Guidance, at last

Every year, about 840 couples in the UK learn that their baby is
deaf. Many parents with no previous exposure to deafness
instinctively fear the implications for their child. However, with
early intervention by skilled professionals, the effects of
deafness on the child and family can be minimised.

The recently published guidance, Deaf Children: Positive
Practice Standards in Social Services provides the first
comprehensive guidance for social workers in contact with deaf
children, and serves to clarify the social services role in its
legal context. These new standards have been produced through a
partnership of voluntary and statutory organisations led by the
Royal National Institute for Deaf People, the National Deaf
Children’s Society and the Association of Directors of Social
Services. The guidance was formally backed by the Department of
Health. Health minister Jacqui Smith says: “It is very clear that
having social services staff and the voluntary sector working
together has resulted in standards that are high quality, that
aspire to the sorts of standards we want to see for deaf children,
but are also realistic and deliverable.” Her views are echoed by
Denise Platt, the chief social services inspector, who says: “This
substantial document should help achieve the government’s ambitions
for all disabled children: to develop to their full potential and
participate fully in society.”

In the UK between one and two children in every 1,000 are born
with a permanent significant hearing loss and a further one in
1,000 will become deaf in childhood due to disease. One-third of
all deaf children will have other physical disabilities and
learning difficulties. Ninety per cent are born to hearing parents
who were previously unaware of deafness, its implications and the
many choices they face concerning their child’s specific
development needs. Serious and often emotive decisions have to be
made, such as the use of hearing aids for very small children,
cochlear implants, whether to use sign language, as well as the
communication options for the wider family. These require the
support of a large network of different professionals, including
audiologists, health visitors, teachers of the deaf, speech and
language therapists, and social workers.

The main role of social care workers in the equation is to
assess the needs of the child and family and help them to access
identified services, such as financial support to fund deaf
awareness and sign language classes, or to provide assistive
equipment for the growing child. They are also well equipped to
counsel the family to cope with the news of having a deaf child.
Deaf children are defined as children in need under the Children
Act 1989 and involvement from social services is therefore a
statutory role undertaken to minimise the effects of disability.
The practice and resource issues which arise tend to be complex,
not least because of the legal duties of councils with social
services responsibilities and the variations in service structures
across the UK. But until now there have been no defined guidelines
in place to prevent parents receiving conflicting advice or an
inconsistent level of service provision.

So the new guidance is a significant development because it
specifies for the first time practice guidelines for social workers
who deal with deaf children and their families. They are also the
first quality standards in the UK for social services and disabled
children.

Importantly, they represent a consensus between leading
voluntary and statutory organisations, jointly chaired by RNID,
NDCS and ADSS. Other groups, including the British Deaf
Association, made valuable contributions.

The new standards are timely on two counts. First, as a support
to the pilot newborn hearing screening programme (NHSP), which is
about to be implemented in 20 sites in the UK. The phased roll-out
of NHSP enables a baby’s hearing to be screened 48 hours after
birth, rather than at about eight months using the unreliable
“distraction test”. One consequence of this is that services will
have to ensure that a support network for the child and family is
in place at a much earlier stage, including access to communication
and language development services.

Second, the standards fit well with the government’s focus on
prevention and improved measurable outcomes for children in need
through Quality Protects, the forthcoming children’s national
service framework, and the general quest for more effective joint
working between statutory agencies for very young children.

The guidelines are based on the quality model advocated by the
National Care Standards Commission and the DoH. This means that
they provide measurable objectives, with clear guidance on how the
objectives may be achieved and performance evaluated.

The standards make transparent what deaf children and their
parents can expect from social services and their partner agencies,
in terms of accessible information, clarity about the choices
concerning communication and sound amplification and support
provided at critical stages. A parents’ checklist enables families
to appraise the services they receive and to feel better informed
and so be able to exert pressure in order to improve services, if
that is needed. Such levers should not be underestimated.

Apart from providing assistance for social workers and parents,
the Deaf Children guidelines will have wider significance.
Commissioners of services will find them helpful when they specify
a quality service for deaf children, and front-line workers can use
them as a resource when they are in touch with the family of a deaf
child. They will also serve as a backcloth to inspections
undertaken by the Social Services Inspectorate, the National Care
Standards Commission, and the Audit Commission.

Finally, they can be used in training courses for social workers
and other social care staff because they provide a model for
quality standards for social services relating to disabled
children.

The ADSS has fully endorsed the recommendations and is committed
to communicating their importance. To be truly effective, however,
implementation will require more than general acceptance.
Individual departments may need to review their services in
response to the standards, adapt their working practices, retrain
existing staff and make different commissioning decisions. Not all
of these changes will be particularly costly, but instead a
“smarter” approach and use of existing resources within the wider
local area may be all that is required.

Recommendations

The standards guidelines include the following:

• Social services should ensure that parents and carers of deaf
  children obtain impartial and comprehensive information on deafness
  and the communication and education choices for their child – it is
  not the role of social services necessarily to provide this
  directly, but to work with others to make sure that it happens
  without fail.
• Workers supporting and assessing deaf children should have a
  high level of communication skills and deaf awareness.
• Qualified specialist social workers for deaf people need to be
  involved in assessing deaf children, especially in the
  investigation of any potential abuse.
• Social services should try to provide deaf adult role models to
  support the development of communication and language for the deaf
  child and their family.
• Expertise in the implications of deafness is scarce and
  therefore it needs to be shared – both within the organisation and
  with neighbouring statutory and voluntary organisations.
• There needs to be better joined-up work within social services
  departments between child care specialists and other specialist
  workers.
• Commissioners should think about the different mechanisms for
  providing a quality service. For example, spot purchasing,
  contracting out, lead commissioning, pooling resources and so
  on.
• Economies of scale will result from a regional approach to the
  provision of services for deaf children.