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By Marian Brandon, June Thoburn, Sacha Rose and Pippa Belderson (Norwich: Centre for Research on the Child and Family, 2005)
Living with significant harm: a follow up study (PDF, 741KB)
The first phase of the study, Safeguarding children with the Children Act 1989 1, was one of a series of research studies commissioned by the Department of Health to discover how successfully the Children Act 1989 was working in its early years. It provided a detailed picture of a cohort of 105 consecutive cases of children who had been newly identified as suffering, or likely to suffer, significant harm between 1993-94. The process of intervention and protection and the progress of the children and their families were followed up over the course of a year (up to 1995).
For many of the children, the complex circumstances which had brought them into the arena of significant harm had not been resolved within a year. The impetus for extending the study, and tracking the children seven to eight years on in 2000-01, was to see how the lives and life opportunities of the young people were unfolding as they matured.
We were interested to learn about the children's well being and to discover what had happened to them since our last contact in 1994-95. We were concerned to find out whether they were protected from significant harm, or significant impairment of their development, and whether they suffered further episodes of abuse and neglect. We also wanted to see whether any combinations of social work and other services (including out-of-home care) were associated with more or less successful outcomes.
We were able to trace 77 children from the original sample of 105. Information was gleaned in the following ways:
We analysed a composite of the information from files, interviews and standardised scales to help answer the research questions.
There were a number of limitations on the information collected. Firstly, it was easier to track the cases where social services had been involved for considerable lengths of time, than cases which were closed early. This means we have more robust information about high threshold cases which continued to have high levels of risk to the children's healthy development, and less information about the closed cases where successful outcomes may have been located. Had we been able to track more closed cases the overall outcomes for the children may have looked more positive. Also, we were unable to gain access to one of the four authorities which participated at the outset and represented 13 per cent of the original sample of cases. However the absence of cases from this authority appeared to make only a small difference to the profile of the 77 cases in comparison to the beginning 105.
As our searches were confined to social services files, we have limited information about services from other agencies. Another major limitation of the data was the quality of information available in social services files. Over time the extent of information about parents dwindled. Overall there was scant detail about fathers, which exemplifies the dearth of fathers in many children's services, even though we are aware of the importance fathers play in children's lives. Of even more concern was the absence of the child's own views and communications from a quarter of the files.
Profile of the children and their experiences
We found a very high number of children with long-standing conduct problems (46 children, 60 per cent) and with emotional problems (nine children, 12 per cent). These difficulties affected children's lives at home and at school and it was evident that one of the possible consequences of suffering significant harm is social exclusion.
An influential finding from the first phase of the study was the extent of domestic violence in the 105 families and its detrimental impact on children. Most of the young people we spoke to this time related recent experiences, or vivid memories, of their parents or carers fighting and gave examples of how they coped with this over time.
Loss of various kinds and disruption featured in the lives of many of the 77 children. Thirty-two (41 per cent) experienced considerable disruption and 10 of them had moved more than eight times between carers. However, 30 children did experience continuity of care, staying with the same carer (usually their mother) throughout.
Of the 105 children 17 (16 per cent) experienced the death of a parent at some point over the eight years of the study. Between 1995-2001, eight of the 77 children we traced lost a parent and three parents' deaths followed many years of dangerous and self-destructive behaviour.
Re-abuse
We determined that a child had been re-abused if there was evidence in the files of further child protection enquiries leading to child protection registration, or if court orders had been granted to protect the child. We found that 44 of the 77 children (57 per cent) had experienced further abuse or neglect since our last contact in 1994-95, and nine children were still suffering maltreatment at our latest point of data collection in 2000-01.
Child protection registrations revealed a pattern of changing and multiple categories of harm over the years. Many children who were originally listed in single categories (especially of physical injury or neglect) were living through multiple kinds of harm and harmful experiences.
The following factors in relation to further abuse all reached statistical significance:
Patterns of social work intervention
Twenty-six cases were 'closed early', either within a year of the initial identification of significant harm, or shortly afterwards, and they stayed closed.
Twenty-two children received services over a period of many years but their cases are now closed.
Twenty-eight cases were 'open' and the children/young people are still receiving intervention from social services seven/eight years after harm was first identified.
Outcomes
When we ranked the well being of the children and linked it to interventions, we found that 46 children (60 per cent) showed moderate success while for 22 children (28 per cent) the outcome looked poor. However nine children (12 per cent) emerged with signs of marked developmental improvement. But an alarming 13 per cent of children were no safer, up to eight years after significant harm was initially identified.
We linked outcomes with children's pathways over the seven to eight years, and encapsulated these in five different routes. One group of 30 children stayed at home with the same carer throughout while 38 children changed carers, taking four different pathways:
We know that more than half of the 77 children suffered further maltreatment, but this was more pronounced for those children who shuttled many times between home and care (Route 4), where all 10 suffered repeat abuse. Fewer children who stayed at home throughout (Route 1) suffered further maltreatment, although even then, 11 out of the 30 were re-abused.
Linking outcomes to interventions was difficult because of the variability of the information and because the long-term progress of most of the closed cases was not known. The outcomes for the children were complex and did not link straightforwardly to experiences of further abuse or continuity and stability. Three quarters of the 30 children who stayed at home (Route 1) had a good or moderately good outcome but so too did seven of the 10 children who shuttled numerous times between home and care (Route 4), who had all been repeatedly abused. The children with good outcomes were well settled in care or with relatives, when we last heard about them.
There was evidence from the outcomes in Route 4, and especially Route 3, that long-term intensive services, including placement, were effective for many of the children. The children faring best overall came from Route 3 (17 out of 20 of them). These children had moved away from home (10 of them within a year) and become well settled away from home, including with relatives. In these cases children were helped to deal with extreme adversity and with serious problems. Services appeared to produce the best outcomes when they were coupled with a high level of commitment from carers (particularly relatives and foster carers).
Among the 21 worst outcome cases only four children had experienced multiple moves and seven had never lived away from home, showing that movement is not the only issue in determining the lack of security and stability associated with a poor outcome. The children doing least well appeared to be those who had been cared for away from home but returned home later (Route 2). Only seven out of 14 of these children were doing moderately well, while the other half had poor outcomes. Two of these children were abused at all three time points despite being on the child protection register for most of the seven years.
The vulnerabilities that seem to stem from the combination of factors that produced significant harm, stay with the children for many years. Thirty-four children showed little change over the seven to eight years since significant harm was identified. These lingering effects have important implications for recognising the need for long-term help for many children and families. Once a family's problems have reached the point where significant harm is identified, there are few quick fixes. It needs to be acknowledged that late intervention is often lengthy intervention.
Recommendation 1: A range of services need to be made available on a long-term basis for all children who have suffered significant harm.
Even many children whose cases were closed relatively early struggled to achieve reasonable levels of overall development. In eight of the 26 closed cases there was evidence that problems had resurfaced, although not sufficiently to warrant a high threshold service from social services. Two out of three of the children we were able to interview whose cases were closed early, talked about troubled lives and had a number of problems, including regular experiences of domestic violence, but no one to confide in about this.
Recommendation 2: Readily accessible community based services, set at a lower threshold (especially school based) should be available for children and young people who have suffered significant harm, if necessary on a long-term basis.
Problems were exacerbated by not tackling hostile and uncooperative families. Children's safety and well being was often overlooked in these circumstances. The reluctance to act or plan effectively when children's difficulties are recognised has detrimental long-term implications for children's outcomes which will show up across all five outcome domains promoted by the DfES.
Children who returned home after being looked after or being the subject of a care order appeared to be particularly vulnerable to a poor outcome, unless well planned services were provided and the situation was not allowed to drift without clear progress. Child protection registration in itself does not protect children or promote a better outcome. Registration identifies children who are still not safe, but offers no indication of how well they are protected. We found some children languishing on the register over long periods, often listed in multiple and changing categories of harm where the ongoing planning was neither promoting their well being, nor keeping them safe.
Recommendation 3: Children should not 'drift' on the child protection register. Services to children on the register and their families should be carefully planned and individually tailored.
Children who used high threshold services the longest were those whose families had multiple problems (using the Cleaver and Freeman (1995) classification2) at the outset. Families which we identified initially (using the same classification) as beset by 'acute distress' or 'single issue' problems tended not to linger long with social services.
Recommendation 4: Assessments which identify families with multiple (and often entrenched) problems where children are considered by the multi-agency grouping to be suffering or likely to suffer significant harm, need planning which takes into account the likely need for long-term services.
There was evidence from the outcomes of children living away from home (Routes 3 and 4), that long-term intensive services, which supported placements with relatives or in foster care, were effective. Services appeared to promote the best outcomes when they were coupled with a high level of commitment from carers (particularly relatives and foster carers).
Recommendation 5: long-term placement services (including with relatives) can produce good outcomes.
The transition to adult services left a number of young people adrift of helping relationships. The knowledge of how powerfully past experiences affect current relationships needs to be recognised by professionals across agencies and especially in the transition from children's to adults' services. Rigid adherence to policies in the transition between services poses threats to young people's well being. Professionals need a sensitive understanding of the needs of young people who have lived with significant harm and its consequences. This includes an empathic understanding of the risks they may pose to their own children when they become parents. It is difficult to see how this informed transition will be achieved given the widening split between children's and adults' services.
Recommendation 6: File recording needs to present a coherent story about each young person as an individual. Each file should include an analytical summary of the chronology which makes sense of events and of the impact of relationships and past and present experiences. This is especially important in cases being transferred and moving out of children's services.
This study has illustrated not only that the effects of significant harm are long lasting and may extend into adulthood, but also that good outcomes are possible for children with severe problems in these high threshold cases if consistency and security can be promoted, often with the assistance of very long-term services.
1. Brandon, M., Thoburn, J., Lewis, A. and Way, A. (1999) Safeguarding Children with the Children Act 1989, London, The Stationery Office.
2. Cleaver, H. and Freeman, P. (1995) Parental Perspectives in Cases of Suspected Child Abuse, London, HMSO.
Living with significant harm: a follow up study (PDF, 741KB)
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