Sue Peckover

Making and managing electronic children : e-assessment in child welfare.

‘Every Child Matters’ (ECM) is a government response to longstanding concerns about child welfare and protection. A key feature is the use of information and communication technologies (ICTs) to improve information sharing and inter-professional communication. One of the proposals requires the establishment of an index, ContactPoint, which is a database containing information on all children in their area, to be used by child welfare professionals to indicate their involvement with a child and, where there is ‘cause for concern’, to facilitate joint action. Whilst these proposals for harnessing ICTs within child welfare are a central part of the governments modernization strategy, plans for the Index have been heavily criticized for its panoptic potential to invade privacy and override professional discretion and judgement. This paper reports findings from an ethnographic study funded by the ESRC e-Society Programme. Drawing on data collected in one ‘Trailblazer’ local authority area during the pilot phase, it describes the introduction of a local child index and the ways in which professionals and the technologies are drawn together within the local child welfare network. For the Index to achieve its original purpose of improving information sharing and inter-professional communication it must be ‘used’ by child welfare practitioners. But establishing the Index as a friend to the child welfare professional is not a straightforward process. The research suggests this is dependent on a set of relations that are being constantly negotiated and accomplished in everyday practice. It is clear the deployment of ICTs in professional practice is highly contingent upon local policy implementation, the local arrangement of services and the everyday practices of busy and sceptical practitioners.

Child-Centric Information and Communication Technology (ICT) and the Fragmentation of Child Welfare Practice in England

The ways in which government supports families and protects children are always a fine balance. In recent years, we suggest that this balance can be characterised increasingly as ‘child-centric’, less concerned with families and more focused on individual children and their needs. This article charts the changes in families and government responses over the last 40 years, and the way this is reflected in organisational and administrative arrangements. It notes in particular the impact on everyday practice of the introduction of information and communication technologies. Findings are reported from recent research which shows the struggles faced by practitioners who try to manage systems which separate children from their familial, social and relational contexts. As a consequence, we suggest, the work has become increasingly fragmented and less mindful of childrens life within families. While the data and analysis draw on research carried out in England, we suggest that similar changes may be going on in other Western liberal democracies.

Too frightened to care? Accounts by district nurses working with clients who misuse substances

Drug misusers have complex health and social care needs, and experience considerable difficulties in accessing the assessment, care and treatment that they require. Despite the development of specialist services in many parts of the UK, substance misuse is often marginalised within mainstream general healthcare, and many practitioners are unprepared for the challenges of working with this client group. The present paper reports findings from a qualitative study that aimed to explore district nurses’ understandings and practices in relation to discrimination and inequalities issues. The research took place during 2003 in two city-based primary care trusts in the North of England. Semistructured interviews were undertaken with 18 ‘G’ grade district nurses. The authors present findings that highlight some of the challenges and tensions district nurses encounter when providing care to clients who misuse substances. The discourses of ‘prejudice’ and ‘risk’ were intertwined throughout the data, and served to shape service provision for clients who misuse substances. This was reflected in the district nurses’ accounts of their own practice and that of other services, suggesting that these clients receive suboptimal care. The discourse of ‘risk’ was also used by district nurses to construct themselves as ‘vulnerable’, and this helped to explain some of their own practices of care provision. Many participants acknowledged their limited knowledge and experience of working with this client group. There is an urgent need for district nurses and other health professionals to develop their practice with these clients, who may present as both vulnerable and dangerous, in order to ensure that care is provided equitably and safely.

Whither practice-near research in the modernization programme? Policy blunders in children's services

In this article, we lament the effects of practice-distant research and associated policy initiatives on contemporary childrens services in England. In the last decade, as a result of high profile inquiries into non-accidental child deaths, statutory childrens social care services in the UK have been subject to a wide-reaching ‘modernization’ programme. We studied decision-making in the high blame environment of local authority childrens services. Our research sought to examine the relationship between performance management and the impact of anticipated blame within the decision-making practices of those providing, supervising and managing these services. We show that systems and technologies can be developed which both assist the users in their daily work and achieve desired organizational goals, but without an ethnographically informed, practice-near approach, unsafe work regimes and practices can ensue.

Trust, risk and the (mis)management of contingency and discretion through new information technologies in children’s services

• Summary: While UK social work’s core purpose in children’s services continues to invoke the ready virtues of universal care, protection from significant harm and a child rights led approach as foundational to effective intervention, there is a ‘real-world’ context of organizational practices that inevitably mediate who gets what services and why. This was ever thus. What has changed however is not so much the claims by social work to a virtuous purpose (the ethic of care offers a durable discourse from which to cast service users as worthy and our efforts as honourable) but that new risk-reduction technologies are exposing a worrying gap between the rhetoric of a humane-oriented project of care and the actionable decision-making of professionals drawing upon administrative targeting systems that seek to reduce organizational exposure to error, blame, reputational damage and unwanted external scrutiny. • Findings: The article exposes a gap between core values and risk management by examining the erosion of trust in professional social work and consequent shift towards new information technologies which intend to generate system confidence, such as the Integrated Children’s System (ICS) which seeks to provide a more accountable management of contingency. Drawing on data from our recent multi-method research of frontline practice funded by the UK Economic and Social Research Council, we challenge the view that the uncertainty and ambiguity of risk-immersed social work can be more safely moderated by computer-based technologies for reporting and decision-making. • Applications: The findings of this study suggest the need for significant reform of the ICS system. Our explorations in front line decision-making suggests that the IT workflow systems that channel and shape the way need is responded to in order to make actions and their often distributed ownership transparent and justifiable, have the unintended potential to obscure risk. We outline ways in which risk in its institutional and personal contexts in children’s services may become less evident and tractable to moderation by the ICS systems that seek this very purpose. In doing so we consider the balance between professional trust and system confidence and consider whether the time has come to shift the balance back to the former if we are to re-engage more fully with the occupation’s humane mission.

The formalized framework for decision-making in child protection care orders: A cross-country analysis

Care orders within the child protection system are some of the most invasive interventions a state can make. This article examines the discretionary space governments set out for child protection workers when they prepare care orders. We analyse the formalized framework for these decisions in England, Finland, Norway and the United States. We focus on knowledge, timelines, how children and parents are involved and accountability. We find that Norway and Finland have highly de-regulated systems with wide discretionary space, whereas England and the United States are highly regulated systems with narrow discretionary space. The United States differentiates itself with relatively little parent and/or child involvement in decision-making. England and Finland do not have defined deadlines for terminating the process, and Norway has few directives on what information to collect. Such differences will influence the quality of decisions as well as the principles of the rule of law.

Teaching research to undergraduate community nursing students: reflections upon curriculum design

Despite the widespread inclusion of research education within nursing courses, there remain a number of tensions about the purpose, content, and philosophy underpinning such programmes. Of particular concern is the importance of establishing appropriate teaching and learning strategies in order to ensure that research education is enjoyable and effective. These issues are explored within this paper, and provide the background context for this discussion on the redesigning of a research module within an undergraduate programme for post-registration community nursing students. The paper highlights the rationale for undertaking this change, and discusses the educational frameworks, which were used in order to develop the programme. An initial evaluation suggests the redesigned curriculum is a positive development that has enhanced both the teaching and learning of research.

Inter-professional electronic documents and child health: a study of persisting non-electronic communication in the use of electronic documents.

Information and communication technologies are widely used in health and social care settings to replace previous means of record keeping, assessment and communication. Commentary on the strengths and weaknesses of such systems abound, thus it is useful to examine how they are used in practice. This article draws on findings from two separate studies, conducted between 2005 and 2007, which examined how child health and welfare professionals use electronic documents in Finland and England. Known respectively as Miranda and CAF, these systems are different in terms of structure and function but in their everyday use common features are identified, notably the continued use of and reliance on non-electronic means of communication. Based on interviews with professionals, three forms of non-electronic communication are described: alternative records, phone calls and letters, which facilitate the sharing of the electronic record. Finally, the electronic documents are further analysed as potential boundary objects which aim to create common understanding between sites and professionals.

Examining the social construction of surveillance: a critical issue for health visitors and public health nurses working with mothers and children

AIMS AND OBJECTIVES To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. BACKGROUND The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. DESIGN We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. METHODS Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. RESULTS Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. CONCLUSIONS Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.

Putting Men’s Abuse of Women on the Childcare Agenda: An Innovative Specialist Domestic Abuse Project

The MAZE project is an innovative specialist domestic abuse service that undertakes intensive work with women affected by domestic abuse and their partners. This paper will describe the project and present findings from a small evaluation undertaken in 2010. Examples from MAZE work with individual women, direct work with men, and the MAZE project contribution to multi-agency work are used to illustrate how and why the project is successful and the challenges in achieving this. An important theme arising from this work is the central importance of keeping focused upon the safety of women and children, and upon understanding, assessing and addressing the risks and responsibilities of the domestic violence behaviours. Importantly this turns professional attention towards men and their behaviour and benefits women and children. Whilst the MAZE project is an example of innovation in service user-led organisations, it also demonstrates new directions for working with high risk families where domestic abuse is a feature.