Drawing The Line

The threshold for compulsory intervention into family life is 'significant harm' to a child. This threshold is often challenged by parents who question whether it is based on completely reliable knowledge of what is known to cause harm to children. Social workers therefore need to be very careful when making judgements about 'significant harm'.

I know from my experience as a social worker that the task of deciding whether it is safe for a child to continue living in the family or whether alternative arrangements have to be made is very challenging. Public concern about tragic cases where children have died makes social workers acutely aware of their investigative duty. At the same time, social workers should also recognise the child's basic need for stable and lasting relationships with caring adults. In child protection work it can therefore be difficult to strike an appropriate balance when pursuing two apparently different objectives. Social workers can only do their work if they get help from others in assessing the level of risk and recognising when a more active investigative approach is required. Their decisions about where to draw the line are underpinned by ethical considerations that are informed by their professional knowledge base.

When deciding whether harm is significant social workers should identify, as precisely as possible, the nature of the harm which the child is suffering or is likely to suffer. It is important to remember that their assessment may be used at a later stage as evidence in court and subjected to legal scrutiny. Where the harm which is feared is psychological harm, which would impair emotional development, there are often difficulties because the social work evidence may come from a knowledge base where opinion is often divided, or simply ambiguous. Another way of thinking about harm is to focus on the prediction of future harm. This requires fine judgement and realistic thinking about the level of support and supervision that would have to be offered to the family over the long term. For example, in a situation where there are concerns about a mother's capacity to care for her baby due to her own deep-rooted psychological problems social workers would need to consider very carefully the future risk of significant harm, as well as the resources that would have to be provided to ensure the child is protected.

I believe that current policies and practices in children's services are not helping social workers with this task. Some of the problems come from the language of 'safeguarding' which has resulted in a loss of clarity about their child protection duties. The legal and political mandate of 'safeguarding' has allowed the notion of 'harm' to be widened and this has given social workers additional duties to work with families where concerns might be anywhere on the continuum from 'harm' to 'significant harm'. This places a heavy burden of responsibility on social workers to remain alert to any evidence of neglectful or harmful parenting which may shade into abuse or neglect and may reach the threshold for 'significant harm'.

Many child and family teams are struggling to carry out their safeguarding duties. Their intervention in families begins with investigation and assessment and may continue with a safeguarding intervention but this seldom leads on to the provision of support services to meet the practical needs of families who are struggling. Despite all the rhetoric of 'early intervention and prevention' children's services have few resources for genuinely supportive work with families on a voluntary basis. Most safeguarding interventions with families involve an element of coercion.

In the early days of the child protection system the issues were not as complex as they are today. In 1974 the Maria Colwell report led to the creation of child abuse registers to identify children at risk. Initial concerns about the stigma of registration were followed by the realisation that registration could be a constructive tool for structured work with families where children were at risk and might prevent the need for care proceedings. However, there were weaknesses in the investigative role due to a lack of training. There were also concerns about professional judgement when making care and protection plans for children and whether they struck the right balance between the assessment of harm caused by abusive behaviour of parents and consideration of likely future harm to the child.

The Children Act 1989, which was informed by the principles of good practice, was an important step in understanding that the issues were more complicated than previously thought. It was increasingly recognised that there were various ways of conceptualising the problem of child maltreatment and this required a move away from the narrow concept of child abuse so that services could be more responsive to the needs of vulnerable children and their parents. Policies were devised to re-focus services and the Children Act 2004 provided a legal framework for this. It expanded the definition of 'harm' but took practice away from thinking clearly about the different levels of harm. New policy initiatives put more emphasis on multi-disciplinary working and less on social work duties under section 47 of the 1989 Act. This may have contributed to a better understanding of the complexities of good social work practice but in many ways has made the job more difficult because much of the recent practice wisdom in investigation and risk assessment has been lost.

During the 1980's multi-agency child protection procedures were concise and easily understood. There was a broad consensus in society that a small number of families with problems might harm their children and it was the responsibility of social workers to support these families and protect the children. The political and social system accepted that children at risk needed services and was prepared to validate the social work role and support the idea of resources being made available to this group of families. In recent decades public confidence in the child protection system has declined and there has been a growing challenge to the legitimacy of social work intervention.

It is in the interests of everyone that children's services acts lawfully when fulfilling statutory duties. The threshold for 'significant harm' used in care proceedings can be understood by reference to facts that can be proved in court on the balance of probabilities. The tension between children's rights and parents' rights was played out in a court case in 2009 about a child who was subjected to physical punishment and social workers regarded this as significant harm. Care proceedings were commenced and three children were placed with foster parents. However, the family court decided the physical punishment did not reach the threshold for 'significant harm' here.

The basic facts of the case are that the girl was kicked and slapped by her parents and the court concluded that while this amounts to ill-treatment and harm it did not reach the threshold for 'significant harm' and the care proceedings were therefore dismissed. The guardian-at-litem then made a legal challenge to the decision but the case was upheld by the Appeal Court, although one of the three judges gave a dissenting judgment saying that he would have allowed the guardian's appeal.

The Appeal Court judgment stated 'It sounds terrible. It could speak of a persistent campaign of abuse causing real suffering. But it could equally amount, in fact, to no more than a handful of isolated minor acts of chastisement forgotten as soon as administered.' Essentially, it appears that if harm is repeated throughout childhood it is deemed serious but a small episode of harm, followed by support and recognition which helps recovery, was not deemed significant in this case. It appears that other areas of the child's life in her family had been assessed as more-or-less satisfactory. This case is unusual in the way it sets the dividing line between harm and significant harm, whilst also reflecting the differing views that exist within society.

Obviously, some events that come to the attention of social workers clearly indicate 'significant harm' e.g. a child has suffered physical harm which is medically confirmed as suspicious, or a child has made a disclosure of abuse or neglect. However, when considering the actual harm suffered by the child social workers need to place their suspicions about an incident within the context of all the other information known to them about the child and family.

The current practice framework for professionals requires that any potential harm to children must be identified and safeguarding measures put in place. However, social workers may be reluctant to make the decision that the level of harm is 'significant' and a threshold has been crossed. Furthermore, managers considering cases which are on the borderline of 'significant harm' may be more concerned with containing concerns than recognising that a more active, or decisive, approach may be necessary to protect the child.

Although social work intervention with children is structured to carry out assessment of 'risk' as well as 'need' the favoured practice model for ongoing work with families is supportive and strengths-based and primarily concerned with helping parents meet their children's basic needs. This approach is assumed to be consistent with social work values. However, in reality it can be difficult for social workers to avoid looking at the fitness of each of the parents to provide satisfactory parenting. If one of the aims is to reduce risk of harm this can only begin if the social worker can develop an understanding of the parents and how their personal difficulties impact on their parenting. If parents are resistant to change social workers may have to be very explicit about what needs to change and how this might be achieved. It is often the social worker's ongoing interest in the family, and care shown to them, that enables parents to sustain a commitment to addressing their problems.

There are concerns that current social work practice tends to exaggerate the efficacy of therapeutic work with parents. Many adults with children have had experiences during their formative years of care needs not being adequately met by their own parents. Although children can achieve a good adaptation by finding other people who can meet their needs, the traces of unsatisfactory early experiences can often be found in their adult identity or personality. The consequences of any earlier deficiency are only partially reversible and the process of psychotherapy for parents who are thought to need this would probably be experienced as too unsettling for them to commit to this. On the other hand, therapeutic help that is targeted on a psychological problem that a parent acknowledges e.g. addiction or aggression, can often be effective.

In the current environment in which new types of abuse are continually emerging children's services can be seen as acting 'like a rabbit caught in the headlights' when faced with something unfamiliar. In a recently publicised case of a mother who suffered from 'factitious disorder', and who fabricated symptoms of illness in her two children which led to unnecessary and potentially harmful medical care, the judge criticised the local authority for showing alarming ineptitude, neglecting the case and missing opportunities to intervene over many years here.

The three most common concerns that social workers deal with are domestic abuse, mental health issues and substance misuse and there is often a complex interaction between all three. Families presenting these concerns cannot be worked with effectively by any single agency and usually require input from a multi-disciplinary team that can work intensively with the whole family. However, the team often faces considerable challenges owing to the way that conflicts in the family may get played out within the professional team. The way these conflicts are resolved in the professional system may replicate the family dysfunction and may be insufficiently child-focused. An example of a dysfunctional professional system is shown by the case of 21-month-old Ayeeshia-Jayne Smith. It appears that professionals focused their attention on the risks to the family from male violence and consequently the multi-agency risk assessment conference (MARAC) held the day before her death failed to make an accurate assessment of the risks to the child from her mother. Social workers also showed significant confusion about the implications of the supervision order on the child and their role in monitoring risk Serious Case Review - Staffordshire News.

There is an urgent need for a good 'front-door' service that fully protects children here - particularly in authorities where current arrangements do not give referrers a satisfactory professional response. Social workers may find the notion of the 'cry for help' useful in this context. Sometimes a referral to children's services can be thought of as a 'consultation' and allows the referrer to offload anxieties onto an understanding social worker and feel reassured that everything possible is already being done. However, if it is a genuine 'cry for help' local authorities have a duty to ensure that urgent help is provided. However, it seems that in some authorities serious child protection referrals are not always recognised as such, or decisions made are not acted upon. The creation of a centralised social work team with responsibility for formal investigations of child abuse and neglect, under section 47 duties, could raise standards of practice and has many advantages over the Multi-Agency Safeguarding Hub (MASH).

There is little consistency across different local authorities about the use of legal powers to reduce harm. Current practice guidance does not provide the necessary clarity about thresholds and this may be the reason for different 'custom and practices' developing in different local authorities. It appears that there has been a sustained re-conceptualisation of the section 47 duty and abandoning of social work training for it. Children's services has a moral imperative to use a formal child protection approach when the informal approach has been unsuccessful. Parents who are in denial about their problems should be helped to understand the legal duty on social workers to investigate suspected abuse and neglect and the reasons for professional judgements being made about them.

The government recognises that standards of child protection practice must be raised. It is hardly surprising that social workers struggle with the dilemmas when there is so little agreement in society about how to deal with child maltreatment and so much uncertainty about what works. Resources for children's services are not going to increase and priority should be given to raising standards of social work practice in formal child protection work, with resources for this complex work being ring-fenced. Improving professional competence in drawing the line for 'significant harm' throughout the multi-agency system would also have a crucial influence on the effectiveness of social work practice.

Hilary Searing