‘Consequences’ by Elizabeth Reinach and Glyn Roberts

Elizabeth Reinach and Glyn Roberts (1979) “Consequences”: the progress of sixty-five children after a period of residential observation and assessment Portsmouth: Social Services Research and Information Unit

This short report into the outcomes of the work of one observation and assessment centre provided the first detailed evidence of why the changes brought in by the 1969 Children and Young Persons Act were not working. It was widely cited but few similar attempts to assess the effectiveness of the work of a single centre have been published, one notable exception being the evaluation of Medway Secure Training Centre (Hagell et al., 2000).

Key Points

• Children had had on average five placements in three years with 29% having seven or more.
• Children who did not get their preferred placement, older children, offenders, those from unstable families and children described as manipulative tended to have more moves.
• Few placements actually provided stability.
• There were no significant differences between the needs of children sent to community homes with education and other boarding schools other than that whose who went to boarding schools tended to be more deprived.
• Heads of homes and children often had significantly different perceptions of the placement.
• Quality of staff:child relationships was not associated with staff ratios.
• Children reported more positive relationships with the head or a peripheral member of staff than with the other staff.
• Disliking staff or making complaints was not associated with the placement recommendation.
• The children’s assessments of their peer group relationships were significantly different from those made by the staff of Fairfield Lodge and the heads of homes.
• There was no association between the heads’ perception of a successful placement and the type of establishment except that facilities for older girls tended to have fewer successes.
• Community-based placements tended to be unhappy or in unstable accommodation.
• Two thirds of children earlier assessed as offenders were no longer offending.
• Most children’s social situations were no different from their parents’.
• Some children’s problems can appear intractable.
• Children may be deeply unhappy in superficially successful placements.
• Few children had understood the purpose of the observation and assessment centre.
• Most had positive memories of it even though over half had been unhappy in some way when there.
• Most children had not been meaningfully consulted about the assessment and most had been unhappy with their subsequent placement.
• Most children would like to have been in their case conference.
• A significant minority of heads had never received the assessment report and only a minority had considered it satisfactory.
• Most were critical or sceptical of the value of observation and assessment centre reports but heads of community homes with education were more likely to make use of them and heads of hostels not at all.
• Where heads had been involved in the process of making the decision about placement rather than being directed to take a child, the placement was more likely to have been successful.
• Half of social workers thought the assessment report was of no value and those that did see it as of value saw it as of value mostly in relation to placement rather than for any insights it had revealed.
• Overall children placed in a planned placement tend to do better.

Contents

In the Introduction, the authors recall that, in The first year at Fairfield Lodge (Reinach et al., 1976), they had found that 43% of children had not proceeded to their recommended placement. They wondered what outcomes this had led to and what the consumers, the social workers, heads of homes and children had thought about this.

Their research had been based on material from Fairfield Lodge, social work records, interviews with social workers, interviews with heads of homes and sometimes houseparents and interviews with the children.

One of the problems in assessing outcomes was the narrowness of criteria such as ‘re-offending’ or ‘absconding’ but they did not have the resources for a complex study though they did believe it was important to rate individual views. They had also found that some social workers objected to them interviewing some of the children and they had accepted this. They also did not want the study to disclose which were poor homes and so had not asked social workers for their views on the heads and staff.

Another problem was whether what had happened afterwards was linked with what happened in the past. They had rejected setting up a matched sample because of the difficulties in matching and in isolating variables between the match and the sample. So they had ended up with a descriptive account involving over forty of the children. They did not meet every social worker or head of home where the children had had more than one placement; also some social workers had left the area, some homes had closed and some staff had left.

In Method, they point out that no one else was asking these questions. The study began in April 1977 and they went on to examine the file data from Fairfield Lodge and subsequent placements and in particular the reasons for any move or breakdown. Only 19 of the 65 children had had the same social worker throughout and in the end they had managed to interview 59 social workers.

They had data from 46 heads of homes on the quality of the assessment documents and how children had fared and data from a further 15 interviews with staff closer to the child. They were able to interview 45 children aged nine to eighteen out of the 65 original children; in fifteen cases their address was missing, one child refused and in four cases the social worker refused to allow the child to be interviewed.

The research design was completed by July 1977; in the autumn of 1977 the social workers were interviewed and the files examined; in the winter of 1977/8 the heads of homes of homes were interviewed and over the period June 1978 to April 1979 the children were interviewed.

In Chapter 1 Placement mobility, they report that the 65 children had had 308 placements, that is on average five new placements in three years, but this masked a range from 23 (35%) who had had no more than two addresses to 19 (29%) who had had between seven and sixteen moves. Though there was a tendency for those placed as recommended to have fewer moves, not all children who got their preferred placement had fewer moves and older children tended to have more moves. In particular, offenders, those from unstable families and manipulative children tended to drift between placements. This group had lots of short placements in residential care; out of 70 moves, seventeen were positive placements, twenty-one were temporary placements and forty-two involved friction between the child and the home. Nine, all girls, were rejected by or rejected hostel placements and three had been expelled.

Among the children who had fewer moves, sixteen were natural moves (changing or leaving school or going home), six were temporary placements and six were because of the child’s difficulties. Once a child in the group that tended to have more moves had had a breakdown, the chance of a further move increased.

The two children recommended for foster care were doing well but those in foster care who had not been recommended for it were doing less well.

In Chapter 2 Description of the homes, the authors describe the homes they had visited. The eleven children’s homes and two observation and assessment centres had staffing ratios ranging from 1.2:1 to 5:1 with an average of 3.1:1. They varied in how far recreation was organised, how community links were monitored and how often children went home at weekends. Though most heads emphasised care and stability, few were stable because of the turnover; the heads had deemed five of the placements unsuitable.

In the ten hostels the young people’s free time was their own time and staff limited themselves to support and advice; the authors were left wondering whether social services departments choose between secure accommodation and hostels for children with an ‘adventurous life style’.

The community homes with education offered remedial education, mostly of a traditional nature, and counselling; three had trade instructors. Their staffing ratios varied from 2:1 to 8:1 with an average of 4.5:1.

All but one of the seven special schools were single-sex establishments for children five to sixteen years old. Their heads tended to highlight similar needs to the heads of the community homes with education and the children who went to them had no more need for special education than those recommended for community homes with education. However, very few went home at weekends and they were mostly very deprived. Staffing ratios varied from 3:1 to 12.6:1 and they had limited psychiatric or psychological support in spite of the problems they were supposed to be dealing with.

The remaining school placements were in a boarding school for physically handicapped children, a boarding school for children with learning difficulties and a Catholic girls day school with a hostel attached.

In Chapter 3 Progress during the child’s ‘key’ placement, the authors report their findings about the placement where each child stayed longest; however, eleven children had no long term placement and in eight cases they could not interview the relevant staff; so they ended up interviewing 46 heads of establishments.

One child had two periods in the same placement; so, out of 47 placements, five lasted for less than six months, sixteen for six to eighteen months and twenty-six for more than eighteen months.

Twenty-eight of these placements were the first placement but six were the fourth, fifth or sixth placement the child had had since leaving Fairfield Lodge. Seventeen were in children’s homes, seventeen in community homes with education, seven in boarding schools, five in hostels and one in a foster home.

Forty-two of the sixty-five children were interviewed about these placements and they often gave completely different answers from the heads.

They found that good staff:child relationships did not correlate with better staffing ratios or with the size of the establishment though children tended to have more favourable opinions of staff in larger homes. Most could name a member of staff they really liked but they were often peripheral figures; children tended to be more able to confide in larger homes though some had not been able to.

Eighteen children said they had disliked no one, six that they had disliked one person but they were not important, twelve that they had disliked one person who was important and six that they had disliked several people. According to the heads twenty-two of the forty-six children had not complained and, of those whose had, the head had not been sympathetic to seven; in the remainder the heads had had varying degrees of sympathy. The children were not asked this question. There was no correlation between dislikes or complaints and the placement recommendation.

There were considerable differences between the heads’ assessments of children’s popularity and the children’s views about their peer relationships; these were also different from what had been written in the assessment documents. The heads generally thought that the children had progressed, albeit sometimes from a low base; the children generally thought they did slightly better in community homes with education; this finding did not correlate with the placement recommendation. The heads thought the trade training had been useful whereas the children did not and the children appeared less happy with the recreation opportunities than the heads.

Over half the heads had been happy with the levels of parental visiting and the rest had been split between ‘not enough’ and ‘too much.’ The heads in children’s homes thought they had been able to help with family relationships in six cases. Only nine heads thought social workers visited too infrequently.

Discharges from ‘key’ placements had mostly been for natural reasons though, in four cases, they had been for severe problems.

If children went back, it was mostly to see friends or a favourite member of staff.

Twenty-two of the placements were adjudged largely a success by the heads and seventeen were adjudged to have had little or no success; there was no relationship between staffing ratios and success. The facilities for older girls tended to be less successful but otherwise there were no differences in success rates.

In Chapter 4 Where are they now? A summary of how the children fared since they were in Fairfield Lodge, the authors give pen pictures of some of the children before commenting that there was a tendency for successful placements to lead to stability of education; excluding those unable to work, the unemployment rate among the group was 15%. Most of those not in a school or children’s home were in unhappy or unstable accommodation. Of the twenty-one initially described as offenders, five had become persistent offenders, two were on the fringes of criminality and fourteen had kept out of trouble. However, most were entering adult life with the same problems as their parents.

In fifteen cases (23%) there had been a successful rehabilitation, in fourteen cases (22%) it had failed; the remaining 55% fell somewhere in between. Of particular concern were some for whom there appeared to be no remedy, some who had been upset by their family and some who had been in the wrong placement, particularly if the placement had been unhappy about it. In eight superficially stable placements the child had been unhappy or miserable.

In Chapter 5 Perspectives on observation and assessment, the authors report that eleven of the forty-five children interviewed said they had not known how long they would stay in Fairfield Lodge and nineteen said they had been given a number of weeks though they had often stayed longer. Some had become confused about this question because they had first been on remand and two children said they had thought Fairfield Lodge was long-stay anyway. Seven said they had been unhappy or had absconded; two had experienced staff violence; fifteen had been dissatisfied because they had been there longer than expected; twelve had been aware of a delay but had been happy to stay; nine had been happy to be there but had not known there had been a delay; overall just over half had been unhappy in some way.

A minority had known why they were in an observation and assessment centre but twenty-six had never known why they were there; overall, less than half had been told in detail that Fairfield Lodge was an observation and assessment centre.

The children had tended to like the school, especially the teachers and the small classrooms; most had also liked the activities at Fairfield Lodge but some had felt their social life had been restricted, in respect of either going home or pursuing hobbies.

Most had liked the superintendent; ten of the forty-three who had spoken about this had disliked him; they were mostly offenders, but included two girls. Children had been less positive about the other staff and only tended to remember them if they had understood their problems or behaved in ways which would be acceptable to their peer group. The authors received more negative accounts of the other staff.

Very few children reported disliking other children, which did not correlate with what staff had reported in assessment reports; so do children underplay problems or do staff see ones that aren’t there? Overall inter-child relationships appeared to have been more harmonious than staff had assumed.

Most children recalled being cooperative during testing but about half had found the psychological interview unpleasant.

Twenty-five children said that no one had asked their opinion about the assessment; eight children could not remember being asked and eleven remembered being asked some question but it was not clear whether they had understood the point of the question.

Nine said they had been given a week’s notice of placement; another nine said they had been given one to three days’ notice and five had been taken on a visit. Ten children said they had initially been pleased with the placement though two had later been disappointed; twelve said they had not known what to think and thirteen recalled being hostile. Generally they had not felt positive towards the placement; most recalled saying nothing or something neutral; eight said they had objected.

Over half said they would have wanted to be at the case conference; two gave a qualified answer and eleven said they would not have wanted it (for a variety of reasons seven children were not asked this question). Overall, it appeared that too little time had been taken to inform the child about placement decisions and reasons.

Seven of the twenty-three heads who had received children directly from Fairfield Lodge could not recall any paperwork; about half of the heads who had received a child at a later placement had also received the Fairfield Lodge paperwork. Some had received the information from the social worker.

Half of the twenty-eight who had received the paperwork considered it adequate or better, nine partly satisfactory and three unsatisfactory; two had forgotten their response. Fifteen heads had taken children with no current paperwork; some had felt handicapped by this but others had been filled in by the social worker or thought it did not matter. Most criticisms were about lack of factual data. Few heads saw the reports as able to identify potential and most were critical or sceptical of the value of observation and assessment centre reports.

The heads who had been involved in placement decision were more likely to have had successful placements even though they had often had general reservations; where heads had been involved but there had been a subsequent failure, there were usually other factors to explain the failure. In practice, heads who had not been involved generally did not object to an admission and accepting a child had not been influenced by whether or not they had been involved in the decision-making.

Heads of hostels and most heads of children’s homes did not use the information, though a few did to deal with both negative and positive things. Most heads of community homes with education used the information but heads of maladjusted schools less so. It was unclear how far not using the information contributed to breakdowns.

Nineteen children had had the same social worker throughout, twenty-four two social workers, thirteen three and one four.

About half said the Fairfield Lodge report had not been useful and three-quarters said they had never referred to it again; even those who had used it did not always see eye to eye with its contents. They had no view of planned changes in a child’s situation and many felt unable to plan because of the child’s family situation. Overall twenty-eight thought the report had been of value, mostly in relation to placement finding and a few commented positively on insights it had revealed but nineteen said it had been no use.

In Conclusions, the authors note that observation and assessment centres tend to do more than just assessment and conclude that children placed as planned tend to do better.

Discussion

The most unfortunate omission from this report is the parents’ view, particularly in view of Taylor and Alpert (1973), though, in fairness, this research was not widely publicised in the UK until Walton (1978). However, Reinach and Roberts effectively come to the same conclusion as Taylor and Alpert – that none of the things that professionals tend to think of as important have much effect on the success of a placement. Rather it is factors such as being a persistent offender or disturbed in some way, coming for an unstable family or living in unstable circumstances that are more significant for a successful outcome. In noting that there was little in the children’s backgrounds that was different from their parents’ backgrounds, they also echo several of the studies in Clarke and Clarke (1976) which showed that short-term interventions rarely have long-term impacts, and long-term changes in a person’s circumstances are normally required to long-term effects. An average of five placements in three years hardly suggests long-term change in children’s situations and, as Wiener and Wiener (1990) found that successful outcomes declined after five placements in fourteen years, the prognosis for many of the children could not be good.

The finding that children were more likely to mention positive relationships with the head nicely complements King et al. (1971) who had found that positive outcomes were associated with positive relationships with the head of the unit and the finding that children also remembered peripheral staff echoes the observation by Lennhoff (1960) that children often made relationships with those peripheral to the staff team.

The fact that people appeared so often to have misread children’s peer group relationships might be explained by the finding that teenagers very often quarrelled with their siblings but that this did not mean that there was anything wrong with the relationship (Fogelman, 1976).

The extent to which children were not told what was going on or were not invited into case conferences reflected what Page and Clark (1977) had found, but the low value colleagues and social workers placed on assessment centre reports may have been rather discouraging to the framers of the  Children and Young Persons Act 1969 who had seen successful assessment at the key to successful treatment.

Shortly after this the Department of Health and Social Security Working Party undertook a major review of assessment (1981).

In the decade that followed, Berridge (1985), Millham et al. (1986) and Rowe et al. (1989) were to flesh out these findings and make it clear that most of the objectives of the Children and Young Persons Act 1969 and of social workers more generally were not being achieved. Reinach and Roberts signposted the way.

References

Berridge, D (1985) Children’s homes Oxford: Blackwell

Clarke, A M and Clarke, A D B (Eds) (1976) Early experience: myth and evidence London: Open Books See also Children Webmag May 2010

Department of Health and Social Security (1981) Observation and assessment: report of a working party London: Department of Health and Social Security

Fogelman, K (1976) Britain’s sixteen year olds: preliminary findings from the third follow-up study of the National Child Development Study (1958 Cohort) London: National Children’s Bureau

Hagell, A, Hazel, N and Shaw, C (2000) Evaluation of Medway Secure Training Centre London: Home Office

King, R D, Raynes, N V and Tizard, J (1971) Patterns of residential care: sociological studies in institutions for handicapped children London: Routledge & Kegan Paul See also Children Webmag April 2009

Lennhoff, F G (1960) Exceptional children: residential treatment of emotionally disturbed boys at Shotton Hall London: George Allen & Unwin

Millham, S, Bullock, R, Hosie, K and Haak, M (1986) Lost in care Aldershot: Gower

Page, R and Clark, G A (Eds) (1977) Who cares? Young people in care speak out London: National Children’s Bureau See also Children Webmag December 2008

Reinach, E, Lovelock, R and G. Roberts, G (1976) The first year of Fairfield Lodge Portsmouth: Social Services Research and Information Unit

Rowe, J, Hundleby, M and Garnett, L (1989) Child care now: a survey of placement patterns Research Series 6 London: BAAF Publications See also Children Webmag April 2010

Taylor, D and Alpert, S W (1973) Continuity and support: following residential treatment New York: Child Welfare League of America See also Children Webmag March 2009

Walton, R G (1978) Continuity and support for children in homes Social Work Today 9 (40), 22

Wiener, A and E Wiener, E (1990) Expanding the options in child placement Lanham MD: University Press of America. See also Children Webmag January 2010