Marian Brandon

Social work with children

Introduction PART 1: THE CONTEXT OF WORKING WITH CHILDREN Child Care Policy, Childrens Rights and the Children Act Age and Understanding: The Developmental Framework PART 2: WORKING WITH CHILDREN IN PRACTICE The Voice of the Child in Practice Working with Children in Need and in Need of Protection Children who are the Subject of Care and Adoption Proceedings in the Courts Children Looked after by the Local Authority Children and Youth Justice Conclusion

Fatal child maltreatment in England, 2005-2009

OBJECTIVE This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. METHODS Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment). RESULTS A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. CONCLUSIONS Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

Variation in recording of child maltreatment in administrative records of hospital admissions for injury in England, 1997–2009

Background Information on variation in the recording of child maltreatment in administrative healthcare data can help to improve recognition and ensure that services are able to respond appropriately. Objective To examine variation in the recording of child maltreatment and related diagnoses. Design Cross-sectional analyses of administrative healthcare records (Hospital Episode Statistics). Setting and participants Acute injury admissions to the National Health Service in England of children under 5 years of age (1997–2009). Outcome measure Annual incidence of admission for injury recorded by International Classifications of Diseases 10 codes for maltreatment syndrome (child abuse or neglect) or maltreatment-related features (assault, undetermined cause or adverse social circumstances). Proportion of all admissions for injury coded for maltreatment syndrome or maltreatment-related features. Results From 1997 to 2009, the annual incidence of injury admissions coded for maltreatment syndrome declined in infants and in 1–3-year-old children while admissions coded for maltreatment-related features increased in all age groups. The combined incidence of these categories remained stable. Overall, 2.6% of injury admissions in infants, and 0.4–0.6% in older age groups, had maltreatment syndrome recorded. This prevalence more than doubled when maltreatment-related codes were added (6.4% in infants, 1.5–2.1% in older age groups). Conclusion Despite a shift from maltreatment syndrome to codes for maltreatment-related features, the overall burden has remained stable. In combination, the cluster of codes related to maltreatment identify children likely to meet thresholds for suspecting or considering maltreatment and taking further action, as recommended in recent National Institute of Health and Clinical Excellence guidance, and indicate a considerable burden to which hospitals should respond.

Fatal child maltreatment in england

Aims This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. Methods Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of five broad groups of maltreatment deaths: severe physical assaults; overt homicide; infanticide and covert homicide; extreme neglect; deaths related to but not directly caused by maltreatment. Findings A total of 276 cases were recorded giving an incidence of 0.63 cases per 100 000 children (0–18) per year. 246 cases could be classified based on the data available. Descriptive data suggest particular class characteristics of the different categories of death (table 1). The commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. A large number of deaths appeared related to but not directly caused by maltreatment, these included sudden unexpected death in infancy where the cause of death was considered natural but in which there were associated concerns. Other related deaths included teenage suicide with evidence of previous maltreatment and accidental and natural deaths with evidence of poor parental care. Conclusions These data provide a first attempt to systematically classify and describe characteristics of fatal maltreatment in England. Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

Responses to concerns about child maltreatment: a qualitative study of GPs in England.

Objectives To provide a rich description of current responses to concerns related to child maltreatment among a sample of English general practitioners (GPs). Design In-depth, face-to-face interviews (November 2010 to September 2011). Participants selected and discussed families who had prompted ‘maltreatment-related concerns’. Thematic analysis of data. Setting 4 general practices in England. Participants 14 GPs, 2 practice nurses and 2 health visitors from practices with at least 1 ‘expert’ GP (expertise in child safeguarding/protection). Results The concerns about neglect and emotional abuse dominated the interviews. GPs described intense and long-term involvement with families with multiple social and medical problems. Narratives were distilled into seven possible actions that GPs took in response to maltreatment-related concerns. These were orientated towards whole families (monitoring and advocating), the parents (coaching) and children (opportune healthcare), and included referral to or working with other services and recording concerns. Facilitators of the seven actions were: trusting relationships between GPs and parents, good working relationships with health visitors and framing the problem/response as ‘medical’. Narratives indicated significant time and energy spent building facilitating relationships with parents with the aim of improving the childs well-being. Conclusions These GPs used core general practice skills for on-going management of families who prompted concerns about neglect and emotional abuse. Policy and research focus should be broadened to include strategies for direct intervention and on-going involvement by GPs, such as using their core skills during consultations and practice systems for monitoring families and encouraging presentation to general practice. Exemplars of current practice, such as those identified in our study, should be evaluated for feasibility and acceptability in representative general practice settings as well as tested for efficacy, safety and cost. The seven actions could form the basis for the ‘lead professional’ role in general practice as proposed in the 2013 version of ‘Working Together ’guidance.

Social work intervention with adults who self-neglect in England: responding to the Care Act 2014

Purpose – The paper reports on findings from an evaluative research study which looked at a timed intervention model of practice comprising of up to 24 weeks of intensive meetings with adult service users set up by one local authority in England, to prevent and delay the need for care and support. A particular focus of this paper is adults who hoard. Design/methodology/approach – The study employed a mixed-methods design, consisting of interviews with service users (n=13); social workers (n=3); social work managers (n=2); and stakeholders from external services and agencies (n=6). It included a costings analysis of staff time and an analysis of service users’ goals and of ‘satisfaction with life’ self-report questionnaires (n=20), completed at pre- and post-intervention stages. Findings – There was evidence that social workers used strengths, relationship-based and outcome-focused approaches in their work. The techniques used by social workers to engage, achieve change and assess effectiveness with service users varied. These included the use of photographs to enable the service user to map and assess their own progress over time, encouraging hoarders to declutter and reclaim their living space. The service users valued the time the social workers spent with them and the way that they were treated with sensitivity and respect. Research limitations/implications – The study focused on one local authority in England; there was no comparison group. This, and the small sample size, means that statistical generalisations cannot be made and only limited conclusions can be drawn from the quantitative data.

Children Looked After by the Local Authority

Social work with children looked after by the local authority draws on skills and values shared with other areas of social work practice with children, but there are some important and distinctive aspects of practice that social workers need to develop. However, these are rarely seen as specific skills. Social workers involved in child protection investigations or taking cases to court generally receive specialised training. Social workers who are responsible for children in foster or residential care often get less help in defining what constitutes good practice in relation to their face-to-face work with the child. Where children are placed with carers who are meeting their everyday needs, the nature of an appropriate relationship between worker and child may seem hard to define. Are social workers to be mere representatives of the social services bureaucracy or do they have the opportunity to play a much more significant part in the child’s life? This chapter will begin by looking at the context of this work and then look in some detail at models of good practice in face-to-face work with the child.

Understanding attachment theory

In his early studies, Bowlby was intrigued by two findings in particular. The first arose out of his work conducted in the 1940s and 50s that looked at the long-term developmental impact on children who had either been separated from their parents for long periods of time (as war orphans or evacuees) or suffered emotional adversity in childhood (Bowlby 1944, 1951). Many of these children, Bowlby believed, went on to suffer a range of behavioural, emotional and mental health problems that he felt were in some way connected to their earlier upsets and losses.

Children who are the Subject of Care and Adoption Proceedings in the Courts

The very thought of ‘court’ is extremely daunting, even to most adults. For children, images of court are generally based on television and are mostly frightening. The idea of a formal court room in which judges look down from a great height, most commonly when deciding how to punish criminals, is one that is familiar to all of us. For social workers as well as children, coming into contact with a court may shake their confidence. For children whose future is to be decided in the courts, there is very great anxiety about what will happen next, whom they will live with and all the important details of their lives that may change following the court’s decision. Social workers therefore need to be very clear about the court system, the options available and their various roles during proceedings involving children. They also need to be very aware of the impact of the process on children as well as the outcome. Their confidence and concern will be communicated to the child.

The Trouble With Fathers: The Impact of Time and Gendered-Thinking on Working Relationships Between Fathers and Social Workers in Child Protection Practice in England:

The lives of families entering the child protection arena may be shaped by a range of troubles, including material deprivation, physical and mental health problems, and substance misuse or domestic abuse. Despite the interest in whole family approaches, the issue of how professionals fail to work effectively with fathers is long-standing and resistant to change. This article illustrates challenges in building working relationships with men, including the challenge of avoiding binary thinking in the assessment of fathers as “risk” or “resource.” Drawing on our qualitative longitudinal study of men’s experiences of child protection in England, we highlight how both organizational (clashing time perspectives) and cultural (gendered-thinking) factors can trouble the potential relationship between social workers and fathers. We argue for a more gender sensitive approach to social work practice, which can respond more fully and effectively to the experiences of fathers and mothers.