HOW WELL ARE WE HELPING CHILDREN AT RISK OF, OR CURRENTLY EXPERIENCING, NEGLECT?
Data collection and service planning
The survey asked about the efficacy of systems for helping services to plan how to meet local need in relation to neglected children'. Some areas gave us information about the ways in which services are planned and commissioned and most were using Performance Data or other mechanisms, such as measuring the extent to which Resource Panels were able to meet identified needs or data from SCRA, to plan levels of services required and inform Joint Commissioning Frameworks. Others comments reflected recognition that data collection is as yet only partial and could be improved, while others felt that new data recording systems need to be developed which would fit with the GIRFEC framework and enable service planning to be undertaken in a more directly needs-led way (see figure 2):
We could do better but we do have systems which allow us to use Performance Monitoring Data to inform strategic planning. So colleagues from across a wide range of services, including social work and health (GPs, psychologists and psychiatrists) report to the Children's Services Core Group and we can see what we need using these Thematic Reviews. This sort of data and process allowed us to see the need for a service for children affected by parental substance misuse. Our knowledge of how many children are affected by parents' mental health problems is the next we need to address.
Other = numbers are too small (1) and information of this type not used for service planning (1)
Figure 2: Showing responses to the survey question: 'Local information collection systems in relation to child neglect are effective in helping services to plan how to meet local need in relation to neglected children'
What services are provided to help children?
A network of services is in place to support families and to try to ensure that children are not experiencing neglect. However, the routes by which these services are accessed by children and families themselves and by professionals seeking a service on their behalf vary in different areas. To an increasing extent the organisation of routes to services is being shaped by the ways in which the overarching GIRFEC framework is being adopted.
We were given lists and examples of services across Scotland which provide help for children, support their parents and monitor whether children are being cared for well enough. The types of services are outlined in Appendix B. In summary, they range from early years parenting support and nursery provision to Family Centres and additional support in schools, for example Nurture Groups in Primary Schools and support provided by Guidance Teachers in High Schools through to targeted help for teenagers and their parents, run by both social work services and voluntary sector agencies.
Time4Us is a joint service, run by Aberlour Child Care Trust and Signpost Forth Valley, for children and parents affected by parental substance use in the Forth Valley Health Board area. The service aims to provide support and treatment to children and parents where the parent substance use is affecting their capacity to parent. Time 4 Us works with parents, children and young people aged 0-16 years and provides parenting programmes for parents who do not live with their children but have or are seeking contact with their child.
Edinburgh is in the process of setting up four community-based Recovery Hubs, co-locating Social Work (Adult and families), Nurses and the Third Sector. They operate a drop-in service where people receive a triage assessment and then access the right service from the above. One area Hub is open, with a second more recently opened and undertaking triage assessments, with the co-location following at the end of May. Premises are still being sought before roll out in the other two areas of the city.
Dundee Families Service is a residential and outreach service, run by Action for Children in partnership with social work and housing services and initially funded by 'Breaking the Cycle' monies. It aims to help service users avoid homelessness and family break-up, for example through children being looked after and accommodated and aims to promote broader social inclusion for family members as well as safer, more cohesive communities. Referrals for support are triggered by anti-social behaviour. It works with both parents and children. It is now also operational in Perth and Aberdeen.
Some areas described ways in which local authority social workers continued, or were finding new ways, to reclaim the traditional social work 'hands-on' work with families:
Social work staff are creative and tend to do a lot of the work themselves instead of farming it out to other agencies. It's good old-fashioned social work, that's how it has been described by Inspectors who identified it as good practice, but it also fits with the Munro agenda of a return to less bureaucratic and more practical social work. Increased funding would allow us to be even better at doing this.
There was a range of views across the different areas about whether there are enough services in place to help all the children who are identified as needing it. Those responding to the survey considered that they have a good range of services, although in answer to a more detailed question a more nuanced reply was offered (see figure 3).
Figure 3: Survey responses to the question: There are adequate services in this area to help children who experience neglect and to support their families.
In general, some areas stated that they were relatively well provided for although there would always be more children whose needs were less pronounced who could be helped. Services in rural areas were generally seen to be very patchy and generally limited to larger towns, with very little choice of services on offer. Families often had to travel long distances to access services and public transport was usually inadequate and expensive. If families had their own transport the price of fuel was prohibitive and fuel poverty was an issue for some. Professional staff who visited families at home had to travel longer distances and could not do so as regularly as they would have liked. In some rural areas there was limited if any voluntary sector provision available and in some the home care service was the only support which could be offered.
In two of the three large urban areas in which focus groups took place, practitioners reported that services were extremely stretched and could only meets the needs of children at 'the tip of the iceberg'.
Just under half the survey respondents indicated that more services would be welcome:
There are never enough services. We cope but we could do more. There is no capacity to do pro-active work so we have to concentrate on those with higher need. But we do our best with what we have and there is good practice within what we do have.
While it is possible for families to self-refer to some services, this is not common and families were more likely to be referred through formal channels, at least to targeted services. Voluntary sector agencies reported that this had become increasingly the case as their services became more stretched and targeted, although those which were sited in the community sometimes had parents approach them for help.
Researchers and practitioners are learning more about how services can actively encourage and engage parents and children and the hope is that a greater use of non-stigmatising, universal-based services will help with this. In relation to families moving in and out of services, there is increasing recognition that some need long-term support and the GIRFEC approach is designed to provide ease of movement from intensive to 'maintenance' type support. It remains to be seen whether this will work in practice but there is general optimism, if all levels of support are adequately funded.
Communities: what services would people like to see?
The YouGov poll indicated that the general public are in support of services being provided to help children and their parents (Burgess et al., 2012). When asked about the types of services the public in Scotland think should be in place to support children who may be experiencing neglect, members of the public clearly saw a role for services aimed at prevention and based within universal services. Projects that supported families and children before problems got worse polled 57% of their vote followed by preventative services (45%). Forty-four percent of those asked saw a role for health services such as specialist health visitors and 38% thought that school based services would be helpful. This was broadly similar to the rest of the UK, but more of the Scottish public recorded that better approaches were needed for tackling problems relating to drugs and alcohol compared with the national response (37% and 30% respectively).
How is the GIRFEC framework shaping the context within which professionals are providing help to neglected children?
Focus group discussions indicated that there is a general optimism about the potential of the GIRFEC framework to provide help to children and families at an earlier stage and in a less stigmatising way, if the help that is identified to meet families' needs is adequately funded. There had been some apprehension amongst staff in universal services, particularly in relation to what would be required by the Named Person and Lead Professional role. In some areas where this was now operational the paper work and the role was not considered to be as onerous as feared.
Two, inter-related issues are affecting the shaping of systems within the GIRFEC framework. The first is the move towards earlier intervention within universal and targeted services and joint decision-making about who is best placed to provide intervention without the need for 'referral' between agencies. There were strong views expressed that there needed to be greater capacity at universal service level if children were to be helped and parents supported at an earlier stage. Practitioners stated that, during this transition time of maximising capacity in services aiming to help children and their families at an earlier intervention stage, the 'higher end' work will continue to need funding. They felt that if financial resources are not spread across the spectrum of service provision there will not be a shift of focus towards earlier intervention.
The second is the continued need to provide appropriate protective responses where there is high risk of harm. There are a significant number of families and children who need help because there are serious child protection concerns or who are at what practitioners describe as being 'just below child protection level'. There will always be some children for whom a child protection investigation, usually with police involvement, is required, sometimes when the child first comes to the attention of services. Such child protection processes can be integrated within the over-arching GIRFEC system as was shown in the 'pathfinder' without having to adopt dual pathways (Stradling et al., 2009). Across Scotland, though, we identified three main models of GIRFEC adoption, either incrementally or by taking a whole system approach.
Partial or incremental adoption of the GIRFEC practice model
Approximately one third of local authority areas are at an early or partial stage of GIRFEC implementation and still use the term 'referral onto services'. Some of these areas describe parallel pathways of either a Child Protection or Child in Need route:
We do still speak about referrals and the Duty Team would take these and make a decision about whether to go down the full-blown CP route or Family in Need of Support route, unless the child already had a social worker. It could go back and forth between CP and Child/Family in Need further down the line. So the mechanism would be through the Duty Worker.
These areas have not yet implemented the Named Person, and if required, Lead Professional role with the responsibility they have for arranging multi-agency discussion and planning for a child. Some of the areas do have multi-agency planning groups although these may not be fully integrated as yet into a full GIRFEC model which focuses on discussion about what services should be put in place and the plans to do so rather than 'referral on to services'.
We do not have enough information to say whether all these areas are actively choosing an approach which continues to use a dual pathway system or whether they are incrementally moving towards one pathway.
A partial GIRFEC model (mixed pathways)
A small number of local authority areas have implemented a GIRFEC model but are using a mixed model of parallel pathways with some elements of a 'meeting around the child' system:
There's the dual pathway of Family/Child in Need or family support and the Child Protection one. If the former, then the Locality office will consider a 'meeting around the child'. We use GIRFEC and the IAF and it's well embedded, with Named professionals able to call a meeting around the child, at least from Health although not from Education as yet. The Meeting Around the Child (MAC) system works well, especially in small localities where relationships are well established. It can work well as a filter such that cases don't get to Child Protection but if it's working very well none would. It has worked well with some suspected neglect cases if supports are accepted and put in. The system is being used; the problem is buy-in by parents, if they don't then it can end up as a child protection case.
GIRFEC practice model in place
Over a third of local authority areas report that the GIRFEC system, using a Named Person and if required, a Lead Professional system with multi-agency collaboration (including families themselves in some cases) is now in place. This is in the early stages of being used in practice in some areas and may not include all (for example some adult-focused services). Some areas reported that well-established multi-agency collaboration at a local level, small authority size and a stable workforce have aided the process:
It's the GIRFEC practice model so we wouldn't talk about a referral to SW or a handing on process. To ensure the child doesn't fall through the net they will be allocated a Named Person/Lead Professional depending on age and which service has the most input (usually, birth-10 days - midwife; 10 days to school age - health visitor; school age (primary and high school - Guidance or Head Teacher, if small school). We also had to think through the situation with children who are not registered with a GP or don't attend school. We needed to help people who will be Named Persons not see it as 'this is more work for us'.
GIRFEC Learning Partners in North and South Lanarkshire recently launched a Getting it right 'toolkit' - a comprehensive resource based on their three years' work to develop culture, systems and practice changes across Lanarkshire:
The toolkit includes a combination of written reports, exemplars, graphic images, animations, assessment paperwork and digital resources which are the result of a three year development programme. The report aims to share the experience of implementing Getting it right for every child in the hope that it may be of interest to other areas at different stages in their own journeys. It is aimed at Heads of service, strategic managers, planning managers, operational managers and programme managers who are responsible for any aspect of implementing Getting it right for every child.
Do the public and professionals know what services there are?
Overall, information about services is fairly widely available. From the survey,
17 areas had information available to the public, six had some information available and one area reported that the information is so small that this is not necessary. Nineteen areas said that information is readily available to professionals and four that some is available with one again stating that its small size meant that this was not appropriate.
The type of information available ranged from leaflets provided by individual services, directories of services on the local authority websites or a link to, for example, a Family Information Service website. In most cases, the content of the information provided is very general and describes the service, possibly referral criteria, sometimes the numbers of children/families it could work with but is not very detailed. The evidence on children's help-seeking suggests that they tend not to speak to professionals directly (Daniel et al., 2011). Two areas reported on web-based child focused service information aimed at encouraging children to seek help and showing them how to do this which could be a fruitful approach.
East Renfrewshire Council have developed a website for children and also one for teenagers. Both provide information on keeping safe, bereavement, bullying and internet safety amongst other subjects. There is also information about where to get help if children and young people need it.
However, information about services can soon become out of date and, even with web-based directories, this can be a problem. Some areas acknowledged that this information could be improved:
We did locality speed-dating - lots of people didn't know what services existed. People really benefited knowing about what resources were available. We used a DVD to record what was known and it was easy to set up
Can most children who need it get help and if not, why not?
It was clear from the YouGov poll that, at times, professionals working in all areas of the UK felt that it could be difficult to act in all cases where children may be experiencing neglect. Fifty-two percent of the Scottish public surveyed were confident that professionals would respond adequately to their concerns about a child (52% in Wales, 53% in England). However, 39% chose the response that would suggest less confidence in professionals responding adequately (37% in England and Wales).
From our survey, results reflected a range of responses in answer to this question with at least half the areas indicating that on the whole they considered that most children were able to get help. Some were able to identify gaps, perhaps in relation to geographical areas (some areas of large cities or rural areas) or for certain age groups:
Universal services do support the under 5s through health and education and there is the Guidance system in schools. But it is hard to say if all older children are getting the help they need as there is a lack of targeted services for them, although there are Youth Services. They will get some help although not specifically about neglect.
Where children were recognised to still not be receiving help several reasons were ascribed.
Lack of agreement between professionals
Some referred to lack of agreement between professionals about whether the care the child is receiving is acceptable or not:
The main barrier is in relation to practitioners accepting that in issues of neglect the care of the child is perhaps good enough when arguably it's not. Practitioners can get sucked into the families' way of functioning. It can be difficult to stand back and say we need to do something about it, alongside the feeling of wanting to give a second chance and allow parents to start again - which doesn't move things on for the child.
Capacity, funding and resource issues
While there were many respondents who reported that there were no immediate plans for budget cuts in their area there was a general unease and some anxiety that there are increasing threats of this and that by next year some family support services would be at risk of closure and/or reduction. In some areas there was a suggestion that staff numbers could be reduced and that even statutory local authority social work services could be affected, for example due to vacant posts not being filled. It was noted that the voluntary sector in particular had already had services reduced or were expected to do more for less money. Some areas had been able to prioritise front-line services and one or two saw opportunities in having to think more carefully about commissioning services which would not overlap with one another. This was balanced with a wish to see preventative and earlier intervention, including universal services, given adequate funding to maximise capacity at this stage and implement the GIRFEC agenda:
In social work, we do have better tools of assessment; we do have better systems and clearer structures. We are more accountable, but that quality of work takes more time and yet the demand keeps increasing.
Focus group participant
Knowing how best to help children experiencing chronic neglect
Finding ways of intervening effectively with families in which children who were experiencing chronic neglect at a level which did not warrant removal from home was seen as problematic by some participants in focus groups. Challenging the cycle of generational neglect was seen as difficult when there were large numbers of families in this situation:
The problem is the thresholds issue and services coming to an agreement about what should happen. Frontline relationships are key and while there may be verbal sharing of information there may not be agreement about what is then needed. Also it's about knowing how to intervene with well-known families, where neglect may be intergenerational.
Focus group participant
Legal challenges and evidence issues
Some respondents stressed the difficulties they had encountered if a Supervision Requirement Order is needed to effect change when attempts to provide help on a voluntary basis are not leading to the required improvements. There was a widespread perception by focus group participants and in some areas surveyed that there is often a stumbling block at the Children's Hearing stage when Panel Members require more evidence of neglect to be provided. This is a perception that requires further exploration because a number of factors could be at play here. It could be that, in some cases, the evidence is available but is not being delineated in reports effectively. But in other cases it could be that Panel Members require further training on the impact of chronic or cumulative neglect on a child's wellbeing or long term development.
It was identified that there is a real issue with legal frameworks and technicalities which often do not work to protect children. Once in Court parents' rights are sometimes seen as taking precedence with solicitors arguing that parents did not get the help they needed to improve their parenting or that learning disability is affecting parenting capacity and specialist support is required. It was thought that some solicitors need to know more about the impact of neglect on the child and Sheriffs need to be more informed. Again, this is a crucial issue that needs further exploration. It could be that in some cases reports are not providing sufficient information to evidence parental lack of capacity and/or willingness to change even with support. Or in others it could be that parental perspectives are overshadowing those of the child. A number of review respondents believed that some Children's Panel members, Reporters and Sheriffs need more training in this area.
And is it the right sort of help?
In the survey we asked whether there were processes in place to measure whether services provided made a difference to children by helping to keep them safe and ensuring they were well cared for. Some areas are doing this by measuring the effectiveness of services overall in relation to groups of children and others have devised, or are in the process of devising, methods of capturing the outcomes or progress towards outcomes for individual children. Some areas are doing both. The aim for those who are gathering individual outcome information is to develop a system to aggregate individual children's outcomes in order to present an overall picture of the effectiveness of services and interventions.
There are a range of ways in which areas are measuring outcomes. Performance management indicators and quality improvement processes are used by some to gather information about overall service effectiveness. A few areas are using proxy measures to measure effectiveness such as a reduced number of children being accommodated, although proxies such as this could act as perverse incentives. Case file audits are used to look at both individual cases and the impact of services overall. One mentioned reviewing 'stuck' cases to see what could have a better impact and outcome for children.
In relation to the measurement of individual outcomes, some respondents described using children's plans and the reviewing system to measure progress towards identified goals. Other areas also gather children's and service users' views of the impact services have had on them for example through Viewpoint and other feedback tools. Some indicated that they are at various stages of developing individual outcome measurement tools, mostly based on GIRFEC Well-being Indicators. One or two mentioned the development of outcomes measurement frameworks in partnership with the voluntary sector; Barnardos was specifically mentioned in one area. Two or three are quite far ahead with their own systems for measuring outcomes for children.
Angus Council Social Work and Health Department have developed an outcomes tool similar to the Outcomes Star, called the Wellbeing Web, based on SHANARRI, being launched in May. They will use it as part of the GIRFEC Practice toolkit as a conversation tool to assist and empower children and families to identify their outcomes and work collaboratively to achieving improvement.
Moray Council has a range of evaluation methods. It uses Real Time case evaluation which includes self-evaluation and has an Action for Children project which uses information from the Neglect Assessment Tool to feed into an outcomes framework. Child protection Committee staff also undertook a sample of multi-agency file audits by revisiting initial referral discussions, seeing what was put in place and looking at outcomes. One outcome of doing this has been less SW/Police Joint Investigations. Staff also explored case studies using NSPCC Ten Pitfalls document to see if they were taking into account the full impact of neglect and to see if parents' own history had also been taken into account.
For most areas, measuring the effectiveness of services for individuals is still work in progress but they are all aware of the importance of developing this work. As one respondent commented:
I would say that there are adequate services to help children but whether their involvement results in a positive outcome for children in neglect cases is debateable.
Data collection to inform service planning most often makes use of Performance Management Data rather than prevalence data; most areas thought that data collection was adequate or improving.
Across Scotland there are a range of services in most areas, both universal and targeted, which aim to help children and their families. While survey responses from half the areas considered service to be adequate and/or improving, there was anxiety in some areas about the effects of future spending cuts on services. In urban areas in particular it was considered that there was not enough provision available to help all children who were at risk of or experiencing neglect.
Finding ways of intervening effectively with families in which children who were experiencing chronic neglect at a level which did not warrant removal from home was seen as problematic by some participants in focus groups.
Implementation of GIRFEC is at different stages across Scotland and in some areas is very much a work in progress, particularly in relation to the Named Person and Lead Professional process and the extent to which single or dual pathways are used.
It was identified that there is a real issue with legal frameworks and technicalities which often do not work to protect children. A number of review respondents believed that some Children's Panel members, Reporters and Sheriffs need more training in this area, in particular about the short and long term impact of neglect on a child.
The review indicated that there are pockets of progress in relation to measuring the effect of service provision on children and families and that it would be useful to be able to share practice learning about this across the country. There is clearly a need to ensure that services are effective and the work in developing outcome measurement processes might be best shared across all areas within Scotland.
Email: Philip Raines