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  CASE STUDIES


 
Introduction Beginnings Making sense of the information Deciding what to do Reviewing the plan
 
     
     

Stage 1 - Beginnings

Case Information

  • 10 year old girl runs away from home. She is unhappy at home and wants to go and live with her father
  • There have been longstanding concerns about the family expressed by school and health visitor
  • There are five children at home aged 2 - 12, one boy of 3, the rest are girls
  • There are particular worries about two men - the step-father who has recently left the family home and the father of the 10 year old, who is a Schedule 1 offender
  • Previous social work contact with the family has been difficult and unproductive because of opposition from the men
  • The previous social worker is on sick leave.

Key questions

  • What is currently known about this family from the SSD and other agency records?
  • What is unknown and what are the areas of information where we need to know more?
  • Are there any considerations in relation the family’s ethnicity, religion, cultural issues or any other special needs (e.g. does anyone in the family have a disability or illness that might impact on the assessment and intervention stages?)
  • What is the mother's view of the situation?
  • What are the children's views?
  • Where is the 10 year old now?
  • Who is in a position to provide the information we lack?
  • What contact are the men currently having with the children?
  • Are any members of the extended family subject to any current or recent court orders?
  • What personal support networks does the family, in particular the mother, have?

Research focused questions

The questions that follow in bold are an attempt to help social workers use one approach to evidence-based practice that has four linked concepts: Need; Threshold; Outcome; Service. The process begins with questions about needs. What are the needs that this family and these children present? Risks and protective factors are seen within the same context and have to be balanced against each other. The next concept is about thresholds, which means making a judgement about levels of seriousness of concern. How serious is the risk of significant harm without intervention?

The third linked concept is outcome. Given the assessed needs and thresholds, what outcomes are we seeking to achieve? What are our objectives? What is our timescale? The service response is then about trying to put together a mix of services (in complex cases you cannot rely on one service or one agency input to do the trick) which will achieve the outcomes that have been agreed. All of this will, of course, be recorded in your local care planning form but the need, threshold, outcome and service framework helps you see the connections between the different parts.

  • What are the needs of the individuals within this family?
  • How serious are the risks of significant harm?
  • What protective factors can be identified?
  • What is the balance between needs, risks and protective factors?

Need, threshold, outcome and service are the key concepts in what Michael Little of Dartington Social Research Unit calls the Common Language project which is designed as a means of helping child care workers in different disciplines and across different cultures communicate more effectively with each other. His Prediction: perspectives on diagnosis, prognosis and interventions for children in need (Warren House Press. 2002) offers a short text on how practitioners can become more analytical and make more effective use of the case information that they routinely gather. He looks in particular at the inter-relationship of risk and protective factors.

Relevant knowledge

Framework for the Assessment of Children in Need and their Families Department of Health (1999)
The Introduction to the case study referred to the conceptual framework that the DoH has produced to help practitioners assess and plan more effectively. The domains (Child's Developmental Needs, Parenting Capacity & Family Environmental Factors) indicate the scope of a holistic assessment and the dimensions are described on pages 19, 21 & 23. These offer triggers to help you identify the key elements in relation to the individual children, the crucial factors about the parental context as well as wider issues about the availability of support or lack of it in the family environment. In addition, there is an attempt on pages 39 & 40 to provide an explanation for parents about what an assessment is - something that workers may be in danger of taking for granted. Jenny Gray, one of the key officers at the SSI, has written a useful summary article of the assessment framework in Child Psychology and Psychiatry. You may also need to refer to the specialist section on working with Black families or those with children with disabilities.


The Child’s World: Assessing Children in Need was produced as a companion volume to the Department of Health’s Assessment Framework. The following chapters are of particular relevance: 3, Ecological perspectives in assessing children and families by Gordon Jack; 4, The core assessment: how to synthesise information and make judgements by Margaret Adcock; 7, Entering the child’s world: communicating with children to assess their needs by Anne Bannister; 11, Promoting positive outcomes for children in need: the assessment of protective factors by Robbie Gilligan; and 16, David Jones' chapter 'The effectiveness of intervention'.

Gilligan has written a further work on resilience: Promoting Resilience: A resource guide on working with children in the care system which has wider relevance than for children looked after.


You will need to know how to access information related to legal frameworks, for example the Children Act 1989.

It may also help you to be familiar with what being a Schedule 1 offender means for the assessment and the family. See the Sex Offenders Act 1997.

You may need to refer to these throughout all the stages of the process.


Ann Hagel's short 1998 research review, Dangerous care: Reviewing the risks to children from their carers, highlights some of the characteristics of abuse that lead to serious harm. She cautions that this is a complex area that it is impossible to summarise adequately but identifies three key factors. The first is what she calls abuse that damages attachments, where abuse comes from a parent or primary care giver with all the implications for the betrayal of trust. The second she describes as acute versus chronic abuse with the focus on abuse that persists over time. The third factor is severity of abuse. She quotes material that was reported in the well-known Blue Book, Child Protection: Messages from Research.

'…in a generally warm and supportive environment, children who had been hit once or twice seldom suffer long-term negative effects. It is equally clear that even a short period of neglect, whether physical or emotional, could cause children harm. However, in families that were low in warmth and high in criticism the consequences of the same maltreatment accumulated in a way that they do not in more benign family contexts. Moreover, these low warmth/high criticism environments are not only potentially damaging to children's general development, but are also contexts in which the risk of physical maltreatment, sexual abuse and neglect is high.'

Even when children are removed from such environments and placed in good quality substitute family placements, there is no guarantee that the damage can be undone.

Promoting Children's Emotional Well-being, Ann Buchanan & Barbara Hudson, Oxford University Press (2000) (ISBN 0 19 263174 8). Child Abuse Inquiries like Climbie typically concentrate on cases that have gone tragically wrong and on key turning points that, with different case management, might have led to different outcomes. Buchanan and Hudson's work offers a valuable review of a range of studies that focus on children's emotional well-being rather than their physical safety. This includes among its chapters one by Katz on young people's views of being parented and what matters to them. Another by Wells demonstrates the important contribution of school-based interventions towards the mental health of young people.

A very useful text for social workers that relates child development issues to their specific issues in child care and child protection is by Brigid Daniel, Robbie Gilligan and Sally Wassel, Child Development for Child Care and Protection Workers London, Jessica Kingsley (1999). Its use of concepts of developmental pathways, risks, resilience, adverse and protective environments and the impact of social circumstances is helpfully illustrated through practice case studies.

Another useful recent research resource is Dorota Iwaniec and Dominic McSherry's Understanding Child Neglect: Contemporary Issues and Dilemmas, 2002, available from the Institute of Child Care Research at Queen's University, Belfast. They argue in this paper that neglect is the poor relation of the child protection world, too often overshadowed by physical and sexual abuse. Of course, we need to learn to respond effectively to child abuse of any kind but these last two works point to forms of child suffering that, because they are not so readily described in terms of dramatic incidents, rarely grab the headlines.


Another recent practice tool that helps you assess the varying weights of different risk factors is contained in a chapter by David Jones called The effectiveness of intervention. This pages 107-113, provides indicators to identify those cases with better or worse prospects of success. Indicators for less successful intervention include:

  • Continual parental denial of abuse or impairment;
  • Parents who refuse or who do not co-operate with professional help;
  • Severe parental personality problems;
  • Parental learning disabilities with accompanying mental illness;
  • Persistent parental substance misuse;
  • Parental psychosis with delusions involving the child;
  • Severe child neglect or psychological abuse;
  • Severe sexual abuse (involving penetration and of long duration);
  • Sadistic, premeditated abuse.

Provided that the men can be kept under control out of the family household, none of the above indicators is present in our case example, but the situation could quickly change if one of the men returned or another 'dangerous' adult joined the family.

It is important not to use these tools simplistically i.e. they provide solid research information to inform practice decision-making but they are not a substitute for thinking critically how an individual case fits or does not fit what is known from previous studies. Applying research to practice always requires making links between what is known generally - research knowledge comprises, typically, generalisations about groups - and the unique individuals with whom practitioners are working.

 

     
       
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