Chris Dillow’s concerns about the child database made me think about what we know about serious cases where children are hurt of killed.

I used to work with one of the authors of this report, which looked at 40 reviews for the Department of Health and is probably the cutting edge of what is known about serious case reviews. 

One of the things they say early on is that:

there are no readily accessible data on the number of Serious Case Reviews that are undertaken.

I felt, and feel, that it was a scandal that the Department of Health didn’t (doesn’t?) know how many reviews have taken place each year and that it isn’t consistently commissioning research to learn from them.  I just don’t understand why, given that the Department requires that when a review is undertaken that a copy is sent to them, they don’t want or need a national picture on what is going on at this most extreme and most vulnerable end of the child protection spectrum.

Over the 9 years that I was a councillor I read a number of reports prepared for, what was then, the Area Child Protection Committee where something had gone wrong.  My memory was that on almost every occasion (when the child was ‘known’ to the local state) the professionals involved – social workers, doctors, teachers, housing officers, the police, prison service etc. – hadn’t communicated enough.  The other thing that I recall was there often seemed to have been a period where the people involved had gone off the radar.  They’d moved from one borough to another, changing doctors, changing schools, and the bureaucracies involved hadn’t been quick enough to keep up.

But the report makes it clear how difficult it is to rely on our individual perceptions of what the common factors are in these cases:

As Serious Case Reviews are a relatively rare occurrence in a social services department, respondents to our interviews were often tempted to generalise from their single case or clutch of experiences. The validity of these perceptions, however, does not stand up to empirical testing.

They then show the reader what they mean by looking at the comments of a number of the people they interviewed.  Here’s a senior manager, interspersed with results from this survey of 40 cases printed in italics:

I have done four of these reviews and the same things keep coming up. It’s young mothers (9 of the 40 main carers were aged under 21 when the child was born) who are depressed (18 of the 40 had mental health problems) and simply cannot cope (for 16 children no concerns about their welfare had ever been expressed) with their babies (19 of the 40 children were aged less than 12 months) in poor living circumstances (in 23 cases there was no significant poverty or accommodation problems), especially when their situation is compounded by a violent partner (22 of the 31 current partners were known to be violent).

But it looks like my memory has an okay fit with some of the evidence.  Here’s a bit of what they say about information and working relationships:

Difficulties often arise from getting material on time from agencies whose evidence has to be approved by various layers of management or where extraneous factors delayed the gathering of information. In one case, the police repeatedly refused to interview a mother saying that she was too distressed. This frustrated the review team as ‘we thought we could understand her situation better if we had some information’. Co-operation from education authorities and schools was equally variable. The quality of information from GPs was also often poor, in one case it arrived after six months and comprised a list of rheumatism prescriptions and in two others there was a total unwillingness to co-operate with the review. One respondent commented in interview,

I think GPs are given too much liberty to opt in or out of the child protection system and I think that they need to be compelled to opt in. I think Working Together to Safeguard Children is completely weak on this issue.

They point out that of the 40 cases they looked at 12 were completely unknown to social services, and conclude:

Only one of the 40 cases scrutinised was seen as highly predictable and only three as highly preventable.

Whether the factors that are in play at this end of children’s services, where we are focusing on failings, can be applied to what the children’s database is trying to do (preventative work with children and families) is a moot point.  But, my memory of the debates as the ideas were developed, was that the organisation I worked for at the time argued there needed to be a balance between the rights of the child to privacy and the potential to intervene early enough to undertake effective preventative work.