of ‘drift’ is irrelevant. On the contrary, it is often tragically apparent that children have been left sinking (not swimming) whilst courts and professionals dither. But it is to suggest that if a well-considered decision is taken to leave certain children at home, it is highly likely that continuing support will be needed over a long period – sometimes the lifetime of the family cycle. Tanner and Turney (2003) have helpfully explored these matters. They point out that, in cases of chronic neglect, as distinct from ‘reactive’ neglect, the evidence (which they cite) clearly shows that long-term intensive support may be neces-sary. ‘In the absence of sustained, targeted work, a revolving door syndrome develops, in which families repeatedly return to agencies with the same unre-solved difficulties’ (p.31).
Tanner and Turney stress that such sustained work is to be based on ‘clear assessment, objectives re change, strategies for achieving change and way of evaluating whether change has taken place’ (p.32). They suggest that the conse-quences of such an emphasis will be a ‘rethinking of the concept of depend-ency’. They recognize that ‘current social work thinking has tended to regard dependency as a bad thing’ (p.32). The authors use the phrase ‘managed dependency’ to describe a relationship in which the worker ‘can offer the parent an alternative model of attachment and way of relating, and perhaps allow them to recognize previous damaging internal working models, which will, in turn, affect their parenting capacity’ (p.32).
In short, the authors propose a model for working in serious and chronic cases which is founded on the familiar theory (at present somewhat out of favour) of the inherent value of long-term relationships in such cases but in which they have tightened the prerequisites for such an approach. These are the careful assessment of a case as ‘chronic’, the use of ‘managed dependency’ as a key element in long-term work, and, finally, the need for a continuing focus on the children which has been discussed earlier in this chapter.
If the general thrust of this argument is accepted, what are the implications for the organization of work? Current arrangements do little to facilitate such an approach and at times positively hinder it. Behind practical arrangements may lie managerial disapproval of long-term dependency and of a perceived insatiable demand for services.
There has, therefore, to be a shift in thinking so that this ‘managed depend-ency’ is made more possible by the way social services staff are deployed in relation to such cases. This means affording opportunities for consistent and longer-term working with a relatively small group of families. There remains the question of whether such specialized work would be attractive to social workers. The strains and problems are well understood. Certainly job satisfac-tion from this type of work is partly a matter of temperament and professional inclination. But it is possible that some workers would be receptive to the idea of a steadier, more concentrated specialized focus over a longer period in working with such families.
The suggestion of the crucial importance of a key relationship with the family, which is acknowledged on both sides, does not imply that it should be exclusive. The key worker, in addition to working with other disciplines, is certain to utilize the services of others who can support the family in other ways. But crucial to the plan is that one social worker is recognized as having a special, if not unique, role in the life of a family, some at least of whose members are likely to be very needy.
Some compromise is inevitable; whatever families may need, the practi-calities of staff shortages and mobility and the intense demands of such work means that it is not often feasible to offer such families the security of very long-term relationships. However, a ‘neglect sub-team’ with a small group of social workers would offer a real opportunity for more consistent, focused and planned intervention than is usually the case. It would also offer a much sounder basis for interdisciplinary co-operation, which is discussed later.
There may seem to be a tension between such initiatives and the present emphasis, given strong impetus by the Lord Laming recommendations (2003), on a continuum of support for neglectful families. Services are not to be sharply distinguished at the point when the children are seen to be ‘in need of protec-tion’ rather than simply ‘in need’. This report is not alone in suggesting that the consequences of moving children on to child protection registers has been to unlock resources which would not otherwise be available and which might at an earlier stage have prevented deterioration. This is clearly perverse and it is essential that bureaucratic categories should not dominate practice. However, acknowledgement of the value of a seamless service to families where there are problems of neglect is not inconsistent with a decision to provide particularly intensive services over substantial periods of time at certain stages in a family’s life cycle. Certain families who had been extremely dependent, but who were improving, should and could remain on the case load of the sub-team for sig-nificant periods of time, whilst they are helped to utilize wider sources of support of different kinds.
An additional complication in realizing this proposal is that the services involved in supporting neglectful families are by no means themselves seamless. Recent years have seen a proliferation of services, located within different agencies, of which ‘Sure Start’, programmes designed to intervene at early stages of neglect, is the best known example. There are also long-standing arrangements with the large voluntary children’s organizations for intensive work to be undertaken with certain families. These involve partnerships with local authorities. Indeed, some may wish to argue that such work is best done in such settings. At the level of social policy, careful consideration needs to be given to the effects of such diversification. There would seem to be a real danger that the local authority social worker may be left in the unenviable position of having neither the satisfaction of early preventative work nor of focused specialized intervention. That would seem a recipe for disaster.
Questions for practice
The preceding section has addressed the organization of work within the context of social services. However, the ‘questions for practice’ which follow have implications for those health professionals, notably health visitors, whose contribution to these services is so vital.
If managers and practitioners accept the need for some alteration in the pattern of work, they will need to explore the best ways of achieving this within their own particular organizational context, which varies considerably across authorities and agencies. (Voluntary agencies and family centres are examples.) The geographical or agency location must be determined at local level. It is suggested that the following issues are explored:
· In a given locality, how many families would be judged to be in need of intensive long-term help at a particular time? (This may well lead to reassessment, which is in itself valuable at certain stages.)
· Are there workers who would be prepared to take on work with such families for a significant period of time? (Perhaps two years?) Would the following influence their decision?
· Initial agreement as to ‘manageable’ case loads and regular review:
this needs sophisticated discussion. It is not simply a matter of numbers but of ebb and flow and of the nature of intervention.
· The certainty of some reflective consultation/supervision outside the formal line management process: the aim of this is to encourage flexible modes of intervention and to help workers with the anxieties and despondency such cases generate.
· The certainty of easily accessed information/research on neglect in line with ‘evidence based practice’; such material can be used as part of the consultative arrangements.
· The possibility of instituting other forms of reflective learning: for example, planned peer group consultation between social workers or between disciplines.
Interdisciplinary work
Thus far, the argument has concentrated on the possibility of special work arrangements within social services. However, it can justifiably be argued that whatever is done to improve the position of social workers in undertaking such work is of little avail without improving the ways in which interdisciplinary co-operation can be facilitated. It is frequently asserted that physical proximity is the best aid to effective co-operation.
The Green Paper (Chief Secretary to the Treasury 2003) has made impor-tant proposals for the creation of a wide range of multidisciplinary teams across the whole field of ‘safeguarding services’ (p.60). It suggests ‘co-location’ ‘in and around the places where children spend much of their time, such as schools, Sure Start Children’s Centres and primary care centres’ (p.62). None of these is currently part of social services provision. The debate and controversy which the implications of such proposals, rather than the essential idea, are likely to raise may push into the background the specific needs of seriously neglected children and their families. The key factor in providing better service lies in the model of consistency and in medium to long-term intervention.
It is possible to envisage social workers and health visitors as full-time members of such a team, the latter being seconded for an agreed period. Other professionals, such as community paediatricians and special needs teachers, might be involved on a sessional basis. This would provide structured opportu-nities for planning of intervention, for review of progress and for sharing of anxieties. Such a grouping would be particularly valuable in ensuring that the focus is kept on the well-being of individual children. It should point to the need for the involvement of other disciplines whose contribution is less exten-sive, but very important for certain individuals at certain points in time. In fact, one might see such working groups at the core of interdisciplinary activities, drawing in as necessary a range of others.
Questions for practice
The suggestions above are relatively modest once the principle of dedicated workers (such as social workers and health visitors) is agreed, with sessional input from others. Some of this work already occurs but it would give formal acknowledgement to the importance of tackling neglect in a systematic way which recognizes the interdependence of the disciplines for effective work.
Area child protection committees (or their successors in England to be styled ‘Local Children’s Safeguarding Boards’) can initiate discussion with agencies concerning innovatory projects designed to improve the quality of interdisciplinary work with seriously neglectful families. The essential elements of such innovations is to provide opportunities for more co-ordinated, concentrated and long-term work. This can be done in the context of the work suggested in the ‘questions for practice’ sections in the first two parts of this chapter.