By Richard Devine (02.09.2020), Social Worker for Bath and North East Somerset Council.
Originally I had intended to write a blog with 10 pithy lessons from my experience of being a social worker since I qualified in 2010. What I have done instead is write 10 lengthy (ish) lessons, each amounting to the equivalent of a blog. Therefore, given the length of each one, I am going to share one every working day for the next two weeks (hoping that I can finish the final two before next week!). I cover a range of topics from relationship-based practice to decision making and removing children and time management. Each of these topics reflects my current understanding after a decade of working as a children and families social worker. If I were to imagine myself writing this 10 years ago, or even 5 years ago, I suspect I would be embarrassed at how little I understood. Therefore, I can only assume I will think the same about what I have written in these 10 lessons in a few years’ time. Some of you will be further along with your understanding than I am, and if this is the case I would appreciate feedback and critique. None of what I write about is static – they represent my best understanding of issues in a moment in time.
Lesson 3. Decision making and Removing children
Introduction:
The hardest decision I have been involved in as a social worker is to decide whether a child should remain in the care of their parents. I should note, however, that this is not a decision a social worker can make because only a Judge in a Family Court has the power to make such a decision (or the police in extreme circumstances). Nonetheless, we must make recommendations and advocate for those recommendations through a legal process. This decision, and others similar, are fraught with ethical and moral challenges. You have to choose from a range of options that are in conflict with one another, all of which contain some positive and negative elements. Furthermore, if the outcome that you decide to be in the best interest of the child is removal, this can invoke personal emotional distress and pain, in part because you are involved in a process that inflicts substantial distress on another but also because it violates your values. I have yet to leave the court following the conclusion of care proceedings without a gut wrenching feeling of despair, even in cases where there is no ambiguity that the child’s safety and well being necessitated permanent removal, and everything had been tried to prevent it. Feelings that are no doubt incomparable to what the parents must feel.
Featherstone et al (2018: 18) draw attention to the work of Weinberg and Campbell (2014) and Weinberg (2019) who refer to ‘ethical trespassing’ and ‘moral distress’. ‘Ethical trespassing’ is when ‘no correct response is clear or indeed entirely right’ and ‘moral distress’ is when ‘professionals feel blocked from doing what they consider morally correct’.
The challenges of decision making:
There are two dominant ways of reasoning that if left unchecked can undermine effective decision making. The first is intuition and the second is deductive reasoning. Intuitive reasoning is; largely unconscious: looks for patterns: emotion-laden; rapid processing; draws on practice wisdom (Kahnemann, 2011: Munro, 2011). Intuitive reasoning has many benefits, for example, it can predispose us towards rapid self-protection in ambiguously dangerous situations. Or it may generate a feeling of despair after visiting a family that may reflect the well being of the parents and/or children that would benefit from further exploration.
However, intuitive reasoning is fraught with biases. Munro et al (2016: 96) identify the following: ‘Confirmation bias: holding on to beliefs despite new information that tells against it: First impression bias: the first impression of a family can shape the future interpretation of information about them: Availability bias: being selective about what information to consider, with most attention being given to information that is vivid, concrete, emotion-laden or recent: The fundamental attribution error: the tendency to explain other peoples behaviour due to internal personality traits with insufficient attention paid to the context in which the act’
Intuitive reasoning is unavoidable. You can’t decide to opt-in or out of it, and it powerfully shapes how we think and make decisions. Kahnemann argues that ‘many people are over confident, prone to place too much faith in their intuitions’ (2011: 45). Being mindful of these biases is crucial, and the role they may play in producing for error. As pointed out by Munro (2008: 125) ’The single most important factor in minimising errors [in child protection] is to admit you may be wrong’.
The second flawed way of making decisions is deductive reasoning. To give an example:
1. The child is at significant risk of harm in his/her parents care
2. The child’s safety would be secured by placing the child in alternative care
3. Any child at significant harm should be removed and placed in alternative care
Remiss from this reasoning is the devastating consequences for children and their parents when separated. It is a common fallacy, especially as a newly qualified social worker, to underestimate the harm caused by removal and overestimate how beneficial alternative care will be for children. As pointed out by the legendary Bertha.C.Reynolds in 1963 (47):
‘If we have naive faith that a good home would cure the lack of one in the case of every unhappy child, we were often disappointed…painful experiences may live on in the unconscious and be of as productive conflict in a new environment as the old’
The Decision Tree:
How do we avoid simplistic linear decision making? And is there a method that enables us to utilise the benefits of intuitive and emotional reasoning but counteract their limitations with formal and analytical reasoning? Munro, in her excellent book Effective Child Protection (2008) advocates the use of a decision tree. Munro (2008 p. 105) suggests there are 7 stages to a decision tree:
1) What is the decision to be made? 2) What options are there? 3) What information is needed to help make the choice? 4) What are the likely/possible consequences of each option? 5) How probable is each consequence? This will be based upon research, knowledge of the family, understanding of available support, and practice experience. In probability theory chance are rated between 0 and 1. Something that is impossible is 0; it has no chance of happening. Something rated as certain is 1. Something that is 50/50 is 0.5. 6) What are the pros and cons of each consequence (what is their utility value?). 0 is highly undesirable and 10 is highly desirable.
| Consequence | Pros | Cons | Utility value |
7) The final decision. You multiply each probability score with utility value and add them all together.
If you were to consider for example a school aged child at significant risk of harm and whether that child should be removed, you would need to outline the potential consequences i.e.
- Very stable placement for rest of childhood
- A mostly positive placement with some difficulty and possible breakdown
- Very little stability, multiple placements.
An assessment would need to be made about how likely each consequence could be. In answering this question an exploration of research into placement stability for children in care is required. This proves to be challenging because there is a lack of information on children’s experience of stability across the country. Nonetheless, I found some statistics from a report from a 2017 Department of Education Report: 17% of all fostered children have been in the same placement for 5 years or more: Over the past year 68% had 1 placement, 21% had 2 placements and 10% had 3 placements. In other words, the likelihood that you the young person will experience placement stability, a key indicator in determining positive outcomes for children in care, is less than 20%. At least 10% of children in care will experience 3 or more moves, leaving approximately 70% who experience one or two moves.
There are other factors worthy of consideration, such as the child’s age, their individual needs, the availability of high-quality placements. For example, the likelihood of placement stability can improve with pro-active case management and a robust matching and preparation process. Likewise, if there has been a lack of consideration to finding the right match between a foster carer and a child because of poor case management or the child is removed in an emergency, then the likelihood of placement stability may decrease substantially.
Once a rating has been provided for the probability of each consequence, then an assessment of the desirability of each consequence is made. For example, if a child comes into care, then it is highly desirable that they access a stable placement and highly undesirable that they experience multiple placements. Finally, an evaluation is completed that computes the data to provide a final score, and this guides and informs decision making. This analysis would need to be contrasted with a similar analysis of the risks and benefits of remaining at home. In some cases, the risk of harm associated with parental substance misuse, domestic abuse and/or poor mental health may indeed be less than the risk incurred with removal. Equally, the risk deriving from the parents functioning may be such that removal is unavoidable and necessary, even with the negative effects of change in placement.
Conclusion:
If you are thinking that this method is complex, I would agree. The decisions that social workers are expected to make are exceptionally complex. In the context of a busy and pressurised environment, we may risk simplifying these decisions and relying on proficient, albeit flawed, ways of reasoning. Munro’s decision tree is the most effective method that I have encountered to facilitate effective decision making. It is time expensive, but the cost pales in comparison to making the wrong decision. Furthermore, once you’ve applied the method deliberately, you can remember some of the key concepts which then improves your decision making, even when not relying on it formally.
By Richard Devine (02.09.20)
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Bibliography:
Kahneman, D (2011). Thinking, fast and slow. London. Penguin Books
Featherstone, B., Gupta, W., Morris, K & White, S. (2018). Protecting children: A social model. Bristol: Policy Press.
Munro, E. (2008): Effective Child Protection (2nd Edition), London: Sage.
Munro, E., Cartwright, N ., Hardie, C., and Montuschi, E (2016). Improving child safety: deliberation, judgement and empirical research. Centre for Humanities Engaging Science and Society (CHESS), Philosophy Department, Durham University.
Reynolds, C, Bertha. (1963). An unchartered journey: fifty years of growth in social work. New York. The Citadel Press.
Richard Devine, Social Work Enthusiast and Blogger 