Panorama: the child protectors

by endlesspsych

Last night on BBC one panorama featured Coventry’s social work child protection team as they tried to identify which children under their charge were at risk of abuse, neglect and the like. It scored many points on how it presented social workers as human beings as opposed to child snatching representatives of the nanny state, but didn’t really mention much about how social workers identify and assess risk. Perhaps understandable as it’s a reasonably technical area of research (in some cases at least). Given this is my area of research I figured I pretty much have to blog about it.

The United Nations convention on the Rights of the Child Article 12 (1989) states:

“Young people have the right to consent to treatment and have the same right to confidentiality as adults”.

When faced with a sexually active young person, health professionals have to balance their statutory responsibility to protect the person from harm, while simultaneously respecting the rights demanded by the UN Convention. The discharge of this responsibility rests on a complex professional judgement of both the level of risk to which the young person is exposed, and the level of competence which the young person possesses, and to how these two assessments interact.  Judgement of the level of competence is based upon the practitioner’s assessment of the young person’s maturity and understanding.    This judgement then requires the practitioner to make a decision on the appropriate course of action, while being mindful of all potential consequences of all possible courses of action. Levinson and Morin (2006) have found that risk factors  fall into several broad categories including child characteristics, parental characteristics, environmental factors and parent-child interactions.

Child in Corridoor hugging Knees

Some Children unfortunatly need protecting

Variables identified as being predictive of child sexual abuse include age and vulnerability of child and perpetrators access to the child (Weedon et al 1988). Unlike physical abuse and neglect cases child sexual abuse cases present unique and ambiguous indicators to the investigating professional (Levinson and Morin, 2006) sexual abuse occurs and thrives in secrecy and children maybe unlikely to report abuse by family members or caregivers because of fear, loyalty to the abuser of the belief that they have contributed to the abuse (Summit, 1983). Children will also often recant allegations they have made when they see the disclosure has caused a crisis for the family (Summit 1983). Children often find sexual activity confusing and embarrassing and this leads them to frequently disclose abuse in an unconvincing fashion, statements are often tentative, contradictory and minimizing (Sorenson and Snow 1991).

Child protection assessment and decision-making confronts practitioners with noisy, unclear and uncertain information meaning that making risk assessments and decisions in child protection can be highly complex.  Above and beyond the characteristics of the case under consideration time and emotional pressures can also affect the risk assessment and decision-making process as can the previous experiences of the practitioner.  This renders the judgement of risk  and decision for action particularly suitable for study within Social judgement theory (SJT)/risk assessment decision making (RADM) theoretical framework.

The method of SJT has grown to be applied in diverse ecological situations and to assess a variety of judgment domains: educational decision-making (Cooksey 1988; Heald 1991; Snow 1968; Shulman and Elstein 1975), medical and health related decision-making and ethics (Byth 1992; Flynn 1994; Slovic, Rorer and Hoffman 1971; Smith and Wigton 1988; Wigton 1988) accounting and auditing (Libby 1981; Waller 1988) risk judgments (Earle and Cvetkovich 1988) and social welfare judgments (Dalgleish 1988).

SJT is well suited to the areas of medical judgment and risk assessment as these areas present judges with an abundance of fallible cues and ask them to make decisions based upon uncertainty (Wigton 1996). This type of ecological situation could be considered a “wicked environment” (Hogarth 1995) as it offers unclear and ambiguous information on which to base a judgment.  In many ecological situations and areas risk assessment is rarely straightforward and practitioners have to be wary of making type I or type II errors.

Among contemporary risk assessment systems the Risk Assessment and Decision making Model is unique as judgments about the amount of risk a particular case presents are separate from decisions about whether this risk is acceptable. As such it links judgment and decision-making. (Dalgleish 1997)

Every decision maker has a threshold of acceptable risk, if a risk assessment falls under this no action is taken and action is taken if the assessed risk exceeds this threshold. In the general RADM model there is an underlying judgment dimension for each key decision point mentioned above.  The decision is made on whether or not the practitioner believes that the strength of evidence is enough to indicate maltreatment or abuse. Here the distinction between judgment and decision becomes important as it is the practitioners threshold for acceptable risk coupled with their risk assessment of the current case that leads them to judge action or inaction (in this case a child protection referral) appropriate. A low threshold would indicate a practitioner would judge action appropriate in cases where there is relatively low risk and a high threshold would indicate more ‘risk’ (or a higher level of concern) could be tolerated. Dalgleish (1997) suggests that the latter is more cautious by nature of its “wait and see” approach however that perhaps presupposes that practitioners suppose a greater risk by taking action than not taking action.

To my mind the focus of the program on the number of cases a social worker should undertake was misleading, as I don’t hold that there is a magic, essentially arbitrary, case load that will somehow improve the social workers ability to perform a judgement of risk. Factors such as past experience and personal politics are much more likely to influence a social workers judgement threshold and correlate much more strongly with whether they make a correct or incorrect child protection decision.  Although I concede that a lower case load has other benefits – such as reducing stress and thus reducing sick leave from what has to be one of the most stressful jobs going. Certainly the qualitative data I have gathered in the course of my research would turn a few stomachs and horrify even the most stone hearted of folks.

However my worry is that cases like Baby P resonate so much with the public, and social workers, health practitioners and anyone else who might make a child protection decision, that it makes that extremely rare type of abuse seem more likely. People become more risk averse and start making decisions at a much lower perceived level of risk.  There is thought to be a pendulum that swings back and forth in sway with public opinion and highly emotional events such as the tragic death of Baby P. Events such as the Orkney “satanic panic” indicate how external influences can affect practice – with children being removed on the pretext that they were suffering ritual abuse. A cursory glance at the descriptions of ritual abuse should indicate the ridiculousness of the accusations but it was a genuine fear and panic for many.

Since the Satanic panic was debunked there has been, arguably, a lowering of judgement thresholds – as instead of being risk averse those involved in child protection may have become slightly scandal averse – erring on the side of preserving the family as oppossed to child protection and not removing children as often. (I stress this is not intended as  a criticism of social workers risk assessment but rather an attempt to show how judgement is affected by external situational factors.) I strongly suspect that as the scrutiny on child protection services increases we will see more referrals, more children removed and more families split up. This will increase the number of people who are saved from abusive or neglectful situations but will also increase the number of false positives. Children removed from families who needent of been. Some may say “so what” it’s better a few mistakes are made in order to protect as many children as possible but the outcomes for children who grow up in care are, unfortunatly, less then rosy. Not saying for one minute that growing up in care is an inhernently bad thing but statistically the kids who do are likely to have much harder lifes then if they were left with their families.

Anyway that’s my take on the matter. Hope it stimulates some debate.