January 5, 2016

Assessment in Practice with Vulnerable Children and Families Series – Part 2

This article was authored by Joe Tucci, CEO at the Australian Childhood Foundation.

In this, the second article in my series on assessment (see part 1), I am interested in examining the construct of risk and its function in the practice of assessment.

The increased attention to family violence and its impact on children has again highlighted the need for effective ways to assess risk and identify situations where children are in high danger.

Over the past decade, there have been a number of debates in the literature about what is the best form of assessment framework for decision making in relation to protecting children from abuse and violence.

More recently, models that combine actuarial with consensus models and, give weight to professional judgement are being proposed as effective decision making approaches for contemporary practice. Such models have also incorporated an analysis of the typical errors in judgements made by humans when they attempt to make complex decisions with multiple sources of information.

For example, Stewart and Thompson (2004) identified four biases which could lead to errors in practitioner judgement:

  1. practitioner’s can under use base rates when predicting events that are uncommon (which can lead to a tendency to overestimate the occurrence of an event);
  2. practitioners often carry confirmatory biases which prevent them from considering evidence impartially (which can lead to a tendency to search for evidence consistent with the conclusion they believe to be correct);
  3. practitioners allow illusory correlations to influence their clinical predictions (which leads to a tendency to see two events as being related when they are not, or are related to a lesser extent); and,
  4. practitioners can tend to place too much importance on the unique characteristics of a case (which leads to a tendency to believe that similar cases are quite different and that unique characteristics are better predictors than those that are more common).

In order to help prevent such biases from presenting in our assessments, I think it is useful for practitioners to revisit the basic principles of risk assessment, including a focus on immediate and future likelihood of harm.

Likelihood of immediate harm

The assessment of the likelihood of immediate harm is a constant process of evaluation and analysis. It is the role of child protection workers to focus on these questions at any time during their involvement with children, young people and their family. If any of the safety controls in and around a child stop being effective, then the child or young person may be in immediate danger and the safety plan needs to be adapted or changed altogether.

It considers answers to the following starting questions.

  • Is the child or young person safe enough to remain with their parents or current carers?
  • What are the precipitating factors that triggered the abuse, family violence and neglect? Can these factors be reduced or controlled in some way to ensure the immediate safety of the child or young person?
  • Are there specific vulnerabilities in the child or young person that increases the likelihood of harm occurring in the next 48 hours?
  • How severe was the harm experienced by the child or young person?
  • What is the likelihood in the immediate future of the child or young person being harmed again if nothing changes now?
  • How confident are you that you will be able to determine if the likelihood of harm increases if the child remains with his/her parents or current carers?

Likelihood of future harm

The assessment of the likelihood of future harm is a process whereby the child protection practitioner attempts to understand the possible causes and underlying dynamics of the abuse, family violence and neglect.

In my experience, this is often a poorly undertaken phase in the assessment process. In order to be effective, the assessment process should include all three of the following steps.

Step 1. Recognise and acknowledge the impact of experiences of trauma and loss that remain unresolved in the lives of parents/carers.

These experiences not only require resolution in some way, they also need to be understood by parents/carers as a coherent narrative that reflects their insight into how their past has influenced their development as adults and as parents. This is an important outcome for parents/carers as it is the single most significant predictor of positive and attuned connection between children and their parents which in turn is the most critical factor to protect them from future harm.

These past experiences of trauma and loss which are often accompanied by disempowerment and lack of support can form a backdrop of unmet needs in parent/carers that reverberate through their relationships and interactions with their children, family and community. These needs are not always verbalised. They sit in the background influencing the thinking, reaction, motivations and behaviour of parents/carers.

Examples of the sorts of trauma and loss that parents/carry with them are

  • their own sexual or physical victimisation as a child or young person;
  • experiences of fear, threat and instability arising from being the targets of family violence;
  • experiences of painful separation from their parents and families as is felt by those who part of the Stolen Generation;
  • a lack of emotional connection and security to safe adults;
  • a lack of success at school;
  • addictions and substance misuse;
  • shame associated with breaking cultural lore; and
  • experiences of racial and sexual discrimination.

Step 2. Identify any contextual problems that add stress and weaken the capacity of parents/carers to care for or protect their children.

It is critical that any current problems, issues or stressors are identified and recognised in parents. These are the factors that act as triggers to abuse, family violence and neglect.

Examples of contextual problems that parents/cares can face are

  • Unstable and inadequate housing;
  • Unemployment;
  • Isolation from family and community;
  • Limited financial resources;
  • Relationship conflict; and,
  • Death of a family member.

These problems may, in and of themselves, not result in abuse, family violence and neglect. But they can create a landing base for other problems that enable the abuse to occur. This can include the following examples:

  • Isolation from family and community decreases the degree of incidental supervision provided to children which increases the possibility of children being alone and falling prey to sexual abuse;
  • Overcrowded housing may mean there are less resources available to provide adequate nutrition to everyone living there increasing the risk of children not being provided with adequate diet;
  • Relationship conflict may lead to one of the partners abusing alcohol and triggering a cycle of family violence that affects the children in the household.

Often in practice, it is the contextual factors and the secondary problems which evolve from them that become the focus of intervention and case management. Practitioners see their role as referring these parents/carers to agencies that support them to procure better housing, manage their income more effectively, deal with the alcohol abuse, or relationship counselling to deal with the conflict.

Of course, for many families, this referral for support can lock in exactly the right resource to address the problem. The trigger to the abuse and neglect is removed and it stops.

However, for many families who repeatedly come back to the attention of the child protection system, this layer of intervention is not effective in resourcing meaningful and sustainable change. For these families, the final step in the assessment process is critical.

Step 3. Make the connection between historical experiences and contextual stressors that are expressed in parental behaviour that can be abusive towards themselves, other adults, their community and their children.

This part of the assessment requires analytical skills and judgement. It is the link between the past and the present that perpetuates the abuse.

It is important to understand the deeper reasons behind the issues and problems that lead to experiences of abuse, family violence and neglect. This understanding should never excuse any abusive or neglectful behaviour. Instead, it can form an explanation to help child protection practitioners think about why some plans do not work, or only work for short periods of time.

In principle, the assessment of background needs offers insights into how those needs might be able to be acknowledged and validated, which is the first step in reducing their influence on the behaviour of the parents/carers.

The process of assessment requires critical thinking, knowledge and reflective attention. The assessment of risk in contemporary practice provides the platform for change in families and ultimately better protection of children. The connection between the past, present and the likelihood of future risk is not only about predicting whether parents/carers will harm their children again, it is about understanding the patterns of problems and needs in families that require some form of validation and resolution.

The outcomes of an assessment is a plan that

  • appreciates the specific vulnerabilities of a child or young person
  • ensures the immediate safety of a child or young person;
  • articulates the underlying causes of abuse, family violence and neglect in a family and the context of their community and co-ordinates collective effort to meaningfully address these problems;
  • recognises protective factors in a family and community that can be strengthened and made available to children and young people to care and protect them into the future; and,
  • identifies the developmental and relational needs of children and young people created by the harm they have experienced and how best to meet them.

In the third part of this series, published next month, I will look at keeping assessments trauma-informed.