‘This is social work with knobs on’: the realities of supporting disabled children

“Sometimes it feels like we’re working with a different client group now,” says Libby Welsh, reflecting on the changing issues facing her social workers in the 14 years they have been delivering short-break fostering placements for disabled children.

“Life has just become, well…”, she pauses while trying to explain how advances in medicine and technology have revolutionised support for children with severe physical and learning disabilities, “…at one level we’re working with children who would not have survived birth five years ago.”

Since 1999, Welsh – an experienced social worker – has been seconded to the charity Quarriers by Dumfries and Galloway Council, the first local authority you reach when travelling north over the Scottish border. She was tasked with leading Quarriers’ region-wide family support service, which is commissioned by the local authority to deliver certain statutory fostering social work duties.

Welsh’s social workers – who are employed directly by Quarriers – work with disabled children from birth until the age of 18. The core of their work is assessing, training and managing foster carers who can provide family-based short-breaks for the children. They also work directly with the child and their family to build up relationships that can help them “make the right fostering match”, Welsh says.

Another branch of the Quarriers team provides support for families who social services have identified as having additional needs. The social workers also help run a project supporting the fathers and male carers of disabled children.

The fathers project came about thanks to two male social workers realising that many men felt marginalised from the care of their disabled children, Welsh says.

“Those social workers were recognising things in the dads that just didn’t hit my radar at all. They were able to engage at a completely different level,” says Welsh.

“For many of the dads, this group was the first chance they’d had to meet with other guys who recognised the difficulties of caring for a child with a significant disability. I think we all – social work, health and education professionals – have some things to learn about how we could change our approach to working with men.”
 
So what is life like as a fostering social worker in the field of children with disabilities? Welsh stresses that her team can face cases where a range of issues – drug and alcohol misuse, domestic violence, high levels of mental distress, family breakdown – are present alongside learning disabilities.

“There is a perception among mainstream social workers that if you’re working with a disabled child and their family that it is ‘nice work’,” she says.

“Actually it’s social work with knobs on. You only have to find a children and families social worker faced with these kind of cases and often they’ll want to pass it on because they don’t know how to start unpicking the complexities of that family.”

Barbara Aitken, a social worker and team manager for children with disabilities at Dumfries and Galloway council, agrees.

Aitken’s social workers are the initial port of call for referrals from GPs, education, health, other agencies and parents themselves. After conducting initial assessments, they often refer cases into the Quarriers short-break fostering service.

“From the outside, people can think this is just ‘a nice wee job’ but we’ve had examples in the past where social workers have struggled,” says Aitken, who previously worked as a senior social worker in a children and families team.

“Cases that I consider to be the most complex – and there are not a huge number of them – but those cases, where you have parents with their own particular issues, on top of the issues that present with a child with a complex learning disability or life threatening condition…,” she pauses,“…well, it just makes the whole thing challenging on a whole different level and all the emotional stuff that goes along with that.”

The workload of Aitken’s team has increased in recent years. Her social workers now routinely handle caseloads from the “high 40s to around 55”, she says.

Two key factors driving the growing demand are the “huge increase” in the number of children diagnosed as having autism spectrum disorder, and the fact that many children with disabilities are living longer thanks to technological and medical advances, says Aitken.

The growth in autism diagnoses has been a challenge for Welsh’s team at Quarriers too. She now estimates that around 75% of the children her service supports are on the autism spectrum. There is ongoing debate locally and nationally regarding the reasons behind the rising diagnosis rates, she says.

“Has the prevalence of autism increased? Has the complexity of autism increased? Are professionals getting better at diagnosing it? Or is another factor involved? The jury is probably still out. But there is no doubt that those issues are commanding more and more resource locally,” says Welsh.
“We’re getting to grips with it. But sometimes it can feel like you still have your L plates on.”

The signs are that the Quarriers team have adapted well. The service was commended by members of the Scottish parliament and Quarriers’ fostering work was awarded top marks following a recent inspection from The Care Inspectorate – Scotland’s equivalent of the Care Quality Commission.

Aitken says that the early intervention work of the Quarriers social workers has also helped contribute to the “huge reduction” seen locally in the number of children with disabilities who have been sent to out-of-area placements because local schools and social services can’t meet their needs. 

Being able to help children with disabilities remain in their family settings is one of the best parts of this area of social work, says Aitken.

“Sometimes I felt in children and families that a lot of the work, just by the nature of it, was with children basically on the brink of being removed from their families, where there can be huge issues present,” she says.

“Whereas, we actually support a lot of families to continue caring for their child at home and all the benefits that come with that for long periods of time. So there can be very nice positive outcomes in this part of work that you don’t often get in some other areas of social work.”