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  CASE STUDIES


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

Stage 3 - Deciding what to do

Case Information

  • The new social worker has recognised mother's commitment to her children and her desire to work to prevent the children entering care
  • The family’s personal support network is very limited
  • There are no local foster care placements that would enable the children to stay together or remain in close contact
  • The 10 year old has had a couple of temporary placements but has not settled
  • The local family centre cannot begin work with this family for several months
  • There are still high levels of concern about the men and the risks they pose for this family. One is a Schedule 1 offender and the other is under his influence.
  • The health visitor is sceptical as a result about the prospects for change

Key questions

  • What can be done to keep these children safe and to address their wider developmental needs?
  • What steps can be taken to reduce the risks posed by the father and former step-father?
  • What can be done to support the mother?
  • What resources are available?
  • What will she accept?
  • What contribution can other professionals make and what support from other agencies is available realistically?
  • What protection and resources can legal and policy frameworks provide?

Research focused questions

  • What are the needs and risks that merit top priority?
  • What outcomes are you seeking to achieve?
  • What range of interventions are likely to achieve those outcomes?
  • What evidence is available about: 1) the implications of doing nothing, 2) the likely effectiveness of any services you might offer.
  • What legal interventions can be used to support positive outcomes?

    These lead to more key questions
    • What objectives need to be set over what timescale?
    • Who is going to do the work?
    • What is it likely to cost?
    • What are the mother's and children's views about the plan?

Relevant knowledge

Reference has already been made to the DoH Framework for the Assessment of Children in Need and their Families. This has a useful chapter devoted to Analysis, Judgement and Decision-Making - p.53-62. Among the factors that need to be considered are: how existing good relationships and experiences can be nurtured and enhanced; what type of interventions are known to have the best outcomes for the particular circumstances of the child who has been assessed as in need; and what the child and family can cope with at each stage (p.57). These are important considerations in any complex case. Taking on too much at the same time may be unproductive. Equally, following a single track without an understanding of the whole picture may also lead to parallel disappointment.


One of the indicators for unsuccessful cases in the David Jones chapter, p.107, referred to in the 'Beginnings' section was parents who refuse or do not co-operate with professional help. In this particular case in previous years the men had successfully held professionals at arms' length, using threats, bluff and moving around to escape effective scrutiny. However, the men are now both out of the family home and the mother is actively seeking help. This is a time of opportunity to work with her provided there is firm action in relation to the men. Positive indicators are where children and families are able and willing to co-operate with helping agencies and where successful partnerships between professionals and family members have occurred. We do not know whether active collaboration will be forthcoming, but it is time to test what can be achieved despite the scepticism of the health visitor.


Working with Children, Adolescents and their Families. This is a highly useful book because of its successful and rare combination of clearly explained theory with many practical examples of relevance to child care practitioners.


Ronen's chapter on Cognitive-Behavioural Therapy summarises six rules which could be applied to either the mother here or to individual children. Each would require a separate programme so a key decision would necessarily be which should take priority and where you start. The six rules are: think behaviour (this is opposed to thinking about problems; the emphasis is on action rather than interpretation); think solution (this is opposed to getting bogged down in the history; it requires thinking about the future that you want to achieve); think positive (not easy amid so many obvious reasons for being depressed); think small steps (care plans are sometimes made meaningless by their failure to be specific and realistic when setting objectives); think flexible (do not fall in love with your plan or your method; be open to new learning and be willing to adapt); think future (the past is important but it can become a snare; focus on the changes that people want to make). Ronen then quotes a twelve step process which could be applied:

  1. Inventory of problem areas
  2. Problem selection and contract
  3. Commitment to co-operate
  4. Specification of target behaviours
  5. Baseline of target behaviour
  6. Identification of problem-controlling conditions
  7. Assessment of environmental resources
  8. Specification of behavioural objectives
  9. Formulation of a modification plan
  10. Implementation of modification plan
  11. Monitoring outcomes
  12. Maintenance of change

It is not suggested that cognitive-behavioural therapy is the only or even necessarily the most appropriate approach in this case but it is certainly worth consideration because it is being grounded in empirical research. A less ambitious programme might arise out of Marsh's description of Task-centred Work in the same volume. Here the progression is from identified problems and needs to goals negotiated with the family via a series of tasks. Tasks are, in effect, the stepping stones which enable the family and the worker to move towards their agreed objectives. Its strength as a method is its concreteness (tasks not just talk) and the fact that any plan of work is based on an explicit partnership. It is also highly amenable to evaluation. Objectives are clearly spelled out which helps make success or failure much more visible to everyone.


Other references

As for stage 2 but also:

Jackson S.& Thomas N. (1999) On the Move Again? What works in creating stability for looked after children? Barnardos

Macdonald G. & Winkley A. (1999) What Works in Child Protection?, Barnardos

Newman. T. (2002). Developing Evidence Based Practice in Social Care: locating, appraising and using research findings on effectiveness - Guidelines for practitioners.

If you are looking for something more weighty, there are two books that can be recommended:

What works for children? Effective services for children and families.

What works? Evidence-based policy and practice in public services. As the title implies the second book has more policy relevance while the first is more geared to practitioners.

     
       
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