MULTI-AGENCY CHILD PROTECTION: CAN RISK ASSESSMENT FRAMEWORKS BE HELPFUL? 37 Social Work & Social Sciences Review 16(3) pp.37-49. DOI: 10.1921/3703160304 Multi-agency child protection: Can risk assessment frameworks be helpful? Julia Stroud1 and Chris Warren-Adamson2 Abstract: Public concern over, and recent developments in, the field of child protection are well known (Munro 2012). Within these developments, there has been a strengthening of the role of social work with an increased focus on, and recognition of, professional knowledge, skills and ‘expert’ decision making (Munro 2011; Gilbert et al. 2011). Focus on inter-professional and multi-agency practice has developed alongside (Frost and Lloyd 2006; Frost and Robinson 2007; Ruch 2009), and continues to have a clear focus in the recently issued Working Together to Safeguard Children (H.M. Government 2013). Thispaperenquiresintoarelativelyunder-exploredareaofmulti-agencychildprotectionpractice, specifically, that of the police (that is,. non-specialists in child protection) making an urgent, first response to a child protection call, often out of hours and without immediate recourse to the expertise and knowledge of child protection practitioners. In these situations, the police are called upon to make key decisions: for example, whether to immediately protect and remove children using police protection powers (Section 46(1) Children Act 1989), to refer on to local authority social services for a s47 investigation or s17 services, or to take no further action. There is exploration of the issues raised by a request from the police to develop an assessment framework as an aid to practice in these situations. The police had in mind an equivalent instrument to a domestic abuse framework already adopted by them. The paper reviews debates, particularly about predictive efficacy, in the construction of assessment and decision-making tools. The nature and distinction between consensus based and actuarial risk assessment instruments are examined, as are challenges for general multiagency working, alongside the specific challenges for front line police officers. It is proposed that a consensus based assessment framework to support decision making, drawing on empirically tested, actuarially informed risk assessment evidence, which is collaboratively tested with a multi-agency group, is indicated. Keywords: inter-agency child protection; child abuse; risk assessment 1. Principal Lecturer, and Director of Studies, Social Work 2. Senior Lecturer Address for correspondence: School of Applied Social Science, University of Brighton, Falmer, Brighton BN1 9PH. J.Stroud@brighton.ac.uk Date of first (online) publication: DR JULIA STROUD AND CHRIS WARREN-ADAMSON 38 Introduction The following exploratory discussion originates from a request to review whether a child protection risk assessment framework would assist front-line police officers, as non-specialist workers, in their decision making (Drury-Hudson 1999). Generally, social work has been sceptical about risk assessment frameworks and checklists (Spratt 2000; Gillingham 2006; Gillingham & Humphries 2009; Broadhurst et al 2010) viewing them as having insufficient concern with inter and intra personal issues, and inter-professional interactions and emergent factors – the very areas that Munro (2011, 2012) and the profession is concerned about so rightly. This paper reviews what is known about risk assessment frameworks, commonly distinguished as actuarial and consensus-based. The former are generally accepted as having stronger predictive success, the latter accepted as engaging and guiding practitioners in risk assessment (Baird & Wagner 2000). The paper assesses the positive and negative aspects of non-child protection specialists using these instruments in their contribution to multi-agency child protection practice. A paradigm debate: Subjectivist and objectivist perspectives A straightforward request by the police about the development of a risk assessment frameworktoguidefrontlineofficers,introducesarich,on-goingliteratureandmajor debates or ‘wars’ (according to at least one author, Johnson 2006). Principally, there is an argument about paradigms, which turns on the subjectivist and objectivist debate. The subjectivist position is well represented by theorists such as Parton (1998; 2011), Houston & Griffiths (2000), Gilbert et al. (2011), who note directions in societal governance and, in particular, the ascendance of regulatory and legal practice. They claim that the objectivist position is over-preoccupied with prediction, control and culpability, whereas proponents of the subjectivist position aim to re-establish the role of relationships and intra and inter personal perspectives in assessment and intervention as, of course, does Munro (2011; 2012). Moreover, given the reflexive and non-linear process of many complex interventions in this area of practice, social work literature has increasingly debated the manner in which it recognises and manages uncertainty in decsion making in child protection . The objectivist position dismisses so-called clinical or practitioner assessment as essentially instinctive and, therefore, flawed. This objectivist position turns on arguments about empiricism, design, and the relative merits of qualitative and quantitative methods. Early attempts at designing risk assessment instruments are attributed to Johnson and L’Esperance (1984). From 2000-2008 in particular, and principally through the pages of the Youth Services Review, researchers (inter alia, Lyle and Graham 2000; Cash 2001; Shlonsky & Wagner 2005; Gambrill and MULTI-AGENCY CHILD PROTECTION: CAN RISK ASSESSMENT FRAMEWORKS BE HELPFUL? 39 Schlonsky 2001; Johnson 2006; Schwalbe 2008) have debated the relative merits of two categories of risk assessment instruments. These categories are consensusbased systems and actuarial systems. In the consensus based system, practitioners are required to assess specific characteristics which have been brought together by accepted experts in the field and then they are expected to employ their clinical or practice judgement, including a measure of prediction, about future risk of neglect and abuse. The actuarial based assessment instruments are constructed and applied differently,beingdevelopedfromdatafromlargesamplesofcasematerial.Researchers identify factors and characteristics which are associated with risk of future abuse and neglect and from this data construct an actuarial instrument which requires that practitioners score, often according to a graded response, low, medium and high risk. As computer management of data and associations becomes ever better, the overall conclusion of researchers from within this paradigm has been that actuarial assessment instruments far out perform consensus based instruments in predicting risk of abuse and neglect by people with particular characteristics, with only rare claims to the contrary: see, for example, Johnson’s (2006) rebuttal of Baumann et al. (2006). There seems to be a common agreement that risk assessment is ‘a process for assessing the likelihood that a given person (usually a parent) will harm a child in the future’ (Wald & Wolverton 1990). However, even within the objectivist debate researchers have acknowledged that frameworks and instruments which predict future harm are not the whole story. What is needed also, argue Schlonsky and Wagner (2004) and Schwalbe (2008), is a contextual assessment of child and family functioning to develop case plans, using a structured decision-making (SDM) approach to integrate contextual and predictive strategies. Thus, what they propose is a combination of an actuarial instrument and what is commonly termed a Family Strengths and Needs Assessment (FSNA) instrument. However,whenitcomestoimplementationofsuchaninstrumentwhereimmediate protection is needed, Schwalbe (2008) highlights the predicament for utilising such an approach. What is needed in such situations, he concludes, is that: a) the goal of riskassessmentshouldextendbeyondpredictivevalidity,b)theorganisationalculture of the practitioner should support structured decision-making, and c) continued reflection and research is required into the utilisation of risk assessment findings by human service professionals. In the light of Schwalbe’s (2008) observations, how can multi-agency child protection practitioners proceed in combining what Cash (2001) describes as the art and the science of risk assessment? Indeed, Parton famously opened the debate in the 1990s, rejecting the assumption of rationality of child welfare and child protection, and arguing that ambiguity and uncertainty are at the heart of practice (Parton 1998). Later, Munro (2011; 2012) has elaborated and reinforced the perspective. DR JULIA STROUD AND CHRIS WARREN-ADAMSON 40 Munro: Organisations, risk and uncertainty In considering the environment in which decisions are made in child protection assessments, we have been informed by several of Munro’s (2011; 2012) recommendations. Firstly, in identifying unwieldy protocol, she recommended that both the Working Together to Safeguard Children (DfE 2010) and the Framework for the Assessment of Children in need and their Families (DH 2000) should be significantly revised. Secondly, she highlighted the central place of uncertainty in decision making in child protection. Munro echoes Parton’s (1998; 2011) consistent claim for the management of uncertainty to be at the centre of practice. Finally, we need to rememberthatseriousrisktochildrenisitselfacomplex,heterogeneousphenomenon (Stroud 2008; 2011). Munro observed that accumulated embellishment and addition to guidance on the multi-agency management of child protection since the seventies was such that it had become unwieldy and unhelpful. Further, the focus on unrealistic time frames militated against sound, informed professional practice – issues which have been addressed in the revised, recently issued Working Together to Safeguard Children (H.M. Government 2013). In anticipating changes to the Framework for Assessment (HMSO 2000), we note its similarity in approach to Schwalbe’s (2008) structured decision-making (SDM) approach outlined above, constituting a broad framework to assist the wisdom, professional expertise and intuition of practitioners, combined with accompanying materials, to assist prediction. The Framework’s appearance and application has been met with many misgivings, not least the claim that it mimics the pre-occupation in the United States with instruments for risk prediction, and there have been fears of an ‘anti-relationship’ and ‘score’ culture (Garrett 2003). Munro captures well the challenge of uncertainty in decision making in relation to risk: The second stage at which uncertainty arises is when making predictions about children’s future safety. The big problem for society (and consequently for professionals) is establishing a realistic expectation of professionals’ ability to predict the future and manage risk of harm to children and young people. Even when it is ascertained that abuse or neglect has occurred, there are difficult decisions to make about whether the parents can be helped to keep children safe from harm or whether the child needs to be removed. Such decisions involve making predictions about likely future harm and so are fallible. It may be judged highly unlikely that the child will be re-abused but low probability events happen. This does not in itself indicate flaws in the professional reasoning. The ideal would be if risk management could eradicate risk but this is not possible; it can only try to reduce the probability of harm. (Munro, 2011 p.18, Para. 1.13). MULTI-AGENCY CHILD PROTECTION: CAN RISK ASSESSMENT FRAMEWORKS BE HELPFUL? 41 Munro: Systems and complexity Munro’s (2011) discussion of child protection systems fell just short of the adoption of a contemporary paradigm, relevant to considerations of uncertainty in child protection, which is complexity theory (Bolland and Atherton 1999; Stevens and Hassett 2007; Marks-Tarlow 2008; Stevens and Cox 2008). Complexity theory originates from the natural sciences and is used and applied regularly in the social sciences in a range of areas including management, social and public policy (see, for example, Haynes 2008) and social work. There is much in the narrative of the Munro Review which indicates an implicit adoption of principles from complexity theory. ‘How systematic features of people’s environment can reasonably (and predictably) trigger particular actions; actions that make sense given the situation that helped bring them forth ... When you go behind the label ‘human error’, you see people and organisations trying to cope with complexity, continually adapting, evolving along with the changing nature of risk in their operations. Such coping with complexity is not easy to see when we make only brief forays into intricate worlds of practice’ (Woods et al, 2010; cited in Munro, 2011, p 19, Para. 1.17). Complexity theory underpins exploration of uncertainty in its emphasis on nonlinearity in causal matters (Hoffman 2008). It also takes account of the effects of changes in organisations (that is, multi-agency institutions) through the concepts of self-organisation and the way organisational effects are explained by the ‘magnetic’ power of attractors. The metaphor of the attractor (for example, issues of power, leadership, values, creativity), pictured as a deep basin of activity or a concentration of contour lines, which deepens or shallows, engulfs or is engulfed by others, gives a colourful image of the way organisations evolve, respond to or resist interventions and actions. See, for example, the discussions of Stevens and Hassett (2007) and Stevens and Cox (2008) on child protection, and Butz et al. 1997, on organisations and family therapy. Butz et al. particularly repudiate the reductionist and positivist paradigm which underpins much of the quest for risk assessment instruments. Houchin and Maclean’s (2005) complexity theory-based study of a new organisation developed and based on value ideals, showed how the destructive power of anxiety, as a powerful attractor, was instrumental in the organisation’s decline. As we know, the ClimbiéReportdemonstratedgraphicallyhoworganisationalissuescanaffectdecision making, assessment and multi agency practice in child protection (Laming 2003). Complexity theory and the concept of uncertainty offer key insights to inform decision making in child protection and the environment in which this occurs. We need to be mindful also of the acknowledged limitations of the assessment framework proposed for the police. These considerations lead to recognition both of the challenges of practice within the inter-agency system and also of the potential of the practitioner and the practitioner system in terms of decision making. DR JULIA STROUD AND CHRIS WARREN-ADAMSON 42 The challenges and opportunities of the inter-agency, inter-professional system Inconsideringtheinter-agency,inter-professionalcontext,anumberofauthors(Norris 1990; Anderson 2005; Frost and Lloyd 2006; Cooper, Braye et al 2004; Ruch 2009; Warren-Adamson 2009a,b), highlight many of the barriers to effective collaborative practice between organisations. For example, Warren-Adamson (2009:133) reminds us of potential areas of territorial difficulty; inter alia, denial (don’t think about it and it will disappear); avoidance (bypass it or make excuses); projection (casting one’s own feelings on to others); reaction formation (people taking on the behaviour of people with whom they are in conflict); counterphobia (denying anxiety by adopting an aggressive stance); displacement (rather than take it out on the person causing the grief, take it out on another); reflected blame (allied to the above, place bad feelings on another to avoid receivingitoneself);rationalisingorintellectualising(avoidtheemotionalandconcentrate onthefactual); escalation (blowingsomethingoutofproportion). Arguably, it is suggested that anxiety, relating to uncertainty, lies at the heart of many of these defences. Menzies Lyth’s (1959) famous psychodynamic study of nursing services underlines the critical place of anxiety in decision making, and documents responses echoing those above. Menzies Lyth’s insights and vocabulary are widely recognised and used: for example, drowning or keeping at bay; splitting, dangerous triangles, and taking flight. As identified, Houchin and MacLean (2005) used complexity theory, seen as a sympathetic companion to psychodynamic theory, in their study of organisational failurewhereanxietywasfoundtooperateasapowerful,negativeattractorsubverting values, structures, goals, and so on. Cooper et al (2004), also drawing on complexity theory, urge caution about our understanding of multi-agency and inter-professional training and education, and propose that its advocates tend to base their arguments on a spurious ‘common sense’ and a linear approach. Systemic psychotherapy reminds us consistently of competition between sub-systems. Non-specialist police officers working in child protection could be seen as inexperienced ‘novices’, working with the experienced child protection system where knowledge and expertise is located. Serious students of Bronfenbrenner’s eco-systemic framework will note that the critical system is the link between systems, the meso-system, which lays bare the tendency of disharmony between systems, the embeddedness of the organisational culture, and the variable and often impenetrable boundaries between practice settings (Bronfenbrenner 1979). Discussion The nature of risk assessment frameworks and the operation of the child protection system in an environment of uncertainty and anxiety, which can be understood with MULTI-AGENCY CHILD PROTECTION: CAN RISK ASSESSMENT FRAMEWORKS BE HELPFUL? 43 reference to complexity theory, has offered the opportunity to review some of the key aspects of this area of practice. We now turn back to consider the demands upon and needs of the non-specialist frontline police officer called to make immediate and urgent decisions in relation to child protection. What do the above debates and reviews offer the development of a framework to assist, inform and support appropriate decisionmaking where immediate protection or later referral may be required? Although not recent, two publications echo the system challenges outlined above and highlight the potential challenges for non-specialist practitioners, required making major, specialist decisions. Waterhouse and Carnie (1991) identified serious difficulties such as differing values, knowledge and competiveness between practitioners, including the police, in inter-agency working. Drury-Hudson (1999) highlighted the challenges for novice/ inexperienced practitioners in understanding and making sense of child abuse and protection. Both studies recommended more training. Can a risk assessment framework be constructed, noting the strengths and difficulties of the actuarial and consensus debate, taking account of the challenges identified and the potential for positive multiagency, inter-professional working? We reviewed the possibilities as follows: Figure 1: Challenges and strengths of actuarial, consensus and inter agency approaches to risk assessment Approach Challenges of Approach Strengths of Approach Risk/actuarial Does not take account of non-linearity of context and intervention. Time and burden of completion can be unrealistic in urgent situations. Offerslongertermpredictions as opposed to immediate prediction of risk Challenge for non-specialist practitioners to use. Possible to enumerate and cluster key risk indicators. Serve to immediate prompt to memory and may be absorbed over the longer term. May have longer term statistical use in terms of developing risk profiles of groups with particular characteristics/ histories. Consensus A prompt to guide the officer’s best thinking and response, but lack of time and initially officer inexperience could undermine use A prompt to guide the officer’s thinking, helped by the time available in the situation and the officer’s previous experience Inter-agency, inter-professional Well documented challenges to inter-agency and interprofessional working, which can be aggravated by inexperience, time and changes in staffing within the inter-agency system. Well established referral system and joint working procedures, which can be triggered by the risk assessment framework under development Risk assessment framework may serve as concrete attractor around which key members of the inter-agency child protection system collaborate, train and work together DR JULIA STROUD AND CHRIS WARREN-ADAMSON 44 Notwithstanding the challenges, we have begun to develop a framework which draws on the following: 1. The need for guidance notes which helps officers to establish whether or not a child or children are immediately safe. 2. Asetofevidencebasedcriteriawhichenablesuitablesignpoststochildprotection procedures to be instigated by a more senior police officer. 3. A systematic piloting of the instrument with officers reporting back on its use to the inter-agency, inter-professional child protection system, to support the framework’s further collaborative development and refinement. The development of the framework is being informed by a range of evidence from cohort studies (for example, Lee et al 2008); examination of records (for example, Kahn and Schwalbe 2010) and reviews of literature (for example, Levinson and Morin 2006). We are drawing also on two particular sources of evidence. Firstly, the actuarially based Michigan Family Risk Assessment of Abuse and Neglect (Baird et al 1995;BairdandWagner2000),whichusestwoseparatesetsofriskfactors,developed from significant U.S. child abuse and neglect data sets which are, therefore, evaluated as significant predictors of neglect and abuse. Secondly, we are being informed by the work of Brandon et al. (2010; 2011) and Sidebottom (2010) and their studies of serious case reviews. A strength of the studies of Brandon et al. and Sidebottom rests not only in the categorisation of abusive criteria, but also in the identification of organisational and contextual factors. Thenextstageinthedevelopmentoftheframeworkistopilottheinstrumentusing two types of focus groups. The first will take place with police officers who will have used the framework. The second brings together the police officers with members of the wider multi-agency child protection system, to explore and examine its use and usefulness further. It will be important to test validity, usefulness in decision making in urgent and immediate situations, the ownership of the framework by non-specialist practitioners and by the wider multi agency child protection system. Being alert to the potential for differing views on the usefulness of risk assessment frameworks, and to differing degrees of expertise in relation to child protection, we are interested to appraise whether the framework and its collaborative development, can, in the language of complexity theory, serve as an attractor to promote and assist positive joint working within the multi-agency child protection system. Warren-Adamson (2009b) proposed a further stage in the collaborative multiagency process, which is to set up a collaborative enquiry group. Collaborative or co-operative enquiry groups have growing support (Heron and Reason 2001; Murphy 2004) and involve practitioner groups, with suitable leadership, engaged in self-directed learning over time. As well as process outcomes, growing trust and professional support, such groups can engender synergistic outcomes, that is, unexpected learning. The more dispersed the professional group, which can be a MULTI-AGENCY CHILD PROTECTION: CAN RISK ASSESSMENT FRAMEWORKS BE HELPFUL? 45 characteristic of the multi-agency child protection system, the more challenging it can be to sustain meeting structures. It is proposed that on-going review of the risk assessment framework would add focus to the impetus, meeting and negotiating process of the collaborative enquiry group. Returning to Munro, we have been encouraged by action by The Association of Chief Police Officers (ACPO) which has grappled hard with the issue of risk. ACPO have produced a list of organisational risk principles which have been adapted by the Munro Review (2011; 16) to embrace all those who are engaged in the work of child protection. Such principles amount to a telling, enabling framework for our front-line police officers. These principles can be summarised as follows: 1. The willingness to make decisions in conditions of uncertainty (risk taking); 2. Maintaining or achieving the safety, security and wellbeing of individuals and communities is a primary consideration in risk decision making; 3. Risk taking involves judgment and balance; 4. Harm can never be totally prevented; 5. If the decision is shared, then the risk is shared too and the risk of error reduced; 6. Risk decisions should be consistent with those that would have been made in the same circumstances by professionals of similar specialism or experience; 7. Whether to record a decision is a risk decision in itself; 8. Child protection needs a culture that learns from successes as well as failures. Good risk taking should be identified, celebrated and shared in a regular review of significant events; 9. Those working in child protection should work with partner agencies and others to share relevant information; 10. Those working in child protection ... should receive the encouragement, approval and support of their organisation. Such principles should be an addendum or footnote to the risk assessment framework we are developing, highlighting the spirit of the framework’s composition; that is, to offer a brief set of signifiers about risk, prompts about action, to be shared in a multi-agency, inter-professional protective system. Conclusion A request to design a risk assessment framework for frontline police officers has led to an exploration of the relative merits of actuarial and consensus based risk assessment instruments or tools and to an acknowledgement of the need for an amalgam of some of the strengths of both in a risk assessment framework to support DR JULIA STROUD AND CHRIS WARREN-ADAMSON 46 and inform decision making by non-specialists in child protection. At the same time, it is important that such a framework is owned and piloted by the front line police officers for whom it has been developed and also by practitioners from the wider child protection system. Joint ownership of such a framework may overcome some actual, imagined and symbolic features of non-cooperation. Our review of child protection practice and multi-agency child protection systems leads us to recognise the place of complexity theory and the importance of uncertainty and anxiety in understanding the nature and challenges of such systems and the need for a sophisticated strategy in operating amongst them. Challenges and complexity notwithstanding, we conclude that a consensus based framework, tested with rigour and shared and tested with multi-agency, inter-professional colleagues can be helpful in informing front-line, non-specialist police officers’ decision making and knowledge, and would support the working of the multi- agency child protection system. 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