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Scotland Child Committee Purpose Social Work Essay

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Published: Mon, 5 Dec 2016

The North East of Scotland Child Protection Committee (NESCPC) has produced this Risk Assessment Framework in response to an identified need for a Pan Grampian approach.

This framework is for use by all agencies located within Aberdeen City, Aberdeenshire and Moray with the aim of ensuring that there is a consistency of understanding and approach to risk assessment across all sectors.

The framework is written with the additional understanding that all practitioners have a responsibility to ensure that they are familiar with and follow their own organisation’s child protection procedures. These should all link to the overarching NESCPC Guidelines and give advice on who to contact, how to take immediate action and how concerns should be recorded.

Background

Several models of Risk Assessment exist but are not used in a systematic way because they are not thought to be comprehensive enough to be used in all situations (Scottish Government: Effective Approach to Risk Assessment in Social Work: an international literature review (2007).

To enable greater consistency and conformity across Scotland, the Scottish Executive (2005) proposed a programme of change: Getting it Right For Every Child, incorporating the development work undertaken on an Integrated Assessment Planning and Recording Framework (IAF). This is based on requirements to gain a thorough understanding of:

the developmental needs of a child

the capacity of a parent/carer to respond appropriately to those needs

the impact of the wider family and wider environmental factors on parenting capacity and on the child’s needs

This Framework emphasises the need to treat assessment as a process rather than an event. In evaluating the assessment and planning a response, practitioners are expected to consider the totality of the child’s development and any unmet needs rather than focusing too narrowly on a need for protection.

This approach should make sure that:

Children get the help they need when they need it;

Help is appropriate, proportionate and timely;

Agencies work together to ensure a co-ordinated and unified response to meeting the child’s needs;

The plan is used to put in place arrangements to manage risk and to co-ordinate help for the child or young person;

The plan is based on assessment and analysis of the child’s world, including the risks, needs and resilience factors.

What is Risk Assessment?

Risk Assessment is a frequently used term without practitioners always being clear about what is meant.

“Risk assessment is merely the description of good methodical practice to risky situations” (Jones, 1998).

Risk Assessment is a critical element of the integrated assessment process pulling together, as it does the identified strengths within a family as well as those areas of concern or risk that need to be addressed. It is a complex, continuous and dynamic process, which involves the gathering and weighting of relevant information to help make decisions about the family strengths, needs and associated risks and plan for necessary interventions. Good systematic assessment confirms what may have happened, how this may affect the immediate and future safety of the child or young person, places this in context and informs what needs to be done. Risk assessments can also be used to predict the escalation of the presenting behaviour as well as the individual’s motivation for change. Assessing risk is not an exact science; prediction involves probability and thus some errors are inevitable.

Basic Principles when assessing risk.

The welfare of the child is paramount.

Risk assessment should be based on sound evidence and analysis

Risk assessment tools should inform rather than replace professional judgement

All professionals involved in risk assessment should have a common language of risk and common understanding of information sharing to inform assessment

Risk assessment is influenced by professionals own personal and professional values, experiences, skills and knowledge

The judgement and experience of practitioners needs to be transparent in assessment

No tool, procedure or framework can adequately account for and predict human behaviour

Effective communication and information sharing is crucial to protecting children

Children, young people and family views should be sought, listened to and recorded with clear evidence of their involvement in decision making where possible.

A good risk assessment process should elicit and highlight both commonalities and differences in professional and family perspectives

Good risk assessment requires the best possible working relationship between worker and family members

All staff must always be alert and aware to situations where children may be at risk and address any potential concerns through their own agency’s child protection policy / NESCPC child protection guidance.

Risk Assessment Framework

This framework is adapted from the work undertaken by Jane Aldgate and Wendy Ross (“A Systematic Practice Model for Assessing and Managing Risk”, 2007) and is structured in 9 different stages:

Using the SHANNARI well-being indicators (Safe, Well, Active, Nurtured, Achieving, Respected, Responsible and Included).

2. Getting the child and family’s perspectives on risk.

Drawing on evidence from research and development literature about the level of risk and its likely impact on any individual child.

4. Assessing the likely recurrence of harm.

5. Looking at immediate and long-term risks in the context of “My World” triangle.

Using the Resilience Matrix to analyse the risks, strengths, protective factors and vulnerabilities.

7. Weighing the balance of that evidence and making decisions.

8. Constructing a plan and taking appropriate action.

9. Management of Risk

1. Using the SHANARRI well-being indicators:

The Scottish Executive (2004) agreed a vision for Scotland’s Children. They should be:

Safe

Healthy

Active

Nurtured

Achieving

Respected

Responsible

Included

Using these SHANARRI indicators, professionals consider the child’s holistic needs. In any assessment professionals should ask themselves the following key questions:

What is getting in the way of this child being safe, healthy, active, nurtured, achieving, respected, responsible and included?

Why do I think that this child is not safe?

What have I observed, heard, or identified from the child’s history that causes concern?

Are there factors that indicate risk of significant harm present and is the severity of factors enough to warrant immediate action?

What can I do?

What can my agency do?

Do I need to share / gather information to construct a plan to protect this child?

What additional help may I find from other agencies?

2. Getting the child and family’s perspectives on the risk.

The involvement and partnership with children, young people and their families is integral and essential to successful risk assessment and management. Information is incomplete and a good understanding of the risks of harm and needs of the children cannot be reached without families’ perspectives on the risks to their children’s difficulties. An open and transparent approach that actively involves all involved, including the children and families is of clear benefit in that:

Children, young people and families can understand why sharing information with professionals is necessary;

Children and families can help practitioners distinguish what information is significant;

Everyone who needs to can take part in making decisions about how to help a child;

Everyone contributes to finding out whether a plan has made a positive difference to a child or family;

Professionals behave ethically towards families;

Even in cases where compulsory action is necessary, research has shown better outcomes for children by working collaboratively with parents.

3. Drawing on evidence from research and developmental literature about the level of risk and its likely impact on any individual child.

Risks need to be seen in the wider context of short and long term risks to children’s wellbeing and development. Core factors can be identified in relation to abuse or neglect but these should not be used as predictors for current and future abuse without being considered in the context of the child’s own nature and environment.

In all cases of child abuse, parenting capacity should also be considered and this involves taking account of historical information as well as assessing the “here and now”. Protective factors need to be weighed up against risk factors and vulnerability to determine the level of risk to the individual child or young person and the likelihood of future harm. The factors should be used as a knowledge base to underpin more detailed assessments of strengths and pressures based on the “My World” triangle. (See Section 5).

Factors to be considered:

(This list is not complete – but is a general guide). Adapted from “City of Edinburgh Risk Taking Policy and Guidance” (2004).

Consideration of significant harm (link to Safety Threshold considerations, Section 3 NESCPC guidelines for further explanation);

Current injury/harm is severe: the more severe an injury, the greater the impairment for the child/young person and the greater the likelihood of reoccurrence;

Pattern of harm is escalating: if harm has been increasing in severity and frequency over time, it is more likely that without effective intervention the child/young person will be significantly harm;

Pattern of harm is continuing: the more often harm has occurred in the past the more likely it is to occur in the future;

The parent or care-giver has made a threat to cause serious harm to the child/young person: such threats may cause significant emotional harm and may reflect parental inability to cope with stress, the greater the stress for a person with caring responsibilities, the greater the likelihood of future physical and emotional harm to the child/young person;

Sexual abuse is alleged and the perpetrator continues to have access to the child/young person: if the alleged perpetrator has unlimited access to the child/young person, there is an increased likelihood of further harm;

Chronic neglect is identified: serious harm may occur through neglect, such as inadequate supervision, failure to attend to medical needs and failure to nurture;

Previous history of abuse or neglect: if a person with parental responsibility has previously harmed a child or young person, there is a greater likelihood of re-occurrence;

The use of past history in assessing current functioning is critical.

Factors relating to the child or young person

Physical harm to a child under 12 months: very young children are more vulnerable due to their age and dependency.

Any physical harm to a child under 12 months should be considered serious and the risk assessment should not focus solely on the action and any resultant harm, but rather that the parent has used physical action against a very young child. This could be as a result of parenting skill deficits or high stress levels.

Child is unprotected: the risk assessment must consider parental willingness and ability to protect the young child.

Children aged 0-5 years are unable to protect themselves, as are children with certain learning disabilities and physical impairments. Children, who are premature, have low birth weight, learning disability, physical or sensory disability and display behavioural problems are more liable to abuse and neglect.

The child/young person presents as fearful of the parent or care-giver or other member of the household: a child/young person presenting as fearful, withdrawn or distressed can indicate harm or likely harm.

The child/young person is engaging in self-harm, substance misuse, dangerous sexual behaviour or other “at risk” behaviours: such behaviour can be indicators of past or current abuse or harm.

Factors relating to the parent or care-giver

The parent or care-giver has caused significant harm to any child/young person in the past through physical or sexual abuse: once a person has been a perpetrator of an incident of maltreatment there is an increased likelihood that this behaviour will re-occur.

The parent or care-giver’s explanation of the current harm/injury is inconsistent or the harm is minimised: this may indicate denial or minimisation. Where a parent or care-giver fails to accept their contribution to the problem, there is a higher likelihood of future significant harm.

The parent or care-giver’s behaviour is violent or out of control: people who resort to violence in any context are more likely to use violent means with a child or young person.

The parent or care-giver is unable or unwilling to protect the child/young person: ability to protect the child/young person may be significantly impaired due to mental illness, physical or learning disability, domestic violence, attachment to, or dependence on (psychological or financial) the perpetrator.

The parent or care-giver is experiencing a high degree of stress: the greater the stress for a parent or care-giver, the greater the likelihood of future harm to the child or young person. Stress factors include poverty and other financial issues, physical or emotional isolation, health issues, disability, the behaviour of the child/young person, death of a child or other family member, divorce/separation, and large numbers of children.

The parent or care-giver has unrealistic expectations of the child/young person and acts in a negative way towards the child/young person: this can be linked to a lack of knowledge of child development and poor parenting skills. Parents or care-givers who do not understand normal developmental milestones may make demands which do not match the child/young person’s cognitive, developmental or physical ability.

The parent or care-giver has poor care-giving relationship with the child/young person: a care-giver who is insensitive to the child or young person may demonstrate little interest in the child/young person’s wellbeing and may not meet their emotional needs.

Indicators of poor care-giving include repeated requests for substitute placement for the child/young person.

The parent or care-giver has a substance misuse problem. Parental substance misuse can lead to poor supervision, chronic neglect and inability to meet basic needs through lack of money, harmful responses to the child/young person through altered consciousness, risk of harm from others through inability to protect the child/young person.

The parent or care-giver refuses access to the child/young person: in these circumstances it is possible that the parent or care-giver wishes to avoid further appraisal of the well-being of the child. Highly mobile families decrease the opportunity for effective intervention, which may increase the likelihood of further harm to the child/young person.

The parent or care-giver is young: a parent or care-giver under 21 years may be more likely to harm the child through immaturity, lack of parenting knowledge, poor judgement and inability to tolerate stress.

The parents or care-givers themselves experienced childhood neglect or abuse: however caution has to be exercised here; parenting skills are frequently learned/modelled but later positive experiences can counteract an individual’s own childhood experiences.

Factors relating to the Environment

The physical and social environment is chaotic, hazardous and unsafe: a chaotic, unhygienic and non-safe environment can pose a risk to the child/young person through exposure to bacteria/disease or through exposure to hazards such as drug paraphernalia, unsecured chemicals, medication or alcohol.

Conversely, an environment with overly sanitised conditions, where the child’s needs are not recognised or prioritised is also harmful.

4. Assessing the likely recurrence of harm.

When assessing how safe a child is consideration must be given to likelihood of recurrence of any previous harm.

Factors for consideration:

The severity of the harm (How serious was it? How long did it continue? How often?)

In what form was the abuse / harm?

Did the abuse have any accompanying neglect or psychological maltreatment?

Sadistic acts?

Was there any denial? This could include absence of acknowledgement, lack of co-operation, inability to form a partnership and absence of outreach.

Are there issues with parental mental health? This could include personality disorder, learning disabilities associated with mental illness, psychosis, and substance/alcohol misuse.

These also link to consideration of additional family stress factors, the degree of social support available to the family, the age of the children and number of children and the parents’ own history of abuse. Other agencies may be able to add additional knowledge and expertise to inform an effective risk assessment.

Looking at immediate and long-term risks in the context of the “My World” triangle.

The Assessment Triangle

Being healthy Everyday care and help

Learning and achieving Keeping me safe

Being able to communicate Being there for me

Confidence in who I am Play, encouragement and fun

Learning to be responsible Guidance, supporting me to make the right choices

Becoming independent,

looking after myself Knowing what is going to happen and when

Enjoying family and

Friends Understanding my family’s background and beliefs

Support from School Work opportunities

family, friends and for my family

other people Enough money

Local resources Belonging

Comfortable and

safe housing

An important principle underpinning the evidence-based planning in Getting it Right for Every Child is that there are many positive and negative influences in the world

each child experiences. Each child is unique and will react differently to these influences but all children will react to what is going on in different parts of the family

and the wider world in which they are growing up. This is why recent thinking in child development urges that we take a look at all the different influences in a child’s

whole world when assessing children’s development. This is called a child’s ecology

and is encapsulated in the “My World” triangle.

Each domain of the “My World” triangle provides a source of evidence that enable a full developmental holistic assessment of any individual child. The domains can be used to identify strengths and pressures, which balance risk and protective factors.

6. Using the Resilience Matrix to analyse the risks, strengths, protective factors and vulnerabilities.

The Resilience – Vulnerablity Matrix

As defined by Daniel and Wassell, (2002).

RESILIENCE

Normal development under difficult conditions eg.secure attachment, outgoing temperament, sociability, problem solving skills.

High Support / Low

Concern

PROTECTIVE ENVIRONMENT

Factors in the child’s environment acting as buffer to the negative effects of adverse experience.

ADVERSITY

Life events / circumstances posing a threat to healthy development eg. loss, abuse, neglect.

Low Support / High

Concern

VULNERABILITY

Those characteristics of the child, their family circle and wider community which might threaten or challenge healthy development eg. disability, racism, lack of or poor attachment.

Low Support / High Concern

Families assessed to be in this category are the most worrying.

Low Concern / High Support.

Families in this group have a network of support and are generally more able to cope with advice and guidance from standard services.

Resilience includes the protective factors that are features of the child or their world that might counteract identified risks or a predisposition to risk such as:

Emotional maturity and social awareness.

Evidenced personal safety skills (including knowledge of sources of help).

Strong self esteem.

Evidence of strong attachment.

Evidence of protective adults.

Evidence of support networks (supportive peers / relationships).

Demonstrable capacity for change by caregivers and the sustained acceptance of the need to change to protect their child.

Evidence of openness and willingness to co-operate and accept professional intervention.

Protective factors do not in themselves negate high risks, so these need to be cross-referred with individually identified high risks and vulnerabilities.

Vulnerabilities are any known characteristic or factors in respect of the child that might predispose them to risk of harm. Examples of these include:

Age.

Prematurity.

Learning difficulties or additional support needs.

Physical disability.

Communication difficulties / impairment.

Isolation.

Frequent episodes in public or substitute care.

Frequent episodes of running away.

Conduct disorder.

Mental health problems.

Substance dependence / misuse.

Self-harm and suicide attempts.

Other high risk behaviours.

The more vulnerabilities present (or the more serious one single vulnerability is) then the greater the predisposition to risk of harm. The presence of vulnerability in itself is neither conclusive nor predictive. These must be set alongside identified risk factors to be properly understood as part of an assessment process.

7.Weighing the balance of that evidence and making decisions.

Decisions now need to be made about what to do to address the needs relating to the child’s safety. These decisions lead to a plan to protect the child. This plan should also address the child’s broader developmental needs.

Stages of decision-making:

Data gathering

Weigh relative significance

Assessment of current situation

Circumstances which may alter child’s welfare

Prospects for change

Criteria for gauging effectiveness

Timescale proposed

Child’s plan (child in need plan, child protection plan or care plan, depending on the status of the child).

What Factors Reduce the Effectiveness of Risk Assessment?

Poor integrated working practices between agencies and individuals.

Lack of holistic assessment.

Inadequate knowledge of signs, symptoms and child protection processes.

Information that has not been shared.

Difficulty in interpreting, or understanding, the information that is available.

Difficulty in identifying what is significant.

Difficulty in distinguishing fact from opinion.

Difficulty in establishing linkage across available evidence.

Working from assumptions rather than evidence.

Over confidence in the certainty of an assessment.

A loss of objectivity.

Making Effective Risk Assessments

Assess all areas of potential risk

Define the concern, abuse or neglect

Grade the risks

Identify factors that may increase risk of harm

Consider the nature of the risk – its duration / severity

Set out and agree time scales for the assessment to be carried out

Specifically document the identified risk factors

Gather key information and evidence

Has all the required information been gathered?

Assess the strengths in the situation

Check if any risk reducing factors exist?

Build a detailed family history and chronology of key events/concerns

Assess the motivation, capacity and prospects for change?

What risk is associated with intervention?

Be aware of potential sources of error

Identify the need for specialist supports

Plan your key interventions.

Constructing a plan and taking appropriate action.

Constructing the child’s plan is a fundamental part of the “Getting it Right for Every Child” (Scottish Executive, 2005) initiative. This specifies that there will be a plan for a child in any case where it is thought to be helpful. This can be in both a single agency and a multi-agency context. The assessment of risk and the management of risk is incorporated into the child’s plan. This also includes an analysis of the child or young person’s circumstances based on the “My World” triangle and should cover:

How the child or young person is growing and developing (including their health, education, physical and mental development, behaviour and social skills).

What the child or young person needs from the people who look after him / her, including the strengths and risks involved;

The strengths and pressures of the child or young person’s wider world of family friends and community; and

Assessment of risk, detailing:

The kind of risk involved;

What is likely to trigger harmful behaviour; and

In what circumstances the behaviour is most likely to happen.

“The plan should note risk – low, medium or high – as well as the impact of the child or young person on others.” (“Guidance on the Child or Young Person’s Plan”, Scottish Executive. 2007, page 13).

The plan should address key questions:

What is to be done?

Who is to do it?

How will we know if there are improvements?

The Child’s Plan should be monitored and reviewed and amended as need, circumstances and risks change. (Scottish Executive, 2007).

Child Protection Case Conferences play a key role in the management of risk. A Child Protection Case Conference will be arranged, where it appears that there may be risk of significant harm to children within a household and there is a need to share and assess information to decide whether the child’s name needs to be placed on the Child Protection Register and be subject to a Child Protection Plan. (Link to Part 4 NESCPC guidelines)

9. Principles for Risk Management

There is a need to ensure that the ongoing shared plan:

Manages the risk

Puts the decisions into a recorded form – that clearly shows how and why decisions were reached.

Makes the risk management an ongoing process that links with all areas of agreed and informed professional practice and expertise.

Ensures that the decisions made have actions with named persons, clear timescales and review dates.

Ensures that any agreed timescales can be reduced if new risks / needs become apparent.

Ensures that new risk assessments and analysis inform reviews.

Lessons from Significant Case Reviews.

Significant Case Reviews repeatedly describe “warning signs” that agencies have failed to react to which have should acted as indicators that children and young people at risk of serious harm. Examples include:

Children and young people who may be hidden from view; are “unavailable” when professionals visit the family or are prevented from attending school or nursery.

Parents who do not co-operate with services; fail to take their children to routine health appointments and discourage professionals from visiting.

Parents who are consistently hostile and aggressive to professionals and may threaten violence.

Children and young people, who are in emotional or physical distress, but may be unable to verbalise this. Children and young people who are in physical pain (from an injury) may be told to sit or stand in a certain way when professionals visit the family or may hide injuries from view.

Children and young people who have gone missing / run away (with or without their families).

Workers should adopt an enquiring and investigative approach to risk assessment and not rely on parents or carers statements alone. Further corroboration of statements and challenging of parental views and perceptions is essential if to effectively determine the risk to the child or young person.

Interventions should not be delayed until the completion of an assessment, but they have to be carried out in accordance with what is required to ensure the child or young person’s safety, taking account of any indications of accelerated risks and warning signs. The type and level of intervention, irrespective of when it is made, must always be proportionate to the circumstances and risks faced by the child.

Workers should pay particular concern to the “rule of optimism”. Many significant case reviews have illustrated that practitioners’ views can be strongly influenced by factors such as seeing indicators of progress or apparent compliance and co-operation. This does not, however, always mean that the child or young person is safe and such factors need to be balanced against the overall balance of evidence and actual risks.

It is essential that those exercising professional judgement in relation to child protection take account of all multi-agency skills and expertise. This is of particular importance in relation to understanding of child development and the impact of child abuse and/or neglect on children and young people, both in the immediate and long term. Thus whilst immediate safety provisions have to be put in place, consideration must also be given to the longer term outcomes as a result of abuse or neglect.

Significant case reviews highlight the importance of communication between all agencies that work either directly, or indirectly with children and/or their families.

Thus it is imperative that:

Adult services MUST ALWAYS consider any potential risks for any child linked to their adult clients.

Children’s services MUST ALWAYS ascertain whether any adult services may be involved with their child clients.

All services MUST ALWAYS ensure there is effective communication where there are concerns about the protection of a child.

Concerns relating to actual or potential harm should never be ignored and are an indication that immediate intervention might be needed to ensure the protection of the child from future harm. Decisions to protect children and young people should never be delayed and where applicable, emergency measures should be considered. (see Part 3 of NESCPC Guidelines).


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