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“You won't take away my children!” families' participation in child protection. Lessons since a best practice
Children and Youth Services Review 82 (2017) 214–221
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“You won't take away my children!” families' participation in child protection. Lessons since a best practice
MARK
Sara Serbati⁎ Lab of Research and Intervention in Family Education, Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padua, Italy
A B S T R A C T Users' participation in Child and Family Social Work is widely acknowledged as a central and hard-to-reach issue for successful and effective intervention. The article considers a methodological proposal in pursuing participation, called Participative and Transformative Evaluation (PTE) that uses instruments and data as a means of reflection and negotiation between all the actors involved, in order to justify choices and make decisions. The PTE is realised inside the Programme of Intervention for Prevention of Institutionalization (P.I.P.P.I.), involving 144 child care and protection cases (198 children) in nine Italian cities, in order to prevent out-of-home child placement and reduce child neglect. Inside the P.I.P.P.I. a series of case studies were developed to achieve an indepth understanding of the effective processes undertaken by participants with families. The case selected for this article has been chosen because it reflects a best practice in using the PTE as well as the participation path and is undertaken following the indications of the Critical Best Practice. It allowed an in-depth understanding of the mother's and professionals' viewpoints about what built the success in their practice. During the discussion three components are considered: the technical solutions offered by research or science (technical components) become meaningful when participants not only apply them, but act upon them, building, internally, the meanings to be enacted (internal component). In the case study this came about through dialogue between people, and through negotiation and reflection on competence, visions and values (communicative component).
1. The question of participation in Child and Family Social Work The literature widely acknowledges users' participation in Child and Family Social Work as linked to successful interventions (Serbati et al., 2012; Dumbrill, 2006; Healy & Darlington, 2009; Holland, 1999; Van Bijleveld, Dedding, & Bunders-Aelen, 2015). Moreover, the importance of participation in facilitating the achievement of planned goals is not only a literature assumption, but also a question of common sense. Professionals normally stress the importance of users' participation (Darlington, Healy, & Feeney, 2010; Gallagher, Smith, Hardy, & Wilkinson, 2012), but participation is a tough-to-reach goal. Several studies concerning parents' voices confirm the gap between the families' world and the services: parents often feel blamed by professionals, excluded from the decisions regarding interventions on their life, and confused by a system of power, which is often used against them (Serbati and Gioga, 2017; Dale, 2004; Dumbrill, 2006; Kapp & Propp, 2002). The literature also highlights the difficulties of professionals in realising a participative path with children and vulnerable families. Participation requires listening, answering, and thinking together. Quite an easy task when there are few worries to deal
⁎
with. But working with vulnerable families can be very problematic and may also be characterised by high levels of uncertainty (Arnkil & Seikkula, 2015; Roose, Roets, Van Houte, Vandenhole, & Reynaert, 2013). It is possible, therefore, to understand professionals' efforts to assure the safety and protection of the child, even if this entails an imbalance of power. In particular, if there is a condition of insecurity for the child, a safe process involving power control may be justified. Many participation ladders are available in the literature, representing power distribution between users and professionals. Table 1 proposes an elaboration of O' Sullivan's (2011) ladder related to participation in social work decision-making. The lowest level is the “non-participation” level that takes place when there are uncertainties about the child's protection. But children continue to seek answers for their needs from their parents (Ainsworth & Maluccio, 1998) and it is important to make efforts to proceed along the participation ladder. Even in these situations, another process is always needed that allows the parent and/or the child to understand the meanings and the reasons for what has happened. It is a process that gives the other the chance to learn from the past and manage decisions about their lives a little at a time. During a single care process many
Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Beato Pellegrino 28, 35139 Padova, Italy. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.childyouth.2017.08.032 Received 6 June 2017; Received in revised form 24 August 2017; Accepted 24 August 2017 Available online 15 September 2017 0190-7409/ © 2017 Elsevier Ltd. All rights reserved.
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(Dewey, 1933, 1938): instruments and data are used as a means of reflection and negotiation in order to justify choices and make decisions.
Table 1 Participation ladder for users' decision making (reworking of O' Sullivan, 2011: 46–50). Participation steps
Description
Being in control
The users' competence to make decisions for themselves is respected. An agreement is reached through dialogue and negotiation with users. Users' opinions are considered, but the decision is taken by professionals. Decisions are taken by professionals, users are informed.
Being a partner Being consulted Being told
3. Context and methodology of the case-study The case study featured here is taken from a research-action programme involving 144 child care and protection cases for a two-year period between 2013 and 2014 (198 children) in nine child protection agencies belonging to nine Italian cities (Bari, Bologna, Florence, Genoa, Milan, Palermo, Reggio Calabria, Turin, and Venice). The programme is carried out through the collaboration between the University of Padua and the Italian Ministry of Welfare and is called the Programme of Intervention for Prevention of Institutionalization: its abbreviation, P.I.P.P.I. is inspired by the fictional character Pippi Longstocking, a creative and amazingly resilient girl known all over the world. Children 0–14 y.o. were considered eligible for the programme if the case manager with the other professionals considered them in a situation of child neglect (following the completion of a questionnaire). The P.I.P.P.I. is used to test new approaches to assisting family situations, preventing out-of-home child placement and strengthening families in the effort to reduce child neglect, defined as a significant deficiency or a failure to respond to the needs of a child recognised as fundamental on the grounds of current scientific knowledge (Dubowitz et al., 2005; Lacharité, Ethier, & Nolin, 2006). In accordance with the bio-ecology of human development (Bronfenbrenner, 2005), the P.I.P.P.I. aims to respond to children's needs with a collective action, putting in place four “specific activities” involving families' ecosystem levels. These are: (1) home-care intervention: in-home activity aiming at addressing relationship problems and modifying behaviours; (2) parent's group: parents are involved in group activities with other families, fostering reflective practice, encouraging exchange and interaction between participants; (3) family helper(s): each family is provided with a support family or a family helper offering concrete support; (4) cooperation between schools, families and social services: teachers, with the other professionals, outline actions (both individualised and involving the entire class) allowing a positive school environment. The P.I.P.P.I. requires the PTE to be implemented through various quantitative and qualitative instruments that are also used to measure outcomes (for results see Serbati et al., 2016). Data were collected at three times: at the beginning of the intervention (T0), at the middle (T1) and at its end (T2). The results of the P.I.P.P.I. are encouraging and during the years the Italian Ministry of Welfare continued supporting the research. So, in 2014–2018 a scaling up has begun, where 150 new cities and approximately 2000 children has been involved. The analyses in aggregated form fail to give account to the real processes that build the success of the programme. So, a series of case studies were developed inside the P.I.P.P.I. to reach an in-depth understanding of the final results of the research, highlighting mechanisms and actions really undertaken by participants with families in order to realise the programme proposals presented during the three-day trainings attended by the professionals. The main aim of the case-studies is therefore to achieve an in-depth knowledge of what happens in child-neglect situations using the methodological proposals by the P.I.P.P.I. and by the PTE. An in-depth knowledge that is useful for generating reflections and thoughts among professionals and researchers on what really contributes to make participative work with families successful. The case selected for this article has been chosen because it reflects a best practice in using the PTE as well as the participation path. The meaning of best practice is assumed in accordance with the definition by H. Ferguson (2003: 1012):
levels of participation can be experienced and these can change over time. A second level is dedicated to the “apparent participation”, where the user maintains a passive role and the aim is to obtain consent for choices and decisions defined by the professionals. The highest levels correspond to real participation, to experiences of shared decisionmaking, in which participation is not only seen as a means to reach the goals, but as an integral part of the aim. In these levels, people gradually gain more and more decision-making power, through its redistribution, which can also lead to the self-management of their care plans. This participation ladder reflects the tough work that is needed to really pursue users' emancipation. One of the greatest difficulties experienced by professionals seems to be “not knowing how to do it”. Woodcock (2003) in his exploratory study, notes that professionals use intervention models designed more on their life experience, rather than on theories, tending to urge parents to change, rather than giving them the tools to do it. Through a case study analysis, this article is thus dedicated to making a methodological proposal in order to pursue participation at the highest levels. 2. The participative and transformative evaluation The Participative and Transformative Evaluation (PTE, Serbati and Milani, 2013) is a method aiming to guide the achievement of participation. The PTE follows the typical steps of the evaluation process (referral, welcoming, assessment and planning, intervention and monitoring, conclusion). It involves a cyclic path (Adams, Dominelli, & Payne, 2009), where each cycle corresponds to a phase of the care process (Fig. 1). The cycles suggest that there is not a simple linear process of assessing, planning, intervening, and monitoring: “the phases lack order and sequence, and include iterative elements” (Shaw, 2011: 89). To be fully realised each cycle needs two functions: 1. reflection and negotiation: each cycle requires time for listening and reflecting, in order to deepen the perspective of each participant and negotiate an agreement for the action; 2. action: the realization of the negotiated tasks, which always requires feedback and new negotiations and adjustments in order to produce change. In the steps of the care process several instruments could be used to build such participative contexts where families try to experiment a new balance or make new decisions enabling them to improve the children's development and their daily life. This task, which is inspired by the thoughts of Dewey, is a task of thinking and reasoning, in order to negotiate between all the actors, the meanings of what we are doing with families and children. During the PTE, professionals and families are expected to work together around instruments and information that are used as means to identify both the strengths and the difficulties. Practitioners become co-workers and co-researchers with parents, teachers and other actors in helping to foster positive child developmental pathways. In realising each cycle, a process similar to a scientific inquiry is adopted in which the competence of thinking is developed
“What constitutes best practice is not determined alone by the agency, the law and wider system of rules and regulations, but the views of the broad range of participants—service users, managers, front line professionals—should be represented in terms of how the practice was constructed 215
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Fig. 1. The Participative and Transformative Evaluation model (PTE).
HOW IS IT GOING? A question to be considered during the intervention period for the monitoring, as well as at the end for the final evaluation. The completion of the grids requires the use of a concrete language, otherwise defined SMART, an acronym for Specific (targeting a specific goal for improvement), Measurable (quantifying or at least suggesting an indicator of progress), Assignable (specifying who will do what), Realistic (stating what results can realistically be achieved, given available resources) and Timely (specifying when the goal can be achieved). The set of completed grids constitute the “shared care plan”, representing all the work that is done by all the actors involved. In the P.I.P.P.I. programme it is expected that the “shared care plan” should represent the four “specific activities”. The completed Triangles and Micro-planning grids of the case-study were considered as documents to be analysed in order to find out processes that realise the PTE. A content analysis was conducted, comparing the participants' Triangles between each other and with the final “shared care plan”. Moreover, the case study is based on interviews with eight of the key actors in the case: two social workers (child protection and disability area), two home-care workers (child protection and disability area), the director of home-carers, the psychologist, the physiotherapist and the mother. The interviews took place one year after the conclusion of the P.I.P.P.I. All the participants signed the Informed Consent, accompanied by the Information Sheet with all information about the objectives of the research and the possibility to withdraw the consent at any moment of the research. Semi-structured, audio-taped interviews were conducted and transcribed. Broad, open-ended questions were used to elicit the practitioners' and mother's stories and points of view about the P.I.P.P.I. experience. Thus, the interviews specifically focused on different ways and steps of defining and implementing the PTE, with particular attention paid to the manner of sharing decisions and using Triangles and Micro-planning grids. The coding of the transcripts collected themes, concepts and propositions belonged to the respondents around the phases of the PTE, in order to compare the different points of view and highlight agreements about what constitutes the best practice.
and given meaning”. A key analytical challenge for the case-study was therefore to collect the diverse narratives and to build from them a unifying representation of what constitutes a (best) practice (Houston, 2014). The methodologies used are coherent with the Critical Best Practice (CBP, Ferguson, 2003) which “honours the fact that practice is a co-construction between all the actors and systems involved. Practice may still mean different things to different people, but points of agreement about what constitutes ‘best’ are crucial”. The selected case constitutes an exemplary case for learning in respect of the core dimensions of engaging service users, establishing helping relationships and realising participation experiences. It involved the ‘neglect’ of a single mother with three children, aged 9, 7 and 4 years at the time of the start of the programme. The first and the third children are female, the second child is a male and has a developmental cognitive delay. Two key instruments by the P.I.P.P.I. will be considered for the case study: The Child's World and the Micro-planning grid. The first (usually depicted as a Triangle, Fig. 2, Milani et al., 2015) is the Italian adaptation of the British Framework for the Assessment of Children in Need and their Families (FACNF-DoH 2000; DfES 2003). The adaptation refers to previous experiences (Serbati et al., 2012) and to other international programmes (Chamberland, Lessard, Lacharité, Dufour, & Lemay, 2012; The Scottish Government, 2008). Like the original version, the three sides of the triangle represent the instrument's three domains (Child's developmental needs, Parenting Capacity, Family and Environmental Factors), which organise the overall 17 factors. The Triangle is used by professionals to conduct a comprehensive assessment collecting the voice of each participant and to plan the activities that will be carried out, and subsequently to document changes. If a factor deserves being planned, professionals use the Micro-planning grid (Serbati and Milani 2013; Serbati and Gioga 2017), in which the following questions are answered: (a) WHAT? What problems/resources are to be addressed; (b) WHY? The goals to be achieved; (c) HOW? The actions to be undertaken; (d) WHO? Responsibilities; (e) WHEN? When are the goals expected to be achieved; and finally, (f) 216
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Fig. 2. The child's world multidimensional model.
4. Results
4.2. Welcome The proposal to use the P.I.P.P.I. programme arrived when a change of course was needed. The professionals participated in a three-day training course and so were aware of what the PTE asked for, requiring full participation from all the actors involved and particularly from the mother. The words used by the social worker to describe the introduction of the P.I.P.P.I. to the woman signal a notable shift in approach: the blackmails disappeared and the P.I.P.P.I. is presented as something to do together.
The case study will be presented following the phases of the PTE. 4.1. Referral The mother started the referral which opened the case two years before the beginning of the P.I.P.P.I. programme. She was asking for a help in her difficult situation, and explains: We were inside a big tornado […] It was tough … I had just separated from my ex, I had been pregnant … and the pregnancy had not gone so well. Then, of course, the baby was born … I was really in the total shit. I called my mother, because with all this stress, I also had health problems. I had neglected loads of things. It was impossible for me to cope with it all. (Interview with the mother).
We told her: “Madam, we have thought of this programme as a way to help you”. We said: “We need you to do it”. (Interview with Social worker).
4.3. Assessment and planning
Professionals shared the difficult situation of this woman and underlined some issues related to her children's care:
The professionals, thinking of how to elicit the mother's participation, decided that the Triangle should be used first by the children separately, then by the mother for each child, and finally by the practitioners. The Triangle was used to explore the views of all the actors, assuring each of them their own space of narration. The children's triangles were filled with the home-care workers, who proposed it as a game (Fig. 3). The triangle was creatively re-interpreted by the children, abandoning the reference to the single factors and also using card games to complete it. The children' triangles were read and discussed by the social worker with the mother, and the discussion brought something new to this relationship, as recognised by the social worker:
The mother was not so focused on her children, they showed signs of neglect, the teachers complained about them being late in the morning and we found that at home there weren't regular meals… (Interview with director of home-carers). After her spontaneous referral, professionals expected to find collaboration from the mother. It did not happen: the woman did not follow the practitioners' suggestions. Here an escalation began, the more the professionals made new proposals for activities to the mother, the more she remained still. This immobility led the practitioners to use blackmails and to foreshadow her children's removal. No trust relationship was established with the mother. The woman said that she felt betrayed by the professionals that she had called for help:
It was interesting to look at the triangles together, to see the mother astonished at seeing what the four-year-old child wrote: she said that her mum had a cold, often crying because of her colds. But in reality the mother cried because of the house [an eviction was pending], but she told her children that she cried because of colds. So the mother learned that the young girl sensed her malaise. […] And she acknowledged that it is important for the children to know that she was fine, that she was working, that she was calm. (Interview with the Social worker).
When I met them [the professionals], they told me: “Come on, madam, you have to react. Otherwise we have to call the judge for child protection”. Here, I just saw red. Stress after stress, I got angry. So, I said: “No, you won't take away my children!” […] I felt betrayed by them. I went to them to ask for help. And instead of supporting me, they betrayed me. (Interview with mother).
The path of the PTE using the Triangle continued and the mother built her triangles (one per child) accompanied by the social worker, after seeing those of her children. The mother said that this activity 217
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Fig. 3. The child's world completed by the children.
mother, team of professionals) during the completion of the triangle. Similarities (in bold) are observable between the different actors. The professionals decided not to involve the mother and the children in writing the micro-planning grids. In their opinion, the completion of the Triangles required so much effort that it was excessive to think of their involvement in the grids. They considered the family's viewpoints about actions following the completion of the triangle and used them for the micro-planning grids. Referring to the Child's developmental needs of the oldest child, two of the common themes were chosen by the professionals, linked to two factors of the triangles, namely Learning and Play and Leisure (Tables 3 and 4). These two grids, like the overall 30 completed grids, are successful in respecting the requirements of the acronym SMART: they are specific, measurable, assignable, realistic and timely. Overall, out of the 30 micro-planning grids completed during the 18 months of the P.I.P.P.I. implementation, eleven are referred to T0, seven to T1 and twelve to T2. The micro-planning grids are evenly distributed between the three children (nine for the first child, twelve for the second one and seven for the third one). The slightly higher attention for the second child is due to his disability. Moreover, there are five micro-planning grids dedicated to common goals for the three children, referring to Employment and Income and Housing. There is an even distribution also between the three sides of the Triangle: fourteen for the Child's Developmental Needs, thirteen for the Parenting Competences and six for the Family and Environmental Factors. The latter also involves the five grids common to the three children. The factors chosen for the micro-planning grids are different for each child, except for Play and Leisure, which recurs for the first and the second child and Basic Care, which is common to the first and the third child. Responsibilities attributed to the planned actions see a high predominance of the mother, child and home-care worker, particularly for the Child's Developmental Needs and for the Parenting Competences (out of twenty-seven grids, twenty-seven responsibilities are for the mother, twenty-two for the child and twenty-two for the home-care worker). The responsibilities attributed to the triad mother/child/home-care worker reflect the hard work done around the parent-child relationship, as recognisable also from the analysis of the themes that arose. In three instances the responsibilities of other informal actors were involved (schoolmate's family and neighbors) and in another three, other professionals were involved (physiotherapist and psychologist). An exception is the factor Parents' Self-Realization, where only the mother is involved with the help of the social worker and home-care worker, and the parents group's facilitator. Quite different considerations are possible for the micro-planning grids completed for the Family and Environmental Factors: six times out of six they refer to issues involving the mother alone, struggling with the problems of house, employment and relationship with school. The mother is always accompanied by the home-care worker and four times by the social worker. Consequently, referring to the four “specific activities” required by the P.I.P.P.I. programme, the ‘home-care’ activity shows a much higher recurrence than ‘family helpers’ and ‘parents' group’ activities.
helped her to change her viewpoint and to focus her action on her children's needs: The kids really enjoyed [working with the triangles]. The boy loved to answer the questions. They are curious. They helped me to focus on things, on everyday life, whereas before I was more focused on anger, other things. I could see what they saw. Last year I took them on vacation. They said we hadn't done it for such a long time. Last year I took them around a lot, to have fun. For two years we hadn't had any vacation. Last year I took them, they saw new places, and they enjoyed it. (Interview with the mother). Also the home-care worker confirmed this change in the mother: It was possible for the mother to understand that every child needs her or his own space and own time. (Interview with the home care worker). The path of the PTE allows the circulation of information, the sharing of viewpoints that became common for the professionals and for the mother. It makes it possible to change people's view, particularly the professionals' view of the mother, as described by the social worker: We [the professionals] compared the mother's triangle with those of the kids. We were astonished, because in the triangle we saw a very competent mother. She pointed out things that match the children's desires and aspirations. For example, the children would like their clothes to be prepared by their mum in the evening for the next morning, and the mother had similar things in mind, like preparing the schoolbag for example. All things that concern caring for the children… (Interview with the social worker). Then, the team of professionals built its own triangles (one per child) and compared them with those reported by the mother and by the children. And again they discovered that their expectations for the children's care were close to those expressed by the mother, even if she had not put them into practice yet. Moreover, the professionals testified how the work of reflection and negotiation of the different points of view required by the PTE also helps to reinforce the professionals' relationships in order to carry out different actions but with common goals and aspirations: It was important to connect all the different actors, everyone with their own skills. And this also makes it easier to focus on common goals. Like a common track that everyone can follow. And this also promotes trust between the actors. (Interview with home-care worker 2). We were also a much stronger team, we all felt our actions to be more legitimate. (Interview with social worker). This work of communication, reflection, and comparison allowed the definition of various themes and in many cases the voices of children, mother and professionals agreed. The themes that arose were considered in order to build the care plans following the factors of the triangle. An in-depth understanding of the process can be gained by focusing on the Child's developmental needs of the oldest child at T0. Table 2 represents the themes considered by the different actors (child, 218
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Table 2 Example of themes arising through the PTE.
Summary of the speech Themes
Child
Mother
Team of professionals
To dance, to find the clothes ready, to be helped and get together with others, to learn to read by myself, to play with Shanghai. To be helped (homework); To read by myself; Dance; To play/To stay with friends.
To go to the dentist, to sleep well, to express emotions about her father, to be gratified, to stay in contact with friends. To sleep well; To be helped (emotions); To stay with friends.
To sleep well, to study, to read alone and be helped to do it, to dance, to learn some board games that help her to have more friends. To sleep well; To be helped (homework); To read by herself; Dance; To play/To stay with friends.
‘Cooperation between schools/families and social services’ is never cited.
Table 4 Example of micro-planning grid. Play and Leisure
4.4. Intervention and monitoring
Problem
The work done for the phase of assessment and planning was used as a map for all the actors involved during the intervention periods (between T0 and T1, between T1 and T2, after T2). The mother was not aware of the existence of the map, but it was used by the professionals, and particularly by the home-care workers, to build the plan of actions with her, keeping the map in mind.
Goal Actions and Responsibilities
Time
In everyday life it [the map] helped me with the mother to understand concretely what we could do. I'll give you an example. It was difficult for the mother to stay with the kids all together and from the triangles we learned that the three children would like to do some things with her. We planned some practical activities where the children and mother could stay together, like making a cake. (Interview with home-care worker 2).
The child is not involved in activities to enjoy herself. To occupy the free time with sports and simple games to have fun The mother, together with the home care worker, does the following activities: playing with Shanghai and with other board games, cooking. The mother, with the help of the home care worker, invites the child's friends at home 3 months
external issues to be faced by the family, such as the hospitalisation of the male child at T0, or the eviction coming at T1. These external issues clearly stress the competences of the family and of the mother, hindering the achievement of the planned goals. The same external issues plus the mother's unemployment were at the origin of the “not-reached goals”. Particularly the eviction is described by the professionals and by the mother as a difficult time: the mother and children were placed in temporary accommodation in a charity-run apartment block where the family lived in a single room and the kitchen was shared with the other residents. It should have been an emergency solution, only for two months, but it was prolonged for two years due to the unavailability of public housing. This situation “held everything back” as the home-care worker commented. The unexpected event hindered the completed achievement of the planned goals and this explains the increase of the “partially-reached” goals. However, it didn't prevent the continuation of the acquisition of autonomies: a mechanism had been activated to help the mother find a way to ensure her children's wellbeing, as suggested by the home-care worker:
After the actions had been implemented, the professionals assessed the achievement of the planned goals (reached, not-reached, partiallyreached). Only a few of the micro-planning grids are classified as “reached” (3 at T0, 1 at T1 and 2 at T2). Also the classification “not reached” is infrequent (3 at T0, 2 at T1 and 0 at T2). On the other hand, there is an increase over time of the classification “partially-reached” (5 at T0, 4 at T1 and 10 at T2). Overall the trend of the reached/notreached/partially-reached goals seems to suggest a small improvement. Each completed micro-planning grid is accompanied by a text explaining the motivations that allowed or hindered the achievement of the goals. By analyzing these motivations it is possible to observe that the six grids with the “reached goals” are characterised by actions planned involving the relationship between mother-children-professionals. They involve actions such as “playing with the mother”, or “paying for the swimming pool” or “showing the child how to have a shower”. Only twice did the realised action involve other people such as teachers. These were not previously involved in the assessment and planning work but were present during the action. The nineteen “partially-reached goals” are commonly (twelve times) due to goals with high demands needing more time to be achieved. In one case it is due to the need to carry out actions involving not only the children, mother or professionals but also informal resources (schoolmates' family) and this was not done. In six cases the “partially-reached” goal was due to
The PTE and its instruments gave the mother a good basis for creating the necessary competences […]. Now she is gradually coping on her own, also organising the school buses, once you had to stand behind her, urge her, this year she has done everything alone. (Interview with home-care worker).
Table 3 Example of micro-planning grid. Learning Problem Goal Actions and Responsibilities
Time
The child arrives late at school and seems so tired as to not participate in school activities The child goes to sleep on time and the mother prepares all she needs for school the evening before. With the financial help of the neighbors, the mother buys a bed for each child; At 21:30 the mother puts the children to bed and the light is turned off until the morning; During the evening the mother, with the children, gets the clothes and the school bag ready for the morning; At 7:50 the children leave the house with the mother to go to school. 3 months
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four of the “specific activities” foreseen by the P.I.P.P.I. programme. ‘Cooperation between schools/families and social services’ is never cited in the planned goal, but it appears twice in the comments after the implementation of the planned actions. So the requirement to build a “shared care plan” collecting the actions for all the participants is satisfied. By analyzing the themes of the micro-planning grids, it is possible to see that the higher presence of the home-care activity has its place because it is linked to a greater focus on children-mother relationship issues, which could be dealt with inside the family's home, by the home-care worker. Besides the technical components, other components are recognisable that can help explain the success of the intervention. The participative path allowed the mother, but also the professionals, to change their view of one another, thus fulfilling components that could be defined as internal since they are linked to changes in the participants' minds. With regards the mother, the case study shows that her parenting competences are potentially present as early as the time of first use of the triangle. They were there, but weren't put in place. During the programme, a change happened internally for the mother: she started to see herself and her children in a new way and, thus, to act differently. Similarly, also her view of the professionals changed and they stopped being enemies and became partners in finding solutions in order to respond to the children's needs. There was also a change in the professionals, who started to recognise the mother's competences. The professionals also changed the way they viewed one another and began to integrate their competences towards the same goals, which also led to a higher inter-professional satisfaction. The internal components therefore changed the way the various participants saw each other and allowed them to promote new ‘actions’. The technical components alone, that is to say the observance of the specified technical rules, would not be sufficient, as they would only be defined externally (Habermas, 1987; Kemmis, 2001). But social work is not “some kind of robot-like mechanical performance that is devoid of any theoretical reflection” (Carr & Kemmis, 1986: 116). It was necessary to build the internal legitimacy with the reasons that explain the action (Geertz, 1997; Soulet, 2014). In the case study, the professionals and the mother discovered their “reasons for acting in one way rather than another", they were "able to evaluate those reasons, to revise or abandon them, and replace them with others” (MacIntyre, 1999: 12). It required patience, time and effort. Moreover, the accomplishment of the internal and technical components was not enough. In the case study they didn't happen in a vacuum and neither in isolation. It was necessary to abandon the image of the autonomous, rational individual, with a purposeful rational way of thinking and acting, as the mother was seen by the professionals during the referral phase. Participation required not only technique, managed by a single person, but also reason and the reasoning of all the people involved (Bernstein, 1983). In the case study, also communicative components were involved that made it possible to change the participants' viewpoints internally and to carry out the techniques appropriately. They were able to question the technical proposals, in a way that permitted them to forge their views and assumptions through consensus and coordination (Bove & Sità, 2016). According to Dewey (1933) the reality of social action lies in the thoughts of the people that do it. The proposals for negotiation and reflection foreseen by the PTE (technical components) were effective not because they were taken in a rigid way and reproduced on the basis of protocols. The effectiveness derived from the technical components being redesigned and taken within a collective communicative process able to establish "the basis for a unanimous coordination of individual actions" (Habermas, 1987: 521). Participants became co-researchers in examining and challenging the new proposals with respect to those already embodied in their practice. Only within this ‘unanimous coordination’ was it possible for the participants' viewpoints to change (internal components), thus allowing them access to the highest levels of participation. The paper assumes that it is not sufficient to follow the technical
4.5. Conclusion: towards autonomy Today the care process with this mother and her three children has not yet ended, but it continues in the form of light supervision by the social worker. The professionals state that the process of the PTE has allowed the mother to become more autonomous and she can now get by using her own resources. When the interviews took place, the family had finally been moved into new public housing. As described by the social worker, the mother was able to cope by herself with the issues concerning the change of home: The mother now considers the children one by one, and not as ‘the children’ in general; she understands that she has three children with three different individualities who need her in three different ways. This was the greatest goal for her. Even now that she has to decide how to divide the children bedrooms, she did it thinking of the children's needs. (Interview with social worker). 5. Discussion and conclusions Following the assumptions of the PTE, the case study of the three children and their mother shows an overall small improvement over time, testified by the results of the micro-planning grids, even if several partially-reached and some not-reached results remained. The partial improvement seems linked to external issues that prevented the planned goals from being attained. The hindering issues reported by the interviewees include the mother's unemployment and the housing eviction, which found no solution during the experimental path. However, results since the micro-planning grids were made reveal the mother's competence in ensuring her children's care, despite the difficult conditions (Barudy & Marquebreucq, 2005). The success of the intervention is even more evident on considering the interviews, which took place about one year after the conclusion of the experimental path: all the involved actors show full satisfaction for the mother's acquisition of several autonomies. The case study suggests that mothers' and children's participation in the decision making was central for achieving this important result. In the ‘Referral’ phase, the mother could be said to have been involved at the being told or being consulted levels (with reference to the participation ladder presented in the first section) and decisions were taken by the professionals. The shift happened after the training sessions attended by the professionals about the proposals of the PTE, when they applied the model to the phases of ‘Welcome’ and ‘Assessment and Planning’, using the participation instruments, and, in particular, the triangle with the mother and children. At this point, the being a partner level was reached with the mother. Certainly, some limitations can be recognised. For example, the mother was not directly involved in the planning phase and neither the children. The interview with the mother shows that she did not know how the triangles were used after their completion. There was the risk of taking the concept of participation only to the level of being consulted, with decisions still being taken by professionals. However, the actions planned in the grids were constantly re-discussed between the mother and the home-care worker, suggesting that higher levels of participation were continually sought. All participants consider the care path a best practice, outstanding for the users' participation processes put in place. The case study helps to understand and discuss the different components of the mechanism that allowed it to be achieved. A first level of analysis concerns the technical components, referring to the good correspondence between the requirements of the PTE and the actions really undertaken. As required by the PTE, through the Triangle all the participants' voices were heard and through the micro-planning grids these voices became concrete actions for the care plan. The Triangle was used for an in-depth understanding in all of its three sides, for each child, in each of the three completions (T0, T1, T2). Moreover, during the completion of the micro-planning grids, goals and actions were defined for three out of 220
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Child Abuse Review Child Abuse Review, 13, 137–157. Darlington, Y., Healy, K., & Feeney, J. A. (2010). Approaches to assessment and intervention across four types of child and family welfare services. Children and Youth Services Review, 32, 356–364. Dewey, J. (1933). How we think. New York: D. C. Heath. Dewey, J. (1938). Logic: The theory of inquiry. New York: Henry Holt and Company. Dubowitz, H., Pitts, S. C., Litrownik, A. J., Cox, C. E., Runyand, D., & Black, M. M. (2005). Defining child neglect based on child protective services data. Child Abuse & Neglect, 29, 493–511. Dumbrill, G. C. (2006). Parental experience of child protection intervention: A qualitative study. Child Abuse and Neglect, 30, 27–37. Featherstone, B., White, S., & Morris, K. (2014). Re-imagining child protection. Towards humane social work with families. Bristol: Policy Press. Ferguson, H. (2003). Outline of a critical best practice perspective on social work and social care. British Journal of Social Work, 33, 1005–1024. Gallagher, M., Smith, M., Hardy, M., & Wilkinson, H. (2012). Children and families' involvement in social work decision making. Children and Society, 26(1), 74–85. Geertz, C. (1997). Local knowledge. New York: Basic Books. Habermas, J. (1987). The theory of communicative action, vol. 2: Lifeworld and system: A critique of functionalist reason. Boston, MA: Beacon Press. Healy, K., & Darlington, Y. (2009). Service user participation in diverse child protection contexts: Principles for practice. Child and Family Social Work, 14, 420–430. Holland, S. (1999). Discourses of decision making in child protection: Conducting comprehensive assessments in Britain. International Social Welfare, 8, 277–287. Houston, S. (2014). Meta-theoretical paradigms underpinning risk in child welfare: Towards a position of methodological pragmatism. Children and Youth Services Review, 47, 55–60. Kapp, S. A., & Propp, J. (2002). Client satisfaction methods: Input from parents with children in foster care. Child and Adolescent Social Work Journal, 19, 227–245. Kemmis, S. (2001). Exploring the relevance of critical theory for action research: Emancipatory action research in the footsteps of Jurgen Habermas. In P. Reason, & H. Bradbury (Eds.). The handbook of action research (pp. 91–102). London: Sage. Lacharité, C., Ethier, L., & Nolin, P. (2006). Vers une théorie éco-systémique de la négligence envers les enfants. Bulletin de Psychologie, 59, 381–394. Lorenz, W. (2012). Response: Hermeneutics and accountable practice: Lessons from the history of social work. Research on Social Work Practice, 22, 492–498. MacIntyre, A. (1999). Dependent rational animals: Why human beings need the virtues. Chicago: Open Court. Milani, P., Ius, M., Serbati, S., Zanon, O., Di Masi, D., & Tuggia, M. (2015). Il Quaderno di P.I.P.P.I. Teorie, metodi, strumenti per l'implementazione del programma di intervento per Prevenire l'Istituzionalizzazione. Padova: IT: BeccoGiallo. O' Sullivan, T. (2011). Decision making in social work. New York: Palgrave Macmillan. Roose, R., Roets, G., Van Houte, S., Vandenhole, W., & Reynaert, D. (2013). From parental engagement to the engagement of social work services: Discussing reductionist and democratic forms of partnership with families. Child & Family Social Work, 18, 449–457. Serbati, S., Gioga, G., & Milani, P. (2012). Évaluer pour mieux intervenir. Évaluer les résultats et les processus pour améliorer les pratiques d'intervention auprès des familles négligentes. Revue Internationale Enfances, Familles, Générations, 16, 74–94. Shaw, I. (2011). Evaluating in practice. Aldershot: Ashgate Publishing. Serbati, S., & Milani, P. (2013). La tutela dei bambini. Roma: IT: Carocci. Serbati, S., Ius, M., & Milani, P. (2016). P.I.P.P.I. Programme of Intervention for Prevention of Institutionalization. Capturing the Evidence of an Innovative Programme of Family Support. Revista de Cercetare si Interventie Sociala, 52, 26–50. Serbati, S., & Gioga, G. (2017). Building a successful care path in residential care: findings from qualitative research with young people who have left residential care and their professionals. Child Care in Practice, 23(1), 34–48. Shaw, I., & Holland, S. (2014). Doing qualitative research in social work. London: Sage. Soulet, P. M. (2014). Analyse qualité oupratique qualité? Quand la qualité devient un enjeu de définitiondu travail social? Actualités Sociales, 51, 1–4. The Scottish Government (2008). Getting it right for every child. (Edinburgh). Van Bijleveld, G. G., Dedding, C. W. M., & Bunders-Aelen, J. F. G. (2015). Children's and young people's participation within child welfare and child protection services: A state-of-the-art review. Child & Family Social Work, 20, 129–138. Woodcock, J. (2003). The social work assessment of parenting: An exploration. British Journal of Social Work, 33, 86–106.
solutions and proposals made by science or research in order to make a successful intervention in Child and Family Social Work. Participation is a key issue but cannot be simply applied. In this regard the question from W. Lorenz (2012) appears fitting: “was it possible (and appropriate) to transfer the scientific approach that proved successful in relation to the nature, to the social sphere without robbing its members of the very freedom gained by the advance of reason and subjecting their behaviour instead to laws and regularities over which they had little control?” Technical solutions have their place, but social work is not a standard process to be managed directly through procedural or technological means. The in-depth understanding of the different viewpoints about what built the best practice highlighted that social work is best managed by indirect means, such as competence, dialogue, visions and values, through culture in other words (Featherstone, White, & Morris, 2014). It “requires practitioners to act upon research methods rather than simply apply them” (Shaw & Holland, 2014: 292). Consistently, the PTE requires people to think and reflect on its proposals, interpreting them in their own way. H. Ferguson's Critical Best Practice and qualitative methods in general seem helpful in questioning the different components that made the intervention effective. However, more qualitative studies are needed in order to understand whether the categories of technical/internal/communicative components could really be useful in supporting effective intervention. Acknowledgements I wish to thank [anonymised] for her helpful advice and support during the preparation of this paper. I am also indebted to all participants that take part to the interviews. Funding This study was supported by [anonymised], inside the financing of [anonymised]. References Adams, R., Dominelli, L., & Payne, M. (2009). Social work. Themes, issues and critical debates. Hampshire: Palgrave MacMillan. Ainsworth, F., & Maluccio, A. N. (1998). The policy and practice of family reunification. Australian Social Work, 1, 3–7. Arnkil, T. E., & Seikkula, J. (2015). Developing dialogicity in relational practices: Reflecting on experiences from open dialogues. Australian and New Zealand Journal of Family Therapy, 36, 142–154. Barudy, J., & Marquebreucq, A. P. (2005). Les enfants des mères résilientes. Paris: Solal Editeurs. Bernstein, R. J. (1983). Beyond Objectivism and Relativism. Oxford: Blackwell. Bove, C., & Sità, C. (2016). Collegare le esperienze nella ricerca. Sostenere esperienze di inquiry collaborativa tra ricercatori e professionisti. Encyclopaideia, 44, 57–72. Bronfenbrenner, U. (2005). Making humans being human. Bioecological perspectives on human development. London: Sage Publications. Carr, W., & Kemmis, S. (1986). Becoming critical. Education, knowledge and action research. Lewes: The Falmer Press. Chamberland, C., Lessard, D., Lacharité, C., Dufour, S., & Lemay, S. (2012). Recherche évaluative de l'initiatives AIDES. Université de Montréal. Dale, P. (2004). “Like a fish in a bowl”: Parents' perceptions of child protection services.
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“You won't take away my children!” families' participation in child protection. Lessons since a best practice
MARK
Sara Serbati⁎ Lab of Research and Intervention in Family Education, Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padua, Italy
A B S T R A C T Users' participation in Child and Family Social Work is widely acknowledged as a central and hard-to-reach issue for successful and effective intervention. The article considers a methodological proposal in pursuing participation, called Participative and Transformative Evaluation (PTE) that uses instruments and data as a means of reflection and negotiation between all the actors involved, in order to justify choices and make decisions. The PTE is realised inside the Programme of Intervention for Prevention of Institutionalization (P.I.P.P.I.), involving 144 child care and protection cases (198 children) in nine Italian cities, in order to prevent out-of-home child placement and reduce child neglect. Inside the P.I.P.P.I. a series of case studies were developed to achieve an indepth understanding of the effective processes undertaken by participants with families. The case selected for this article has been chosen because it reflects a best practice in using the PTE as well as the participation path and is undertaken following the indications of the Critical Best Practice. It allowed an in-depth understanding of the mother's and professionals' viewpoints about what built the success in their practice. During the discussion three components are considered: the technical solutions offered by research or science (technical components) become meaningful when participants not only apply them, but act upon them, building, internally, the meanings to be enacted (internal component). In the case study this came about through dialogue between people, and through negotiation and reflection on competence, visions and values (communicative component).
1. The question of participation in Child and Family Social Work The literature widely acknowledges users' participation in Child and Family Social Work as linked to successful interventions (Serbati et al., 2012; Dumbrill, 2006; Healy & Darlington, 2009; Holland, 1999; Van Bijleveld, Dedding, & Bunders-Aelen, 2015). Moreover, the importance of participation in facilitating the achievement of planned goals is not only a literature assumption, but also a question of common sense. Professionals normally stress the importance of users' participation (Darlington, Healy, & Feeney, 2010; Gallagher, Smith, Hardy, & Wilkinson, 2012), but participation is a tough-to-reach goal. Several studies concerning parents' voices confirm the gap between the families' world and the services: parents often feel blamed by professionals, excluded from the decisions regarding interventions on their life, and confused by a system of power, which is often used against them (Serbati and Gioga, 2017; Dale, 2004; Dumbrill, 2006; Kapp & Propp, 2002). The literature also highlights the difficulties of professionals in realising a participative path with children and vulnerable families. Participation requires listening, answering, and thinking together. Quite an easy task when there are few worries to deal
⁎
with. But working with vulnerable families can be very problematic and may also be characterised by high levels of uncertainty (Arnkil & Seikkula, 2015; Roose, Roets, Van Houte, Vandenhole, & Reynaert, 2013). It is possible, therefore, to understand professionals' efforts to assure the safety and protection of the child, even if this entails an imbalance of power. In particular, if there is a condition of insecurity for the child, a safe process involving power control may be justified. Many participation ladders are available in the literature, representing power distribution between users and professionals. Table 1 proposes an elaboration of O' Sullivan's (2011) ladder related to participation in social work decision-making. The lowest level is the “non-participation” level that takes place when there are uncertainties about the child's protection. But children continue to seek answers for their needs from their parents (Ainsworth & Maluccio, 1998) and it is important to make efforts to proceed along the participation ladder. Even in these situations, another process is always needed that allows the parent and/or the child to understand the meanings and the reasons for what has happened. It is a process that gives the other the chance to learn from the past and manage decisions about their lives a little at a time. During a single care process many
Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Beato Pellegrino 28, 35139 Padova, Italy. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.childyouth.2017.08.032 Received 6 June 2017; Received in revised form 24 August 2017; Accepted 24 August 2017 Available online 15 September 2017 0190-7409/ © 2017 Elsevier Ltd. All rights reserved.
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(Dewey, 1933, 1938): instruments and data are used as a means of reflection and negotiation in order to justify choices and make decisions.
Table 1 Participation ladder for users' decision making (reworking of O' Sullivan, 2011: 46–50). Participation steps
Description
Being in control
The users' competence to make decisions for themselves is respected. An agreement is reached through dialogue and negotiation with users. Users' opinions are considered, but the decision is taken by professionals. Decisions are taken by professionals, users are informed.
Being a partner Being consulted Being told
3. Context and methodology of the case-study The case study featured here is taken from a research-action programme involving 144 child care and protection cases for a two-year period between 2013 and 2014 (198 children) in nine child protection agencies belonging to nine Italian cities (Bari, Bologna, Florence, Genoa, Milan, Palermo, Reggio Calabria, Turin, and Venice). The programme is carried out through the collaboration between the University of Padua and the Italian Ministry of Welfare and is called the Programme of Intervention for Prevention of Institutionalization: its abbreviation, P.I.P.P.I. is inspired by the fictional character Pippi Longstocking, a creative and amazingly resilient girl known all over the world. Children 0–14 y.o. were considered eligible for the programme if the case manager with the other professionals considered them in a situation of child neglect (following the completion of a questionnaire). The P.I.P.P.I. is used to test new approaches to assisting family situations, preventing out-of-home child placement and strengthening families in the effort to reduce child neglect, defined as a significant deficiency or a failure to respond to the needs of a child recognised as fundamental on the grounds of current scientific knowledge (Dubowitz et al., 2005; Lacharité, Ethier, & Nolin, 2006). In accordance with the bio-ecology of human development (Bronfenbrenner, 2005), the P.I.P.P.I. aims to respond to children's needs with a collective action, putting in place four “specific activities” involving families' ecosystem levels. These are: (1) home-care intervention: in-home activity aiming at addressing relationship problems and modifying behaviours; (2) parent's group: parents are involved in group activities with other families, fostering reflective practice, encouraging exchange and interaction between participants; (3) family helper(s): each family is provided with a support family or a family helper offering concrete support; (4) cooperation between schools, families and social services: teachers, with the other professionals, outline actions (both individualised and involving the entire class) allowing a positive school environment. The P.I.P.P.I. requires the PTE to be implemented through various quantitative and qualitative instruments that are also used to measure outcomes (for results see Serbati et al., 2016). Data were collected at three times: at the beginning of the intervention (T0), at the middle (T1) and at its end (T2). The results of the P.I.P.P.I. are encouraging and during the years the Italian Ministry of Welfare continued supporting the research. So, in 2014–2018 a scaling up has begun, where 150 new cities and approximately 2000 children has been involved. The analyses in aggregated form fail to give account to the real processes that build the success of the programme. So, a series of case studies were developed inside the P.I.P.P.I. to reach an in-depth understanding of the final results of the research, highlighting mechanisms and actions really undertaken by participants with families in order to realise the programme proposals presented during the three-day trainings attended by the professionals. The main aim of the case-studies is therefore to achieve an in-depth knowledge of what happens in child-neglect situations using the methodological proposals by the P.I.P.P.I. and by the PTE. An in-depth knowledge that is useful for generating reflections and thoughts among professionals and researchers on what really contributes to make participative work with families successful. The case selected for this article has been chosen because it reflects a best practice in using the PTE as well as the participation path. The meaning of best practice is assumed in accordance with the definition by H. Ferguson (2003: 1012):
levels of participation can be experienced and these can change over time. A second level is dedicated to the “apparent participation”, where the user maintains a passive role and the aim is to obtain consent for choices and decisions defined by the professionals. The highest levels correspond to real participation, to experiences of shared decisionmaking, in which participation is not only seen as a means to reach the goals, but as an integral part of the aim. In these levels, people gradually gain more and more decision-making power, through its redistribution, which can also lead to the self-management of their care plans. This participation ladder reflects the tough work that is needed to really pursue users' emancipation. One of the greatest difficulties experienced by professionals seems to be “not knowing how to do it”. Woodcock (2003) in his exploratory study, notes that professionals use intervention models designed more on their life experience, rather than on theories, tending to urge parents to change, rather than giving them the tools to do it. Through a case study analysis, this article is thus dedicated to making a methodological proposal in order to pursue participation at the highest levels. 2. The participative and transformative evaluation The Participative and Transformative Evaluation (PTE, Serbati and Milani, 2013) is a method aiming to guide the achievement of participation. The PTE follows the typical steps of the evaluation process (referral, welcoming, assessment and planning, intervention and monitoring, conclusion). It involves a cyclic path (Adams, Dominelli, & Payne, 2009), where each cycle corresponds to a phase of the care process (Fig. 1). The cycles suggest that there is not a simple linear process of assessing, planning, intervening, and monitoring: “the phases lack order and sequence, and include iterative elements” (Shaw, 2011: 89). To be fully realised each cycle needs two functions: 1. reflection and negotiation: each cycle requires time for listening and reflecting, in order to deepen the perspective of each participant and negotiate an agreement for the action; 2. action: the realization of the negotiated tasks, which always requires feedback and new negotiations and adjustments in order to produce change. In the steps of the care process several instruments could be used to build such participative contexts where families try to experiment a new balance or make new decisions enabling them to improve the children's development and their daily life. This task, which is inspired by the thoughts of Dewey, is a task of thinking and reasoning, in order to negotiate between all the actors, the meanings of what we are doing with families and children. During the PTE, professionals and families are expected to work together around instruments and information that are used as means to identify both the strengths and the difficulties. Practitioners become co-workers and co-researchers with parents, teachers and other actors in helping to foster positive child developmental pathways. In realising each cycle, a process similar to a scientific inquiry is adopted in which the competence of thinking is developed
“What constitutes best practice is not determined alone by the agency, the law and wider system of rules and regulations, but the views of the broad range of participants—service users, managers, front line professionals—should be represented in terms of how the practice was constructed 215
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Fig. 1. The Participative and Transformative Evaluation model (PTE).
HOW IS IT GOING? A question to be considered during the intervention period for the monitoring, as well as at the end for the final evaluation. The completion of the grids requires the use of a concrete language, otherwise defined SMART, an acronym for Specific (targeting a specific goal for improvement), Measurable (quantifying or at least suggesting an indicator of progress), Assignable (specifying who will do what), Realistic (stating what results can realistically be achieved, given available resources) and Timely (specifying when the goal can be achieved). The set of completed grids constitute the “shared care plan”, representing all the work that is done by all the actors involved. In the P.I.P.P.I. programme it is expected that the “shared care plan” should represent the four “specific activities”. The completed Triangles and Micro-planning grids of the case-study were considered as documents to be analysed in order to find out processes that realise the PTE. A content analysis was conducted, comparing the participants' Triangles between each other and with the final “shared care plan”. Moreover, the case study is based on interviews with eight of the key actors in the case: two social workers (child protection and disability area), two home-care workers (child protection and disability area), the director of home-carers, the psychologist, the physiotherapist and the mother. The interviews took place one year after the conclusion of the P.I.P.P.I. All the participants signed the Informed Consent, accompanied by the Information Sheet with all information about the objectives of the research and the possibility to withdraw the consent at any moment of the research. Semi-structured, audio-taped interviews were conducted and transcribed. Broad, open-ended questions were used to elicit the practitioners' and mother's stories and points of view about the P.I.P.P.I. experience. Thus, the interviews specifically focused on different ways and steps of defining and implementing the PTE, with particular attention paid to the manner of sharing decisions and using Triangles and Micro-planning grids. The coding of the transcripts collected themes, concepts and propositions belonged to the respondents around the phases of the PTE, in order to compare the different points of view and highlight agreements about what constitutes the best practice.
and given meaning”. A key analytical challenge for the case-study was therefore to collect the diverse narratives and to build from them a unifying representation of what constitutes a (best) practice (Houston, 2014). The methodologies used are coherent with the Critical Best Practice (CBP, Ferguson, 2003) which “honours the fact that practice is a co-construction between all the actors and systems involved. Practice may still mean different things to different people, but points of agreement about what constitutes ‘best’ are crucial”. The selected case constitutes an exemplary case for learning in respect of the core dimensions of engaging service users, establishing helping relationships and realising participation experiences. It involved the ‘neglect’ of a single mother with three children, aged 9, 7 and 4 years at the time of the start of the programme. The first and the third children are female, the second child is a male and has a developmental cognitive delay. Two key instruments by the P.I.P.P.I. will be considered for the case study: The Child's World and the Micro-planning grid. The first (usually depicted as a Triangle, Fig. 2, Milani et al., 2015) is the Italian adaptation of the British Framework for the Assessment of Children in Need and their Families (FACNF-DoH 2000; DfES 2003). The adaptation refers to previous experiences (Serbati et al., 2012) and to other international programmes (Chamberland, Lessard, Lacharité, Dufour, & Lemay, 2012; The Scottish Government, 2008). Like the original version, the three sides of the triangle represent the instrument's three domains (Child's developmental needs, Parenting Capacity, Family and Environmental Factors), which organise the overall 17 factors. The Triangle is used by professionals to conduct a comprehensive assessment collecting the voice of each participant and to plan the activities that will be carried out, and subsequently to document changes. If a factor deserves being planned, professionals use the Micro-planning grid (Serbati and Milani 2013; Serbati and Gioga 2017), in which the following questions are answered: (a) WHAT? What problems/resources are to be addressed; (b) WHY? The goals to be achieved; (c) HOW? The actions to be undertaken; (d) WHO? Responsibilities; (e) WHEN? When are the goals expected to be achieved; and finally, (f) 216
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Fig. 2. The child's world multidimensional model.
4. Results
4.2. Welcome The proposal to use the P.I.P.P.I. programme arrived when a change of course was needed. The professionals participated in a three-day training course and so were aware of what the PTE asked for, requiring full participation from all the actors involved and particularly from the mother. The words used by the social worker to describe the introduction of the P.I.P.P.I. to the woman signal a notable shift in approach: the blackmails disappeared and the P.I.P.P.I. is presented as something to do together.
The case study will be presented following the phases of the PTE. 4.1. Referral The mother started the referral which opened the case two years before the beginning of the P.I.P.P.I. programme. She was asking for a help in her difficult situation, and explains: We were inside a big tornado […] It was tough … I had just separated from my ex, I had been pregnant … and the pregnancy had not gone so well. Then, of course, the baby was born … I was really in the total shit. I called my mother, because with all this stress, I also had health problems. I had neglected loads of things. It was impossible for me to cope with it all. (Interview with the mother).
We told her: “Madam, we have thought of this programme as a way to help you”. We said: “We need you to do it”. (Interview with Social worker).
4.3. Assessment and planning
Professionals shared the difficult situation of this woman and underlined some issues related to her children's care:
The professionals, thinking of how to elicit the mother's participation, decided that the Triangle should be used first by the children separately, then by the mother for each child, and finally by the practitioners. The Triangle was used to explore the views of all the actors, assuring each of them their own space of narration. The children's triangles were filled with the home-care workers, who proposed it as a game (Fig. 3). The triangle was creatively re-interpreted by the children, abandoning the reference to the single factors and also using card games to complete it. The children' triangles were read and discussed by the social worker with the mother, and the discussion brought something new to this relationship, as recognised by the social worker:
The mother was not so focused on her children, they showed signs of neglect, the teachers complained about them being late in the morning and we found that at home there weren't regular meals… (Interview with director of home-carers). After her spontaneous referral, professionals expected to find collaboration from the mother. It did not happen: the woman did not follow the practitioners' suggestions. Here an escalation began, the more the professionals made new proposals for activities to the mother, the more she remained still. This immobility led the practitioners to use blackmails and to foreshadow her children's removal. No trust relationship was established with the mother. The woman said that she felt betrayed by the professionals that she had called for help:
It was interesting to look at the triangles together, to see the mother astonished at seeing what the four-year-old child wrote: she said that her mum had a cold, often crying because of her colds. But in reality the mother cried because of the house [an eviction was pending], but she told her children that she cried because of colds. So the mother learned that the young girl sensed her malaise. […] And she acknowledged that it is important for the children to know that she was fine, that she was working, that she was calm. (Interview with the Social worker).
When I met them [the professionals], they told me: “Come on, madam, you have to react. Otherwise we have to call the judge for child protection”. Here, I just saw red. Stress after stress, I got angry. So, I said: “No, you won't take away my children!” […] I felt betrayed by them. I went to them to ask for help. And instead of supporting me, they betrayed me. (Interview with mother).
The path of the PTE using the Triangle continued and the mother built her triangles (one per child) accompanied by the social worker, after seeing those of her children. The mother said that this activity 217
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Fig. 3. The child's world completed by the children.
mother, team of professionals) during the completion of the triangle. Similarities (in bold) are observable between the different actors. The professionals decided not to involve the mother and the children in writing the micro-planning grids. In their opinion, the completion of the Triangles required so much effort that it was excessive to think of their involvement in the grids. They considered the family's viewpoints about actions following the completion of the triangle and used them for the micro-planning grids. Referring to the Child's developmental needs of the oldest child, two of the common themes were chosen by the professionals, linked to two factors of the triangles, namely Learning and Play and Leisure (Tables 3 and 4). These two grids, like the overall 30 completed grids, are successful in respecting the requirements of the acronym SMART: they are specific, measurable, assignable, realistic and timely. Overall, out of the 30 micro-planning grids completed during the 18 months of the P.I.P.P.I. implementation, eleven are referred to T0, seven to T1 and twelve to T2. The micro-planning grids are evenly distributed between the three children (nine for the first child, twelve for the second one and seven for the third one). The slightly higher attention for the second child is due to his disability. Moreover, there are five micro-planning grids dedicated to common goals for the three children, referring to Employment and Income and Housing. There is an even distribution also between the three sides of the Triangle: fourteen for the Child's Developmental Needs, thirteen for the Parenting Competences and six for the Family and Environmental Factors. The latter also involves the five grids common to the three children. The factors chosen for the micro-planning grids are different for each child, except for Play and Leisure, which recurs for the first and the second child and Basic Care, which is common to the first and the third child. Responsibilities attributed to the planned actions see a high predominance of the mother, child and home-care worker, particularly for the Child's Developmental Needs and for the Parenting Competences (out of twenty-seven grids, twenty-seven responsibilities are for the mother, twenty-two for the child and twenty-two for the home-care worker). The responsibilities attributed to the triad mother/child/home-care worker reflect the hard work done around the parent-child relationship, as recognisable also from the analysis of the themes that arose. In three instances the responsibilities of other informal actors were involved (schoolmate's family and neighbors) and in another three, other professionals were involved (physiotherapist and psychologist). An exception is the factor Parents' Self-Realization, where only the mother is involved with the help of the social worker and home-care worker, and the parents group's facilitator. Quite different considerations are possible for the micro-planning grids completed for the Family and Environmental Factors: six times out of six they refer to issues involving the mother alone, struggling with the problems of house, employment and relationship with school. The mother is always accompanied by the home-care worker and four times by the social worker. Consequently, referring to the four “specific activities” required by the P.I.P.P.I. programme, the ‘home-care’ activity shows a much higher recurrence than ‘family helpers’ and ‘parents' group’ activities.
helped her to change her viewpoint and to focus her action on her children's needs: The kids really enjoyed [working with the triangles]. The boy loved to answer the questions. They are curious. They helped me to focus on things, on everyday life, whereas before I was more focused on anger, other things. I could see what they saw. Last year I took them on vacation. They said we hadn't done it for such a long time. Last year I took them around a lot, to have fun. For two years we hadn't had any vacation. Last year I took them, they saw new places, and they enjoyed it. (Interview with the mother). Also the home-care worker confirmed this change in the mother: It was possible for the mother to understand that every child needs her or his own space and own time. (Interview with the home care worker). The path of the PTE allows the circulation of information, the sharing of viewpoints that became common for the professionals and for the mother. It makes it possible to change people's view, particularly the professionals' view of the mother, as described by the social worker: We [the professionals] compared the mother's triangle with those of the kids. We were astonished, because in the triangle we saw a very competent mother. She pointed out things that match the children's desires and aspirations. For example, the children would like their clothes to be prepared by their mum in the evening for the next morning, and the mother had similar things in mind, like preparing the schoolbag for example. All things that concern caring for the children… (Interview with the social worker). Then, the team of professionals built its own triangles (one per child) and compared them with those reported by the mother and by the children. And again they discovered that their expectations for the children's care were close to those expressed by the mother, even if she had not put them into practice yet. Moreover, the professionals testified how the work of reflection and negotiation of the different points of view required by the PTE also helps to reinforce the professionals' relationships in order to carry out different actions but with common goals and aspirations: It was important to connect all the different actors, everyone with their own skills. And this also makes it easier to focus on common goals. Like a common track that everyone can follow. And this also promotes trust between the actors. (Interview with home-care worker 2). We were also a much stronger team, we all felt our actions to be more legitimate. (Interview with social worker). This work of communication, reflection, and comparison allowed the definition of various themes and in many cases the voices of children, mother and professionals agreed. The themes that arose were considered in order to build the care plans following the factors of the triangle. An in-depth understanding of the process can be gained by focusing on the Child's developmental needs of the oldest child at T0. Table 2 represents the themes considered by the different actors (child, 218
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Table 2 Example of themes arising through the PTE.
Summary of the speech Themes
Child
Mother
Team of professionals
To dance, to find the clothes ready, to be helped and get together with others, to learn to read by myself, to play with Shanghai. To be helped (homework); To read by myself; Dance; To play/To stay with friends.
To go to the dentist, to sleep well, to express emotions about her father, to be gratified, to stay in contact with friends. To sleep well; To be helped (emotions); To stay with friends.
To sleep well, to study, to read alone and be helped to do it, to dance, to learn some board games that help her to have more friends. To sleep well; To be helped (homework); To read by herself; Dance; To play/To stay with friends.
‘Cooperation between schools/families and social services’ is never cited.
Table 4 Example of micro-planning grid. Play and Leisure
4.4. Intervention and monitoring
Problem
The work done for the phase of assessment and planning was used as a map for all the actors involved during the intervention periods (between T0 and T1, between T1 and T2, after T2). The mother was not aware of the existence of the map, but it was used by the professionals, and particularly by the home-care workers, to build the plan of actions with her, keeping the map in mind.
Goal Actions and Responsibilities
Time
In everyday life it [the map] helped me with the mother to understand concretely what we could do. I'll give you an example. It was difficult for the mother to stay with the kids all together and from the triangles we learned that the three children would like to do some things with her. We planned some practical activities where the children and mother could stay together, like making a cake. (Interview with home-care worker 2).
The child is not involved in activities to enjoy herself. To occupy the free time with sports and simple games to have fun The mother, together with the home care worker, does the following activities: playing with Shanghai and with other board games, cooking. The mother, with the help of the home care worker, invites the child's friends at home 3 months
external issues to be faced by the family, such as the hospitalisation of the male child at T0, or the eviction coming at T1. These external issues clearly stress the competences of the family and of the mother, hindering the achievement of the planned goals. The same external issues plus the mother's unemployment were at the origin of the “not-reached goals”. Particularly the eviction is described by the professionals and by the mother as a difficult time: the mother and children were placed in temporary accommodation in a charity-run apartment block where the family lived in a single room and the kitchen was shared with the other residents. It should have been an emergency solution, only for two months, but it was prolonged for two years due to the unavailability of public housing. This situation “held everything back” as the home-care worker commented. The unexpected event hindered the completed achievement of the planned goals and this explains the increase of the “partially-reached” goals. However, it didn't prevent the continuation of the acquisition of autonomies: a mechanism had been activated to help the mother find a way to ensure her children's wellbeing, as suggested by the home-care worker:
After the actions had been implemented, the professionals assessed the achievement of the planned goals (reached, not-reached, partiallyreached). Only a few of the micro-planning grids are classified as “reached” (3 at T0, 1 at T1 and 2 at T2). Also the classification “not reached” is infrequent (3 at T0, 2 at T1 and 0 at T2). On the other hand, there is an increase over time of the classification “partially-reached” (5 at T0, 4 at T1 and 10 at T2). Overall the trend of the reached/notreached/partially-reached goals seems to suggest a small improvement. Each completed micro-planning grid is accompanied by a text explaining the motivations that allowed or hindered the achievement of the goals. By analyzing these motivations it is possible to observe that the six grids with the “reached goals” are characterised by actions planned involving the relationship between mother-children-professionals. They involve actions such as “playing with the mother”, or “paying for the swimming pool” or “showing the child how to have a shower”. Only twice did the realised action involve other people such as teachers. These were not previously involved in the assessment and planning work but were present during the action. The nineteen “partially-reached goals” are commonly (twelve times) due to goals with high demands needing more time to be achieved. In one case it is due to the need to carry out actions involving not only the children, mother or professionals but also informal resources (schoolmates' family) and this was not done. In six cases the “partially-reached” goal was due to
The PTE and its instruments gave the mother a good basis for creating the necessary competences […]. Now she is gradually coping on her own, also organising the school buses, once you had to stand behind her, urge her, this year she has done everything alone. (Interview with home-care worker).
Table 3 Example of micro-planning grid. Learning Problem Goal Actions and Responsibilities
Time
The child arrives late at school and seems so tired as to not participate in school activities The child goes to sleep on time and the mother prepares all she needs for school the evening before. With the financial help of the neighbors, the mother buys a bed for each child; At 21:30 the mother puts the children to bed and the light is turned off until the morning; During the evening the mother, with the children, gets the clothes and the school bag ready for the morning; At 7:50 the children leave the house with the mother to go to school. 3 months
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four of the “specific activities” foreseen by the P.I.P.P.I. programme. ‘Cooperation between schools/families and social services’ is never cited in the planned goal, but it appears twice in the comments after the implementation of the planned actions. So the requirement to build a “shared care plan” collecting the actions for all the participants is satisfied. By analyzing the themes of the micro-planning grids, it is possible to see that the higher presence of the home-care activity has its place because it is linked to a greater focus on children-mother relationship issues, which could be dealt with inside the family's home, by the home-care worker. Besides the technical components, other components are recognisable that can help explain the success of the intervention. The participative path allowed the mother, but also the professionals, to change their view of one another, thus fulfilling components that could be defined as internal since they are linked to changes in the participants' minds. With regards the mother, the case study shows that her parenting competences are potentially present as early as the time of first use of the triangle. They were there, but weren't put in place. During the programme, a change happened internally for the mother: she started to see herself and her children in a new way and, thus, to act differently. Similarly, also her view of the professionals changed and they stopped being enemies and became partners in finding solutions in order to respond to the children's needs. There was also a change in the professionals, who started to recognise the mother's competences. The professionals also changed the way they viewed one another and began to integrate their competences towards the same goals, which also led to a higher inter-professional satisfaction. The internal components therefore changed the way the various participants saw each other and allowed them to promote new ‘actions’. The technical components alone, that is to say the observance of the specified technical rules, would not be sufficient, as they would only be defined externally (Habermas, 1987; Kemmis, 2001). But social work is not “some kind of robot-like mechanical performance that is devoid of any theoretical reflection” (Carr & Kemmis, 1986: 116). It was necessary to build the internal legitimacy with the reasons that explain the action (Geertz, 1997; Soulet, 2014). In the case study, the professionals and the mother discovered their “reasons for acting in one way rather than another", they were "able to evaluate those reasons, to revise or abandon them, and replace them with others” (MacIntyre, 1999: 12). It required patience, time and effort. Moreover, the accomplishment of the internal and technical components was not enough. In the case study they didn't happen in a vacuum and neither in isolation. It was necessary to abandon the image of the autonomous, rational individual, with a purposeful rational way of thinking and acting, as the mother was seen by the professionals during the referral phase. Participation required not only technique, managed by a single person, but also reason and the reasoning of all the people involved (Bernstein, 1983). In the case study, also communicative components were involved that made it possible to change the participants' viewpoints internally and to carry out the techniques appropriately. They were able to question the technical proposals, in a way that permitted them to forge their views and assumptions through consensus and coordination (Bove & Sità, 2016). According to Dewey (1933) the reality of social action lies in the thoughts of the people that do it. The proposals for negotiation and reflection foreseen by the PTE (technical components) were effective not because they were taken in a rigid way and reproduced on the basis of protocols. The effectiveness derived from the technical components being redesigned and taken within a collective communicative process able to establish "the basis for a unanimous coordination of individual actions" (Habermas, 1987: 521). Participants became co-researchers in examining and challenging the new proposals with respect to those already embodied in their practice. Only within this ‘unanimous coordination’ was it possible for the participants' viewpoints to change (internal components), thus allowing them access to the highest levels of participation. The paper assumes that it is not sufficient to follow the technical
4.5. Conclusion: towards autonomy Today the care process with this mother and her three children has not yet ended, but it continues in the form of light supervision by the social worker. The professionals state that the process of the PTE has allowed the mother to become more autonomous and she can now get by using her own resources. When the interviews took place, the family had finally been moved into new public housing. As described by the social worker, the mother was able to cope by herself with the issues concerning the change of home: The mother now considers the children one by one, and not as ‘the children’ in general; she understands that she has three children with three different individualities who need her in three different ways. This was the greatest goal for her. Even now that she has to decide how to divide the children bedrooms, she did it thinking of the children's needs. (Interview with social worker). 5. Discussion and conclusions Following the assumptions of the PTE, the case study of the three children and their mother shows an overall small improvement over time, testified by the results of the micro-planning grids, even if several partially-reached and some not-reached results remained. The partial improvement seems linked to external issues that prevented the planned goals from being attained. The hindering issues reported by the interviewees include the mother's unemployment and the housing eviction, which found no solution during the experimental path. However, results since the micro-planning grids were made reveal the mother's competence in ensuring her children's care, despite the difficult conditions (Barudy & Marquebreucq, 2005). The success of the intervention is even more evident on considering the interviews, which took place about one year after the conclusion of the experimental path: all the involved actors show full satisfaction for the mother's acquisition of several autonomies. The case study suggests that mothers' and children's participation in the decision making was central for achieving this important result. In the ‘Referral’ phase, the mother could be said to have been involved at the being told or being consulted levels (with reference to the participation ladder presented in the first section) and decisions were taken by the professionals. The shift happened after the training sessions attended by the professionals about the proposals of the PTE, when they applied the model to the phases of ‘Welcome’ and ‘Assessment and Planning’, using the participation instruments, and, in particular, the triangle with the mother and children. At this point, the being a partner level was reached with the mother. Certainly, some limitations can be recognised. For example, the mother was not directly involved in the planning phase and neither the children. The interview with the mother shows that she did not know how the triangles were used after their completion. There was the risk of taking the concept of participation only to the level of being consulted, with decisions still being taken by professionals. However, the actions planned in the grids were constantly re-discussed between the mother and the home-care worker, suggesting that higher levels of participation were continually sought. All participants consider the care path a best practice, outstanding for the users' participation processes put in place. The case study helps to understand and discuss the different components of the mechanism that allowed it to be achieved. A first level of analysis concerns the technical components, referring to the good correspondence between the requirements of the PTE and the actions really undertaken. As required by the PTE, through the Triangle all the participants' voices were heard and through the micro-planning grids these voices became concrete actions for the care plan. The Triangle was used for an in-depth understanding in all of its three sides, for each child, in each of the three completions (T0, T1, T2). Moreover, during the completion of the micro-planning grids, goals and actions were defined for three out of 220
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solutions and proposals made by science or research in order to make a successful intervention in Child and Family Social Work. Participation is a key issue but cannot be simply applied. In this regard the question from W. Lorenz (2012) appears fitting: “was it possible (and appropriate) to transfer the scientific approach that proved successful in relation to the nature, to the social sphere without robbing its members of the very freedom gained by the advance of reason and subjecting their behaviour instead to laws and regularities over which they had little control?” Technical solutions have their place, but social work is not a standard process to be managed directly through procedural or technological means. The in-depth understanding of the different viewpoints about what built the best practice highlighted that social work is best managed by indirect means, such as competence, dialogue, visions and values, through culture in other words (Featherstone, White, & Morris, 2014). It “requires practitioners to act upon research methods rather than simply apply them” (Shaw & Holland, 2014: 292). Consistently, the PTE requires people to think and reflect on its proposals, interpreting them in their own way. H. Ferguson's Critical Best Practice and qualitative methods in general seem helpful in questioning the different components that made the intervention effective. However, more qualitative studies are needed in order to understand whether the categories of technical/internal/communicative components could really be useful in supporting effective intervention. Acknowledgements I wish to thank [anonymised] for her helpful advice and support during the preparation of this paper. I am also indebted to all participants that take part to the interviews. Funding This study was supported by [anonymised], inside the financing of [anonymised]. References Adams, R., Dominelli, L., & Payne, M. (2009). Social work. Themes, issues and critical debates. Hampshire: Palgrave MacMillan. Ainsworth, F., & Maluccio, A. N. (1998). The policy and practice of family reunification. Australian Social Work, 1, 3–7. Arnkil, T. E., & Seikkula, J. (2015). Developing dialogicity in relational practices: Reflecting on experiences from open dialogues. Australian and New Zealand Journal of Family Therapy, 36, 142–154. Barudy, J., & Marquebreucq, A. P. (2005). Les enfants des mères résilientes. Paris: Solal Editeurs. Bernstein, R. J. (1983). Beyond Objectivism and Relativism. Oxford: Blackwell. Bove, C., & Sità, C. (2016). Collegare le esperienze nella ricerca. Sostenere esperienze di inquiry collaborativa tra ricercatori e professionisti. Encyclopaideia, 44, 57–72. Bronfenbrenner, U. (2005). Making humans being human. Bioecological perspectives on human development. London: Sage Publications. Carr, W., & Kemmis, S. (1986). Becoming critical. Education, knowledge and action research. Lewes: The Falmer Press. Chamberland, C., Lessard, D., Lacharité, C., Dufour, S., & Lemay, S. (2012). Recherche évaluative de l'initiatives AIDES. Université de Montréal. Dale, P. (2004). “Like a fish in a bowl”: Parents' perceptions of child protection services.
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