Effective Safeguarding for Children and Young People

What next after Munro?

Blyth, Maggie, Solomon, Enver

• Publisher: Policy Press
• Year: 2012
• ISBN:
  9781447308171
• Edition: 1
• Topic: Ciencias sociales
• Subtopic: Trabajo social

The number of children entering the child protection system has risen dramatically in the last three years with implications for children's services and partner agencies.This timely volume takes a critical look at the impact of the Munro Review (2011) on child protection and the Government's response. It looks at questions including how effective Local Safeguarding Children Boards are in providing the necessary scrutiny to ensure children are safe, how the early offer of help at local level might reduce the numbers of children at the critical end of the spectrum and whether reducing regulation from the centre will result in better outcomes for the most vulnerable? Moreover, it also considers those young people who traditionally bypass child protection services but remain at risk of harm. These are critical questions for both policy and practice in understanding the reforms Munro states are required. Contributions from leading experts working in the child protection system review current safeguarding policy and explore the future after Munro.

ONE

Early intervention

Colin Green

Introduction

What do we mean by early intervention? As Eileen Munro (2011) sets out in her review of child protection, the term ‘early intervention’, or as she prefers ‘early help’, is ambiguous and open to a wide range of interpretations. In this chapter I will follow her lead and take the term to refer to both intervention early in a child’s life and to intervention early in the development of a problem or vulnerability, whatever the age of the child or young person. My focus will be on early intervention in relation to safeguarding children from harm arising from poor or dangerous or neglectful parental care rather than other sources of harm. With that focus, the chapter is aligned to, considers and develops some of the issues raised in chapter 5 of the Munro Review (2011: 69),‘Sharing responsibility for the provision of early help’.

There is a wealth of material on the benefits of early intervention in the scope of the meaning of the term described above. Recent reviews by Graham Allen MP, Dame Clare Tickell and Frank Field, evaluation of the Sure Start programme, the EPPE study and other UK work, as well as considerable historical research from the US and other countries, all support the moral and financial case for various kinds of early intervention (Institute of Education, 1999–2008; DfE, 2002–11;Allen, 2011;Tickell, 2011; Field, 2011). The Marmot Review (Marmot, 2010) demonstrated unequivocally the link between positive early development and whole of life health. The Every Child Matters programme was based on the premise that the best protection for all children is through access to high-quality universal services, the most comprehensive form of early help. Past and current government focus on educational attainment is the most visible expression of this. It is based on the strong evidence that education can be life-changing, that attainment at 16 years is a key indicator of life chances and that there are links between wider health and wellbeing and educational attainment. We have evidence of the positive impact of targeted programmes such as the Family Nurse Partnership, the Reading Recovery programme and the positive parenting (Triple P) programme developed by the Parent and Family Support Centre at the University of Queensland. There is also a range of more specialist programmes such as Multisystemic Therapy (MST), family intervention projects (FIPs) and developments such as the Swindon Family LIFE programme, all of which have a growing evidence base for effectiveness.

Benefits of intervening early

All of these programmes appear to show impressive returns on investment. In his second report, Graham Allen (2011) develops the economic case for early intervention in some detail and outlines potential models for attracting investment in early intervention.

Given this developing evidence base and the very substantial investment in early intervention and in universal services over the past decade or so, it begs the question as to why those agencies and organisations which work with children and families have not more wholeheartedly adopted the methods shown to have the most impact. In addition, we must consider why all this investment and effort has not produced better results for all children and especially for those who are most vulnerable. International comparisons of children and young people’s welfare continue to place English children and young people among the most disadvantaged in the OECD nations, with some of the greatest inequalities (OECD, 2011). In the area of educational attainment, the improvement in results in national tests at key stages 2 and 4 is contested. Even if we accept that overall levels of attainment have significantly improved, the evidence suggests that any narrowing of the gap between vulnerable children and young people and others has been minimal and for some groups the gap may have become wider.

If we consider the more specific area of child protection, there is no evidence that the need for child protection services has diminished. If anything, the evidence points in the other direction. In spite of the huge investment in Sure Start, schools, young people’s services through Connexions and integrated youth support services (IYSS), the number of children with child protection plans has increased from 25,900 in 2004/05 to 42,300 in 2010/11. This is an increase of 63%. The numbers of referrals to children’s social care have increased over the same period, from 552,000 to 613,000, and numbers of initial assessments from 293,000 to 441,000, an increase of 34% (DfE and BIS, 2011). At the sharpest end of child protection work, the evidence points to more need, as the figures for children subject to care proceedings have risen by more than 40% since 2008/09 and continue to rise (CAFCASS, 2011). I do not think we can just see this as an effect of the Peter Connelly case. The rise started before the case attracted widespread public attention, and unlike the rises in activity following other high-profile cases such as Victoria Climbié this rise has been sustained; the latest figures from CAFCASS indicate that over two years later the level of activity is still rising.

What do we make of this conflicting evidence for the benefits of early intervention of various kinds against a lack of impact on outcomes at population level and for the most vulnerable children and young people who require a child protection service? This is in a context of sharply reduced public expenditure, especially for local authorities and the police, severe pressure on NHS budgets and likely increased pressure on school budgets. For hard-pressed local authority directors of finance, promises of savings in the mid-term or savings that accrue to other agencies do not cut much ice. They are looking for changes in services that will have an impact on expenditure now.

Have early intervention services in children’s services made a difference? The macro evidence on the impact of early intervention thus far is weak. However, this is an area where evaluation and judgements of impact are inherently difficult, not least as the interventions are taking place in a very dynamic social and economic environment. Our population has changed markedly over the past 10 years. We are in the middle of the worst recession for 70 years. There is no doubt that there is less social solidarity than before, with more fragmented families and greater expectation that the state will solve problems which might previously have been seen as solely the preserve of family members or the community to resolve. Our ideas on what is acceptable care for children have changed as our knowledge of what is harmful has developed. Graham Allen (2011) makes particular use of the evidence of the impact of the quality of care of babies and young children on brain development. There is a much better focus on the impact of domestic violence on children and young people and we have improved our understanding of the risks to missing children and of sexual exploitation of children and young people.

One hypothesis is that the increased resources for early intervention have led to more identification of need and to the identification of children in need of protection. Nearly all local authorities have changed their services to provide a wider range of response: for example, the development of processes and resources to support implementation of the common assessment framework, development of referral and assessment services to provide a better front door, and work to ensure that thresholds for intervention are well understood across the whole network of local agencies and services.

Evidence from inspection would suggest that most local authorities are offering better child protection responses. The current inspection framework is the tightest to date in its focus on this area of service, and while its sharpest focus is on local authority services, it also gives a clear picture of NHS and police service contributions to child protection and safeguarding services. I believe the inspection process has raised standards, though it is of concern that local authorities are still receiving ‘inadequate’ judgements for their safeguarding services more than two years into the inspection programme. Ofsted (2011) published an analysis of inspection outcomes which suggested that far fewer local authorities were judged inadequate during the last year of inspection than in the first. However, there was bias in the selection of authorities for inspection in the first year towards those where there was concern about the quality of services.

My conclusion is that we may have the paradox of better early intervention and better identification of need, which leads to more child protection responses as more need is identified, and that those responses are also better.

Early intervention and child protection

The Munro Review offered a very positive view of the potential of early intervention to improve outcomes for children and young people who need help. The review drew on the sources referred to above to make the moral and financial case for early intervention. In chapter five, ‘Sharing responsibility for the provision of early help’, it made the case for the importance of engaging universal and targeted services in the identification of children and young people who need help, including those who may be at risk of or are being harmed. The review’s analysis that earlier intervention leads to better outcomes is sound.

What is much more difficult to establish is whether the kinds of early intervention which the Munro Review describes and others promote have the ability to make a difference to that relatively small number of children and young people living in families with serious difficulties that lead to child protection plans and care proceedings. What Munro does advocate is that, whatever the difficulty, it is best identified and addressed early and in that sense she must be right. In child development terms, we must provide help to those families and their children where there are the most serious risks of poor outcomes as soon as possible.

Munro correctly identifies that there remain significant problems in coordinating services and in the confidence of universal and targeted services in identifying and working with children who are or may be abused and neglected. The review identifies a number of approaches to strengthening and changing services that could help address these problems. Notably she advocates greater use of lead family workers and the development of multidisciplinary teams acting as first points of contact for those with child and family concerns. These teams would provide expertise to universal and targeted services. In particular, she advocates using social work expertise in evaluating information on potential harm to children and in assisting other services to understand and manage risk and to identify those children and young people who are at risk of harm and require a specialist child protection response. These approaches are being tried in a number of local authorities, which are very positive about their impact on quality of work and improving identification of children at risk of harm.

Munro does not explore how well these approaches work in relation to the genesis of different types of abuse. It is evident that where the issues are of neglect or emotional abuse, that is, matters that tend to develop or be observable over time, these approaches will work. It is less clear how effective they may be at identifying those families where the risk of harm is physical or sexual abuse.

For all forms of early intervention there is the issue of the willingness of those identified as having a need to recognise that need and engage with services. There is substantial evidence that early identification gives more opportunity to engage before problems are entrenched or those who are identified as needing help become entrenched in their view of their problems. For example, the point of engagement with the Family Nurse Partnership is at about 14 weeks into the pregnancy because there is evidence that this is the point where the likelihood of positive engagement is greatest for both mothers and fathers of the baby (DH, 2011a).

Experience from a range of services where those receiving the intervention may be at best ambivalent and at worst hostile has shown that assertive and highly skilled staff can engage in the most unpromising of circumstances, for example, assertive outreach in adult mental health and the MST programme.

Munro recommends a duty on local authorities and statutory partners ‘to secure the sufficient provision of local early help services for children, young people and families’ to try to ensure that these promising developments are widely implemented (Munro, 2011: 78). The recommendation goes on to detail how they should do this. Given that much of the rest of the review advocates the removal of detailed specification of how services should be provided and a reduction in the quantity and specificity of guidance, it seems counterintuitive for the report to recommend a new statutory duty, especially when the government has removed requirements designed to promote effective working together of agencies, such as the requirement for children’s trusts and for the production of a Children and Young People’s Plan. In its response, the government agreed with the principles of this recommendation but said it would give further consideration to how best to achieve the aim during the summer of 2011 (DfE, 2011). In other words, it did not make any commitment to implement a new statutory duty.

If there were a new duty, or simply if the principles behind this recommendation were widely accepted, what would this mean in practice?

As noted earlier in this chapter, the current financial pressures could make the job of implementing a new duty seem very unpromising. Local authorities and their partners, especially the NHS and police partners, are all required to deliver very substantial savings. The financial pressures also make it more critical than ever that whatever we do to intervene to improve the lives of children, young people and families is effective and delivers the necessary outcomes. All the agencies involved want to make savings in reducing high-cost interventions which are delivered late in the development of a child or young person’s difficulty and often deliver the least gain because, by then, problems are entrenched and the child or young person’s development has already been significantly impaired.

The Munro Review commends a number of initiatives, such as MASH (multi-agency safeguarding hub) teams and locating social workers in early intervention services to help them manage safeguarding concerns by providing advice and expertise on safeguarding issues and developing the confidence of services in managing risk without referring the child and family on to children’s social care (Munro, 2011: 81). All of these developments are at a relatively early stage of implementation, and while evaluation suggests promising results, there is not yet a body of secure evidence of the difference these and other workforce remodelling initiatives can make.

Making early help a reality

If we are to make a reality of early help now when we have not succeeded in delivering sufficient early help over the past 10 years in financially more favourable circumstances, I think we need to address four key issues.

First, we need to reconfigure services in the way the Munro Review suggests. This would mean increasing the capacity of services to identify vulnerable children and young people and to offer them and their families help. In a context of diminishing resources overall, this capacity can only come either from taking resources away from remedial child protection and other services that provide services to the most vulnerable or through universal services taking a greater role in identification of need and then meeting that need through targeted help. In the medium to long term, better early help may release resources from remedial services. To date, the investment in early intervention has not achieved this, so we cannot count on this delivering resources in the immediate or near future.

The resources would need to come from a refocusing of services such as Sure Start children’s centres, health visiting, school nursing, school support and youth services towards services targeted at those requiring early help. The direction of government policy for Sure Start (DfE, 2010) and health visiting (DH, 2011b) at least in part supports this, with a greater focus on the most vulnerable and identification of need as early as possible in a child’s life through improved screening implemented through the Healthy Child Programme (DH, 2009). The expansion of the Family Nurse Partnership as a targeted programme also supports this approach. What is less clear is whether schools are ready to develop their role further in this direction. With increasing numbers of schools becoming academies and loosening their ties with local authorities, ending their duty to cooperate, and the focus on absolute measures of attainment, there are powerful messages and incentives to schools to focus their efforts away from the most vulnerable children. While there is a great deal of talk about moral purpose in education and the importance of increasing social mobility and closing attainment gaps between the socially advantaged and the socially disadvantaged, there is little sign that even under previous policies this occurred, with their focus on the disadvantaged and disadvantaged communities, for example the original academies programme that focused on low-attaining schools almost all in very disadvantaged communities. I expect this to be even harder with market-based reforms, which by their nature will favour those with the greatest resources, whether these are material wealth, information or motivation.

Second, if the way to deliver early help is through refocusing existing universal and targeted services, how might this be done? It is evident that this requires partnership working. The Every Child Matters reforms sought to build partnership and integrated working into the framework for delivery of children’s services. It was always envisaged that it would be a 10-year programme to achieve the cultural changes and outcomes sought. The programme, as government policy, has been halted about two thirds of the way through this time period. Some of the levers that helped partners work together have been removed. There is an argument that effective partnership is built on common purpose, shared objectives, effective joint performance management and shared incentives for change, not on whether there is a legislative duty in place or not. There is a good deal of truth in this. However, the signals from government are important, especially those delivered through the performance management and inspection frameworks for the key services in this area. All these are in varying states of flux. The inspection framework for local authorities’ work in safeguarding children remains robust. However, it has a limited focus on ‘early help’. The framework for schools has been amended to focus on a narrower range of issues (Ofsted, 2011). While safeguarding children and young people remains central, the general message is that the focus is o...