Monday, 10 June 2013

CHILD PROTECTION AND CAMHS


CAMHS and CHILD PROTECTION

The importance of understanding the link between child abuse and mental health problems is paramount. InBritainat least one child dies each week as a result of adult cruelty. It has been estimated that about 5000 minors are involved in prostitution in Britain at any one time. Nearly 23,000 children were being looked after by local authorities for the year ending 2007. About 60 per cent of these children had been abused or neglected with a further 10 per cent coming from ‘dysfunctional families’ (ONS 2008). In 2007 there were over 300,000 children in need in England. Of these 69,100 were looked after in state care while the rest were in families or living independently. One quarter of all rape victims are children. 75 per cent of sexually abused children do not tell anyone at the time. Each year about 30,000 children are on child protection registers. Children with learning disabilities are at a greater risk of experiencing all forms of abuse and neglect. Recorded offences of gross indecency with a child more than doubled between1985-2001 but convictions against perpetrators actually fell from 42 per cent to 19 per cent. Fewer than one in fifty sexual offences results in a conviction. In 2007-08 there were 20,000 recorded sex offences against children (NSPCC 09).



Prevalence of abuse

Solid data about the prevalence of abuse is difficult to obtain but a reliable indication is that about 750,000 children will have been abused by the time they reach 18 years of age, with 400,000 having been sexually abused (Cawson et al 2000). This NSPCC research suggests that about 30 per cent of girls have been sexually abused and about 15 per cent of boys. Reductions in the length of time children spend with their names on child protection registers seem to imply that child abuse is decreasing- which is not the case, rather they illustrate the shorter time spent on registers consistent with the reported increase in de-registrations. In other words the government target for shorter registration periods may be being achieved, but the consequence is that risk is being hidden.



The problem with child abuse is the often hidden nature and secrecy surrounding it combined with societal ambiguity about state intervention in family life. Crude structural and organisational changes to the way child protection services are delivered are the institutional knee-jerk response to improving the safeguarding of children and young people in the wake of the damning Laming inquiry into the death of Baby P (2008), Victoria Climbie (DOH 2003) and The Bichard Report of the deaths of Holly Wells and Jessica Chapman (Home Office 2004). Every Child Matters: Change for Children (2004) established the new framework for building services around children in which previously separate services must work together in an integrated way.



Above all, these changes aimed to provide professionals with consistent ways of communicating about children’s welfare. In many ways it is the most important because organisational change of itself cannot bring about shifts in entrenched attitudes, beliefs, customs and vocabulary. And despite repeated child abuse inquiries citing poor communication between agencies as one of the major reasons why children have not been properly protected, it remains difficult to get right. Recent research also highlighted the paradox of the disproportionate investment in management performance recording templates, rigid timescales and IT systems resulting in a reduction in safety of systems and children rather than an increase in safety (Broadhurst & White 2009).

Despite the hyped publicity and modern media circus exploding around high profile child deaths, historically expectations of child protection staff have tended to be lower than they are nowadays. Up until 1914 around 250 children every year died in child protection cases that were known about – more perished without coming to the attention of professionals. By 1970 the number of deaths in child protection cases had shrunk but the impact of the cruel death of Maria Caldwell and the blaming of professional staff started a trend in public discourse that endures today. Ironically, the better social workers have become at protecting children and preventing their deaths, the more bitter the public and political outcry has become when this fails to happen (Ferguson 2007.) Poor inter-agency communication is usually cited in subsequent internal investigations and public inquiries.



Rather than trying to design ever more elaborate bureaucratic data systems, Reder et al (1993, 2003) suggest that agencies need to put greater effort into understanding the psychology of communication in order to improve it. This means more than superficial and tokenistic exercises hosted by agency managers, but a fundamental re-appraisal of the knowledge, values and personal beliefs held by every member of staff engaged in work with children and young people so that integrated working is actualised. The mental health and emotional well-being of children can be both a consequence of child abuse and a precursor. You must consider this aspect of your work in safeguarding children as much a priority as learning new procedures, computer data systems and legislative guidance.



Integrated working does not mean absence of disagreement- indeed the evidence suggests closer proximity with other agency staff accentuates differences between professionals. But this need not be a problem provided you work hard to appreciate each other’s perspectives and not be so certain of your omnicompetence. Thinking about yourself as an equal part of an integrated system, rather than as an individual agency representative is a crucial re-conceptualisation to make. Disagreement may actually be healthy and force staff to compromise or continue seeking a solution. At another level such differences between professionals may reflect the dynamics in the family situation which produce splits. The mental health of a young person at risk of abuse can find expression in other family members through a process of indentification and projection (Walker 2005).



Equally you should be wary of rushing too quickly to agreement and consider whether the multi-agency group are avoiding or denying some unanswered and complex issues because of the risk of exposing an argument. This could reflect the emotional dynamics within the family. Self awareness is one of the keys to managing the stress and strain inherent in working together to safeguard children. This requires skilled and highly developed supervision skills from line managers and a willingness to expose your practice to scrutiny and to engage in reflective practice (Walker & Thurston 2006).

Interagency working

CAMHS and child protection often seem to occupy different parts of child welfare services yet they are always linked in some way. By separating them institutionally and dividing staff who are often involved with a vulnerable family, government is not optimising the conditions for more effective child protection.
The much vaunted aim of joint working and closer collaboration has echoed throughout much of the past 30 years of public reports where young people have been killed by their parents/carers, when problems in communication between agencies have occurred. In fact it appeared much earlier in the 1945 inquiry report into the death of Denis O’Neill- often cited as the first child killed in the UK while subject to child protection agency involvement.

Guidance suggests that staff should receive more comprehensive safeguarding training that equips them to recognise and respond to a person’s welfare concerns. Thus the policy aspiration to foster closer collaborative working between agencies involved in safeguarding children faces serious obstacles.CAMHS staff receive separate child protection training and rarely work effectively with child protection social workers. Joint, multi-agency teams working from a single base would be a major step forward, but jealous budget holders and insitutional envy hampers this.

The principal reason given for failures in interagency cooperation is that one key individual within that system failed to fulfil their part of the process which resulted in a breakdown in the protective intervention. It is not the individual within the system but the structure of the system itself that is of key importance. That one individual within a system can be blamed for a child's injury denies the whole concept of collective interagency decision-making and responsibility. Agencies can fall into the convenient practice of finding a scapegoat reflecting a societal individualistic culture and the adversarial legal system: ‘In Britain, when things go wrong, the system encourages a blaming of individual agencies and practitioners’(Murphy 2000).

If better communication is to happen it is essential that the practitioner or agency concerned behaves in an assertive way by explaining the reasons behind a judgment or opinion to the rest of the interagency group. You must never attempt to take over another agency's role or sphere of activity. It is helpful to use the technique of predicting positive or negative outcomes for the proposed courses of action. Where possible, aim for compromise if not consensus. Where there is a sense that one side has forced a decision through, the probability of positive interagency cooper­ation being achieved around that decision is extremely low.

By being pro-active about potential problems and difficulties much goodwill can be generated and mis-conceptions dealt with before they occur during stressful situations. Acknowledging the powerful feelings aroused during this stressful work in a safe environment away from the front line with a neutral facilitator can be very helpful in reducing all sorts of barriers to better communication. These training experiences are not add-on extras or self-indulgent experiential exercises. They are the real process by which learning takes place, practice improves and clients are better safeguarded.



Skills and Knowledge for Safeguarding

This is an attempt to enhance integrated practice in safeguarding people. The main elements of the common core in which people who work with vulnerable people need to know about and become proficient in are:

Effective communication and engagement- includes establishing rapport and respectful, trusting relationships; understand non-verbal communication and cultural variations in communication; active listening in a calm, open and non-threatening manner; summarising situations to check understanding and consent; outline possible courses of action and consequences; ensuring people feel valued; understand limits of confidentiality and relevant legislation; report and record information.



Human growth and development- includes observing behaviour in context; understand developmental processes and mental health issues; evaluate circumstances in a holistic way and distinguish fact from opinion; know when to refer on for further support; demonstrate empathy and understanding; support the person to reach their own decisions; take account of different life styles; distinguish between organic disability and poor parenting producing delayed development; understand attachment patterns and the inter-relationship between developmental characteristics and being clear about your role and how to reflect on practice to improve it.



Safeguarding and promoting the welfare of the person- includes ability to recognise overt and subtle signs that people have been harmed by considering all explanations for sudden changes in mood or behaviour; involve parents/carers in promoting welfare and recognising risk factors; develop self-awareness about the impact of child abuse; build confidence in challenging oneself and others; understand legislation, guidance and other agency roles; share information in the context of confidentiality; appreciate boundaries of your knowledge and responsibility; Respond appropriately to conflict, anger and violence and understand that assumptions, values and prejudice prevent equal opportunity.



Supporting transitions- includes recognising changes in attitudes and behaviour; empathise and reassure to help the person reach a positive outcome; consider issues of identity and the effects of peer pressure; understand key areas affecting emotional well-being such as divorce, bereavement, puberty and family break-ups, primary to secondary school, unemployment, leaving home; disability and increasing levels of vulnerability; knowledge of local resources and how to access information.



Multi-agency working- includes effective communication by listening and ensuring you are being listened to; work in a team and forge sustaining relationships; share experience through formal and informal exchanges; develop skills to ensure continuity for the person; know when and to whom to report incidents or unexpected behaviour changes; understand how to ensure another agency responds while maintaining a focus on the persons best interests.



Sharing information- includes making good use of available information such as a common assessment; assess the relevance and status of different information and where gaps exist; use clear unambiguous language; respect the skills and expertise of others while creating a trusting environment and seeking consent; engage with people and their families to communicate and gain information; share confidential information without consent where a child is at risk; avoid repetitive questions and assessment interviews; appreciate the effect of cultural and religious beliefs without stereotyping; understand the Fraser principles governing young people’s consent; distinguish between permissive information sharing and statutory information sharing and their implications.