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

Stage 2 - Making sense of the information

Case Information

The 10 year old girl ran away because her step-father hit her and put his hands around her neck. Although her behaviour can be challenging, she is a bright and able girl.

  • Step-father has left the family home
  • The Schedule 1 offender is father of the 10 year old and has convictions for sexual offences against two of his children from another family
  • Mother is depressed and was abused as a child
  • The social worker notes how 'frozen' some of the other children seem to be
  • The 5 year old has very limited speech - no other professionals seem to have picked this up before despite her attendance at a day nursery
  • The family is socially isolated
  • There are no routines around meal and bed times for the children
  • The family is white British, lapsed Church of England and does not have the need to access any specialist provision

Key questions

  • What are the mother's views about the situation?
  • What are the children's views?
  • What are the current views of school, other education services and the health visitor?
  • What interventions are likely to be appropriate?
  • How could the family’s personal support networks be enhanced?
  • What resources are available in the community locally?

Research focused questions

  • How serious would you rate the risks of impairment or harm if you did nothing?
  • What are the needs of the individuals within this family?
  • What protective factors can be identified?
  • What is the balance between needs, risks and protective factors?

There is a companion volume, The Mental Health Needs of Children Looked After, that looks, via some case scenarios, at some of the mental health issues that may arise for children looked after.

Relevant knowledge

The Brown & Harris study, Social Origins of Depression: A Study of Psychiatric Disorder in Women, despite its age, still offers a useful model for identifying key social factors in an individual's history which may lead to depression in later life. These include the experience of loss in childhood, the absence of a supportive relationship with a partner, the physical and emotional responsibility for several young children who are close in age and the lack of the stimulus and support gained through working outside the home. Given the pressures on the mother in this case from the men in her life and the absence of support from relatives, it would be surprising if she were not depressed. This mother may well need considerable investment in her own right to help meet the needs stemming from her own early years before she can increase her capacity to meet the needs of her children.

Finding the evidence: a gateway to the literature in child and mental health (second edition), edited by Angela Scott, Mike Shaw & Carol Joughin, Gaskell, 2001, ISBN 1901 242 684. This resource is published by the Royal College of Psychiatrists and can be downloaded from their website. Although its scope is far wider than this particular case, it offers material that is likely to be relevant and useful. Apart from the wide-ranging information about specific disorders, it provides guidance on searching for evidence to make the process more efficient and effective.

The Policy Research Bureau has undertaken a number of studies relating to parenting in recent years. Parenting in Poor Environments: Stress, Support and Coping is a large scale study of parenting against the odds. It looks at those families who are likely to be the most vulnerable, how formal support services could improve and how crucial it is to families that sources of external support, formal and informal, do not become sources of external control.

Among the other Policy Research Bureau studies available is one in summary form at the Joseph Rowntree Foundation website. This is How family centres are working with fathers . This describes how often family centres in reaching out to women and children are sometimes less than welcoming to many men. Taking Fathers Seriously is another recent work that argues for a more constructive approach to working with men.

Parenting matters: What works? has information about a number of parenting programmes. P.67 offers a list of potential benefits of parenting groups that would be relevant in this case. They can: help socially isolated families meet people and make friends; help build cohesiveness among group members; provide opportunities for individuals to share views and learn from others; encourage parents to listen and respond to the needs of others; provide appropriate role models; boost confidence and self esteem; and be cost effective compared with services focused on individuals. There is a basic distinction between relationship and behavioural parent education programmes. Overall, behavioural programmes produce the biggest changes in children's behaviour (P.73) and there are research abstracts about four such programmes P.74-80.

Children's Needs - Parenting Capacity: The Impact of Parental Illness, Problem Alcohol and Drug Use, and Domestic Violence on Children's Development is an especially useful resource because of the way it is structured around two of the domains in the DoH Assessment Framework. It looks at the implications of adult behaviour for children's development under the dimensions of health; education and cognitive ability; identity and social presentation; family and social relationships; emotional and behavioural development; and self-care skills at the different stages - for the unborn child; for children aged 0-2; then 3-4; 5-9; 10-14; and 15 and over. As with the Gilligan chapter quoted above, protective factors are identified alongside the risks.

As an example which relates to the younger children in this case here are some of the pertinent problems for the 3-4 year age group: children may have their physical needs neglected; their cognitive development may be delayed through lack of stimulation, disorganisation and failure to attend pre-school facilities; their attachment may be damaged by inconsistent parenting; they may learn inappropriate behavioural responses through witnessing domestic violence; they may take on responsibilities beyond their years because of parental unavailability; they may be at risk because they are unable to tell anyone about their distress. On the protective side is the potential of support to the family through primary health care, pre-school facilities and social services which might include day and respite care, accommodation and family assistance.

For the 10 year old in this case the potential problem list includes the following: children have to cope with puberty without support; they are at increased risk of psychological problems; they fear being hurt; their education may suffer because they find it difficult to concentrate; their school performance may not reflect their ability; friendships are restricted; they are cautious of exposing family life to outside scrutiny; they feel isolated and have no one to turn to. Protective factors include regular attendance at school; sympathetic and vigilant teachers; and having a trusted adult with whom the child is able to discuss sensitive issues.

The previous section mentioned the Prediction book. This is highly relevant for the analysis required for this making sense and the next deciding what to do stage.

Other relevant references

Jones D. & Ramchandani P. (1999) Child Sexual Abuse: Informing Practice from Research Radcliffe Medical Press

The National Study of Parents, Children and Discipline in Britain: Summary of Key Findings. This four page summary gives an empirical baseline for what are 'normal' methods of child discipline in Britain today. Unless practitioners have a reliable knowledge base in this area, their judgements are likely to be too dominated by personal experiences.

Young Runaways: an analysis of the SEU's Report. The SEU here is the Social Exclusion Unit and here is a brief review of its findings. Each year there are 129,000 incidents reported of children staying out overnight without parental agreement. 77,000 children and young people are estimated to run away for the first time each year.

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