An impressive Serious Case Review Report

In the past I have complained bitterly about the usefulness (or rather lack of it) of the executive summaries of Serious Case Review (SCR) reports.

But I was very impressed by the report - it is the full report, not just a summary - of a Serious Case Review undertaken in Haringey into the case of Family Z. 

The review was based on the ‘SCIE approach’ which was developed by Fish, Munro and Bairstow (http://www.scie.org.uk/publications/reports/report19.asp).

It draws heavily on a human factors perspective.

The contrast with traditional SCRs could not be more striking. And in sharp contrast to SCR reports which just provide a long list of procedural recommendations, this report provides an impressive analysis of underlying issues (summarised in paragraph 20). Some of the main conclusions are:

• Management systems lacked “… a coherence between family support services and emergency response…”  

• There was an “autocratic management style” that created fear and paralysed thinking so preventing “constructive case work challenge”

• There was an “… absence of systems to promote review of professional judgements…” and “…no effective challenge to, or ability to work with, non‐engaging families”

• A “… poor understanding of the causation and impact of neglect across agencies…” was identified and there was “... no shared culture of authoritative challenge amongst professionals allowing for the exploration of disagreements”

• The design of work processes and procedures made it difficult to respond effectively to incidents of neglect, a problem exacerbated by the design of computer systems

To my mind, the most important thing about this analysis is that it provides a substantial agenda of issues which both managers and practitioners need to address constructively. 

This contrasts strongly with the traditional approach to implementing the recommendations of SCRs such as the issuing of new top down instructions and the updating of procedural documents.

The Haringey Safeguarding Children Board is to be congratulated for this review and a most interesting and useful report.

A brief report of the case is provided in today’s Daily Mail, but do go to the Haringey Safeguarding Children Board’s website and download the full SCR report which contains a full and balanced summary.

A bad idea gets air time

I listened to Polly Neate of Action For Children , speaking on today’s Woman’s Hour on BBC Radio 4  in support of what is now a firm proposal to make emotional neglect and abuse of a child a criminal offence.

What she said made me angry. It was confused and confusing. She seemed attached to an idea that I cannot endorse – that in order to respond to emotional neglect and emotional abuse they must be made a criminal offence.

Professor Corrine May-Chahal from the College of Social Work, who was also part of the discussion, did a good job in trying to persuade Polly of the very obvious point that the civil law provides a very good basis for authorities to intervene in cases like this. And she made the point that criminalising needy people really doesn’t achieve anything.

What she didn’t mention is what I often found when I was a practicing social worker. Frequently children suffer emotional abuse and neglect because their parents are themselves experiencing depression or other mental health difficulties. How will prosecuting people like this help the situation? Obviously it won’t.

And there is another problem with Action for Children’s proposals. It would be very difficult to draft a criminal law that separated emotional abuse/neglect from perfectly normal conflicts and upsets that routinely occur between parents and children. If you don’t believe me have a go at drafting such a law. It is very difficult.

Badly drafted laws are a very bad idea. If Action for Children’s suggestion was adopted it wouldn’t be long before somebody who had had an argument with their child or somebody who had had a breakdown or somebody who was bereaved or depressed was dragged into the criminal courts and convicted. Imagine the cry that would go up from the tabloid press.

That would really drag child protection into disrepute.

Ofsted, the core assessment and bureaucracy

Ofsted conducted an unannounced inspection of Wiltshire Council’s safeguarding services in March 2012. The report, just published, gives the Council an “inadequate” rating and generally says a number of uncomplimentary things.

I was struck by one of the inspector’s recommendations:

"Wiltshire Council to ensure core assessments are regularly used and updated to reflect and evaluate the impact of changing family circumstances."

That might sound sensible to somebody who has never seen a ‘core assessment’ before. But to me it sounds like a bureaucratic nightmare. I couldn’t find a copy of Wiltshire’s core assessment form on line so I downloaded one from another authority. That doesn’t matter because they are all very similar.

The most striking thing about the form is the length: SIXTY TWO pages. Yes, sixty two pages of box after box after box concerning such items of information as height and weight and whether vision is satisfactory, sleep patterns, diet, bed-wetting, punctuality/behaviour/performance at school, friends at school, relationships with parents/peers/siblings – it just goes on and on and on.

I cannot imagine how forms like this were ever thought to be helpful. The likelihood of there being sound reliable evidence for much of the information entered is inversely related to the length of the form. How can a social worker assemble and validate all this information in a relatively short space of time? Often, I suspect, the boxes are filled in as best they can be without much attention being given to how well-evidenced the information is or how useful it will be in providing a service to the child. The process supplants the purpose; ends and means are unhelpfully reversed.

And the idea that the assessments exercises be undertaken repeatedly every time there is some change in circumstances borders on the absurd. A file full of 62-page forms, each one subtly different, is mind boggling.  On the contrary, keeping track of at risk children is best done using what we used to call a 'running record' or what is sometimes referred to as a 'chronicling system'. We can make sense of changing circumstances through a narrative, but our brains are not wired to keep track of changes in discrete information captured in boxes in forms.

Nearly a year after Munro reported – stressing the need to get away from mindless bureaucracy – and we still seem to have Ofsted urging local authorities to tick all the boxes and keep all the paper work up-to-date, without any thought about what doing so is likely to do to the quality of service.

How much time will social workers have left to build relationships with children and their families, and how much time will they have left to carefully consider momentous decisions, if they are repeatedly filling out core assessment forms? Very little I’d say.

It would be funny if it weren’t so sad.

Wooden Thinking and Bad Policy

Once again we are being told that the law in England is failing to protect children suffering neglect and emotional abuse.  We are told that the law needs updating.

We have heard this kind of stuff before – from the NSPCC’s Philip Noyes at the Education Select Committee who argued, I thought implausibly, that the law’s definition of neglect is a big problem.

Now we are hearing it from Dame Clare Tickell at Action forChildren. And the Labour Party have joined in with calls for more law, with Shadow Children’s Minister, Catherine McKinnell MP jumping on the bandwagon.

Oh dear! Oh dear!! Oh dear!!!

They are, of course, all talking about the criminal law, because nobody could believe that the civil law – The Children Act 1989 – is particularly weak in this area. To be precise they are talking about Section 1 (2) a of the Children and Young Person’s Act 1933 which makes it a criminal offence to fail “… to provide adequate food, clothing, medical aid or lodging for (a child)”.

Perhaps it’s because the 1933 act sounds a bit archaic, but I struggle to see why it needs changing. However, Dame Clare Tickell says:

“Neglect is the most common form of child abuse affecting children in the UK, yet we have an outdated law which does not reflect what we now understand children need and what neglect actually is.

“The law leaves children unprotected and parents without support and unclear about their responsibilities until it’s too late. We must ensure that these vulnerable children are protected from the serious harm which neglect, in all its forms, causes to their health and wellbeing.

“We know that intervening early to tackle emerging issues within families prevents neglect before it spirals out of control. Under the current law, parents are punished only after serious damage to children has been done. This is why the law is failing children and why it must urgently be updated.

“In April next year the law on neglect will be 80 years old – Action for Children does not want to see that anniversary come and go without government commitment that it will be changed so that more children are protected.”

That all sounds well and good, until you think about it; then it begins to unravel. Firstly the same section of the same act of parliament also makes it a criminal offence to physically assault a child. But nobody seems to be saying that’s out of date. Then Dame Clare says that “(t)he law leaves children unprotected and parents without support and unclear about their responsibilities until it’s too late”. But it does no such thing. Local authorities have responsibilities under the Children Act 1989 to provide services to children in need and to act to protect children where there is a likelihood of significant harm. That they may not always do it very well has nothing to do with the 1933 Act – it has to do with poor policies and lack of resources.

She goes on to say that there is a need for early intervention, something nobody would deny. But how on earth will changing the criminal law make a difference, unless we are going to make it a criminal offence to not be a very good parent? But perhaps that's what she has in mind because she also says: “Under the current law, parents are punished only after serious damage to children has been done.” Hopefully she is not calling for anybody to be punished before a crime is committed!!

Basically I think this initiative is just wooden thinking and bad policy. People aren’t good parents because they fear punishment if they are not. And criminalising people who are overwhelmed or inept at parenting is not the way to go forward. Engaging with people, gaining their trust and providing them with support and services which they can draw on to transform their lives is the way to create better parents – not the threat of jail if you fail to come up to scratch.

Let's not get sucked into the idea that changing the criminal law is likely to improve anything. It will be a big distraction, just like the Children Act 2004 was. And this 'reform' also risks criminalising people who are weak and needy while not doing anything to help neglected children.

Learning lessons not scoring points

Inevitably journalist Christopher Booker writes at length in yesterday’s Daily Telegraph about the Baby Jayden case. 

Inevitably he uses this tragic case to bolster his general attack on the child protection system and the family courts with what seems to me reckless talk of “‘experts’ paid to get it horribly wrong” and of “judges who too readily accept it (experts' evidence)”.

But his blanket criticisms seem to offer no way forward. What would he have medics do when they are faced with what they believe to be a case of non-accidental injury? Go home and forget it?

There seems to be no question that all involved in this tragic case acted in good faith. Medics may have got a difficult diagnosis wrong, but no-one is party to a plot to rob caring families of their children. Those who believed the case was one of non-accidental injury were genuine in their belief, even if they were in error.

As I tried to argue in a previous post, cases like those of Baby Jayden are particularly risky because everything turns on one piece of crucial medical evidence. If it is true then urgent action is required to protect a child; if it is false then there is no reason for any concern. So on the rare occasion that the medics get it wrong, nothing stands in the way of injustice.

Rather than railing against the courts and the medical profession, critics such as Christopher Booker would do better to try to contribute ideas about how we could reduce the risks of getting it wrong.

We might begin by considering:

(1)   Whether such cases could be referred for second opinions at a very early stage; and if necessary for third fourth and fifth opinions before criminal charges are brought

(2)   Undertaking careful reviews of the diagnosis at an early stage

(3)   Treating parents who find themselves in such circumstances with greater respect and care

(4)   Devising better ways of maintaining high levels of supervised contact between parents and any surviving children while court cases are in progress

(5)   Being less concerned with issues of guilt and conviction and more concerned with achieving the right outcomes for children

More on the case of Baby Jayden

Further to my last post, an article about Baby Jayden and his parents has now appeared in the Guardian:

http://www.guardian.co.uk/society/2012/apr/20/children-safety-jayden-rickets-misdiagnosis?newsfeed=true

And, also in the Guardian, Denise Turner writes movingly about her own experience of sudden child death and her research into the subject.

http://www.guardian.co.uk/commentisfree/2012/apr/20/parents-children-die-suddenly-criminals 

Wrongly Accused

It is, of course, impossible to say exactly what went wrong in the sad case of the couple who were wrongly accused of killing their four-month-old son and as a result had another child taken into care at birth. All we know at this stage are the bare facts as given in the first press and radio reports of the case.

The couple has now been cleared of all criminal charges and their daughter has been restored to their care. We are told that their son was suffering from rickets that was not diagnosed at the time of his death. Rickets results in softening of the bones predisposing towards fractures that can occur spontaneously as a result of the normal handling of a small child, so producing symptoms similar to those of a shaken baby.

Cases like this one have also resulted in injustice in the past. The crucial issue appears to be that everything rests on the medical diagnosis. There is no history of poor care and there is no other reason to suspect that the parents would harm a child. Without the diagnosis there would be no concern at all; with it care proceedings and criminal charges appear to be the only option.

We need to learn much more about the risks in cases like this one. It would certainly be preferable to be aware of any conflicting medical opinions as early as possible, rather than having rival experts disputing their differing diagnoses in court many months, or even years, after the event. And it would certainly be best to spend more time getting the diagnosis right in the first place.

However, this type of case is not routinely put through the Serious Case Review process and there seems to be no repository of learning of how to reduce the risks of mistakenly proceeding against innocent parents. Perhaps some research would be a good idea?