By Richard Devine, Social Worker for Bath and North East Somerset Council
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Undertaking direct work with children can be the most rewarding part of being a social worker. Yet, it can also be the most challenging.
Two types of direct work:
- To ascertain the wishes and feelings of a child. The purpose is to discover a child’s worries, anxieties, hopes, and wishes. To understand how they’ve made sense of their world. This could be as part of an assessment under Section 17 (voluntary) or an ongoing feature of our work. For example, if the child is subject to a Child Protection Plan or a Child in Care.
- A therapeutic piece of work to help a child understand their experiences, especially the experiences that have warranted social work involvement, such as exposure to domestic abuse, parental mental health, and substance misuse.
There are several challenges to undertaking direct work in child protection, and based on a previous blog by Andy Black, I will cluster these into three domains, 1. Social/cultural, 2. Professional, and 3. Psychological.
- Social / Cultural:
The unfortunate reality of our work means that we only become involved in a child’s life if someone is concerned for a child. Therefore, we are visiting children suspected of having harmful experiences, or this has already been established, and we are working with them on an ongoing basis. Either way, we have to have conversations with children that you don’t typically have with children. Conversations about violence, parental mental health, death, drug and alcohol use, criminal behaviour, sexual abuse, physical abuse, and so on.
As pointed out by Andy Black, in modern society, ‘childhood is conceptualised as a sacred and discrete time of life that should be protected. It is, therefore, socially acceptable and preferred to actively protect children from the often-harsh realities of adult life, and in some cases, lie to them to preserve preconceived notions of innocence’.
Turnell and Essex, echoing this point, note, ‘Professionals, perhaps informed by an overly sentimental view of childhood innocence are often at a loss regarding how to communicate the enormity of the events to children caught up in situations of abuse’ (2006: 72).
I will touch upon this later, but it’s worth remembering that whatever we think we are protecting children from, they have already lived through. Illustrating the importance of talking to children about these difficult and potentially traumatic experiences, research has found that not discussing a distressing experience can be more damaging than the event (Pennebaker, 2016).
The challenges we experience professionally are twofold.
Firstly, the sheer volume of work expected of a child protection social worker provides a challenging context to plan meaningful work and spend enough time to establish a trusting relationship with a child. Learning how to build trust efficiently becomes a necessary skill in child protection.
Secondly, we often visit children in their homes. If the child is subject to a child protection plan, these visits occur regularly and often require us to have conversations with parents as well. Ferguson captured this, in a brilliant paper titled, How Children Become Invisible in Child Protection Work, ‘multiple tasks had to be completed, invariably within time limits: parents and other carers interviewed, children spoken to on their own, interactions between family members observed, and bedrooms and other home conditions inspected, to name just some’ (2017 p.1012).
In this paper, Ferguson also described the challenges workers faced with some families, despite being effective with others as they would be ‘overcome by the sheer complexity of the interactions they encounter, the emotional intensity of the work, parental resistance and the tense atmospheres in the homes’ and this could result in them unintentionally losing sight of the child’ (p.1017).
From a personal and psychological perspective, the topics might be challenging to tolerate talking about. Even if we can overcome our impulse to protect children from ‘adult’ topics and create enough space and time, our unease could prevent us from asking questions or exploring certain issues.
In a paper by John Burnham (2018), systemic practitioner, he described an experience that illustrated this. Burnham was working with a woman who he thought was avoiding why she was attending therapy, which was because of her experience of sexual abuse. He detailed the conversation he had after he realised this:
‘Every time we approach that issue, you seem to change the subject….I am wondering why?’ As I began to speak the question, I changed it to, ‘Every time we approach that issue, the conversation goes somewhere else. Who you think avoids it more…me or you?’
My thinking was still influenced by the idea that she was avoiding, but I wanted to be kinder by including myself in the question’
She replied, ‘you do’.
I was taken aback, but eventually received curiosity to enquire ‘How? What do I do?…How do you notice that?’
Thankfully she replied, ‘Well, whenever I am close to talking about what happened you will say something like ‘It doesn’t have to be now…take your time and so on’.
Burnham reflected, ‘in my wish to be sensitive I had acted superficially’ (2018, p.17). So often, our discomfort about a particular topic can lead to us avoiding it, thus denying the child the chance to talk about it. Of course, some children might not want to, and that should be respected, but it would be a shame to close down that option to them based on our insecurities. Learning to be comfortable exploring these topics is not easy but can be achieved through practice and the use of tools that provide a structure to have difficult conversations.
Recognising the social, professional, and psychological barriers is the first step in overcoming them. In the next section, I will outline some fundamental principles that I have acquired over the years to increase the chance of meaningful and effective direct work while considering the above challenges.
10 Principles for direct work
We need to ask what the child thinks or knows as the reason for why we are visiting. To find out how naughty I am? To find out things and tell my parents/carers? To punish me? To trick me? To find out about the ‘special games’ me and dad play? Does he/she want to play ‘special games?’ (These questions are from a handout provided by Rob Tucker, during some training he delivered).
If a child is unclear about the reason for us visiting, then they might be fearful or defensive. Explaining our role and clarifying why we are seeing them is the main way to allay these fears. Even when we have shared the reasons for our visits, some children will remain apprehensive. We must recognise the potential cost they might incur for sharing their experiences. Common causes include embarrassment, shame, and fear of consequences (to self and their family).
Undertaking effective direct work is a skill that can be developed. Some practitioners might be innately talented, but most of us are not. For the first couple of years in practice, I was expected to do six sessions of wishes and feelings with every child I was the allocated social worker for. If you are a student or newly qualified, I highly recommend you ask to do this with children you work with. I found that I could use the same worksheet with two children of the same age, and it would have completely different effects. I learned that a tool that worked for a 6-year-old didn’t work for an 8-year-old. Or, what worked for a boy didn’t work for a girl. I became comfortable at experimenting various techniques and tools.
Later on, when I would need to visit children in urgent circumstances, I learned to condense the relationship and trust-building that typically occurred over several weeks into less than an hour. However, I wouldn’t have been able to do this without all the practice.
As well as practicing how to communicate and interact effectively with children, I had to learn how to communicate to children about domestic abuse, parental mental health, and substance misuse. Susie Essex and her colleagues developed words and pictures, and then Turnell integrated them into the Signs of Safety Approach (where I learned about it). In my opinion, every child subject to a child protection plan should have one. Learning how to write about complex subjects so that children can understand them helped me substantially in being able to talk about these issues with children.
Meet the child where they’re at. Whether they are four years old or a teenager, we need to adjust ourselves to enter the interaction in their preferred way. Madge Bray reflected on this ‘Because sitting on chairs and using language came naturally to me, as it does for most adults, I imposed it on children without thinking. Yet, surely play was child’s first language, through which thoughts, feelings and dilemmas were communicated to the world…I needed to enter [the child’s] world…rather than trying to drag [a child] kicking and screaming into mine, demanding that he co-operate on my terms’ (1992, p.16).
When I was an allocated social worker for a child, I wanted to ensure that they were provided every opportunity to share their wishes and feelings. Our job is not to force children to talk about their experiences, but rather to maximise the chance that if they want to, they are given that opportunity.
The challenge is that most children won’t easily open up about their experiences because it’s all they’ve known (e.g., asking a child what it’s like living in a pervasively neglectful home is unlikely to yield anything because they know no different). Or they are fearful about the repercussions for their parents or are unsure whether they can trust you. Concerning this latter point of building trust, I tend to take this to the extreme and think that if a child isn’t opening up and talking about their experiences, then I am responsible. I need to be more proactive, adopt a different tact or find a way to build more trust. In the vast majority of cases, this is successful. In some cases, this isn’t possible. Then I provide a hypothesis for the underlying function of their reticence but will only do this when I know that the reason isn’t a function of my failure to build the relationship.
Another reason children might find it difficult is that they have developed coping mechanisms to deal with their experiences. I have observed two common reactions.
Firstly, some children develop a way of coping with their experiences that involves ignoring or minimising the effects of adverse events. They learn to inhibit and hide their emotions and comply with adults or try to take care of them in a role reversing strategy. Part of their difficulty in opening up is that they have developed a self-protective coping mechanism that requires them to avoid negative feelings and therefore distract away from topics that invoke negative feelings.
Secondly, some children can be hyperactive, unable to concentrate and flit about from one task to another. They will refuse to join in with a conversation or game designed to elicit wishes and feelings through challenging, provocative behaviour. These children are anxious, and the distracted/distracting behaviour might function in a home where the problems are too threatening or scary for them to attend but too important to entirely ignore. Therefore, they find it difficult to engage in a sustained dialogue, especially in relation to difficulties at home.
These two strategies constitute attachment patterns developed in response to certain experiences (Crittenden 2016). If these strategies dominate our sessions, I begin to hypothesize about their behaviour’s function and seek further information by observing the child at home and speaking with parents and teachers to test the hypothesis. In my opinion, reporting on the child’s coping strategies is a way of encapsulating their wishes and feelings.
Sometimes, what a child doesn’t say can also be valuable. For example, we receive a police report due to mum and dad fighting while intoxicated. When the police attended, there was lots of commotion, and the children were present, observed to be dishevelled and distressed.
In this example, there is a two-step process if you were to visit the following day. Firstly, you ask the child generally about their life to see if they voluntarily discuss what they did the night before.
If that is unsuccessful, you ask them more directly about the police attending their home. We are in an unusual position in child protection as we often understand what is happening for the child at home, unlike, for example, a teacher who spends time with a child. That means we can share our knowledge with the child that we know their mum and dad have been fighting, or dad was drunk over the weekend. Suppose the child still chooses not to discuss; in that case, your analysis will need to include evidence of the domestic abuse incident and the child’s unwillingness to discuss as well as a hypothesis for the reasons as to why they might not discuss their wishes and feelings.
Have fun with children. It’s one of the most effective ways to build a relationship. Some of the best direct work I have done with children has been while I’ve sat next to them playing Fifa on their games console or playing basketball with them. Physical play can be incredibly effective, as it can change the physiological state of the child and activate their ‘social engagement system’ (Porges, 2017: 22), making them more capable of engaging in dialogue. Play is an activity you can do with a child, but its’ also a way of being. I recommend always ending any direct session with a child with playful activity, in part because when we retrospectively evaluate an experience, the ending has a disproportionate impact on whether we consider it positive or negative (Kahneman, 2011).
A note of caution: if all you are doing is playing, you might want to consider whether you or the child is avoiding the reasons for you visiting them. Remember, our job is to elicit their wishes and feelings or help them make sense of difficult experiences.
The child’s age should not preclude you from obtaining their wishes. However, the method in which we secure these will differ depending on their age. Eliciting an infant’s wishes and feelings requires observations coupled with an integration of information from various sources about their lived experiences. School-aged children’s wishes and feelings can be obtained directly through play, activities and talking. In adolescence, you’d be hard pushed to get them into a room to complete a worksheet. Instead, driving around and asking them to play their favourite music tends to have greater levels of success. In my experience, adolescents prefer it when someone can joke and be playful with them.
There is ample literature on communications skills therefore I will describe two techniques that I used the most.
Firstly, the acronym TED. Tell, Explain, Describe. A handy tool to ensure you utilise open questions.
Secondly, paraphrasing. Reflecting to children what they’ve just said, with a raised intonation at the end, encourages them to share more without the need to ask a question. Reflecting back to children their emotions and actions can also be effective.
Achieving Best Evidence (which I recommend every social worker reads – see page 68-86) is the guidance police officers, and other trained professionals use for interviewing children and vulnerable adults about allegations of abuse.
This guidance provides a formula for conducting each session/interview, 1. Establishing rapport, 2. Initiating and supporting a free narrative account. 3. Questioning. 4. Closure. Ever since I learned about this, I have more or less followed this process in all the direct work sessions I have completed. I begin each session by establishing rapport (or re-establishing it) by exploring neutral topics, then transition into encouraging a discussion about the reason for my visit, following up with specific questions, then concluding by returning back into trivial issues or something playful.
It is vital to explain to parents why we talk to children and encourage them to share their experiences. Parents are often apprehensive about the children knowing the reasons for our involvement, but once they understand the benefits to children understanding, they are, in my experience, relatively easily persuaded. I often explain that without an explanation, children are prone to make up their own reasons, and given their tendency for ego-centric thinking, it will probably involve self-blame. Helping their children understand the reasons for our involvement will reduce their anxiety. It can be a therapeutic intervention in itself. Children who have an age-appropriate understanding of events happening in their life, especially ones that cause distress, are far healthier psychologically than children who experienced distressing events then feel compelled, for whatever reason, to conceal this.
I will conclude with Bessel Van der Kolk describing the benefits to listening and the difficulties we can face when deprived this opportunity:
‘Feeling listened to and understood changes our physiology…As long as you keep secrets and suppress information, you are fundamentally at war with yourself. Hiding your core feelings takes an enormous amount of energy, it saps your motivation to pursue worthwhile goals, and it leaves you feeling bored and shut down. Meanwhile, stress hormones keep flooding your body, leading to headaches, muscle aches, problems with your bowels or sexual functions – and irrational behaviours that may embarrass you and hurt others. Only after you identify the source of these responses can you start to use your feelings as signals of problems that require your attention’
(The Body Keeps Score, Van Der Kolk 2014: 233)
By Richard Devine (04.02.22)