Thursday, 29 August 2013

Do we need to focus on ‘a hard core’?

In New South Wales, and elsewhere in Australia, there is a shortage of child protection social workers. Some agencies are experiencing severe problems.

An interesting argument on this topic is developed by Jeremy Sammut who argues that “…(t)he real and systemic problem with child protection in Australia concerns the large number of children who are re-reported because of unresolved safety concerns”.

Sammut tells us that approximately half of all child protection reports in New South Wales concern what he calls “…a hard core of around seven or eight-thousand frequently-reported, highly dysfunctional families”. He says that “… many of these children have a long history of risk of harm reports stretching over many years, and end up being damaged by prolonged exposure to parental abuse and neglect”.

He concludes that too little is being done for these children who, he says, “… would be better off if they were removed earlier and permanently, preferably by means of adoption”.

Sammut concludes by saying that a welcome consequence of so doing would be a reduction in the numbers of child protection referrals, resulting in less stressed and therefore more effective services.

There is more than a superficial plausibility to this argument. Many years ago quality gurus, such as Deming and Crosby, told us that doing it right first time is usually cheaper than doing it wrong and then putting it right. ‘Rework’, as it is known in operations management, is usually very costly and there is no reason to suppose that it is any less of a problem in child protection than in a commercial manufacturing context. Indeed, if a consequence of not getting it right first time is that children continue to suffer abuse or neglect, ‘rework’ in child protection is not only a financial but also a moral evil.

Where I part company from Sammut’s argument is that he appears to ascribe the cause of the problems to an underlying assumption that the authorities “… believe in 'family preservation' at nearly all costs”. Personally I do not know many social workers or child protection managers, or even policy makers, who believe that ‘family preservation’ is worth a child suffering abuse and neglect; indeed I do not know any.

My own view is that we lack the relevant knowledge and resources to deal with this kind of problem. In the first place we do not have anything like the right kind of research or routine statistics to understand what is happening; about what kind of ‘hard core’ exists and how to find it. How many children who receive a child protection service each year are re-referred suffering re-abuse or re-neglect? What are their characteristics: how old are they; what are their family circumstances; what systemic and organisational factors result in their being returned home after an abusive or neglectful incident?

Secondly we are not developing the right kinds of assessment tools to use particularly with very young children. If we were to make an impact on the numbers of children who are re-referred we would need some way of having much more accurate assessments at the first signs of abuse or neglect and particularly during the child’s earliest years. Just having different versions of some standard form – along the lines of the Assessment of Children in Need approach – is completely the wrong idea. What we need are ways in which different professionals from different professions and agencies can work together to create a much fuller and more accurate assessments of, particularly, very young children referred for the first time. Possibly some multi-agency expert assessment units are required, or at the very least the incorporation of psychological and paediatric expertise into front-line teams.

Finally we need much better community child health services focused on the early years. For too long in Britain there was a catastrophic decline in health visiting and, although there are plans in hand to reverse this trend, the outcomes are still not certain.  

Having more well trained health professionals regularly visiting families at home more often, and monitoring child care and development especially during the first one or two years of life, seems to me to be something most people would welcome. It would facilitate much quicker and more decisive action if concerns of abuse and neglect come to light during the early years.