An examination of the factors that facilitate and hinder the care planning process for very young children in Scotland.

Author:McKenzie, Karen
Position:Case study
 
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The study reported here by Linda Davidson and Karen McKenzie examined the care planning process for very young children in Scotland using both quantitative and qualitative approaches. Data were gathered from existing case files on 18 looked after children aged 0-2 years. A qualitative approach was used to explore the views of six randomly selected social workers about current practice in relation to care planning. The social workers identified a number of factors which both facilitated and hindered the care planning process and in a number of cases the same factor was identified as doing both. The most commonly identified factor was waiting for an expert assessment. This could cause serious delays but once completed, was often the catalyst for change. The participants identified a further number of factors which they felt could improve the process, including additional training. Their responses are discussed in the context of recent legislative changes in Scotland.

Introduction

Our understanding of the needs of young children has changed dramatically in the last 30 years, with research highlighting the importance of a good attachment relationship in determining their long-term physical, emotional, social and cognitive development (Bowlby, 1979; Zeanah and Emde, 1994). In addition, a wealth of research demonstrates the consequences for a young child's mental health of disruptions to the attachment process (American Academy of Paediatrics, 2000; Balbernie, 2001). In particular, the quality of relationships in the first two years of life has been found to affect the development of the infant brain (American Academy of Paediatrics, 2000) with neglect, trauma and abuse impairing early brain development and the child's physical, social and emotional growth (Shonkoff and Philips, 2002).

Increased understanding about the importance of attachment relationships has led to recommendations that, in cases where it is necessary to remove a child from the birth family, this should ideally occur within the first six months of life, to reduce the distress of losing the main attachment figure at an older age (Howe, 2005). In addition, it is recommended that any delay in moving towards a permanent placement should be minimised and that a stable caregiver for the child should be identified as soon as possible (Cousins et al, 2003; Ward et al, 2006). However, research indicates that these recommendations are not always followed (Goerge and Wulczyn, 1998; Cousins et al, 2003).

Goerge and Wulczyn (1998) noted that in the US there were twice as many 0-5-year-olds in foster placement as 5-17-year-olds, and that young children were in substitute care longer than other age groups, with infants spending between 11 to 42 months therein. Similarly, Cousins and colleagues (2003), in their study of 11 Health and Social Services Trusts in Northern Ireland, found that as age increased, the child's chances of securing an alternative permanent placement reduced. In addition, while 48 per cent of young children remained with one carer, 52 per cent had experienced more than one placement. Ward et al (2006) carried out a comprehensive study of six local authorities in England and found that of 42 babies who were admitted to care before their first birthday, most were looked after for between 14 and 69 months. They concluded that achieving stability and permanence was a lengthy process for many of them.

Figures from Scotland indicate that while intervention is occurring at an earlier stage in children's lives (Scottish Government, 2007, 2008c) and nearly half of very young children are looked after for less than six weeks, 21 per cent of those who were aged under one year had been looked after for between six and 12 months (Scottish Government, 2008b). This suggests that there is still room for improvement in the care planning process.

It is acknowledged that the assessment and care planning process can be confusing and emotional for families and professionals alike (Rocco-Briggs, 2008). This lack of clarity can result in some young children drifting in care until assessments are completed, by which time the process of rehabilitation is further complicated by the disruption of normal attachment relationships within the family. As many of the looked after children will not have experienced a stable environment during infancy (Richardson and Lelliot, 2003) and are more likely than their peers who live in private households to experience some form of psychological problem (Meltzer et al, 2004), it is crucial to ensure that their life chances are not further damaged by the process of becoming 'looked after'.

One of the most complex and challenging tasks undertaken by a social worker is the process of assessing risk and whether parenting is 'good enough' (Winnicott, 1953). Good practice demands that the decision to separate children from their parents should never be taken without careful consideration of the child's needs and, whenever possible, targeted support should be provided to assist children to remain with their families (Children [Scotland] Act, 1995). However, for those children where the risks are deemed to be too great, a robust care plan is required to ensure that timely, child-centred decisions are made to secure their long-term future. Devaney and Spratt (2009) argue that this is because child abuse is a 'wicked' problem--here, 'wicked' in the sense of being complex and difficult to solve. They recognise that social workers operate within a climate where they must make decisions about the future of a child, often in a context of incomplete information, conflicting demands and time constraints.

This decision-making process can be made even harder when social workers take account of the research which raises serious concerns about the outcomes for children growing up in local authority care (Social Exclusion Task Force, 2007). A lack of suitable foster parents, instability of placements, re-admission rates and poor educational and social outcomes would suggest that some local authorities are struggling to...

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