vulnerable children at risk”.

The core of the campaign’s concern seems to be that the Government’s proposals remove national minimum standards for child-in-need assessments. The campaign’s website points out that while the Working Together proposals are focused on ‘children at risk,’ the changes will apply to all children in need. There is concern that removing the requirement that a child in need (for example a disabled child) must be assessed within 35 working days, will allow local authorities to get away with leaving such children “… to languish, without the assessments and services they desperately need – and are statutorily entitled to”.

It is very sad that we have to think about things in this way – that local authorities will only respond appropriately to need if they are required to do so through meeting a Government imposed deadline. But if this is the realpolitik of modern children’s services, then the campaigners’ points deserve to be taken seriously.

The problem with the imposed deadline in child protection work is that it ties the hands of social workers, possibly distracting them from work necessary to complete the Section 47 enquiry and from work necessary to take protective action. Rather than doing what is best for the child, the aim becomes one of completing the paperwork in time. So I am very much in favour of a more flexible approach where a child is at risk of significant harm.

On the other hand I can see the campaigners’ point, that families who ask for a child’s needs to be assessed do have a right to have an assessment in reasonable time.

My own view is that the rigid format of the Framework forthe Assessment of Children in Need is a significant part of the problem. Assessing the needs of a disabled child, for example, could be a much more focused (and briefer) activity, looking specifically at the impact of the disability on the child’s life-style and development and her/his entitlement to services.  While ‘holistic’ assessment is high sounding, its downside is that disabled children and their families neither need nor welcome a wide-ranging enquiry into their circumstances and history. They do not want ‘assessment’; they want services and support.

So I would suggest that where families request an assessment under Section 17 of the Children Act 1989, that they should be entitled to a decision from the local authority about services and support within a fixed timescale. Whether that should be 35 working days is difficult to say. Personally I would prefer it to be less.  

Policy Developments In Ireland

The Irish Times welcomes the publication by Frances Fitzgerald (Ireland’s Children’s Minister) of the task force report. The report recommends a single agency for support, safeguarding and protection of children and young people, a policy that the government will now pursue. The editorial also welcomes the recognition of the importance of preventative work and early intervention.

It’s good to see positive developments in Ireland but I think the Irish Times is too hopeful. However good the reforms are – and they certainly seem promising – they will never ensure that “… past mistakes by professionals in the protection of vulnerable children will not happen again”; they will only reduce the probability of re-occurrence.

Brief Encounters

I managed to get to an interesting seminar this week - looking at issues of emotional neglect and emotional abuse. The main presentation was devoted to what the academic literature has to say about the consequences (sequelae) of what Americans, who undertake nearly all of this research, call ‘psychological maltreatment’.

There were no real surprises. Insecure attachment, delayed development, cognitive delay, negativity and aggression during play, poor peer relationships, low self-esteem and language delays; all featured prominently. It was reassuringly, if tragically, familiar. But what I suddenly found myself taking a great deal of interest in was an aside about research methods, particularly relating to observation of parent-child interaction in longitudinal cohort studies such as the Minnesota Mother-Child Interaction Project [1]

It was blindingly obvious really, but I had never thought about it with such clarity before. Researchers are trained to be objective and dispassionate. They try to minimise observer effects, to be like a fly on the wall. And that, it occurred to me, is why they can produce such clear and incisive descriptions of emotional abuse and neglect.  They watch for a long time and so they see the negative, but often subtle, behaviours of some parents - lack of eye contact, failure to respond to distress, mechanical handling, disparagement, subtly conveying to the child that s/he is worthless/unloved/inadequate, having developmentally inappropriate expectations of the child, preventing the child participating in normal social interactions etc.

On the other hand social workers and other service providers may find it much more difficult to spot the signs of emotional abuse and neglect.  That’s not because they do not know what it is, but because the nature of the service encounter [2] makes sustained observation difficult. Unlike the researcher, the social worker often has only a relatively brief encounter with the family. Perhaps a couple of visits of less than an hour each in order to assess child-parent interaction. So it’s not surprising that emotional abuse and neglect, in the absence of other types of abuse, are often missed; or at the very least, not confirmed by social workers during a child protection episode.

Another consideration needs to be entertained at this point. The impact of emotional abuse and neglect – which, of course, will always accompany other types of abuse – is known to be particularly significant during the first two years of life, not only because babies are highly dependent and vulnerable, but also because the impact is long-term, involving both emotional and physical consequences. Studies [3] of young children emotionally neglected in Romanian orphanages found that their brains did not grow at the normal rate and were significantly smaller than those of normal children [4]. Such studies point to the need for the earliest possible intervention, before the long-term physical damage becomes established.

Applying some of these thoughts to the design of child protection service encounters it seems to me that we need to think much more imaginatively about how they take place. Following-up a concern of emotional abuse and neglect may be, quite literally, a different sort of job to following up an allegation of physical abuse where there is often clear, objective evidence in the form of a bruise, fracture or lesion.  It may involve longer and more sustained observation in the early stages of involvement. Working practices that mean that contacts are brief, and procedures that mandate that decisions be taken quickly, may simply result in lots of emotional abuse and neglect being ruled out because of lack of evidence in what are, in effect, fleeting involvements.

End notes 

[1] See Erikson, M.F., Egeland, B. and Pianta, R. (1989) "The effects of maltreatment on the development of young children", in Cicchetti, D. and Carlson,V. (eds) Child Maltreatment: theory and research on the causes and consequences of child abuse and neglect, Cambridge University Press, pp. 647–84.

[2] The term ‘service encounter’ is used extensively in services management and services marketing, referring to the moment of interaction between the service-user or customer and the service. Thus a service-user will typically have several service encounters with the same service. (See Mary Jo Bitner, (1990), "Evaluating Service Encounters: The Effects of Physical Surroundings and Employee Responses," Journal of Marketing, 54 (April), 69-82.) A home visit by a social worker to investigate a concern that a child is being abused is an example of what I call ‘a child protection service encounter’.

[3] See Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221-238). Washington, DC: American Psychiatric Press, Inc.

[4] A good summary of research in this area can be found on the Child Welfare Information Gateway, http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm

Continuous improvement as an approach to improving quality in child protection.

For too long we have had ‘experts’, senior managers, civil servants and politicians telling us how to achieve high quality. We should ignore them. Those who understand quality issues best are usually those who deliver or those who receive the services. Harness that understanding in manageable chunks – by the week, by the day, by the hour – and it can be the beginning of a slow, incremental but relentless journey to levels of quality that have hitherto been thought impossible.

Checkout this website: http://www.thecqi.org/Knowledge-Hub/Resources/Factsheets/Continual-improvement/

Human factors as an approach to greater safety in child protection.

Safer services are not created through more procedures, rules and regulations. They are created by people who have a constant awareness of opportunities for error and an insatiable desire to learn ways in which to practice more safely.

Human factors training has been highly successful for the pilots who keep you alive while flying you for your holiday on the Costas, or the surgeons and anaesthetists who keep you alive during your operation. Why not give it a try in the child protection workplace?

Check out the Atrainability website: www.Atrainability.co.uk

Hotlines

The US state of Louisiana has introduced a toll-free hotline on which members of the public and professionals can report concerns of child abuse and neglect.

http://www.fox8live.com/story/19013702/louisiana-child-abuse-hotline-wins-praise

An official is quoted as saying that the central child abuse reporting hotline has several advantages:

• It achieves greater consistency in determining if a report meets the criteria for child protection investigation
• It allows for a rigorous, multi-level quality assurance process
• Members of staff are involved more quickly and appropriately
• There are reduced waiting times for those phoning in

And, of course, it is available 24/7.

 

In Britain the NSPCC Helpline offers advice to those concerned about a child. It is not, however, a reporting hotline on the Louisiana model. But modern technology would allow such a hotline to be developed to cover the whole of the UK, or alternatively individual UK countries, regions, urban centres or rural areas.

I think this idea should be examined very seriously. If implemented properly it would not only be an opportunity to improve the quality of service, but it might also reduce administrative costs.

Right idea, wrong organisation?

Community Care reports on Ofsted’s ‘radical’ new inspection programme for child protection in England. http://www.communitycare.co.uk/Articles/11/07/2012/118366/Ofsted-sets-out-39radical39-new-inspection-programme.htm

It is certainly a good idea for inspections of child protection to focus on multi-agency working and the role, not only of the local authority, but health, education, the police and probation services as well.

But I very much doubt that Ofsted is the right body to carry this out. To date it has shown little talent for advancing the cause of quality in child protection work and a horrible tendency to inspect bureaucracy in.

Some wise words from Ireland’s Children’s Minister

The Irish Times quotes Ireland’s Minister for Children, Frances Fitzgerald, as saying:

“In finalising the children’s rights amendment, the first significant challenge is finding a wording that will find balance, finding the blend that allows the essential quiet revolution in child protection without creating constitutional hostages to fortune.”

“The second major challenge will be one of communication, as most people are not immersed in the realities of childcare and child protection.”

http://www.irishtimes.com/newspaper/ireland/2012/0707/1224319601583.html

Spot on Frances.

IT for Child Protection

-->

I only have to see those two little letters “I” and “T” in connection with child protection, or, for that matter, children’s services in general, and I begin to develop a nervous tick. Getting depressed and angry is usually not far away. Nine times out of ten I find that IT in the context of child protection stands for:

I …. ’m about to read something that I’m not going to like

T …. ake it away before it makes me ill

There may be some who would have me as a latter day Ned Ludd  – an ill-educated opponent of any new technology, a trasher of laptops and a smasher of iPads.

But I don’t fit the bill. Not only do I love my iPad, but thirty years ago I was an early adopter of the PC and an advocate of it as a tool of social work practice [1]. In the late 1980s I was involved in the design of case management databases. In the 1990s I managed the IT section of a small public sector organisation and developed several innovative applications. I wrote my MBA dissertation on IT in the Probation Service and I concluded the IT part of my career working to upgrade the payroll and HR systems of a large local authority.

Not to mention having been a tutor on an MBA information systems management course for nearly 10 years.

So I do know what I’m talking about when it comes to IT – more, I think, than most. But knowing something about IT is probably where all the trouble starts – I know enough to know when it’s not right, which doesn’t always please people.

Take ContactPoint - if you remember it. ContactPoint was an IT system proposed by the last Government. It was designed to track the involvement of children with ‘practitioners’. All eleven million children in England were to be on the database and 330,000 ‘practitioners’ were to have access. We were told, by Lord Laming among others, that this system was necessary to prevent another child dying like Victoria Climbié. ‘Practitioners’ we were informed had failed to share information about Victoria. What better way of ensuring this did not happen in future than using IT to force them to share information about every child? It was a whizz idea, so whizz indeed that children and young people [3], their parents and virtually every kind of civil liberties organisation condemned it as Orwellian meddling and there was a general recognition that it raised serious ethical and human rights issues [4]. The new incoming Government in 2010 took only a few months to reflect before scrapping it completely.

ContactPoint was not just a human rights disaster waiting to happen, it was a bad application of technology. The whole point about ‘information sharing’ is that it is selective and reflective. It should be done sparingly, when it is necessary, otherwise the result is information overload; what David Shenk calls a ‘data smog’ [2].

Information sharing involves a professional having something important they need to communicate to another professional. Both sender and recipient need to view the information in context and to assess its significance and importance. ContactPoint on the other hand elevated the automated exchange of data to supreme importance. Sharing was more important than understanding, and the sharing process was more important than the helping process.

Another example of a really bad application of technology was the Integrated Children’s System (ICS), developed by the Department of Health and then the Department for Education over the last 10-15 years.

Designed for use by staff in ‘children’s social care’ ICS went beyond the case management databases of the 1990s by incorporating the highly bureaucratic – and in many ways arbitrary – formats of the initial and core assessments of the Framework for the Assessment of Children in Need [5]. In an effort to be child centred, it omitted ‘the family’, requiring multiple entries of common data for siblings. And just to guarantee that it was a complete disaster, ‘work flow’ was added to ensure that anyone trying to complete a record was pushed to do so within arbitrary timescales. This usually resulted in data being added whether or not it was valid, simply to stop the screen turning red and the software ‘escalating’ the record for review by management. Whatever happened to the idea of a helpful tool!! If you wanted to design bad software you couldn’t have done better. Professor Darrel Ince put it rather well when he said: “To put it bluntly, as a computer scientist I found this system had no redeeming features whatsoever ….” [6]

Look back to the mid-naughties, to the time of Every Child Matters [7]. ContactPoint and ICS were then held-up as panaceas, as the digital engines of a revolution in children’s services, as the lynch-pins of a universal child surveillance culture. Today ContactPoint has been wound-up and nobody appears to be brave enough to advocate ICS, even tentatively.

While it is good news that bad systems have been recognised as such, the not so good news is that there seems to be very little systematic or creative thinking about what happens next.

Section 4.26 of the Munro Review progress report [8] describes progress in this area as ‘slow’, pointing to ‘demands of data entry’, the fact that many local authorities are already locked-in to contracts and procurement issues as reasons for the lack of progress. I am not so sure. I think that the main reason for lack of progress is lack of a clear definition of what is required.

The report concludes: “We recommend that actions be taken to instigate an open source project to provide a successor to ICS.” And I thought: “No. No. No. Please don’t do this! You are spoiling my day!!”

The last thing we want is a ‘successor to ICS’ – another failed system. We want an alternative to ICS, some IT that delivers real value for practitioners and the children whose needs are being served. And in order to get that we need to have a critical understanding of the business and professional processes and an idea of how new IT can result in better services.

I think that there is a very urgent need to re-think the role of IT in supporting child protection, in the wake of failed and misconceived systems such as ContactPoint and ICS. Maybe the slow progress is because people want to achieve too much.

It is so easy to think in terms of a 'system'; some whopping big application with lots of bells and whistles. And it is so easy to fall into the hands of developers who will build you a 'system' and suggest every sort of elaboration you are willing to pay for. The end result is likely to be another failed government IT project. Software that doesn't work or doesn't deliver a benefit. 

I think we would do well to start off with more modest aspirations. It is highly unlikely that IT is likely to ‘transformate’ [9] a complex professional process like child protection. So much of how the process is delivered depends on what happens in peoples’ heads that the role of IT is bound to be limited.

So I am highly skeptical of projects that claim that IT can drive organisational change in social work and child protection or, even less likely still, change practice.

That sort of Business Process Re-engineering talk is generally suspect when applied to complex professional processes. BPR advocates such as Michael Hammer [10] argued in the 1990s that IT could transform simple business processes, ‘obliterating’ wasteful and costly ‘as-is’ and substituting cheap and accessible new technology. That was true of Amazon, but selling books is a very simple process compared to protecting a child. The fact that most child protection involves interpreting unstructured information and making complex decisions means that the role of IT will always be limited - and anyone who claims that IT can lead the way to better practice is probably deluding themselves (and, sadly, sometimes others too).

My view is that good support is where IT can contribute most to child protection – IT as the under-labourer, “… clearing the ground a little, and removing some of the rubbish that lies in the way to…” better services (to misquote John Locke [11]).

Any operation (business or professional) has five performance objectives [12]. These are: Quality, Cost, Flexibility, Dependability and Speed. One approach to beginining to think about where IT will add value is to think about where it will help in achieving one or more of the five performance objectives. How can IT help achieve higher quality, lower cost, quicker and more flexible responses, and more dependable services?

Quick wins might be achieved if IT can be used to free-up more professional time by reducing or obliterating unnecessary administration … or by providing more dependable ways of storing information which can be accessed more flexibly and quickly … or by using communications to reduce the amount of time spent in meetings [13]… or better scheduling of activities to reduce wasted staff time, etc etc.

This way of thinking is likely to result in a portfolio of different systems some ‘shrink-wrapped’ and off-the-shelf. And there needs to be careful research to assess the likely impact and the costs and benefits. Some of it may be desperately dull - costly administration usually is. But the benefits could be profound - better supported professionals with more time and space to devote to direct work with families and making professional decisions.

None of this is very sexy, perhaps, but it is achievable in a steady incremental way. And I like the consequence that it results in people getting benefits now rather than waiting until some ill-conceived national project frees itself from a disastrous mess - in ten years time!!.

Endnotes

[1]  Mills, C “The computer as a tool of social work practice” Social Work Today, vol. 19 no. 45 July 1988

[2] David Shenk, Data Smog Harper Collins 1997

[3] Hilton Z. and Mills C. (2006) ‘I think it’s about trust’: the views of young people on information sharing. Office of the Children’s Commissioner, London.

[4] Munro, Eileen (2007) Confidentiality in a preventive child welfare system. Ethics and Social Welfare, 1 (1). pp. 41-55.

[5] http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003256

[6] Ince, D. “Computer says: ‘Misery’” Professional Social Work March 2010, pp 12-13

 [7] https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DfES/1081/2004

[8] The Munro Review of Child Protection Progress report: Moving towards a child centred system. Department for Education, May 2012

[9] Zuboff, S (1988) In the Age of the Smart Machine (Basic Books) talks about the power of IT to ‘automate’, ‘informate’ and ‘transformate’.

[10] Hammer, M and Champy J. Reengineering the Corporation: A manifesto for Business Revolution, Harper Collins, New York, 1993

[11] Locke, J. 'Epistle to the Reader' in An Essay Concerning Human Understanding, Edited by Pauline Phemister Oxford World's Classics

Oxford, 2008

[12] 

--> Nigel Slack, Stuart Chambers, Robert Johnston, Alan Betts Operations and Process Management: Principles and Practice for Strategic Impact 2nd Edition, Pearson 2009.

[13] 

--> Mills, Chris “Online conferencing might be the answer”, British Medical Journal 2011;342:d1777 http://www.bmj.com/content/342/bmj.d1777

Children's Homes - inspection and safety

I am pleased to see that the Government is responding speedily to concerns that some children and young people living in children’s homes are being preyed on by sexual abusers. A review conducted by Deputy Children’s Commissioner for England, Sue Berelowitz, has highlighted the nature and extent of this problem.

http://www.guardian.co.uk/society/2012/jul/03/children-in-care-protection

It is of concern that these problems do not appear to have been identified by the inspection regime, with Ofsted finding only 2% of children’s homes unsatisfactory. Perhaps the reason for this is that Ofsted places more emphasis on compliance with legislation and requirements than it does on creating a safe environment.

Ofsted published new guidelines for the inspection of children’s homes in April 2012. Paragraphs 24 and 25 of these state:

24. An overall effectiveness judgement of inadequate is made where there are failures to comply with requirements and, as a result, the outcomes for children and young people are inadequate or their welfare is not safeguarded.

25. Where a children’s home is judged inadequate, the inspector will set requirements to achieve compliance with the Care Standards Act 2000 and the Children’s Homes Regulations 2001. The registered person/s must meet these requirements as set out in regulation.

http://www.ofsted.gov.uk/resources/inspection-of-childrens-homes-for-inspections-1-april-2012

Notice in paragraph 24 that the cause of inadequate safeguarding is assumed to be “failures to comply with requirements”. But those who draw-up the rules are not infallible and it is quite possible to imagine a serious safeguarding failure might occur even when all the rules are followed. Likewise it cannot be assumed, as paragraph 25 does, that compliance with regulations will remedy a safeguarding deficit.

This is more evidence of wooden thinking by Ofsted. Rules and regulations may on balance make children safer, but they can never guarantee it. And in some cases the rules may even make children less safe, particularly if they are too numerous.

An inspectorate that focuses too much on the issue of compliance, and too little on the issue of safety, will be likely to fail those it is designed to protect.

Inspecting the impact of cuts

I see that HM Inspectorate of Constabulary has carried out an inspection to assess the impact of funding cuts on police forces in England and Wales. http://www.bbc.co.uk/news/uk-18670282

Why, I wonder, has Ofsted not carried out a similar study to determine if local authority spending cuts are having an adverse impact on child protection services?