Understandign Vulnerability Dr. Laura Davies
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Understanding vulnerability: children and young people in challenging circumstances Dr. Laura Davies, Research Fellow, University of Leeds Children and Young People in Vulnerable Circumstances Conference 18th July 2013
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Understandign Vulnerability Dr. Laura Davies
- 1. Dr Laura Davies University of Leeds l.davies@leeds.ac.uk
- 2. Outline What is ‘vulnerability’? Understanding children’s needs Causes of vulnerability and how it may be assessed Responding to the needs of ‘vulnerable’ children Points for discussion
- 3. ‘Official’ definitions of vulnerability Children with additional needs Children with complex needs
- 4. “all children and young people are vulnerable by virtue of their age, immaturity and dependence on adults” (Munro, 2011: 135)
- 5. Three definitions: 1) children at risk of significant harm children at risk of ‘Significant Harm’ in relation to s47 investigations of child protection under the Children Act 1989, for example where the child is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect or an Emergency Protection Order has been used
- 6. 2) Children in need ‘Children in Need’ of support under s17 of the Children Act 1989 which includes all children with disabilities
- 7. 3) Needs of all children and, as outlined in Every Child Matters and the subsequent Children Act 2004, all children have needs in relation to the five key outcomes; Being Healthy; Staying Safe; Enjoying and Achieving; Making a Positive Contribution; Achieving Economic Well Being which should be addressed by universal services
- 8. Policy Review of Children and Young People (DfES, 2007) low income, or coming from a low socio-economic background low attainment poor social and emotional skills poor parenting low birth weight poor health poor parental mental health; and living in a deprived neighbourhood
- 9. Areas of need: Health general health, physical development and speech, language and communications development understanding, reasoning and problem solving, participation in learning, education and employment, progress and achievement, aspirations
- 10. Areas of need: Parents and carers Basic care, ensuring safety and protection Emotional warmth and stability Guidance, boundaries and stimulation
- 11. Areas of need: Family and environment Family history, functioning and well-being Wider family Housing, employment and financial considerations Social and community elements and resources, including education
- 13. New Learning from Serious Case Reviews 2009-11
- 14. Early Intervention based on the principle that providing support and guidance early, can prevent the escalation of problems and difficulties later (eg: Allen, 2011; Field, 2010; Tickell, 2011) based on knowledge that inequalities interact with each other: poor health in early childhood can lead to poor educational outcomes which reduce chances in labour market and workless adults more likely to suffer ill health (Eisenstadt, 2011).
- 15. Family Nurse Partnership Research indicates that this early intervention can: Reduce smoking in pregnancy Lead to larger intervals between and fewer subsequent births Fewer accidents A reduction in child abuse and neglect Better language development in children Increases in employment Greater involvement of fathers
- 16. Inter-professional collaboration Legislation and policy guidance reiterates the importance of and duty to share information across professions The Children Act (1989) The Children Act (2006) Working Together to Safeguard Children (2012)
- 17. For discussion: How can services address needs? What are the opportunities? And the challenges? How can inter-agency working /integrated service models improve service delivery?
Editor's Notes
- Children with additional needs: A broad term used to describe all those children at risk of poor outcomes in relation to the five outcome areas defined in Every Child Matters. An estimated 20% to 30% of children have additional needs at some point in their childhood, requiring extra support from education, health, social services or other services. This could be for a limited period, or on a long-term basis. It is the group for whom targeted support within universal settings will be most appropriate. Their needs will in many cases be cross-cutting and might include: • disruptive or anti-social behaviour; • overt parental conflict or lack of parental support/boundaries; • involvement in or risk of offending; • poor attendance or exclusion from school; • experiencing bullying; • special educational needs; • disabilities; • disengagement from education, training or employment post-16; • poor nutrition; • ill-health; • substance misuse; • anxiety or depression; • housing issues; • pregnancy and parenthood. Children with complex needs: Of those children with additional needs, a small proportion have more significant or complex needs which meet the threshold for statutory involvement: • children who are the subject of a child protection plan; • looked after children; • care leavers; • children for whom adoption is the plan; • children with severe and complex special educational needs; • children with complex disabilities or complex health needs; • children diagnosed with significant mental health problems; • young offenders involved with youth justice services (community and custodial). (2)
- we also know that some children and young people are more at risk than others, as identified in the framework for the CAF outlined above. Vulnerability then can be better conceptualised as being about a range of circumstances and experiences and understood in terms of impacts on physical health, mental health and emotional/psychological resilience to challenging circumstances
- This approach can assist with the identification of the centrally important consideration in attempts to understand vulnerability and risk by asking what will happen to that child in the absence of services and assessing the extent to which services can have a positive impact on their life (Department of Health, 2000). In appointing a lead professional, the use of a CAF can provide a framework for managing the offer of integrated services and the associated need for information sharing to take place (CWDC, 2007).
- The CAF, lead professional and information sharing developments are central to the strategy outlined in Every Child Matters and Youth Matters. This is because it shifts the focus from dealing with the consequences of difficulties in children’s lives to preventing things from going wrong in the first place and promoting five priority outcomes for all children: It is clear that across these categories there is a spectrum of potential intervention and support for children and young people in vulnerable and challenging circumstances. This ranges from those services that are provided as part of universal provision such as education and health, through targeted support for identified additional needs through to statutory intervention in situations where there is a serious risk of and/or actual harm occurring. Definitions of what it means to describe a child’s circumstances as ‘vulnerable and challenging’ vary widely across this spectrum, from describing the situations of children and young people experiencing extreme neglect and abuse, to those who need some targeted support such as speech therapy.
- Identified indicators or ‘risk factors’ that can help to identify whether children are more likely to develop problems in adolescence or adulthood. The precise set of indicators for specific poor adult outcomes varies. However, some indicators are common across a range of poor outcomes. Some of the most important indicators are:
- Development of child • Health – general health, physical development and speech, language and communications development • Emotional and social development • Behavioural development • Identity, including self-esteem, self-image and social presentation • Family and social relationships • Self-care skills and independence • Learning – understanding, reasoning and problem solving, participation in learning, education and employment, progress and achievement, aspirations Parents and carers • Basic care, ensuring safety and protection • Emotional warmth and stability • Guidance, boundaries and stimulation Family and environmental • Family history, functioning and well-being • Wider family • Housing, employment and financial considerations • Social and community elements and resources, including education (21)
- Children who are defined as in need under the Children Act 1989 are those whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health and development, or their health and development will be significantly impaired without the provision of services. The critical factors to be taken into account in deciding whether a child is in need under the Children Act 1989 are what will happen to a child’s health and development without services, and the likely effect the services will have on the child’s standard of health and development. Determining who is in need, what those needs are, and how services will have an effect on outcomes for children requires professional judgement by social services staff together with colleagues from other professional disciplines who are working with children and families. “DIMENSIONS OF CHILD’S DEVELOPMENTAL NEEDS Health Includes growth and development as well as physical and mental wellbeing. The impact of genetic factors and of any impairment should be considered. Involves receiving appropriate health care when ill, an adequate and nutritious diet, exercise, immunisations where appropriate and developmental checks, dental and optical care and, for older children, appropriate advice and information on issues that have an impact on health, including sex education and substance misuse. Education Covers all areas of a child’s cognitive development which begins from birth. Includes opportunities: for play and interaction with other children; to have access to books; to acquire a range of skills and interests; to experience success and achievement. Involves an adult interested in educational activities, progress and achievements, who takes account of the child’s starting point and any special educational needs. Emotional and Behavioural Development Concerns the appropriateness of response demonstrated in feelings and actions by a child, initially to parents and caregivers and, as the child grows older, to others beyond the family. Includes nature and quality of early attachments, characteristics of temperament, adaptation to change, response to stress and degree of appropriate self control. Identity Concerns the child’s growing sense of self as a separate and valued person. Includes the child's view of self and abilities, self image and self esteem, and having a positive sense of individuality. Race, religion, age, gender, sexuality and disability may all contribute to this. Feelings of belonging and acceptance by family, peer group and wider society, including other cultural groups. Family and Social Relationships Development of empathy and the capacity to place self in someone else’s shoes. Includes a stable and affectionate relationship with parents or caregivers, good relationships with siblings, increasing importance of age appropriate friendships with peers and other significant persons in the child’s life and response of family to these relationships. Social Presentation Concerns child’s growing understanding of the way in which appearance, behaviour, and any impairment are perceived by the outside world and the impression being created. Includes appropriateness of dress for age, gender, culture and religion; cleanliness and personal hygiene; and availability of advice from parents or caregivers about presentationin different settings. Self Care Skills Concerns the acquisition by a child of practical, emotional and communication competencies required for increasing independence. Includes early practical skills of dressing and feeding, opportunities to gain confidence and practical skills to undertake activities away from the family and independent living skills as older children. Includes encouragement to acquire social problem solving approaches. Special attention should be given to the impact of a child's impairment and other vulnerabilities, and on social circumstances affecting these in the development of self care skills”. (19) “DIMENSIONS OF PARENTING CAPACITY Basic Care Providing for the child’s physical needs, and appropriate medical and dental care. Includes provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate personal hygiene. Ensuring Safety Ensuring the child is adequately protected from harm or danger. Includes protection from significant harm or danger, and from contact with unsafe adults/other children and from self-harm. Recognition of hazards and danger both in the home and elsewhere. Emotional Warmth Ensuring the child’s emotional needs are met and giving the child a sense of being specially valued and a positive sense of own racial and cultural identity. Includes ensuring the child’s requirements for secure, stable and affectionate relationships with significant adults, with appropriate sensitivity and responsiveness to the child’s needs. Appropriate physical contact, comfort and cuddling sufficient to demonstrate warm regard, praise and encouragement. Stimulation Promoting child’s learning and intellectual development through encouragement and cognitive stimulation and promoting social opportunities. Includes facilitating the child’s cognitive development and potential through interaction, communication, talking and responding to the child’s language and questions, encouraging and joining the child’s play, and promoting educational opportunities. Enabling the child to experience success and ensuring school attendance or equivalent opportunity. Facilitating child to meet challenges of life. Guidance and Boundaries Enabling the child to regulate their own emotions and behaviour. The key parental tasks are demonstrating and modelling appropriate behaviour and control of emotions and interactions with others, and guidance which involves setting boundaries, so that the child is able to develop an internal model of moral values and conscience, and social behaviour appropriate for the society within which they will grow up. The aim is to enable the child to grow into an autonomous adult, holding their own values, and able to demonstrate appropriate behaviour with others rather than having to be dependent on rules outside themselves. This includes not over protecting children from exploratory and learning experiences. Includes social problem solving, anger management, consideration for others, and effective discipline and shaping of behaviour. Stability Providing a sufficiently stable family environment to enable a child to develop and maintain a secure attachment to the primary caregiver(s) in order to ensure optimal development. Includes: ensuring secure attachments are not disrupted, providing consistency of emotional warmth over time and responding in a similar manner to the same behaviour. Parental responses change and develop according to child’s developmental progress. In addition, ensuring children keep in contact with important family members and significant others.” (21) “FAMILY AND ENVIRONMENTAL FACTORS Family History and Functioning Family history includes both genetic and psycho-social factors. Family functioning is influenced by who is living in the household and how they are related to the child; significant changes in family/household composition; history of childhood experiences of parents; chronology of significant life events and their meaning to family members; nature of family functioning, including sibling relationships and its impact on the child; parental strengths and difficulties, including those of an absent parent; the relationship between separated parents. Wider Family Who are considered to be members of the wider family by the child and the parents? Includes related and non-related persons and absent wider family. What is their role and importance to the child and parents and in precisely what way? Housing Does the accommodation have basic amenities and facilities appropriate to the age and development of the child and other resident members? Is the housing accessible and suitable to the needs of disabled family members? Includes the interior and exterior of the accommodation and immediate surroundings. Basic amenities include water, heating, sanitation, cooking facilities, sleeping arrangements and cleanliness, hygiene and safety and their impact on the child’s upbringing. Employment Who is working in the household, their pattern of work and any changes? What impact does this have on the child? How is work or absence of work viewed by family members? How does it affect their relationship with the child? Includes children’s experience of work and its impact on them. Income Income available over a sustained period of time. Is the family in receipt of all its benefit entitlements? Sufficiency of income to meet the family’s needs. The way resources available to the family are used. Are there financial difficulties which affect the child? Family’s Social Integration Exploration of the wider context of the local neighbourhood and community and its impact on the child and parents. Includes the degree of the family’s integration or isolation, their peer groups, friendship and social networks and the importance attached to them. Community Resources Describes all facilities and services in a neighbourhood, including universal services of primary health care, day care and schools, places of worship, transport, shops and leisure activities. Includes availability, accessibility and standard of resources and impact on the family, including disabled members.” (23) challenging circumstances as family background: problems implicated in poor child outcomes include “mental health, physical disability, substance misuse, domestic violence, financial stress, neither parent in work, teenage parenthood, poor basic skills and living in poor housing conditions”
- Extrapolating from these figures, a typical Local Authority with a population of 500,000 would have just over 100,000 children aged 0-17. They could expect to have around 3,500 Children in Need at any one time. In a typical year, they could expect around 420 children to become the subject of a child protection plan, while on average one child might suffer serious or fatal maltreatment each year resulting in a serious case review. This latter figure, being so small, is subject to considerable year-on-year variation. A single serious incident involving a large family could skew the figures for a single year. Thus at a local or even at a regional level, single-year figures for serious case reviews need to be treated with some caution.”
- This integrated approach with a focus on early intervention or ‘early help’ to prevent problems becoming entrenched with the aim of improving the life chances of children and young people in general, aligns with three key recommendations made in the Munro Review (2011) that “preventative services will do more to reduce abuse and neglect than reactive services coordination of services is important to maximise efficiency; and within preventative services, there need to be good mechanisms for helping people identify those children and young people who are suffering or likely to suffer harm from abuse or neglect and who need referral to children’s social care.” (Munro, 2011: 69).
- Some services, notably the Family Nurse Partnership, aim to address concerns by supporting young parents through pregnancy and the early years of parenting (Department of Health, 2011). As parenting quality is recognised as having an impact on children’s vulnerability, enabling young parents to develop their own parenting ability is a key way in which future outcomes for children can be improved. Developing warm, stable family relationships which model moral values and conscience are regarded as central ways in fostering resilience in children and young people. In addition, a variety of other factors are known to have an impact on parents’ abilities to manage their family lives, including quality of housing, income, employment and the wider social and community environment (Department of Health, 2000).
- There has been an increasing focus on the role of early intervention in addressing the needs of young people who are living in vulnerable and challenging circumstances that may make them particularly liable to less positive outcomes across a range of indicators including health, education and social and welfare (Field, 2010; Allen, 2011). Alongside this, serious case reviews and reviews of child protection have highlighted the importance of information sharing and inter agency working in protecting children and young people from harm (Laming, 2003; Laming, 2009; Munro, 2011; Brandon, 2012). As noted previously, The Common Assessment Framework is predicated on efficient information sharing systems and collaborative decision making across professions. Identifying children at risk may also depend on information sharing between adult and children’s services, for example in recognising the potential for problems experienced by adults to impact upon their children. Practitioners working in services including health and social care, education and the criminal justice system can work together to identify and respond to cases of abuse and neglect (ibid.) and information sharing may assist practitioners from different agencies to make connections and better protect children (OFSTED, 2011).
- Further, while we may tend to concentrate on aspects of vulnerability and challenging circumstances in an individual sense we need also to be aware of the social and cultural circumstances within which children grow and develop and the institutional and societal structures that construct and define both their identity and their needs. Any work with children and young people needs to address the issues of children’s rights, anti oppressive practice and empowerment and their rights to construct their own identities. Recognising and balancing young peoples’ rights, needs and vulnerabilities as children whilst upholding their rights and responsibilities as young adults is a key challenge for practice (OFSTED, 2011). Vulnerability and challenge may occur for any child at some time and for some children for a substantial amount of time. Defining the need and negotiating the sort of intervention are challenges for all workers across all welfare sectors such as education, health and social care.