Safeguarding Children in the UK: A Longitudinal Study of Services

Safeguarding Children in the UK: A Longitudinal Study

A longitudinal study in the UK tracked 105 children and young people who had suffered or were likely to suffer significant harm due to maltreatment or neglect.

Abstract

The study followed children across four English social services departments. Data was collected at baseline, 12-18 months later, and 8-9 years after initial concerns. 40% of children remained at home with a parent throughout the study. A majority experienced disruption. 57% experienced further maltreatment or neglect. Some children made good progress despite challenges. The study examines service patterns and factors that helped or hindered children's capacity to deal with stresses. It explores policy and practice implications to promote positive outcomes for high-risk children.

Keywords

Child maltreatment, kinship care, outcomes of protective services, safeguarding.

Introduction

The England and Wales Children Act 1989 defined 'significant harm' and 'likely significant harm' as thresholds for intervention in cases of maltreatment or severe neglect. The study evaluated the impact of the new legislation and aimed to identify if the 'balancing' required by the Act was achieved in a way that minimized risk and met the needs of vulnerable children. 105 children were identified in four local authorities in England. The initial report was published as Safeguarding Children with the Children Act 1989. The 8-year follow-up was funded by the National Society for the Prevention of Cruelty to Children.

Study Design and Follow-Up

The complex circumstances bringing families into the arena of significant harm often persisted beyond the initial study phase. Over half the cases still had problems indicating the child needed further help, and 40% had experienced further maltreatment or neglect. While two-thirds of children improved to some extent by time 2, one-third showed no change or deterioration. The study was extended to examine the life course and opportunities of these young people as they matured (time 3). An 8-year follow-up allowed observation of changes in younger children while making it feasible to trace files and conduct interviews for those already in their teens.

Risks to Healthy Development

Predictions on lasting improvements were influenced by research identifying enduring risks linked with child maltreatment like school failure, drug and alcohol problems, emotional and behavioral issues, and psychopathology. Early maltreatment was associated with higher disruption rates even in well-functioning adoptive or foster families. Additional losses and moves between caregivers, sometimes due to the protection process itself, can also be damaging. Returns home after placement can threaten stability. Disruption and lack of continuity are causes for concern in relation to child well-being. Poor outcomes are associated with repeated placement moves, impacting educational performance, physical health, relationships, and mental health. Reduction in placement moves was a target for local authority performance.

Positive Outcomes and Protective Factors

Movement in care is not inevitably associated with poor outcomes. Some 'successful' young people have experienced many moves. Some maltreated children demonstrate developmental competence due to inherent self-righting tendencies combined with protective factors in the individual and environment. Achieving good outcomes despite major developmental risks is possible. Emotional support from a non-abusive adult and a satisfying adult relationship can protect maltreated children from repeating cycles of abuse as parents. Gauging the extent to which interventions contribute to good outcomes and recovery from abuse is difficult. Many families receive multiple services concurrently or sequentially rather than intensive treatment.

Effective Interventions and Complex Cases

There is no more intensive treatment than a responsive family environment offering therapeutic care. Targeting parents and parent-child interaction in the home during early childhood shows stronger effects. Reviews suggest a gap in effectiveness for complex cases and 'late' intervention. The most needy, challenging families may be least helped by the most effective programs. Serious abuse and neglect often lead to less positive outcomes. The study describes the routes taken by 77 children tracked over 8 years, in conjunction with service levels. Data is placed in the context of baseline and time 2 data on the full cohort. Interim outcomes associated with various routes are outlined. Adversities, disruptions, and losses faced by children are considered, with examples of how some children coped, and factors associated with successful coping.

Methodology

Data was collected from four areas (two inner-city with multi-ethnic communities and two largely urban areas of mainly rural counties with mainly white British populations) on referrals of possible significant harm cases (n = 151) over an 8-month period in 1993–1994. Researchers identified 105 children for whom there was a prima facie case of significant harm. In most cases, a child protection conference (CPC) was held, and in 79 cases, names were entered on the child protection register (CPR). In 26 cases, a protection plan was put in place without formal registration or court action. Neglect was the major form of maltreatment for 33 children. Baseline data was collected from records on the 105 children. An intensive sample of 51 children whose parents were willing to be involved was identified. Children, families, and professionals were interviewed shortly after significant harm was identified and between 12 and 18 months later. Factual data, including changes of carer and maltreatment, were collected at time 2. Standardized scales were used to gauge well-being and satisfaction with services for the 51 intensive cases. Researcher ratings were made at times 1 and 2 on the extent of need and likelihood of future maltreatment or impairment. Ratings were also made of improvements or deterioration in well-being. This paper draws on these earlier data, as well as ‘time 3’ data, with respect to the 77 children whose records could be traced 8 years after ‘significant harm’ was identified. Progress was drawn from structured searches of 76 social services files and semi-structured interviews. Standardized scales were administered to young people, parents, and carers. The follow-up sample was broadly similar to the 105 cohort children in terms of age and ethnicity. More of the 77 were initially placed on the CPR.

Findings

The study focuses on outcomes for the young people, describing their experiences and services received over the 8 years. Information was triangulated to achieve a rating of the young people’s well-being and the overall success of the intervention. Researcher ratings were used to allocate each case to one of four outcome groups: ‘successful outcome’, ‘moderately successful outcome’, ‘little change’, ‘slightly worse’ or ‘worse’ than the time when significant harm was first identified.

Patterns of Intervention

Interventions by local authority social services departments were the focus. The task of protecting these children and supporting families was often carried out in multi-agency groups. Almost two-thirds of the children received long-term social services intervention over many years. A substantial number of cases (29) were still ‘open’ 8 years after significant harm. Just over one-third of the children’s cases (26) had been closed relatively early. In eight of these ‘closed’ cases, files revealed further problems that did not reach the threshold for intervention. Overall, there was continuity in interventions, but few children experienced continuity of social worker.

Family Changes and Placement Patterns

The complexity of interventions and changes in residence arrangements is summarized. This illustrates service provision and degrees of continuity or disruption.

Route 1: Children Who Stayed at Home (30)

Thirty children stayed at home with a parent or parents throughout. Most cases were closed relatively early (20), although a third received long-term help and five were still getting help at time 3. Further neglect or maltreatment was recorded for one-third (11) of the children, with concerns persisting for seven. Three-quarters had a good or moderately good outcome, a-quarter had not. An example included a baby with a fractured limb following an isolated outburst by the father. The case remained closed after a family support intervention and support from extended family.

Route 2: Children Who Returned Home and Stayed Home (14)

Fourteen children returned to live at home after time away and were still living at home when information was last collected. Cases were ‘closed early’ or received long-term intervention. Four children were still getting help. Over half suffered further episodes of neglect or abuse (8), persisting for five. These five were ‘unprotected’ children with poor outcomes. Half had a moderately successful outcome, half had a poor outcome. Andrew, with global developmental delay, spent 6 months in foster care due to neglect, but returned home at age 2 and was not re-abused. The multi-agency team established good relationships, and Andrew made progress with continued support.

Route 3: Children Who Left Home and Stayed Away (20)

Twenty children left home without returning. All had some formal oversight. Three were adopted as babies. Seven teenagers received long-term help. Ten other young people’s cases are still open. Another was in a mental-health setting, and another in a residential unit. Half suffered one or more episodes of neglect or abuse during the follow-up period, mostly before leaving home. The 10 children who were not re-abused had moved away within 1 year. Most had successful outcomes, but four did not. Nine children stood out as having the best overall outcomes and all but one took this route.

Route 4: Children Who Returned Home But Left Again and Stayed Away (10)

Ten children who returned home within 1 year, but then left again, have not subsequently gone home. Most had multiple moves, but three had settled with grandparents. All received long-term services, and eight were still getting help. All 10 had experienced further episodes of abuse or neglect. Seven appeared to have at least a moderately successful outcome. Terry had numerous moves before settling with foster carers at 14. He had experienced neglect and sexual abuse at home. Terry was still having family contact but said visits home often included witnessing bouts of domestic violence.

Route 5: Children Already in Care (3)

Three young people were already being looked after when significant harm was identified and stayed away from home throughout. All stayed in care for many years, experiencing multiple moves, and received leaving care services. Two had babies while teenagers and were offered parenting support. All three were in the ‘moderately good’ outcome group.

Incidence of Stability and Disruption

Children lived in various circumstances that changed over time. In addition to the 30 children who stayed at home, just over a-quarter (27%) experienced a reasonable level of stability. Over 40% experienced considerable disruption, with 10 having more than eight moves between carers. Some young people talked about the impact of being uprooted including detrimental effects on education. Many young people valued the stability achieved with the same set of carers. Benito (aged 17 at time 3) had spent 7 years with the same foster carers. For another young woman, stability was achieved by spending 8 years at the same school, boarding during the week and going home at weekends. The school environment provided a refuge from acrimony at home.

Re-Abuse Related to Continuity and Stability

Further episodes of abuse or neglect were noted on the files of 57% of the children. For most of the 33 whose names were placed on the register, there was an ‘on-off’ pattern of registration, but six were still registered at time 3. The changing categories of abuse and registration provide a reminder that registration does not protect children. In some cases which “drifted” on and off the register, files revealed a preoccupation with decision-making rather than helping. The following variables were statistically significantly associated with re-abuse:

• Children who suffered further episodes of abuse or neglect were significantly more likely to have experienced disrupted care.

• Children who continued to experience maltreatment were more likely to have conduct problems at home and school. $60$ had conduct problems.

• Children experiencing further episodes of maltreatment were more likely to have received intensive social services intervention throughout the study. This was often due to targeting resources on those who needed them most, but sometimes poor decisions and practice were associated with poor outcomes. Some cases were (temporarily) closed due to an inability to engage parents.

Overall Ratings of Outcomes for the Young People

Despite further maltreatment for some, 56 of the 77 children (almost three-quarters) had been protected from significant impairment to their health or development. However, for around a-quarter, the long-term outcome is likely to be poor, indicating implications for follow-up service.

The Most Successful Cases

A group of nine young people stood out as showing evidence of improvement and good well-being. The positive attributes they seemed to show could be set against key domains used in outcome evaluation in child mental-health treatments. Common factor for these nine young people, all of whom had remained in the same placement for extended periods, was developing good relationships either with family or with carers and good social relationships. A grandparent described how she set clear boundaries for her grand- daughter and was guided by strong religious prin- ciples.

Moderately Successful Cases

For a larger group of 20 children, the outcome was rated as ‘moderately good’ because they had enough of the characteristics of successful cased to instill some confidence about their future but had more areas of potential vulnerability. Twelve of these young people had had long-term or permanent placements.

Worst Outcome Cases

At the other end of the scale were the 21 children whose outcome was poor or little different to the time when significant harm was first identified. These young people demonstrated difficulties across the four domains where the nine most successful children had shown positive attributes. However, only four of them had experienced multiple moves and seven of them had never lived away from home. In this study, therefore, age at onset of abuse did not appear to be a factor in predicting outcome.

Explanations/Limitations of the Data

The study is a descriptive, longitudinal study of interventions in the lives of children, families and carers over an 8-year period. It was easier to track information about children where social services had been involved for considerable lengths of time, so we have more detailed long-term data about the high-threshold cases. The loss to the sample of more of the youngest children placed early in stable substitute families means that in the data on child outcomes the less successful cases from the 105 original cohort cases are likely to be over-represented among the 77 followed up. The quality of information available on some social services files was a further limitation of the data. The researchers rated the information in over one-third of the files as ‘good’, in almost half as ‘satisfactory’ and in the remaining 15% as seriously defi- cient. Because of this, and as some families received a short-term, low-intensity service, the extent of re-abuse is likely to be under-reported and under- recorded. The absence of interviews with practitioners at the latest stage of the study also made it difficult to report in depth on social work practice and models of intervention. Given the fact that a large proportion of the children received a long-term, or episodic service, and that detailed records have in some cases been supplemented by an in-depth, triangulated, interview process, descriptive data on services are more robust than is often the case. Because of the many variables about the children, their differing experiences of maltreatment, and the complexity of the services provided over time, causative inferences between outcomes for the children and particular aspects of the service they received cannot be definitely drawn. The richness of our data does, however, allow us to explore possible explanations as to why some had more positive outcomes and others did less well.

Discussion: Evaluating the Safeguarding Service to the 77 Children

The outcome was positive or moderately positive with respect of $72$ of the children and poor for $28$. All of the children in our study lived with the consequences of neglect or abuse, or, if removed early, of being born to parents who were incapable of meeting their needs. Many also suffered parallel adversities and disruptions of family life, like loss, separations and repeated moves. Stress and adversity are not passive experiences but an active process by which people deal. In these circumstances, it is helpful to have a repertoire of coping strategies for life’s challenges and we have demonstrated how this appeared to work for the nine young people with the most successful outcomes. Coping strategies could be nurtured by carers or relatives who provided responsive care and ‘a secure base’ for the child. Carers needed good support, since the children’s behaviour was often oppositional and difficult. There was evidence that the well-being and life chances of 24 children ($31$) had improved at least to some extent, and that the well-being of 19 ($25$) had deteriorated. For 34 ($44$), the evidence indicated that there had been little change. A key but extremely complex ‘effectiveness’ ques- tion, is whether outcomes (in terms of well-being or any changes over time) can be linked to protective intervention, and even more so with any particular aspects of intervention. Some children in each of the three ‘outcome groups’ received long-term and intensive services. The records and our interviews evidenced skill, creativity and commitment in many of those who provided these services, although only a minority of the young people were able to develop a trusting relationship with the same social worker over a period of years. In the five routes identified, outcomes tended to be less positive for children who were restored home. On the other hand, a period back with their parents may have helped some of the children to see the necessity of ‘cutting their losses’ and helped them to settle with grandparents or alternative carers.

Conclusions

The study demonstrated that, with the possible exception of the early placement of infants with respect of whom there is clear evidence that the parents are incapable of meeting their needs, there are no ‘quick fixes’ when children are abused or seriously neglected. Even where cases are closed early to social services, children may struggle to achieve reasonable standards of overall development. A group of children who would have gained from having been removed earlier and placed with substitute parents was identified. In other cases, skill needed by those interevening or continuity of service were inadequate to the demands of the case. That some of those in long-term care did well, is an important reminder that the negative impact of care should not be overstated. The role of the social worker in complex cases is to try to ensure that effective decision-making takes place but not solely as a case manger at the expense of a relationship-based, helping service that seeks to promote close relationships between children and their parents and carers. Social workers need to per- severe in their relationships with difficult and even hostile children and families. To do so they need backing, and supervision from their own agency as well as shared responsibility with the multi-agency team.