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Parental perspectives in cases of suspected child abuse
242
Book Reviews
Briggs includes the excellent concept that wheelchairs, crutches, frames, and sticks are part of the disabled child's image (part, therefore of their body) and must be seen as such. This is important, as I have known these things withdrawn as punishments, and this practice should be perceived as assault. The module on private body parts includes the mouth as a private part. I find this extremely useful as it will address the issue of "oral" abuse. This is an important part of a disabled child's body, particularly if they are fed by another or have tube feeding. It must therefore be part of any program dealing with touch. I would have valued more on the very sensitive issues of personal intimate care. Disabled children often need extensive touch as part of medical/hygienic care (rectal Valium, colostomies, body braces, physiotherapy, injections, callipers, toiletting, etc.). Staff should have very strict guidelines on such procedures and disabled children must be part of choice/decision making when procedures impact intimately on them. It should never seem "routine." This book is valuable for all teachers, care staff, and child protection practitioners. It should be available within all training on child protection. It is almost shameful the neglect disabled children have experienced by child protection specialists. If there are parts of this book that needs further work at least it cannot be said of Freda Briggs that she ignored disabled children.
MARGARET KENNEDY
Disability & Child Protection Training and Consultancy 5 Albion Works Sigdon Road London E8 lAP, UK
PII S0145-2134(96)00149-4
Parental Perspectives in Cases of Suspected Child Abuse. Hendy Cleaver and Pam Freeman. HMSO, London, 1995. 178 pages. It was an unusual experience to review a new book when a number of responses have already appeared in the public domain. This arose through the political aspect of this work, being part of a research series sponsored by the Department of Health in the wake of the 1988 Cleveland Inquiry into overzealous professional interventions following suspicions of child sexual abuse. Many of the projects were conducted by members of the University of Bristol's Dartington Social Research Unit and are either currently available in similar reports to this one, or else are in press. The Department of Health has also published a summary of the main findings from the 20 studies (Child Protection; Messages from Research, London, HMSO, 1995) and concluded from them that, since too much social work activity appears to be devoted to investigation and too little to family support, a shift in policy is required. Recently, Nigel Parton has argued that the research program has not properly represented the complexities of child protection work ( "Child protection, family support and social work," Child and Family Social Work, 1996, 1, 3-11 ). This project was concerned with the developing impact on parents of suspicion and investigation and the meaning they attribute to such scrutiny. Five hundred and eighty three children's cases were followed up for 2 years after the initial investigation, while a representative sample of 61 children's cases in 30 families was focused on in a more intensive study. As a result, a useful picture emerges of the spectrum of child abuse investigations undertaken by social workers and how many cases represented significant risk. Of the 583 children's cases referred, 84% were deemed to warrant investigation, but the names of only 29% were eventually placed on Child Protection Registers (implying that a protection plan was necessary). Fewer than 10 cases were considered dangerous. Over the follow-up period, 16 of the 61 children were reliably believed to have experienced re-abuse of some degree. The rest, however, was disappointing and did not justify the policy changes it heralded. The researchers propose that "operational perspectives" are a collection of socially oriented perceptions that people use to make sense of their lives, including helping them cope with abuse accusations. They are influenced by past experience, current interaction, motivation, power relationships, context, and so on. The main hypothesis was that the closer the operational perspectives between parents and professionals, the more satisfactory the outcome is experienced to be, but neither the terms of reference nor outcome criteria were defined more closely. Follow-up was by observation (of case
Book Reviews
243
conferences, for example) and interview, but the findings are reported as overall impressions, illustrated by case examples. Interesting findings were that most of the parents investigated wanted relief from poverty and the resources to be able to lead uncomplicated lives. The abuse allegation was experienced as highly disruptive to the family, particularly if the professionals intervened in a routine manner. Most parents did not understand the investigative process, were unaware of their rights, and felt guilty until proven innocent, violated, disempowered and angry. However, the study took place before parents' attendance at case conferences was routine. Furthermore, this reaction usually changed as the case progressed, until many ultimately felt that the intervention had been beneficial. Responses to child abuse have tended to be guided by the minority of high profile cases which go wrong and it is illuminating that most referred cases do not appear to involve appreciable risk. The disruptive impact on families is also concerning. However, the government's policy inferences are equally worrying, since any number of different conclusions are possible from this research. One is that assessment needs to be conducted more thoughtfully and sensitively; another is that assessments are bound to be experienced by families as unpleasant, but that is a small price to pay for effective child protection. PETER REDER Consultant Child Psychiatrist Centre f o r Relationship Studies Riverside Mental Health Trust 1 Wolverton Gardens London W6 7DQ UK
PII S0145-2134(96)00150-0
Child Protection Practice: Private Risks and Public Remedies. Elaine Farmer and Morag Owen, Studies in Child Protection. London, HMSO, 1995. GBP 25.00 The study reported in the book is part of the U.K. Department of Health's program of studies into child abuse. It is about risk assessment, interventions and their outcome in child protection work. Based on sound methodology, it uses a content analysis approach of 120 initial child protection conferences in two different local authorities in the U.K., involving 73 children on child protection registers. A quantitative survey of case conference decision making, planning, and process occupies the first part of the study. The second part is an intensive study of 44 of these children who were traced on follow-up, representing 60% of the original sample of registered cases. The research spanned the pre- and postChildren Act (1989) period. This fact is reflected throughout the study, in the various issues raised concerning professional practice and ethics, the ideology of the system per se, cross- cultural issues, the position of children as consumers of the system. The results of the study raise a number of issues for policy and practice among which those standing out mostly are: (a) the relationship between the dimensions of outcome; (b) the presence of continuities and discontinuities over time and; (c) the impact of gender in shaping child protection interventions. Although the conclusions derive from a small sample, they provide a picture of the child protection system in the U.K. as confirmed by previous studies, which needs further confirmation by replication. The study analyzes in depth the various aspects of intervention in connection with outcomes related to the child's safety through protection, the enhancement of the child's welfare and the coverage of needs of the child's primary carer. Further themes emerging are the issue of partnership with parents, the child's participation in decision making, the balance of power among professionals, but also between professionals and the family, the general ideology characterizing the British child protection system. The authors, in discussing their results, stress the importance to shift from focusing on children's protection to caring for children's overall well being. I believe that this should be the lesson learned from this book. By looking at the tree, we professionals tend to miss the forest. We tend to do too little too late or too much too soon, often showing little respect for the family's rhythm of change and the child's need to participate in what is being decided for its own "best interests." The application of the three P's (Provision, Protection, Participation) of the Convention of the Rights of the Child in everyday practice will no doubt help us to shift ideologically from protecting to caring.
Book Reviews
Briggs includes the excellent concept that wheelchairs, crutches, frames, and sticks are part of the disabled child's image (part, therefore of their body) and must be seen as such. This is important, as I have known these things withdrawn as punishments, and this practice should be perceived as assault. The module on private body parts includes the mouth as a private part. I find this extremely useful as it will address the issue of "oral" abuse. This is an important part of a disabled child's body, particularly if they are fed by another or have tube feeding. It must therefore be part of any program dealing with touch. I would have valued more on the very sensitive issues of personal intimate care. Disabled children often need extensive touch as part of medical/hygienic care (rectal Valium, colostomies, body braces, physiotherapy, injections, callipers, toiletting, etc.). Staff should have very strict guidelines on such procedures and disabled children must be part of choice/decision making when procedures impact intimately on them. It should never seem "routine." This book is valuable for all teachers, care staff, and child protection practitioners. It should be available within all training on child protection. It is almost shameful the neglect disabled children have experienced by child protection specialists. If there are parts of this book that needs further work at least it cannot be said of Freda Briggs that she ignored disabled children.
MARGARET KENNEDY
Disability & Child Protection Training and Consultancy 5 Albion Works Sigdon Road London E8 lAP, UK
PII S0145-2134(96)00149-4
Parental Perspectives in Cases of Suspected Child Abuse. Hendy Cleaver and Pam Freeman. HMSO, London, 1995. 178 pages. It was an unusual experience to review a new book when a number of responses have already appeared in the public domain. This arose through the political aspect of this work, being part of a research series sponsored by the Department of Health in the wake of the 1988 Cleveland Inquiry into overzealous professional interventions following suspicions of child sexual abuse. Many of the projects were conducted by members of the University of Bristol's Dartington Social Research Unit and are either currently available in similar reports to this one, or else are in press. The Department of Health has also published a summary of the main findings from the 20 studies (Child Protection; Messages from Research, London, HMSO, 1995) and concluded from them that, since too much social work activity appears to be devoted to investigation and too little to family support, a shift in policy is required. Recently, Nigel Parton has argued that the research program has not properly represented the complexities of child protection work ( "Child protection, family support and social work," Child and Family Social Work, 1996, 1, 3-11 ). This project was concerned with the developing impact on parents of suspicion and investigation and the meaning they attribute to such scrutiny. Five hundred and eighty three children's cases were followed up for 2 years after the initial investigation, while a representative sample of 61 children's cases in 30 families was focused on in a more intensive study. As a result, a useful picture emerges of the spectrum of child abuse investigations undertaken by social workers and how many cases represented significant risk. Of the 583 children's cases referred, 84% were deemed to warrant investigation, but the names of only 29% were eventually placed on Child Protection Registers (implying that a protection plan was necessary). Fewer than 10 cases were considered dangerous. Over the follow-up period, 16 of the 61 children were reliably believed to have experienced re-abuse of some degree. The rest, however, was disappointing and did not justify the policy changes it heralded. The researchers propose that "operational perspectives" are a collection of socially oriented perceptions that people use to make sense of their lives, including helping them cope with abuse accusations. They are influenced by past experience, current interaction, motivation, power relationships, context, and so on. The main hypothesis was that the closer the operational perspectives between parents and professionals, the more satisfactory the outcome is experienced to be, but neither the terms of reference nor outcome criteria were defined more closely. Follow-up was by observation (of case
Book Reviews
243
conferences, for example) and interview, but the findings are reported as overall impressions, illustrated by case examples. Interesting findings were that most of the parents investigated wanted relief from poverty and the resources to be able to lead uncomplicated lives. The abuse allegation was experienced as highly disruptive to the family, particularly if the professionals intervened in a routine manner. Most parents did not understand the investigative process, were unaware of their rights, and felt guilty until proven innocent, violated, disempowered and angry. However, the study took place before parents' attendance at case conferences was routine. Furthermore, this reaction usually changed as the case progressed, until many ultimately felt that the intervention had been beneficial. Responses to child abuse have tended to be guided by the minority of high profile cases which go wrong and it is illuminating that most referred cases do not appear to involve appreciable risk. The disruptive impact on families is also concerning. However, the government's policy inferences are equally worrying, since any number of different conclusions are possible from this research. One is that assessment needs to be conducted more thoughtfully and sensitively; another is that assessments are bound to be experienced by families as unpleasant, but that is a small price to pay for effective child protection. PETER REDER Consultant Child Psychiatrist Centre f o r Relationship Studies Riverside Mental Health Trust 1 Wolverton Gardens London W6 7DQ UK
PII S0145-2134(96)00150-0
Child Protection Practice: Private Risks and Public Remedies. Elaine Farmer and Morag Owen, Studies in Child Protection. London, HMSO, 1995. GBP 25.00 The study reported in the book is part of the U.K. Department of Health's program of studies into child abuse. It is about risk assessment, interventions and their outcome in child protection work. Based on sound methodology, it uses a content analysis approach of 120 initial child protection conferences in two different local authorities in the U.K., involving 73 children on child protection registers. A quantitative survey of case conference decision making, planning, and process occupies the first part of the study. The second part is an intensive study of 44 of these children who were traced on follow-up, representing 60% of the original sample of registered cases. The research spanned the pre- and postChildren Act (1989) period. This fact is reflected throughout the study, in the various issues raised concerning professional practice and ethics, the ideology of the system per se, cross- cultural issues, the position of children as consumers of the system. The results of the study raise a number of issues for policy and practice among which those standing out mostly are: (a) the relationship between the dimensions of outcome; (b) the presence of continuities and discontinuities over time and; (c) the impact of gender in shaping child protection interventions. Although the conclusions derive from a small sample, they provide a picture of the child protection system in the U.K. as confirmed by previous studies, which needs further confirmation by replication. The study analyzes in depth the various aspects of intervention in connection with outcomes related to the child's safety through protection, the enhancement of the child's welfare and the coverage of needs of the child's primary carer. Further themes emerging are the issue of partnership with parents, the child's participation in decision making, the balance of power among professionals, but also between professionals and the family, the general ideology characterizing the British child protection system. The authors, in discussing their results, stress the importance to shift from focusing on children's protection to caring for children's overall well being. I believe that this should be the lesson learned from this book. By looking at the tree, we professionals tend to miss the forest. We tend to do too little too late or too much too soon, often showing little respect for the family's rhythm of change and the child's need to participate in what is being decided for its own "best interests." The application of the three P's (Provision, Protection, Participation) of the Convention of the Rights of the Child in everyday practice will no doubt help us to shift ideologically from protecting to caring.