Hidden dangers.

Greg Williams has 25 years’ experience as a social work
manager. For 12 years he has been principal officer for strategic
child protection arrangements in Staffordshire, including
co-ordinating the work of the area child protection committee. He
chairs the West Midlands Regional Safeguarding Children
Network.   

The old order changes, and area child protection committees are
beckoned towards new horizons in the Children Bill. But any
enthusiasm for change in children’s services should be tempered by
a recognition of past achievements. Lord Laming graphically exposed
deficits in organisational systems in the Victoria Climbie inquiry,
but he may also have inadvertently conferred a disproportionate
share of blame on area child protection committees (ACPCs).

Few would deny the benefits that a statutorily reinforced mandate
will bring to local child welfare networks. But before local
safeguarding children’s boards (the successors to ACPCs) throw the
baby out with the bathwater, they would do well to remind
themselves of ACPCs’ positive influences upon modern
practice.

Staffordshire ACPC is one of many that can readily identify modest
achievements. One of those achievements, not least in terms of
deploying staff time, is the priority it gives to conducting
serious case reviews. There is a paradox in placing cases that have
arguably gone wrong upon a pedestal of achievement, but closer
inspection reveals much more telling messages about better-informed
practice in safeguarding children’s welfare.

Like Victoria Climbie herself, children and families who
exceptionally experience tragic episodes are not necessarily those
who have attracted concerns shared routinely on an inter-agency
basis. They are not children for whom episodes of serious harm have
been necessarily regarded as predictable, save for the chilling
wisdom of hindsight (1).

The 1991 edition of  Working Together introduced the Part 8 review
into the vocabulary of child welfare organisations. The 1999
edition of Working Together to Safeguard Children appreciably
expanded the criteria in serious case reviews.

Between 1993 and 2003, Staffordshire ACPC carried out 30 Part 8
reviews. These took account of the deaths of 23 children, including
two sibling groups of three, and of life-threatening injuries to 14
others.

The main purpose of the reviews is to examine how agencies worked
together and to identify lessons about operational practice.
Detailed analysis often reveals previously unknown features of a
family’s circumstances.

Some themes, such as shortfalls in information-sharing and certain
pre-disposing risk factors, inevitably recur. Where domestic
violence and substance misuse co-exist, the risk to vulnerable
children becomes acute.

These factors only become evident under the searching scrutiny of a
case review. Only three of the 37 children had their names on the
child protection register at the time of the critical episode that
triggered the review.

But less prominent trends were also part of Staffordshire’s
experience. Thirteen of the 23 children who died were under three
months old and so were clearly not cases in which a pattern of
maltreatment had emerged over time. As a consequence these cases
led to more effective collaboration between local antenatal
services, with hospital-based social work services being seen as a
key player within local antenatal arrangements.

Concealment of pregnancy also featured prominently, prompting a
harmonisation of collaboration between a range of professional
disciplines.

If concealment represents one aspect of risk during pregnancy, the
advent of a multiple birth may be another. Four of the reviews
featured multiple births, well above the incidence of 15 per 10,000
live births nationally. Factors associated with multiple birth –
premature birth, neonatal complications and consequent difficulties
in bonding – generally coincide with episodes of maltreatment
rather than any expressed increase in stress from having to meet
the demands of more than one infant (2).

There are compelling messages here about vulnerable children and
their families needing timely access to help and support.
Pre-disposing stress remains an enduring trigger to those
spontaneous episodes in which young children sustain serious
harm.

A feature of the cases in question were serious head injuries
sustained by very young children, often accompanied by consistent
denials by those believed responsible. While the medical profession
remains divided on the aetiology of shaken baby syndrome,
Staffordshire ACPC is clear about the prospects of an inconsolably
crying child suffering the traumatic effects of a serious shaking
injury. It has sought to increase awareness among clinicians about
aspects of diagnosis, including the association of hypothermia with
serious brain injury in young children.

As this ACPCembarks upon its 31st serious case review, it remains
confident about the priority it gives to this aspect of its work.
It is not just a matter of reflecting upon how things might have
been. By revealing the harsh realities of child maltreatment,
serious case reviews can help identify more creative ways to
support vulnerable children, their families and professional staff
in facing these challenges. There is much still to be done.
Preparing care leavers for the challenges of parenthood may be a
typical example of a legitimate target that is yet to be fully
realised.

But the prospects are good. Let us hope that some of the ACPCs’
past achievements might be fulfilled in the new order.

PRE-DISPOSING RISK FACTORS:

• Domestic violence identified in 60 per cent of cases
  reviewed.
• Adult mental health problems identified in 40 per cent of
  cases.
• Strong correlation between adult mental health problems and
  substance addiction.

CRITERIA FOR SERIOUS CASE REVIEW:

• Child death (including suicide) when abuse is a known or
  suspected factor.
• Child suffering potentially life-threatening injury through
  abuse or neglect.
• Serious sexual abuse or sustained serious and permanent
  impairment of health or development.
• Particular emphasis where circumstances give rise to concerns
  about ways in which agencies have worked together.
• Particular consideration given to children suffering harm
  arising from specific organisational contexts.

OTHER CHARACTERISTICS:

• Six children died on day of their birth.
• Seven other children died before the age of three months.
• Significant number of parents were looked after as
  children.
• Four cases involved multiple births. 

ABSTRACT:

This overview of 30 serious case reviews in Staffordshire
provides an insight into some of the challenges facing
professionals in child protection. There are familiar trends, such
as domestic violence, and recurring case examples of serious head
injuries in young infants, but also less obvious factors, such as
multiple births, which warrant closer inspection of how effectively
agencies work together.

REFERENCES:

(1) R Sinclair, R Bullock, Learning from Past Experience: A
Review of Serious Case Reviews, Department of Health, 2002 .

(2)  J C Becker and colleagues, “Shaken Baby Syndrome: Report on
Four Sets of Twins,” Child Abuse and Neglect, Vol 22, No 9,
1998.

CONTACT THE AUTHOR:

e-mail: greg.williams@ staffordshire.gov.uk