Effective Child Protection Practice

It is absurd that social work has accepted the complex task of protecting children at serious risk and in greatest need while at the same time failing to develop a coherent theory to make sense of what it is trying to do. Training courses have developed a mish-mash of theories to accommodate the disparate tasks given to the profession but the absence of a relevant theory of change means that there is a huge gulf between what social workers are taught and the realities of their encounters with families. There is hardly any recognition that there are different kinds of change and many unspoken assumptions about how it can be achieved.

There are two problems with the current approach to child protection which never get addressed. The first is the obligation on the social work profession to define what it is they do - it is the study of the task that makes it professional and teachable. The other is a sense that the practice framework developed by the profession seems to assume social workers simply act on behalf of their clients and do not have a broader duty to society. When social workers say that the families they are dealing with simply need understanding, not controls, they reveal a blind faith in keeping families together at all cost. This can have tragic consequences - not only for children who unfortunately die but also for children whose parents make them feel unlovable, unworthy and flawed. Society recognises that some parents cannot be helped and some children may even need to be rescued. The profession therefore has an obligation to show society that it has a balanced and responsible approach to risk in child protection.

The competence with which the child protection plan is handled has a crucial influence on the effectiveness of subsequent work but, unfortunately, local authorities do not really understand the child protection plan. Their policies to reduce the number of child protection plans seem to be based on an assumption that they are little more than a stigmatising, bureaucratic exercise. Instead, they should be seen as an important social work tool for child protection work which is underpinned by all the principles of working in partnership and building a positive relationship with children and their families.

In the context of current policies to reduce the number of children in care I will show how ideas from psychotherapy, family therapy and attachment theory can make sense of the social work task and inform professional thinking about how to respond constructively to aspects of parenting that cause concern. Psychoanalytic theory can also help social workers who struggle to understand the apparently irrational behaviour of some people they work with.

Dual Roles

In their everyday activities social workers try to bring hope and optimism to often the most hopeless and despairing people in society through the use of relationship-based work. However, they often struggle to work effectively to address family dysfunction. Many children known to them are suffering psychological impairment, or even significant harm, and it is often the corrosiveness of long term emotional, physical and occasionally sexual maltreatment that is causing this. Social work practice with this group of children is very complex and challenging.

Social workers with statutory duties perform a difficult balancing act - between protecting children from harm and avoiding unwarranted intervention into family life. Situations are often construed as dilemmas to be resolved in favour of one alternative or the other. On the one hand, the profession assumes that social workers can work effectively using a model of practice that is driven by a focus on need and a non-judgemental approach. On the other, the employing organisation recognises that social workers are officers with statutory responsibilities who must also think about risk and make difficult professional decisions. Social workers must grasp this tension within their role and use it as an important opportunity to work with the family - requiring the social worker to be able to hold the apparent contradictions, avoid unnecessary labelling and engage the family in constructive work.

Child protection work operates within the context of a legal system where evidence is scrutinized and challenged. Social workers also have to give an account of their work and their views to managers and conferences. When legal considerations arise the binary thinking of the law is often at odds with the holistic thinking of social work practice. This can take decision-making in a more authoritarian direction and even allow unethical practices to take place. All of this shows how important it is that social workers have a strong professional identity based on the highest possible standards of practice and underpinned by knowledge of legal thresholds.

Social work practice has tried to move away from the label 'child protection', which it perceived as blaming and punitive, to one of 'safeguarding'. This was well intentioned but it added another layer of uncertainty to the social work task and complexity to professional judgement. Furthermore, the protection of children from significant harm has become an increasingly contested area of work and sometimes social workers face parental resistance to the possibility of any kind of collaborative work. In these situations it is essential that social workers understand their legal duties, recognise when circumstance justify further action and reach sound judgements. This is profoundly important in view of the risks to children if mistakes are made.

A fundamental principle of good child care practice has always been that the personal welfare of the child is paramount. During the 1980s, after a series of scandals, the child care service was gradually transformed into a service dominated by child protection, with a much greater emphasis on procedures. The Children Act 1989 introduced greater complexity into the law, with its new concepts of ‘parental responsibility’ and 'significant harm' and the duty on authorities to work in partnership with parents. Since then the concept of risk to children has been expanded and statutory duties placed on all agencies to safeguard children. As a consequence of these changes problems in families are possibly picked up at an earlier stage but an important distinction between 'early intervention' and 'child protection' has been lost.

Relationship-based Work

Social workers doing ongoing work with families should be familiar with a range of practice models based on 'the use of the relationship' that support personal growth and development. They need the skills to incorporate elements of both care and control in their work and use their judgement with confidence as they move between these two positions - helping and supporting the family and protecting the children. In the past psychoanalytic theory was seen as offering insights into child welfare work - but has fallen out of favour. I believe it should be brought back into use.

Good Enough Parenting

The pioneering psychoanalyst Donald Winnicott recognised the mother's contribution to society when he formulated the concept of 'good enough mothering' and the part played by the 'ordinary devoted mother' in giving her child a good start in life. His ideas about the centrality of the mother-infant relationship for the future wellbeing of the child are key ones for social work - though we now avoid gender stereotyping. The term 'good enough parenting' is still used in a reassuring way with parents, recognising that it is unhelpful and unrealistic to demand perfection of them, but at the same time recent policy initiatives have brought more families into the orbit of children's services. Consequently, there is now a perception that social work practice has become more judgemental and has lost touch with the understanding and reflective approach of Winnicott.

Early Child Development

Winnicott believed that during the pre-verbal stage a baby goes through a critical stage in its development, which has a lasting effect on its emotional development. If all goes well an infant gradually learns to manage its instinctive feelings and impulses and begins a gradual process of developing a sense of self, giving the child a sound basis on which to relate to others in the social world. During the first five years of life a process of 'integration' also takes place in which pleasure in self-expression is contained by external realities. However, unsatisfactory care during these years can give rise to a self built on weak foundations and the growing child either being prone to primal fears or anxieties, unable to relate positively or securely with parental figures, or developing a false self built on compliance, which is equally unsound as a basis for relationships. Winnicott argued that society should support the early infant-child relationship and ensure parents provide a 'good enough' environment so that children grow and develop into adults who have a fundamentally healthy orientation towards self and others. Any deprivation in the quality of care, affection and interaction suffered by the child in early life can have a negative effect on the child's subsequent development, leading to low self-esteem and poor mental health in adult life.

Psychoanalytic thinking from Winnicott and many others has been hugely influential, ensuring that practices are informed by therapeutic insights into the value of early intervention. This has almost certainly contributed to the large rise in the number of initial assessments carried out on children under five by children's services. The policy was intended to be non-judgemental and preventative but one of the consequences of it has been that irresponsible parents are being identified earlier and more babies are being removed at birth, leading to a perception that social workers have become too risk averse.

The family today has been reduced in its function as most women are at work and different forms of family life emerge. It now places less emphasis on the stable home base as the place for the nurturing and socialising of children. Furthermore, some parents are happy to let other people provide the care and education that their children need and may have a limited notion of what parenting means, although most parents want to offer their child a caring relationship. It is often the case that parents who receive social work help tend to be those who, due to their family circumstances or lack of resources, are struggling to provide the care and/or parenting that is necessary to promote their child's wellbeing and safety.

Safeguarding

The current safeguarding system, comprising of a multi-agency network around the family, performs an important function in identifying need and risk. In this work the model of social work practice with families tends to be supportive, strengths-based and non-judgemental. The team around the child works together to identify needs and to find ways of helping the family. It is sometimes apparent that the parents grew up in less than ideal families themselves and consequently their internal framework for judging what is 'good enough' is under-developed. Social workers who offer whatever support and practical help is required to enable these parents to care for their children better may find their intervention is sufficient to raise standards to a 'good enough' level.

Unfortunately, the quality of risk analysis underpinning social work assessments is not of consistently high standard and, although child in need plans are generally child-focussed, social workers do not always take sufficient account of the impact that the adults’ behaviours have on their children. Social workers may therefore need to be more confident and reflective when working with families who have not asked for help and skilled in setting out more clearly their professional analysis of risk and needs.

Child Protection Investigation

If there is reasonable cause to suspect that a child is suffering, or is likely to suffer significant harm, a section 47 inquiry is required and a strategy meeting must be held to collate information and carefully plan the investigation. The process of investigation is often very stressful for professionals and family members. For a significant proportion of parents this is when they first hear of any suspicions, or an allegation, and many experience shock, confusion, anger and the onset of profound feelings of anxiety. Social workers often underestimate the impact of the investigation on parents and may have a tendency to view an initial, defensive reaction as fixed.

The question of whether a child is suffering significant harm may then be discussed at an initial child protection conference. Parents who attend this have often said they have felt intimidated, embarrassed and humiliated by the way professionals discuss their family. During this process of inter-agency sharing of professional knowledge decisions are made - although dilemmas about the most effective form of intervention may continue. The conference may decide that further work is necessary to gather information about possible risk to the child. If the conference recommends a child protection plan this is often something parents feel obliged to accept.

The Child Protection Plan

The child protection plan is an appropriate tool for focusing the necessary resources on protecting the relatively small number of children actually at risk of significant harm. The complex nature of social work practice under a child protection plan should not be underestimated. This gives the social worker, as key worker, the authority to speak directly to the family about concerns and say things that others have possibly felt unable to say. Social workers who are open and explicit about what they are trying to do have a greater chance of achieving a genuinely collaborative relationship with parents.

The child protection plan is a structured, multi-agency approach to reducing the risk of maltreatment and improving the wellbeing of the child. The social worker has oversight of this work, assumes lead responsibility for child protection and normally undertakes direct work with the child and family. Good organisational conditions must be in place so that social workers are supported in achieving consistently good standards of practice in this important area of work.

The social work task is often made more difficult because social workers find themselves working in a hostile climate a great deal of the time. Parents often find the experience of their child being on a child protection plan makes them feel uncomfortable. They are often acutely aware that their parenting is being judged and initially feel disbelief and anxiety. The social worker requires considerable skills in getting alongside the family, understanding their difficulties, offering help and keeping a watchful eye on the children. A major preoccupation of the social worker will be that of thinking about the nature of change within the family. This could of course feel threatening to the parents.

Applying psychoanalytical thought to the relationship between the social worker and parents can provide new understanding. Psychoanalysis recognises the central importance of the unconscious in adult life and the persistence of infantile conflicts. The concept of 'defence mechanisms', psychological strategies that are unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings, is useful. For example, parents who feel they were not well parented themselves often invest emotionally in their own children and want to give them whatever was missing in their own childhood. When their child is put on a child protection plan they may feel a profound sense of failure and display defensive responses to the work the social worker is trying to do. These might include open hostility, avoidance of reality, estrangement from reality, devious and manipulative behaviour or an overwhelming sense of despair and hopelessness. The anxieties of social workers on the receiving end of these feelings will lead them to also make use of defences. Reflective supervision can be helpful in managing these feelings and thinking about the possibility of some kind of collaborative approach to addressing concerns.

In cases of neglect and emotional harm it is possible that some low-level concerns will be apparent to the social worker during home visits and the most constructive response would be to offer immediate advice and support to the parents in a matter-of-fact, non-judgemental way. By giving information about practical matters such as aspects of health and safety within the home, the child's needs regarding diet, personal hygiene and dental hygiene, the social worker would simply be acting in the best interest of the child.

In families where the level of neglectful and irresponsible parenting may actually be causing harm to the child but this does not meet the threshold for care proceedings a longer period of work under a child protection plan may be necessary. A strong focus should be on giving personal support and understanding to the child and identifying his or her need for community resources. Sometimes the level of deprivation and neglect has already caused the child to be so emotionally damaged that the child's capacity to communicate complex and disturbing feelings in words is under-developed.

An example of this can be seen in the case of Daniel Pelka who suffered cruelty and extreme neglect and was murdered in 2012 at the age of four by his mother and her partner. Although social workers had been involved with the family the case was never treated as child protection, despite the presence of numerous risk factors, including a chaotic lifestyle, many house moves, and numerous incidents of serious domestic abuse and violence within the home. However, if a child protection plan had been put in place, a comprehensive assessment carried out and core group meetings held, the outcome might have been very different. These measures would have enabled professionals to take Daniel's cries for help, in the form of stealing food, more seriously. His teachers would possibly have helped him to speak about what was happening at home and triggered more effective social work intervention. With hindsight it is easy to see that social workers had grounds for a child protection plan with this family. This would have been more effective than their incident-focused response to concerns, which failed to develop strategies for achieving the changes necessary for Daniel's safety.

Social Work With Parents

When a child is deemed to be a 'child in need' the measure of need recorded is often a parental one i.e. substance or alcohol misuse, learning disabilities, mental ill-health, physical ill-health or domestic abuse. The social worker obviously has to think very carefully about the quality of parenting and the underlying family difficulties. It is not unusual to find parents who are under stress and feeling overwhelmed. An understanding social worker may offer hope of finding a way out of their difficulties.

In ongoing work with families professionals must guard against allowing inter-agency child protection work that assumes a narrow focus on supporting parents and an unthinking, passive acceptance of poor parenting. In reality, if the child is on the borderline of 'risk of significant harm' it is inevitable that, if an incident takes place which raises more serious concerns, consideration should be given to commencing legal proceedings.

Social workers sometimes want parents to attend a parenting class. However, in reality, the possibility of teaching parents if they have little interest in learning in a group setting is low. Real learning is more likely to take place when the parent discovers something from their own experience. Sometimes it can be beneficial to introduce a support worker into the family to work on specific parenting issues - whose role is quite distinct from that of the social worker.

Social workers often deal with situations in which family dysfunction is a consequence of one or both parents suffering from a mental illness, such as a depressive or psychotic illness, bipolar disorder or personality disorder. The child protection plan will include information about the precise nature of the specialist help being offered. If depression is identified as problem a referral to a counsellor, or therapist, might be considered and this may give a parent the opportunity to address unresolved issues from the past. It should be recognised that therapy can stir up painful feelings, and may even affect parenting capacity, despite the fact that working at this level may be beneficial in the long term.

The concept of the 'treatment barrier' by R.D.Scott here describes a process which occurs when symptoms are labelled as an 'illness' and a clinician is given responsibility for treating the illness. Scott offers a critique of campaigners who use vague notions of therapy to demand that the health service should provide 'treatment' for a mentally ill parent instead of removing the child. They often underestimate the formidable task of treating someone who is clinically ill.

Family therapy looks at the family as a system - in which patterns of relating repeat themselves and rigidity in the system means the family does not function well in meeting the developmental needs of individual family members. In this approach the process of growth and change is often dependent on people becoming aware of themselves as active players in relationships that do not serve their needs and which may impair their health and development. This way of working can be appropriate for a range of family relationship difficulties, with the therapist joining the family as a facilitator helping the family system moving forward in accordance with the child's developmental needs. In families where the parents dispute professional allegations of child abuse the focus of family work is often on working with the denial - as in the Resolutions Approach here and this can assist in the process of decision-making.

Attachment Theory

Attachment has long been seen as significant in child development and attachment theory and research can offer insights into parent-child interactions. However, social workers must take care with the application of this theory because they will invariably bring subjective feelings about attachment from their own personal lives to practice here. Keeping the child within the family is seen as central to child welfare work but child protection work is often dealing with attachment that has gone wrong. Obviously, in their work with looked after children social workers need to keep in mind information about the child's background - as this can enable them to develop an understanding of the impact of any adverse experiences suffered by the child in the past.

Attachment normally starts from the moment of birth and continues with a process of learning to find pleasure in self-expression and discovering how to feel at ease away from attachment figures and confident out in the social world. Although an understanding of the place of attachment in child development is important it should not be forgotten that genetic predisposition and personality are also factors which can make it difficult for a satisfactory attachment to take place between infants and parents. An approach that includes observation of the dynamics of parent-child relationships within the family home is usually required during an assessment.

A good parent tends to give the child the benign illusion that the child relates to the parent as an equal. However, problems can arise when a parent has an unconscious need for the child to satisfy something unresolved in their psyche and relates to the child more as a friend - rather than based on recognition of their adult responsibilities and the very different positions of the parent and child. This may even lead to the development of a symbiotic relationship in which each feed off the other emotionally and the child fails to develop a separate identity.

Another type of unhealthy attachment can happen when parents have a limited capacity to become emotionally attuned to their child's needs, due to stress factors in both their inner and outer worlds. Furthermore, if the child experiences an absence of any real parental influence or authority in the home there may be a risk that the child grows into an emotionally troubled and anti-social young person. Research has found that a negative parenting style characterised by harsh and inconsistent discipline is clearly associated with anti-social behaviour here. This link remained true even after a range of child and family socio-economic factors were taken into account.

It is not difficult to imagine what it might be like for a child growing up in a chaotic and abusive family. If a child or young person later presents violent behaviour this needs to be recognised as displaying a compulsive re-enactment to what was once done to the child by attachment figures. This points to the importance of providing robust, early intervention in what are often unstable families, where boundaries are inconsistent, discipline is harsh and there is little interaction between parent and child of a positive and affectionate quality.

Social work intervention to interrupt the inter-generational cycle of harmful parenting can be very challenging. Social work practice has to recognise that a wide range of socially acceptable models of family life now exists. An understanding of the precise nature of any relationship difficulties is necessary in order to spot situations that cause stress to children and put them at risk of developing emotional and behavioural problems. Public opinion is divided over the question of whether a ban on the physical punishment of children would be effective in producing a decrease in child maltreatment in society. However, I believe that it would and this is one way in which the social work task is made easier by a change in the law.

Appropriate Use of Authority

The large number of children now being referred to children's services is something that some people find difficult to reconcile with social work values. There seems to be a great deal of moral confusion about whether middle class social workers should assess and manage the family problems of disadvantaged people whose children present troubled and challenging behaviour. There is often a sense that social workers view their role primarily as supporting children to stay within their family and community. Ambivalence about the use of authority is deeply embedded within the profession.

Any discussion of effectiveness in child protection raises philosophical questions about the function of social work for society. One of the aims of state intervention into family life is to establish an environment in which a child can grow up free from violence of any kind. Social work has a central role in the delivery of services to achieve this aim.

Conclusion

In child protection work an essential aspect of the work is about recognising the 'cry for help'. This way of interpreting behaviour is non-judgemental and opens up the possibility of working constructively with the person in need. However, the help offered may or may not be what is expected and may or may not be welcome. The challenge for social workers is to recognise the cry for help and to think carefully about how to respond.

Hilary Searing