Violent young people: research and best practice

THE RESEARCH

Title:Children Who Commit Acts of Serious Interpersonal Violence: Messages for Best practice , ISBN 1-84310-384-2,  published in 2006 by Jessica Kingsley

Book editors: Ann Hagel, Programme Director for Adolescent Mental Health at The Nuffield Foundation and Renuka Jeyarajah-Dent, Executive Director of NCH - The Bridge Child Care Development Service.

Book synopsis: The book provides a literature review of what is known about these young people, the similarities of their presentation in different countries and, crucially, what we know about available interventions and their effectiveness. The empirical material is drawn from different samples in Germany, Greece, The Netherlands as well as the UK. The authors aim here to bring together two literatures - the large, well developed body of research on intervention strategies for children that are antisocial and the research and writing on the day to day management of such children.

OBJECTIVES 

We are sadly familiar with headlines about the latest victims of guns and knives whose stories put in the public domain the issues with which practitioners, policymakers and, of course, parents, grapple day by day. The purpose of this collection is to:

● highlight the plight of, and extent of the problem posed by, potentially dangerous children who fall between agencies and are difficult to place
● outline current strategies for dealing with them
● encourage agencies and policymakers to think creatively about how best to intervene and support good practice
● raise the quality of discussion over issues of managing risk and public protection while at the same time actively managing care and providing successful intervention.

It is important to be clear which children are the focus of this evidence base. The authors define their target group as follows:

● looked-after children who have been seriously physically violent towards their families, carers or other children, but who are not being prosecuted or dealt with by the criminal justice agencies
● looked-after children who are suspected of (or unprosecuted for) serious sexual abuse of others
● children who have committed homicide (murder or manslaughter) but are being placed outside prison accommodation in local authority secure accommodation or secure psychiatric wards, or have been released from custody

● other cases where there is concern that the child has potential to be dangerous, either sexually or through violence.

The most recent, authoritative review of youth crime in the UK is probably still Antisocial Behaviour in Young People by Rutter, Giller and Hagel published in 1998, the same year that Ann Hagel produced her own book, Dangerous Care. This 2006 book focuses on a small subset of the very large number of young people who get into trouble of one sort or another.

FINDINGS

It is difficult if not impossible to put an exact figure on how big this subset is. But there is general agreement that as a proportion of the child care population in general and of the looked-after population in particular, those with the potential to commit serious acts of interpersonal violence fortunately constitute a very small group. But their needs are wide-ranging and not amenable to quick, single-agency interventions. And because the interventions are multiple and need to be provided for some time, they are expensive. So, strategically they will continue to challenge repeated attempts to transfer more resources into early years provision for the many.

In the second part of the book, Hagel outlines the key characteristics of successful programmes to change behaviour. These are:

● they are based on a clear theoretical model of how they are intended to change behaviour
● there is a clear focus for all activity involved in the programme, i.e. the different elements contribute to a larger whole which is capable of being measured
● they should last a reasonable length of time - six months as a minimum
● there is a reasonable level of programme intensity - at least twice a week contact time with the young person
● there is an emphasis on rewarding positive behaviour
● there is recognition of the need to provide aftercare after the programme ends.

Hagel then goes on to look at specific intervention approaches - child and parent-focused programmes, multimodal programmes, multisystemic treatment, multidimensional treatment foster care and residential/institutional treatments. Under the first heading she uses the findings of Farrington and Walsh's 2001 article, "What works in preventing crime", that found four types of effective programmes - home visitation, parent education plus daycare/preschool, school-based training plus parenting training and multi-systemic therapy. But these interventions presupposed that the child at risk was within reach of the family.

Under multimodal programmes is cited the example of schemes for those who have sexually abused others. The package might include specific group therapy in relation to the sexual offending plus social skills, anger management, sex education, correction of cognitive distortions and work on understanding the point of view of victims. Multimodal approaches are designed around the individual young person.

In contrast, multisystemic treatment, as its name implies, targets the "systems" surrounding the young person - individual, family, social and cultural factors. It is these contextual factors that have reinforced the problematic behaviour so they need to be addressed if the young person is to have a better chance of moving on from patterns of violence and abuse. Multidimensional foster care recruits, trains and supports community families to work with young people on the programme. There is an emphasis on close supervision, clear setting of boundaries and positive reinforcement of good behaviour. There seems to be more than an echo here of what Nancy Hazel introduced to the UK back in the 1970s.

There then follows a section on day-to-day management. However good the intervention or specific programme that is delivered, it will not work on a child living in an unstable or chaotic environment - be that environment one that is provided by the family or the state. This is where these children pose the most serious challenges for their families and social care staff.

Providing the stability that these children need is no easy task and the authors are very aware that research offers few answers other than to point out that some family and residential environments can be extremely damaging in their own right. And they point to the evidence about the downside of secure accommodation - the risk of abuse from or the risk of abusing others, the distance from friends and family, the risk of learning new bad behaviour through contamination.

In relation to caring for young people who are sexually abusive use is made of Farmer & Pollock's work. They recommend that:

● caregivers should be given full information about children's backgrounds in order to make decisions about the suitability of a placement and plan to keep a child safe
● greater use of foster care placements where there are no other children or only much older children and use of single foster mothers or same-sex residential placements
● greater assistance for foster carers in planning high levels of supervision
● development of practice for residential care workers to provide higher levels of supervision of young people's activities when outside the home
● providing a more effective means for children in placement to communicate concerns about being bullied or harassed sexually.

CONCLUSIONS

When policy and practice in relation to this target group is compared - see Chapter 9 in particular which concentrates on Germany, Greece and England and Wales - there is a great deal of common ground.

The characteristics of the children, the ordering of the risk factors that make them so difficult to manage or place, the range of options that have been tried and ideas about what would be best for them all demonstrate many similarities.

Nevertheless, despite those common features, the impact of different cultural factors is clearly evident. For example, in Greece 70% of these children had been retained within their families compared with 10% in England and 28% in Germany. Foster care was particularly rare in Greece, more common in Germany and most common in England. Residential care was a more frequent feature in both Germany and England. These differences challenge any easy assumptions about the rightness of the systems in which we work.

The overall tone of this book is one of cautious optimism. We have moved on some way from the pessimism of the 1970s and 1980s when it was believed that "nothing works". Research does not know all the answers but has identified some of them. Reference was made earlier to the depressing, and sometimes misleading, headlines about youth crime. We are familiar in the UK with the repeated litanies about the failures of the care system and it is easy to give in to helplessness. This book is a reminder that we can and must make a difference.

In previous years I have had responsibility for making decisions about admissions to secure accommodation, chairing reviews and ensuring that the care plans for these young people go some way to reflecting the enormity of their needs. The physical, financial and emotional costs are high but we have evidence that can inform and change our practice for the benefit of this group.

Early intervention
Abusive, neglectful families harm children. Identify as quickly as possible those families who lack the capacity to relate to the child with warmth and overload him or her with criticism. Involve other agencies if problems cannot be sorted.

Education and health
Ensure that every child receives a good enough education that promotes learning through teaching and nurturing relationships that help make up for some of the deficits at home. Remind health, education and social services that even if there is no agreed diagnosis, working together is still vital. Shared assessment should be the basis for any intervention.

For children considered dangerous to be at home

Services should:

● continue to provide good education and health care
● provide qualified staff to oversee any treatment programme
● provide opportunities for staff to talk with those not caught up in the day to day management of the young person
● provide a framework that treats the young person primarily as an individual not as label to be managed
● have an inspection regime that is rigorous but that also has some appreciation of the difficulties of the task
● maintain and support a stable workforce
● listen and talk to the child
● being sensitive to possible hidden mental health needs
● respect and reward staff. Recognise the cost of what they do.

Resources

● Rutter M, Giller H & Hagell A (eds), 1998, Antisocial Behaviour by Young People, CUP.
● Hagell, A, 1998, Dangerous Care, Policy Studies Institute.
● Farrington D & Welsh B, 2001, "What works in preventing crime: systematic reviews of experimental and quasi-experimental research," Annals of the American Academy of Politics and Social Science, 578, special edition.
● Hazel N, 1981, A Bridge to Independence, Blackwell - a report on Kent's special family placement project.
● Farmer E & Pollock S, 1998, Substitute Care for Sexually Abused and Abusing Children, Wiley.

John Randall is a post-adoption social worker with Families for Children, a voluntary adoption agency. He writes monthly reviews of newly published research articles for the Research in Practice Research and Policy Update

Research in Practice is the largest children and families research implementation project in England and Wales. It is a department of the Dartington Hall Trust run in collaboration with the Association of Directors of Children's Services, the University of Sheffield and a network of over 100 participating agencies.

This article appeared in the 12 July issue under the headline "Violent children"