205
parenting tasks and coping with the changing relationship with boyfriend or husband. Early contraceptive advice, help with practical problems and encourage-
ment of social activities may be needed, but all intervention should be aimed at encouraging competence, promoting independence and developing personal skills. Traditional medical or nursing methods have often relied upon the provision of information and the ’correction of wrong attitudes’ by drawing a mothers attention to the error of her ways but such techniques are often ineffective. A nurse or grandmother who takes over mothering roles and performs them skilfully when a mother is experiencing difficulty is more likely to reinforce incompetence than improve coping. Support, encouragement, example and reinforcement of skills, however meagre, offer a better chance of permanent
change. If it were possible to achieve a reduction in the rate of premarital conception and a rise of a few years in the average age at marriage we should achieve a greater reduction in family violence than has resulted from the
combined
efforts of medical and social treatment ser-
vices. Better preparation for parenthood and a progression through dating, courtship, marriage and parenthood in measured sequence would achieve an even greater prospect of family stability. These changes will not be brought about by legislation alone and will never, in any case, eliminate violence. None the less the family remains the cornerstone of our society, and there can be no family and no society without children. It is time that the interests of the child took precedence over those of the parents. BIBLIOGRAPHY 1 BORLAND. M. EDITOR (1976) Violence in the Family. Manchester University Press. 2 GAYFORD. J. J. (1975) Wife battering: a preliminary survey of 100 cases. British Medical Journal i 194-7. 3 PIZZEY. E. (1974) Scream quietly the neighbours will hear you. Penguin Books. Harmandsworth. 4 SCOTT, P. D. (1974) Battered wives. British Journal of Psychiatry 125, 433-41. 5 CLARKE. A. M. and CLARKE. A. D. B. (1976) Early Experience. Myth & Evidence. Open Books London.
SOCIAL SERVICES AND CHILD ABUSE: SOME DILEMMAS AND OPPORTUNITIES
PROFESSOR OLIVE STEVENSON Department of Social Policy and Social Work, LTHOUGH this session is entitled ’The Violent
Home’,
and has therefore implications wider than matters concerned with child abuse, it is my intention to restrict my observations to the effect upon our British Social Services of the intense public concern about, and concentration upon, child abuse. Child abuse is here used in the sense of deliberate acts of commission or omission by parents or other care-givers which have seriously harmful effects upon the children. The term is thus wider than ’non accidental injury.’ It is time we abandoned the emotive and inaccurate phrase ’baby battering’ and, although ’child abuse’ is somewhat vague, it is increasingly used with the connotation described above. The social context in which public concern has developed in the U.K. must first be outlined. Both lay and professional persons frequently ask the question ’has the incidence of such abuse increased?’ The responsible answer to that must surely be that we do not know and there is at present no way of mapping the territory with any precision. I do not propose here to enter the statistical jungle; others are more competent than I to cut away the tangled trees and, given time and the will to improve data collection, to see the wood. What is, however, indisputable is that there has been in the last five years a dramatic increase in public interest in this problem and in the attention the media has paid to it. This is bound to create in the mind of the lay person the impression that it is more common than heretofore. This in turn leads to lay and professional
alike
spiral
University of Keele
observing and reporting more cases. So we have a of anxiety. I shall return later to the effects of
this. Since the Maria Colwell enquiry in 1973, of which I was a member, there have been two similar reports, published by central government.’ There have also been a number of locally organized enquiries, of which at least three2 are a valuable addition to the evidence concerning the problems of effective professional communication in such cases. All have attracted media attention, although none have received the protracted interest shown in the Colwell enquiry. There are probably two main reasons for this: the first is, quite simply, that it was the first government enquiry of its kind for many years. We were all inexperienced (and I include committee members and the DHSS in the handling of such enquiries. With hindsight, one can well argue that the flames of public anger were fanned by aspects of its conduct and that that anger was not wholly constructive, not simply in relation to the particular case but to subsequent events and developments elsewhere in the country. Secondly, it was, in my view, most unfortunate that, in that tragedy, there were two quite separate issues intertwined. One, the subject of this paper, was child abuse. The other was the so-called &dquo;tug-of-love&dquo; situation in which a child was trapped in a conflict between between relatives. That adults, in this case there are complex, heart-rending problems in such cases is well known. Before the enquiry, there was a
itself)
(unusually)
206 member’s bill &dquo;on the stocks&dquo;, which, with the of government, was promulgated by the Labour government and became law, in 1975.Some aspects of this Act are concerned to redress the balance of rights between parents and foster parents, or prospective adopters, with the child’s welfare as the overriding consideration. But to speak of that Act, as have some politicians, as an effective contribution to the prevention of tragic deaths, such as that of Maria Colwell, is sheer moonshine. Children are abused by adults, not just by parents, as the Richard Clark report tragically demonstrated.* Indeed, the services for deprived children were reorganised in 1948 following the death of a child, Dennis O’Neill, in a foster home. In any case, the new law does nothing to alter the existing position with regard to the protection of children in their own homes. This is not a criticism. The law can only provide a framework, within which the welfare of the child is balanced against the rights of the parents to be protected from state intrusion. Ultimately, the protection of children at risk lies with a caring community, of which the professionals form a crucial part. The blaze of publicity which attended the Colwell enquiry was, therefore, in my view, in some ways (though not altogether) unhelpful and misleading. There are some indications that the media may be seeking other areas to which to direct public attention. Reports and enquiries seem to be receiving diminishing attention. But the effects upon social services have been profound and will be long lasting. In this section of my paper, I shall examine some of these effects. Participants at this congress will be familiar with the organisational background against which these events have taken place. Statutory social services have been the subject of two major reorganisations in the last five years; first, the re-grouping of the personal social services within local government, which had considerable implications for the activities of social workers; secondly, the reorganization of local government itself. At about the same time, two new Acts concerned with the Chronic Sick and Disabled4and with Children and Young Peoplessubstantially increased the volume of work for social services. Some would also claim that the actual re-organization of the personal social services increased the volume of demand for services from the general public and related professions. Thus specific anxiety about child abuse mounted at the same time as did general levels of anxiety about the effects of re-organizations and increasing demand for services. Central government, reasonably enough, issued circulars about child abuse, exhorting the use of fairly elaborate procedures to ensure ’fail-safe’ mechanisms. Social services, though not alone, were first in the firing line for public criticism when children were harmed by their parents. The results were predictable. When resources are scarce, concern about child abuse high and central government more positive in its advice than in any other field, work with families where children are at physical risk is accorded top priority. This means that the time of the qualified and more experienced workers is concentrated more and more upon that area of work. Their time is spent, of course, not simply in the visiting of families, but in improving the complex web of communications, the inadequacy of which the various enquiries have constantly emphasized. This trend is a matter of common knowledge amongst social workers but, lest there be any doubt that it be myth rather than
private change
*See
bibliography
knowledge,
my current research amply confirms it. in one authority, well provided with qualified national standards, we were told of an area which had agreed on ’priority ranking’ to help social workers with caseload management and that, in a five point scale, the qualified workers found themselves with time only for Category 1, children at physical risk, and a little of Category II, ’other families with children’. So much, then, for the ideal of a personal social services department for all citizens. It exists in theory as an ideal, and in practice in the limited sense that some services are provided for a wide range of people in need. But in no sense can it be said that people in need are getting an equal share of resqurces, above all in terms of staff time. This is dangerous, not simply in terms of the amount of service offered to different client groups but because the impetus to development of special interest and skill in relation to different people or problems is lacking. To give but one example: our research suggests that, by and large, the elderly are served by the unqualified or assistant social workers. Indeed, in two areas of N. Ireland, this group is served more or less exclusively by assistant workers, who even organise, at local level, the home help service. It is no part of my argument to on the contrary, denigrate the work of assistants their dedication and job stability is in many cases exceptional. What is of concern is the underlying value assumptions as to the needs of different client groups and the potential consequences for professional development. Doctors will need no convincing of this in the field of geriatrics. This may appear to be a departure from the theme of this paper. However, my object has been to point out how important it is to relate emphasis and activity in one sphere of social services activity to others. Do we have to have a spate of media interest in ’granny battering’ to give social services, as it were, permission to redirect some resources? However that may be, the fact is that most energy and care is being directed at present to children at physical risk in their own homes. What are the consequences, both negative or positive, of that for development of social work expertise and for the attitudes of social workers to the problem? A measure of anxiety is healthy and necessary for effective action. The question is when does this level become unacceptably high and result in misdirected or ineffective activity? There have been some indications that we are in a dangerous phase. The Auckland enquiry* was concerned about confusion and inconsistency in recording which at least raised the possibility of some retrospective alteration. If this is so, it illustrates
Indeed, staff by
-
-
graphically
a more
general danger, especially
grave
after the Colwell witch hunt: that is, that fear of being found wanting may lead to greater preoccupation with covering of tracks, than with protection of the child and family. (I must emphasize this risk is just as great for others, such as health visitors, as for social workers). To an extent, these objectives are not incompatible. For example, it is an essential part of the activity of any professional to keep adequate records. Failure to do so by different professions has been noted, time and time again, by different enquiries. If such criticisms lead to greater awareness of the need to do so, and even if the impetus to do so springs from fear, then there will have been a positive outcome. However, there is another, much more sinister possibility, especially relevant to social services, arising from fear of being held accountable for the death of a child.
207 That is, of course, that there will be a tendency to ’play safe’, which in this context means - if in doubt ’remove the child’. This is a complex and emotive issue about which even the most sophisticated professionals are prone to become irrational. In this paper, I intend to explore only two aspects: first, the broader social implications of precipitate removal of children from their homes; secondly, the more immediate implications for the children involved. CHILD WELFARE AND PARENTAL RIGHTS T H E R E I S no clear-cut solution to the conflict between the welfare of children and the rights of parents. Since the beginning of the century we have seen a progressive (but by no means steady) movement towards the protection of the child and away from the rights of parents to bring up their children as they will. It is salutory to remind ourselves that the first legislation introduced to enable the state to remove a child from his parents against their will was strenuously opposed as an unwarrantable intrusion upon the liberty of the individual. Sine then, parental rights have been limited, (some might say eroded) and there are some who fear that parts of the new Children Act 1975 take this dangerously far. It is interesting to recall how, in the ’50s’ when I was a Child Care Officer, we lived in the shadow of various High Court judgements which had decided in favour of parents, who withheld their consent to adoption for children long established in defacto adoptive homes. I, and others like me, believed such judgements to be wrong. Nonetheless, because this is, and must always be, a balancing act, one waits now for the inevitable ’back-lash’ against present trends. The headlines are predictable: &dquo;Judge censures social services for precipitate removal of child.&dquo; The Times: &dquo;The snoopers swoop to remove child&dquo; The Mirror. Indeed there have already been some such cases reported. Behind the florid headlines or the artificial calm of the courtroom, lie decisions of the greatest complexity, which we are ill equipped to make in terms of scientific certainties or predictors. Although there is a growing body of knowledge concerning factors associated with child abuse, there is not yet, and probably never will be, a substitute for professional judgement, comparable to that exercised by the medical clinician in matters purely physical.’i~ For example, in a case which recently came to my attention, there was clear evidence that a very young mother had injured her first born and he was committed to care. She had had herself a deprived background, was living with a young man, known to be somewhat unstable. A few years later, when her personal situation, psychological and material, had stabilized to some extent, she again became pregnant, by the same man, with whom she was still cohabiting but after a period of separation. The baby was removed from the hospital at birth on a Place of Safety order, pending care proceedings, because social services feared she might again injure a child. In this case, the social services’ action was not upheld by the court and the child was returned to her mother. In this brief illustration, there is encapsulated the dilemma of social services. One might further add, and I will return to this point later, that the advice of other experts, (I do not know whether or not they were sought in this case) may support social services in a tThis is not to underestimate the social research which is offer a cluster of predictors.
beginning
at
least to
of action but it remains ’a balance of No-one knows with certainty, or even with confidence, what the outcome of such a case might be. The social services must live with that uncertainty; it is their job to do so. They cannot ’pass the buck’, even if they seek help from other professionals or confirmation from the Courts, it is they who must seek the Place of Safety or the Care order and, in so doing, accept the responsibility for the separation of a child from his parents. That they should do their utmost to protect children is unarguable, and that includes a proper knowledge of indicators of child abuse and of the need for professional co-operation, both of which have often been lacking in the past. But, even so, there will be times when professional judgement fails and the child, as the doctor’s patient, dies. It is impossible to conceive of a situation in which the protection of the child was so pre-eminent that society would accept ever-increasing numbers of children taken into care to ’be on the safe side’. At present, it is necessary, in my view, to be vigilant lest the pendulum swing too far in that direction. This arises not simply because of fear and anxiety in individuals of becoming ritual sacrifices, although this does exist. I have referred to the dilemmas, sometimes agonizing, in relation to individual cases. This must be all too familiar to the medical profession and I imagine the point can be taken easily by analogy. Less easy to convey is the underlying doubt in the minds of social workers as to the value of the alternatives offered by a life in care. I will not dwell on the futile talk about ’blood ties’ which, as I contended in the Colwell report, has been, in the past, a phrase much loved by lawyers and little used by social workers. Nor am I for one moment arguing against the advantages for some children of a life in care in contrast with their own homes. The point is, quite simply, that when a child is removed and placed in care, events are set in train which we cannot predict or control and which, in some cases, prove so disastrous that the experienced social worker is forced to ask ’Was it worth it?’. A trail of broken foster homes or, the equivalent in psychological terms, of changing residential staff may only serve to perpetuate and increase the trauma of the original experiences. It is neglect of this aspect which weakens crucially the otherwise powerful arguments of the influential Beyond the Best Interests of the Child.6 The answer must surely lie in developing, concurrently, knowledge of, and skill in, treatment with the family and outside it. But in the meanwhile, social workers are in the unusual and painful position of seeing more of the products of substitute care than most other professionals. It is bound to make them wary. Another complicating factor affecting the attitudes of social workers is the confusion between personal. responsibility, as professionals, and organisational accountability, within a hierarchial system of local government. It is my impression that some members of the medical profession are particularly intolerant of this problem. Put bluntly, one gets the impression that for some doctors, phrases like ’professional responsibility’ equal ’good’, whereas phases which include words like ’accountability’ or, particularly ’hierarchy’ equal ’bad’! One is therefore diffident about entering such Indian territory in this Congress. It must, nevertheless, be acknowledged that there is considerable confusion over this matter within social services at the present time and that it has a bearing upon the handling by social workers of cases of child abuse. Social work does not yet know how to reconcile certain
course
probabilities’.
208
opposing styles of operation. On the one hand, there is the concept of the field worker, ’the man on the spot’, with professional autonomy, and the right to exercise the equivalent of clinical judgement. (In relation to this model, one has, however, to recognize that, as yet, less than half the field workers in social services are professionally qualified). On the other hand, social services are embedded in a long established bureaucracy. I do not use the word pejoratively. In its proper sociological sense, it describes an organisation, which, to get work done effectively, operates with clear lines of accountability by which each person within the hierarchical structure, knows the limits of his authority. The nursing service in hospitals is a particularly clear exbut a further complication in the local authority ample is the hierarchical accountability of all officers to elected members. So long as social workers continue to perform their task within a government setting, there is bound to be some compromise between personal responsibility and organisational accountability. This is, of course, to some extent a problem for all professionals in all organizations. Remarkably few in modern societies operate independently, although the myth of such independence is a long time a-dying. two
SUPERVISION
.
IN the many detailed interviews which we have undertaken in our research with field level social workers and their immediate seniors the ambiguity and ambivalence about the present situation is apparent. One of the matters about which we have enquired at length is that of ’supervision’, that is, regular case discussion between field workers and their seniors. Leaving aside the obvious problems which affect this, such as pressure on time and staff shortages, there remains a deeper problem which can be crudely summarized as ’who carres the can?’ If the process of case discussion is purely one of consultation, then professional autonomy is paramount and this is the way in which many senior social workers prefer to describe it. There is a marked dislike amongst them of assuming authority over their field level colleagues who carry the cases. Yet, even when the workers are qualified, there have been in the various enquiries, assumptions, albeit sometimes only implicit, that the decisions concerning children at risk are too important to be left at this level and must be referred upwards, not simply for report, but for decision. To an extent this view seems to be shared by many field workers, who are only too glad of the support this offers; just as many health visitors welcome the new structures which offer them the support of nursing officers as seniors. But it leaves unanswered the key issue, perhaps best illustrated by ’what happens when field the simple question worker and senior disagree on the proper course of it has happened.) It action?’ (This is not hypothetical also suggests a potential danger area if seniors and field workers tend to perceive differently a process formally described as ’supervision’. Until the balance between the two models is more clearly understood, social service departments may have problems which work to the detriment of the child and family. Thus far, I have concentrated upon some effects upon social services of the current preoccupation with child abuse. I have been mainly concerned with the internal dynamics of the situation, although I believe that much of what I have written is relevant also to other professionals. Finally, I turn to the implications for social services
HOWEVER,
-
-
of their relationships with other professionals concerned with child abuse. None of the relevant professions have been immune from a flurry of advice concerning communication and co-ordination in cases of child abuse. However, it is inescapable that in most instances the social services department is at the centre of this web and thus carries a special responsibility for the continuing improvement of the procedures and processes involved. Part of the research, funded by the DHSS, which I have been directing, has been concerned with a small scale study of interprofessional communication. We focused upon the case conference and attended 14 in 3 different local authorities in the month of July 1976. We then followed up 6 of these by interviewing individually all the participants. We are at present in the process of preparing our report and it would be inappropriate to present conclusions to this Congress before our sponsors and the Area Review Committees concerned have seen them. What follows, therefore, is in part an outline of some of the matters in which we were interested and in part of my own personal reflections upon the problems involved. In any case, our small sample cannot be statistically significant :t all it will do is raise what are, I hope key questions and issues. In our investigation, we were interested in two main areas: first, the use made of case conference procedures for different purposes, and secondly, the manner by which these purposes were achieved. The first of these includes such questions as: how are ’at risk’ cases defined in relation to calling a case conference and at what stages? Are children in the family, other than those accepted as at risk, considered ? Is the conference for pooling of information; for gathering of evidence, in the legal sense; for decision if so about what?); or for some or all of making these purposes? (A secondary question is do the participants perceive the purposes as the same?) The second area of interest about processes includes such issues as the role of the chairman, including the preliminary decision as to who takes the chair; those who are invited and those who accept the invitation; the venue of the conference and its effect upon participants ; the taking and circulation of minutes. There is a great deal to be said about the views and attitudes of our informants about the problem of child abuse and relations between professionals on these and many other matters. However, if one focuses upon the role of social services departments, it is clear that few of those we interviewed had questioned the desirability of social services assuming the main responsibility at the case conference level, distinct from Area Review Committees). This responsibility includes convening and chairing. An exception to this is to be found in those cases in which a child has been admitted to hospital. Here, naturally enough, initiative may rest with the medical staff of the hospital; even so, it is not necessarily clear to those present at a conference where aspects of responsibility rest, (for example, for ’summing up’ and circulating minutes). There is an interesting question here as to whether social services are, or are perceived to be, sufficiently neutral to chair some conferences. If, for example, there is a strong possibility of court proceeding’s which would be taken by social services, can the department concerned manage the involvement of its own staff, where there are conflicts with other professionals? Yet, alternatives are rarely
(and
-
(as
tWe have, also gathered some simple information nationally concerning numbers of conferences called in two months in 1976. This data is now being
analysed.
209
suggested and there may be a measure of relief amongst other professionals that, usually, they would not be called upon to make the crucial decision which might set in train removal of the child. So far as process is concerned, when one considers the levels of anxiety at many conferences; the inevitable interprofessional tensions and rivalries; the shyness of those for whom attendance is unusual; the complexity of the family situations under discussion and the dangers, (well illustrated in the Howlett enquiry*) of concentrating upon one child to the neglect of others, it is clear that chairing of such meetings requires very considerable skill. These skills do not necessarily come by the light of nature. Yet it is no exaggeration to say that the life of a child may, to a not inconsiderable extent, depend on that skill, consisting as it does in part of an ability to draw people out and yet to control irrelevance. It is likely that in this, social work education, whether basic or advanced, and however organized, will need to consider much more than heretofore the dynamics of committee behaviour, in the wider context of understanding the roles of others and the way each interacts. To do so requires a good deal of knowledge of the preconceptions which each brings to his own job and that of others. It is obvious that other professions too would benefit from such understanding and there is no question of it being the social worker’s responsibility alone. It may be, however, that for the foreseeable future, it is proper to emphasize the social worker’s part as a prime agent in facilitating interprofessional communication. Social workers, as other professionals, have tended to grumble at the amount of time spent about clients, not with them. There is, of course, a balance and it may have gone wrong in relation to child abuse; for example, if the time taken at conferences is excessive because thought and planning beforehand has not been adequate or because they are called unnecessarily. Yet although it is important to keep a check on the escalation of meetings, whether formal or informal, it remains inevitable, above all in complex industrial areas with shifting populations and changing staff, that considerable time will have to be given to the task. There is no other way of protecting the children at risk and family visits paid in isolation can be useless without professional interaction, as the enquiries have repeatedly shown. In the midst of much gloom at present in the health and social services, I cherish obstinately the hope that there can be a ’spin-off’ from the communication forced upon the professions by outcry over child abuse. But that must depend on readiness to extrapolate and transfer knowledge gained from one area to others in which interprofessional collaboration is equally important (as in work with the elderly). If social services contribute to this, good will have come of evil. In conclusion, I venture into more uncharted territory. Reading the reports of the six enquiries to which I referred, especially those where the reported events took place well after the Colwell tragedy, one is bound to ask some seemingly simple questions which probably have very complicated answers. They concern the seeming inability of well-intentioned, hard working people to learn from the experience of others, despite high levels of anxiety and a spate of exhortations from on high, giving indications of child abuse and outlining basic elements of good professional practice. Why, for
does accurate recording still not take place? ineffective visits not reported as a matter of concern? Why are case conferences not called? Why are G.P.s ’bad attenders at meetings’? Why does simple routine information not get passed on? It is increasingly rare for a child at risk not to be identified; it is what happens (or does not happen) after that that is crucial. I am not persuaded that these elementary failures and mistakes are due simply to pressure of work, especially as we know that anxiety levels have been higher in the last five years than ever before. In the days when medical pioneers were outlining the clinical picture of child abuse, the reluctance of the medical profession to accept that it could and did happen, was noted. Where are we now? Are we in a phase of professional ambivalence, whereby, on the one hand, child abuse is talked about, suspected and investigated, whilst, on the other hand, the old denial persists and, as with other disasters, the underlying phantasy is ’but it could not happen to me’? I realize that, in all professions, many other factors, such as the management of work-loads, may play an important part in this curious mixture of anxiety and carelessness, revealed in all the reports in the actions of various professionals. But I am not persuaded that this is the whole story. I have deliberately ended on a note of speculation about deeper issues which underly the successful implementation of policies and procedures because, whilst the need for the latter is unquestionable, they will not suffice on their own. We must probe further than that if children are to be protected; some will die whatever we do. I referred earlier to calculated risks and errors of judgement which may lead to tragedy. But that is very different from trivial muddles, which can be equally disastrous and which the enquiries reveal with depressing frequency. The professions who claim skill in interpersonal relations should co-operate, not simply in relation to specific cases, but to explore their underlying attitudes to the problem of child abuse and to the work they are required to do in connexion with it. There is always ’a hidden agenda’ both in terms of deep feelings roused in individuals by the problem and in the different approaches created, or reinforced, by different professional training and roles. I would like to think that social work may come to play a part in bringing that agenda out of hiding.
example, Why are
REFERENCES
1 (a) Report of the Committee of Enquiry into Care and Supervision provided in relation to Maria Colwell. H.M.S.O. 1974. (b) Report of the Committee of Enquiry into Provision and Coordination of Services to the family of John Auckland. H.M.S.O. 1975.
(c) Report of the
Committee of Enquiry into the consideration given and steps taken towards securing the welfare of Richard Clark by Perth Town Council and other bodies or persons concerned. 2 (a) Report of the Joint Committee of Enquiry into Non-Accidental Injury to Children, with particular reference to the case of Lisa Godfrey (Lambeth Local and Health Authorities and Probation Committee 1975). (b) Report of the Review Body appointed to enquire into the case of Stephen Meurs (Norfolk Country Council and Area Health Author-
ity 1975).
3 The Children Act 1975. 4 The Chronic Sick and Disabled Persons Act, 1970. 5 The Children and Young Persons Act, 1969. 6 GOLDSTEIN. FREUD and SOLNET (1973), Beyond the Best Interests of the Child. The Free Press.
These papers were 28 April 1977
presented
at
the Health
Congress, Eastbourne,
parenting tasks and coping with the changing relationship with boyfriend or husband. Early contraceptive advice, help with practical problems and encourage-
ment of social activities may be needed, but all intervention should be aimed at encouraging competence, promoting independence and developing personal skills. Traditional medical or nursing methods have often relied upon the provision of information and the ’correction of wrong attitudes’ by drawing a mothers attention to the error of her ways but such techniques are often ineffective. A nurse or grandmother who takes over mothering roles and performs them skilfully when a mother is experiencing difficulty is more likely to reinforce incompetence than improve coping. Support, encouragement, example and reinforcement of skills, however meagre, offer a better chance of permanent
change. If it were possible to achieve a reduction in the rate of premarital conception and a rise of a few years in the average age at marriage we should achieve a greater reduction in family violence than has resulted from the
combined
efforts of medical and social treatment ser-
vices. Better preparation for parenthood and a progression through dating, courtship, marriage and parenthood in measured sequence would achieve an even greater prospect of family stability. These changes will not be brought about by legislation alone and will never, in any case, eliminate violence. None the less the family remains the cornerstone of our society, and there can be no family and no society without children. It is time that the interests of the child took precedence over those of the parents. BIBLIOGRAPHY 1 BORLAND. M. EDITOR (1976) Violence in the Family. Manchester University Press. 2 GAYFORD. J. J. (1975) Wife battering: a preliminary survey of 100 cases. British Medical Journal i 194-7. 3 PIZZEY. E. (1974) Scream quietly the neighbours will hear you. Penguin Books. Harmandsworth. 4 SCOTT, P. D. (1974) Battered wives. British Journal of Psychiatry 125, 433-41. 5 CLARKE. A. M. and CLARKE. A. D. B. (1976) Early Experience. Myth & Evidence. Open Books London.
SOCIAL SERVICES AND CHILD ABUSE: SOME DILEMMAS AND OPPORTUNITIES
PROFESSOR OLIVE STEVENSON Department of Social Policy and Social Work, LTHOUGH this session is entitled ’The Violent
Home’,
and has therefore implications wider than matters concerned with child abuse, it is my intention to restrict my observations to the effect upon our British Social Services of the intense public concern about, and concentration upon, child abuse. Child abuse is here used in the sense of deliberate acts of commission or omission by parents or other care-givers which have seriously harmful effects upon the children. The term is thus wider than ’non accidental injury.’ It is time we abandoned the emotive and inaccurate phrase ’baby battering’ and, although ’child abuse’ is somewhat vague, it is increasingly used with the connotation described above. The social context in which public concern has developed in the U.K. must first be outlined. Both lay and professional persons frequently ask the question ’has the incidence of such abuse increased?’ The responsible answer to that must surely be that we do not know and there is at present no way of mapping the territory with any precision. I do not propose here to enter the statistical jungle; others are more competent than I to cut away the tangled trees and, given time and the will to improve data collection, to see the wood. What is, however, indisputable is that there has been in the last five years a dramatic increase in public interest in this problem and in the attention the media has paid to it. This is bound to create in the mind of the lay person the impression that it is more common than heretofore. This in turn leads to lay and professional
alike
spiral
University of Keele
observing and reporting more cases. So we have a of anxiety. I shall return later to the effects of
this. Since the Maria Colwell enquiry in 1973, of which I was a member, there have been two similar reports, published by central government.’ There have also been a number of locally organized enquiries, of which at least three2 are a valuable addition to the evidence concerning the problems of effective professional communication in such cases. All have attracted media attention, although none have received the protracted interest shown in the Colwell enquiry. There are probably two main reasons for this: the first is, quite simply, that it was the first government enquiry of its kind for many years. We were all inexperienced (and I include committee members and the DHSS in the handling of such enquiries. With hindsight, one can well argue that the flames of public anger were fanned by aspects of its conduct and that that anger was not wholly constructive, not simply in relation to the particular case but to subsequent events and developments elsewhere in the country. Secondly, it was, in my view, most unfortunate that, in that tragedy, there were two quite separate issues intertwined. One, the subject of this paper, was child abuse. The other was the so-called &dquo;tug-of-love&dquo; situation in which a child was trapped in a conflict between between relatives. That adults, in this case there are complex, heart-rending problems in such cases is well known. Before the enquiry, there was a
itself)
(unusually)
206 member’s bill &dquo;on the stocks&dquo;, which, with the of government, was promulgated by the Labour government and became law, in 1975.Some aspects of this Act are concerned to redress the balance of rights between parents and foster parents, or prospective adopters, with the child’s welfare as the overriding consideration. But to speak of that Act, as have some politicians, as an effective contribution to the prevention of tragic deaths, such as that of Maria Colwell, is sheer moonshine. Children are abused by adults, not just by parents, as the Richard Clark report tragically demonstrated.* Indeed, the services for deprived children were reorganised in 1948 following the death of a child, Dennis O’Neill, in a foster home. In any case, the new law does nothing to alter the existing position with regard to the protection of children in their own homes. This is not a criticism. The law can only provide a framework, within which the welfare of the child is balanced against the rights of the parents to be protected from state intrusion. Ultimately, the protection of children at risk lies with a caring community, of which the professionals form a crucial part. The blaze of publicity which attended the Colwell enquiry was, therefore, in my view, in some ways (though not altogether) unhelpful and misleading. There are some indications that the media may be seeking other areas to which to direct public attention. Reports and enquiries seem to be receiving diminishing attention. But the effects upon social services have been profound and will be long lasting. In this section of my paper, I shall examine some of these effects. Participants at this congress will be familiar with the organisational background against which these events have taken place. Statutory social services have been the subject of two major reorganisations in the last five years; first, the re-grouping of the personal social services within local government, which had considerable implications for the activities of social workers; secondly, the reorganization of local government itself. At about the same time, two new Acts concerned with the Chronic Sick and Disabled4and with Children and Young Peoplessubstantially increased the volume of work for social services. Some would also claim that the actual re-organization of the personal social services increased the volume of demand for services from the general public and related professions. Thus specific anxiety about child abuse mounted at the same time as did general levels of anxiety about the effects of re-organizations and increasing demand for services. Central government, reasonably enough, issued circulars about child abuse, exhorting the use of fairly elaborate procedures to ensure ’fail-safe’ mechanisms. Social services, though not alone, were first in the firing line for public criticism when children were harmed by their parents. The results were predictable. When resources are scarce, concern about child abuse high and central government more positive in its advice than in any other field, work with families where children are at physical risk is accorded top priority. This means that the time of the qualified and more experienced workers is concentrated more and more upon that area of work. Their time is spent, of course, not simply in the visiting of families, but in improving the complex web of communications, the inadequacy of which the various enquiries have constantly emphasized. This trend is a matter of common knowledge amongst social workers but, lest there be any doubt that it be myth rather than
private change
*See
bibliography
knowledge,
my current research amply confirms it. in one authority, well provided with qualified national standards, we were told of an area which had agreed on ’priority ranking’ to help social workers with caseload management and that, in a five point scale, the qualified workers found themselves with time only for Category 1, children at physical risk, and a little of Category II, ’other families with children’. So much, then, for the ideal of a personal social services department for all citizens. It exists in theory as an ideal, and in practice in the limited sense that some services are provided for a wide range of people in need. But in no sense can it be said that people in need are getting an equal share of resqurces, above all in terms of staff time. This is dangerous, not simply in terms of the amount of service offered to different client groups but because the impetus to development of special interest and skill in relation to different people or problems is lacking. To give but one example: our research suggests that, by and large, the elderly are served by the unqualified or assistant social workers. Indeed, in two areas of N. Ireland, this group is served more or less exclusively by assistant workers, who even organise, at local level, the home help service. It is no part of my argument to on the contrary, denigrate the work of assistants their dedication and job stability is in many cases exceptional. What is of concern is the underlying value assumptions as to the needs of different client groups and the potential consequences for professional development. Doctors will need no convincing of this in the field of geriatrics. This may appear to be a departure from the theme of this paper. However, my object has been to point out how important it is to relate emphasis and activity in one sphere of social services activity to others. Do we have to have a spate of media interest in ’granny battering’ to give social services, as it were, permission to redirect some resources? However that may be, the fact is that most energy and care is being directed at present to children at physical risk in their own homes. What are the consequences, both negative or positive, of that for development of social work expertise and for the attitudes of social workers to the problem? A measure of anxiety is healthy and necessary for effective action. The question is when does this level become unacceptably high and result in misdirected or ineffective activity? There have been some indications that we are in a dangerous phase. The Auckland enquiry* was concerned about confusion and inconsistency in recording which at least raised the possibility of some retrospective alteration. If this is so, it illustrates
Indeed, staff by
-
-
graphically
a more
general danger, especially
grave
after the Colwell witch hunt: that is, that fear of being found wanting may lead to greater preoccupation with covering of tracks, than with protection of the child and family. (I must emphasize this risk is just as great for others, such as health visitors, as for social workers). To an extent, these objectives are not incompatible. For example, it is an essential part of the activity of any professional to keep adequate records. Failure to do so by different professions has been noted, time and time again, by different enquiries. If such criticisms lead to greater awareness of the need to do so, and even if the impetus to do so springs from fear, then there will have been a positive outcome. However, there is another, much more sinister possibility, especially relevant to social services, arising from fear of being held accountable for the death of a child.
207 That is, of course, that there will be a tendency to ’play safe’, which in this context means - if in doubt ’remove the child’. This is a complex and emotive issue about which even the most sophisticated professionals are prone to become irrational. In this paper, I intend to explore only two aspects: first, the broader social implications of precipitate removal of children from their homes; secondly, the more immediate implications for the children involved. CHILD WELFARE AND PARENTAL RIGHTS T H E R E I S no clear-cut solution to the conflict between the welfare of children and the rights of parents. Since the beginning of the century we have seen a progressive (but by no means steady) movement towards the protection of the child and away from the rights of parents to bring up their children as they will. It is salutory to remind ourselves that the first legislation introduced to enable the state to remove a child from his parents against their will was strenuously opposed as an unwarrantable intrusion upon the liberty of the individual. Sine then, parental rights have been limited, (some might say eroded) and there are some who fear that parts of the new Children Act 1975 take this dangerously far. It is interesting to recall how, in the ’50s’ when I was a Child Care Officer, we lived in the shadow of various High Court judgements which had decided in favour of parents, who withheld their consent to adoption for children long established in defacto adoptive homes. I, and others like me, believed such judgements to be wrong. Nonetheless, because this is, and must always be, a balancing act, one waits now for the inevitable ’back-lash’ against present trends. The headlines are predictable: &dquo;Judge censures social services for precipitate removal of child.&dquo; The Times: &dquo;The snoopers swoop to remove child&dquo; The Mirror. Indeed there have already been some such cases reported. Behind the florid headlines or the artificial calm of the courtroom, lie decisions of the greatest complexity, which we are ill equipped to make in terms of scientific certainties or predictors. Although there is a growing body of knowledge concerning factors associated with child abuse, there is not yet, and probably never will be, a substitute for professional judgement, comparable to that exercised by the medical clinician in matters purely physical.’i~ For example, in a case which recently came to my attention, there was clear evidence that a very young mother had injured her first born and he was committed to care. She had had herself a deprived background, was living with a young man, known to be somewhat unstable. A few years later, when her personal situation, psychological and material, had stabilized to some extent, she again became pregnant, by the same man, with whom she was still cohabiting but after a period of separation. The baby was removed from the hospital at birth on a Place of Safety order, pending care proceedings, because social services feared she might again injure a child. In this case, the social services’ action was not upheld by the court and the child was returned to her mother. In this brief illustration, there is encapsulated the dilemma of social services. One might further add, and I will return to this point later, that the advice of other experts, (I do not know whether or not they were sought in this case) may support social services in a tThis is not to underestimate the social research which is offer a cluster of predictors.
beginning
at
least to
of action but it remains ’a balance of No-one knows with certainty, or even with confidence, what the outcome of such a case might be. The social services must live with that uncertainty; it is their job to do so. They cannot ’pass the buck’, even if they seek help from other professionals or confirmation from the Courts, it is they who must seek the Place of Safety or the Care order and, in so doing, accept the responsibility for the separation of a child from his parents. That they should do their utmost to protect children is unarguable, and that includes a proper knowledge of indicators of child abuse and of the need for professional co-operation, both of which have often been lacking in the past. But, even so, there will be times when professional judgement fails and the child, as the doctor’s patient, dies. It is impossible to conceive of a situation in which the protection of the child was so pre-eminent that society would accept ever-increasing numbers of children taken into care to ’be on the safe side’. At present, it is necessary, in my view, to be vigilant lest the pendulum swing too far in that direction. This arises not simply because of fear and anxiety in individuals of becoming ritual sacrifices, although this does exist. I have referred to the dilemmas, sometimes agonizing, in relation to individual cases. This must be all too familiar to the medical profession and I imagine the point can be taken easily by analogy. Less easy to convey is the underlying doubt in the minds of social workers as to the value of the alternatives offered by a life in care. I will not dwell on the futile talk about ’blood ties’ which, as I contended in the Colwell report, has been, in the past, a phrase much loved by lawyers and little used by social workers. Nor am I for one moment arguing against the advantages for some children of a life in care in contrast with their own homes. The point is, quite simply, that when a child is removed and placed in care, events are set in train which we cannot predict or control and which, in some cases, prove so disastrous that the experienced social worker is forced to ask ’Was it worth it?’. A trail of broken foster homes or, the equivalent in psychological terms, of changing residential staff may only serve to perpetuate and increase the trauma of the original experiences. It is neglect of this aspect which weakens crucially the otherwise powerful arguments of the influential Beyond the Best Interests of the Child.6 The answer must surely lie in developing, concurrently, knowledge of, and skill in, treatment with the family and outside it. But in the meanwhile, social workers are in the unusual and painful position of seeing more of the products of substitute care than most other professionals. It is bound to make them wary. Another complicating factor affecting the attitudes of social workers is the confusion between personal. responsibility, as professionals, and organisational accountability, within a hierarchial system of local government. It is my impression that some members of the medical profession are particularly intolerant of this problem. Put bluntly, one gets the impression that for some doctors, phrases like ’professional responsibility’ equal ’good’, whereas phases which include words like ’accountability’ or, particularly ’hierarchy’ equal ’bad’! One is therefore diffident about entering such Indian territory in this Congress. It must, nevertheless, be acknowledged that there is considerable confusion over this matter within social services at the present time and that it has a bearing upon the handling by social workers of cases of child abuse. Social work does not yet know how to reconcile certain
course
probabilities’.
208
opposing styles of operation. On the one hand, there is the concept of the field worker, ’the man on the spot’, with professional autonomy, and the right to exercise the equivalent of clinical judgement. (In relation to this model, one has, however, to recognize that, as yet, less than half the field workers in social services are professionally qualified). On the other hand, social services are embedded in a long established bureaucracy. I do not use the word pejoratively. In its proper sociological sense, it describes an organisation, which, to get work done effectively, operates with clear lines of accountability by which each person within the hierarchical structure, knows the limits of his authority. The nursing service in hospitals is a particularly clear exbut a further complication in the local authority ample is the hierarchical accountability of all officers to elected members. So long as social workers continue to perform their task within a government setting, there is bound to be some compromise between personal responsibility and organisational accountability. This is, of course, to some extent a problem for all professionals in all organizations. Remarkably few in modern societies operate independently, although the myth of such independence is a long time a-dying. two
SUPERVISION
.
IN the many detailed interviews which we have undertaken in our research with field level social workers and their immediate seniors the ambiguity and ambivalence about the present situation is apparent. One of the matters about which we have enquired at length is that of ’supervision’, that is, regular case discussion between field workers and their seniors. Leaving aside the obvious problems which affect this, such as pressure on time and staff shortages, there remains a deeper problem which can be crudely summarized as ’who carres the can?’ If the process of case discussion is purely one of consultation, then professional autonomy is paramount and this is the way in which many senior social workers prefer to describe it. There is a marked dislike amongst them of assuming authority over their field level colleagues who carry the cases. Yet, even when the workers are qualified, there have been in the various enquiries, assumptions, albeit sometimes only implicit, that the decisions concerning children at risk are too important to be left at this level and must be referred upwards, not simply for report, but for decision. To an extent this view seems to be shared by many field workers, who are only too glad of the support this offers; just as many health visitors welcome the new structures which offer them the support of nursing officers as seniors. But it leaves unanswered the key issue, perhaps best illustrated by ’what happens when field the simple question worker and senior disagree on the proper course of it has happened.) It action?’ (This is not hypothetical also suggests a potential danger area if seniors and field workers tend to perceive differently a process formally described as ’supervision’. Until the balance between the two models is more clearly understood, social service departments may have problems which work to the detriment of the child and family. Thus far, I have concentrated upon some effects upon social services of the current preoccupation with child abuse. I have been mainly concerned with the internal dynamics of the situation, although I believe that much of what I have written is relevant also to other professionals. Finally, I turn to the implications for social services
HOWEVER,
-
-
of their relationships with other professionals concerned with child abuse. None of the relevant professions have been immune from a flurry of advice concerning communication and co-ordination in cases of child abuse. However, it is inescapable that in most instances the social services department is at the centre of this web and thus carries a special responsibility for the continuing improvement of the procedures and processes involved. Part of the research, funded by the DHSS, which I have been directing, has been concerned with a small scale study of interprofessional communication. We focused upon the case conference and attended 14 in 3 different local authorities in the month of July 1976. We then followed up 6 of these by interviewing individually all the participants. We are at present in the process of preparing our report and it would be inappropriate to present conclusions to this Congress before our sponsors and the Area Review Committees concerned have seen them. What follows, therefore, is in part an outline of some of the matters in which we were interested and in part of my own personal reflections upon the problems involved. In any case, our small sample cannot be statistically significant :t all it will do is raise what are, I hope key questions and issues. In our investigation, we were interested in two main areas: first, the use made of case conference procedures for different purposes, and secondly, the manner by which these purposes were achieved. The first of these includes such questions as: how are ’at risk’ cases defined in relation to calling a case conference and at what stages? Are children in the family, other than those accepted as at risk, considered ? Is the conference for pooling of information; for gathering of evidence, in the legal sense; for decision if so about what?); or for some or all of making these purposes? (A secondary question is do the participants perceive the purposes as the same?) The second area of interest about processes includes such issues as the role of the chairman, including the preliminary decision as to who takes the chair; those who are invited and those who accept the invitation; the venue of the conference and its effect upon participants ; the taking and circulation of minutes. There is a great deal to be said about the views and attitudes of our informants about the problem of child abuse and relations between professionals on these and many other matters. However, if one focuses upon the role of social services departments, it is clear that few of those we interviewed had questioned the desirability of social services assuming the main responsibility at the case conference level, distinct from Area Review Committees). This responsibility includes convening and chairing. An exception to this is to be found in those cases in which a child has been admitted to hospital. Here, naturally enough, initiative may rest with the medical staff of the hospital; even so, it is not necessarily clear to those present at a conference where aspects of responsibility rest, (for example, for ’summing up’ and circulating minutes). There is an interesting question here as to whether social services are, or are perceived to be, sufficiently neutral to chair some conferences. If, for example, there is a strong possibility of court proceeding’s which would be taken by social services, can the department concerned manage the involvement of its own staff, where there are conflicts with other professionals? Yet, alternatives are rarely
(and
-
(as
tWe have, also gathered some simple information nationally concerning numbers of conferences called in two months in 1976. This data is now being
analysed.
209
suggested and there may be a measure of relief amongst other professionals that, usually, they would not be called upon to make the crucial decision which might set in train removal of the child. So far as process is concerned, when one considers the levels of anxiety at many conferences; the inevitable interprofessional tensions and rivalries; the shyness of those for whom attendance is unusual; the complexity of the family situations under discussion and the dangers, (well illustrated in the Howlett enquiry*) of concentrating upon one child to the neglect of others, it is clear that chairing of such meetings requires very considerable skill. These skills do not necessarily come by the light of nature. Yet it is no exaggeration to say that the life of a child may, to a not inconsiderable extent, depend on that skill, consisting as it does in part of an ability to draw people out and yet to control irrelevance. It is likely that in this, social work education, whether basic or advanced, and however organized, will need to consider much more than heretofore the dynamics of committee behaviour, in the wider context of understanding the roles of others and the way each interacts. To do so requires a good deal of knowledge of the preconceptions which each brings to his own job and that of others. It is obvious that other professions too would benefit from such understanding and there is no question of it being the social worker’s responsibility alone. It may be, however, that for the foreseeable future, it is proper to emphasize the social worker’s part as a prime agent in facilitating interprofessional communication. Social workers, as other professionals, have tended to grumble at the amount of time spent about clients, not with them. There is, of course, a balance and it may have gone wrong in relation to child abuse; for example, if the time taken at conferences is excessive because thought and planning beforehand has not been adequate or because they are called unnecessarily. Yet although it is important to keep a check on the escalation of meetings, whether formal or informal, it remains inevitable, above all in complex industrial areas with shifting populations and changing staff, that considerable time will have to be given to the task. There is no other way of protecting the children at risk and family visits paid in isolation can be useless without professional interaction, as the enquiries have repeatedly shown. In the midst of much gloom at present in the health and social services, I cherish obstinately the hope that there can be a ’spin-off’ from the communication forced upon the professions by outcry over child abuse. But that must depend on readiness to extrapolate and transfer knowledge gained from one area to others in which interprofessional collaboration is equally important (as in work with the elderly). If social services contribute to this, good will have come of evil. In conclusion, I venture into more uncharted territory. Reading the reports of the six enquiries to which I referred, especially those where the reported events took place well after the Colwell tragedy, one is bound to ask some seemingly simple questions which probably have very complicated answers. They concern the seeming inability of well-intentioned, hard working people to learn from the experience of others, despite high levels of anxiety and a spate of exhortations from on high, giving indications of child abuse and outlining basic elements of good professional practice. Why, for
does accurate recording still not take place? ineffective visits not reported as a matter of concern? Why are case conferences not called? Why are G.P.s ’bad attenders at meetings’? Why does simple routine information not get passed on? It is increasingly rare for a child at risk not to be identified; it is what happens (or does not happen) after that that is crucial. I am not persuaded that these elementary failures and mistakes are due simply to pressure of work, especially as we know that anxiety levels have been higher in the last five years than ever before. In the days when medical pioneers were outlining the clinical picture of child abuse, the reluctance of the medical profession to accept that it could and did happen, was noted. Where are we now? Are we in a phase of professional ambivalence, whereby, on the one hand, child abuse is talked about, suspected and investigated, whilst, on the other hand, the old denial persists and, as with other disasters, the underlying phantasy is ’but it could not happen to me’? I realize that, in all professions, many other factors, such as the management of work-loads, may play an important part in this curious mixture of anxiety and carelessness, revealed in all the reports in the actions of various professionals. But I am not persuaded that this is the whole story. I have deliberately ended on a note of speculation about deeper issues which underly the successful implementation of policies and procedures because, whilst the need for the latter is unquestionable, they will not suffice on their own. We must probe further than that if children are to be protected; some will die whatever we do. I referred earlier to calculated risks and errors of judgement which may lead to tragedy. But that is very different from trivial muddles, which can be equally disastrous and which the enquiries reveal with depressing frequency. The professions who claim skill in interpersonal relations should co-operate, not simply in relation to specific cases, but to explore their underlying attitudes to the problem of child abuse and to the work they are required to do in connexion with it. There is always ’a hidden agenda’ both in terms of deep feelings roused in individuals by the problem and in the different approaches created, or reinforced, by different professional training and roles. I would like to think that social work may come to play a part in bringing that agenda out of hiding.
example, Why are
REFERENCES
1 (a) Report of the Committee of Enquiry into Care and Supervision provided in relation to Maria Colwell. H.M.S.O. 1974. (b) Report of the Committee of Enquiry into Provision and Coordination of Services to the family of John Auckland. H.M.S.O. 1975.
(c) Report of the
Committee of Enquiry into the consideration given and steps taken towards securing the welfare of Richard Clark by Perth Town Council and other bodies or persons concerned. 2 (a) Report of the Joint Committee of Enquiry into Non-Accidental Injury to Children, with particular reference to the case of Lisa Godfrey (Lambeth Local and Health Authorities and Probation Committee 1975). (b) Report of the Review Body appointed to enquire into the case of Stephen Meurs (Norfolk Country Council and Area Health Author-
ity 1975).
3 The Children Act 1975. 4 The Chronic Sick and Disabled Persons Act, 1970. 5 The Children and Young Persons Act, 1969. 6 GOLDSTEIN. FREUD and SOLNET (1973), Beyond the Best Interests of the Child. The Free Press.
These papers were 28 April 1977
presented
at
the Health
Congress, Eastbourne,
