The Need for Social Work Intervention: A Discussion Paper for the Scottish 21st Century Social Work Review

SECTION TWO: SOCIAL WORK WITH CHILDREN AND FAMILIES

2.1 THE 'POLITICAL' CONTEXT

This section looks at the need for social work and some of the issues outlined above specifically in relation to children and families. Traditionally this has been dealt with as a distinct area of social work. Further, it has attracted wide-ranging attention because of the vulnerability of children, their natural dependence upon adults and sense of outrage when this dependence is neglected or exploited. The intensity of public interest when children in touch with social work suffer extreme harm has led to changes in policy, law and guidance. This intensity determines the context for children and families' work, heightening the inherent tension in making decisions about where to target resources, creating a distinction between promoting and safeguarding children's welfare and increasing anxieties in making judgements about risk.

2 .2 THE NATURE OF SOCIAL WORK WITH CHILDREN AND FAMILIES

Social work with children and families is defined here as activity undertaken by a professionally qualified social worker. It does not include other activities undertaken by or on behalf of a social work department.

Work with children and families must be set within the broader framework of social work as a whole. This blends together knowledge from a range of disciplines: social administration, sociology, psychology, human development, ethics and law. Its practitioners develop working knowledge of systems, organisations and national and local resources. They learn skills in building relationships, communication, advocacy, organisation and administration ( CoSLA et al., 2003). Importantly, underpinning values require its practitioners to develop empathy and respect for people as unique individuals. The British Association of Social Workers' Code of Ethics for Social Work's (2002) value on human dignity and worth states:

Every human being has intrinsic value. All persons have a right to well-being, to self-fulfilment and to as much control over their own lives as is consistent with the rights of others. (p2)

None of these items is unique to social work but the blend offers a particular approach to people in difficulty. Practice experience shows us that, at its best, this approach enables obstacles to be overcome and positive outcomes to be achieved. Social work with children and families is about the whole child in the family, taking account of all the surrounding circumstances.

2.3 NEED AS FRUSTRATED OUTCOMES

2.3.1 Outcomes for children

Desired or desirable outcomes for children are taken as the starting point. For the state the prime focus for work with children and families is the well-being of the children. The Children (Scotland) Act 1995 sets out in section 1(1), '…a parent has in relation to his child the responsibility (a) to safeguard and promote the child's health, development and welfare…' and in section 20(1) (a) requires that local authorities 'promote and safeguard the welfare of children in need in their area (b) so far as consistent with that duty promote the upbringing of children by their families'. More recently, the Commissioner for Children and Young People (Scotland) Act 2003 section 5(3) indicates that 'The Commissioner must, in particular, (a) regard, and encourage others to regard, the best interests of children and young people as a primary consideration'. The crucial contribution of parents' well-being becomes apparent as the discussion proceeds.

'For Scotland's Children' (Scottish Executive 2001a) indicates that by the end of the journey to adulthood each child should have reached his/her potential in terms of emotional and social maturity, be in good health, and have attained a level of academic achievement and other skills. The Scottish Executive's guidance for integrated children's services plans (2004b) sets out seven areas of aspiration for Scotland's children and young people:

• Safe: Children and young people should be protected from abuse, neglect and harm by others at home, at school and in the community.
• Nurtured: Children and young people should live within a supportive family setting, with additional assistance if required, or where this is not possible, within another caring setting, ensuring a positive and rewarding child hood experience.
• Healthy: Children and young people should enjoy the highest attainable standards of physical and mental health, with access to suitable healthcare and support for safe and healthy lifestyle choices.
• Achieving: Children and young people should have access to positive learning environments and opportunities to develop their skills, confidence and self esteem to the fullest potential.
• Active: Children and young people should be active with opportunities and encouragement to participate in play and recreation, including sport.
• Respected and responsible: Children, young people and their carers should be involved in decisions that affect them, should have their voices heard and should be encouraged to play an active and responsible role in their communities.
• Included: Children, young people and their carers should have access to high quality services, when required, and should be assisted to overcome the social, educational, physical, environmental and economic barriers that create inequality.

Similarly, the Westminster government's policy, Every Child Matters ( DfES 2003), sets out five priority outcomes for children and young people:

• being healthy: enjoying good physical and mental health and living a healthy lifestyle;
• staying safe: being protected from harm and neglect; having security and stability and being cared for;
• enjoying and achieving: getting the most out of life and developing skills for adulthood; enjoying school and recreation; achieving national education standards;
• making a positive contribution: being involved with the community and society and not engaging in antisocial or offending behaviour; developing positive relationships; developing self-confidence and dealing with life changes and challenges;
• economic well-being: not being prevented by economic disadvantage from achieving their full potential in life; access to transport and material goods; living in households free from low income.

These choices of outcome reflect to some extent the United Nations Convention on the Rights of the Child. In particular, it is possible immediately to identify the right to be protected from abuse and neglect, the right to the highest level of health possible and to health and medical services, the right to an adequate standard of living, the right to education and the right to leisure, play and participation in cultural and artistic activities.

Further, in its Looking After Children materials ( DH 1995) and Framework for the Assessment of Children in Need and their Families ( DH 2000), the Department of Health set out seven dimensions of development crucial to children's well-being: health, education, emotional and behavioural development, identity, family and social relationships, social presentation and self care skills. These were developed in response to an expanding body of research about what is important for children and concern about how little was really known about the impact of public care on children (ed. Ward,1995). The materials were piloted with parents and professionals and there was assent to the validity of the dimensions.

2.3.2 Obstacles to desired outcomes

In our view there is a range of obstacles that may frustrate the achievement of these outcomes and give rise to need. This approach is implicit in the seventh of the Scottish Executive's (2004b) aspirations, that children should be assisted to overcome barriers that create inequality. In part it is the nature of the obstacle that determines whether or not the need is one which requires/would benefit from social work intervention.

Obstacles may be found at the level of the individual child, the parent(s), family, wider family, community or on account of broader social conditions. A genetic condition or disability caused by disease or accident may prevent a child reaching desired outcomes. The physical or mental ill health of a parent, substance abuse by a parent, the absence of a parent or disharmony in the parents' relationship may impinge on the outcomes for a particular child, as may serious illness or a death in the wider family. Lack of support from wider family and/or friends, living in a community characterised by poverty, crime or anti social behaviour may also have a negative affect on the outcomes for children. Racism or general antipathy to the poor in a society that measures value by economic wealth may further disadvantage children who fall outside the preferred group. A child may be affected by any number of these, and other similar, conditions simultaneously or at different times in childhood. The interplay between the child's developmental needs (categorised into the seven dimensions outlined above), parenting capacity and the environment are recognised in the Framework for Assessing Children in Need and their Families ( DH 2000) as affecting outcomes.

These needs may present in a number of ways. Writing about the matching needs and services method of planning for children in need, Jo Tunnard (2002) helpfully identifies in order of their relative size, 'a fairly typical set of need groups from a local authority audit of children newly referred to social services'. The need groups are:

• for practical support;
• for help to parents to gain confidence in parenting;
• for help with resolving adult conflict;
• for help to ensure children receive better care;
• for help to resolve tension between parents and children;
• for help to deal with emotional problems and mental health issues;
• for support because of a child or parent's illness or disability;
• for help to improve or control a child's behaviour;
• for help to deal with loss or trauma;
• for immediate protection of the child;
• to help parents or older children to stop or reduce a substance misuse; and
• to assist asylum seekers.

Alternatively, the Scottish Executive's Guidance for Integrated Children's Services Plans (2004b) sets out a list of examples of children in need, including some that would fall into Hardiker's level four need, for example children looked after. Others might fall into levels two and three depending on the how far an individual situation had deteriorated e.g. children/young people in poor housing, children who have emotional and mental health problems. In most cases the need descriptions themselves include obstacles to good outcomes e.g. children affected by the imprisonment of a family member, young runaways, and it is notable, though to be expected, that very few of the needs listed would be met simply by universal services.

2.4 THE NEED FOR SOCIAL WORK INTERVENTION

This section sets out how our threefold categorisation of the need for social work applies to children and families. The need arises when parents:

1. know they face obstacles to achieving the outcomes they want for their children's development or to keeping them safe, but:

• they, their families, their support networks or communities cannot overcome them
• the costs (physical, emotional, social and financial) to them are too high in the short, medium or longer term
• the resources needed are so specialised that they are only available through social work or medical assessment;

2. do not recognise that there are ways of overcoming the obstacles to their children's development or safety either partially or completely; and
3. seek, or their behaviour creates, outcomes for their children that are contrary to legislation and regulation.

As children grow older and begin to have more responsibility for their own well-being it may be they, as well as or instead of their parents, who fall into the categories outlined. In all three situations it is most likely that social work will need to be provided to both children and parents.

2.5 ASPECTS OF SOCIAL WORK INTERVENTION

Here we describe different stages and aspects of social work intervention with children and families.

2.5.1 Identifying the problem to be overcome

The first stage to overcoming obstacles is to recognise and describe the problem and acknowledge that change is needed. Social workers can assist the family to identify the issues using empathy and problem solving skills. In any of the situations outlined in 2.4 there may be a number of factors impinging on the parents' or child's capacity to overcome obstacles and achieve desired outcomes. Some may be immediately apparent. Others may be more difficult to discern. It is likely that neither parent nor child is aware of all the elements contributing to difficulties. They may be oblivious to the consequences that may ensue if difficulties remain unresolved. Particularly in cases referred by others for local authority social work intervention, the family may desire outcomes that conflict with legislation and/or social work's responsibilities to protect or control. For example, children or parents may be using prohibited substances, parents views of child care may leave children wandering the streets at an age and/or times which put them at risk. Social work's distinctive contribution here is to use empathy, communication and relationship skills to achieve acknowledgement that change is needed. A change in organisational response may be required. Both individuals and organisations may need to be convinced of the need for change.

2.5.2 Assessing the situation

At an early stage of contact social work involves assessment of the child and family's situation through appraisal of what is seen and heard in contact with the family in and out of the home, through careful interviewing, enabling members of the family to express their feelings and views, and through communication with other organisations and professionals in contact with the family. The social worker will lead the family through the process, highlighting and explaining the importance of examining the various kinds of information. Social workers will use a range of knowledge, models and frameworks to decide what information is needed and to assess the information collected. To ensure that necessary information is collected social workers need to establish working relationships of trust with family and professionals. They must be able to understand the cultures and attitudes of all those they involve, through their own knowledge and skill, or by drawing on that of others. Assessment continues throughout contact and involvement with children and families. Recognition and understanding of behavioural patterns, systems of communication and patterns of events over time are vital to successful outcomes. In situations referred to the local authority for intervention the social worker may have difficulty in engaging the family's cooperation and interest. Social work skills and persistence are needed to find the key to engagement.

In recognition of the difficulties inherent in achieving effective assessments the Department of Health introduced the Framework for the Assessment of Children in Need and their Families ( DH 2000), referred to above in section 2.3.

Macdonald (2002) notes the pitfalls that arise when conducting assessments. It is not enough simply to follow a framework setting out the areas to be investigated, social workers need to exercise professional judgement and be alert to unconscious bias which may creep into the work, distorting assessments and the degree of risk.

The Department for Education and Skills is developing a Common Assessment Framework to help ensure that all children achieve the outcomes set out in Every Child Matters:

'Through the CAF, we intend to implement a common approach to needs assessment that can be used by the whole children's workforce, whether they are in universal or specialist services, for any child in need of support. Its aim will be to provide a mechanism whereby any practitioner working with a child or young person can conduct a good quality, but relatively non-specialised, assessment of unmet needs and, where appropriate, share it with other agencies. It aims to provide a non-bureaucratic 'whole child' assessment…

'Common assessment would also essentially form a front-end to more specialist assessments, which would themselves need modification to accommodate the standards imposed by the CAF.'

It is recognised that the CAF will need to have a relationship to responsibilities to promote and safeguard the well-being of children in need:

Common assessment would normally therefore be undertaken before a decision about referral to social services is made.

Social care workers will be expected to use this framework but it is clear that this will not replace the more in depth assessment for children in greater need.

The Scottish Executive has established a multi-agency working group to prepare an assessment framework for use by all those working with children: the Integrated Assessment Framework (Scottish Executive 2004b, Annex C).

2.5.3 Empowering the family

It is endemic to social work that family members should participate in determining the direction of change. What is happening in the family may belie the wishes of family members and undermine the needs of some or all. Neither parents nor children may be able to express or live out their wishes. Social workers seek to enable family members to identify both what they want and the extent to which they are able, with or without help, to achieve those ends. They will discuss ways of achieving those things that the family cannot currently achieve and develop plans for achieving them. In these ways they begin to enable and empower families. The extent to which they can develop relationships of trust with family members will determine how far family aims, capacities and plans are identified and developed.

2.5.4 Dealing with conflicting needs and wishes

While this partnership approach is at the heart of social work, there is a further responsibility to ensure that the needs of those who are most vulnerable in the situation are not neglected to their detriment. In families it is the children to whom social workers owe the greater duty of care. There may be tensions between children's needs and wishes, parents' needs and wishes, the views and wishes of the wider family, of the community, other professionals, and with the requirements of the law, regulation and procedure. Social workers must take all of this into account. Consulting with others they must judge what action should be taken in the best interests of the children, though where there is a dispute with parents it will be the children's hearing tribunal that makes the 'final' decision. The protective role is always at the forefront of social work considerations. The need for immediate protective action may appear to frustrate the family's goals. It is in such areas of social control that conflict between perspectives about the need for social work intervention and what it should be about is most apparent.

If the assessment is that the child's need for protection requires removal from its parent(s) the resulting action may indeed frustrate the family's goals in the long, as well as the short, term. The requirement for formal processes to be followed and the work entailed often divert the social worker's time, attention and efforts away from the work needed to enable the parents to meet their support goals. The action may also break any relationship of trust between a particular social worker and parent(s) and destroy any possibility of working together on a longer-term goal. Nonetheless, the way social workers conduct their business can make a difference. Looking at families' involvement in child protection Thoburn et al (1995) found that parents and children most valued being cared about as individuals, with both strengths and weaknesses.

2.5.5 Achieving change, meeting goals: direct and indirect work

If the assessment allows for the child to remain in the care of parent(s) the social worker may be become principal person enabling the parents to achieve their goals. The social worker's skills in counselling may help the parent(s) identify why they are not attaining their goals, what they need to do to meet their own and their child's needs. The social worker may develop and implement a programme of work with the parent(s) or child, negotiate for another professional to undertake a programme of work with parent(s) or child or negotiate access to day care, respite care, welfare benefits, any or all of which may relieve stress or exhaustion. The social worker works as therapist and advocate or broker. Again, the social worker's role can be the necessary element in making a package of services successful:

'…there should always be a key worker who will offer continuity and a supportive or therapeutic relationship as well as marshalling and coordinating the packages of help and monitoring the child's well-being…If this element of continuity is in place our study suggests that additional workers can with advantage be brought in alongside the key worker to provide short term specialist assessment or therapeutic services…' (Thoburn et al 1995)

[But in tertiary prevention it] appears important to combine it [social network interventions] with intensive casework, advocacy and case management…particularly in the early stages of relationship-building with families. (Macdonald, 2002, examining a controlled study by Gaudin et al, writer's words in brackets)

As advocates, negotiators or brokers social workers have to understand the needs of the family members and have knowledge about services, their purpose, qualities, accessibility and availability. Social workers must be able to put a convincing case to the service provider and provide relevant and sufficient information for the provider to make an informed decision. For the provider to have to collect information to make a full reassessment of the need for the service would be inefficient and unhelpful to the user. As before, having obtained a service for the user, the social worker is involved in assessment, measuring the progress being made towards change and the effect of the process and any change on the overall situation for the family.

The social worker's protective role may extend to promoting the particular needs of vulnerable children and families in the context of services designed for the less vulnerable. While the change to greater teamwork and integrated assessments places more equal responsibilities on the range of professions and agencies, at least for the time being, social work needs to champion those who cannot speak up for themselves or who alienate themselves through disruptive behaviour or poor social skills.

Social workers may take a direct role with children, including helping them to come to terms with transitions in their lives brought about by parent's inability to continue caring for them, on account of, for example, of illness or substance abuse. They may counsel young carers helping them to work out the extent of the care they can give and what they personally need to do in the absence of sufficient support for the parent/s needs.

Social workers may also help children and parents to maintain any changes made. Continued support of this kind may attract criticism as encouraging dependency but practice experience has indicated that failing to provide such support may reduce the return on substantial investment of social work resources. A complementary strategy is to assist and encourage families in developing wider family and social networks.

2.6 A NEW FOCUS FOR SOCIAL WORK INTERVENTION

2.6.1 The present picture

Because of the social and political context for social work with children and families the process of social work intervention described above may easily be distorted by an assumption that care and expertise lie outside the family. And, despite much broader policy and aspirations for social work with children and their parents ( e.g. Children (Scotland) Act 1995; Scottish Executive 2004b), the major preoccupation of statutory social work departments appears to be with protecting children from abuse and neglect and protecting others from abuse by children and young people. (The latter issue falls outside the remit of this paper.) Examination of what happens in practice indicates that attention and effort are driven towards children living in the most difficult circumstances. Sometimes even they have to wait for intervention. Examples of this are described in For Scotland's Children, Chapter 3 (Scottish Executive 2001a) . The control functions mandated by the state take precedence.

This is not the whole picture. Scottish Executive statistics on local authority expenditure for 2003-04 (Scottish Executive 2004a) show spending on children with disabilities, on support to carers, on day care and on 'other services'. But the main focus of these statistics is on children looked after by local authorities and on child protection.

2.6.2 A wider picture

The literature indicates that it is very difficult to untangle what works in social work ( e.g. Macdonald 2001; Maluccio et al. 2000; Sellick et al 2004) but several studies make it clear that families appreciate consistent, continuing and reliable support of social workers ( e.g. Thoburn 1995; Falkov 2002).

Children can be clear about what they need - a focus on them as individuals; response without having to repeat their story; respect; and promises delivered (Scottish Executive 2001a). Scotland's Charter for Protecting Children and Young People (Scottish Executive 2004c) acknowledges and embodies these views.

There is professional and political acknowledgement that a wide variety of situations make children and their parents vulnerable (Scottish Executive 2004b; Scottish Executive 2003c; Scottish Executive 2001b).

Social work is undertaken in a variety of voluntary and independent organisations - small and large. It is not confined to the statutory sector.

Social work skills and processes outlined above:

• recognising and describing the problem
• assessing the situation
• empowering the family
• enabling family members to identify both what they want and how they can best achieve those ends
• counselling
• negotiating access to information, advice and services
• acting as therapist and advocate or broker
• championing those who cannot speak up for themselves

can be valuable to any children and families involved in the childhood journey to independence, adulthood and citizenship. Drawing on earlier work and describing a social work team based on a neglected estate in Rotherham, Holman (1998) notes that its activities

brought isolated parents together and provided outlets for their children and so alleviated some local problems; the nearness of the social workers meant that needy parents came to them early before their difficulties became a crisis; the outcome was that numbers in care decreased while none were seriously abused. (p180)

This indicates clear benefits to the children, their families and the wider community. Social work is not always so bold in setting out its positive impact. And, as noted, it is often impossible to disentangle the effect of social work from the other factors at work in families' lives.

It is encouraging to record and be involved in social work that has tangible impacts, that change lives for the better, measured in terms of outcomes set down in public policy. Social work has value also in working alongside people who want change, results and improvement and for whom none comes. In children and families work this may be most easily understood, and acceptable, in situations in which parents are supported in caring for severely disabled or terminally ill children; or with parents whose children are placed for adoption against their will. The changes may not fit the desired outcomes for children but may make an important but less tangible difference to the quality of life of all concerned.

This aspect of social work, supporting and being alongside people whose lives are painful, is more controversial in other aspects of children and families work. There are many situations in which the obstacles to the state's objectives for the child being met appear to emanate from the parents' inability or unwillingness to provide the desired environment and care. Removal may be the societal response; in all children and family work ultimately, and rightly, the overriding principle is that the welfare of the child is paramount. But there is no guarantee that alternative care, in the wider family, or in family or residential placement, will meet the needs of the child. Social work is needed to point out the difficulties, weigh up the choices, and stay with the situation, listening and supporting, preventing deterioration where possible and organising compensatory experiences for the child. In these situations social work is also needed to be alert to the signals of possibilities for positive and negative change, to keep alert to the whole picture, while other professionals address more discrete needs.

Were social work to be seen as non-threatening, available to all at the behest of the user and to meet the requirements of the user, social work by invitation rather than social work intervention, parents and children might also value social work's 'whole person/whole situation' approach. Families might be readier to accept the support and encouragement of social work to fight or withstand obstacles outside their and social work's control, for example, separation from the wider family, poor housing, poverty, intolerance, complex systems and procedures. Social work's contribution may again be difficult to measure but significantly affect the quality of life of the whole family. Families might also be prepared to explore what social work has to offer in intra and interpersonal issues, without compulsion.

2.6.3 Conflicts and tensions

Social work and much of the financial resource for it get their legitimacy from legislation. Social work with children and families is highly regulated and increasingly all sectors are brought within the statutory frame. This seems to have resulted in an approach/attitude that legitimises only that work which is in line with objectives and targets. The state wants children to flourish; so do parents. Parents and children are individuals; some may not have the capacity to meet targets. Social work bears the burden of working with the individual within the context of a framework for the many. It is needed to hold the balance.

Children and parents may flourish at different rates. They may flourish in response to different stimuli and settings. They need confidence and a safe environment. Social work is required to help to prevent tragedies. Social work is needed to give confidence to families to flourish and to the state to be safe.

There is an inherent tension in social work with children and parents between the needs and wishes of the parents and the needs and wishes of the child. Most usually the needs and wishes of the child are met through the agency of parents. Thus social work has to promote parental needs for the sake of the children but may need to abandon them to maintain the primacy of the child's welfare. The consequences of getting the balance wrong in either direction expose both children and parents to suffering and pain.

Social work is dependent on engaging its service users. This involves listening and understanding and responding to what is heard.