Transcript Risk - Child Centred Practice
A one day workshop by Child Centred Practice
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The assessment of needs?
Judgement about eligibility?
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A calculation of the match between need and available resources?
Evaluation of risk and urgency?
In fact social workers undertake assessments for a range of purposes and there is no consensus on what those purposes are (Crisp et al, 2003)
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Assessment is not only multi-faceted but multi layered in ways that are not always visible in the assessment encounters of individuals. Individual assessments may be made on the basis of ‘professional judgement’ or a set of independent ,agency criteria, but both are carriers of judgement and priorities formulated outside the assessment situation. ( pg 22, Assessment in social work: A guide for learning and teaching, Whittington. C, scie,2007) 3
Developing a sound approach Hertfordshire County Council Changing the Culture 4
people's beliefs 'are remarkably resilient in the face of empirical challenges that seem logically devastating' (Kahneman, 1990, p.144). Hertfordshire County Council Changing the Culture 5
Consideration of all possible known alternatives Use of a maximum amount of information Careful weighing of all information and avoiding intuitive conclusions A maximum degree of sound reasoning 6
In reality we all use SHORTCUTS: Based on similarity to pass knowledge Information Experience Beliefs Help to minimise cognitive effort needed to thoroughly assess a case 7
The Halo Bias – case work attributing too much to general impressions of person, situation, report The negative information bias – tendency to weigh negative information more heavily than positive when making decisions The stereotype bias – stereotypes a way of organising information – does not tell the whole story.
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The confirmation bias – seek information that supports one’s decisions or beliefs whilst ignoring evidence that challenges the conclusion.
The supporting evidence bias – the tendency to be more engaged by what we like than what we do not like. We subconsciously decide what we want or expect the outcomes to be before we understand why we want it.
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Intuitive How people reason Establishing rapport Using empathy and experience Imagination Unconscious appraisal of competence.
Analytical Formal logic Probability theory Decision theory Formal instruments Empirical research Measure specific dimensions Statistics of equations Taken from Dalzell and Sawyer,
Putting Analysis into Assessment
, NCB, 2007.
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Strengths
Fundamental Swift Interpersonal Draws on knowledge and research Tacit – even if can ’ t be articulated, still valuable Survived over time Weakness Implicit – defective as knowledge not shared Not necessarily reliable Limited to a range of own experience and bias Blind spots – evidence to confirm assumptions.
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Strengths
Knowledge base from empirical research Summaries and critics readily available All aspects of subject has been studied Need to justify actions – public accountability Weaknesses Findings tentative – casual link at times only weak Can ’ t just read findings – need to understand context, use judgement Difficult to export to different populations Definitions of abuse change over time Cannot have random controls Hertfordshire County Council Changing the Culture 12
Actuarial tools
Do demonstrate a higher level of accuracy and consistency than professional judgements Provide an opportunity for consistency across agency and workers Help in developing clear standards Are not infallible 13
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30% 40% 15% 15%
Therapeutic Technique Client Hopefulness Client Characteristics & Social Support Relationship between client and therapist Kieran McKeowan A guide to what works in family support services for vulnerable families (Dublin, 2000) Hertfordshire County Council Changing the Culture 15
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Critical period in lives of all young people for young people who are looked after – – particularly dealing with uncertainties about the future & traumas or their past.
How young people deal with all the changes adolescence brings will be influenced by what has happened before - experiences in infancy & childhood - quality of attachments - their ways of resolving problems.
- Their connections to the wider community.
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Physical changes – earlier than boys) puberty (physically girls Development of sexual identity (can be exciting, confusing, overwhelming) Cultural & family expectations need to be resolved.
If previous sexual abuse needs to be dealt with.
– often arises and Hertfordshire County Council Changing the Culture 18
Preparation for financial independence – responsibility for this.
Increased domestic responsibility tension in the home.
– taking more often a source of Separation from family of origin stages for various reasons L.A.C – – can happen at various no choice usually when younger, will affect things when adolescent.
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Development of moral code. Draw on and are powerfully influenced by beliefs & behaviours of their family & communities.
Often go through periods of questioning, trying out different ideas.
Negotiating peer relationships – esteem/poor social skills) – can be a difficult task major challenge (esp if child has poor self Hertfordshire County Council Changing the Culture 20
Peer group pressures – be very powerful.
can Finding & sustaining intimate relationships outside the family of origin – adolescence- growing up leaving behind childhood dependency autonomy.
– balancing needs for closeness & Hertfordshire County Council Changing the Culture 21
Often thought of as a period of turmoil & uncertainty but can be exciting & challenging.
Can be a period where the prevalence of problems & disorders rises – e.g: rates of depression.
What is ‘ normal mental disorder.
’ adolescence? – difficult at times to distinguish between ordinary transitional development & Hertfordshire County Council Changing the Culture 22
‘ Normal ’ – powerfully influenced by our values & beliefs.
Children who are looked after also have the beliefs & opinions of carers, social workers & other professionals plus policies of agencies involved in aspects of their lives.
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A self harming young person who seems out of control can be very distressing for the professionals surrounding them. This is not the time to opt out.
Sometimes we work with young people one hour at a time and hope.
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Playing a bad hand well, rather than getting a good hand Hertfordshire County Council Changing the Culture 26
Sufficient income support and good physical standards in the home.
Practical and domestic help.
Regular medical and dental checks including school medicals.
Factual information about puberty, sex and contraception.
Regular attendance at school.
Sympathetic, empathic and vigilant teachers.
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Belonging to organised, out of school activities, including homework clubs.
A mentor or trusted adult with whom the child is able to discuss sensitive issues.
An adult who assumes the role of champion and is committed to the child and
'acts vigorously, persistently and painstakingly on their behalf'
(Department of Health 1996, p.24).
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-clubs and hobbies -summer camps -belonging to something good (families, peer groups etc.) - -doing good, volunteering etc.
being paid holistic interventions that don’t just tackle ‘the issues’ or ‘one issue’ having mentors who stick with disadvantaged kids over time (challenge to ‘projects’ and specialisation) Using the mass media (celebs) exploiting the full potential of the internet, mobile phones and other new technologies (Youth matters) Hertfordshire County Council Changing the Culture 29
To achieve their maximum potential kids will be protected by having all the things we know they need: good education love and sense of belonging decent standard of living great parenting intelligence good looks opportunities to contribute Hertfordshire County Council Changing the Culture 30
Some kids do better than others having had very similar experiences – we can be the factor that makes a massive difference Complexity theory: small changes, big effects; and we can’t always see the protective effects immediately –daring to do things differently, being open minded, confident There is hope for everybody! Resilience theory helps us to work relentlessly towards better outcomes– helps us keep enthusiastic and focused Resilience theory gives us a framework within which to plan positive chain reactions with and for individual children (and for yourselves), and to reduce negative ones For young people doing risky things it is still really helpful to get some protective processes going Hertfordshire County Council Changing the Culture 31
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An adolescent needs adults who care for them to support them & contain them.
Challenging, worrying or extreme behaviour makes us feel anxious which can stop us thinking clearly about how to deal with the situation.
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Risk can be defined as ‘the possibility of beneficial and harmful outcomes, and the likelihood of their occurrence in a stated timescale’
(Alberg et al, in Titterton, 2005)
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Risk assessments can have a number of different purposes.
Frameworks for assessment of children, young people and families address service user vulnerability and avoidance of significant harm.
Most models of risk assessment recognise that it is not possible to eliminate risk, despite the pressure on public authorities to adopt defensive risk management (Power, 2004) Hertfordshire County Council Changing the Culture 36
Focus on the negative distorts reality and can lead to a skewed picture.
There is a duty to maximise well being as well as minimise risk Identifying and quantifying risk is a small part of the social work task.
The larger part of the task concentrates on managing the risk and developing strategies to intervene to reduce those risks.
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The concept of risk asks the social worker to predict with a degree of accuracy the likelihood of something negative occurring to a child in the future.
Without the use of actuarial tools social workers can be reduced to a kind of ‘fortune telling’ approach which relies on a combination of practice wisdom and past behaviour of the parents to predict future home. Hertfordshire County Council Changing the Culture 38
A risk factor for abuse is a feature found more commonly in abusive families than in the general population.
It is not about how often it occurs but how much more often it occurs when you compare it to the frequency within the non abusing population.
It is rare in child abuse to get an absolute indicator who does not have this illness has the gene).
– you see them much more often in medicine (for example the presence of this gene is a predictor of this disease. No-one Hertfordshire County Council Changing the Culture 39
Data taken from Brandon et al, Analysing Child deaths and serious injury through abuse and neglect: what can we learn? 2003-2005 A history of rejection and loss (often including the death of a parent) and usually severe maltreatment (physical, sexual, and neglect often in combination) over long periods of time A history of long term intensive involvement from multiple agencies e.g. from children’s social care CAMHS and YOT Hertfordshire County Council Changing the Culture 40
Parents or carers with their own history of abuse and rejection, most of whom misused substances and had mental health difficulties It was difficult to contain these young people in school. Challenging and threatening behaviours to staff and fellow students resulted in temporary or permanent exclusions from school By adolescence, if not earlier, these young people were typically harming themselves and mis-using substances Hertfordshire County Council Changing the Culture 41
A pattern of self-neglect could accompany the self harm and this might include an ability to manage chronic illness or other serious health problems and a habit of presenting to accident and emergency for emergency treatment or to seek nurture Numerous placement breakdowns Running away and going missing Increased risk of sexual exploitation and risky sexual activity Hertfordshire County Council Changing the Culture 42
Risk management means maximising potential benefits.
These benefits should form part of any intervention Hertfordshire County Council Changing the Culture 43
A pro social peer group A supportive school environment Good problem solving skills An adult willing to take responsibility for decision making Responding in a sustained way to the young people’s extreme distress which often manifests itself in their very risk behaviour Hertfordshire County Council Changing the Culture 44
Brief solution focused therapy – dealing with the issues day by day whilst trying to find ways to move them into a hopeful state for the future.
Motivational interviewing – a technique of challenging and increasing discomfort with current situation to a level where change talk becomes possible Cognitive behaviour therapy – challenging self defeating thoughts and replacing them with a dialogue that allows for positive self talk Scaling and tracking – demonstrating change through documenting progress in a small scale and developing patterns of success Hertfordshire County Council Changing the Culture 45
Important concepts with different emphasis along the continuum of the assessment process.
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One of the great conundrums of child protection = How to recognise the occasional families that cannot be assisted or coerced to provide increased safety, without demonising excessive numbers of other families with the same, though inappropriate label.
(pg: 45, Dazell & Sawyer, OpCit) Hertfordshire County Council Changing the Culture 47
A child/young person can be considered to be safe when there is no threat of danger to a child within the family/home or when the protective capacities within the home can manage the threats of danger.
A child/young person is Unsafe when there is a threat of danger to a child within a family/home and the protective capacities within the home are insufficient to manage the threat of danger thus requiring outside intervention.
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A specific family situation or behavior, emotion, motive, perception or capacity of a family member that is out-of-control, imminent and likely to have severe effects on a vulnerable child Hertfordshire County Council Changing the Culture 49
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Violent Caregivers or Others in the Household Caregiver Makes Child Inaccessible Caregiver Lack of Self Control Caregiver Has Distorted Perception of a Child Caregiver Fails to Supervise/Protect Caregiver Threatened/Caused Serious Physical Harm to a Child Caregiver Will Not/Cannot Explain a Child's Injuries Child Provokes Maltreatment Fearful Child Caregiver Is Unwilling/Unable to Meet Immediate Needs of Child Hertfordshire County Council Changing the Culture 50
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Certain recurrent signs taken together can provide an early warning: History of unstable, damaging or violent adult relationships (including violence outside the family) Violence to children in the form of corporal punishment Hertfordshire County Council Changing the Culture 51
3. Violence to children in, or no longer part of, the family.
4. Changes in a child’s behaviour. This may not appear to be directly related to abuse which is occurring 5. Warning from neighbours or extended family 6. Help seeking behaviour from parents. The message may be disguised.
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7. Statements from children 8. Recurrent injuries and recurrent biographical patterns 10. Resistance to professional intervention 11. Plausible lies and deception by parents/carers 12. Non-access to children including absence from nursery, disappearance of families Hertfordshire County Council Changing the Culture 53
13. Violence & threats, to self and others 14. Subverting child protection plans 15. Family pressure on children & adults not to disclose information 16. Delay in seeking medical help This is not intended to be an exhaustive list and nor is the presence of any one indicator alone a sign of abuse. However, they must be given weight in the assessment process.
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Static risk factors do not change and are often seen as more reliable indicators for future risk Dynamic risk factors are both variable and often outwith the control of the individual It is the interplay of the static and dynamic risk factors that are most likely to bring an accurate understanding of the picture.
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Using the assessment record to manage interventions Hertfordshire County Council Changing the Culture 56
‘ We have remarked on the way in which (the social worker) came up with new and often significant information which cannot be found in her file notes. We think this matters. Procedurally it meant that if anybody had to deputise for her they would be under informed about things which turned out to be important. Substantially it meant that she maintained a personal hold on the case, because she had it within her power to use or withhold information… it helped her skew the case conference appraisals’ (Tyra Henry, 4.30 A study of Inquiry reports 1980 -9, Dept of Health) Hertfordshire County Council Changing the Culture 57
Is not a substitute for clarity of purpose Is not a substitute for high practice standards Is not a substitute for face to face communication Is not an add on to the ‘day job’ Is not filling in a form Hertfordshire County Council Changing the Culture 58
The legacy to leave the young person Part of formal accountability A basis for action by deputies A way of guarding against isolated and biased work Hertfordshire County Council Changing the Culture 59
Detailed but not irrelevant Accurate and include dates, times and information sources Available and easy to access Hertfordshire County Council Changing the Culture 60
Using knowledge critically from research and practice Systematic recording and updating of information, distinguishing sources such as observation, records of other agencies and information from family members Evaluating continuously the effectiveness of intervention and modifying action accordingly Evaluating interventions to develop practice wisdom (Whittington, C, op.cit, 2007) Hertfordshire County Council Changing the Culture 61
Immediate Vivid verbal account makes an impact Making it obvious – again and again Sitting comfortably with ambiguity Supporting the written word – easy access Hertfordshire County Council Changing the Culture 62
Presenting concerns coherently and in a focused manner Making the links between evidence and opinion explicit Re-enforce visually –anchor points to return too Supporting the spoken word – easy to access written words Hertfordshire County Council Changing the Culture 63
In order to have a better chance of understanding how difficulties interact, practitioners must be encouraged to be curious, and to think critically and systematically (Brandon,et al, 2008,p98) Hertfordshire County Council Changing the Culture 64