The preoccupation with thresholds in cases of child death or serious injury through abuse and neglect

Abstract

Thresholds into and between services emerged as a significant theme in the biennial analysis of cases of child death and serious injury through abuse and neglect ‘serious case reviews’ carried out in England for the (then) Department for Education and Skills between 2003–05. The preoccupation with thresholds was one of a number of interacting risk factors and many children's cases were on the boundary of services and levels of intervention. In most cases child protection did not come ‘labelled as such’ which reinforces the need for all practitioners, including those working with adults to be alert to the risks of significant harm. Policy makers should acknowledge that staff working in early intervention are working within the safeguarding continuum and not in a separate sphere of activity. The emotional impact of working with hostility from violent parents and working with resistance from older adolescents impeded engagement, judgement and safeguarding action. In the long term neglect cases that were reviewed, the threshold for formal child protection services was rarely met and some agencies and practitioners coped with feelings of helplessness by adopting the ‘start again syndrome’. Adequate resources are essential but not sufficient to redress the problems. Effective and accessible supervision is crucial to help staff to put into practice the critical thinking required to understand cases holistically, complete analytical assessments, and weigh up interacting risk and protective factors. Copyright © 2008 John Wiley & Sons, Ltd.

How do we identify and support maltreated children?

“…Despite the impact on the child, the complex, ongoing and cumulative nature of neglect means that these children may not reach thresholds for formal child protection services. 6 Even when problems have been identified, the primary care team is the main or only service contact for these children, especially for preschool children.…”

“…6 The primary care team can play a critical role in addressing health problems on an ongoing basis. This continuity of care is particularly important for the most vulnerable families, who may spend periods of time being monitored and supported by children's social care services (for example, on a child protection plan), but who may nevertheless require ongoing support, possibly throughout childhood, with a focus on health needs.…”

Preventing child deaths

“…Marian Brandon and colleagues (Brandon et al, 2008b) draw upon the third, biennial study of SCRs. They studied all the SCRs that had been carried out in England and notified to the Commission for Social Care Inspection.…”

“…. The preoccupation with thresholds was one of a number of interacting risk factors' (Brandon et al, 2008b, DOI: 10.1002/ car.1043). The paper is also about the pressures, sometimes very severe, that practitioners face in this area of work, and which might explain their concern with thresholds.…”

“…The authors distinguish profound problems in the child protection system: 'there was frequent reference to staff absence through ill health or staff vacancies (front line and managerial), a backlog of unallocated work and very high case loads' (Brandon et al, 2008b, DOI: 10.1002/car.1043). Resources were a particularly acute issue: 'local authorities' pressures on resources often lead to a push for a reduction in the numbers of children looked after.…”