Care Matters? Yes, It Really Does.

Applause

Whatever we may criticise about the detail of the Government’s thinking in the Green Paper, we have to applaud them for giving serious attention to the needs of the children and young people who are the most vulnerable. Children with physical, sensory or mental disabilities or emotional, family or behavioural problems may have considerable needs, but they are a minority with a small voice as far as voting power is concerned, and it is easy for politicians to overlook them.

Dealing with their needs properly in childhood, though, can make a real difference to their whole lives. If they are to avoid a lifetime of institutional containment in prison or mental hospital or hospital, they need to receive the right care and treatment as children and young people. Not only it this important for them and their families, but it is also good for the wider community in economic terms, in respect of social nuisance and the prevention of crime.

Let us start with a round of applause for the Government, then, in addressing the needs of children and young people squarely.

Beyond Party Politics

The proposals are fundamental, and entail considerable change. Local authority Social Services Departments have already been carved up in most parts of the country to create the new Children’s Services. This level of change is necessary at times, but its advocates are rarely aware of the problems it creates – the loss of experienced workers who are retired early, the disruption in working relationships, the uncertainty for individual staff members as things shake down, the time spent on creating new systems and policies, and the impact on the children and their families whose problems receive less attention during the reorganisation.

There are lots of casualties, both staff and service users, when there is reorganisation on this scale, and those in positions of power at national level often seem to be unaware of the mayhem that they create in people’s lives in the process. The impact is felt not only at the time, but it affects people’s lives for years afterwards. It has been found, for example, that children’s childhoods have been blighted because their social workers’ attention was being diverted by re-organisation at critical points in their lives. It is a high price to pay. Fundamental re-organisation may be needed from time to time, but it should not be undertaken lightly.

The point is that the new systems being established – including the Green Paper’s proposals – need to have a long life. Social Services Departments lasted for thirty-five years, and the new system needs to be robust enough to have a similar life. It must not be subject to continual tinkering of the sort which has damaged the National Health Service.

If so, the proposals need to have the backing of all the key political parties. The Government needs to carry not only its own party with it, but also those in opposition. It is not in the interests of children and young people for the systems to be subject to regular change, and the foundations for these proposals need to be based on the consensus of politicians and professionals from all key viewpoints.

It will take a decade for the practical changes to be well embedded in practice, another decade to achieve the attitude changes required, and at least another ten years to be able to commence evaluation of the long-term effects and outcomes of the legislation. Because of the timescales to which politicians work, they rarely undertake long-term evaluations of previous systems, preferring to go for the headlines of proposing further changes.

We therefore issue a Government warning. If Alan Johnson wants to be remembered like Butler for the Education Act 1944 or Aneurin Bevin for setting up the National Health Service, he will need to make sure that any action taken is thoroughly thought through and is based on widespread support.

Haven’t We Been Here Before?

In some areas of public life, the experts are seen to know most. In child care in the United Kingdom (unlike continental Europe) the politicians and civil servants see themselves as the experts and tend to take the lead, producing the new ideas which they expect will solve current problems. This may be because (unlike continental Europe) there is no united child care profession to give an expert lead, comparable to that provided in other countries by social pedagogues or social educators.

In the absence of the professional lead, the interest and enthusiasm of the politicians is most welcome, but they need to be aware of the dangers of taking a political lead in this field. Because of the adversarial nature of politics, the typical approach taken to a major subject is to identify the problems, throw the blame for failures onto other people, and put forward alternative proposals. There is often inadequate appreciation of the history of improvements in the field to date, and a real danger that trite proposals are put forward without a thorough understanding of the problems addressed, the successes and the failures of the past. The Government needs to take a long hard look at the history of child care, therefore, if they are to avoid replicating the mistakes of the past.

Until the Children Act 1969, the Home Office was responsible for child care; then it was the Department for Health and Social Security, which became the Department of Health; and now it is the Department for Education and Skills. Because of the cyclical change of Ministers and civil servants, – let alone Government Departments – it may well be that there is no one closely involved in the processing of the Green Paper who knows the problems of the past. If so, time spent on looking at past formulations, solutions and pitfalls might well improve the current proposals and make them more effective.

Good Ideas

The issues covered by the Green Paper and the bulk of the proposals make good sense. Having identified the need for reform and the scale of the problems faced, the Green Paper covers the role of the corporate parent, the importance of selecting the right placements, the need for good education, life outside school, aftercare, and support systems. The Green Paper’s proposals were summarised in last month’s Webmag, and will not be repeated here, but it can be assumed that we support them – or are not opposed to them – if they are not subject to comment below.

A Sound Basis

Working successfully with children and young people is primarily dependent upon the workers developing good relationships with them, and in turn the building of good relationships grows from the values and attitudes of the workers. Their motivation and commitment are therefore a key component. It is not the only factor by any means; workers need skills, knowledge, training, supervision, reasonable working conditions, pay and so on, but unless they genuinely care for the children and young people, like working with them and obtain their main job satisfaction from seeing the children and young people succeed, the other factors will be ineffective.

This may sound terribly obvious, but there are aspects of recent practice and of the Green Paper which do not reflect this basis.

In the nineteenth century many of the main child care charities were founded by Christian philanthropists who were deeply concerned about the needs of “the perishing and dangerous classes”, as Mary Carpenter called them. Over the years since then, the charities have become more secular and generally less campaigning, and politically correct thinking has undermined the emphasis on personal commitment and the influence of beliefs on the motivation of workers.

A range of pressures have led to a less personal service – avoidance of touching in case of allegations of sexual abuse, increased inspection leading to increased time spent on bureaucracy, shorter working weeks requiring more staff and less continuity of personal care for children, residential workers no longer being resident in children’s homes, the widespread use of agency staff, the emphasis in NVQ training on specific competencies rather than the broad education of workers, and so on. All these factors and dozens more have gradually transformed the work into being less of a vocation and more of a job. There are, of course, still many workers dedicated to meeting children’s needs, but there has been a shift of emphasis.

The problem facing the authors of the Green Paper is to find ways of creating the right sort of commitment to children’s welfare for the twenty-first century. The Green Paper rings some alarm bells in this respect.

When children have to live away from their families in residential or foster care, they need to build strong relationships with their foster carers or with the staff  (their keyworkers, at least) in the residential accommodation. These people need to be models for them, and although there is no pretence that they become the children’s parents, they do need to fulfil some parental roles and offer the unconditional love and concern which parents should have, especially when children have suffered rejection or abuse.

There is often quite a range of workers who can have an impact on the children’s lives – teachers, social workers and psychologists, for example. The Green Paper’s emphasis on partnerships between professionals, jointly working in the children’s interests, is therefore very welcome. However, the Green Paper fails to give proper weight to the key roles of the primary carers – the foster carers and the residential workers. They should be seen as the central people in the lives of the children, with other workers acting as their supporters and advisers.

The Green Paper therefore gives excessive weight to the role of social workers. They certainly have important roles to play in carrying case accountability, ensuring that assessments of need are carried out, that resources are lined up to meet identified needs, that cases are properly recorded and reviewed, that statutory requirements are met, and that court action is taken where necessary. None of these roles, though, implies that social workers will build close relationships with the children, or be seen by them as people to confide in.

A study of case files will indicate that children in extrafamilial care frequently become very close to their primary carers, sometimes becoming virtual family members, but it is relatively rare for the same depth of relationship to be formed with social workers. There are many reasons. Children and their families often see the social workers as representing intrusive authority figures who have removed them from their families. They see their social workers for relatively brief periods, often only once or twice a month, as against the hours of daily contact between the primary carers and the children. And, of course, when there is a high staff turn-over, new social workers understandably often fail to absorb the detail of the children’s previous history.

Social workers have important roles, then, but the Green Paper is in danger of failing to appreciate that in the child’s map of relationships, they may be peripheral, even when undertaking all their required duties properly. The corollary is that the primary carers’ roles are insufficiently appreciated. The children need to see their carers as positive models, but they cannot fulfil their substitute parental roles and their standing is undermined if they have to continually seek permission from social workers for expenditures or staying away for the night.

Historically in the UK it is field social workers who have not only maintained case accountability but have retained the power to take a variety of decisions. The balance of power needs to be shifted. We suspect that in continental Europe, with its well-trained pedagogical profession, the balance is different. From the child’s viewpoint, the person closest to him or her should have the authority to take all the decisions necessary related to daily life.

Creating Suspicion

Over the last two decades there has been an increasing emphasis on quality assurance, with several re-organisations of the inspecting bodies, the establishment of standards for services and the registration of workers. This is all commendable, but in any positive development there is always the risk of unintended consequences or side effects. When drawing up new plans or legislation it is important to be aware of possible dangers, and to fine-tune in order to avoid their effects.

Assuming that the foster carers or residential workers are the primary carers for children in extrafamilial care, it is vital to recognise that the main check on bad practice – and the main initiator of good practice – is the commitment of the carers themselves. If they are motivated properly, they will be self-checking, and this is the most powerful and continuous sort of check.

The children’s social workers then provide an external check, and should be well enough known to the children for the children to be able to trust them and confide in them if things go wrong. A study of case histories unhappily shows that children frequently have not confided when carers have abused them, and frequently children turned to teachers, whom they knew better. Nonetheless, social workers have at times played vital roles in blowing the whistle, and they are well placed to observe the quality of care provided and the way the children are developing.

In so far as they play an inspectorial role and ask children how well they are being cared for, there are implied assumptions that the children’s carers might not be trustworthy but that the children should trust the visiting social worker.  With the introduction of independent visitors, there is the further implicit assumption that the children might not trust their foster carers or any of the residential staff or their social workers, but that they will trust an external independent person who is involved in their welfare because of their concern, and not the money.

There are then the external inspectors, the visiting Councillors (if the children are in a local authority home), the senior local authority managers, the social workers responsible for supporting the foster carers, and a host of other people who are more peripheral, such as practice teachers for students on placement, environmental health staff and so on. All of these may have access to the home where the children are living and may raise questions relating to the quality of life experienced by the children. If the children are told that they are meant to trust their primary carers, they must sense that they are receiving mixed messages if these people need to be checked for quality so much.

We do not advocate the ending of quality assurance, and the availability of independent visitors is to be commended. We do argue, though, that it is time to switch the emphasis from inspection to support. Inspection against set standards carries adversarial overtones in the event of failure to meet requirements; support is more collaborative, with all those involved sharing the joint aims of meeting the children’s needs. In so far as inspectors are simply checking, it is also a waste of their expertise if they are not expected to provide support and advice to improve practice, however bad or good it is. It may be argued that inspectors to provide help already; we argue that the balance is wrong, wasting resources and undermining the primary carers.

Records do have to be kept, but it would be helpful if the inspection process could be evaluated in detail, to see what proportion of staff time is spent simply fulfilling the requirements of the inspection process. The hidden demands on staff time – senior staff in particular – may well be considerable. It is not just that good practice entails good record-keeping in the interests of the children; it is that excessive time spent on bureaucratic duties to meet requirements is time diverted from face to face work with the children.

Positive Practice

Since the early 1970s residential child care has been modelled on social work. One of the aims at that time was to give residential workers the same status as field social workers. Retrospectively, this link was a failure. Social work is targeted on the resolution of problems; casework is problem-focused, and when problems have been resolved cases are closed. By contrast residential care is designed to give children and young people a good childhood, building on their strengths, helping them to develop to adulthood and addressing their problems in the course of daily life.

The social work model, applied to residential care, has abbreviated placements. As soon as children’s problems have been stabilised, they have been moved, disrupting their lives once more, rather than building on the success of their stabilisation to let them settle and achieve educationally.

Mental Health Care

This is particularly important because a very high proportion of children in care suffer mental health problems in later life. It has been customary practice to avoid attaching labels to children in care, despite the range of emotional, family, personality and behavioural problems which they may have. The best psychiatric and psychological care has been given in close conjunction with children’s primary carers, so that a consistent approach can be taken towards their problems. However, there has been a dearth of the support needed, and it is our view that every child in extrafamilial care should have such services available.

A Range of Services

Another lesson from history dates back to the 1970s. Two well-intentioned measures combined to change residential care without any thought being given to the impact on children. First, staff were asked to pay realistic rents for their residential accommodation. Since the hidden subsidy no longer made being resident attractive, they all moved out, and children’s homes became homes only for children. Secondly, a fixed working week was introduced, which entailed the doubling of staff in many homes.

The combination of these two factors changed the homes dramatically. Many poorly staffed group homes had been virtually large foster homes, and the women (usually) in charge often stayed for many years and treated the long-stay children as their oen families. Even in larger homes, the continuous presence of adults on site provided stability. Following the changes, children’s homes became places of work to which staff went for shifts and their nature was altered.

Furthermore, a gap opened up in the range of provision between foster care and children’s homes, which was partly filled by the introduction of professional foster parents, who received rewards beyond the usual level of fostering allowances. That gap still remains, however, and we believe that there is room for the development of provision to provide a hybrid form of extrafamilial care, offering long-term stability to children and young people.

The model, developed about thirty years ago in Switzerland, entails the appointment of a trained and qualified couple to care for three or four children. They are salaried and supported as if they were paid workers, but the type of care they offer amounts essentially to fostering. A key feature is that they contract to care for a cohort of disturbed children for the remainder of their childhood, and when the cohort reaches adulthood, they consider whether to take on another cohort or move to a different sort of work. The model provides for high levels of skill, continuity, consistency and a distinct child-centred focus.

A Weak Idea

Perhaps the weakest proposal in the Green Paper sounds regrettably – from the way it is promoted so enthusiastically in the text – as if it may be the Minister’s pet idea. It is proposed that private partnerships of social workers should be established to undertake long-term work with children and young people. That long-term work is important is undoubted, and it needs to be well done, but whether this model will help to any great extent is doubtful for the following reasons.

It is not a new model. Voluntary bodies have undertaken work of this sort in the past. The NSPCC, for example, has had teams of social workers specialising in child protection scattered in various cities. Unfortunately, these teams have gained the reputation of selecting the cases with which they wish to work, and refusing others. Naturally, local authorities have accused them of cherry-picking, and have felt that they still had to cope with the most complex cases. The system proposed would be vulnerable to similar accusations and reactions.

Some authorities already split their social workers into emergency and long-term teams. It is hard to see what advantage would be gained by giving the long-term work to a private agency, especially when the two teams need to work together so closely.

In other authorities social workers are intentionally given mixed case loads, so that they have a blend of short-term emergency work and long-term cases. The proposal would not be compatible with such a system.

There is no guarantee that establishing private teams of this sort would be any more effective in recruiting and retaining social workers than the present structure, unless there were other changes such as reduced workloads or improved training and supervision, but these improvements would equally help in the current predicament.

In short, there is no real argument for the proposal, but it could do damage.

Child Protection

If the Green Paper is intended as a call for lateral thinking, there is one issue which should be addressed which appears until now to have been unthinkable. Children who are being abused in their own homes sometimes refuse to provide evidence because they do not want their families broken up and their abusers sent away. Even though they want the abuse to stop, they feel it is preferable to society’s current response.

The present action is very heavy-handed, with lengthy evidence-gathering and complex court procedures, which may be traumatic for the child. Few cases of child abuse reach court, and many of them fail. It is no wonder, then, that children prefer to continue to be abused. Furthermore, on reaching adulthood, people who were abused as children frequently return to live with the parent who abused them.

Our suggestion, then, is that a less heavy-handed approach should be taken. It is not that we condone abuse or fail to recognise the pain and long-term harm it causes; it is simply that the measures currently taken may be even more harmful and less acceptable to the victims. On occasions, current systems will need still to be applied, but we suggest that in some cases ways need to be found to help the abuser to cease without the threat of court action and the destruction of the family.

Aftercare

In recent years much greater attention has been paid to aftercare, and this is very welcome. The contrast between children in care and those in their blood families, where children on average leave at the age of 24, and may return thereafter for support or celebrations, is very telling. The measures proposed, however, do not  – in our view – go far enough.

If young people leaving care are to depend only upon their social workers for aftercare, they will be vulnerable to changes in staffing and support is likely to be limited. The support provided by a natural family usually involves a number of people maybe within an extended family and possibly involving close family friends. There is therefore often a network of people able to offer various sorts of help. This is what local authorities need to replicate.

We suggest that there need to be aftercare communities through which people who have established themselves after leaving care can act as mentors to those moving to independent living. The key indicators of success are a stable place to live, an occupation and a social circle. An aftercare community could offer the latter, helping young people leaving care to settle down and develop their own networks and social lives. There would need to be a base and a small team of paid staff to maintain the community, but it would be the ongoing network of relationships that would provide the range and continuity of support required.

This type of support has been offered for many years by foster carers who have received the children into their families and by children’s homes and voluntary organisations which have sometimes developed world-wide networks of former children in care. Local authorities, however, have not developed the same continuity, especially with the opening and closure of homes, and the proposed aftercare communities need to continue regardless of such developments.

Failure

The biggest failure of the current services for children and young people is that nearly 3000 are in the penal system. In 1856 reformatories were set up specifically to prevent children and young people having to fulfil their sentences in prisons. Reformatories were developed into training schools, which became approved schools in 1933, changing to community homes with education following the Children Act 1969. This system, which organised regionally, crumbled and the CH(E)s were closed. The consequence is that young offenders are once more placed in prison. After 150 years we provide a worse service than our Victorian predecessors, a fact of which we should be ashamed.

A further problem is that local authority secure accommodation, which is superior to the penal system from a childcare point of view, is also more expensive, and the result is that local authority units have been closed, pushing a higher percentage of young people in security into the penal system.

A major factor in this failure is that managing large child care establishments is a high-cost complex business, and typically local authorities have not had senior managers with the expertise to manage and support such establishments. Some, influenced by entrenched social work antipathy to residential care, have taken positive moves to close them.

We suggest that the solution is to recognise the specialist nature of the service and to re-establish a national service on behalf of local authorities, with a view to the complete removal of young people (who legally are still children) from the penal system. A specialist service could develop the full range of support systems and specialised management required.

Central to any such arrangement is the need to develop a financial system which is not self-defeating. Under the regional system following the Children Act 1969, the charging system drove occupancy down and costs up, which contributed to the undermining of the system as a whole. The Green Paper advocates the re-creation of a regional system. In view of the failure of the previous system, the Government needs to compares its proposals carefully with past history, in order to avoid repeating the same mistakes.

A Single Profession

The one single factor in creating good child care services in the future is the creation of a first-rate workforce. With the establishment of the Children’s Workforce Development Council there has never been a better opportunity.

It is not, though, just a workforce that is required; it is a profession. Unlike other professions, such as medicine or teaching, which have an overall identity and specialisms within it, child care has been splintered. Workers see themselves as youth workers, childminders or foster carers first, and members of a wider profession a distinct second. This lack of unity has damaged the development of the profession, reduced its standing in relation to other professions, and contributed to society’s failure to appreciate the importance of bringing up children properly.

It is our view that to provide a high level of service, a united child care profession is required on the continental model of social pedagogy or social education.