Risks, rights and the role of the state: Parents with learning disabilities

[Introduction]

The Research in Practice and Research in Practice for Adults podcast, supporting evidence-informed practice for children, adults, and families.

Dez: Welcome to the Research in Practice podcast. I'm really pleased to be joined by two colleagues who both work at Bristol University, Beth Tarleton and Danielle Turney. Hello, both of you.

Beth: Hello.

Dez: So, we've been doing a series of interviews loosely themed around this overarching notion of risk, and rights, and the role of the state. And I was particularly keen to invite you two to come and talk to us as a duo, in fact, because some of the work that you've been doing I think speaks really closely to this theme, and if you like, this tension around risk, and rights, and the role of the state. And that's the work that you've been doing around working with parents who have a learning disability or learning difficulty. So, just give us a headline then, tell us about your different backgrounds, introduce yourselves, and why you wanted to bring your expertise together on this particular topic.

Beth: I'm Beth Tarleton, I've worked around this subject about parents with learning difficulties for thirteen years, I think. And it just came out of an initial tender, but became a, sort of, really important subject that's really come to the fore over the last few years, about what support parents with learning difficulties have the right to, but also looking at the risks and the outcomes for children. Which is novel from a learning difficulty background, it's often just about parents' rights, but I've tried to look at rights, and risks, and outcomes for children. And so that's why I wanted to work with Danielle.

[Language]

Dez: And I'm conscious as you talk there, Beth, you're talking about learning difficulties.

Beth: I am, yes.

Dez: And, no, it's a really helpful comment to make. So, is it helpful or unhelpful to think about learning difficulties and learning disabilities together, or do we need to differentiate? I don't want to get my language wrong in this interview, apart from anything else.

Beth: Well, I suppose the guidance says 'learning disability', the good practice guidance says 'learning disability'. That's for people who might have an IQ of 69 or below, and would get access to adult services for support in their own right. But there's a far wider group of parents who don't have a diagnosed learning disability, but they have learning difficulties, and often struggle with the same things as the other parents, and may not get support in their own right. So, actually, they're often in a worse position when it comes to looking for support.

Dez: That's a really helpful distinction, thank you.

Danielle: I'm Danielle Turney, and I work mainly from a social work background, I am from a social work background, working primarily with children and families, and have been teaching and researching social work issues for quite some time. I have a particularly interest in child neglect, and this particularly was, I think, how Beth and I started talking together, because what we found interesting, and where our work has developed particularly, has been looking at what happens when parents with learning difficulties come into contact with children's services. And typically, where there are concerns about parenting, they relate to child neglect. We know that child neglect is already the largest category of concern in relation to child protection plans in England, has been for some time, and so working with Beth has allowed us, together, to think about what are the issues from both the social work and a learning difficulty/disability perspective? And how can each perspective talk more effectively to the other?

Dez: That's great, thank you. I was really struck, Beth, when you said that you'd always been thinking about parents' rights, but you've been challenging yourself in this work to think about children's rights as well. And I'm sure, Danielle, those of us that work in children's services sometimes have to challenge ourselves to think about parents' rights, so I think that really illuminates for me that crossover, that ambition of yours to get greater connectivity. So, thinking about your work, Beth, which I think you said was for thirteen years, Danielle declined to date herself, I noticed.

Danielle: Definitely.

[Developments in the sector]

Dez: Beth, how have you seen the discussions and the understanding about supporting parents with learning difficulties or disabilities? Have you seen that change over time?

Beth: I don't think I have, really.

Dez: Oh, gosh, that's a slightly depressing thought.

Beth: No, well, I think there have always been people that are really engaged with the subject and set up specialist services, and they're really challenging things in their local area. But we've had good practice guidance ten years ago, which was innovative and brought all brilliant themes for people, but it hasn't really been taken up because it wasn't statutory guidance, it was just guidance. And so there have been some really good initiatives, but there hasn't been a, sort of, sea change in how we do things around these parents, and the context has got a lot less money in it now, so lots of the services that were starting to do-, might not be there anymore.

Dez: I suppose the context of families and the services being under real financial constraint.

Beth: Yes, it's a lot tighter.

Dez: And Danielle, from your perspective, thinking particularly around child and family social work, have you seen a change in attitudes? Is it, as an area, you know, working with parents with a learning difficulty/disability, is it something that's gaining traction in child and family social work? Is it a neglected issue? Has that changed at all?

Danielle: I think that's a really interesting question, because I have to confess from my own point of view, from somebody so immersed in children and families social work, I would have to own up that I've probably given it less thought than I should have done over the years until relatively recently. Only the last… I don't know how long we've been having these conversations, probably longer than I realise, yes, it's a while.

Beth: About nine years.

Danielle: But actually trying to think about how challenges for parents, and challenges for children, need to be two sides of the same coin. And I think practice has become so polarised, and with such an emphasis, certainly in children's social work where the focus is more and more tightly bounded into thinking about child protection, but actually the whole agenda around, 'How do we support families more generally?' has become harder to keep track of. My experience is primarily, these days, working with post-qualifying programmes, so working with professionals who are already doing the job, who are experienced children and families practitioners. My sense from talking to them, and this is obviously more anecdotal than formal, but my sense is that they are very aware of working with parents who struggle, who may have learning difficulties, but feel somewhat under-skilled and under-prepared for working with them. They're just families who are in the mix, who, as Beth said earlier, may not have a formal diagnosis, so are harder to see as a group, and so it becomes a very submerged issue. I don't think there's an unwillingness to think about it, but I think unless there's a reason to focus in on learning difficulties, it perhaps becomes something that drops below the surface. Does that make sense?

Dez: It does, yes. That notion of being a submerged issue I think is one that really resonates. I mentioned before that we're loosely theming these interviews around this, sort of, umbrella issue of risk, and rights, and what that might mean for the role of the state. And my hunch is that working with parents who have a learning disability or difficulty in the context of child protection or safeguarding concerns, is an area where risk and rights really crash up against each other. Here's your chance to tell me my hunch is wrong, or that…

Danielle: No, I think we've really found that a significant challenge to our own thinking, and actually starting to think, 'What does it mean to work with parents with learning difficulties? What does it mean to talk about parenting? What does it mean to talk about support?' And with this service user group, particularly thinking about, this gets a bit God and the universe here, but it's about what are the big issues that this really brings us up against? And for me, and I think these are things we've talked about, so I hope I'm speaking for both of us, its thinking about how do we understand notions of parenting? How much do you have to be able to do of the parenting tasks to be a parent? If you need support, and we all need support at different times in our lives, let's face it, but if you need external supports to come in to help you with those tasks, what's the balance that we as a society think is both ethically right and sustainable? Where do we draw those lines? At what point do we say, 'Actually, with all this support, yes, you can just about hold it together, so we should be providing that, and that's the right thing to do, your children seem to be okay, so that's what we should do, possibly for eighteen years, hang the expense'? At what point do we say, 'Actually, that isn't sustainable'? And if we say that, on what grounds? Is it financial, is it ethical? What grounds are we drawing on? So, I think, at the risk of opening up a very big debate, this is a big debate.

Dez: Indeed, and every conversation I have with you does get a little bit God/the universe, it's why you're such a joy to talk to, Danielle, so don't apologise for the philosophical perspective.

[How the rights of children interact with the rights of parents]

Beth: Its rights of children and rights of parents, and-,

Dez: And do you observe those, Beth, being in conflict with each other ever?

Beth: I don't personally see them as being in conflict, and it's a position I've tried to take all the way through, so that children's social workers will actually talk to me quite a lot of the time. But often it does feel like adult services think about parents' rights, children's services think about looking after the children, and they don't seem to, sort of, talk in the middle.

Dez: You're reminding me of… there's been some really interesting discourse recently about how the narrative around the focus on the child, the voice of the child, 'keep your eye on the child', professional gaze being on the child, has sometimes, some would argue, sometimes led professionals to overlook the fact that that child exists in a context, has a relational identity, is part of a family system or a community. So, I'm quite heartened to hear you say that there's not an inherent conflict, one can attend to the rights of parents and the rights of children, but it's got to be trickier than we've just made it sound.

Beth: Well, I suppose children have a right to be with their parents as well, and if the parents can't meet those needs with support, then they possibly should be somewhere else. But it's thinking about, sort of, giving the parents the support to see if they can meet the children's needs and give them the support in the right way, tailored for the individual parent.

Dez: And it does, of course, have interesting implications for the role of the state. I was interviewing Jo Warner in this same theme of podcast, and she was saying that as a state we're very happy not to intervene in all family circumstances where a child might be unhappy or experiencing what could be considered, you know, harm or abuse. She gave the example of sending children off to boarding school when they're very young and how we don't tend to intervene there. I was sharing the example of parents who put their children into talent competitions, you know, the level of cortisol that we might imagine those child performers experience is not miles away from what they might experience in some forms of maltreatment, but we wouldn't expect the state to intervene in each one of those cases. Do you think, the two of you, do you think that we have a tendency to over-intervene or under-intervene with these families, or is it a heady mix of both?

Danielle: It's an interesting one again, because research by one of our colleagues at Bristol, Elaine Farmer, suggested that actually social workers are so minded towards supporting families and trying to help parents to cope, that her studies have suggested that perhaps in some instances, they've intervened too little and too late, and left children in situations that were not helpful, for longer than they should have. So, that's one perspective.

Beth: Yes, but it's how and when you intervene, because lots of the time if you picked up a family in the early stages of pregnancy, or when they've just had a small baby, and provided early support to teach parents how to do things, you wouldn't get to the current response, which is often picking up a family when it's in crisis. And it's straight into child protection, and everybody's saying how awful this situation is. Families need good relationships with workers who they can trust, who can help them with the everyday things, so you don't get to the crisis.

Dez: So, I'm hearing in that a call for relationship-based practice, but also you're talking about… it's music to Danielle's ears, talking about the practical support, practical support alongside therapeutic with a small T support, which I think is arguably not always what's on offer.

Beth: No, parents often are, when they engage with workers, it's when somebody's telling them they're really poor parents, or something's going wrong, and they're really scared, and that's not the best time to engage, and learn, and trust a worker.

Danielle: But it is, I guess, part of a bigger picture about the balance between support and protection that maybe has been discussed elsewhere, but is a common concern. That actually as budgets are cut back, thresholds for involvement with services keep on going up, eligibility criteria get tighter and tighter, so actually how we start to support families, as Beth says, right from day one, or even before day one, gets more of a challenge. And nobody's going to go out looking, you know, nobody's in a position to, in a sense, go out looking for work, if I can put it like that.

Dez: Yes, that does make good sense. And are there, I mean, I'm not aware of any randomised control trials looking at particular interventions or programmes, so I don't mean evidence-based in that particular sense, but of the available evidence, and we certainly need to build our knowledge base. Of the available evidence, what, to your mind, are the key characteristics or common threads of effective, humane, rights-based support?

Danielle: Well, can we talk about a framework that we've been mulling over for some time?

Dez: You can. Are you going to charge us for the privilege of hearing it before its trademarked?

Danielle: We'll get back to you on that.

Dez: Please do, yes. So, to clarify for the listeners, this is a framework that you guys have developed between you?

[A model for effective practice]

Danielle: Yes. And with a staggering level of imagination we've called Six Ts framework, and not because our names have Ts in them, because of the components that we think are important to effective practice. So, can we talk you through them?

Dez: Yes, please.

Danielle: It's a triangular model.

Dez: You heard it here first, folks. Okay, let's hear it.

Danielle: Well, the six elements that we've come back to as critical for thinking about effective practice are, first of all, time, trust, tenacity, truthfulness, transparency, and a tailored response.

Dez: The six Ts, I get it, I've grasped the concept.

Danielle: Yes. And we can elaborate on each of those, but I guess that our starting point is to say that one of the challenges with working with parents with learning difficulties is time. And that actually time, you cannot build a relationship out of nowhere, and workers and families need to have time to get to know one another, to trust one another, to feel that they've got the basis to have difficult conversations, if need be. And actually, we are in an environment where short-term responses are increasingly the norm. They are not generally, I think, effective in relation to neglect, they are almost certainly not effective in relation to parents with learning difficulties, for whom time may be a very particular challenge. Notions of time, understanding abstract concepts of time may be quite a challenge.

Dez: That's helpful, because I was going to suggest that, of course, you know, time and trust, that's true for all of us in any support we get, but you're highlighting that it's particularly important to the parents who have a learning disability or difficulty.

Danielle: Also, time as in involvement through time. Because one of the things that strikes us as, it's a fairly evident point, but learning difficulties don't go away. If a parent has a learning difficulty or a diagnosed learning disability, it's there for life. Which may not mean it's always having the same effect on their ability to parent, if it has any at all, but that the likelihood is that parents may need to come in and out of support.

Dez: Yes, it's not a crisis, it's not an episodic situation.

Danielle: And how do we think about re-engagement as a benefit, as a positive, not as a failure?

Dez: Of course.

Danielle: Because if you have worked well with a professional who has supported you, and you feel you trust them, and you've been coping fine, and you're getting to a point where you think, 'Actually, I'm not really sure what to do with this five-year-old, or this 3.5-year-old who's behaving in ways I don't understand,' I think our perspective would be it must be a benefit if you feel confident as a parent to go back to a practitioner and say, 'Can you help me? I don't know quite what to do, I don't know if I'm doing it right. Can I talk to you?'

Dez: And yet we talk about re-referrals or the revolving door in a very negative way.

Danielle: Whereas actually, I think what we're asking for here is a re-thinking of some of those dynamics about length of engagement, and the possibility of re-engagement, and seeing that as a resource to the parent, rather than a failure of practice.

Dez: Yes, okay. And that, I guess, links to the third one, which was around tenacity. Which, do you want to tell me a little bit about?

Beth: Yes, tenacity, keeping going, helping with the wider issues in their life, so it might not just be about how the parent is working with the child, it might be dealing with housing problems, debt, harassment in the community, all those things that parents, adults with learning difficulties, face anyway. So, dealing with the wider issues that are part of the package of complex needs.

Danielle: And it's a sticking with-ness.

Beth: Yes, sticking with it.

Danielle: Yes, actually, you're in it for the duration. And again, that's not really our message, in some ways. Although in others, if we think relationship-based practice has any meaning at all, then actually, sticking with might be quite a key part of that. Particularly families who might be quite untrusting in the first instance, they may have had very bad experiences. If they've already had children removed, we know that families are not going to come bounding in, you know, with open arms, if they've already had a child removed. How do you show that you are there to support, to stay with, and to have the difficult conversations? Because if we talk about the truthfulness and the transparency, those are absolutely key, because in my view, a positive working relationship, professional relationship, requires a level of honesty. And if parents don't know what you're concerned about, if they don't understand why you're worried and what you're worried about, and how it might be addressed, what's the nature of that relationship?

Beth: And so many parents that I've spoken to over the years have never really understood why their children were removed. Words have been said to them, but not in a way that they really understood what the fundamental issue was.

Dez: Which is terrible. I mean, to have one's child removed anyway is unimaginable pain, but to never then understand why is… yes, that's indefensible, really.

Danielle: And that may not just be an issue obviously with parents with learning difficulties, but I think we have to be aware that some of the language that gets used, some of the concepts that get used, if we are aware that parents may struggle with some abstract ideas, have we had the time and the training to explain things more simply? One of the exercises that we've done recently with workshops that we've run for Research in Practice and Research in Practice for Adults actually involves asking practitioners to produce a piece of easy-to-read information explaining an initial child protection conference. If you knew how long people spent trying to work out how to explain just what those words meant, never mind what it might entail.

Beth: So difficult.

Danielle: But actually inviting people to take the time, to give them the time to stop and think about how do we talk about complex issues in ways that are accessible? And if we realise how much we do without unpacking those difficult ideas, and how difficult it is to do well, then perhaps we start to have slightly different conversations with parents in general, and particularly parents with learning difficulties. Things like Signs of Safety talk about accessible language, so I don't think, again, this is a unique issue, or that we've got a unique insight. But I think what we are saying is if we know that parents may have difficulties with these particular issues and they may be in situations where there are sufficient concerns about their children that proceedings might be in place or being considered, what responsibility do we have to present information, and to share information, to communicate in ways that parents can manage?

Dez: Because that is about rights, the right to understand the process you and your children are involved in, to me, seems critical. And you're right, of course it's all parents, all of us all the time, and not just jargon or professional, complex language, but subjective language. We often talk about this in training that we do, you know, 'What exactly does dishevelled mean?'

Beth: 'We have concerns. We have concerns about your child,' what does that mean?

Dez: 'Attachment issues.'

Beth: You don't cuddle them enough.

Dez: And anything that says 'appropriate', because how on earth do we manage progress or regress around a word like 'appropriate'?

Danielle: So, there are a whole lot of language issues, but we've, sort of, strayed away from our Ts again.

Dez: No, that was all within that truthfulness and transparency.

Danielle: Truthness and transparency, and a tailored response, because actually, again, a learning difficulty isn't one thing. It's not one thing to that person, it may be it affects different aspects of their life at different times, there may be some things they continue to have difficulties with, there may be other things that they grasp very quickly, and you can build on those. So, again, it's about strengths and working from capacity, but also not being disingenuous about lack of capacity or limited capacity, and thinking about what to do to address difficulties in that regard.

Dez: And Beth, thinking particularly about your professional background, that notion of a tailored response, of the personalisation, of building things around the individual, you might argue that's a little more advanced in adult social work and adult services than perhaps there's been opportunity to do in children's services or child protection. But perhaps you disagree? I'm just conscious that there's a great…

Beth: We possibly don't use the same language.

Dez: Yes, we tend not to talk about personalisation so much, with some exceptions in children's services.

Danielle: But child-centred working, child-focussed, keeping the child in mind, I appreciate can become a way of not seeing the parents, but again, if we try and understand what does it mean to be child-focussed, to keep children in mind, then it's always in context, isn't it? Ideally.

Beth: Hopefully.

Danielle: In theory. It should be in context. So, it's trying to hold all those things. It is about trying to look in more than one direction. I think maybe the challenge has been that adult services stereotypically have looked in one direction, children's services stereotypically have looked in another, and what Beth and I are trying to do through, in a sense, conversations we have together, is nudge them back towards… so they're facing each other again, rather than perhaps looking in different directions.

Beth: And there are quite a few places that are working in that way, adults' and children's services working together around families, and having pooled budgets, and joint protocols, and working within the good practice guidance, so it's not it never happens, it's just not happening everywhere. There are lots of good examples, such as Cornwall, and Enfield, and Valuing People support service in Medway. There are examples, it's just not…

Dez: It's not always easy.

Beth: Common practice, and it's not always easy.

Danielle: And it's not required.

Beth: No, it's not required.

Dez: You've touched…

Beth: Can I mention the good practice guidance?

Dez: Please, yes, do.

Beth: Because that fits with the six Ts. We thought the six Ts was, kind of, a way practitioners could live out the good practice guidance in their relationships and how they work with parents. So, the good practice guidance was written in 2007, but was updated by the Working Together with Parents Network two years ago, in 2016. And there are five themes within the good practice guidance, which are parents' need for accessible information and communication, so as we've said, making things really clear and simple, and not using jargon or abstract concepts. That local authorities need clear pathways and processes, joint protocols, joint budgets, those sort of things. That there needs to be support to meet the needs of the parents and the children, it might be that children need their own support with things like homework, or go into clubs or things that their parents can't do so somebody else would need to do that. Long-term support where necessary, and independent advocacy, particularly if they're involved with child protection proceedings, so that they've got someone to speak up for them, or help them to speak up for themselves.

Dez: That's really helpful. So, again, a lot of those sound to me very rights-based in their perspective, both the rights of the children and the parents, but it being about entitlement, and I mean that in a very positive sense. It's come to mean something negative, I mean it positively. What I'm not seeing in there is an emphasis on risk management, risk assessment. And again, I'm not suggesting that's a difficult thing, but is that an area that practitioners can struggle with? I suppose, if I put it really bluntly, is it conceivable that you might have someone working with the parents who's a highly skilled practitioner in their field, and someone who is working from a child protection perspective, equally highly skilled, and that they would not be able to find common ground, or that they might experience tensions in their practice?

Beth: I think all professionals should see the children's rights as most important, and the welfare of the children as most important. So, if you start from there, even a worker from an adult background should keep the child's welfare, and positive outcomes for them, in mind. But often, there are differences of opinion, or a difference of perspective. I think we've tried to see our work talk about supporting parents with learning difficulties for the best outcomes of the children, not all organisations might take that stance, some organisations take a more parents' rights…

Dez: That's important. So, you're deliberately constructing your work around supporting parents in order… well, supporting parents, not just adults generically, and with a view to promoting the best possible life chances for the children.

Beth: Yes.

Dez: Okay, that's an important distinction to make.

Danielle: And I guess recognising that there will be conflicts of view, and actually, there needs to be a framework within which those can be explored, because we need to understand what difficulties, if parents are having difficulties. And again, this may be a more general point, but where parents are having difficulties, or where care of children is raising sufficient concern to bring child protection gaze to bear, then we need to be able to actually talk together about what the concerns are. What might alleviate them? What can parents do themselves that would address concerns? What could parents do with support? What could other supports do alongside? So, I think it actually invites a more complex analysis of what's going on in families, and actually there will be challenges, there will be difficulties, there will be times when-, and it typically will be perhaps the children's social work end of things that has to say, 'Actually, this is not okay.'

Beth: It's about giving the parents the chance with the right support to see if it can work.

Danielle: And not from a presumption that it won't. So, starting from a point of view of saying, 'What are the challenges? What are the strengths? What are the issues that are going on in this family at this time with these children, or this child?' Because it may be different issues with each child in a family. And then saying, 'What package of response-,' I'm using 'package' in the broadest sense, 'What ways of responding have we got as a system here, drawing across adults, children, multi-agency, multi-professional agendas? How do we bring those together into a team around the child, around the family, actually? And how would we know if it was working?' I think this is really key, and I think perhaps with a children's social work hat on, you would have to say in the end, 'Is this okay? Is this good enough? Is this child making the progress we would hope to see for them? Are they okay? What level of harm might this situation have, and is it addressable?'

Dez: Within the child's time frame.

Danielle: Within the child's time frame. And that actually, again, may be different from the parents’, and I think those are the acutely painful decisions, because we're not talking, generally, about parents who don't care, who don't want to care, who don't love their children, it's all of those things. It's not about vicious, bad parents, it's about can you do this alongside your child at a pace that works for your child? And sometimes there will be cases where actually the answer's no.

Dez: And I'm hearing a really powerful case for not presuming. Have we been guilty, do you think, over the years, of presuming the parents with a learning disability or difficulty are not capable of doing "good enough" parenting, air quotes, for the benefit of the listeners.

Beth: I think so. I think often that if families are involved with services and they've got different issues, like domestic violence or something, those problems can be, in air quotes again, "fixed", in the, sort of, shorter term, whereas the learning difficulty is there for the long term, is always there. And it often comes with a package of all different needs going on, and it feels sometimes as if the learning difficulty is the extra thing that can't be sorted, that breaks the camel's back.

Dez: Right. And of course having a learning difficulty or disability, from my understanding of the literature, increases other forms of disadvantage, so you're more likely to be in poverty, you're more likely to be exploited or abused in some way yourself, or experience oppression. You're more likely to encounter housing difficulties or to be less financially independent, so a whole range of other factors that make parenting even more difficult than it already is.

Beth: They're, kind of, almost vulnerable parents with the most vulnerable children, in a way.

Dez: So, holding that knowledge of heightened vulnerability alongside a values-based approach that says, 'But I will not presume you present a risk to your child,' that's some balancing act.

Beth: I don't think… most social workers I've met, they don't presume that. They are just, sort of, faced with this big struggle of trying to work in a good way with these parents, having the time to do it, finding the right resources to do it.

[Early intervention]

Dez: You've touched on something really important there. I've been interviewing some colleagues around evidence-based programmes, and particularly things in early help. I guess some of the interventions, or programmes, or approaches that have the strongest evidence, or are most popular, tend to be quite, sort of, discreet, contained programmes, interventions, twelve-week courses, that kind of thing. How inclusive or appropriate are such interventions, and thinking particularly about things like parenting courses? I don't like the language, I have to say, but you know, 'We'll send you off to be a parent.' Yes, how appropriate are they, and what kind of things do commissioners need to think about?

Beth: I think there's been lots of work about parenting courses for parents with learning difficulties, and the standard ones often aren't very accessible, they're quite intellectual, they're very, 'You need to read this, or think about this concept.' There are some that have been adapted, like Triple P has been adapted, and there's one called Mellow Futures from Mellow Parenting in Scotland, and they're far more accessible, working with parents' issues, getting them taxis, extra time, doing things in a more creative way, so moving away from the reading and this approach. And those work, there are parenting programmes that you can do with a parent in their own home, one-to-one, and they've been shown to work really well. And lots of these, the more recent, the Mellow Parenting, The Triple P, have taken on some of the learning from the individualised ones to make them more interactive and user-friendly, and longer.

[Bridging adults’ and children’s services]

Dez: Okay, that's helpful. It strikes us sometimes in Research in Practice and Research in Practice for Adults, working as we do across children's and adults' social care services, that although social work is clearly a unified profession, underpinned by core professional values and common training, it can be seen to be operating quite separately. Talking about children's social work, child and family social work and adult social work, they often have quite limited structural overlap, even when people have constructed a people's directorate, you tend not to see much homogeny or overlap structurally. I'm interested as well in differences in practice, and culture, and policy focus. I have heard some colleagues describe it as two different planets, which sounds quite extreme. Do you notice that? I'm thinking you've been all round the country delivering workshops recently to a mixed group, do you see a difference in practice or culture, or culture, or language?

Danielle: Well, one thing that struck us was actually although these workshops are pitched at both constituencies, actually they've been predominantly children and families practitioners in our understanding.

Beth: But when we run them for the Working Together with Parents Network, because it's got the word 'parents' in the title it's mainly adult services that come.

Dez: So, people immediately identify with a-

Danielle: Yes, I don't know if it's within the practitioners' heads that these are two camps, I don't know, but you get very locked in to your own systems. We talk about multi-agency working and multi-professional working, and I think we would argue that working with families in these circumstances, that is likely to be absolutely essential, and, you know, quite a wide network of different services might need to be drawn in in a thoughtful way over time. But actually, the practicalities of that are immense when you've got different budget holders, different financial accountability structures, and different pressures, different eligibility criteria, and different-,

Dez: Absolutely. And different practice emphases. I was thinking of, you know, very often in adult social work particularly, where there's a really strong rights-based perspective, and I think Lyn Romeo in particular has led that very effectively, the right to make unwise decisions, but not as a parent. One can make all the unwise decisions you like, provided that we are operating a good risk enablement framework, that is your right as an adult, but not necessarily your right as a parent. Because the needs or risk factors around the child are, as one colleague put it, 'It Top Trumpses everything,' which I don't think is the official policy rhetoric.

Beth: No, but I say that often. Children's rights trump the parents' when it comes down to it.

Dez: And specifically, I think it's the child's right to safety Top Trumpses anything else, so their right to remain with their parents, for example, comes secondary to their rights to safety.

Beth: I guess so, yes.

Danielle: Best interests of that child, we're back to the Children Act, and again, push comes to shove, social work is children and, well, the law is there, legislation states a principle very clearly, and I think that's one that children's social workers and others will have to come back to each time. What it means in each case, I think, you know, the devil's in the detail, isn't it?

Dez: Always.

Danielle: And the point at which you say, 'The child's best interests have tipped over a line into this rather than that,' those are the practice challenges, I think, that are always there in any child protection situation, any concern. Again, that boundary that we talk about a lot between care and control, maybe these cases, the families that we're talking about here, not cases, the families that we're working with, the families we're talking about, actually just bring some of those issues that run through social work like Brighton rock, but actually put them into a very acute perspective. They bring them into focus in a different way.

Dez: That's very much the sense I get, that so much of what you're talking about is true in many, many other professional spheres, but children protection practice with parents who have a learning difficulty, it's almost like a little snow globe, it's a microcosm of these much wider issues across a number of different disciplines.

Beth: And as with lots of parents, I think if you got in there a lot earlier with the right kind of support, you might not get to the sharp end of, 'Have we tipped over?' But then when you did get to that place, that's because you need to be in that place.

Dez: It's interesting you say that about the early help. One of the interviews in this series, it's with Nick Axford around early intervention, and we were exploring the potential risk that some early intervention, depending on how it's conceptualised, depending on how it's implemented, you might end up, sort of, over-scrutinising, over-intervening, dragging lots of families into the system. And we were saying if you look hard enough at anyone's family, you'll find something that reaches threshold, and I wonder whether that's a balancing act here as well? Both the need to get in earlier for these families and to support them when they need it most, but being conscious of our-

Beth: It wouldn't need to be from children's services or children's social care, it could be from the children's centre, just knowing how to work with parents when they walk in the door, or midwives being trained so they can explain the tests and what's happening when they go to appointments in an easy way, so that parents aren't scared and will engage. It doesn't have to be serious professionals, it can be anybody who comes into contact-

Dez: With apologies to midwives, who of course we do consider to be very serious colleagues.

Beth: No, I didn't mean midwives, I meant child protection workers!

Dez: … send the heavies in, okay. And what about professionals working in adult services? Those who understand a great deal about learning disabilities and how to support adults, but may not understand about parenting. What role can they play here in earlier intervention?

Beth: I think they can be advice-givers about how to work with parents, how to communicate things, how to explain things, how to role model things for parents. And they can do training about child protection and understand that, and so children's social workers can have training about working with adults with learning difficulties to all work in a more joined-up way.

Dez: So, a really strong call for integration. I mean, you're, sort of, role modelling it yourselves, aren't you? Getting all out your comfort zones and spending lots of time doing co-working. You had a couple of examples, where do you see the best of integrated, holistic practice that gets the best of children and families social work expertise, the best of colleagues working in learning disabilities? Are there live examples with services or whole parts of the country?

Beth: I mentioned it before, there's a Valuing People support service in Medway that's joint-funded by adults' and children's services, and workers there have said that they will close cases early so that the service can carry on supporting them, because they trust the workers in that service to flag up any issues and send it back to child protection if needed. And they work in a very holistic way with families, helping them to do whatever they need, do routines, shopping, tidying up their house. They have been quite blunt with families to tell them what the issues are, advocating for them.

Dez: Transparency, yes.

Beth: Yes, advocating for them. And an evaluation we did a few years ago showed that with the longer term support from that service, the children had better outcomes than other families being supported by the standard children's services.

Dez: That's really interesting.

Beth: And we've got a project at the moment that's looking at three areas of positive practice around the country, and those professionals there are working in the, sort of, six Ts way that we mentioned. Those are our findings, the summary of our findings are the six Ts.

Dez: And I know that because you haven't published that work I can't ask you to tell us where in the country those areas are, but what would you describe as the real key ingredients of what they're doing that makes it so promising? What are they getting right that others could learn from?

Beth: Commitment to families, and understanding that the neglect is in relation to parents not understanding and not having the right resources, rather than deliberate. And trying to explain to colleagues how the issues of having a learning difficulty impact on their parenting, and how it can be helped, rather than not assuming that it's a…

Dez: And of course, that point you made about neglect not being deliberate is true in many, many other instances, it's not particular to parents with a learning difficulty or disability, but yes, I can see that playing an important role. So, if we want, and I'm going to hazard a guess and suggest that you both do want a more integrated and more holistic, family-aware approach. If you want practitioners to be able to operate in this field in a way which balances the need for really sensible risk appraisal and risk attunement, but whilst honouring the rights of parents, children and families to stay together and not be over-intervened with, what are the conditions then for really excellent practice? What needs to happen, you know, at a management level, at an organisation level, at a policy level? This is your magic wand question there.

Beth: I think parents need to have support in their own right. Lots of parents who might not fit the criteria for learning disability services should probably get support under the Care Act, and that's possibly not being done so much yet.

Dez: So, where adults have care and support needs, but they might not have care and support needs with a little trademark symbol next to it, okay.

Beth: But they have support needs in their role as a parent, that's one of the criteria.

Danielle: But maybe it is that notion of things cutting across structural boundaries, and actually how do we try and think more creatively about, for example, joint commissioning? When budgets are being cut, the temptation to hang on to what you've got, and ringfence it, and put a little bit of barbed wire round the edges to keep people out must be quite powerful. Actually, how do we try and see this as a shared responsibility, a shared concern, a shared engagement to support families where possible? And again, this isn't 'under any circumstances regardless of what happens', but saying, 'If there is a valid opportunity to provide support and to see that it can make a difference, surely then we have a responsibility to think about bringing together those who need to do that in a coherent and thoughtful way.'

Dez: That's important, we're not, and I'm not hearing either of you say that we're talking about leaving children in homes that aren't safe, but we're saying, 'Let's exhaust all our possibilities before we decide these parents can't do it.'

Danielle: Within a time frame that is sustainable, and actually, again, the courts will expect.

Beth: But recognising that some parents might need longer-term support, we might have to think about the idea of parenting with support, or supported parenting, as they say in Scotland. Recognising these families are going to need support, with the support, they can do it.

Dez: For as long as it takes.

Beth: For as long as it takes.

Dez: And that might be much, much longer than any commissioning cycle we currently work with.

Beth: Indeed.

Dez: And just finally, because you are absolutely role modelling what we want to see at, sort of, practice and local authority level, would you, this is a bit of an on-the-spot, sorry, there was no prep time. In your co-working and collaboration, one thing that you found really hard to get your head around, or one real challenge you faced. Or, one thing that really shocked you and was like, 'God, that's not what my background taught me,' or, 'I'm going to need a bit of time to work on that before I can-'

Beth: I don't think there has been, really. I think when I first did one of my first presentations on this, a children's social worker came up to me and said, 'We don't do Booth, we don't like them because they don't talk about the children.' They're two researchers who worked with parents with learning difficulties years ago, and they always took a parents' rights position, and they talked about advocacy for parents, and parents need this, and parents need that, but they never talked about the children. And the social worker said, 'We don't even read their stuff, because they don't talk about children,' and I think somebody said that to me, like, twelve years ago, and so I've always been, 'Oh, it's about both. It's definitely about both,' and to engage with children's social workers, we need to be talking in that way. So, I don't think we've had a major difference, but I think in other places where people are coming together for the first time, they might come from those two different adults versus children perspective.

Danielle: And we did spend some time, and again, this is going back a ways, we did spend some time talking together about what do we understand about parenting, for example? What does it mean to us from our different perspectives? There was another colleague who was involved at that stage as well, and we did want to actually spend the time to think about our own assumptions and values, prejudices, discomforts, and try and at least be aware of them, be honest about them, in order to try and think together about how to work more effectively.

Beth: And we do an exercise about that when we do our joint training, at the very beginning, where we ask people to say what their attitudes are to parents with learning difficulties, and they can say it generally, it doesn't have to be what they-

Danielle: What do they think are the stereotypes and views?

Beth: Yes, what are the stereotypes, and what are the views?

Danielle: And actually, you don't have to go very far to get some pretty poisonous ideas, and they are out there, and we're, none of us, immunised against them. So, how do we make sense of them, but still hold on to some basic values about change, the capacity to change, the capacity to grow? Which, from a social work point of view, is pretty fundamental. But I suppose it's always that caveat of not at any cost, and that's always going to be a fine line.

Beth: But there might be things that might not be able to change, that might need to be covered. And if that can be covered in the right way by another adult engaging with the family regularly, or granny, or a support worker that has a good relationship with the child, then that might be fine too. It might not all be about the parent changing, it might be about putting the right things in place so that the child gets everything they need.

Dez: That's really helpful. And as with every conversation I have with Danielle, it always winds up getting to that very reflective relationship-based practice point. So, not at all surprised to hear that that's your first exercise of the day. Thank you both very, very much indeed, really, really lovely to talk to you. Thanks for your time.

Beth: Thank you.

Danielle: Thank you.

[Outro]

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