Blogs

Inequality Matters

Cathy Ashley

December 10, 2013 by Professor Paul Bywaters, Coventry University and Professor Brid Featherstone, Open University

In the last decades there has been a considerable rise in inequality in the UK. The work of epidemiologists Wilkinson and Pickett (2009) has illuminated the impact of this rise in inequality bringing an array of evidence in their book, The Spirit Level: Why More Equal Societies Always do Better, to reach conclusions that have been the subject of considerable debate and critique (for a good review see Rowlingson, 2011). Wilkinson and Pickett collected internationally comparable data on health and a range of social problems: levels of trust, mental illness (including drug and alcohol addiction), life expectancy and infant mortality, obesity, children’s educational performance, teenage births, homicides, imprisonment rates and social mobility. Their findings suggest that there is a very strong link between ill health, social problems and inequality. Differences in average income between countries are important up to a certain level of development, but differences within developed countries are key. The amount of income inequality in a country is crucial, often reflected and compounded by a range of other markers of inequality, such as access to good housing, education, employment and health services.

When it comes to children’s services policy, however, this evidence and, indeed, this way of thinking, is strangely absent. In 2013 a child in Blackpool has an 8 times greater chance of being a looked after child (LAC) in out-of-home care, than a child in Richmond Upon Thames, and similar differences are found in rates of children on child protection plans(CPP), with relative deprivation as the major causal factor (Bywaters, 2013). However, only recently have these differences in rates of children’s services interventions begun to be thought of as an issue of childhood inequality, forty years on from the emergence of health inequalities into public discourse. Child welfare inequalities have been defined as, ’unequal chances, experiences and outcomes of child welfare that are systematically associated with social advantage/disadvantage’ (Bywaters, 2013, p.4).

New research for the Nuffield Foundation1 studying over 10% of children in England has found:

• Very large inequalities. Children in the most deprived 10% (decile) of neighbourhoods have a 10 times greater chance of being on a CPP and an 11 times greater chance of being a LAC than children in the least deprived decile. In the most deprived 10% of neighbourhoods, on average, around 1 child in 90 is in out-of-home care, in the least deprived 10%, only 1 child in 1000.

• A gradient in CPP and LAC chances across society. There are children on CPPs or in out-of-home care from neighbourhoods across all levels of deprivation from the most affluent to the most deprived but each step increase in deprivation brings an increased rate of these extreme children’s services interventions. This gradient is also found for children’s health and educational attainment. Reducing inequalities (the steepness of the gradient) in children’s chances of welfare interventions could be an aim of policy and practice.

Graph

• Evidence of an ‘inverse care law’ in children’s services. In neighbourhoods with equivalent levels of deprivation, local authorities with low overall deprivation scores have higher rates of CPP and LAC than more deprived local authorities. For example, in the most deprived 10% of neighbourhoods nationally, the LAC rate in relatively affluent Herefordshire is 4.75 times greater than the LAC rate in much more disadvantaged Sandwell. This inverse relationship between the overall deprivation in a local authority (LA) and their rates of CPP and LAC interventions at each decile of deprivation holds true across all levels of deprivation albeit with variations between individual LAs.

This study needs replication and we have only briefly reported the findings here. But the pattern of inequalities reported is supported by the fact that it clearly reflects what has been found for health: large socially constructed inequalities, a gradient in life chances across society and an inverse relationship between need and access to services.

One thing needed now in children’s services policy and practice development is a debate about the significance of and explanations for these inequalities and a central and highly topical issue concerns the impact of relative poverty on parenting and child maltreatment. . As Wilkinson and Pickett note, whether people are happy with their income depends not only on its level but also on how it compares with what others around them have. However, the lack of income in an unequal society poses concrete everyday challenges for all members of families affected and these can be intensified by, as well as sometimes ameliorated by, services. The important research by Hooper et al. (2007) offers some helpful pointers for further debate and research. Their findings on the relationship between poverty and maltreatment focus on stress, with social support as a key factor in promoting resilience. These findings fit with a wider literature from a range of disciplines that points to the importance of social networks in supporting and promoting wellbeing and the reverse (see Cottam, 2011). Hooper et al (2007) found the ‘spoiled’ identities associated with poverty and other life experiences could lead to social isolation. The need for recognition and respect, often denied to people living in poverty and those who experience forms of adversity such as violence and abuse, could make children’s behavioural problems difficult to bear or manage.

‘Some life experiences made poverty more difficult to manage and poverty made all other forms of adversity more difficult to cope with’ ( p,32). Children’s actions such as running away, or wanting contact with an ex-partner could impede the capacity to protect especially when social, financial and personal resources were stretched. Finally, services could compound feelings of powerlessness especially when practical resources (such as housing) were not addressed.

Hooper et al found in discussion with professionals that poverty often slipped out of sight as they focused on drug or alcohol problems and on individual attitudes, values and priorities. ‘A limited conception of poverty, lack of resources to address it, and lack of attention to the impacts of trauma, addiction and lifelong disadvantage on the choices that people experience themselves as having may contribute to over-emphasising agency at the expense of structural inequality’ (p, 97).

Perhaps it is because ‘it is well established that the need for children’s personal social services is directly related to social disadvantage’ (Department of Health, 2000, p. 90), because social workers see so much social inequality without feeling able to have an impact on it, that they become immune to recognising its impact on people’s lives. Or perhaps the policy context in which social workers operate fails to support action to minimise and mitigate material deprivation.

This failure to recognise extreme child welfare interventions as markers of social inequalities (and which may sometimes compound social inequalities) is not helped when the Secretary of State, Michael Gove, equates social workers ‘understanding of the impact of social inequalities with robbing ‘families of a proper sense of responsibility, …. (and) abdicat(ing) their own.’ Understanding does not mean ‘explaining away’. It does not mean failing to recognise and act when children are vulnerable. It does mean focusing strategic attention on the upstream and midstream causes of damaged childhoods. And it does mean that practice downstream has to be re-imagined to break the link between deprivation and coercive state interventions in family life. As the WHO put it for health inequalities (with our additions):), ‘It does not have to be this way and it is not right that it should be like this. Where systematic differences in health (child welfare) are judged to be avoidable by reasonable action they are, quite simply, unfair…. Putting right these inequities – the huge and remediable differences in health (child welfare) between and within countries – is a matter of social justice.’

Notes

1. Bywaters, P., Brady, G, Sparks, T. and Bos, E., Deprivation and Children’s Services Outcomes; what can mapping looked after children and children on child protection plans tell us? Funded at Coventry University by the Nuffield Foundation, 2013-14.

References

Bywaters, P. (2013) ‘Inequalities in child welfare: towards a new policy, research and action agenda’, British Journal of Social Work, online advanced access.

Cottam, H (2011) ‘Relational Welfare’, Soundings, Summer, 48, 134-144

Department of Health (2000) The Children Act Report 1995 - 1999, London, The Stationery Office.

Hooper C-A., S. Gorin, C. Cabral and C. Dyson (2007) Living with Hardship 24/7: The diverse experiences of families in poverty in England, London, The Frank Buttle Trust

Rowlingson, K (2011) Does income inequality cause health and social problems? York, Joseph Rowntree Foundation

Wilkinson, R and Pickett, K (2009) The Spirit Level, London, Penguin

An adviser's reflection on the Children and Families Bill 2013

March 26, 2013 by Susan Moore, Adviser

We are in a time of huge change for families with welfare reform and major spending cuts affecting children and families.

One of the most significant changes that will impact on the families who use our services is the Children and Families Bill 2013.

The Bill includes major reform to the systems for adoption, looked after children, family justice and special educational needs. In short, all of the issues that families contact us to discuss are about to get a serious overhaul and the implications are huge.

The Government is promoting the Bill as improving services to vulnerable children and supporting strong families but, from the point of view of many of our service users, there are some very serious concerns.

In particular, I feel increasingly worried about the effect that the Bill will have on the ability of family and friends carers to care for children being removed from their parents.

If a child is removed from a parent’s care, either by consent of the parent or by order of a court, the Children Act 1989 currently gives priority to placing the child with a suitable family member before someone not connected to the child. Under a clause in the new Bill, however, if adoption is being considered as a possible outcome for a child, the local authority must consider placing the child with a potential adopter who is temporarily assessed as a foster carer (a “foster to adopt placement”). The local authority is exempt from prioritising family members as carers in these circumstances.

As an organisation, we believe strongly that it is best for children to be raised within their birth family wherever this is safe and suitable to meet their needs. The above development is, therefore, of great concern. Taken with measures such as the speeding up of care proceedings, it is going to be vital for potential carers from within a child’s family to come forward as early as possible, otherwise they are in serious danger of being overlooked and for the child to end up outside the family.

There are many examples from our advice line of situations where family members do not put themselves forward at an early stage for various reasons.

Some relatives simply don’t know what is happening early on, like the aunt I recently advised who had a strained relationship with her sister. She had received third hand information through a family friend that her niece and nephew had been removed in to care but had no details of the situation and no idea what to do to have the children placed in her care.

I was able to talk her through approaching the local authority and putting herself forward as a carer for the children. I can’t help wondering, though, if, in a year’s time, some of these calls may come too late to keep children safely within their families, particularly when there are very young children involved.

In other situations, family members may be fully aware of a situation and involved in supporting the child’s parents through care proceedings. In some of these cases, relatives can feel unable to come forward and offer to care for children for a fear of undermining mum and dad’s position.

I can think of a grandmother I have spoken to in the past who found our conversation extremely hard. She wanted to support her daughter, who had mental health problems as much as possible. Coming forward as a potential carer for her grandson felt like a betrayal as well as an assertion that her daughter was not capable of parenting him. Her view was, if she was needed, she would come forward and do whatever was necessary to keep her grandson safe, even if that meant restricting her contact with her daughter. But she didn’t want to do that until she was certain that he was not going home with mum.

In the above case we had a long discussion about parallel planning and the importance of having a back up plan for children even if they may be able to remain with their parents. Putting herself forward as a carer for her grandson was not letting her daughter down but supporting her to ensure that the baby was not going to be permanently placed outside of the family.

In the future, such conversations may well be more frequent and more urgent. Family members will not have the luxury of time if they wish to have children placed in their care. They will need to be clear about their availability from the very beginning of the process.

A day in the life of an adviser

October 23, 2012 by Susan Moore, adviser

Demand for our advice service is growing month by month; it is a challenging time to be advising in this complex area. It is vital for us advisers to keep up to date with legal and policy developments but also to be constantly aware of how these changes are impacting on services on the ground.

It’s difficult to prepare for a shift on our advice line because the calls we get are so varied both in terms of content and tone. The best thing for me to do is ensure that I’ve cleared my mind of previous calls or anything else from the morning. When the phone rings, it’s a blank page to be filled.

The first call comes in early. A grandmother calls in tears. Her two grandchildren, who live at the other end of the country, have been removed into foster care because of an unexplained injury to the baby. The whole family are devastated. She feels confused and helpless. What is going to happen…?

Unfortunately that’s a question I can’t answer. I can explain the process though, talk about options, help the caller to realise that there are things she can do to effect the situation. We talk about the importance of the family in care cases; kinship care options, family group conferences. The call is longer than many but the result is worth the extra time. By the end of the call, the caller feels reassured “I haven’t got an answer, but I have got a plan”. There is a good chance that our 40min call will result in two children being back within their family in the near future.

A number of short and straightforward calls are dealt with including referrals to our partners when the issues fall outside of our remit and signposts to advice sheets and decision trees on our website.

My next caller has just attended a review child protection conference and is angry and distressed that her child remains under a child protection plan. She is a victim of domestic violence but feels blamed rather than supported regarding her ex partner’s behaviour.

It is important to hear and acknowledge the caller’s anger without allowing it to dominate the call. It’s in the caller’s best interests to see the situation from Children’s Services’ perspective. We discuss what aspects of the child protection plan the caller can agree with, what issues she feels she needs to challenge and the most productive way of doing this.

I refer the caller to our discussion board for parents as a safe and supportive space for her to vent her frustrations and benefit from peer support while co-operating with the process surrounding her child.

Finally, I am speaking to an expectant mum whose husband has been arrested on suspicion of child sex offences. She is devastated and bewildered. She knows her husband and knows he could not have done this and yet the social worker carrying out the core assessment is already talking about them separating.

It’s a hard call. It is vital that I am completely honest and realistic with the caller. She feels she knows her husband but she cannot truly know what lies behind the allegations. Regardless of the outcome of any police investigation, Children’s Services may remain firm in their view that her child will not be safe while she and her husband are together.  In this case, she may be faced with the stark situation of choosing her child or her husband. Only she can make the right decision for her family; my priority is to ensure that any decision she makes is as informed as possible.

As the line closes, my focus turns to recording the afternoon’s calls on our confidential database. It is vital that these are as clear and detailed as possible to ensure any future queries are dealt with as quickly and efficiently as possible if a caller needs to come back to us as their situation develops.

With records complete and any relevant follow up work done, now it’s time to tackle the emails…..

To find out more about our impact read the Evaluation of Family Rights Group Advice and Advocacy Service.

When is an advice call more than an advice call…...?

December 21, 2012 by Susan Moore, Adviser

Advice is defined as an opinion which someone offers you about what you should do or how you should act in a particular situation (Cambridge University Press- Cambridge dictionaries online)

Our advice line receives an average of 700 calls per month. Some of these fit in to the definition of advice very well. A question is asked, information is provided, and the caller goes away with a clear sense of what they should do and the implications of this action.

However, people’s lives are rarely so straightforward. The majority of our callers come to us with a complex package of experiences, questions and needs and most calls could not be described as pure advice.

Providing a listening ear

Advisers have a wealth of knowledge and experience in order to offer callers clear and in depth information and advice about a range of legal and practice issues. In addition, however, it is vital that we have and use a range of counselling skills such as empathy, a non judgemental approach and active listening.

Callers come to us in a range of emotional states. Because of the nature of the advice we offer, many callers are deeply distressed, desperate, frustrated, and angry. Some calls can appear to be predominantly “counselling” calls.

A recent independent evaluation of our advice service, asked callers about their experiences of the advice line and what they had found most helpful. The evaluation report repeatedly highlights the value that callers place on this element of our service.

The truth is that much of the advice I and my colleagues give to parents is hard to hear. Often I advise parents to accept very difficult realities about their own situations, to understand concerns about them and their children and accept where changes might need to be made. I also, very frequently, advise people to co-operate with and engage in processes that feel desperately negative and unfair. Some of what I am advising a parent to do, for example, may have been said already by local authority social workers but they have been unable to hear or accept it. 

In order to give advice meaningfully, we must first truly listen to and understand our callers. Once they feel heard, callers are more able to hear, trust and act upon our advice. Of course it also helps that we’re independent of any decision about the child, which also assists in building callers’ trust. This is a real strength of our advice service.

Advocating for families

For some callers, advice is not enough. However well a caller feels heard, however accessible the information that is presented to them, however much they might understand and accept the advice being given, some callers simply do not have the capacity or resources to make full use of the advice without further support.

The advice we are providing to a grandmother caring for her 2 severely disabled grandchildren without appropriate support from the local authority may be the key to moving things forward and preventing the placement from breaking down. But if she is too exhausted and overwhelmed to act on the advice, however, this value is lost and we are just another service unable to make a difference to her difficulties.

We have been successful in securing funding from the Orp Foundation and the Rayne Foundation to provide a limited amount of self and indirect advocacy to callers to our advice line who require this service. In practice, these are not big pieces of work. But sending the above grandmother a template letter, which she can adapt and send to Children’s Services or making a telephone call to a social worker on her behalf may be enough to make the advice truly meaningful and move the situation forward. The value that this adds to the advice service is tremendous, and this too is noted in the evaluation.

People’s lives are complicated, complex and fluid. As a result, our advice line has to match this need and be responsive to the people who use our service. As noted evidence from the recent evaluation is overwhelmingly positive, which is reassuring and indicates, in the great majority of cases we are getting the balance right. As we move in to 2013, I look forward to continue learn, listen, advocate and, most importantly, help our service users by giving them the type of advice they need.

Why we decided to set up the Care Inquiry

Cathy Ashley

September 30, 2012 by Cathy Ashley, chief executive of the Family Rights Group.

Family Rights Group advises over 7000 parents and family members a year who are involved with or require support from children’s social care services.  Some of these parents are crying out for help, for example to deal with their teenager’s violent behaviour, with their partner’s abuse or because their child has significant disabilities and they need practical help and respite. But too often they meet only rejection, until the crisis escalates into the child protection or youth justice arena, when they are then subject to statutory interventions.

There are huge differences across the country as to what preventative and early intervention support is in place, how readily the local authority initiates proceedings and the proportion of children who end up in care.

Since the death of baby Peter Connellly, many local authorities have become more risk averse and are more readily applying for care proceedings, with some children now being removed from their parents, who in the same circumstances a few years ago, wouldn’t have been. Unsurprisingly the courts and local authority social work teams are extremely stretched, the system is very expensive (care order applications cost the public purse well over £25,000 a case on top of the child’s care costs) and significant delays in finding a permanent placement for the child is a common occurrence.

Children who are in the care system are there either under a court order or a voluntary agreement with parents. In the latter, we see cases which have been allowed to drift, with no coherent plan in place and no external court scrutiny, the child is subject to multiple moves and split up from their siblings. Many of these children will return back to parents and many want to.  But often little work has been done with the adults or the child to address the very problems that led to the child going into care in the first place.  Whilst there are success stories, there are also cases of some children being deeply damaged or reabused.

There are 200,000-300,000 children in the UK being raised by family and friends carers, only around 4% of whom are in the care system i.e. where the carers are assessed as foster carers and the children are entitled to looked after children support services. The rest are raised under a residence or special guardianship order or indeed just with the parents’ agreement. Research shows these children have experienced the same adversities as those in the care system and do as well if not better, but the carers are often forced to give up work, suffer significant financial hardship and have to deal on their own with very difficult situations, such as managing contact or supporting a child deal with abandonment.

Initial research findings indicate that whether a child who is being raised by a family and friends carer ends up inside or outside the care system is primarily a reflection of their circumstances rather than their need or the level of abuse or trauma they have experienced. Moreover, in some cases, these children were placed by the local authority, and should be treated as looked after children, according to established case law, but the carer is kept in ignorance of this or the local authority actually denies such responsibility.   We also know that there is significant variation between and even within authorities as to what effort is made to explore whether a child who cannot live with their parents, but could live with a relative. Family group conferences, which are an effective approach in supporting family members to come forward to be assessed as a potential carer for the child, are still not routinely offered pre proceedings in most parts of the country.

At the end of March 2012, 4% of children who were in the care system were placed for adoption in England. In the last 18 months we’ve had revised adoption guidance from Government, new adoption scorecards, the appointment of an adoption Tsar, an adopters’ charter, an expert working group on redesigning adoption, an action plan for adoption, a House of Lords select committee inquiry into adoption and fostering to adoption measures will be included in the forthcoming Children and Families Bill. Yet adoption will never be the answer for the great majority of children who are in care, no matter how many adoption initiatives are announced.

Some children do remain or return home to loving parents, who have managed to address their own problems and put their child’s needs first with the help of committed social workers and other professionals.  Some children can’t remain at home and thrive under the care of an amazing foster carer, a loving and remarkable older sibling or a dedicated and battling adoptive parent.

However what the above picture shows, is that the system is inconsistent, can work against rather than facilitate the right outcome for each child, that policy announcements and practice on the ground are often driven by factors unconnected with evidence, and that when we get it wrong it is costly for the public purse, in terms of individual children’s lives and for society.

Read more about the Care Inquiry here.