Messages from research
· The assessment framework emphasizes that standardized practice is most likely to occur if the use of professional judgement is informed by an evidence-based approach to care.
· Social workers display a diverse range of individual assumptions of parenting and the needs of the children that are likely to influence attitudes towards neglect.
· Personal judgement and double standards operated among the social work professionals in this study.
· In the Irish study there were regional variations regarding defining neglect which in turn influenced the assessment process.
· There were differences between what workers believed they did and what happened in actual practice.
· There was a lack of meaningful communication with children about their lives.
· The focus for assessment and intervention tended to be on the mother.
· Social workers differed in their understanding of ‘good enough parenting’.
· If practitioners are to be more open-minded when assessing cases of child neglect they need an aide memoire.
Lessons learnt and the implications for social work
between what practitioners believe they should be doing when working together with children and families and what actually occurs. Members of the focus groups had a number of ideas about developing practice in light of these findings, which have been developed by the author and are outlined below.
From Rumpole of the Bailey to Sherlock Holmes: assessing the needs of children and families
If practitioners are to be more open-minded when assessing cases of child neglect then they need an aide memoire (Macdonald 2001) or prompts remind-ing them what they should be considerremind-ing when assessremind-ing cases of children in need. Assessment frameworks such as the Framework for the Assessment of Children in Need and their Families (Department of Health 2000) can be seen to provide an aide memoire. However, the Irish respondents who attended the focus group believed that they would work more effectively with children and families if they had a detailed assessment framework that gave them specific prompts to remind them what to consider when assessing cases of child neglect. Using data obtained from the study the author developed an assessment framework, which has been successfully piloted amongst social work personnel; this framework is shown in Table 5.3. Members of the focus groups believed the following prin-ciples should underpin the framework:
· Assessments and interventions should be child focused.
· Effective management of child neglect requires an ecological approach.
· Child neglect impacts on the developmental needs of the child.
· Working with both children and families is crucial to assessing and addressing issues of neglect.
· Effective assessment and intervention in cases of child neglect requires an ongoing multidisciplinary approach recognizing the contribution of professionals working with carers’ issues.
· Professional knowledge, values and skills should inform assessment, planning, intervention and evaluation of neglect cases.
The framework builds on the definition of child neglect used by the Depart-ment of Health and Children (Ireland) (1999) in Children First: National Guide-lines for the Protection and Welfare of Children. Child neglect is:
an omission, where the child suffers significant harm or impairment of develop-ment by being deprived of food, clothing, warmth, hygiene, intellectual stim-ulation, supervision and safety, attachment to and affection from adults, medical care. (p.31)
Continued on next page
Table 5.3 Horwath framework for assessing child neglect
Area of
Concern The child The parent/carer The outside world
Intellectual
stimulation Consider:
Level of
school/playschool attendance
Freedom to play with toysTime for play Interaction with adults and other children
Type of activities undertaken, for example, watch TV all day
Particular educational needs of child
Consider:
Importance attached to educational activities and social opportunities Provision of toys and books and
opportunities to use them
Interaction and stimulation from carer Ability to listen and communicate with child
Encouragement for intellectual development Recognition and ability to meet special needs
Consider:
Engagement in learning at school/
pre-school Access to activities outside home Relationships with peers
Opportunities for extra-curricular school and social activities Provision of service to meet special needs Basic care –
food, clothing, warmth and hygiene
Appearance and quality of clothing, seasonal, fit and level of cleanliness and repair
Physical presentation including level of cleanliness, condition of hair, body odour, skin infections, dental and optical care Child’s development using centile charts
Provision of clean fitting clothes appropriate for season Ability to recognize when child needs help with basic care, for example dressing Encouragement to or commitment to wash/bath child regularly
Attitude to changing nappies regularly Treatment of infections
Attendance at clinics, dentists, opticians etc.
Attitude of school and peers to the
appearance of the child
Condition of home, for example, human/animal excrement, soiled bathrroom, broken toilet, old/decaying food on floor, evidence of infestation Child’s development and ability to meet basic care needs in relation to peers
Table 5.3 continued Area of
concern The child The parent/ carer The outside world
Basic care – food, clothing, warmth and hygiene (cont.)
Child’s attitude to food
Whether child is warm/cool as appropriate
Attitude and ability to provide regular and balanced meals Ability to keep child warm/cool according to season
Provision of food for school
Attitude to food outside the home Warmth of house, fo example, damp, source of heating, broken windows, bedding, financial ability to provide heating Medical care Child immunized if
appropriate Receiving necessary medical checks
Child receiving any medical care as considered necessary by health professionals
Parents’ attitude to immunization Response to medical, dental and optical appointments, use of medication, treatments and therapies Commitment to meeting child’s specific medical requirements
Ability to keep appointments through lack of transport, finance, child care commitments
Supervision
and safety Child given
appropriate amount of freedom dependent on age and ability, for example, left at home alone, playing in streets unsupervised, time of day when out playing
Child’s physical safety in the home
Child protected from inappropriate behaviours, for example, domestic violence
Carer’s ability to meet the child’a needs for dependence/
independence and establish appropriate boundaries Carer’s level of awareness of child’s whereabouts Ability to recognize and provide protection against hazards in the home
Ability Ability and commitment of parents to demonstrate and model appropriate behaviours
Norm in the area for playing out, being left unattended etc.
Home environment, for example dangerous electric sockets, broken windows, no fireguard, hazards in garden, medication and alcohol kept out of reach of children Support network for child outside home in situations of domestic violence etc.
Continued on next page
This framework can be used alongside the Department of Health framework (2000) as the prompts link into the three domains that are central to the English and Welsh framework: child’s developmental needs, parenting capacity and family and environmental factors.
The framework should encourage practitioners to act as detectives rather than barristers when assessing child neglect as the prompts remind workers of the variety of direct and indirect causes and consequences of neglect on a child.
Area of
concern The child The parent/carer The outside world
Supervision and safety (cont.)
Child able to demonstrate
appropriate behaviours according to age and ability, for example, anger management
Ability to protect children from harm and danger Recognition and commitment to protecting child from unsafe adults/
children including siblings
Attachment andaffection
Child’s feelings about themselves, for example, self-esteem, self-worth
Sense of own identity taking into account culture and disability Attitude to
parents/carers and significant others Response to others
Sense of belonging to family and other relevant groups Feelings of security
Attitude of parents to child
Value placed on the child
Parents' ability to consistently demonstrate warmth, love and affection verbally, cognitively and physically Parents' emotional availability
Appropriate physical contact, ability to make child feel important member of the family
Ability to feed back on negative behaviour in a manner that encourages growth Ability to praise and reward
Child's positive relationships outside homeAttitude of teachers to the child
Attitude of significant others to child's identity
Significant people in the child's life
Identity in
out-of-home settings
Activities that increase child's sense of self-worth Table 5.3 continued
The effective use of the framework will be determined by managers using the framework with team members to create a culture that encourages practitioners to act as detectives rather than barristers.
The study highlighted that different perceptions of child neglect were influ-enced not only by the gathering of information but also by the assessment process and planning interventions. Munro (2002) notes that assessment is not only about being more open-minded when gathering information, it is also about explicit and clearer use of reasoning processes. As she notes this increases the empowerment of children and parents as issues can be explained to them and their role in the assessment process becomes clear. The assessment process has several phases, which overlap and lead into planning, interventions and evaluation of those interventions (Adcock 2001). The prompts shown in Box 5.2 are designed to assist practitioners together with team managers to work their way through this process. Moreover, the questions act as reminders to practitioners of the importance of working in partnership with children and families in order both to gain information and to make sense of that informa-tion. The section on making judgements offers practitioners prompts to enable them to draw conclusions about the parents’ or carers’ ability to be the good enough parents that provide the ‘facilitating environment’ a child requires as described by Winnicott (1964).
Box 5.2 Prompts to use when carrying out assessments
(Adapted from unpublished work undertaken by Buckley, Horwath and Whelan).
Who should I contact when gathering information?
· Using the appropriate prompts included in the assessment framework what are the views of the child regarding their situation?
· What are the views of each significant carer?
· Are family members in agreement with information being obtained from professionals?
· Which professionals should be included in the assessment?
· Are there any blocks and barriers that are influencing information-gathering?
What does this information mean?
Consider current and pre-existing factors that could jeopardize the child’s well-being including:
· vulnerability of child to abuse or neglect (current, further and/or future)
· needs of the child not being met.
Consider new and ongoing strengths of child and family that could promote the child’s well-being including:
· protective factors provided by adults
· child’s resilience and ability to protect themselves.
How can I use this information to make a judgement?
· What are the pre-existing and current factors that indicate that the welfare of the child is not being promoted and/or that they are likely to suffer significant harm?
· What are the pre-existing and current strengths that protect the child and promote their welfare?
· What is there about the current situation that increases or decreases risk of significant harm and meeting the developmental needs of the child?
· How does the current situation fit with past patterns of carer’s behaviour?
· What are the child’s views? What do they want to change?
· What insight does the carer/s have in relation to the treatment of the child?
· What are the indicators that carers have both the capacity and motivation to make changes required to promote the welfare of the child?
Reaching a decision
Consider whether:
· the needs of the child are being met
· the needs of the child are being met currently but the child is in a vulnerable position and there is potential that needs will not be met
Effective use of the team and team manager
One of the most striking findings from this study has been the importance of the team in terms of setting the standards for thresholds, content and process of assessment and interventions. Based on the findings of this study insufficient data has been obtained to establish the extent to which it is the team manager, team members or a combination of both that influences the team approach towards working with cases of child neglect. Irrespective of who has the most influence in the Irish study there are lessons that can be learnt by drawing on theory related to group process. Brown (1996) analysed the social influences that operate within groups. He found that individuals tend to conform to the attitudes and behaviours of the majority. This can occur to the degree that indi-viduals are willing to deny the evidence of their own senses to conform to the group perspective. Brown identified three reasons why this occurs:
· the need to depend on others for information about the world and to test the validity of our own opinions
· pressure from within and outside team to achieve group goals
· the need for approval arising out of not wishing to seem different.
This has a number of implications for social work teams. First, practitioners may adjust their own standards to meet those of the team. This could be either advantageous or disadvantageous depending on the individual standards and those of the team. Second, Daley (1999) in a study of decision-making amongst newly qualified nurses found that there was a reluctance to learn from experience. Instead the nurses tended to focus on using memory, accumulating
· the needs of the child are unlikely to be met without the provision of services
· the needs of the child are not being met and their health and development are being impaired.
What services are required?
What interventions are needed to:
· protect the child from immediate harm?
· meet the needs of the child?
· effect change amongst carers in order to protect and promote the welfare of the child?
information and waiting for others to tell them what to learn. This could apply equally to newly qualified social workers who would look to the team members and manager for guidance as to what is important in cases of child neglect.
Third, in a performance-driven culture, which is dominant in the statutory social services, group goals are becoming explicit. These goals in England are linked to targets used to determine quality and funding. A culture can develop in teams where the priority is meeting the targets irrespective of their impact on outcomes for children and families. Finally, front-line social work teams are working under intense pressure (Jones 2001a). In these circumstances the implicit team goal may be survival: the price paid is to be a barrister rather than a detective because of the consequences on workload of taking an open approach towards cases of child neglect.
Brown (1996) makes reference to the work of Janis (1972) who explored the notion of ‘groupthink’ or group standards. He believes groups that are most vulnerable to groupthink are those which are very cohesive; are insulated from information outside the group; rarely search systematically through alternative options; are often under stress and are dominated by a directive group leader. If teams are to avoid distorting assessments of child neglect then antidotes to groupthink are required. These can include:
· using professional advisors outside the team
· ensuring the team devotes time to keeping abreast of practice developments
· holding regular meetings between team managers to compare and contrast team approaches
· managers taking a more facilitative approach towards team decision-making.
Messages for practice
As can be seen, social work practice in cases of child neglect is influenced by a number of factors. If practice is to be developed in ways which promote better outcomes for children and families then work needs to be done with teams, and by team managers and practitioners. The following questions are designed to assist teams of social work professionals, team managers and practitioners in this task.
The team
As a team, select a number of cases of child neglect and audit the cases with the following questions in mind. Alternatively devise a number of case scenarios
for team members to consider individually in terms of ways they would assess and intervene in each case:
· Do we as a team tend to focus on the incident of neglect, safety issues or the developmental needs of the child?
· Do we always make a point of engaging the children and all key carers in the assessment process?
· How do we make judgements in this team? For example, through team discussion with colleagues or through discussion with manager
‘on the hoof’ through regular case supervision?
· What organizational pressures influence our approach towards our work? How do they influence our work?
· How can we address issues of groupthink?
Team manager
As a group of managers, audit a number of cases of child neglect from each team. Alternatively devise case scenarios for team managers to consider indi-vidually in terms of ways their teams would assess and intervene in each case:
· What are the differences between the teams?
· What accounts for these differences? Consider organizational, professional and personal factors.
· How can we develop a standardized approach towards child neglect?
· How can we obtain professional support to encourage an objective approach towards assessment and intervention in cases of child neglect?
The practitioner
· What are my personal values and beliefs about child neglect?
· What are my expectations of parents’ ability to meet the needs of their children?
· Under what circumstances do I tend to reduce/raise my standards?
For example, poverty, young lone mother, aggressive carers.
· What systems can I put in place to ensure I keep an open mind when assessing cases of child neglect?