Managing risk in child protection

GPs

Dr Helena McKeown, chair of the British Medical Association’s community care committee, says GPs are happy to carry greater risk but they remain hampered by the shifting structures of the NHS.

"In a traditional primary care team you have GPs and health visitors all in one place, talking to each other usually on a daily basis, and risk assessment isn’t such a problem," says McKeown, a GP herself.

"We used to have ‘soft concern’ meetings. Often these concerns wouldn’t be serious by themselves but, with the groups communicating them to each other, we were able to build up a whole picture that could sound the alarm bells."

She says funding and a drop in the number of health visitors and child social workers makes it more difficult to bring everyone under the same roof to share information about concerns. The way forward may be through greater use of technology, such as Skype, for meetings.

CAF and early intervention

In Bromley, south London, a multi-disciplinary common assessment framework team headed by a social care manager has been asked to take on all cases that do not need a social care assessment.

Kamini Rambellas, the council’s assistant director of safeguarding and social care, says: "In those cases where children-in-need don’t necessarily need to be looked after or are not meeting thresholds for social care intervention we are asking the CAF team to ‘step up’ and ‘step down’ when appropriate."

However, Stevenson points out that relegating borderline neglect cases to professionals who are not social workers should be done with care. "The workers involved at the early stage so often aren’t social workers," she says. "They’re full of goodwill and want to be helpful, but somewhere along the line there’s a hard-nosed decision to be made about whether parents can do what needs to be done within the timescale that the child needs it to be done. It’s no good if they learn by the time the child is 16."

Police

The police have gone further than most in risk management. After the Baby P case, the Metropolitan Police reconsidered its role in child protection and developed the child risk assessment matrix (Cram) – see below.

"We have tested Cram against high-profile failures such as Baby P and Victoria Climbié. If Cram had been fully used it would have picked up both of them," says Det Chief Insp Dick Henson of the Child Abuse Investigation Command.

Cram breaks down children’s situations into the categories of "victim", "suspect" and "household". Within each category officers must record how much they know for a series of risk factor questions. The aim is to quantify concerns and ensure areas of risk to the safety of the child do not go unnoticed.

"What this matrix doesn’t do is ‘high, medium and low risk’ because we don’t believe they are valid in child protection – each child is unique and the risk can change in a case from day-to-day," says Henson.

"Once the risks are quantified, we look at each one and consider our four options: reduce it, avoid it, remove it or accept it. We record our rationale for each decision which means the effectiveness of our interventions and investigations can be reviewed."

Although this system only applies to those police already involved in child protection, councils often claim it is local police stations that cause problems by sending through too many referrals that fail to meet thresholds, particularly in domestic violence cases.

However, Henson believes such criticism is unfair and councils look at the problem in the wrong way. All councils should consider following the lead of Haringey, which has put in place multi-agency risk assessment teams which filter all referrals to children’s services, he says. The teams, comprising health, police and social workers, have access to their own IT systems so it is easy to collect the information held on a case allowing a better risk assessment.

Maintaining thresholds

In neglect cases, Stevenson believes courts and politicians need to take note of current research which shows neglect can have long-standing and irreversible consequences on the development of a child.

"The problem that social workers face is that, when things get bad, they go through the care proceeding correctly and then the judge says we should give this mother another chance. It’s discouraging for social workers to be told it isn’t time to take action."

David Carson, reader in law and behavioural sciences at the University of Portsmouth, says councils, social services directors and other agencies ought to sign up to a document that accepts the principles of risk-taking. It judges professionals on the quality of their decision-making rather than the outcomes. "Professional risk-taking ought to be the acme of social work and practice, but everywhere it is associated with blame, fear and aversion. With less fear of inappropriate criticism, better decisions can be expected," he says.

Children’s minister Tim Loughton says he believes the UK system is too risk-averse compared with countries such as Denmark.

He insists that any change requires politicians to resist the temptation to engage in knee-jerk reactions and accept some risk themselves.

See article on thresholds in child protection