Understanding Risk and Resilience in young people

Hertfordshire County Council Changing the Culture 1

Understanding Risk and Resilience in young people

A one day workshop by Child Centred Practice

1. The assessment of needs?2. Judgement about eligibility?3. A calculation of the match between need and available

resources?4. Evaluation of risk and urgency?In fact social workers undertake assessments for a range of

purposes and there is no consensus on what those purposes are (Crisp et al, 2003)

What is Assessment for?

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Assessment is not only multi-faceted but multi-layered in ways that are not always visible in the assessment encounters of individuals.

Individual assessments may be made on the basis of ‘professional judgement’ or a set of independent ,agency criteria, but both are carriers of judgement and priorities formulated outside the assessment situation.

( pg 22, Assessment in social work: A guide for learning and teaching, Whittington. C, scie,2007)

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Decision making in assessment

Developing a sound approach

Hertfordshire County Council Changing the Culture

people's beliefs 'are remarkably resilient in the face of empirical challenges that seem logically

devastating' (Kahneman, 1990, p.144).

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Consideration of all possible known alternatives

Use of a maximum amount of information Careful weighing of all information and

avoiding intuitive conclusions A maximum degree of sound reasoning

Classic Decision Making theory

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In reality we all use SHORTCUTS: Based on similarity to pass knowledge Information Experience Beliefs Help to minimise cognitive effort needed

to thoroughly assess a case

Using Intuition in decision making

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The Halo Bias – case work attributing too much to general impressions of person, situation, report

The negative information bias – tendency to weigh negative information more heavily than positive when making decisions

The stereotype bias – stereotypes a way of organising information – does not tell the whole story.

Shortcuts to avoid

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The confirmation bias – seek information that supports one’s decisions or beliefs whilst ignoring evidence that challenges the conclusion.

The supporting evidence bias – the tendency to be more engaged by what we like than what we do not like. We subconsciously decide what we want or expect the outcomes to be before we understand why we want it.

Shortcuts to avoid

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Intuitive How people reason Establishing rapport Using empathy and

experience Imagination Unconscious appraisal of

competence.

Analytical Formal logic Probability theory Decision theory Formal instruments Empirical research Measure specific

dimensions Statistics of equations

Analysis, intuition and the nature of expertise

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Taken from Dalzell and Sawyer, Putting Analysis into Assessment, NCB, 2007.


IntuitionStrengths Fundamental Swift Interpersonal Draws on knowledge

and research Tacit – even if can’t be

articulated, still valuable

Survived over time

Weakness Implicit – defective as

knowledge not shared Not necessarily reliable Limited to a range of own

experience and bias Blind spots – look for

evidence to confirm assumptions.


Analytical reasoningStrengths Knowledge base from

empirical research Summaries and critics

readily available All aspects of subject

has been studied Need to justify actions

– public accountability

Weaknesses Findings tentative – only

weak casual link at times Can’t just read findings –

need to understand context, use judgement

Difficult to export to different populations

Definitions of abuse change over time

Cannot have random controls

Actuarial tools Do demonstrate a higher level of accuracy

and consistency than professional judgements

Provide an opportunity for consistency across agency and workers

Help in developing clear standards Are not infallible

However...

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Knowledge and skills (Munro. E, 2002)


What makes therapy successful?15%

15%

40%

30% TherapeuticTechniqueClient Hopefulness

Client Characteristics& Social SupportRelationship betweenclient and therapist

Kieran McKeowan A guide to what works in family support services for vulnerable families (Dublin, 2000)


Adolescent Development

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Adolescent Development (Key note 3.2)

Critical period in lives of all young people – particularly for young people who are looked after – dealing with uncertainties about the future & traumas or their past.

How young people deal with all the changes adolescence brings will be influenced by what has happened before

- experiences in infancy & childhood- quality of attachments- their ways of resolving problems.- Their connections to the wider community.

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Adolescent development Physical changes – puberty (physically girls

earlier than boys) Development of sexual identity (can be

exciting, confusing, overwhelming) Cultural & family expectations need to be

resolved. If previous sexual abuse – often arises and

needs to be dealt with.

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Adolescent development Preparation for financial independence – taking

more responsibility for this. Increased domestic responsibility – often a source

of tension in the home. Separation from family of origin – can happen at

various stages for various reasons L.A.C – no choice usually when younger, will affect things when adolescent.

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Adolescent development Development of moral code. Draw on and are

powerfully influenced by beliefs & behaviours of their family & communities.

Often go through periods of questioning, trying out different ideas.

Negotiating peer relationships – can be a difficult task – major challenge (esp if child has poor self esteem/poor social skills)

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Adolescent development Peer group pressures –

can be very powerful. Finding & sustaining

intimate relationships outside the family of origin – adolescence- growing up leaving behind childhood dependency – balancing needs for closeness & autonomy.

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Normal Adolescent (key point 3.4)

Often thought of as a period of turmoil & uncertainty but can be exciting & challenging.

Can be a period where the prevalence of problems & disorders rises – e.g: rates of depression.

What is ‘normal’ adolescence? – difficult at times to distinguish between ordinary transitional development & mental disorder.

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Normal Adolescent ‘Normal’ –powerfully influenced by our

values & beliefs. Children who are looked after also have the

beliefs & opinions of carers, social workers & other professionals plus policies of agencies involved in aspects of their lives.

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Risk & resilience in adolescence


Professionals need to be resilient and persistent

A self harming young person who seems out of control can be very distressing for the professionals surrounding them.

This is not the time to opt out. Sometimes we work with young people one hour

at a time and hope.


Signs of a resilient young person

Playing a bad hand well, rather than getting a good hand

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Protective Factors

Sufficient income support and good physical standards in the home.

Practical and domestic help. Regular medical and dental checks including school

medicals. Factual information about puberty, sex and

contraception. Regular attendance at school. Sympathetic, empathic and vigilant teachers.


Protective factors for young adults Belonging to organised, out of school activities, including homework

clubs. A mentor or trusted adult with whom the child is able to discuss

sensitive issues. An adult who assumes the role of champion and is committed to the

child and 'acts vigorously, persistently and painstakingly on their behalf' (Department of Health 1996, p.24).


Interventions that are proving to have

potential-clubs and hobbies

-summer camps-belonging to something good (families, peer groups

etc.)- -doing good, volunteering etc.

-being paid-holistic interventions that don’t just tackle ‘the

issues’ or ‘one issue’ -having mentors who stick with disadvantaged kids

over time (challenge to ‘projects’ and specialisation)-Using the mass media (celebs)

- exploiting the full potential of the internet, mobile phones and other new technologies (Youth matters)


For example, some very obvious ones… To achieve their maximum potential kids will

be protected by having all the things we know they need:

- good education- love and sense of belonging- decent standard of living- great parenting- intelligence- good looks- opportunities to contribute


Implications Some kids do better than others having had very similar

experiences – we can be the factor that makes a massive difference

Complexity theory: small changes, big effects; and we can’t always see the protective effects immediately –daring to do things differently, being open minded, confident

There is hope for everybody! Resilience theory helps us to work relentlessly towards better outcomes– helps us keep enthusiastic and focused

Resilience theory gives us a framework within which to plan positive chain reactions with and for individual children (and for yourselves), and to reduce negative ones

For young people doing risky things it is still really helpful to get some protective processes going


How to support young people

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How to support young people.(Key points 3.6) An adolescent needs adults who care for

them to support them & contain them. Challenging, worrying or extreme behaviour

makes us feel anxious which can stop us thinking clearly about how to deal with the situation.

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Managing riskSession Three


Risk can be defined as ‘the possibility of beneficial and harmful outcomes, and the likelihood of their

occurrence in a stated timescale’ (Alberg et al, in Titterton, 2005)


Risk assessments can have a number of different purposes.

Frameworks for assessment of children, young people and families address service user vulnerability and avoidance of significant harm.

Most models of risk assessment recognise that it is not possible to eliminate risk, despite the pressure on public authorities to adopt defensive risk management (Power, 2004)


Risk as a negative concept Focus on the negative distorts reality and can lead to a

skewed picture. There is a duty to maximise well being as well as minimise

risk Identifying and quantifying risk is a small part of the social

work task. The larger part of the task concentrates on managing the

risk and developing strategies to intervene to reduce those risks.


Concept of risk The concept of risk asks the social worker to predict with a

degree of accuracy the likelihood of something negative occurring to a child in the future.

Without the use of actuarial tools social workers can be reduced to a kind of ‘fortune telling’ approach which relies on a combination of practice wisdom and past behaviour of the parents to predict future home.


What is a risk factor A risk factor for abuse is a feature found more commonly in

abusive families than in the general population. It is not about how often it occurs but how much more often

it occurs when you compare it to the frequency within the non abusing population.

It is rare in child abuse to get an absolute indicator – you see them much more often in medicine (for example the presence of this gene is a predictor of this disease. No-one who does not have this illness has the gene).


Profile of a hard to help young person from serious case reviews

Data taken from Brandon et al, Analysing Child deaths and serious injury through abuse and neglect: what can we learn? 2003-2005

A history of rejection and loss (often including the death of a parent) and usually severe maltreatment (physical, sexual, and neglect often in combination) over long periods of time

A history of long term intensive involvement from multiple agencies e.g. from children’s social care CAMHS and YOT

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Parents or carers with their own history of abuse and rejection, most of whom misused substances and had mental health difficulties

It was difficult to contain these young people in school. Challenging and threatening behaviours to staff and fellow students resulted in temporary or permanent exclusions from school

By adolescence, if not earlier, these young people were typically harming themselves and mis-using substances

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A pattern of self-neglect could accompany the self harm and this might include an ability to manage chronic illness or other serious health problems and a habit of presenting to accident and emergency for emergency treatment or to seek nurture

Numerous placement breakdowns Running away and going missing Increased risk of sexual exploitation and risky

sexual activity

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Risk management as a concept Risk management means maximising

potential benefits. These benefits should form part of any

intervention


Mediating factors for difficult to care for young people A pro social peer group A supportive school environment Good problem solving skills An adult willing to take responsibility for decision

making Responding in a sustained way to the young

people’s extreme distress which often manifests itself in their very risk behaviour

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Interventions to use with young people Brief solution focused therapy – dealing with the issues day by day

whilst trying to find ways to move them into a hopeful state for the future.

Motivational interviewing – a technique of challenging and increasing discomfort with current situation to a level where change talk becomes possible

Cognitive behaviour therapy – challenging self defeating thoughts and replacing them with a dialogue that allows for positive self talk

Scaling and tracking – demonstrating change through documenting progress in a small scale and developing patterns of success

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Difference between risk and safety

Important concepts with different emphasis along the continuum of the

assessment process.


Signs of SafetyOne of the great conundrums of child protection =

How to recognise the occasional families that cannot be assisted or coerced to provide increased safety, without demonising excessive numbers of other families with the same, though inappropriate label.

(pg: 45, Dazell & Sawyer, OpCit)


A child is safe when.. A child/young person can be considered to be safe when

there is no threat of danger to a child within the family/home or when the protective capacities within the home can manage the threats of danger.

A child/young person is Unsafe when there is a threat of danger to a child within a family/home and the protective capacities within the home are insufficient to manage the threat of danger thus requiring outside intervention.


What is a ‘threat of danger’ A specific family situation or behavior, emotion,

motive, perception or capacity of a family member that is out-of-control, imminent and likely to have severe effects on a vulnerable child


Some common indicators of danger1. Violent Caregivers or Others in the Household2. Caregiver Makes Child Inaccessible3. Caregiver Lack of Self Control4. Caregiver Has Distorted Perception of a Child5. Caregiver Fails to Supervise/Protect6. Caregiver Threatened/Caused Serious Physical Harm to a Child7. Caregiver Will Not/Cannot Explain a Child's Injuries

Child Provokes Maltreatment8. Fearful Child

9. Caregiver Is Unwilling/Unable to Meet Immediate Needs of Child


PREDICATION Certain recurrent signs taken together can

provide an early warning:1. History of unstable, damaging or violent adult

relationships (including violence outside the family)

2. Violence to children in the form of corporal punishment


Predicators3. Violence to children in, or no longer part of, the

family.4. Changes in a child’s behaviour. This may not

appear to be directly related to abuse which is occurring

5. Warning from neighbours or extended family6. Help seeking behaviour from parents. The

message may be disguised.


Predicators7. Statements from children8. Recurrent injuries and recurrent biographical

patterns10. Resistance to professional intervention11. Plausible lies and deception by parents/carers12. Non-access to children including absence from

nursery, disappearance of families


Predicators13. Violence & threats, to self and others14. Subverting child protection plans15. Family pressure on children & adults not to disclose

information16. Delay in seeking medical helpThis is not intended to be an exhaustive list and nor is the

presence of any one indicator alone a sign of abuse. However, they must be given weight in the assessment process.


Risk – static and dynamic Static risk factors do not change and are

often seen as more reliable indicators for future risk

Dynamic risk factors are both variable and often outwith the control of the individual

It is the interplay of the static and dynamic risk factors that are most likely to bring an accurate understanding of the picture.


Recording risk and resilience

Using the assessment record to manage interventions


Accountability‘We have remarked on the way in which (the social worker)

came up with new and often significant information which cannot be found in her file notes. We think this matters. Procedurally it meant that if anybody had to deputise for her they would be under informed about things which turned out to be important. Substantially it meant that she maintained a personal hold on the case, because she had it within her power to use or withhold information… it helped her skew the case conference appraisals’

(Tyra Henry, 4.30 A study of Inquiry reports 1980 -9, Dept of Health)


Recording Is not a substitute for clarity of purpose Is not a substitute for high practice standards Is not a substitute for face to face communication Is not an add on to the ‘day job’ Is not filling in a form


Good recording is… The legacy to leave the young person Part of formal accountability A basis for action by deputies A way of guarding against isolated and biased

work


Recording should be… Detailed but not irrelevant Accurate and include dates, times and information

sources Available and easy to access


Children & Families framework approach to evidence based practice Using knowledge critically from research and practice Systematic recording and updating of information,

distinguishing sources such as observation, records of other agencies and information from family members

Evaluating continuously the effectiveness of intervention and modifying action accordingly

Evaluating interventions to develop practice wisdom (Whittington, C, op.cit, 2007)


The power of the spoken word

Immediate Vivid verbal account makes an impact Making it obvious – again and again Sitting comfortably with ambiguity Supporting the written word – easy access


The written word Presenting concerns coherently and in a

focused manner Making the links between evidence and

opinion explicit Re-enforce visually –anchor points to return

too Supporting the spoken word – easy to

access written words


Respectfully skeptical In order to have a better chance of

understanding how difficulties interact, practitioners must be encouraged to be curious, and to think critically and systematically (Brandon,et al, 2008,p98)

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Understanding Risk and Resilience in young people