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.
should underpin multidisciplinary work, illustrated in the recent second phase consultation paper, issued by the Department of Health (2003). Whilst it may be important to itemize these standards (though it has to be said that the risk of platitude is high), we are whistling in the wind if we believe that such measures will have a positive impact on practice unless we are prepared to examine the reasons for the difficulties in achieving improvement.
Reder and Duncan (2003) have recently pointed out: ‘A major concern is that precisely the same failures are occurring now as in the past… How can this be explained?’ (pp.83–84). The focus of their argument is upon the complexi-ties of communication. They assert that issues are ‘far more complex than has ever been envisaged by panels/case reviews and that their more practical rec-ommendations only address a small part of this complexity’ (p.84). Their article is valuable. It unpacks some of the factors involved in the process of communication.
The discussion here is not intended to diminish the importance of under-standing other aspects of interdisciplinary work, such as those explored in earlier work (Stevenson 1998b). Rather it seeks to raise awareness of the feelings and perceptions which are likely to be aroused in cases of serious neglect and the ways in which they impinge and affect the process of communi-cation. What may be behind the message? These are not only questions to be asked of the other party. They must form part of the dynamics of reflective interaction. ‘What is going on between us?’
Evidence from research (Glennie, Cruden and Thorn 1988; Tresider, Jones and Glennie 2003) supports the view that certain powerful feelings are commonly present in at least some of the professionals involved in serious cases of neglect (as well as others). These include: diffuse anxiety; confusion; hope-lessness, even despair; denial and over-optimism, linked to powerful identifica-tion with adults in the family. These feelings arise from the very nature of the cases. Quite often, for long periods of time, there is concern and anxiety about many different aspects of the family’s functioning but none so sharply focused and grave that the course of action which must be followed is clear. Characteris-tically, such families seem to exist in considerable confusion, bordering on the chaotic; frequent crises demand attention and divert workers from planned intervention. The very size of the files, and the knowledge that much previous work seems to have effected little change, can breed a sense of hopelessness, which is contagious. The sheer effort of ‘fire fighting’ may consume energy which might otherwise have been available for sustained consistent work.
When the situation is grave and there is recourse to the courts, it is not uncommon for goals to be set by which parental effort and capacity may be judged. (Parents with learning disabilities often feature in such cases.) The involvement of certain workers in such court requirements places on them a heavy responsibility, knowing that the future of the children may depend on the outcome. This may lead to a wholly understandable but risky identification
with the parent (usually the mother) and a reluctance to acknowledge that parental effort may, sadly, not be adequate to ensure the well-being of the children.
We owe it to the professionals to acknowledge that they are engaged in an extremely difficult area of work. Such emotions as are described above are natural reactions to highly stressful work, the more so when, as is usual, there is a strong commitment to bettering the lives of such families. These feelings cannot be avoided; nor is it ‘professional’ to ignore them. Rather, they have to be worked with. They will sometimes be at their most powerful when the issue of ‘thresholds’ is underlying interprofessional discussion. That is to say, when the functioning of the family and, in particular, the capacity of parents to offer
‘good enough care’ is becoming an urgent focus for debate.
There is a pressing need to provide forums for professionals to discuss the difficult issues underlying work with cases of serious neglect, so that differ-ences of perception may be aired and, if possible, consensus reached. Of partic-ular importance is shared understanding of the various dimensions of neglect and exploration of their effects on children’s development. This is the basis on which effective working relationships can be constructed; if this is sound there is less potential for misunderstanding and conflict.
However, even if groundwork is done on the core topic of neglect, there remains in the hurly burly of daily work, a constant stream of ‘messages’ which professionals must exchange; somehow, there has to be increased sensitivity to the ambiguity which some of these messages carry, especially when the ‘feeling context’ is high. As Reder and Duncan (2003) put it:
Communication involves information processing in order that it acquires meaning; it is a function of interpersonal reality; and it is a manifestation of interagency relating… Both parties need to be aware of these influences and must monitor them. (p.94)
When considering the feelings aroused by serious neglect, it is worth asking such questions as: ‘Why am I giving or receiving this message? Is it to offload anxiety? Is it to offload despair? Is it to cover myself? (If so, is this necessary and justifiable?) What do I, or they, expect to happen as a result?’
In short, there needs to be much greater sophistication about the process.
The roles of supervision, staff development and training are critical in this.
Neither organizational change nor technological improvements, important though they may be, will reduce the need for improved interpersonal aware-ness. This work is about professional people working together; agencies lie behind this. They affect but do not determine the process.
Questions for practice
It is hard to over-emphasize the importance of incorporating this dimension of professional people giving and receiving messages, into strategies for the improvement of working together. This is not simply a matter to be hived off to multi-agency trainers, although training has a critical part to play. It is obvious that these initiatives cannot be sensibly restricted to the issue of neglect.
However, different aspects of child abuse and child protection give rise to ticular areas of tension in interdisciplinary working. Neglect is one. These par-ticular tensions need to be identified so that the unpacking of ‘the messages’
relates more precisely to the nature of the case. It seems, therefore, that area child protection committees, or their successors, have a vital role to play in:
· Developing audit processes to include analysis of the quality of ‘the messages’ and an understanding of the distortions of the content which may arise and why.
· Influencing agencies to work towards a cultural change in which all levels of professional staff are aware of the need for, and difficulties in, achieving unambiguous communication. What are the best means of achieving this?
· Developing the content and delivery of single and multi-agency training programmes to ensure appropriate focus on issues concerning communication.
Conclusion
This chapter has selected three key issues for those who work with seriously neglectful families. They focus on particular aspects of assessment, of the orga-nization of work and of interdisciplinary work. There are many other strands in this complex area of work but from the current evidence on policy and practice, it seems that improvement in these areas is critical if progress is to be made.
Neglect
No Monopoly on Expertise
Helen Buckley
Multidisciplinary involvement in child neglect, in fact in all protection and welfare work, is a notion that has been long debated and promoted. As a desir-able way of working, it is cited regularly in reviews of child abuse cases and child protection systems and its absence is constantly identified as an underly-ing cause of poor outcomes and outputs. However, it is also a concept that is heavily laced with assumptions and implications and open to many different interpretations. Inevitably, any social assessment or intervention will be multidisciplinary in the sense that the different domains and dimensions of a person’s environment will be considered and will undoubtedly compel some level of communication with, or participation of, a variety of staff whose views or input will be sought. The defining element of multidisciplinary work is essentially the process that is operated, which can vary considerably from case to case and terms such as ‘pooling’ skills and perspectives can be so loose as to be meaningless. The term ‘multidisciplinary assessment’, for example, can be interpreted to mean one person carrying out an assessment in the course of which he or she will seek the views of other relevant professionals specializing in different areas. Alternatively, it could be understood as a one-person co-ordinated assessment, where different elements are carried out by a selected group of professionals within their own frameworks for practice but remain the responsibility of the co-ordinator who will draw conclusions from it. Or, it could mean a multidisciplinary group carrying out a joint assessment of one sit-uation using different pieces of an agreed approach and jointly deciding on outcomes and recommendations. The same rationalizing can be applied to interventions into child protection and welfare cases, where, essentially, the crucial questions are how aware each professional is of the involvement of other
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practitioners, how far the work of each individual dovetails with the inputs of others and ultimately, who has overall responsibility.