Thursday, 16 August 2012

Consultation (2): About the document entitled: Managing Individual Cases: the Framework for the Assessment of Children in Need and their Families

Sadly I have written a lot about the document entitled Managing Individual Cases: the Framework for the Assessment of Children in Need and their Families

I didn't like this document at all. 

I wrote:

(About local frameworks for assessment)

I have severe reservations about the idea of local frameworks for assessment. It seems to me that the document is in danger of inviting local managers to compose at local level the very type of convoluted guidance that the Government has been at pains to expunge at national level.

Furthermore I really cannot see why detailed guidance is required on assessment in the first place. Few, if any, would argue that central or local Government – or other bodies - should issue detailed guidance to (say) doctors on diagnosis or to (say) barristers on how to represent their clients in legal proceedings.

But the Framework for the Assessment of Children in Need (DoH, 2000) has, over the past 12 years, become a holy book of ‘children’s social care’, despite its many defects and shortcomings, establishing an unwelcome tradition of proceduralising assessment.

With the benefit of hindsight we can now question why anyone ever thought that an attempt to specify in detail what questions a social worker should ask in carrying out an assessment was anything other than a crude attempt to micromanage practice. And, with the benefit of the insights of the Munro review, we should now be ready to cut free from a tradition based on a ‘framework’ that, through the Integrated Children’s System and previous Government guidance, has become a central element in the bureaucratic proceduralisation of professional practice.

Whether local or national, frameworks drafted by managers and officials and imposed on professional social workers are a bad idea. One only needs to read accounts of the excellent research of Broadhurst and colleagues (“Performing ‘Initial Assessment’: Identifying the Latent Conditions for Error at the Front-Door of Local Authority Children’s Services” British Journal of Social Work (2009) 1–19) to understand the dysfunctional consequences when a framework for assessment becomes a formally endorsed checklist and evolves into step-by-step procedures built in to a computerised system.

This has happened with the Framework for the Assessment of Children in Need spawning the ‘exemplars’ of the Integrated Children’s System. There is a great danger that practice is driven, not by commonsense and professional judgement, but by arbitrary compliance with ‘the rules’. The Munro Review has persuasively drawn attention to the dangers of such a situation and the Government has accepted Munro’s arguments as a foundation for policy change. But this guidance, locating as it does ‘assessment frameworks’ at the apex of policy, is at variance with the new paradigm.

I do not rule out the use of assessment frameworks entirely, but they should not have the force of procedure or regulation; and they should be developed through professional networks and research, not through bureaucratic diktat, whether local or national. Only when the evolution of frameworks is led by practitioners can practice develop and improve, as different ‘frameworks’ are tested, amended or replaced. Professionally evolved frameworks, of this sort, would be more like tools than sets of instructions. Practitioners would choose a framework best suited to the task and their particular needs at the time, and use it flexibly and creatively.

Otherwise, in the top-down world of imposed frameworks, the wheels of government bureaucracy, either central or local, grind too slowly and inflexibly resulting in what might be useful tools of professional practice effectively being set in stone.

(About internal review points)
Specifying ‘internal review points’ or timescales or deadlines is not an effective way to make processes run more quickly while maintaining acceptable levels of quality. Trying to impose these types of requirement is likely to unbalance the process, leading to backlogs of work at some points and idle workers at others. Quality is likely to suffer.

The correct way to speed-up a process is to begin by trying to understand it. Where do bottlenecks occur? Why? How can resources be re-distributed within the process to increase speed? The process will run at the speed of the slowest bottleneck, so there is no point in speeding up some parts of the process if the bottleneck is not addressed. That just wastes resources.

Usually, the speed of the process is not a matter of ‘control’ – it is a matter of design. You can try to control a badly designed process until you are exhausted but you won’t make it operate effectively. Resources are consumed by controls that do not work. Workers are alienated by controls that they perceive as unreasonable. The operation is made more complex than it needs to be while the human beings that run it become confused and dispirited. The quality of the service goes down.

Re-designing a process should always be undertaken interactively with the people currently undertaking the work. They usually have a better understanding of the process than outsiders.

I am saddened that apparently, once again, the guidance appears to be reintroducing practices through the ‘back door’ at local level that the Munro Review has challenged as counter-productive at national level. For local managers to specify normatively timescales, without investigating the process and understanding why it operates as it does, is no better than allowing civil servants or politicians to set deadlines nationally. The whole force of paragraph 2.5 seems to be to urge local authorities to recreate at a local level exactly the kind of timescales and deadlines, that Munro warns against at national level. This must be undesirable. Local bureaucracy is as crippling as national bureaucracy, possible more so.

(About the whole document)
The best thing about the document entitled “Managing individual cases: the Framework for the Assessment of Children in Need and their Families” is that it is short; other than that it is confused, difficult to read and not very helpful.

The problem starts with its title. It is a fundamental mistake to try to weave together guidance about assessing children in need with guidance about how to respond to child abuse and neglect. While the two processes are closely related, and may be carried out by the same people, they should not be portrayed as a single process involving different pathways. The parents of a disabled child, asking for a child in need assessment under Section 17 of the Children Act 1989, would rightly be outraged to find that the service they receive is subsumed under a child protection rubric.

The 2010 version of Working Together makes it clear that Chapter 5 (“Managing individual cases where there are concerns about a child’s safety and welfare”) concerns those cases where there is a concern that a child may be suffering abuse or neglect. This is made abundantly clear in paragraph 5.1 which states that “This chapter provides guidance on what should happen if somebody has concerns about the safety and welfare of a child (including those living away from home) and, in particular, that a child may be suffering, or is likely to suffer, significant harm”.

This new guidance should start with a similar unambiguous statement making it quite clear that the individual cases being managed are those in which abuse and neglect are suspected. It should then concentrate on providing guidance on child protection, and only on the assessment of need in so far as this contributes to managing a child protection episode.

To confuse child protection with cases where there are no concerns at all about abuse and neglect, but where a child has unmet needs, is unhelpful for a number of reasons. First, as indicated above, parents of children who are in need, but not in need of protection, should not be stigmatised. Secondly, a different speed and urgency of response is invariably required where children may be in danger, possibly of their lives. Thirdly, there is no reason why guidance that is applicable to children in need of protection should be applied more widely to children in other types of need. The guidance should fit the service, not vice versa.

The legitimate complaints raised by the Every Child in Need Campaign are a direct consequence of seeking to amalgamate guidance on child protection with guidance on assessment. 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 proposals are focused on ‘children at risk,’ the changes will apply to all children in need. It is argued 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”.

The problem with the imposed deadline for assessment 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. This suggests that the guidance on requested ‘in-need’ assessments might require a deadline, whereas that on child protection does not. What a reasonable deadline would be depends on an analysis of the process of producing such an assessment and the level of resource given to the task.

Generally I am perplexed about why anyone thought it a good idea to try to subsume guidance concerning the Framework of Assessment of Children in Need into guidance on child protection. I see nothing in the Munro report to suggest that such a mishmash of guidance would result in better services.

(About other ways in which the the guidance is defective)

The document does not follow a simple logical order that corresponds to the natural stages of the child protection process. This order is as follows:

·       Recognising the signs of significant harm or otherwise forming a concern that a child may be at risk of significant harm

·       Making a referral to children’s social care

·       Accepting a referral by children’s social care

·       Deciding on action, including involving the police in cases where a crime is suspected

·       Taking emergency action if required

·       Carrying out a Section 47 enquiry

·       Undertaking an assessment of a child’s needs

·       Deciding whether a child protection conference is required

·       Holding a child protection conference

·       Making a child subject to a child protection plan and subsequent involvement

·       Deciding whether further legal proceedings are required

While some of the later stages are dealt with in a sequenced fashion, the guidance begins with assessment and with a lengthy discussion of the “local framework for assessment”. This suggests that the process to which the guidance applies is ‘assessment’, when in reality ‘assessment’ is only a part of the process of protecting and safeguarding a child.

The emphasis on assessment in the early paragraphs of the guidance has another unwelcome consequence; the issue of abuse and neglect is obscured, if not completely avoided. Indeed the definitions of the various types of abuse and neglect are relegated to a glossary. This is very unfortunate. It is only too easy for members of the public, professionals and practitioners, to shy away from the recognition of child abuse; none of us wants to think that a child is being abused. But it is wholly unacceptable for a Government document to fight shy of using robust and accurate language to describe child maltreatment. Apart from references to “low-level abuse and neglect” and “the early signs of abuse and neglect”, both in paragraph 1.3, the word ‘abuse’ does not occur again until page 20 and the word ‘maltreatment’ only appears at page 26, in the glossary. Incidentally there is no such thing as ‘low-level abuse’; that is if you happen to be a child on the receiving end of it!

Section 2 of the guidance continues to integrate the process of receiving a referral requesting an assessment of need with the process of responding to a concern about child abuse and neglect. While it is appreciated that some cases referred for a needs assessment will turn out to involve abuse and neglect, and some cases referred for protection will ultimately not involve child maltreatment, it is difficult to imagine why paragraph 2.4 should apply, for example in the case of a disabled child referred for a needs assessment.

Indeed paragraph 2.4 seems to set a wholly unrealistic timescale. Within one working day it would be reasonable to expect a social worker, handling a child protection referral, to have decided if the referral involved a concern that a child was at risk of significant harm; and such a child should ordinarily be seen immediately and the situation assessed to determine if the child is in need of emergency protective action. However, the social worker will only at this stage have a partial view about “the course of action to be taken” and “what type and level of help and support is needed”. Neither is it realistic, nor indeed safe, to expect that feedback to the referrer should be provided at this stage.

Resource problems for ‘children’s social care’ would be generated if there is an expectation that response to cases where there is no suggestion of child abuse or neglect will also be responded to within “one working day”. Such an expectation is both unnecessary and unworkable.

The heading above paragraph 2.2 “Referral into children’s social care” is at best unusual English. We don’t speak of ‘referral into the X-ray Department’ or ‘referral into a specialist’. Surely the correct English is ‘referral to children’s social care’?

Incidentally, the expression ‘children’s social care’ to describe teams of social workers who undertake child protection work is, in my view, unhelpful. The expression emerged a few years ago when there seemed to be a concerted effort to airbrush the phrase ‘social work’ from Government documents. But ‘social work’ is the correct description of what these teams of social workers do. In the era of ‘reclaiming social work’ we should now not be afraid of speaking confidently about ‘children’s social work’ (see Social Work Reclaimed, by Steve Goodman and Isabelle Trowler, Jessica Kingsley).

(About Flow Charts)
The first of several flow charts appears at page 10 of the guidance document. All the flow charts are amateurish, difficult to understand and do not follow the conventions for drawing flow-charts that are widely used and accepted in the business literature (see Slack et al, Operations and Process Management, 2nd edition, Pearson, 2009 pp 143-146). If flow charts are thought to be essential then they should be drawn by someone who knows how to draw them, based on a sound empirical understanding of the relevant processes, not on speculative or normative presuppositions.

Flow-chart 2 (page 13) refers puzzlingly to a ‘relevant agency’ (a term which is unexplained) and the chart does not make clear how a decision is arrived at to pursue emergency action or not. Whoever constructed the flow-chart seems to have neglected the possibility that the emergency action can occur at any time during contact with a child and family, and may not be considered necessary until after a Section 47 enquiry is complete or almost complete. The flow-chart, however, portrays a Section 47 enquiry as dependent on an upstream decision concerning emergency action.

Flow-chart 3 (page 14) suggests that some assessment of whether a child is at risk of significant harm needs to take place in all cases referred, presumably even if there has been no suggestion at all that abuse or neglect is suspected. This is undesirable for reasons already discussed in answer to Question 5 above.

This flow chart also subsumes Section 47 enquiries under the heading of ‘assessment’ – when ‘enquiries’ is obviously the correct word. And, it is best to keep these two activities distinct so that the questions ‘Has this child been abused and neglected?’ and ‘Is this child in need?’ are addressed separately. This avoids the development of the undesirable mental model in which children are assumed not to be in need just because the allegation of abuse is not substantiated.

Flow Chart 4 (page 16) has at least one important box that has no successor activity, despite the fact that a successor activity is necessary (the sequence ends in a box simply marked “Yes”). Following on from the activity “Social worker leads assessment under section 47 of Children Act 1989 and other professionals contribute” there are three possible outcomes, when there should be at least four – i.e. there is no mention of a situation where the    concerns are not substantiated and the child is not in need.

In Flow Chart 5 (page 24) it is difficult to see if the activities immediately following the commencement of the process are alternatives, resulting from a decision, or parts of the process that occur in parallel. Although it may be obvious to most readers that “No further concerns about significant harm” means that there is no concern that the child is at continued risk of significant harm, the words need to be adjusted to avoid the (erroneous) interpretation that the Child Protection Plan can be discontinued if no additional concerns come to light!!

The text box entitled ‘Response to a Referral’ (page 8) begins with the sentence “When a person contacts local authority children’s social care with concerns about a child’s welfare, it is the local authority’s responsibility to determine the most appropriate response.” While this is literally true, the text box makes no mention of abuse and neglect and the very special responsibilities that any professional or other practitioner has if s/he suspects maltreatment. As it stands the guidance contained in this text box may encourage referrers to refer cases involving less urgent concerns as if they were child protection matters, a situation which could create a bottleneck at the point of initial referral. That would slow the whole process and consume additional resources. And it would have the effect of diminishing the speed and quality of response of the whole service.