Addressing the Disconnects in Child Protection Practice

Our latest issue of Child Abuse Review has been published and is freely available online. It is packed with thought-provoking articles that look at some of the disconnects in our thinking and practice around protecting children.

I am particularly inspired by Jo Aldridge’s paper, ‘This is not just about history…’ Jo, herself a survivor of childhood abuse, reflects on the process and progress of the Independent Inquiry into Child Sexual Abuse (IICSA), a long-running public inquiry investigating the extent to which public bodies and other non-state institutions in England and Wales have taken seriously their responsibility to protect children from sexual abuse (https://www.iicsa.org.uk). Her paper provides a pertinent and meaningful critique of the process being undertaken by this inquiry – a critique that has implications for all those involved in responding to and learning from historical child abuse, but also because it has important lessons for all who are involved in safeguarding children in the present.

If we are to work effectively with children and young people, we need to listen carefully to those children and young people, and to the adults they grow up to become. The voices of survivors are an essential part of our reflection, learning and improvement.

Jo will be speaking at the BASPCAN International Congress in April – along with many other survivors and survivors’ organisations. That, too, promises to be a really worthwhile time of learning, reflection and dialogue. There is still time to register, so do take a look at the website for the full programme and further details.

www.baspcan.org.uk/congress-2018/

Our current issue of Child Abuse Review includes papers on reporting child sexual abuse within religious settings, on the Parents under Pressure support programme, and on peer-on-peer abuse and exploitation in the UK and Romania, and a challenging critique by Michael Preston-Shoot of the recent Wood review into children’s safeguarding systems in England. I encourage you to have a browse and to reflect on some of the disconnects these papers highlight.

‘…just as safeguarding children involves a practice which is inherently social and relational, full of complexity, uncertainty, dilemmas, tensions and complicated truths, so too is the practice of reviewing cases and understanding how to go on better than before.’

Michael Preston-Shoot

You can access my editorial and all the papers in this issue by clicking on the links below:

Child Abuse Review Volume 27, Issue 1

Editorial

Addressing the Disconnects in Child Protection Practice (pages 5–10)

Peter Sidebotham

Reviews

What is Really Wrong with Serious Case Reviews? (pages 11–23)

Michael Preston-Shoot

‘This is Not Just About History…’ Addressing the Disconnect in Historic (Non-Recent) Child Abuse Investigations (pages 24–29)

Jo Aldridge

Original Articles

Reporting Child Sexual Abuse within Religious Settings: Challenges and Future Directions (pages 30–41)

Craig A. Harper and Colin Perkins

Contextual Risk, Individualised Responses: An Assessment of Safeguarding Responses to Nine Cases of Peer-on-Peer Abuse (pages 42–57)

Carlene Firmin

Peer Exploitation: Findings from a Romanian National Representative Sample of Children Living in Long-Term Residential Centres (pages 58–71)

Adrian V. Rus, Ecaterina Stativa, Max E. Butterfield, Jacquelyn S. Pennings, Sheri R. Parris, Gabriel Burcea and Reggies Wenyika

Assessing Capacity to Change in High-Risk Pregnant Women: A Pilot Study(pages 72–84)

Paul H. Harnett, Jane Barlow, Chris Coe, Caroline Newbold and Sharon Dawe

Training Update

Neglect Toolkit: Guidance for Practitioners by Northamptonshire Safeguarding Children Board, 2016.

Wendy Hill

Book Review

Tackling Child Neglect: Research, Policy and Evidence-Based Practice Edited by Ruth Gardner

Claire Monk

September 5, 2017September 5, 2017

In praise of social workers

I was interviewed today by ITN news in the wake of the tragic death of 21 month old Ayeeshia Smith, and found myself getting really frustrated with yet another news reporter once more berating social services for not learning the lessons. ‘Why’, they ask, ‘after so many Serious Case Reviews, do social services keep failing our most vulnerable children?’

But the reality is that social services – and all the other agencies working to support children and families – have learned lessons. And children in this country live far more safely than they did a generation ago.

Every year in England, social services departments deal with over 600,000 referrals of children in need. Over 50,000 children are made the subject of a child protection plan. Nearly all of these are protected from further serious harm, and in the majority of cases, social services, health professionals and others work hard to ensure that these children can stay with their families.

In our recent triennial review of Serious Case Reviews[1] we found that around 26-30 children each year are killed by their parents – far fewer than in the 1980s and 1990s. The majority of these children died in spite of, not because of, all the good work that social care professionals are doing.

Child protection is not a simple job that you can just carry out by following a protocol or just spotting the signs and responding appropriately. Every day child protection professionals are dealing with complex, challenging issues, juggling and appraising the information given to them, and trying their best to find a positive way forward to protect the children, while seeking to support and work with their parents.

So yes, when an innocent child like Ayeeshia Smith is cruelly murdered by her mother, we are right to feel outraged. We are right to ask that lessons be learned – and, as with the current case – there always will be lessons to be learned. But let’s not take it out on the social workers, health visitors, police officers and other professionals without whom many more children would be harmed and many more families would be torn apart by the stresses, grief and turmoil of our complex, messy lives.

[1] Sidebotham P., Brandon M., Bailey S., Belderson P., Dodsworth J., Garstang J., Harrison E., Retzer A., Sorensen P. (2016) Pathways to harm, pathways to protection: a triennial analysis of Serious Case Reviews 2011-2014. DfE RR545. London: Department for Education. ISBN: 978-1-78105-601-1. Available at www.seriouscasereviews.rip.org.uk

November 25, 2016

International Day for the Elimination of Violence against Women

Today, 25th November, has been designated by the UN as an international day for the elimination of violence against women.

“Violence against women and girls is a human rights violation, public health pandemic and serious obstacle to sustainable development. It imposes large-scale costs on families, communities and economies. The world cannot afford to pay this price.” — Ban Ki-moon, UN Secretary-General

In my work in the field of child abuse, I have increasingly become aware of the huge tragedy of violence against women, the awful scars it causes to the women themselves, and to their children. It is also a scar across the whole of humanity – something Elaine Storkey has explored in her powerful book, Scars Across Humanity. We must do more to stop it.

Violence against women harms their children too.

In the three years from April 2011 to March 2014, Local Safeguarding Children Boards in England carried out a total of 293 Serious Case Reviews (SCRs) (1). Each one of these concerned a child or children who had died or been seriously harmed as a result of abuse or neglect. In a review of these SCRs, we found that in 54% of cases, there was documented evidence of domestic violence in the parents’ relationship. This included 70 children who had died within a context of domestic violence in the family.

It is now abundantly clear from research that living with domestic abuse is always harmful to children. This was emphasised in a recent special issue of the journal Child Abuse Review (2). At its extreme, this may result in the death of a child, the risks for which may continue even after separation. However, far more children continue to live in households where domestic violence is a part of ‘normal’ family life. The myth that because the children are in a different room and so don’t witness any actual violence, they aren’t harmed by it, has been very clearly shown to be a myth. Children pick up on the stress their parents feel; they experience the fear and terror when their mother is being hit or shouted at; they suffer from the controlling, threatening behaviour, the isolation and intimidation that are imposed on their mothers (for the reality is that, in most of these cases, it is the mother who is the victim).

Over the past few years, there has been huge progress in how we as a society, and as child welfare professionals, recognise and respond to domestic violence, including a growing recognition of the impact on children of living with domestic violence. However, there is still much to do. In our research we identified the importance of police, health and social care professionals carefully considering the needs of children in a family whenever there is evidence of domestic violence; of recognising that domestic violence should not be seen solely in terms of violent incidents, but also within the context of ongoing coercive control and the impact of this on the parent and children; and that controlling behaviour may continue to pose risks to mothers and children, even following separation.

By recognising these risks, and taking action to protect women and children from domestic violence, perhaps we could prevent some of those 70 deaths and many more of the cases of serious harm and children and women living in fear.

The full research report, Pathways to harm, pathways to protection, is freely available for download from Research in Practice: http://seriouscasereviews.rip.org.uk

The special issue of Child Abuse Review is available via the BASPCAN website: http://www.baspcan.org.uk/child-abuse-review/

Sidebotham P, Brandon M, Bailey S, Belderson P, Dodsworth J, Garstang J, et al. Pathways to harm, pathways to protection: a triennial analysis of serious case reviews 2011 to 2014. London: Department for Education; 2016.
Humphreys C, Bradbury-Jones C. Domestic Abuse and Safeguarding Children: Focus, Response and Intervention. Child Abuse Review. 2015;24(4):231-4.

August 5, 2016

Parental mental health problems and child protection

Our recent triennial review of Serious Case Reviews found a high proportion (53%) of parents whose children died or were seriously harmed through abuse and neglect had mental health problems. This finding is in keeping with other research from the UK and elsewhere which has shown links between parental mental ill-health and child maltreatment.

This, however, presents us with a dilemma: while the prevalence of parental mental ill-health in this population (parents of children seriously or fatally harmed through abuse and neglect) is high, and undoubtedly higher than in the general population, the numbers are small (31 per year) in comparison to the overall numbers of adults with mental illnesses. So, for example, the UK Biobank study, which assessed 172,751 adults from 2009-10, found that 27% met criteria for a mood disorder (major depression or bipolar disorder)[1]; extrapolating this to the 13,887,000 parents with dependent children living in the UK[2], suggests that there will be at least 3.7 million parents with a current or previous mood disorder. If you extend that to include lower levels of anxiety, depression, and other mental health problems, the numbers are likely to be even higher.

So while it may be true to say that children who suffer severe or fatal child maltreatment have a high likelihood of having a parent with a mental health problem, it does not follow that any parent with a mental health problem is likely to abuse his or her child.

Hence the dilemma. Parents with mental health problems need care and support, including support around managing their mental ill-health and support in their parenting. This will not be helped by taking a stigmatising approach, nor by assuming they are not able to effectively parent their children. The vast majority of parents with mental health parents are undoubtedly good parents who love and care for their children. Nevertheless, there will be some for whom the nature or severity of their mental health problems, or the interaction between their mental health problems and other factors, do affect their ability to care for their children.

Our research identified the co-existence of parental mental ill-health with domestic violence, with substance misuse, with social isolation, or with criminal activity all as contributing to presenting risks to children. In particular, the presence of domestic violence, when combined with mental health problems in either parent, may increase the risk to the child, even (and perhaps especially) after separation. Likewise, there may be indicators in the nature or severity of the mental illness itself. So, those parents with a history of attempted suicide, or with delusional thoughts, or who had expressed some intent to harm the child may pose a distinct risk.

So the message of these Serious Case Reviews is not to label all parents with mental health problems as potential child abusers, but rather to consider what impact their mental health may be having on the child, to work with the parent to fully explore any additional risks, and to offer respectful, supportive care for the parent and the child.

Learning to respond appropriately to parents with mental health problems is a challenge for professionals. In our research report we consider some of the implications of this and how we can facilitate better quality child- and family-oriented care. In our journal, Child Abuse Review, we have recently compiled a virtual issue bringing together a number of papers from 1999-2014 which explore some of these issues in greater depth. All of these papers are freely available online for a limited period on the journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-0852

Contents The articles below are freely available online until 31 August 2016.

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses (Volume 8, Issue 1, 1999) Nicky Stanley and Bridget Penhale

Parental mental health as a child protection issue: data from the NSPCC national child protection helpline (Volume 8, Issue 3, 1999) Vanessa Lewis and Susan J. Creighton

Building bridges: the interface between adult mental health and child protection (Volume 8, Issue 3, 1999) Charmian Tye and Gretchen Precey

Parental mental health and child protection — making the links through training (Volume 12, Issue 2, 2003) Jennifer Pearce

The experiences of children living with and caring for parents with mental illness (Volume 15, Issue 2, 2006) Jo Aldridge

The mental health of mothers of physically abused children: the relationship with children’s behavioural problems — report from Japan (Volume 15, Issue 3, 2006) Tsuneo Takei, Hiroshi Yamashita and Keiko Yoshida

Maternal mental health and faltering growth in infants (Volume 16, Issue 5, 2007) Laura Dunne, Helga Sneddon, Dorota Iwaniec and Moira C. Stewart

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in Northern Ireland (Volume 21, Issue 3, 2012 Gavin Davidson, Joe Duffy, Liz Barry, Patsy Curry, Eithne Darragh and Judith Lees

Making Decisions about Parental Mental Health: An Exploratory Study of Community Mental Health Team Staff (Volume 21, Issue 3, 2012) Khadj Rouf, Michael Larkin and Geoff Lowe

[1] Smith DJ, Nicholl BI, Cullen B, Martin D, Ul-Haq Z, Evans J, et al. (2013) Prevalence and Characteristics of Probable Major Depression and Bipolar Disorder within UK Biobank: Cross-Sectional Study of 172,751 Participants. PLoS ONE 8(11): e75362. doi:10.1371/journal.pone.0075362

[2] http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/bulletins/familiesandhouseholds/2015-11-05#families

July 11, 2016

Adolescent harm from abuse and neglect

New research from the University of Warwick reveals an increase in the number of adolescents who died or were seriously harmed as a result of abuse or neglect.

The research was commissioned by the Department for Education and is based on an analysis of 293 serious case reviews (SCRs) carried out in England between 2011-2014.

Serious Case Reviews

The research was led by Dr Peter Sidebotham, Associate Professor of Child Health of Warwick Medical School and Professor Marian Brandon, Professor of Social Work and Director of the University of East Anglia’s Centre for Research on Children and Families of the University of East Anglia.

The study Pathways to Harm, Pathways to Protection: A Triennial Analysis of Serious Case Reviews 2011-2014 is the fifth consecutive analysis of serious case reviews in England undertaken by the same research team dating back to reviews from 2003-2005. A serious case review (SCR) takes place after a child dies or is seriously injured and abuse or neglect is thought to be involved. It looks at lessons that can help prevent similar incidents from happening in the future

Adolescents

Their research showed a small but significant increase in fatalities and non-fatalities among two age groups 11-15 year olds and 16-17 year olds. In the current review 28% of SCRs were within the two older age groups compared to previous years when the figure was 22-25%.

Dr Sidebotham said: “Often people don’t associate abuse and neglect with adolescents and most cases involve infants and younger children, but people don’t recognise that there is a second peak in risk during adolescence.

“The increase in SCRs involving adolescents is a worrying trend. By adolescence the impact of long-standing abuse or neglect may be present in behaviours which place the young person at increased risk of harm.”

Professor Marian Brandon commented: “We found that the vulnerability of adolescents was often overlooked because they were considered to be already adult or thought to be resilient when taking time to listen to them or to understand their behaviour would have revealed the extent of their difficulties. This was often the case with the young people who were sexually exploited and also of many of the young people who took their own lives”

Drug and alcohol misuse

The research highlighted that almost two thirds of the young people aged 11-15 and 88% of the older adolescents had mental health problems. Some responded to adversity by engaging in risk-taking behaviour including drug and alcohol misuse and offending. Others were placed at risk of sexual exploitation.

Dr Sidebotham added: “This group of adolescents may find themselves particularly vulnerable to online grooming. On a positive note we found that being at school can promote good overall development and a buffer against adversities. Children not regularly in school due to poor attendance, home schooling or exclusion can be vulnerable due to their ‘invisibility’ and social isolation.”

The research has been reported in Science Daily and other online news sources.

The full report and other resources are available on the Research in Practice Serious Case Review website

July 4, 2016

Pathways to harm, pathways to protection: a triennial review of Serious Case Reviews

Our long-awaited triennial review of Serious Case Reviews has now been published by the Department for Education and is available, along with a number of other resources, on the Research in Practice SCR website.

Over the past year Professor Marian Brandon from University of East Anglia and I have been working with a small team of researchers to review all 293 Serious Case Reviews undertaken by Local Safeguarding Children Boards between 2011 and 2014.

A Serious Case Review is a local enquiry carried out where a child has died or been seriously harmed and abuse or neglect are known or suspected, and there is cause for concern about professional working together. This study is the fifth consecutive analysis of Serious Case Reviews in England undertaken by our research teams dating back to reviews from 2003-2005, and represents one of the largest national analyses of serious and fatal child abuse and neglect anywhere in the world.

I have been really inspired by this research which I feel gives us some extremely helpful insights into the nature of severe child maltreatment and what we – as professionals and as a society can do to help prevent it and to intervene where appropriate to protect children and support families.

No increase in child maltreatment fatalities in spite of huge increases in child protection activity

The data demonstrate that there has been an increase in the number of Serious Case Reviews carried out since 2012. However, this does not reflect any increase in actual numbers of fatal cases and is set against a backdrop of a steady year-on-year increase in child protection activity. There has been no change in the number of child deaths linked directly to maltreatment and a reduction in the fatality rates for all but the older adolescent age group.

Serious case reviews 2005-14:

fatal and non-fatal cases by year

The research found an average of 66 deaths per year in all age groups, compared to 73 deaths per year in the previous study from 2009-2011. Fatality rates had fallen from 4.67 to 3.78 per 100,000 in infants, but had risen from 0.31 to 0.65 per 100,000 in those aged 16-17. In the same time period, the numbers of referrals to children’s services in this country had risen from 609,000 per year to 619,000 per year.

Children falling below the threshold

As we explored these data in detail, it became clear that only a small proportion of those children suffering severe or fatal abuse and neglect were subject to child protection plans at the time of their death or serious injury (just 12%). However, over two thirds were or had been known to children’s social care at some point prior to the incident. These findings, along with our detailed qualitative analysis, suggest that once children cross the threshold for child protection services, they tend to be well protected, and that we have good child protection systems in place for managing some of these complex cases. However, there are large numbers of children and families who simply do not meet those thresholds, yet nevertheless are vulnerable.

“Throughout our review, we encountered examples of creative and effective child safeguarding. Examples of poor practice were also identified, involving failure to follow guidelines; an absence of safeguarding systems; barriers to effective co-working; or failure to recognise or act upon safeguarding opportunities. These apparent failures, however, need to be seen in the light of the effective safeguarding work that takes place across the country on a daily basis.

For many of these children, the harms they suffered occurred not because of, but in spite of, all the work that professionals were doing to support and protect them.”

Characteristics of the children and families

In keeping with previous research, we found that most, but not all, serious and fatal child maltreatment takes place within the family with children living at home or with relatives.

Babies and young children are inherently vulnerable and dependent, and features which mark them out as especially fragile place them at higher risk of abuse and neglect. However, there is a second peak in adolescence. By adolescence the impact of long-standing abuse or neglect may present in behaviours which place the young person at increased risk of harm. Almost two thirds of the young people aged 11-15, and 88% of the older adolescents, had mental health problems. Some young people responded to adversity by engaging in risk-taking behaviour including drug and alcohol misuse and offending. Others are placed at risk through sexual exploitation.

“We found that the vulnerability of adolescents was often overlooked because they were considered to be already adult or thought to be resilient, when taking time to listen to them or to understand their behaviour would have revealed the extent of their difficulties. This was often the case with the young people who were sexually exploited and also with many of the young people who took their own lives”

Cumulative risk of harm

One of the most important findings in our research has been the cumulative risk of harm to a child when different parental and environmental risk factors are present in combination or over periods of time. This particularly relates to domestic abuse, parental mental ill-health, and alcohol or substance misuse, but it also includes other risks such as adverse experiences in the parents’ own childhoods, a history of violent crime, a pattern of multiple consecutive partners, acrimonious separation, and social isolation.

Cumulative risk of harm:

the number of families experiencing multiple problems

Implications for practitioners

The primary aim of a Serious Case Review is to learn lessons in order to improve inter-agency working to protect children. In this research, we were able to identify a wide range of lessons for practitioners in different agencies, for managers and policy makers, and for our wider society. A lot of these revolve around learning to listen: to children and to families, and to other practitioners. The research has emphasised the importance of safe and trusting environments for children to be seen individually, speak freely, and be listened to; of treating parents with openness and respect; and for moving from incident or episodic service provision to a culture of long-term and continuous support, recognising that many of these situations are complex and ongoing.

“Adolescents may struggle to express their needs or feelings, or to engage effectively with services, and there are dangers of older adolescents falling between child and adult services. Importantly, children and young people may demonstrate ‘silent’ ways of telling about abuse and neglect through verbal and non-verbal emotional and behavioural changes and outbursts.”

We have, in conjunction with Research in Practice, produced a series of practitioner briefings for different professional groups, including health professionals, education, social services and police.

These are available, along with an introductory video, the full report, and a number of other resources on the Research in Practice Serious Case Reviews website:

http://seriouscasereviews.rip.org.uk/

Marian Brandon and I will be discussing some of the key findings of the research in a webinar this Thursday from 12.00-13.00. To register for the webinar, click here. Places are limited, so book early.

Over the next few weeks, I will be posting more blogs highlighting some of the different findings from our research. To keep up to date with these, and with my other blogs, click on the link below: ‘notify me of new posts by email’.

June 29, 2016June 29, 2016

Learning from Serious Case Reviews

Between 2011 and 2014, 293 Serious Case Reviews were carried out in England into cases where children had died or been seriously harmed through abuse and neglect. Professor Marian Brandon and I, together with our research teams from the Universities of East Anglia and Warwick have spent the past year analysing these reviews to see what we can learn about improving our systems for protecting children and promoting their safety and wellbeing.

The research report is due to be published by the Department for Education on Tuesday 5^th July and we will be following this by a webinar on Thursday 7^th July from 12-1 in which Marian and I will be discussing some of the key learning coming from this research.

Anyone is welcome to register for the webinar, which is being hosted by Research in Practice, who will also be a repository for the full research report and a series of practice briefings for different groups of professionals.

To register for the webinar, click here.

I will be posting our press release on my blog on the 5^th July, and over the next few months will post further blogs picking out some of the important learning from this review. To keep up to date with this, do sign up for email notifications below.