A Child's Journey to Recovery

Assessment and Planning with Traumatized Children

Terry Philpot, Patrick Tomlinson

• Publisher: Jessica Kingsley Publishers
• Year: 2007
• Print ISBN: 9781849854788
• eBook ISBN: 9781846427404
• Topic: Social Sciences
• Subtopic: Psychiatry & Mental Health
• Index: Social Sciences

This book shows how carefully planned and assessed treatment can help traumatized children. It outlines how to set up a process for measuring a child's progress towards recovery. Uniquely, the book describes a practical outcomes-based approach that can be provided by an integrated multi-disciplinary team.

Particular themes addressed include the conflict between the child's chronological and emotional ages, the need to work at the child's pace, the importance of the whole-team approach, and the challenges involved in measuring progress. The authors describe clearly defined outcomes for recovery, how children are assessed and how recovery plans are made, and show how progress can be closely monitored and responded to through the continuing process of assessment. An in-depth case study is used to show how this works in practice.

This book forms part of an integrated approach and is an ideal accompaniment to existing titles in the SACCS `Delivering Recovery' series.

CHAPTER 1

Assessment

What it is and How it has Developed

Assessment is a common part of everyday life. It is a process by which we make decisions, large and small; a process by which we take action by trying to understand where we are and what our future needs (or those of others) are and how we can reach them by defining and obtaining the resources that are needed to do so.

In the management of organizations, volumes are devoted to ways of understanding where we are, how we got there and what signposts there are to the future. Yet assessment is too often regarded by practitioners as something fairly straightforward, almost mechanical – this is the service user’s situation, this is what he or she needs and this is the solution in terms of the service to be offered. Such a superficial approach has led to enormous problems across the range of social care services. With regard to the care for children, a failure to understand the facts (which is key to proper and thorough continuing assessment) has led to situations which range from the tragic consequences of children left inappropriately with abusive parents to the damaging instability suffered by children and young people placed in inappropriate care placements that then break down.

One of the pitfalls of assessment in social work has been a tendency to view it as a wholly objective process. This is something which we seek to avoid throughout this book by pointing to both the problems arising from treating it as such and how it should be regarded. This dangerous tendency of seeing assessment as objective has been highlighted by Milner and O’Byrne (2002), when they say:

gathering information, sifting it carefully and coming to an ‘objective’ and ‘accurate’ conclusion is by no means as unproblematic as this suggests; assessment has never been the scientific activity that many writers pretended. (p.8)

Although in the next chapter we look more fully at outcomes, it is relevant at this point to say that Parry and Richardson (1996), in a Department of Health strategic review of policy and psychotherapy services, might have been making a general point about all social care services when they said that therapies could no longer decline to subject themselves to evidence-based research and that practitioners and researchers had to accept the challenge of evidence-based practice, ‘one result of which is that treatments which are shown to be ineffective are discontinued’ (p.43).

Thus, a concern for outcomes and evidence has become a cornerstone of the modernization of social care with its stress on people-centred and responsive services. This derives from work in the 1980s and early 1990s which emphasized evidence-based practice and measuring incomes. As Aldgate and colleagues (2006) say, ‘practice wisdom is a useful, indeed, an essential aid, but it is insufficient unless allied to a firmly based coherent body of knowledge’ (pp.56–57).

With such concerns abounding, assessment has to be regarded as essential because it is the foundation for intervention but, in its turn, a concentration on outcomes and evidence has influenced how assessment is carried out. Thus, Ward’s (2004) axiom when referring to work with children stands us in good stead in any situation, ‘You can have assessment without treatment but you certainly can’t have treatment without assessment’ (p.9). Ward says that ‘assessment for treatment’ is:

the process of making sense of current available experience to help you have some idea of what is going on in your interactions with the child in order to modify, interrupt, emphasize or even ignore certain aspects of the dynamic. (p.9)

But, first, what is assessment? Adcock (2001) defines it as:

the collection and evaluation of information relevant to an identified purpose. Assessment has several phases which overlap and lead into planning, action and review:

•the acquisition of information

•exploring facts and feelings

•putting meaning to the situation

•reaching an understanding with the family wherever possible, of what is happening, to include problems, strengths and difficulties and their impact on the child

•drawing up an analysis of the child’s needs and the parenting capacity as a basis for formulating a plan. (p.76)

However, as we imply above, it should be pointed out that assessment is not a neutral concept, and one of the intentions of this book is to show that there are different ways in which it is conducted, not all of them conducive to providing the necessary service. Horwath (2001) shows how assessment and intervention have narrowed with the increasing concern about child protection. She quotes Stevenson (1998) as stating that this has led to an ‘individualistic model for understanding, and even for constructing the very problem, rather than an emphasis on external factors’ (p.27).

Before this, though, there had been concern that too often assessment perceived children as the sum of their problems, something wholly opposed to the ‘ecological’ assessment whereby the child is seen in relation to her world, family and circumstances. A ‘traditional’ approach to assessment has been found to concentrate on searching for the origins of past problems (Sinclair, Garrett and Berridge 1995). The corollary of this, of course, is that this kind of assessment does not seek to identify the strengths of service users, something that was highlighted by the Department of Health (DoH) and Department for Education and Employment (DfEE) (2000) document, Framework for Assessment of Children in Need and Their Families, which encouraged a move from problem-identification to building on the strengths of a family.

Well-being

In seeking positive factors which go to make an assessment, well-being is a comparatively new concept in children’s services and one popularized by the Green Paper, Every Child Matters, (HM Treasury 2003). It is not something which is applied only to children. Politicians, notably following the lead of the academic Richard Layard (2005), have started to talk generally about concepts of happiness and well-being, and people feeling good about life, which they see (in their rhetoric at least) as being what the goals of government policies should be concerned with. This may be seen perhaps as a response to a widespread, if not always well-articulated feeling that an over-riding regard for material well-being, especially in a consumer and materialistic society that regards image as important, shopping as a pastime and spending as a goal, is unsatisfying, and, indeed, may lead to various personal and social problems.

It is not difficult to see why well-being is a natural component of children’s policies; perhaps it is more surprising as to why it has taken so long to be ‘discovered’. It is axiomatic in any work with children – from social work to education, therapy to parenting – that the only environment in which children can thrive is one which offers love, comfort, stimulation and challenge. It is one where relationships with carers and teachers as much as neighbours, parents and other family members are important, and where reciprocity is stressed – the Green Paper (HM Treasury 2003) has ‘making a contribution’ as one of its five outcomes for children. The process of socialization, which has long been a standard of books on parenting as much as the focus of researchers and the concern of clinicians, is one which underpins and is key to well-being.

The integration of children’s departments and education departments was based on a belief that it would bring together professionals to offer a holistic service to children and thus enhance their potential and so their well-being. Enjoyment, play, creativity and communication, especially in the early years, are seen as a firm foundation for children, although, it has to be said, that it is not long before children enter formal education and these activities are set aside in favour of acquiring skills and having to sit tests.

Jordan (2007) sees the concern for well-being particularly evident in the shift in the criteria used by inspectors. The new perspective, he says, is one which stems from the emphasis on well-being. Inspectors’ reports on day nurseries dwell on whether they ‘demonstrate a sense of belonging’; whether children are ‘playing well together, co-operatively and negotiating well during their play’. How staff interact with children and respond to their needs is remarked upon (p.142).

Aldgate and colleagues (2006) make the point that in the field of psychology the concept of wellness has been around for a considerable time. It is something which embraces both mental and physical health in children and adolescents. They refer back to Kelly (1974) as providing a good summary of what it means:

The work of psychologists is moving from an emphasis upon the troubles, the anxieties, the sickness of people, to an interest in how we acquire positive qualities, and how social influences contribute to perceptions of well-being, personal effectiveness, and even joy. There will be signs that, in the future, psychologists less and less will be viewing us as having diseases. Instead, the psychological view will be one of persons in process over time and as participants in social settings. (p.1)

Thus, a child’s well-being, her reactions to others, how she relates to them, her sense of belonging, creativity and enjoyment, and her ability to give as well as to receive should form part of an assessment.

The meaning of assessment

When children have suffered harm, assessment gains a special importance because it is a means of avoiding interventions which have proved unsuccessful; at the same time it maintains the child’s safety and does all it can to obtain the best outcome (Aldgate et al. 2006, p.267). A commitment to the evidence allows practitioners to think more clearly about assessment and what children’s needs are and how they can be met.

And so Ward (2004) (rightly) sees assessment not as a one-off initial action but as a tool to take us forwards, one which informs us during treatment and allows us to modify what we do and respond to what is happening to the child who is being treated by, first, taking into account her needs. In the therapeutic process, then, treatment and assessment are partners, they go hand in hand; assessment does not merely guide us to what is the most appropriate treatment and is then left behind, it is a part of the treatment because it is informing what is done by acting as a monitor.

But what we want to emphasize in this book, indeed, something which underpins everything we say about assessment, is that it is not only the practitioner (usually a social worker) who first has contact with the child who needs assessment skills: those are required by everyone who has contact with the child. This is because, first, the model that we will describe is based on a shared or joint assessment and, second, because assessment is the means by which staff in all services for children (not only those in a particular team) are able to judge the success or failure of their actions and interventions. For all of them, too, this assessment must be informed by the views of children themselves. The other important principle is the point made by Dockar-Drysdale (1993), ‘I am advocating a therapy based on needs rather than symptoms’ (p.52) (her italics). To do otherwise is to make a basic mistake, which is to see a child in terms of her symptoms rather than as a child, and to regard treating symptoms as more important than meeting needs.

The well-researched, holistic assessment, with its reflective plan, is the antithesis of what Perry and Szalavitz (2006) call ‘quick fixes’. These authors explain this by saying:

Troubled children are in some kind of pain – and pain makes people irritable, anxious and aggressive. Only patient, loving, consistent care works. There are no short-term miracle cures. This is as true for the child of three or four as it is for the teenager. Just because a child is older does not mean a punitive approach is more appropriate or effective. Unfortunately, again, the system doesn’t recognize this. It tends to provide quick fixes, and when those fail then there are long punishments. We need programs and resources that acknowledge that punishment, deprivation, and force merely traumatize children and exacerbate their problems. (p.244)

A holistic or ecological assessment of a child can only come about by a multi-disciplinary and multi-agency assessment. It is not sufficient or helpful, for example, for schools to look only at a child’s educational development or social workers to be concerned solely with the family circumstances. Aldgate et al. (2006) say, ‘nothing can be taken for granted in looking at children’s development and an approach to assessment that emphasizes dimensions and intertwining influences from many sources is essential’ (p.34).

Strengths and weaknesses of assessment

Ward (2004) says, ‘when you look to the literature on assessment, what you tend to find is that it encourages you to think broadly rather than deeply’ (p.4). Assessment is a basis for intervention and a means of securing the best outcomes for c...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Acknowledgements
• Contents
• Foreword
• Introduction
• 1. Assessment: What it is and How it has Developed
• 2. Plans and Outcomes
• 3. Understanding the Whole Child
• 4. Bringing it All Together
• 5. Assessment, Needs and Outcomes
• 6. To and Fro: The Dynamic Process
• 7. A Time to Listen: Putting the Child at the Centre
• Appendix: Grace: A Child, An Assessment and a Plan
• Notes
• References
• The Story of Saccs
• The Authors
• Subject Index
• Author Index