Essay

Building Confidence and Trust in Services for Children

Professor Brid Featherstone, Declan Coogan and Fergal Landy

July 2010

It is important that long-term responses to the tragic deaths of young people in care, and also those known by the HSE to be at risk, move beyond the current preoccupation with audit and blame as such responses are overly focused on identifying the actions and inactions of individuals or organisations and do not engage adequately with bigger and more complex questions.

The following are a sample of such questions:

Are we, as a society, prepared to pay for the resources that are necessary to maximise (but will not inevitably ensure) the chances of all children and young people getting as good a start as possible in life?
Do we, as a society, accept responsibility for the well being of our young people at the individual, family, community and societal level? Or do we consider this outsourced to the HSE and other State agencies?
Are we aware that in addition to the categories of young people focused on in recent media reports, many other young people live in arduous circumstances, some in areas of concentrated socio-economic disadvantage, others in unseen private rented accommodation, more in our direct provision system for asylum seekers and other similar scenarios?
When the intense media coverage has subsided do we remain concerned about the well being of our young people?
In a democratic society is it possible, or indeed desirable, to design systems that can protect all children and young people from harm all of the time?
Are we prepared to develop and support a paradigm of child welfare where the assessment and prevention of risk is an aspect, but not the overriding, feature?
Are we prepared to accept the reality that human beings inevitably make errors of judgement when assessing and working with other human beings and, therefore, our aim cannot be to eradicate the possibility of such errors but rather to design systems that minimise the consequences and maximise the possibilities of discovering these errors as early as possible?

In this piece we offer some suggestions towards developing stronger services for children and families in Ireland. This is part of a bigger piece of work being undertaken by colleagues at NUI, Galway. It builds upon some of the strengths that are already evident in Ireland as well as lessons from international experience. We would stress, however, that although international experience undoubtedly forms part of the information to be taken into account when designing stronger services for children and families it should not lead to a constant need to look outside this jurisdiction. Instead we should add international experience to the wealth of knowledge and expertise that exists within Ireland in order to build confidence and trust in services for children and families that are fit for this context and culture. We must do this in partnership with frontline practitioners, families and, most importantly, children and young people themselves. Any system that fails to recognise children as agents in their own protection is in danger of compounding their vulnerability to harm.

Currently Irish society is struggling with the consequences of a catastrophic failure of regulation and a crisis in leadership at a range of levels. It is possible to see the failures in relation to children and young people in State care as part of a wider, more general failure in governance. We suggest that the building of confidence in the system is vital but we ought to learn from mistakes made elsewhere about excessive, risk-averse regulation. We argue for the importance of developing responses that incorporate both confidence and trust in systems and services drawing from the work of Smith [1]. She explores the extensive literature on both terms to advance the following, very helpful, analysis.

Confidence refers to the general sense of safety and reliability that we invest in systems which include having certain expectations in relation to professional roles and the regulatory frameworks governing these systems. Thus, in relation to child care services, confidence would refer to the qualifications of those working in the system, expectations about their role and crucially expectations about the frameworks which regulate and inspect what they do, in Ireland the Health Information and Quality Authority. Clearly, the current crisis in Ireland has exposed considerable concern about the reliability of our systems at a number of levels. For example, it is difficult to have confidence in a system when crucial information about children and young people seems not to have been collected in a systematic way.

Thus, we accept and support the need to develop measures which support confidence in our system. However, we want to argue for careful attention to be paid to what kinds of measures we introduce and for their location in an understanding of the importance of trust and a deep understanding of the complexities of working with children and families.

What do we mean then by trust? Trust serves as a guide to interpersonal relationships where the outcome cannot be guaranteed, and, indeed, where the possibilities of disappointment and regret are always present. While we think that our argument relates to a variety of helping relationships we take social work as our example here. If activities such as social work are to be really meaningful in the sense of bringing about positive outcomes in people’s lives, then trust is crucial for the following reasons. First, many of those who need services will have experienced situations where their trust was betrayed very profoundly. This might lead us to conclude that it is better, therefore, to concentrate on developing systems based upon rights and entitlements. We think rights, and in particular child rights, are a vital underpinning for children’s services but rights are exercised in inter-personal encounters and services, including those based upon rights, are mediated by people. Research evidence suggests that how a service is delivered really matters in terms of whether people continue to access it. For example, young people constantly give feedback on the importance of how they are talked to by workers, whether they feel such workers are genuine or not [2]. Secondly, developing a trusting relationship with another can help repair the damage that has been done by earlier disappointing relationships. Furthermore, social workers can demonstrate that to trust is not always foolish and that change is possible.

A further reason for the importance of understanding the central role of trust is that in order for risk to be assessed and change to happen, we need service users to tell the truth [3]. That is unlikely to happen if social workers are not able to build up relationships that are compassionate and truthful in return. We know from our own experience, and from research evidence, that service users value and respond to those who are honest and can deliver the bad, as well as the good news, in a respectful manner. Integral to the building of relationships is that workers have enough time to assess what is happening, to mull over differing versions of events, to weigh up conflicting sets of evidence and to elicit truthful accounts. This kind of work cannot be done by harried workers running from one case to another without the space to think. Good quality supervision is also necessary as the research on human cognition suggests we are all prone to error, particularly when we are tired and emotionally overwhelmed [4]. Supervision should offer a space to challenge judgements made and to process the emotions that will arise when dealing with painful and distressing situations.

Trust and confidence are related but not the same and, moreover, systems that are only focused upon confidence building can destroy the possibilities for developing the kind of trusting relationships we have described above. Let us give an example. To build systems confidence, strict guidelines have been set down in some countries such as England for how long it should take to do an assessment and how the assessment should be carried out using specific prescriptive computerised programmes. We recognise that it is important for managers to be able to say confidently that assessments are being carried out efficiently and in a standard way. However, it has become apparent that a key casualty of this approach has been time spent with service users. Indeed, researchers have demonstrated that the audit tail was well and truly wagging the practice dog as social workers prioritised inputting data into computers rather than visiting families in order to meet the timescales. Moreover, it became apparent that too much attention was paid to measuring the time it took to do certain tasks but performance measures did not engage with how the task was done. As we have indicated above, how the task is done is crucial. Thus it is important to be able to measure how many children attend the meetings that are held to discuss their care, but it is just as important, if not more so, to devise meaningful measures that assess their level of participation and how they feel about the quality of those meetings. It may be in these circumstances that simply designing more and more individualised performance measures is not the answer, but rather developing good quality, well resourced consultation mechanisms with children and young people.

A further component of building trust is that we reject a paradigm that is focused solely on assessing risk as has developed in other countries [5]. In Ireland we have a strong tradition of developing services that have family support at their heart and we have engaged with international models of practice that build upon strengths and signs of safety in families [6]. This does not mean that we have avoided the trends in other countries where services have become frontloaded in terms of a focus on assessing risk. It is crucial that we do not go any further with this and there are dangers in the current climate where there is such pessimism and shortage of resources. The focus on risk without a corresponding level of attention to strengths and capacity will alienate service users and demoralise workers who, usually, do not come into this kind of work to go around seeing the ‘bad’ in everyone. Moreover, when resources are tight assessment can become the sole focus of attention and the importance of developing effective interventions and delivering concrete services becomes lost. In Ireland we have many inspiring examples of interventions that have been developed to support parents with ‘difficult to manage’ children. We have wonderful examples of peer support and family support programmes. Many have been evaluated with very positive results [7].

There are gaps too, gaps that have serious implications. We are still not developing enough programmes to work with men who are violent to women and/or children for example. This can mean that services rely on already overburdened mothers to carry the responsibility for protecting children from their violent partners. This is both unfair and unsafe and misses an opportunity to engage men in taking responsibility for changing their behaviour. Alcohol addiction and drug misuse are serious concerns and there are gaps in service provision here also.

So what is to be done? We see confidence and trust as inter-related and the following suggestions are premised on developing both aspects.

In terms of developing and embedding trust the following would seem essential:

A long term strategy designed to gradually redirect resources towards preventative, early intervention services that mobilise family, community and cultural strengths to enhance child well being;
A commitment to integrating risk as an aspect but not the over-riding feature of the systems designed and the work undertaken;
A recognition of children and young people’s agency and the importance of them having a meaningful voice in the services they receive and the development of services through their involvement in service planning, delivery and review;
Well trained, well supervised, well respected workers who have access to a range of services and in service training;
Reflective, including clinical, supervision to be available to all those working with children and families;
Responsive flexible, services at a range of levels; from local youth clubs to family support to therapeutic services;
Services working with addiction, abuse and violence issues including working with men and that are capable of working in an integrated way with children’s services.

In terms of systems confidence it is crucial that the following elements are developed as a minimum:

We see it as crucial that the government give a firm and specific commitment to hold the long- planned referendum on children’s rights. This is crucial both in terms of confidence and trust in children’s services. The debate on the referendum must focus on children’s rights and involve children themselves. Early indications are that the debate could be misrepresented as a choice between the rights of the State versus the rights of parents, not for the first time rendering children in Ireland as mere observers of a debate that is critical to their wellbeing;
Independent, adequately resourced, accessible, information, monitoring and inspection systems for children’s services located within a recognition of the importance of the complexities of the work undertaken and not just focused on the measurement of outputs;
The immediate introduction of a system for registering qualifications and ensuring ongoing professional development of all professions working with children and young people;
A child protection system that is evidence based within a recognition of the need to continually interrogate what counts as evidence and how it should be measured.

Crises are opportunities to take stock and think about what we need in this country to build a competent, confident system where trust is enabled. Crises hold dangers as well as opportunities however. We can choose to react to this crisis in order to be seen to be doing something or we can choose to act with a genuine intent to improve outcomes for children and their families. As we have already indicated there are international examples where measures that were designed to improve system confidence have undermined the trust that is so crucial for good quality work that keeps children and young people safe and improves their well- being. Moreover, ironically the very measures designed to improve system confidence themselves have sometimes led to a catastrophic lack of confidence as happened after the death of Baby Peter Connolly in the UK. We have an opportunity in Ireland to learn from the mistakes made elsewhere and to build upon our existing knowledge base about what works.

Brid Featherstone, Professor of Social Work, NUI Galway

Declan Coogan, Lecturer in Social Work, NUI Galway

Fergal Landy, Researcher, Child and Family Research Centre, NUI Galway

NOTES

[1] Smith, C (2001) ‘Trust and confidence’, British Journal of Social Work, 31:287-305

[2] Featherstone, B and Evans H (2004) Children experiencing Maltreatment: Who do they turn to?, London, NSPCC

[3] Smith, C ibid

[4] Munro, E (2005) ‘A Systems Approach to investigating child abuse deaths’, British Journal of Social Work, 35, 531-546

[5] Lonne, B., Parton, N., Harries, M. and Thomson, J. (2009) Reforming Child Protection, Palgrave Macmillan

[6] Dolan, P., Canavan, J. and Pinkerton, J. (2006) (eds) Family Support as Reflective Practice, Jessica Kingsley Publications

[7] Dolan, P., Canavan, J . and Brady, B (2008) Youth mentoring and the parent-young person relationship, Youth and Policy, 99, Spring