Category Archives: research

“Tales of the Un-experted” (sorry)

Posted on June 7, 2013 by suesspiciousminds

CAFCASS have just published a study looking at experts – their use in proceedings, what type is being used, who asked for them, were they helpful?

http://www.cafcass.gov.uk/media/149859/cafcass_expert_witness_research_6.2013.pdf

It is interesting, although on their study of whether the use of the expert was beneficial, I think it would have been amazingly helpful, rather than just asking the Guardian in the case if they found them to be beneficial (which is in itself a huge leap forward, we’ve never even done that before) the study or a subsequent one could ask the Judge

Did you find that report helpful in reaching your conclusions?
Looking at things now, after the conclusion, was the obtaining of that report worth the waiting time? [ie, was it "value for time"]

This is what I found interesting about it though, in the Guardian’s analysis of whether the report was beneficial or not

100% of the drug and alcohol tests obtained were found to be helpful

100% of the paediatric reports obtained were found to be helpful

But only 75% of the psychological reports obtained were found to be helpful

Given that psychological reports are the most cash-expensive AND time-expensive, the fact that even Guardians (who in my view were being a bit generous with how useful they found reports) found only 3 in 4 of these reports to be helpful is STAGGERING

The report also headlines that since 2009 there has been a massive drop in the instruction of independent social workers – from about 33% of cases then to about 9% now. (That is probably a lot more to do with them being starved out of doing the job and thus not being available than any reduction in need for them, rather than, as some of the reporting I have seen of the report, that it shows how we have been busy embracing the Family Justice reforms)

The study also shows that, so far as Guardian’s were concerned, the quality of the pre-proceedings work done by the LA, or the prior involvement of the LA had no impact on whether or not an independent expert was instructed.

[The report goes on to cite 3 individual cases where Guardian’s had felt that poor social work had been the cause of the instruction, but of a survey of 184 cases this is statistically not significant]

Actually, the Court was rather more likely to instruct an expert if there had been historical social services involvement than in cases where little was previously known about the family prior to proceedings. (still scratching my head about that one)

The other interesting piece of information from the study (given the drive to cut down experts) was the breakdown of what discipline contributes what proportion of the assessments commissioned

The largest by far was psychologists, accounting for 35% of the experts instructed (and we know now that this means that about a quarter of those were unhelpful, or nearly 9% of all expert reports commissioned by the Courts. You’re welcome)

The next largest group was adult psychiatrists – coming in at 20%. I would suggest that this is going to be a difficult group to screen out of the system. One tends to go to an adult psychiatrist because there is a mental health or substance misuse issue that requires expertise over and above that that a social worker or Guardian can give. Even a talented and skilled Guardian or social worker can’t tell you what the prognosis for mother’s bi-polar disorder will be now that she has switched to different medication.

[Honestly though, I think that gathering this information has been a really useful start, and I would really really welcome a follow-up study where the Judiciary are asked on those sample cases, whether the expert report was beneficial and represented “value for time” for that child, submitted of course in an anonymised way so that we get the statistical information but that the judical feedback is kept apart from the actual case]

And in case my clunky pun has got you hankering after seeing a silhoutted woman dancing in front of a roulette wheel whilst playing cards are thrown about, and you have been singing “doo-doo-doo, noo-no0-noo doo-doo-doo” during your reading, here it is :-

http://www.youtube.com/watch?v=Oc46Gk-6qrA

8 Comments

Posted in cafcass, experts, research, social work and tagged are expert reports helpful, cafass study, CAFCASS, care proceedings, costs, expert, family justice, family justice review, guardian, independent social worker, psychiatrist, psychologist. Bookmark the permalink.

What made Tracy Barlow evil?

Posted on May 27, 2013 by suesspiciousminds

Some musings on the biological and neurological causes of crime, with references to Wetherfield’s nasty bit of work.

Firstly, by way of context, this all arises from my reading of this book, “The Anatomy of Violence” by Adrian Raine. It is an absorbing and fascinating book, with a lot of interest to anyone working in the field of violence, abuse and neglect. I’d be very interested to know what the few neuroscientists who dip into this blog make of it. I will be coming back to some more of the issues raised in the book in later pieces.

You can find the book here, and it really is worth reading – even if you end up disagreeing with some or a lot of it, the thought processes involved in formulating your counter opinion are worthwhile – and as Raine points out, the very action of reading the book and thinking about the ideas is altering your brain’s structure.

The Anatomy of Violence: The Biological Roots of Crime

So, Tracy Barlowe. For the benefit of the one reader I know (hi Neville) doesn’t own a television, Tracy Barlow is a television character on Britain’s longest running soap, Coronation Street. When I began watching it, she was a little girl much attached to doing colouring in and wearing a parka coat. She grew up to be a nasty bit of work. Here’s some of what she has done :-

Spiking the drink of a harmless oddball, Roy Cropper, so that she could convince him that he had slept with her, breaking his marriage vows, to win a one penny bet.

Murdered her boyfriend Charlie (who admittedly was a beast) spending months beforehand setting up a fake defence that he had been domestically violent

Blackmailing a teenage boy into lying for her at this trial with promises of sex

Lied that a neighbour (Gail Platt) had confessed to murder which sent Gail to prison

Lying to Steve McDonald that the love of his life Becky, had assaulted her causing her to miscarry his twins

Running through the Hare psychopathy checklist, she doesn’t half tick a lot of those boxes. She has no empathy, no remorse, doesn’t take responsibility, is a glib and charming individual, a pathlogical liar, is cunning and manipulative

http://en.wikipedia.org/wiki/Hare_Psychopathy_Checklist

Now – why is she evil? (I am of course, aware, that the reason her character is evil is that it makes for good drama to have wicked people and once you start doing wicked stuff in a soap, you become the go-to character for driving such storylines – but I am interested in, assuming for a moment that she were real, why that would be?)

She is bright, wasn’t abused as a child, her parents don’t have violent or psychopathic tendencies, she has had no major life traumas that we know of. She didn’t have a troubled adolescence, had a good education. The first time she got into any trouble was taking ecstasy (this inadvertently led to her needing a kidney transplant, which she got from her mother’s toyboy holiday romance fling, who then dies).

When you look at her life, her mother Deidre has had a lot of romantic entanglements, on and off love affairs, which may have led to feelings of confusion, uncertainty, even rejection. The male figure most constant was Ken Barlow, intellectual but distant – a firm moralist and a black and white “right and wrong” sort of man (but simultaneously a hypocrite) who never shied away from letting her know that she was a disapointment. And the family unit was constantly shifting, as one or other of the primary carers found a new passion, a new relationship, before reconciling.

Of course there are bigger issues then – which the book explores a lot. Can we ever understand evil, can we predict violence, can we do anything about the factors that lead to violence and anti-social behaviour? Can we repair someone who has taken that path?

One of the interesting studies in the book shows that children who had a violent crime, a murder, in their neighbourhood went on to perform markedly worse in school tests than other children who had not. And that living in an area where a single murder took place nearby lost the equivalent of what a year and a half of education would provide (in terms of alteration to IQ). Coronation Street may seem far from Baltimore or Washington DC, but it is rife with violence and crime – why even those two old dears in the pub with their sherry (Rita and Emily) both lost husbands to violent incidents AND were the victims of murder attempts.

Another, unexpected one, relates to Tracy’s mother Deidre – she is famous for being one of the few characters on modern tv that is still allowed to do something. In soaps, she is probably the only one left who you see doing this activity and it turns out to be something that studies have shown if you do during pregnacy, you are three times more likely to have a violent or anti-social child or child who turns out to be that in adulthood.

Smoking.

If, as we suspect, Deidre smoked during pregnancy, and judging from her demeanour when she smokes, she’s been a forty a day woman for getting on for forty years now, and her pregnancy was in the early seventies, she almost certainly did, that might actually turn out to be a factor. The hypothesis, supported by these studies, is that smoking in pregnancy affects the formation and structure of the infants brain, and that damage and alteration to the structure increases the relative risk of a violent or antisocial life for your child. [Of course, the concept of relative risk here is important - if for example there is a 1 in a million chance of hving a violent child, then a threefold increase is, whilst not good, still a pretty low chance, and the book doesn't really get stuck into the relative risk]

But it was something that surprised me – and once in a while we have a mild moral outrage in the press when we see a pregnant celebrity smoking, but I had no idea that smoking during pregnancy could have any impact on behaviour in later life. (not as much as alcohol, head injuries, malnutrition and lack of care in first year of life, those are the big big factors)

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Posted in assessment of risk, research, Uncategorized and tagged anatomy of violence, anti social behaviour, smoking during pregnancy, violence, wickedness of tracy barlow. Bookmark the permalink.

“As a drunkard uses a lamppost…”

Posted on May 14, 2013 by suesspiciousminds

A discussion of the new CAFCASS figures on care proceedings issued by Local Authority area. Warning, contains maths, guesswork and ranting.

http://www.cafcass.gov.uk/media/147399/care_demand_per_child_population_by_la_under_embargo_until_9th_may_2013.pdf

“He uses statistics as a drunkard uses a lamppost – not for illumination, but for support” – Winston Churchill

They are interesting though, as the very least, they show up the real differences from area to area of the country. Some of that isn’t terribly surprising, one would not be shocked, for example that inner cities have higher rates of care proceedings than say Saffron Walden. But there does seem to be quite a lot of variance even taking into account that different authorities have different social problems

One might be surprised, for example, to see that Hackney have a lower number of care proceedings per 10,000 children than those notorious hot-beds of poverty, erm Kensington and Westminster. Or indeed that Hackney’s figures on care proceedings per 10,000 children are now twice as high as they were in the 2008 post Baby P spike. Am scratching my head about that one.

What is also, of course interesting, is looking at an authority and comparing it to its neighbours. And also, as a long standing local authority locum lawyer, I can also use the chart as a handy guide to where I haven’t worked yet, and which authorities I’d probably be bored stiff in (I won’t be taking a job in the Isles of Scilly any time soon, based on this chart)

It isn’t terribly surprising that overall, one can see a big spike post Baby P (that’s due in part to the increased referrals, in part to the greater willingness of local authorities to take action, in part due to a reluctance to manage risks at home that might previously have been managed, and in part due to the numbers having been artificially depressed by the double whammy of the PLO and the jacking up of court fees)

Although 13 of the 94 authorities didn’t get this spike, they actually issued on a SMALLER proportion in the year post Baby P – including Hackney.

You can also see that whilst a number of authorities have seen that spike settle down and decrease (though not back to pre Baby P levels) the overall trend is still increasing, from an average of 6 proceedings per 10,000 children pre Baby P, to 8 the year after, to 9.7 in 2012/13. And quite a few authorities are issuing MORE proceedings per 10,000 children than they were in the year post Baby P.

[One should also bear in mind that most proceedings involve more than one child, so the actual number of CHILDREN subject to care proceedings per 10,000 children is higher than 9.7, how much higher is hard to say. I’d guess that the AVERAGE number of children per care proceedings is about 1.5 – you get a lot of babies, but also a lot of large sibling groups]

As the other CAFCASS stats show

http://www.cafcass.gov.uk/news/2013/april_2013_care_application_statistics.aspx

April 2013’s figures were 20% higher than April 2012’s (which were themselves already a high base)

And February 2013 hit 999 applications, the highest for any month ever. (and bear in mind that February is a short month, and it is not historically one of the spike months – which are normally coinciding with imminent long school holidays, so June/July and Christmas period)

On my guess, those 999 applications represent 1,500 children.

And between March 2012 and April 2013, CAFCASS received 11,064 applications (or on my guess, 16,000-17,000 children were made the subject of care proceedings in that year)

This all makes me a little nervous – because when you look at the national figures for adoption recruitment, the English authorities approved 2655 adopters in the whole of last year.

http://media.education.gov.uk/assets/files/xls/u/20130326%20underlying%20data%20for%20maps.xls#’Map C’!A1

Now of course, not all of the children who came into proceedings need to be adopted – one hopes that MOST of them stay with mum and dad, some more are placed with family members, some of them will be too old to be adopted even if they can’t be placed with family members. So the 16,000 children is a MUCH MUCH higher figure than the children who need adoptive placements as a result of coming into care proceedings – I don’t have any hard data to extrapolate that. *

*[Other than the same Government adoption stats that showed 2655 adopters approved in 2012, showed 5750 children waiting for adoptive placements, which I’ve written about previously. But that doesn’t tell me how many of those children had been identified as needing a placement THAT year ]

That might be one of those pieces of management information that Norgrove identified as being lacking in the family justice system – what are the outcomes for children who come into the public law Court arena? Would be much better to have some proper hard and fast statistical analysis, rather than my hamfisted bungling.

[By the same token, it seems to me utterly ludicrous that we have figures on the number of CASES, when what we want to know, what we actually care about, surely is the number of CHILDREN? ]

But it does seem to me, that there’s serious potential for more children to be coming into the State system than the State has resources to deal with. There are, of course, three ways of tackling that problem (if indeed it is a problem). Reduce the number of children who come IN to care proceedings, reduce the number who come OUT needing placements outside of families, and increase the number of adopters who can meet the need where the Court have made that serious decision.

I am in some doubt as to whether the Family Justice Review changes are going to reduce the numbers of children coming IN, or the numbers coming OUT.

Of course, I could quite easily be wrong, and just be a pessimist clutching at lampposts in the absence of straws.

4 Comments

Posted in adoption, cafcass, research and tagged adoption, baby p, CAFCASS, care proceedings, care proceedings broken down by authority, which authorities issue more care proceedings. Bookmark the permalink.

“I’m on the edge, the edge, the edge, the edge…”

Posted on May 13, 2013 by suesspiciousminds

The Judith Masson (et al) research on families on the edge of care proceedings is now available

http://www.bris.ac.uk/law/research/researchpublications/2013/partnershipbylaw.pdf

It is a long and dense piece of research, but no less interesting for that. As ever with Judith Masson’s research, the paper itself is a lively read and if you wanted to get a real sense of context of the whole system of family justice, it would be a very good starting point.

It really tackles the “pre-proceedings” element of intervention and working with families, which is going to become more and more important as the new changes come into force.

Masson highlights how wide-ranging the participation in pre-proceedings work varies across authorities and indeed how wide-ranging the underpinning philosophies and aims of it are, from being a chance to bring about change, to an opportunity for parents to turn away from a course of action or get the help they need, to a recognition that it is fair and ‘right’ for parents to be warned of consequences, right through to it being ‘a mandatory’ step which has to be gotten through.

The research also shows how we ended up with this disparity and range of views, given that what happened was a top down imposition of requirements to have a meeting and a letter and to file a record of the meeting, but without there being any guidance or philosophy as to what was to be achieved.

The real headline from it is one which most professionals will recognise, that the Courts did not recognise or value pre-proceedings work,

They [Judges} preferred cases to come direct to court so that they could control what was done, and felt that the pre-proceedings process would only serve to delay cases which would inevitably need to come to court.

These judges were aware that local authorities were discouraged from undertaking assessments in advance of proceedings by court decisions to order further assessments and, particularly, to expect the local authority to contribute, financially, towards these. However, they felt constrained to allow parents to obtain further assessments, so the local authority’s assessment could be tested in a fair hearing; because they felt that local authority social workers’ assessments were not of the required quality and often merely reflected what their managers wanted; and to prevent their decisions being overturned by the Court of Appeal:

‘[The process] would work much better if there was a mechanism in court for us to say more robustly than we have in the past: you don’t need another assessment.’ Judge 6

‘[I]t’s so much easier to, say, spend £5,000 doing another assessment and the appeal won’t occur.’ Judge 7

These judges were not unique in mentioning the spectre of the Court of Appeal (Pearce et al. 2011). Indeed, the former President of the Family Division sent a letter to judges on case management in response to concerns hehad heard about the need to order further reports to avoid criticism of their decisions (Wall 2010).

and that as a result of Judges routinely commencing fresh assessments rather than actively considering the existing assessments, there was no real discernible difference in the time it took to conclude care proceedings in cases where there had been active and detailed pre-proceedings work from the ones that were issued with no pre-proceedings work.

And when Masson adds the work done pre-proceedings (after a formal meeting with parents and their solicitors) to Court proceedings, then it turns out to take nearly 70 weeks to get a decision for children if you do pre proceedings work, and around 45 if you don’t bother doing any.

She highlights this as being a core issue, going to the heart of care proceedings. Is the purpose of proceedings “to explore solutions to the problems of parenting through ‘investigation, assessment and management of change’” (Hunt 1998) OR is it “to determine matters by assessing the application, in the light of the evidence presented and the parents’ response”

I think either course is a valid approach for the State to take, and I would suggest that at the moment, we have currently the former, and may be about to move to the latter. Personally, I think that there would have been a place for a proper debate about those issues, and it would have been nice for these to be transparent and up front, rather than a fresh approach being sidled in.

Masson also touches on the fierce debate about whether the removal of children is “too few, too late” or “too many, too fast” – she seems to me to come down more on the former, whilst recognising that much more intervention and support could be provided and properly targeted.

Regardless of where you stand on those issues – I know many of my readers are on the “too many, too fast” side of things, it is interesting to see someone actually identifying that this is a genuine debate, with value on both sides and that the State really needs to decide what it wants from a child protection system.

There are some really sound conclusions to the research, I hope some of them get followed (better funding for parents solicitors so that they can devote the pre proceedings work the time it needs is particularly important)

I was taken, particularly, with Masson’s comments about how large changes in the family justice system occur. Of course, she approaches this from the viewpoint of an academic and researcher, but it is a perspective I’ve not heard or considered before, and so I wanted to share it with you [underlining is my own, for emphasis]

Many of the changes to care proceedings practice since the implementation of the Children Act 1989 have been made not as a result of research evidence or interagency consultation but through litigation. The removal of children under interim care orders, the requirements for without notice EPOs and the contact regime where new babies are not in their parents’ care have all been the subject of ‘guidance judgments’. These have imposed standards or procedures which have had major implications for local authorities, the police, carers and children.

The close consideration a judge gives to an individual case gives him or her the detailed knowledge of the factual scenario necessary to make a decision. It is neither designed nor intended to provide a wide understanding of the range of circumstances where similar issues arise. Moreover, in our adversarial system, the information the judge receives is not simply an objective account but is intended to influence the decision. For these reasons, it would be better if judgments which were intended to shape the operation of family justice were subject to review and discussion before they were published.

Research has a contribution to make to law reform. Understandings from theoretical work and experience in other jurisdictions can provide some indication about what might work, the problems and limitations etc. Empirical study of the operation of laws and legal procedures can provide knowledge about practice from a range of perspectives including from litigants themselves, countering beliefs based on anecdote, information derived from the unusual cases that feature in law reports, and from the most vocal in the system. It can supplement the limited information available from case management systems and reach parts of the process that such recording cannot reach. Without research evidence it will not be possible for the Family Justice Board to secure major improvements to the family justice system, or know whether many forms of improvement have actually been achieved.

Now, if you’ve been following this blog at all, you’ll have picked up what a caselaw geek I am, but I think this makes a really important point.

If you take as an example the contact case Masson raises, the decision that our now President made in judicial review case effectively (at least for a period of some years) overnight transformed the amount of contact that babies placed in foster care should have with their parents, and did so dramatically. And that case, which had massive implications for family after family, child after child, local authority after local authority, was decided without hearing any evidence about what was best for a child, it was just what the Judge at the time, considering that case, felt was best.

(Now, as we know, the current research on quantum of contact for babies is pretty fraught, and it is a hot potato; but people on both sides of that debate have at least attempted to research and establish whether contact twice a week is better or worse for infants than contact five times a week, rather than determining it on the basis of listening to four adversarial submissions and concluding which is better. It is quite possible that overall the lives of children were made much better by the President’s decision, it is quite possible that overall they were made worse, it is possible perhaps even likely that for some children having more contact was good and for some it wasn’t so good, but we had no way of knowing at the time, the whole system had to embark on a sea change in contact regimes as a result of one judicial opinion in one case)

That gave me some food for thought.

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Posted in research and tagged assessment pre proceedings, letter before action, Masson, pre proceedings, Public Law Outline, research. Bookmark the permalink.

“How safe are our children?”

Posted on April 19, 2013 by suesspiciousminds

The NSPCC report on child abuse and neglect.

The report can be found here

http://www.nspcc.org.uk/Inform/research/findings/howsafe/how-safe-2013-report_wdf95435.pdf

and is interesting and well worth a read. It is quite stat heavy, but there are decent graphs which make the points well, and they set out how the stats were arrived at. (One of their core ones, I have an issue with, but will deal with that a bit later on)

The latter bits of the report set out the risk indicators for children, nearly all of which are not likely to come to a shock to anyone working within the family justice system.

You are more likely, as a child, to be physically abused or neglected if these factors are present in your family :-

Domestic violence, substance misuse, parents with mental health problems, parents with learning difficulties, children with physical or mental impairments, children from certain ethnic or minority backgrounds, parents who suffered abuse themselves as a child, and poverty.

The poverty one is interesting, because it is the elephant in the room at the moment. Is part of our child protection system, as might be argued by John Hemming and perhaps Dr Dale, a punitive way of dealing with the poorest members of our society (and perhaps even a redistribution of children from those who have them, to those with greater means and income who would adopt them?)

Also of course, from everything we know about the political climate of the country at present, poverty is only going to get worse over the next few years (unless you were on the Board of HBOS or are a stockholder in Vodafone, Starbucks, Google et al)

Here’s what the report says about poverty as a risk factor [underlining is mine, as I think this is a VITAL point]

Children living with poverty, debt and financial pressures

Why is this a risk factor?

Although there is no evidence to show that poverty causes child maltreatment, poverty and child maltreatment share many similar risk factors. Numerous explanations try to explain the relationship between poverty and child abuse and neglect. The impact of the stress associated with poverty and social deprivation on parenting is the most common explanation.

Researchers have found that parents with a low income are four times more likely to feel chronically stressed than parents with higher incomes. Stress levels of parents living in poorer neighbourhoods have been shown to be high. One study identified a “strong relationship between parents’ levels of stress and greater use of physical discipline”. Another associated being in a lower socio-economic group with a more significant level of physical discipline and abuse.

An analysis of women’s childhood experiences of abuse and neglect found evidence that women from poorer childhood homes were twice as likely to have suffered from abuse or neglect and three times as likely to have suffered from more than one form of abuse than those from more well-off childhood homes. Emerging findings from research in England highlight the impact of poor and inadequate housing on families and poor housing is a common characteristic of families in poverty. The unsafe environment and the impact of parental stress have been found to be factors in some SCRs and where children are subject to child protection plans.

This does not mean that parents who are poor will abuse or neglect their children. The relationship has been described as “circular and interdependent as opposed to linear and causal”.

What we know about prevalence

The Institute for Fiscal Studies estimates that the number of children living in relative poverty in the UK85 was around 2.5 million in 2012, rising to about 2.9 million in 2015.86

Being poor doesn’t mean that you will neglect your children, but being poor of course means that you are much more likely to have to make difficult choices about budgeting and poor choices have a much more detrimental effect. (If you are choosing between whether to spend £80 or £110 one week on food shopping for the next week, choosing the latter one week doesn’t massively affect your family, but if you are choosing between whether to spend £15 or £25 on shopping that week, and perhaps to spend the extra £10 means not having the heating on, those choices do make a proportionately greater difference to the wellbeing of the family.

There is an interesting tack in the main body of the report. The NSPCC calculate that for every child known to the authorities to be suffering from abuse or neglect, there are another 8 who are not known. [This is the statistic I am most cautious about, since it is drawn from an extrapolation of their 2011 study that showed children self-reported abuse or neglect (6% of over 11s, and 2.5% of under 11s) and applied that to the population at large. For me, I would need the 2011 study to be much larger and more robust before you could start extrapolating it to the population at large – for example, if you are asking a 14 year old whether they have been seriously mistreated by their parents in the last year, that 14 year old’s idea of serious mistreatment might be very different to society’s idea of it. There might well be days when almost any 14 year old would say that his parents were mistreating him]

But, setting aside my quibble about the number of children who are the bottom part of that iceberg, under the surface and unknown to professionals, the NSPCC say this

The gap is unlikely to close

Could services ever reach all maltreated children? Even if this were desirable (and few would consider this level of state intrusion into family life appropriate) it is very unlikely in the current context. If children’s social services were to become aware of just one quarter of those children who were maltreated (but not currently known to them), we estimate the number of children subject to child protection plans or on registers in the UK would triple. The resources required for this would be significant: an estimated additional £360 million to £490 million in public spending. In today’s fiscal climate this kind of investment is unlikely; to close the gap altogether is highly improbable. Nor is this the most effective approach. While it is vital to support children and adults in speaking up about abuse, in order to stop abuse in its tracks, this will never be enough to prevent children from being harmed in the first place.

This seems to be a bold, if pragmatic, thing to say about child abuse. Particularly for an organisation has been campaigning for the last few years on the basis of ending child abuse. Cruelty to children must end, FULL STOP (remember?)

They are now accepting that society simply can’t end it or stop it. There will always be child abuse and neglect. And as they point out, even if you raised detection levels to a much higher point, that would have a huge and detrimental impact on freedom and privacy and family life, and the resourcing of the services would be utterly unmanageable for our society to fund.

So, are the NSPCC throwing in the towel? Unsurprisingly, not. What they instead posit is moving towards the very early period of child abuse and neglect and nipping that in the bud before it escalates into more serious problems.

We need a different approach to child protection

Which is why a different approach to child protection is needed, one that does more to prevent abuse “upstream” rather than intervening to stop it once it has already happened. Most public spending goes towards picking up the pieces rather than into “upstream” prevention. The National Audit Office estimates that only 6 per cent of public expenditure is focused on stopping problems from emerging in the first place.

While intervening to address abuse once it is known will always be a moral and legal imperative, child abuse and neglect will never be substantially reduced unless we become smarter at preventing it from happening at all.

Understanding the circumstances in which children are at increased risk is essential for prevention. Research points to the personal characteristics, family circumstances and environments that place children at greater risk of abuse and neglect. In Part 3, we set out the available evidence on this, highlighting nine key risk factors. There is no direct causality between these factors and abuse; they are not predictive of maltreatment. But by recognising that children living in such circumstances are at heightened risk, greater support could be directed towards families to reduce the chances of abuse and neglect from occurring at all. While this support comes at a price, it is ultimately more cost-effective to prevent abuse from occurring than to meet the many costs that fall across society because of the damage caused to children who were abused or neglected in their childhood.

Wider society also has an important role to play. Abusive behaviour cannot be stamped out by the state alone; individuals, families and communities must also be responsible for the change. Most adults think parents, families, friends and neighbours have a responsibility to prevent child abuse – and that greater responsibility lies with these groups than with government.

So while government can do much to influence the conditions in which children live and while professionals play an important role in intervening to protect children and helping those who are at risk of abuse, wider society has a responsibility too. However, all too often people frame this responsibility in terms of being willing to act if worried about a child, rather than being willing to address faults in their own or others’ behaviour. Perhaps it is time to reassert our responsibilities to children as citizens.

I can’t say I’m sure how the NSPCC vision here gets translated into action, but I think it is a legitimate and interesting debate to have as a society. I thought the report as a whole (although I don’t agree with every aspect) was a challenging and thought-provoking document.

There are some very mind-boggling figures in it

There were a total of 21,493 sexual offences against children recorded by police in the UK in 2011/12.*

There were 4,991 rapes of children recorded by police in England and Wales in 2011/12.

There were 7,812 cruelty and neglect offences recorded by police in the UK in 2011/12.

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Posted in assessment of risk, research and tagged abuse, child abuse, child neglect, how safe are our children, neglect, NSPCC. Bookmark the permalink.

In England, justice is open to all, like the Ritz Hotel

Posted on January 28, 2013 by suesspiciousminds

Is there a difference in family justice provided to middle-class parents? A discussiony paranoidy rant…

As you may know, the title of this piece is drawn from a remark by an English Judge, Sir James Mathew and was made in the Victorian era. It is intentionally barbed.

It had quite a flurry of revival in popularity last year, as the Government debated and then implemented legal aid cuts that removed free legal advice from large chunks of the most vulnerable in society.

Private law

In terms of private law dispute, my initial question is likely to be true, sadly, as we go past April 2013. After that time, a parent who is denied contact is going to struggle to get their case off the ground and into court unless they are (a) literate (b) articulate or (c) a person of financial means. One might be cynical and say that the three things are interwoven, and that having three possibilities isn’t much use if they mostly capture the same group.

Of course, a person can represent themselves in court proceedings and a great many people do very well at it. (I’d recommend Lucy Reed’s book “Family Courts without a lawyer” for anyone who wants to do this http://www.amazon.co.uk/Family-Courts-without-Lawyer-Litigants/dp/0956777406/ref=sr_1_1?ie=UTF8&qid=1359383824&sr=8-1 )

But even then, the litigant in person will either need to pay the Court fee for a contact application, which will be £200, or (if they are of limited means) navigate the byzantine system by which you can avoid paying the Court fee if you can satisfy an unsatisfiable bureaucracy of your entitlement to do so, a task which exhausts many private law solicitors who are well accustomed to trying.

[A bit like the Groucho Marx line that banks will lend money to people who can prove beyond doubt that they don’t need it]

Moving beyond that, you will as a wealthy or moderately wealthy person, have an option, a choice, which is denied to the non-middle class. You can decide whether to represent yourself or have a specialist used to navigating the courts, who speaks the same language as the judge, who can advise you. That’s a choice that won’t be open to someone who is not middle-class. [using middle-class as shorthand for someone who has a professional job which pays them average or better income, regardless of family background and such - of course there are plenty of plasterers who earn more than bank clerks. Perhaps the class debate is better expressed as ‘haves or have nots’ but is a shorthand for this piece]

If you are faced with allegations of violence or abuse, you won’t get a lawyer to represent you and defend you against them unless you have money. The other parent, the one making them, might well get a lawyer, even if the allegations are false.

More and more private law cases these days are descending into these sorts of allegations, and probably more and more will in the future, as the funding system says that making them gets you a lawyer, whereas defending yourself against allegations that you say are false, doesn’t.

Care proceedings

What about care proceedings though? The law says that if you are a parent and the State might be intervening in the way you bring up your child and might be contemplating your child no longer living with you, you would be entitled to free legal advice.

Everyone is on a level playing field then. Family justice is like the Ritz, it is open to everyone.

But how true is that, really?

Here are some names that you will have seen in care proceedings, often many times, if you work in this field – Zac, Jordan, Chantelle, Destiny.

Here are some names you have probably NEVER seen in care proceedings, Oliver, Crispin, Sophia, Harriet.

You might well say, and you’d be partially right, that a large tranche of care proceedings relate to neglect, and neglect in part springs from poverty. So, a middle-class family don’t face the same social problems as a poor family, since they have choices and options.

A middle-class parent who struggles with managing household tasks has an option to get a cleaner, or to have someone do the ironing, they don’t have to prioritise between food and electricity, or gas or a toy for their child.

I would argue that not all poor families end up neglecting their children, and that it is possible, and indeed the vast majority of poor families do it, to get their children brought up in clean, safe and loving environments despite a lack of resources.

But it is certainly true that you’re at far greater risk of living in neglect if money is very tight than if you are affluent.

[Subsequent to writing this, I came across an excellent blog post in Community Care on why more poverty does not mean more neglect :- http://www.communitycare.co.uk/blogs/childrens-services-blog/2013/01/poverty-does-not-equal-neglect-benefit-cuts-will-not-see-more-children-taken-into-care.html and is an interesting counterpoint to this debate. I don't think we are miles apart, though I think if you increase the basic numbers of families in poverty, you may well increase the numbers of those families who don't manage that sort of poverty well enough]

[This is reminding me of one of my favourite books, George Orwell’s “Down and Out in Paris and London”

It is altogether curious, your first contact with poverty. You have
thought so much about poverty--it is the thing you have feared all your
life, the thing you knew would happen to you sooner or later; and it, is
all so utterly and prosaically different. You thought it would be quite
simple; it is extraordinarily complicated. You thought it would be
terrible; it is merely squalid and boring. It is the peculiar LOWNESS of
poverty that you discover first; the shifts that it puts you to, the
complicated meanness, the crust-wiping….

And there is another feeling that is a great consolation in poverty. I
believe everyone who has been hard up has experienced it. It is a feeling
of relief, almost of pleasure, at knowing yourself at last genuinely down
and out. You have talked so often of going to the dogs--and well, here
are the dogs, and you have reached them, and you can stand it. It takes off
a lot of anxiety.

I have been, in case you doubt, exceedingly poor, as both a child, and as an adult, and recognise what Orwell says, particularly in his passages about how when you are truly truly hungry, nothing else in the world much exists than that hunger, that preoccupation with food and filling your belly with something.

So, perhaps the care proceedings net doesn’t cast over the “Haves” because neglect isn’t much of an issue in the “Haves” world.

But what about violence, what about sexual abuse, what about alcohol abuse?

I’m fairly certain that the disease of alcoholism, and the effect that it has on parenting, is not a class issue – it can take anyone. In fact, I have worked, in the past, with people who drank a bottle of wine a night or more, and who would on that basis fail the sort of psychiatric examinations that we were sending parents to.

I have also encountered paedophiles from all walks of life – yes, very many were from damaged and impoverished backgrounds, but many others were teachers, professionals, doctors.

And I fail to believe that it is only poor people, only ‘common’ people, only ‘rough’ people, who reach the end of their tether, lose control and do something to a child that they should never have done.

There’s sort of a feeling, an unspoken one, in the Court rooms of this country, that child abuse is not done by people like us, that it belongs to a different world, another one, that we can look at, and judge, but not one that we truly belong in. There’s very little “there but for the grace of god” in child abuse cases.

As we know, and must remind ourselves, “The plural of anecdote is not data” and therefore it is of only limited (or indeed no) evidential value that most of the times I have seen parents with middle-class jobs, accents, bearing and relations, facing allegations of physical mistreatment of children, a reason has been found as to why the medical evidence is wrong, and why they can be exonerated.

Efforts seem, again anecdotally to me, to be found by a mixture of professionals (and again, I don’t claim that this is a conscious or deliberate action) to be more amenable to accepting that people like us couldn’t have done these dreadful things, than when similar things are alleged of people who live in a different sort of world to our own.

I don’t know how one could do the research on whether the outcomes for middle class parents are better for them than those for other parents – there’s no box on the application form for “Is the parent a bit posh?” or “Do they shop at Asda or Waitrose?” “Do they say napkin or serviette?” but I’d like to see some, if someone wants to set out to do it.

So there is at least the possibility of an unconscious bias of favouring or being more amenable to accepting the evidence given by people like us.

Can it go even further than that? To the overt stage, where actual cash, actual financial resources buys you a greater opportunity in a family case?

I don’t mind bribery, obviously. I don’t think that bribery plays any part in English justice. Call me naive if you want, I just honestly don’t believe that.

I had recently a conversation which prompted me to think about this piece, about a case (not one I was involved in, even tangentially and not necessarily a recent one) of suspected non-accidental injury, where the parents wanted to get a further piece of medical evidence, a fresh report. The Judge refused it, for good reasons about delay and proportionality.

The parents then pipe up that they could pay for the report themselves, rather than through legal aid, and lo and behold, there’s a reconsideration and the report is directed.

The justification, perhaps not unreasonably, is that the report is likely to be accelerated, expedited, on-time, if the expert knows that people are paying for it privately. So the delay might not be so long, and the expert report will probably not hold the case up so much. And of course, in the world we operate in, the Judge knows that the parents writing a cheque saves at least 2-3 weeks of messing around with the Legal Services Commission and prior authority, so the report probably will get done quicker.

Is that okay, or does that feel wrong?

It feels wrong to me that a person gets the chance to have a report not because of the merits of their case or the circumstances of the case, but because they, unlike someone else, can write a cheque and get it done.

[I couch all of this with the caveat that it wasn’t my case, I wasn’t there, I don’t know the detail – there may well have been very compelling reasons I am unaware of to have taken that course of action, but even just looking at it in the theoretical sense, would it be right in this hypothetical case below to allow the report?

Doctor says “I can do the report in 12 weeks, on public funding, but if it is paid for at my private rates, which are higher, I can do it in 5”

If the Judge was going to refuse the report on basis that 12 weeks delay was too long, should she allow it in 5, if the parents are able to pay for it privately? Or, is refusing it, if 5 weeks is considered reasonable delay, unfair just to preserve equality with some notional other parents who couldn’t pay the private fees?]

Can you go off and pay for your own expert without the Court’s permission?

Well, there have been some important decisions about that. Firstly, you need leave of the Court to give the papers to the expert, and then if you get leave of the court to instruct an expert, you have to cough up the report even if it is not favourable to you (unlike in crime) [Re L : A Minor : Police Investigation : Privilege 1996 1 FLR 731 and then Re V (Care Proceedings : Human Rights Claims 2004 1 FLR 944]

If you don’t get leave of the Court and go off and get the report anyway, it still has to be disclosed.

[If there are ongoing criminal proceedings, the parent can keep those reports secret and even refuse to say if there are any expert reports and who has written them, and can keep legal privilege when discussing those reports with their care lawyer S County Council v B 2000 2 FLR 161]

One clever way around this was tried in RE J (Application for shadow expert) 2008 1 FLR 1501

Where the applicant sought permission not to obtain a report that would have to be disclosed whether it was positive or negative, but instead an expert to basically advise the lawyer and formulate good questions for cross-examination and be a sounding board for the barrister’s theories.

The Court felt that this was not appropriate and would not be granted. And of course, it would only have been a course open to someone paying for the report privately.

Can you get a better barrister by paying money?

A parent relying on a barrister who is being paid with public funding (or what all sane people call “Legal Aid”) will get proper advice, from someone who works hard and does their best and is bright. All barristers who have experience in care proceedings do legal aid work, so you can’t get some better barrister, better advice by paying privately. There’s not a Premier League of barristers who know about care but don’t do legal aid work.

I would NOT, for a second, suggest that the average barrister works harder or better on a case that they are earning more money on, I don’t think money comes into it. Honestly, I don’t.

But what you can get, potentially, is a QC. If you are willing to pay for it, you can get a QC in a case that the LSC (legal services commission, or what sane people call the legal aid board) would not let you have one for free.

That QC is the best of the best, and may give you an edge in the case. Though some barristers who don’t have QC after their name are better advocates than some QCs, in general, a QC is going to be better.

It may well send a subliminal message to the Court about your case and the quality of it. Certainly there’s always an impression that the Court treats a QC with more respect than a run of the mill advocate.

Or you may not even need to go that far. Suppose you think about your barrister doing your case for public funding – they will work hard at your case, and put in effort. But they have another case the week before where they are doing that, and another the week after.

Might you get better representation from the same barrister, if you were willing to pay them to take two or three days off the week before your case to prepare?

We can’t know for certain, but I’d suggest that we all work better when we’re not shattered.

That’s an option available to those who have money that doesn’t exist for those who don’t.

Ring your solicitor up and say “I think my barrister should really only work on my case and nothing else the week before the hearing”, and you’ll get this answer if you have no money “That’s a nice idea, but I’m afraid it doesn’t work like that” – and if you have lots of money, this answer “They don’t normally do that, but we could see if they would – it would be very expensive though, you’d be paying for seven days of their time instead of five. Do you want me to speak to them about it?”

So, is English family justice really like the Ritz, or am I just crackers?

13 Comments

Posted in costs, experts, research and tagged alcoholism, can you get an expert without permission? Can you pay for your own expert in care proceedings?, can you keep an expert report secret, child abuse, do people with money get treated better in care proceedings? can you buy better barristers with money? shadow expert, down and out in paris and london, fairness, instructing an expert in secret, middle class parents and child abuse, neglect, poverty. Bookmark the permalink.

“Two thirds of children who died of abuse in 2012 could have been saved”

Posted on January 22, 2013 by suesspiciousminds

An examination of this very shocking claim from the Children’s Rights Alliance for England report, and discussion of the report itself.

This is a very interesting report, with very weighty contributors. The report is scathing and coruscating of the way that Children’s Rights and issues affecting children is dealt with in the UK, particularly by the Government. I found the tone a bit polemical and overtly political, but there is no doubt that the authors care passionately about children’s welfare and are extremely angry and fearful about the failings they identify.

If you are worried about where we are currently going as a nation, or care passionately about the nation’s children, this report is a must-read. (I did find it too overtly Tory-bashing, but it is still for all of its political slants a meaningful and strong document)

The report is here:- http://www.crae.org.uk/assets/files/s%20Rights%202012.pdf

Here are some of the headline points they open with, and they are shocking.

• Forty-eight children died as a result of ‘deliberately inflicted injury, abuse or neglect’ in 2011-12. Sixty-five per cent of these deaths were ‘modifiable’ – there were factors involved in the death indicating that achievable steps could be taken to reduce the risk of future deaths.

• Between April 2009 and April 2010, Tasers were used on under-18s a total of 144 times. In the previous 12 month period Tasers were used on children 102 times – an increase of 41%.

• Thirty-three children have died in custody in England and Wales since 1990. In January 2012, two children died within a week.

• Official statistics published in November 2012 reported that the number of children going missing from foster care had increased by 19% in the previous year.

• More than 3,000 foster children are estimated to have gone missing in the year up to March 2012. As of 31 March 2012 there were a reported 1% still missing from care.

• In 2011 only 13.9% of children in care achieved good GCSE grades (A* to C) in both English and mathematics, compared to 58.6% of their peers. The attainment gap has risen from 37.2 in 2007 to 44.7 in 2011.

• When they visit a looked after child, social workers are required to speak to the child in private, but only 39% of children say that this happens on every visit, and 5% of children said that this never happens.

• Official figures published in November 2012 revealed that of 6,610 care leavers aged 19, 36% (2,390) were not in education, employment or training. This percentage is at its highest since 2008 (when it was 24%).

Action for Children’s analysis of the impact of Government spending decisions on vulnerable children and families found that family support services have been significantly affected by cuts to local authority spending. Out of 48 family support managers questioned:

• 13% of managers had seen a decrease in the number of hours that staff were able to spend with families and children in the last 12 months;

• More than a quarter of managers (27%) reported a decrease in funding. 4% of services reported a budget increase;

• 44% of managers reported that the number of new referrals is rising, compared to the previous six months;

• According to almost two-thirds (62%) of the managers, families are facing increasingly severe problems

I was staggered to read here that this country is Tasering children. I knew that the number of children who die from abuse each year is roughly one a week, so 48 is obviously tragic and shocking though not surprising to me. The claim that 65% were ‘modifiable’ is probably what is going to be reported in the papers in lines with the headline I have used for this piece.

Let’s have a look at the specific bits in the report on this:-

Statutory guidance sets out the procedures to be followed when a child dies.

Two processes are conducted to review child deaths.

A rapid response by key professionals is undertaken to investigate each individual unexpected death of a child.

A Child Death Overview Panel will also conduct an overview of all child deaths in the area covered by the Local Safeguarding Children Board (LSCB). Either of these processes can trigger a Serious Case Review.

Child death review processes became mandatory in April 2008, though LSCBs have been able to implement these functions since April 2006.

There were 4,012 child death reviews in the year ending 31 March 2012. This is slightly lower than the number of reviews carried out in the previous year.

Official data shows that there were 784 ‘modifiable’ deaths in England in 2011-12. A modifiable death is the official term given to a death where one or more factors could be modified (changed) to reduce the risk of future child deaths. (This is the same proportion as the previous year – 20% of the total number of child deaths reviewed)

The age breakdown of the 784 ‘modifiable’ deaths is as follows:

• Newborns under the age of 27 days accounted for 45% of modifiable child deaths (an increase of 12% on the previous year)

• Infants aged between 28 and 364 days accounted for 21% of modifiable child deaths

• Children aged between 1 and 4 years accounted for 12% of modifiable child deaths

• Children aged between 15 and 17 years accounted for 9% of modifiable child deaths

• Children aged between 10 and 14 accounted for 7% of modifiable child deaths

• Children aged between 5 and 9 years accounted for 6% of modifiable child deaths.

Older children who died aged 15-17 years were more likely to have modifiable factors identified in their deaths, with 32% of this age group having modifiable factors identified, compared to 18% of children aged under one-year.

Of the 43 children that died in England in 2011-12 as a result of deliberately inflicted injury, abuse or neglect over half (28) were deemed to have modifiable factors.

Six per cent (45) of the 784 children who died where modifiable factors were identified were, or had been, subject to a child protection plan at the time of death; and 50 of the 784 children were or had been subject to a statutory order at the time of death.

The EHRC’s Human Rights Review states that local authority mechanisms for investigating and learning from serious cases of ill-treatment may be ‘insufficient’. The Review reiterates the concerns expressed in the Munro Review that serious case reviews are failing to identify the core issues that prevent child protection professionals from protecting children. In addition, the EHRC concludes that agencies often fail to work together effectively to prevent the ill-treatment of children.

The report notes that in child protection cases there is often a blurring of boundaries between different agencies. This lack of communication means that at-risk children can fall through the gaps.

So the 781 child deaths that were reviewed covered a wide range of causes, and it is the 48 who died from abuse that the report is focussing on. I see no reason to dispute that the figures about whether the deaths were ‘modifiable’ are accurate figures and that the decision as to whether they were ‘modifiable’ (or preventable, in plain English) are accurately taken from the investigation into those deaths.

That is a shocking figure. Not least given that we have all been working under the shadow of Baby P for over four years now, with numbers of care proceedings having gone up nearly 50% over that time.

There is an argument that somewhere along the line since Baby P, perhaps explicitly, perhaps in an underlying and unconscious trend, that the nation has moved in child protection terms quite far along the “child rescue” side of the scale rather than “family preservation” and that underpinning that is the understandable desire amongst social workers, and maybe even Courts not to have another tragedy like Baby P, and that perhaps, buried deep under that is the notion that separating more families is a price worth paying to avoid that.

But we don’t seem to have reduced the numbers of child deaths caused by abuse (at least not appreciably) and this report is decent evidence to suggest that even in the most hyper aware culture of ‘child rescue’ we have had in this country, 28 children died of abuse where this could have been avoided.

If there has been a lurch down the ‘child rescue’ side of the scale, as some commentators suggest, has that actually had any positive benefits for the children of the UK compared to the negative aspects of the system not properly balancing ‘family preservation’?

As I was recently suggesting in my post about Baby P, unless you become as a society so risk averse that any sniff of risk results in removal of children, you can’t necessarily tell which children who are at risk will fall into that dreadful bracket.

It all seems terribly inevitable, when you do what the Press does and work backwards from the death to look at the history.

I’d suggest that this is a media fallacy – yes, if you start from the death and look at all of the concerns the outcome seems terribly inevitable, just as if you only interview people who have WON the national lottery you would establish that buying a lottery ticket inevitably leads to winning the lottery.

You need to be aware of how many people buy tickets and don’t have any life-changing event, to have any idea as to whether buying a lottery ticket is likely to lead to you winning the lottery.

Unless you look at the pool of children who have those sorts of pattern of concerns and bruises and worries who end up being able to be safely managed at home, which of course nobody ever does, you don’t get an accurate picture of what risks, if any, do inevitably lead to child deaths, and which are just professionals weighing up the interest of keeping a family together and managing risk against ‘safety first’ and breaking up a family, and who with the magical benefit of hindsight maybe got that balance wrong with tragic consequences.

A thought-provoking report. Worth a read.

12 Comments

Posted in research and tagged 65% of child abuse deaths could have been avoided, baby p, child death, child death from abuse, child rescue, children's rights, children's rights alliance england, crae, crae report, family preservation, un convention on the rights of children. Bookmark the permalink.

Neurology, new neurology, old neurology, neurotic neurology… let’s have a heated debate!

Posted on January 21, 2013 by suesspiciousminds

Am beginning to think that I should move into the new field of paediatric neurology law blogging, as it seemed very popular last time. [Although I am going to have to work harder on titles if I have to do a fourth, because I'm running dry]

This is my third post on this issue.

The last one was here:-

http://suesspiciousminds.com/2013/01/14/semantics-pedantics-and-neuro-mantics/

Which was about the Wastell and White report suggesting that too much political weight is being placed on headlines of neuroscience research when the actual research is more fragile than the headlines would suggest.

You may recall that the thrust of that was whether the impression that is being disseminated that neuroscience is at one on the principle that neglect in early childhood can cause longstanding harm to children, possibly even irreparable harm in the first years of life, is a genuine one on which important decisions can rightly be taken, or whether there is a schism within neuroscience which might need resolution before we start constructing metaphorical housing estates on those foundations.

The key debate seems to be about plasticity of the brain in an infant – is that damage long-lasting and irreparable, or does the brain form new structures and overcome it (obviously ideally with the neglect ceasing and positive parenting being in place) ?

I don’t think anyone would argue that children suffering neglect is BAD, the issue here is whether science is now showing that it is FAR MORE BAD than we had previously believed.

As a result, a kind subscriber has sent me this new report “The Foundations of Life” compiled by Harvard University, which is firmly in the Family Justice Review camp, of neglect causing much greater and more irreparable harm than had earlier been understood.

My initial reading suggests that this is not new research, or commenting on fresh experiments or studies, but again a drawing together of existing research and formulating conclusions from it.

That report can be found here: -

http://developingchild.harvard.edu/index.php/resources/reports_and_working_papers/foundations-of-lifelong-health/

There is a summary of essential findings, which I shall set out here.

(The analysis of whether those findings are made out from the research is a task beyond me, but some of my new readers who have lovely neurosciency brains will probably set to work on considering that).

Advances in molecular biology, and genomics have converged on three compelling conclusions:

Early experiences are built into our bodies.

Significant adversity can produce physiological disruptions or biological “memories” that undermine the development of the body’s stress response systems and affect the developing brain, cardiovascular system, immune system, and metabolic regulatory controls.

These physiological disruptions can persist far into adulthood and lead to lifelong impairments in both physical and mental health.

Messages for Decision-Makers

The biological sciences have two clear and powerful messages for leaders who are searching for more effective ways to improve the health of the nation.

First, current health promotion and disease prevention policies focused on adults would be more effective if evidence-based investments were also made to strengthen the foundations of health in the prenatal and early childhood periods.

Second, significant reductions in chronic disease could be achieved across the life course by decreasing the number and severity of adverse experiences that threaten the wellbeing of young children and by strengthening the protective relationships that help mitigate the harmful effects of toxic stress.

A New Framework for Early Childhood Policy and Practice

The following four interrelated dimensions offer a promising framework for innovative approaches to improving physical and mental well-being. The biology of health explains how experiences and environmental influences “get under the skin” and interact with genetic predispositions, which then result in various combinations of physiological adaptation and disruption that affect lifelong outcomes in learning, behavior, and both physical and mental well-being.

These findings call for us to augment adult-focused approaches to health promotion and disease prevention by addressing the early childhood origins of lifelong illness and disability.

From the report itself, this is interesting – the suggestion that child abuse should start being treated as a public health issue, and treatment programmes designed and delivered.

Child Welfare.

For more than a century, child protective services have focused on issues re¬lated to physical safety, reduction of repeated injury, and child custody.

Now, recent scientific advances are increasing our understanding of the extent to which the toxic stress of abuse, neglect, or exposure to family or community violence can produce physiological changes in young children that increase the likelihood of mental health problems and physical disease throughout their lives.

Based on this heightened risk of stress-related illness, science suggests that all investigations of suspected child abuse or neglect should include a comprehensive assessment of the child’s cognitive, language, emo¬tional, social, and physical development, followed by the provision of effective therapeutic services as needed. This could be accomplished through regularized referrals from the child welfare system (which is a mandated service in each state) to the early intervention system for children with developmental delays or dis¬abilities (which provides services under an en¬titlement established by federal law).

Although the most recent federal reauthorizations of the Keeping Children and Families Safe Act and the Individuals with Disabilities Education Act both included requirements for establishing such linkages, sufficient funding has not been provided, and the implementation of these requirements has moved slowly.

The availability of new, evidence-based interventions that have been shown to improve outcomes for children in the child welfare system168 underscores the compelling need to transform “child protection” from its traditional concern with physical safety and custody to a broader, more science-based focus on health promotion and disease prevention.

The Centers for Disease Control and Prevention has taken an important step in advancing this issue by promoting the prevention of child maltreatment as a public health concern.169,170

I remain in the dark as to whether the current path we are on, of policy decisions being taken, and perhaps individual ones too, on the basis of neglect being irreparably harmful to infants and that our timeframe for making decisions is much more narrow than previously believed, is the right one and that we have some mavericks suggesting otherwise, or whether the current trendy thinking on that is wrong and the naysayers are actually pointing out that this emperor has no clothes on.

I would like someone to find out. Or perhaps we lawyers just have an over-optimistic view of the social sciences, and think that there is a definitive answer out there to be found out (like there really is a definite number for the co-efficient of the expansion of brass and that every scientist in the field would agree on what the number is, and how you could prove it). Maybe there isn’t.

Perhaps the truth of the world of neuroscience is that we are still stumbling in the dark and that every theory is going to have its proponents and opponents.

In which case, we perhaps ought to know THAT, and not be treating the findings and theories of neuroscience as though they represent the final word on any given subject.

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Posted in assessment of risk, research and tagged david wastell, impact of neglect on infants, impact of neglect on the brain, is neglect irreparable, neglect, neurology, paediatric neuroscience, plasticity, plasticity of the brain, sue white. Bookmark the permalink.

imPPPossible, surely? New research shows that Triple P has no effect on parenting

Posted on January 17, 2013 by suesspiciousminds

If this week’s blogging has taught us nothing, it is to be wary of what the headlines of research tell us and read the whole thing. (Unless it is research into what meat is in the burgers you ate last night, in which case best not to read it)

This is research published in the International Journal of Conflict and Violence, which sounds like bedside reading for a ruler of a Middle East country, but I assume is broadly anti conflict and violence, rather than photoshoots of girls with kalashnikovs. I daresay that they still have a hard time booking a venue for a Christmas party though.

http://www.ijcv.org/index.php/ijcv/article/view/263

But this is some research into whether Triple P, which has a lot of Government goodwill backing, takes a lot of public money, and which I spend hours per week hearing people whine about needing a referral to Triple P, actually makes any difference, and it suggests (at least in the headlines) not. An important word in research terms, randomised, comes up, which is promising. You need the study to be randomised so that the researchers didn’t come in with an agenda and pick the hundred best clients Triple P had, or the worst.

[Of course, as these were studies in Birmingham, perhaps it doesn't tell us much more than one of (a) The parents who use Triple P in Birmingham aren't responsive to it, (b) the social problems in Birmingham don't respond all that well to Triple P - and as I recall substance misuse and crack cocaine were pretty frequent issues in cases there or (c) The Triple P deliverers in the Birmingham area are not doing it quite right. ]

But let’s read more.

The Impact of Three Evidence-Based Programmes Delivered in Public Systems in Birmingham, UK

Michael Little, Vashti Berry, Louise Morpeth, Sarah Blower, Nick Axford, Rod Taylor, Tracey Bywater, Minna Lehtonen, Kate Tobin

Abstract

The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on “what works,” and included the implementation and evaluation of three evidence-based programmes in regular children’s services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four–six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four–nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children’s behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children’s relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience.

I’m not familiar with the Incredible Years model, but that seems to be pretty good, PATHS not too bad, and Triple P negligible. Now, if that turns out to be a reputable and replicable study (by which I mean someone else using those methods anywhere else in the country would get similar results) that’s a big deal. Firstly, as I said, Triple P gets a lot of State funding, and is a regular go-to resource. Secondly, parents pretty much only get one shot at an intervention to improve their parenting, so if what we’re sending them to isn’t as good at making a difference as it should be, that’s pretty important.

All this with the caveat that I am not a qualified interpreter of research – I am feeling more and more that we need a Ben Goldacre type to tackle the research that’s going around in family justice to tell us whether the conclusions are robust and fair.

As we know, Birmingham is a very large local authority, the biggest in the country, and it has a range of social problems, so it doesn’t seem like a bad pick for the area. It’s not like it has been skewed by picking Saffron Walden say and claiming that this is representative of the country at large.

Another telling thing is that this research is published, which means it is peer-reviewed and checked over, rather than just being something these guys have written and sent out a press release about. That makes me feel more reassured – the first 4 things I look for are :-

1. Is it peer reviewed

2. Is it randomised?

3. Did the initial sample get skewed?

4. Was it funded by someone with a vested interest in outcome?

And none of those red alarm bells are set off

My next concern is whether you can objectively measure a change in parenting or behaviour, or whether that is by its nature subjective, and if the latter, who is measuring it?

Lets see what they say:-

All of the evaluations applied the “intention to treat” principle, meaning that results include those children, parents, or schools that dropped out of the study. The findings therefore
reflect what happens in real-world situations, with many intervention recipients either not starting or not completing an intervention paid for by the local authority. Each
of the trials used a “waiting list” design, meaning that children or schools not receiving the intervention were given priority to receive it in future if the results of the evaluation
were positive. Children in the control conditions received “services as usual”, which in some cases involved substantial support – for example, the SEAL (Social and Emotional Aspects
of Learning) programme in the case of the PATHS trial. Participants in the programme groups could also continue to receive services as usual – that is, no services were
withdrawn – although it is acknowledged that logistically this may have been difficult (for example, if PATHS lessons
used curriculum time previously allocated to SEAL).

Typically, experimental evaluation is expensive. In order to reduce costs, the Social Research Unit sought only to replicate the findings established in other trials, thereby collecting considerably less data than is usually the case. The experimental approach was taken, randomly allocating units to control and intervention groups. Sample sizes reflect
a calculation of the statistical power needed for any programme effect identified by the evaluations to be greater than chance. Robust measurement was also required. These elements are typical of a good RCT. The focus on replicating findings from other trials offers a different angle, however. Specifically, the data collection was restricted to the factors in the logic model underpinning the evidence-based programme, including the risks targeted, the fidelity of implementation of core elements of the intervention, and the outcomes sought. Other hypothesised
moderators and other contextual information are excluded. The net result is a high-quality evaluation with less data and therefore less cost.

Well, the important thing here is that they didn’t discount those who dropped out – a common trick with research is to not include anyone who doesn’t finish the course of treatment, which of course skews out those people who didn’t feel it was working or had unpleasant experiences. I don’t know enough to know that this is bulletproof, but it is not yelling out at me that there are massive holes in it.

The evaluation of Triple-P was a parallel randomised controlled trial, with pre-post test design. It involved 146 children aged four–nine years whose symptoms indicated a
potential social-emotional or behavioural disorder, determined using the “high need” threshold on the SDQ “total difficulties” score (17 or above out of 40). The sample
comprised 105 boys and 41 girls. The mean age was 82 months (SD = 21). The sample also comprised a high proportion of low-income families: 62 percent of children
were entitled to free school meals compared to 33 percent for Birmingham as a whole.

The parent(s) of half (73) of these children were randomly assigned to attend Triple-P parenting groups, with the remaining half placed on a waiting list and receiving services
as usual. Researchers performed the randomisation foreach eligible child using an online programme, designed by NWORTH. Children were randomised on a 1:1 ratio, using
a dynamic allocation method, stratified by age and sex.

Baseline (Wave 1) data was collected on all children. Follow-up (Wave 2) occurred six months after baseline and included 137 children.2 The programme was delivered to
intervention group parents at some point during those six months. The missing nine cases (three control, six intervention) were made up of two formal withdrawals from the study and seven that could not be contacted. The primary outcome instruments were the SDQ and ECBI. Parenting behaviour was measured using the Arnold and O’Leary Parenting Scale (APS). Estimated mean differences were used to calculate the impact of Triple-P. ANCOVA tests controlled for children’s start scores on respective measures, the age and sex of the child, and the area from
which families were recruited.

I won’t put the figures in, because they’re a bit complex, without reading the whole report for yourselves.

But this is the telling paragraph in relation to Triple P

4.3. Standard Level-4 Triple-P
As Table 3 illustrates, the results for this programme are not promising. Children of parents attending Triple-P sessions improved their behaviour and were happier sixmonths after the course concluded, but at roughly the same rate as children in the control group receiving services as normal. These results are not consistent with most other Triple-P trials around the world. However, as far as we are aware, only four randomised trials (including this one) have been undertaken independent of the programme originator (see also Gallart and Matthey 2005; Hahlweg et
al. 2010; Malti, Ribeaud, and Eisner 2011). When these four studies are viewed together, the evidence of impact on child development is equivocal.

What that is obliquely saying is, that although there might be a great deal of research that Mars bars are really good for you, if you strip out all the research commissioned by Mars, it turns out the research shows that they’re not that good for you.

Their results were that the improvements and changes were no better in the Triple P group than in the group who didn’t have it – a PPPlacebo effect perhaps? Food for thought at least.

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Posted in research and tagged improving parenting, international journal of conflict and violence, intervention on parenting, is triple p effective, placebo effect, research, triple P, triple p research. Bookmark the permalink.

Semantics, pedantics and Neuro-mantics

Posted on January 14, 2013 by suesspiciousminds

A discussion of the fascinating “Blinded by neuroscience – social policy, the family and the infant brain” paper by David Wastell and Sue White

I was sent this compelling and interesting paper by a colleague, and it makes an interesting companion piece to the official family justice research paper on neglect, which I blogged about here :-

http://suesspiciousminds.com/2012/11/05/taking-neglect-seriously/

The paper can be found here : - (you need to click on the PDF to read it, but it is free)

http://www.ingentaconnect.com/content/tpp/frs/2012/00000001/00000003/art00008?token=005015070f39b6e58654624315142576b7921766b3c252e5e4e2663433b393f6a333f256698c60b5

Now, why this is interesting generally, rather than just specifically because it is an interesting paper, is because the authors are positing that the Government is about to go in a direction based on scientific research that neglect :-

(a) causes much more long-standing damage on children than previously understood

(b) that poor quality of care in the early years of a child’s life causes damage to the structure of the brain which is hard to overcome

And of course, the very first piece of research published by the Family Justice Review team is on these very issues, and although it doesn’t advance as far as (c) explicitly, it certainly comes up to the shoreline and says that speed of decision making is critical and that children under two can’t wait for decisions. It certainly endorses unequivocally the viewpoint that science has demonstrated (a) and (b)

What this article does, is question the scientific studies and research that lead to (a) and (b) and suggests that a careful analysis of the source material suggests that it is not so concrete as the FJR research suggests. And if (a) and (b) are not solid foundations, moving to (c) as the public policy seems to be doing at present may be even more risky than it appears.

[As a sidebar, this argument of if (a) and (b) are right, is (c) right, reminds me of Lewis Carroll's dialogue between Achilles and the Tortoise, and you can find that here, and shows that you simply can't prove anything at all with logic, if you are arguing with a smart-arse :- ]

http://www.ditext.com/carroll/tortoise.html

In detail, the authors of this paper suggest that the thinking the Government are working on, that the infant brain is readily susceptible to permanent and irreversible damage from poor care, is wrong and that the truth is rather that the infant brain is resilient and has a plasticity (by which they mean it is flexible and can adjust and will recover from early delays)

Initial caveat - I was concerned by the strident tone of this paper, and I was also concerned that neither of the authors (eminent and smart as they obviously are) are actually neuroscientists. [That will teach me to judge by the titles that people give at the end, have been contacted by one of the authors, who very politely tells me that he is indeed a neuroscientist - ignore every other time I say that in the piece]

I would be terribly interested to learn whether this is a genuine schism in the field of neuroscience as it relates to children, neglect and brain development in infants, or whether one side or the other is cherrypicking data and quotes. I simply don’t know. I’m not a neuroscientist, and though I can make sense of what is said by both sides, I am in no position to weigh up who is right.

Having critiqued the strident tone, I suppose that if the authors are right, and the Government is about to lurch into a public policy on neglect, child protection and quick adoptions based on ‘hard science’ when what they believe the ‘hard science’ says is wrong, I might be pretty forceful in my tone too.

Let’s have a look at some detail

We argue that the neuroscientific claims supporting current policy initiatives have receivedlittle critical commentary. They appear to be operating as powerful ‘trump cards’ in what is actually very contentious terrain, suppressing vital moral debate regarding the shape of state intervention in the lives of children and families.

In this article, we interrogate the nature of the scientific claims made in key documents and the ideological thrust of policy that they have engendered. We examine Allen’s first report in detail first, before developing a more general critique of what Tallis and others have dubbed neuromania: ‘the appeal to the brain, as revealed through the latest science, to explain our behaviour’ (Tallis, 2011: 5; Legrenzi and

Umilta, 2011). Bruer’s (1999) deconstruction of the ‘myth of the first three years’ will feature prominently in our argument, paving the way for a broader critical analysis of the ‘new’ brain science and its influence on policy. We contend that neuroscience is re-presenting an older ideological argument about the role of the state in family life in terms of a biologically privileged worldview. We suggest that there is a great

deal of difference between ‘early intervention’ as defined in the Allen report and what Munro (2011: 69) refers to as ‘early help’, which includes a much wider range of family support activities. Neuromania, we conclude, is the latest of modernity’s juggernauts reifying human relations into ‘technical objects’ to be fixed by the state (Smith, 2002), which always ‘asks nothing better than to intervene’ (Ellul, 1964: 228).

Strong words there, and the phrase at the end that the State generally seeks reasons to intervene is resonant. I feel personally that the State has moved much more towards a paternalistic approach to the lives of its citizens and away from a broad principle that people are autonomous and best placed to make decisions for themselves save in very narrow circumstances, and that the law has done the same in recent years. People’s freedom to make bad, foolish and downright idiotic decisions for themselves has to an extent been eroded.

Criticising Allen’s report, on which a lot of the foundation of the neglect causes irreversible damage in infants is based, the authors say (their quotes from Allen are in italics)

The importance of secure attachment is invoked:

“Children develop in an environment of relationships.… From early infancy, they naturally reach out to create bonds, and they develop best when caring adults respond in warm, stimulating and consistent ways. This secure attachment with those close to them leads to the development of empathy, trust and well-being. (2011a: 13)”

Predictive claims quickly follow regarding the long-term effects of such early attachment patterns, especially the beneficial effects of secure attachment and the dire impact of the failure to cement such bonds:

“Recent research also shows insecure attachment is linked to a higher risk for a number of health conditions, including strokes, heart attacks … people with secure attachment show more healthy behaviours such as taking exercise, not smoking, not using substances and alcohol, and driving at ordinary speed.

(2011a: 15)”

Two studies are cited as the basis for these ominous claims. But again the evidence cited is perplexing. These are not studies of children, but adults; both use ‘attachment style’ as a way of measuring the adult personality with self-report questionnaires. Neither study shows, nor purports to show, any link between early childhood experiences and

problems later in life. In subsequent paragraphs, damaged emotionality and damaged brains are soon united, and the perpetrator of all this devastation is unflinchingly denounced.

Parents are to blame:

“Parents who are neglectful or who are drunk, drugged or violent, will have impaired capacity to provide this social and emotional stability, and will create the likelihood that adverse experiences might have a negative impact on their children’s development … the worst and deepest damage is done to children when their brains are being formed during their earliest months

and years. (2011a: 15)”

If the authors here are right about the studies of attachment and impact on later life, and the flaws that they claim, my faith in the FJR research does wobble. Again, I am not a neuroscientist, and neither are the authors, but if we are going to be taking the FJR research as agreed research on which the judiciary can base conclusions and decisions, we need to know whether the foundations are solid or built on sand.

Returning to Allen’s report, the following excerpt summarises the final

step of his neurobiological argument:

Different parts of the brain develop in different sensitive windows of time. The estimated prime window for emotional development is up to 18 months, by which time the foundation of this has been shaped by the way in which the prime carer interacts with the child…. Infants of severely depressed mothers show reduced left lobe activity (associated with being happy, joyful and interested) and increased right lobe activity (associated with negative feelings).

If the predominant early experience is fear and stress, the neurochemical responses to those experiences become the primary architects of the brain.

Trauma elevates stress hormones, such as cortisol. One result is significantly fewer synapses. Specialists viewing CAT scans of the brains of abused or neglected children have likened the experience to looking at a black hole.

In extreme cases the brains of abused children are significantly smaller than the norm. (Allen, 2011a: 16)

Those damaged brains again. For the claim of lasting damage from fear, stress and trauma, Allen cites no specific scientific support. A significant body of work does, however, exist on the possible damage caused by post-traumatic stress disorder, reviewed by Wang and Xiao (2010). Although there is evidence of reduced volume in one brainstem structure (the hippocampus), the seminal research involves war

veterans, not children; follow-up studies have not shown lasting hippocampal damage, and the scant imaging research on children has failed to find such impact. A recent authoritative review (McCrory et al, 2012) comes to much the same conclusion regarding the hippocampus, and another much-mentioned brainstem structure, the amygdala; only under conditions of prolonged rearing in orphanages is diminished

brain size evident (see below).

Digging into the specific (frontal) lobe evidence invoked by Allen, he cites a paper by Dawson et al (1994), which reviews psychophysiological studies of the children of depressed mothers. Dawson’s evidence, however, actually goes in the opposite

direction to that claimed in the Allen report. Referring to a study on the reactions of children when mothers left the room: ‘the infants of symptomatic mothers exhibited an unexpected pattern of greater left than right activation during the maternal separation condition’ (Dawson et al, 1994: 772). More ‘positive’ emotion it would seem. In truth, there is a vast gallimauphry of neuroscience research, but little settled knowledge. Evidence for policy making does not simply repose in journals ‘ready to be harvested’ (Greenhalgh and Russell, 2006: 36). Rather, it is ‘rhetorically constructed on the social stage so as to achieve particular ends’ (Greenhalgh and Russell, 2006: 37). This seems an apt enough description of Allen’s modus operandi.

Although ‘journal science’ is invoked, he seems not much interested in what it actually says. This is ‘prejudice masquerading as research’ (Furedi, 2001: 155), of science being enrolled to legitimate an a priori ideological position favouring a larger arena for public intervention in the lives of families.

(and later)

It should now be clear that neuroscientific knowledge is at an early and provisional stage. As Bruer (1999: 98) avers, after more than a century of research we are still ‘closer to the beginning than the end of this quest’.

This point was reinforced recently by Belsky and de Haan (2011: 409–10): although the brain ‘packs a punch’ for policy makers, they conclude that ‘the study of parenting and brain development is not even yet in its infancy; it would be more appropriate to conclude that it is still in the

embryonic stage’. Neuroscientists may know the limitations of their research, but such caveats are not what politicians and proselytisers wish to hear;

Again, I am in no position to judge whether what the author’s say of Allen’s report is accurate, fair comment, or a scurrilous attack. I simply don’t know and can’t say. But what does seem clear to me is that simply ignoring the counter arguments and pressing ahead on the basis that there is clear research with firm conclusions on which future plans can be built is problematic unless that research addresses the criticisms of it head on.

We have much the same problem with the vexed issue of contact levels for infants in care. I have blogged before about this being presented in the Family Justice Review research as being strong, almost overwhelming views about how high levels of contact are detrimental to infants, and this underpinned entirely the Government consultation on contact, and how there is a contrary view out there and criticism that the research just isn’t robust enough to bear the weight that is being placed upon its branches. Particularly Dr Peter Dale’s critique of the original research

[See http://suesspiciousminds.com/2012/09/11/family-preservation-versus-child-rescue/ ]

Again, I am not a scientist or researcher practising in this field, so I can’t resolve those debates and come to a firm conclusion about who is right. But that may well be the problem – neither are the politicians who are setting the course, or the Judges who will be deciding individual cases.

We need clarity as to whether the science on infant brain development is as claimed in the Family Justice Research, or as claimed here, or whether it is simply too early to tell, likewise with the impact of contact on children.

It also raises broader and deeper questions – when, as the Family Justice Review intends, we collect research with a view to identifying the current state of play in a particular area and what that means for us, how are we, as lawyers, social workers, judges, politicians, in a position to assess whether that research actually shows what the headlines suggest ? Do we have to get under the bonnet of the individual studies to realise that what was being tested was NOT the central hypothesis, but some ancillary matters from which large extrapolations are being drawn?

I don’t think it is controversial to say that neglect is harmful to children, but if we are working on the basis that science has proven that neglect is not only harmful to children but that such harm carries on into adult life and that harm caused by neglect in the first two years is irreparable, so decisions have to be made very quickly, then we had better be confident about that proof.

I’m not at all saying that the authors here have overturned the research – they are, as I have emphasised a lot, not neuroscientists. But what they have certainly done is gone up to the duvet and said “are you sure that’s someone asleep under there, rather than just some pillows?”

If you do happen to be a neuroscientist, I’d love to have a discussion about this, though it will need to be taken slowly – I’m strictly an amateur.

I’ll conclude with some wise philosophical words, from Descartes via 1980s Manchester

Does the body rule the mind, or does the mind rule the body? I dunno

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Posted in research and tagged development of children's brains, does the body rule the mind or does the mind rule the body?, family justice review, neglect, neuroscience, research. Bookmark the permalink.

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