How do we judge standards of care for children?

I am grateful for this guest post from a parent who wishes to remain anonymous. She is worried about the way parents are judged on their ability to care for their child without being seen in context of the family’s particular circumstances. Why do parents appear to be held to higher standards than professionals, even though the latter are paid? She asks this question to those who work in this system – What kind of legacy will there be in years to come from what is happening here and now in the name of child protection?

Meaning: ‘a level of quality or attainment. Something used as a measure, norm, or model in comparative evaluations’

‘I’ve done the best I can for him. I’ve gotten the most resources I can for him.’ my son’s social worker said to me in what we both understood would be our last conversation together. I believed her and I appreciated her frankness as she went on to explain ‘You should be prepared for at least one crisis before he reaches twenty-one and you will need to be careful about what happens at that point – his package of support may tail off and you will may have a fight on your hands if so.’

She also explained to me that she had a close family member with his profile of strengths and difficulties and I knew she came from a country with a very different cultural approach to working with families to the one we found ourselves in. She was and probably still is, a good social worker working in a very flawed system in a very flawed world.

I thanked her for all her very committed work on my son’s behalf and her kindness and honesty to me.

Should I be able to ask for more?

As it happens the social worker’s predictions were 100% accurate. There was a truly horrible crisis that occurred as a direct result of poor local authority decision-making and yes, ‘his case’ was closed at 21. Good things happened too and I met more good people working in the system. I have to ask though – should I, as a committed parent who went looking for help from services for my son, be able to ask for more for him? Why is it acceptable that a system that sets itself up as ‘rescuing children’ can normalise young ‘rescued’ people experiencing extreme crises and being largely divested of support when they reach 21?

I suspect that Corporate Parenting Principles were articulated in the Children and Social Work Act 2017 in recognition of the low bar of what is and should not be acceptable. I also believe that there are many good people in the system like my son’s then social worker, who will do the best they can for the children and young people in their care and yet in many cases they will fail – corporate parenting principles or not. They will fail because not everything is fixable or the timescales are wrong – what is fixed may come unstuck, what is broken may be mended over time – or for a myriad of other reasons to do with complexity and resources.

…And by contrast

Just ask yourself – What parent who has need of social care help keeping their child safe could say ‘I’ve done the best I can for him’ and not expect to be challenged about why they haven’t ‘done x or y, engaged with a or b, sought help from c or d and tried m or n method of parenting.’ This is a completely different and much higher standard than the one parents can hold professionals to even though professional are paid to deliver, while parents are not.

High standards are good but they are also problematic

High standards are good but they are also problematic if they are based on poor understanding or inability to acknowledge underlying difficulties preventing standards being met. They are also problematic when they give a ‘get out of jail free card’ to one ‘side’ and ‘throw the book ‘at the other. These kind of ‘standards’ are of little value to anyone. Good people will still try and do good things and bad people will still keep doing bad things. Sometimes even good people will do bad things working in bad systems with bad cultures.

What will be the legacy in years to come?

Where the general public are affected by or come up against professionals with a ‘professional’ understanding of abuse and neglect (most often con-joined together as in this very problematic Health and Social Care NICE standard) who are told to suspect that anything that causes a child distress or to ‘malfunction’ could be seen as an indicator of bad parenting or frames every parent without enough material resources as deficient – people question what is happening. As Louise Tickle, a Guardian columnist, noted at the CPConf2018, they are at first confused and then outraged. I know I am and I also know there are risks around that outrage too – risks around professionals doing good work on behalf of abused and severely neglected children becoming thoroughly discredited in the eyes of the public.

My question to professionals who work in this system is one around ‘legacy’ -What kind of legacy will there be in years to come from what is happening here and now in the name of child protection? What will our children’s children judgement be of the standards used that for example ignore context including disastrous welfare policy, particularly affecting the disabled and poor and frame those affected by these policies as ‘abusive and neglectful of their children’? Will the response ‘We tried our best’ be enough?

I very much doubt it. Standards can and are likely to change. I think their question would be ‘How could you have been part of this and not fought against it? How come you saw it happen, knew it was happening and just went about your business as usual? How come you were not part of the solution, only part of the problem’.

12 thoughts on “How do we judge standards of care for children?

  1. Angelo Granda

    In my opinion,those people will always be part of the problem because of an essential lack of professionalism and independence.
    As employees of the LA, they choose to follow the institutional ,mediocre norms and to obey its political policy imperatives rather than put youngsters first.
    For example,ignore correct procedures such as reviews and keeping parents involved.
    It is reality that management PREFER to hold the youngsters in care homes for political reasons and don’t allow any SW to work towards or recommend home visits even let alone home rehabilitation.
    Only when we accept such realities will progress be made.Radical change is needed not continual blather.
    My suggestion is that the CS be re-designated and granted independence from the Local Authorities.

    Reply
  2. looked_after_child

    From the above case :-

    ”The LA has accepted, quite rightly, albeit it very late in these proceedings, that the care provided to Y has been inadequate. Alongside the criticisms of Island Lodge’s care of Y, set out below, the LA must accept (as it does) criticism for:-
    (i) Failing to identify that Island Lodge was inappropriate for a child with Y’s disabilities before it advised the parents to agree to Y being placed there;
    ii) Failing to identify it was inappropriate for a child with Y’s difficulties after he was placed;
    iii) Accepting assurances from Island Lodge (for example in relation to the May and August incident) without adequate further investigation;
    iv) Failing to challenge other aspects of Y’s care which had been poor (for example the failure to organise speech and language therapy);
    v) Failing to realise that Island Lodge had not organised any education for Y for 2 years and that when it started providing some education the allocated teacher could not utilise PECS;
    vi) Failing to realise that Y was unable to communicate with anyone at the unit other than through his behaviour because PECS was not utilised;
    vii) Dismissing the parents’ criticisms without sufficient enquiry
    viii) Failing to challenge the level of restraint;
    iv) Failing to draw together all of the information which was available which supported an analysis that contrary to the social worker’s evidence, Y was in fact unhappy at Island Lodge and not being cared for well in that environment.

    and this

    Once Y moved to the single person placement during the two parts of this hearing, the parents say that there were organisational difficulties resulting in Y’s moving twice. This is accepted. The parents also raise concerns about the quality of staff assigned to work with Y. I accept the parents’ evidence. These matters are significant. Not only do they reflect on the LA as corporate parent but they underline just how very difficult it is for a LA to exercise PR to manage and organise care on a day to day basis for a young person with Y’s high level of needs. Inevitably the practicalities of care have to be delegated. Once that happens, a LA relies on the information provided by those at the residential unit caring for the child or by other agencies in relation to the competence and quality of staff. After all of the failings in the care provided to Y at Island Lodge and the LA’s sincere apology for those within this hearing, reinforced by the commitment of the LA to ensure these are not repeated, it is concerning that further valid criticisms have been made of the interim arrangements. This emphasises the significant disadvantage of these aspects of parental responsibility being exercised administratively by a statutory body rather than by devoted parents.

    Reply
  3. looked_after_child

    and this

    There is no longer any dispute about the fact that the care provided to R at Island Lodge was not only inadequate but positively harmful. The evidence of Dr Sinclair, unchallenged on this issue, supports such a finding. Her evidence provides a damning overview of Y’s care at Island Lodge. She was so troubled by the circumstances in which he was being cared for that she telephoned the lead solicitor instructing her immediately after her visit in order to record her concerns. Her criticisms are set out in a comprehensive, compelling and persuasive report dated 26.2.18. In addition she has given oral evidence. I found Dr Sinclair an insightful, knowledgeable and fair witness. I accept her evidence without hesitation. The key points emerging from her evidence regarding Y’s experience at Island Lodge/Ocean Lodge are set out below:
    i) There have been “worryingly high” incidents of restraint of Y [E57;]
    ii) Members of staff who had been involved in the May 2017 and August 2017 incidents were allowed to have continued contact with Y causing him distress and likely increasing his challenging behaviour. Dr Sinclair noted that one of the members of staff involved in the August incident had been involved in the two recorded restraints in February 2018.

    iii) Some of the records indicate that de-escalation techniques were not applied before physical restraint was deployed.

    iv) Record keeping in relation to restraint was “poor”. Two incidents of restraint by staff were reported to Dr Sinclair in February 2018 but had not been included in the restraint log, nor had an incident which occurred during contact and at Ocean Lodge in the week of 19.2.18. This supports a finding that the level of restraint deployed in relation to Y has likely been higher than the records at Island Lodge indicate.

    v) Dr M Khraishi, Associate Specialist/Acting Consultant Child & Adolescent Psychiatrist, at the Emotional Wellbeing and Mental Health Service reviewed Y on a 3-4 monthly basis after his placement at Island Lodge. He saw Y on 7.3.17 and recorded in a letter to his GP (F76) that he was pleased to have been informed by the Island Lodge staff accompanying Y to the appointment that Y’s behaviour at Island Lodge was manageable and had not required any physical restraints since our last appointment in November 2016. He was said to be communicating more and his concentration had improved so he was able to complete various tasks at college and read up to 20 minutes. Dr Khraishi was provided with false information by staff at Island Lodge. Within this period there were physical restraints of Y and Y was unable to read for 20 minutes.

    vi) Y has engaged in self-harming behaviour at Island Lodge but this had not been observed when Y was at home E58;

    vii) Y’s challenging behaviour has deteriorated in the period he has been accommodated at Island Lodge. Such behaviour is now part of his behavioural repertoire. The absence of effective communication between Y and his carers may have contributed to these escalating behaviours.

    viii) Island Lodge is described in its 2014 Ofsted report as a unit for children with learning disabilities but not autism. At the time Dr Sinclair visited Island Lodge, Y was the only non-verbal child on site. I accept Dr Sinclair’s evidence on this point.

    ix) Staff did not have appropriate skills to support or develop Y’s communication. PECS should have been utilised to enable Y to initiate communication with caregivers but was not deployed. Instead a similar tool was used as a visual timetable when workers wanted to communicate with him.

    x) Y’s keyworker thought he “could understand” and that he communicated through Makaton. Dr Sinclair saw no evidence of Y using Makaton.

    xi) Y’s keyworker was taken by surprise when asked by Dr Sinclair for a description of autism. He told her it was “a medical condition the young person has. It makes them act “abnormal” sorry for using that word. What I mean by abnormal is you can’t expect them to think or feel the same as you do. They struggle with anxiety. I know it is a broad condition”. When pressed by her about what else he knew he said “mainly anxiety and they need time to process information” but said he was unable to add anything else as he had not been prepared for the question.

    xii) There has been no evaluation of Y’s communication needs at Island Lodge. He was seen by a Speech and Language Therapist in December 2016 but nothing happened after that. A further referral was made in October and Speech and Language Therapy only commenced in February 2018.

    xiii) Members of staff have not learned PECS from an accredited course. Instead as Dr Sinclair was told, they have watched a YouTube video. Dr Sinclair searched for a training video for PECS on YouTube but could not find one. She found a video of a review by the co-developer of PECS which explicitly cautioned that it was an overview and not a training seminar and she also found a few training videos which are not training courses.

    xiv) Y did not have access to the PECS cards which were only brought out when staff wanted to prompt him to make choices. Consequently, Y could only respond to but not initiate communication exchange.

    xv) Y has been denied the opportunity to have contact at home because it will be confusing for him but there is no evidence of this as it has not been tried;

    xvi) Y received no education at Island Lodge from December 2015 – October 2017.

    xvii) In October 2017 a class teacher at Ocean Lodge was engaged to teach Y two days per week but had no previous experience in teaching children with severe autism and severe learning disability.

    xviii) Ocean Lodge is a school for children with emotional and behavioural difficulties. The Ofsted report was poor, one example being that teaching assistants at Ocean Lodge had a lack of understanding of how to meet pupils’ academic needs. When Dr Sinclair visited she was alarmed to be informed that provision was undertaken by care staff who have no teaching qualifications.

    xix) When Dr Sinclair visited, Y was being “educated” away from the main school in what she described as a “little hut in the garden” which was “tiny and made the risk of injury to others high if there were an aggressive outburst” .

    xx) Y did not commence full-time education until December 2017 some two years after he had been placed. The education provided by Ocean Lodge was pitched at the wrong level and did not utilise visual support. The physical environment was inappropriate. Although the independent social worker had criticised the parents for their “unspecific plans for education”, Dr Sinclair observes that he made no criticism of Island Lodge/the LA for their manifest failures in this regard.

    xxi) During her visit, Dr Sinclair noticed a change in Y that was very suggestive of a seizure. The care staff thought that the change in Y was suggestive of “aggression”. She recommended a re-referral to neurology.

    xxii) Staff appeared to be hyper-vigilant for outbursts, making numerous predictions of imminent outbursts from Y which did not materialise and when Dr Sinclair did not detect any signs of likely outbursts. Dr Sinclair was concerned that this hyper-vigilance might influence how staff reacted to Y.

    xxiii) Y needed care and education provided by staff who have expertise in severe learning disability and autism. Island Lodge and Ocean Lodge have no such expertise. The provision was and is completely inappropriate for Y.

    Reply
  4. looked_after_child

    and this

    Conclusion re Island Lodge

    Island Lodge was never the right place for Y, nor was Ocean Lodge the right school.

    I am told by those witnesses who have given evidence for the LA that they thought they were buying care and education for Y which was far different from that which was provided. If that is right, the LA did not exercise due diligence in relation to the selection of this unit nor did the LA adequately monitor it afterwards.

    Reply
  5. looked_after_child

    and this

    “Y was placed at Island Lodge pursuant to section 20 Children Act 1989 in December 2015. This placement was approved by the court in 2016 but until the DoL order made on 18th May 2017 by Parker J,

    there was no lawful basis for the deprivation of Y’s liberty at Island Lodge.”

    This was a truly awful case. No-one listened to the parents aside from the Judge. The brilliant judge just, or so it seems to me, asked for evidence to back up the LA’s, the IRO’s, the child’s guardian’s, the home assertions that the young person was getting good care. What that revealed was a terrible catalogue of poor decision and lies that caused harm to a very vulnerable young person

    I’ve only quoted from the judgement – it is worth reading it all.

    Can I say I’m surprised by any of? No and that to say all ‘placements’ for autistic children are like this but no. This is the tip of an iceberg and Parents cannot afford to be as ignorant as this ( and how many other) LAs appear to be and appear to think is fine.

    Reply
    1. Sarah Phillimore Post author

      Thanks for this; I have made a note to read the judgment on my two hour train journey to Plymouth tomorrow…

      Reply
  6. looked_after_child

    Sorry for all the typos above but I’m just trying to process this and failing to do so coherently.

    Re-Written

    This was a truly awful case. No-one listened to the parents aside from the Judge. The brilliant judge only, or so it seems to me, persistently asked for evidence to back up the LA’s, the IRO’s, the child’s guardian’s, the residential home’s assertions that the young person was getting good care. What that revealed was a terrible catalogue of poor decision making and lies over a long period of time that caused harm to a very vulnerable young person.

    I’ve only quoted from the judgement – it is worth reading it all.

    Can I say I’m surprised by any of?

    No and that is not to say that I believe that all ‘placements’ for autistic children and LA decision-making about them is like this but no. Parents simply cannot afford to be as ignorant as this LA, this IRO, this child’s guardian but how many other LAs, other IROs, other children’s guardians are and believe this level of ignorance is fine?

    Reply
    1. looked_after_child

      And a last question:-
      Wonder (or not) if any of the ‘professionals’ were barred from practice as a result?
      The home appears to be in business http://potton-homes.co.uk/young-persons-section/river-lodge/

      ”offering residential and educational care where required to children, aged 8 years to 17 years on admission that have a diagnosed learning disability and or a diagnosis of a lifelong condition that affects their ability to learn. The staff team are highly skilled and have a range of experience and qualifications to meet and support young people within our care. ”

      Ofsted EXCELLENT

      What does ‘a range of experience’ mean?

      Reply
  7. looked_after_child

    This also addresses the problems with these placements
    http://journals.sagepub.com/doi/full/10.1177/1744629512449095?fbclid=IwAR3U4HgwGcnQeEbwEHTvy15nnAl-I3Oh4282oj2MEHj6rTOSq_6fBGN4ndE#articleShareContainer

    Many, not all but significant numbers of, professionals seem unable to grasp what good practice looks like and the problems that can arise in these settings with effective scrutiny by people who care, usually about their own flesh and blood.

    Reply

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