Thursday, 7 February 2013

Another vital child protection skill is communication

In Britain it is not so long since the phrase 'information sharing' was on the lips of every child protection professional. We were all told that children had died because information wasn't shared. So the solution, we were told, was for everyone to share everything, preferably through some form of database.

I am comforted by how rapidly this type of silly idea has met its demise. The notion that we can make vulnerable children safe by sitting at a keyboard has clearly had its day. As Munro and others have reminded us, effective child protection takes place in homes and schools and hospitals, interacting with children and their families: it doesn't happen in the office. And the real issue is not about the routine, semi-automated exchange of information. Rather it is about knowing when and how and what to communicate when a child is thought to be at risk.

So communication is a vital skill in child protection. And we know that in other safety critical industries poor communication results in accidents while good communication saves lives. Wrong side surgery is a case in point: 'right' and 'left' are little words that can easily be confused. In aviation confused communication has frequently been a key factor in fatal accidents, perhaps most tragically in the 1977 Tenerife air disaster in which more than 500 people lost their lives. Poor handover (communication between shifts) was a factor in both the Piper Alpha and BP Texas City disasters.

In the case of Victoria Climbie there were several instances of poor communication. A detailed fax from a hospital to Victoria's social worker was long, contained medical jargon and was difficult to read. The social worker, therefore, did not place the same interpretation on it as the paediatrician. Likewise confused or vague communications between local authorities meant that the full details of previous child protection concerns were never passed on.

In the case of Baby Peter a paediatrician was not made aware of child protection concerns before the child attended the clinic. And confused communication about the nature of the concerns seems to have resulted in mistaken legal advice, stating that the threshold for care proceedings had not been reached.

In the case of Khyra Ishaq school staff were unable to convey to social workers the extent of their concerns and, as a result, their referral was wrongly dismissed as not concerning a child at risk of significant harm.

In nearly every public enquiry or serious case review similar concerns seem to arise. It is not just that information is not passed on - indeed sometimes there seems to be an overload of 'information' - but rather that important communications are misunderstood, misinterpreted or dismissed. The rather obvious moral is that those involved in child protection need to be excellent communicators.

There is no short cut to being a good communicator and communication skills have to be constantly honed and refined. But there are some simple rules of good practice which will improve everybody's ability to communicate. An important one is to avoid unnecessary use of professional or organisational jargon. Another is to put yourself in the shoes of the receiver of the message in order to appreciate how it will sound to them and how it will be understood. Reducing unnecessary background 'noise' and making the priority of the message clear are also important.
Communication is usually two-way and it is often good practice for the receiver to repeat the main points of the message to confirm that these have been properly understood. Structuring important communications can result in reducing ambiguity and misunderstanding. For example, Leonard et al (2004) suggest using SBAR - Situation-Background-Assessment-Recommendations - to structure health care communications (e.g. by phone) [1].

Absolutely essential to good communication is being a good listener. Too often the receiver of a communication hears what s/he expects or hopes to hear, rather than what was said. The captain of the delayed KLM jumbo jet at Tenerife North airport in 1977 was pushed for time. Doubtless he hoped to hear from the tower that he had at last be given clearance for take-off, but that was not the case. He heard what he expected to hear, not what was said. This was clearly a factor in the worst ever civil aviation disaster [2].

People who are involved in child protection work should be good communicators and good listeners, because they have to communicate with, and listen to, children and families. But perhaps less attention than should have been, has been directed towards inter-professional communication. There is no reason at all why this should not become the focus more often of in-service and post-qualification training.

[1] Leonard, M. Graham, S. and Bonacum, D. (2004) "The human factor: the critical importance of team working and communication in providing safe care." Quality and Safety in Health Care, 13, pp. 85-90.

[2] Weick, K. (1991) "The vulnerable system: an analysis of the Tenerife air disaster." in Frost, P et al (eds.) Reframing Organisational Culture. Sage: London.