Health and Social Care Essay
Health and Social Care
We acknowledge with sincere thanks the many people who gave generously of their time to help us with this work. We particularly appreciate the expertise and advice o? ered by Arnon Bentovim, Richard Velleman, Lorna Templeton, Carolyn Davies and Sheena Prentice. The work has been funded by the Department for Education and we thank sta? in the department, particularly Jenny Gray who supported us throughout the work with her interest and valuable comments.
The work was assisted by an advisory group whose membership was: Isabella Craig and Jenny Gray (Department for Education); Christine Humphrey (Department of Health) and Sian Rees (NICE); Arnon Bentovim (consultant child and adolescent psychiatrist at the Great Ormond Street Hospital for Children and the Tavistock Clinic); Marian Brandon (reader in social work, University of East Anglia); Carolyn Davies
(research advisor, Institute of Education, University of London); Jo Fox (social work consultant, Child-Centred Practice); David Jones (consultant child and family psychiatrist, Department of Psychiatry; University of Oxford); Sue McGaw (specialist in learning disabilities, Cornwall Partnership Trust); Sheena Prentice (specialist midwife in substance misuse, Nottingham City PCT); Wendy Rose (The Open University); Lorna Templeton (manager of the Alcohol, Drugs and the Family Research Programme, University of Bath); and Richard Velleman (University of Bath and director of development and research, Avon and Wiltshire Mental Health Partnership NHS Trust). Introduction This second edition of Children’s Needs – Parenting Capacity provides an update on the impact of parental problems, such as substance misuse, domestic violence, learning disability and mental illness, on children’s welfare. Research, and in particular the biennial overview reports of serious case reviews (Brandon et al 2008; 2009; 2010), have continued to emphasise the importance of understanding and acting on concerns about children’s safety and welfare when living in households where these types of parental problems are present.
Almost three quarters of the children in both this and the 2003-05 study had been living with past or current domestic violence and or parental mental ill health and or substance misuse – often in combination. (Brandon et al 2010, p. 112) These concerns were very similar to those that prompted the ? rst edition of this book, which was commissioned following the emergence of these themes from the Department of Health’s programme of child protection research studies (Department of Health 1995a). These studies had demonstrated that a high level of parental mental illness, problem alcohol and drug abuse and domestic violence were present in families of children who become involved in the child protection system. Research context
The 2010 Government statistics for England demonstrate that, as in the 1990s, only a very small proportion of children referred to children’s social care become the subject of a child protection plan (Department for Education 2010b). However, the types of parental problems outlined above are not con? ned to families where a child is the subject of a child protection plan (Brandon et al. 2008, 2009, 2010; Rose and Barnes 2008). In many families children’s health and development are being a? ected by the di? culties their parents are experiencing. The ? ndings from research, however, suggest that services are not always forthcoming. Practically a quarter of referrals to children’s social care resulted in no action being taken (Cleaver and Walker with Meadows 2004).
Lord Laming’s progress report (2009) also expressed concerns that referrals to children’s services from other professionals did not always lead to an initial assessment and that ‘much more needs to be done to ensure that the services are as e? ective as possible at working together to achieve positive outcomes for children’ (Lord Laming 2009, p. 9, paragraph 1. 1). Practitioners’ fear of failing to identify a child in need of protection is also a factor driving up the numbers of referrals to children’s social care services which result in no provision of help. ‘This is creating a skewed system that is paying so much attention to identifying cases of abuse 2 Children’s Needs – Parenting Capacity
and neglect that it is draining time and resource away from families’ (Munro 2010, p. 6). Munro’s Interim Report (2011) draws attention once again to the highly traumatic experience for children and families who are drawn into the Child Protection system where maltreatment is not found, which leaves them with a fear of asking for help in the future. A ? nding which was identi? ed by earlier research on child protection (Cleaver and Freeman 1995). Evidence from the 1995 child protection research (Department of Health 1995a) indicated that when parents have problems of their own, these may adversely a? ect their capacity to respond to the needs of their children.
For example, Cleaver and Freeman (1995) found in their study of suspected child abuse that in more than half of the cases, families were experiencing a number of problems including mental illness or learning disability, problem drinking and drug use, or domestic violence. A similar picture of the di? culties facing families who have been referred to children’s social care services emerges from more recent research (Cleaver and Walker with Meadows 2004). It is estimated that there are 120,000 families experiencing multiple problems, including poor mental health, alcohol and drug misuse, and domestic violence. ‘Over a third of these families have children subject to child protection procedures’ (Munro 2011, p. 30, paragraph 2. 30).
Children’s services have the task of identifying children who may need additional services in order to improve their well-being as relating to their: (a) physical and mental health and emotional well-being; (b) protection from harm and neglect; (c) education, training and recreation; (d) the contribution made by them to society; and (e) social and economic well-being. (Section 10(2) of the Children Act 2004) The Common Assessment Framework (Children’s Workforce Development Council 2010) and the Assessment Framework (Department of Health et al. 2000) enable frontline professionals working with children to gain an holistic picture of the child’s world and identify more easily the di? culties children and families may be experiencing. Although research suggests that social workers (Cleaver et al.
2007) and health professionals are equipped to recognise and respond to indications that a child is being, or is likely to be, abused or neglected, there is less evidence in relation to teachers and the police (Daniel et al. 2009). The identi? cation of children’s needs may have improved, but understanding how parental mental illness, learning disabilities, substance misuse and domestic violence a? ect children and families still requires more attention. For example, a small in-depth study found less than half (46%) of the managers in children’s social care, health and the police rated as ‘good’ their understanding of the impact on children of parental substance misuse, although this rose to 61% in relation to the impact of domestic violence (Cleaver et al. 2007).
The need for more training on assessing the likelihood of harm to children of parental drug and alcohol misuse Introduction 3 was also highlighted by a survey of 248 newly quali? ed social workers (Galvani and Forrester 2009). A call for more high-quality training on child protection across social care, health and police was also made by Lord Laming (2009). Munro’s review of child protection in exploring ‘why previous well-intentioned reforms have not resulted in the expected level of improvements’ (p. 3) highlighted the ‘unintended consequences of restrictive rules and guidance’, which have left social workers feeling that ‘their professional judgement is not seen as a signi?
cant aspect of the social work task; it is no longer an activity which is valued, developed or rewarded’ (Munro 2010, p. 30, paragraph 2. 16). The experience of professionals providing specialist services for adults can support assessments of children in need living with parental mental illness, learning disability, substance misuse or domestic violence. Research, however, shows that in such cases collaboration between adults’ and children’s services at the assessment stage rarely happens (Cleaver et al. 2007; Cleaver and Nicholson 2007) and a lack of relevant information may negatively a? ect the quality of decision making (Bell 2001). An agreed consensus of one another’s roles and responsibilities is essential for agencies to work collaboratively.
The evidence provided to the Munro review (2011) found ‘mixed experiences and absence of consensus about how well professionals are understanding one another’s roles and working together’ and argues for ‘thoughtfully designed local agreements between professionals about how best to communicate with each other about their work with a family… ’ (Munro 2011, p. 28, paragraph 2. 23). Although research shows that the development of joint protocols and informationsharing procedures support collaborative working between children’s and adults’ services (Cleaver et al. 2007), a survey of 50 English local authorities found only 12% had clear family-focused policies or joint protocols (Community Care 2009).