The Child Care Review

The Child Care Review Process Phil Mortell, Principal Social Worker, Organisation Development Unit, HSE West _______________________________________________________________________ Assess – Plan – Implement – Review The Child Care Regulations 1995 make provision for an assessment of the child’s circumstances, the preparation of a plan for each child in care and the review of this plan at regular intervals.1 All these processes are interdependent but this article will focus on the Child Care Review process and assume that the child’s needs have been, or are in process of being, thoroughly assessed and that a care plan is in place. Unless otherwise indicated, the views expressed here are based on my experience as a Senior/Principal Social Worker for more than twenty years in the child care field and, in particular, on my involvement in preparing for and chairing more than 500 statutory child in care Reviews, in both Ireland and the UK. Statutory Requirements on Review and Assessment The Boarding Out of Children Regulations 1954 provided for the “inspection” of boarded out children “at least once a month.”2 It was only in1983 that revised Boarding Out of Children Regulations required for the first time that a Review of “the health and well-being” of children in care take place within two months of placement and at least every six months thereafter.3 In practice this usually entailed a visit by the social worker to the child in placement followed up by a brief paper Review on the child’s file. The Child Care Regulations 1995 significantly developed the 1983 Regulations. They provided for an assessment of the circumstances of the child on entry to care, without – unfortunately – indicating what this entailed, apart from a medical examination.4 They required that “the case of each child . . . and, in particular, the plan for the care and upbringing of the child . . . be reviewed” within two months of placement, and at maximum intervals of six months for the first two years and annually thereafter.5 And they also included a provision, for the first time, to consult with carers (obligatory) and with parents and children (“in so far as is practicable”) in the course of the Review.6 Child Care Reviews: Worst Case Scenario? The Child Care Regulations 1995 were not exactly an overnight success. In my experience, practice on the ground continued to reflect the 1983 Regulations for several years. During this transition period the child’s needs were unlikely to have been assessed in depth either before or after entry to care. Once in placement, the tendency was to rely on the carer to flag up any difficulties, and no news was regarded as good news. In many cases, little attempt was made to assess the ongoing capacity of the placement to meet the child’s needs, unless there were obvious problems with or serious complaints against the carer. Carers, for their part, were often afraid to acknowledge problems they were experiencing with children in their care, lest these be held against them.

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The Care Plan, where there was one, was often not seriously considered at the Review. Some children (and their carers) were left in limbo for years, with rehabilitation to alcoholic or mentally ill parents kept on the agenda year after year on foot of unfounded optimism rather than any realistic assessment of the viability of reunification. The system tended to maintain the status quo, with the occasional exception of the ‘new broom’ social worker or manager who was determined to review all existing plans, whatever the circumstances. Otherwise, the unspoken agenda often seemed to be: let’s not rock the boat, placements are hard to come by, the devil you know, etc. Many Review meetings on children with behavioural or other difficulties tended to take a roseate view and hope that the child’s behaviour would become less challenging or that his attendance at a vaguely relevant service on offer locally would do the trick. Hence fall-back or contingency positions were seldom articulated. Hoping for the best was also the strategy of choice in some low-risk situations, where poor standards of caring were not challenged or properly monitored. A focus on the child could also be sabotaged by other agendas at the Review meeting (e.g. discussion of additional needs payments to carers; unilateral enforcement of residential unit criteria; collusion or conflict between adults; even the setting of dates for other meetings). Discussions at the Review meeting tended to be service-led rather than needs-led, concentrating on identifying what services were available that might be called upon, rather than upon what services the child needed and how to ensure he or she received them. Reading Review Reports Looking back on the notes of previous Review meetings (where they are available), it is often difficult to get a clear idea about what the health board was trying to do, or how it intended to do it. The aims and objectives of the placement were seldom clearly and explicitly articulated. They tended, where they were stated, to be vague, generalised and with more than a hint of wishful thinking (“to provide emotional warmth and support,” for instance, to a 17 year old boy, placed with a middle-aged man who was unhappily separated from his wife). Of course the Review meeting is only one part of a much wider process. It can only be as effective as the quality of the assessment, planning and other input into the case. The most efficiently conducted and elegantly minuted Review meeting will not compensate for poor supervision of the worker, incomplete assessment, inadequate casework and last-minute or no preparation. Simply putting, unprepared, a group of people together in a room to talk about a child and calling it a Review is, at best, a waste of everyone’s time and, at worst, counterproductive What is the Child Care Review for? The Review is primarily about ensuring that the needs of the child have been identified and that the plan for the child is the best one in the circumstances and that the appropriate resources are directed towards implementing the plan. The Review Meeting

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itself should be about clarifying, consolidating and securing agreement to the plan from all the parties. The Review is the primary forum for:7  Monitoring the safety and welfare of the child  Monitoring the implementation of previous Review decisions  Reviewing the Plan for the child: asking “Is it still the right Plan?”  Revising the Plan as appropriate  Ensuring that timeframes (around proposed rehabilitation, for instance) are consistent with the child’s welfare  Planning future work  Outlining responsibilities and tasks of all participants and setting time limits. Who owns the Review? It is clear that statutory responsibility for the Child Care Review lies with the Health Service Executive (HSE). The child is the central focus of the Review. Parents and carers are essential partners. But the Review is owned by the HSE, which is statutorily required to hold, document and deliver on it. This puts obvious limits on partnership. While participation by all parties is crucial to its success, the Review is not a democratic forum. Good preparation and a robust consultation process ensures that due weight is given to the views of all parties, while maintaining a focus on the child’s welfare. Consensus should be aimed for and worked towards (and not just in the Review meeting). It is a bonus if consensus can be achieved, but the formal outcomes of the Review should be the decisions the HSE considers are in the best interests of the child, taking into account the views of the child, parents, other involved parties and the HSE’s own staff. And it is more honest and respectful to be up front about this than to indulge in “let’s pretend” partnership games – until our bluff is called. Young people, particularly in residential units, sometimes get the impression (from wellmeaning attempts to encourage their involvement) that “this is my Review and I can do what I like with it.” When I pick up on this during pre-Review consultations, I will now take time to sit down and clarify the Review process with the young person. This on foot of bitter experience when I failed to prepare properly for a Review Meeting and then had to adjourn it because the young person insisted on confining the agenda to her shopping list of personal requirements. Involvement of children and young people Most children and young people will take seriously an invitation to participate in their Review in line with their age and level of understanding. But for this to be meaningful and possible, children should be used to real involvement in choices in their daily lives. They should be routinely consulted about their wishes and feelings. Planning should be with them and not just for them. A perfunctory once-off consultation as part of a Review, or silent, embarrassed attendance at a Review Meeting, may meet a performance target, but let’s not pretend it does anything else. A recent consumer panel report from young people in care concluded that “most people were angry about Reviews.” 8 3

There also has to be immediate, short-term preparation for the Review. Children need information about the process of consultation, planning and review from their carers and social worker. A child-friendly pre-Review consultation form can provide prompts which elicit the child’s wishes and feelings about being in care. For younger children, or those with a learning disability, the question of who helps them prepare for the Review needs to be looked at sensitively. A visit from the Review chair can be particularly helpful with older children. The Review process and the Review Meeting Should the child or young person attend their Review Meeting? I think it is useful here to make a distinction between the overall Review process and the Review Meeting in which the process culminates. We have somehow come to envisage the child care Review almost exclusively in terms of a large Meeting, where the entire business of the Review is undertaken. I prefer to give equal status (and perhaps more time) to the process of fact-finding and consultation (the Review process) which can make or break the quality of the Review Meeting. Interestingly, the Regulations require only that children and parents are informed about the Review and are afforded “an opportunity to be heard in person on the Review or otherwise to be consulted in relation to the Review.”9 The Regulations nowhere refer to the need for the kind of meeting that we have automatically associated with Reviews. This seems to me to nail down the necessity of the consultation process while leaving room for discretion around the use of, and attendance at, a meeting or meetings to finalise or sum up the process. If we think of the Review, then, as a process which has to involve real consultation with all the parties, whether by report or individual interview or both, the formal Review Meeting is the culmination of this process, drawing together the various threads of the work that has been going on with and for the child since the last Review. In this sense, 90% of the work of the Review should be done before the Review Meeting – which will usefully include those who can contribute helpfully to or otherwise benefit from it. This emphasis on the process of preparing for the Review makes it clear that the Review Meeting itself is not the time or place:10  For resolving issues around allowances, residential unit criteria, inter-agency disputes, etc. These should be identified and dealt with separately.  For surprise announcements, proposals and plans  For group pressure to be applied to the child, parent, carer or voluntary agency  For therapy or casework on child or parent  To thrash out disputes between parents and carers  To give supervision to the workers  To disclose sensitive information to the child for the first time

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Participation by the child or young person So the question becomes: should the child or young person who has been properly consulted, and whose wishes and feelings have been heard and noted, attend their own Review Meeting? And the answer must be: it depends. Talk to young people in care and some will say that they find such meetings too large and intimidating. Others may feel either put on the spot or ignored. Many complain that meetings tend to be repetitious and boring. Or that they are not able to talk freely in front of carers and parents. Experience indicates that it is helpful for the child to attend the Review Meeting if:  the consultation process is seriously and properly undertaken in good time before the Review Meeting,  the contentious issues that would otherwise arise unexpectedly in the Review Meeting have been identified and dealt with in advance,  the Review Chair is confident that parents, carers and social workers are able to be mutually respectful towards one another, at least for the duration of the Meeting,  the agenda, attendance list and style of the Meeting is geared to promote the child’s participation,  strangers to the child are excluded, or at least introduced to the child beforehand,  and, above all, the child wants, and has been prepared, to attend. What is unlikely to be helpful is to invite a child to a poorly prepared Review Meeting at which:  the outcomes are unpredictable  there are more than seven or eight people,  there are people he has never met before,  his parents and carers will be at loggerheads,  there will be serious disagreement about the Plan for him or her. Review Meetings don’t have to be (in fact, shouldn’t be) therapy sessions. But they shouldn’t be traumatic for the child (or parent or carer) either. Younger children will generally be present for part of the Review Meeting, preferably at the beginning. There is something to be said for even having a baby present initially, forcefully reminding the adults present of the central focus of the Review. A modular Review process? What is being suggested here is a move away from the single set-piece Review Meeting with an all-encompassing agenda and attended by all or nearly all the stakeholders. This may serve to meet the letter of the statutory requirements but is often deeply unsatisfactory for many of the participants, particularly those not employed by the HSE. Instead, a modular Review process is being proposed which maximises opportunities for consultation and uses the Review Meeting or Meetings to ensure that the crucial stakeholders are clear about the direction of the work with the child and the tasks that need to be completed before the next Review. 5

Involvement of Parents Much of what has been said above about the involvement of children in the Review process also applies to their parents. At the point of entry to care parents should have been given clear information about their rights as well as the process of consultation, assessment, planning and review. They should also have been involved in drawing up the initial Care Plan. If a Parent’s Rights Group or similar support group is available locally, parents should automatically be put in contact with it. Many parents lack the knowledge and skills to advocate helpfully for themselves and their children and can benefit greatly from independent support and counselling. It is standard practice for social workers to discuss their report for the Review in advance with the parents and to prepare them for the Review. Parents should also be given the opportunity to complete a user-friendly pre-Review consultation form, preferably with independent advice and assistance, and be encouraged to bring a support person (possibly from a Parent’s Rights or similar Group) with them to the Review Meeting. It is important that parents be given an opportunity to meet the chairperson in advance of the Review Meeting. This gives both them and the Chair an opportunity to weigh up the implications of who can helpfully attend the Review Meeting and the wisdom or otherwise of splitting a potentially large and cumbersome Meeting into more manageable modules. Most parents do not welcome being part of the unwieldy and intimidating process that characterises many large case conferences, and there is absolutely no need for the child care Review Meeting to go down that road. Involvement of Carers Consultation with the carers on the Review is a non-negotiable requirement of the Child Care Regulations 1995 (article 18). The work of the Irish Foster Care Association, the development of specialist Fostering Teams (with their Link Worker system) and the gradual implementation of the National Standards for Foster Care, 200311 are all combining to ensure that foster carers are being recognised as key participants in the planning and review processes for children in their care. Nonetheless, foster and relative carers need to be prepared for the Review, given help if necessary to complete the pre-Review consultation form and, as with children and parents, afforded the opportunity of a meeting with the Chair before the Review. Residential care workers have generally taken a pro-active approach to planning and reviewing, ensuring that compliance rates with statutory requirements are generally higher for children in their care. They will generally prepare a comprehensive Report for the Review (usually to their own format) but a consultation between the Review Chair and the unit head or key worker before the Review Meting can be extremely valuable in ensuring that the review process is as focussed and as helpful as possible.

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Critical issues for the Chair The questions which the Chair has to bear in mind throughout the Review process can be summarised as follows:  Does the child need to be in care?  Is the child safe and well cared for?  Is the child in the right placement?  Have the child’s needs been adequately assessed?  Is there a written Care Plan which addresses the child’s assessed needs?  If the Plan is rehabilitation, have the parents’ capacities been realistically assessed?  And is rehabilitation feasible within a time span commensurate with the child’s needs?  Is there a contingency plan?  Are the Review decisions realistic and viable? Core Social Work Responsibilities The allocated social worker is generally responsible for the supervision of the child in placement and coordination of the work with, and services for, the child. For the Review specifically, the social worker provides an up-to-date assessment of the child’s needs and reports on progress in implementing the Care Plan. There is no doubt but that the effectiveness of the Review depends hugely on the work put in and the relationships developed (with the child, parents and carers) by the social worker. The pity is that the quality of this work is so often compromised by the high turnover of staff, unrealistically high caseloads and poor supervision. Social Work Team Leader The social work team leader (SWTL) has a pivotal role in the care planning and review processes. It is the SWTL who signs off on the pre-admission assessment and supervises and authorises the written Care Plan. In addition, the SWTL audits the child in care file, inspects case records and generally monitors compliance with minimum statutory requirements. Crucially, the SWTL supervises the allocated social worker and is responsible for the quality of her work. Where there is not an independent Chair, the SWTL usually chairs the Review. Many SWTLs agree that this is not satisfactory. They are in day-to-day charge of the management of the case, involved in all but the most routine decisions about it, and not in a position to take an independent view, particularly on controversial issues. In addition, their workload often precludes them from putting in the kind of preparation that the process requires beforehand, or producing an adequate written record of the Review in good time afterwards. There is increasing evidence that the Review process is more likely to be experienced as fair and objective by parents, carers and children when the SWTL is a participant in the process but not the chair.12 SWTLs themselves have told me that not having to take a lead role frees them up to use their experience and knowledge of the case more creatively in the Review Meeting – at which they are key participants, representing the HSE. 7

Independent Chair of Reviews? It is surely an anomaly that the Child Protection Case Conference system, which has no statutory basis, has generally been resourced with independent chairs and secretaries, while statutorily required Child Care Reviews in most cases have neither. SWTLs or social workers are expected to administer, prepare, conduct and minute child care Reviews (and to evaluate their own work!) in addition to their other duties. It is not surprising, therefore, that independently chaired Reviews, as documented by the National Care Planning Project13 and elsewhere14, increase basic levels of compliance with the statutory requirements: reviews are held on time. There is also evidence of greater involvement in the process by parents, carers and children – who are much more likely to receive minutes of the Review in good time. Parents, carers and children in difficult relationship with the HSE, who participated in reviews with an independent Chair, reported that they were listened to.15 And the independent chair is in a better position to identify and deal with cases where progress is poor or to provide objective mediation where required. The Independent Review as an audit mechanism As it stands, there appears to be no mechanism by which the HSE can systematically and independently audit and account for the extent to which children in its care are receiving proper care, are safe and well and their needs being met. The Social Services Inspectorate can undertake valuable but limited spot checks on selected aspects of the service for children in care. Otherwise the HSE depends entirely on those who provide the service to self-report on whether and to what standard they are meeting the requirement in the Child Care Regulations to “regard the welfare of the child as the first and paramount consideration”16 The Child Care Review, independently chaired, provides an ideal opportunity to both monitor implementation of the HSE’s plan for specific children and to collect strategic management information in relation to all children in care. For this to happen, there would have to be a feedback loop from the independent Review to the management system, preferably via the Principal Social Worker. Social Workers: Travel Agents or Travel Companions? Much has been written about the growing bureaucratisation of social work in Europe.17 Child Care in Ireland is not immune from this trend with its focus on “getting the job done through the most expedient, and often impersonal, means” rather than deploying the traditional social work skills of good communication and “a capacity to understand and show care.” 18 But an emphasis on regulations, procedures, form-filling, audits and performance indicators does not necessarily preclude value-based best practice which is person centred; it just makes it more difficult to achieve in the time available. Working with children in care is increasingly posing the question for social workers: do we want to be viewed by children and carers as travel agents or travel companions?19 How we go about the child care Review process will go a long way towards indicating our preference.

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Phil Mortell is a Principal Social Worker with the HSE West. But the views expressed here are his own and not necessarily those of the HSE. [email protected] References

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Child Care Regulations (1995), Dublin DOH, Articles 6, 11 and 18 The Boarding Out of Children Regulations (1954), Dublin DOH, Article 14 3 Boarding Out of Children Regulations (1983), Dublin DOH, Article 14 4 Child Care Regulations (1995), Dublin DOH, Article 6(1) 5 Child Care Regulations (1995), Dublin DOH, Article 18(1) 6 Child Care Regulations (1995), Dublin DOH, Article 18(4) 7 Jamieson, S (1995) The Reviews of Children in Care in Statutory Reviews in Practice: A Scottish London BAAF, p.4 8 From Us to U (2005), Young People in Foster Care Consumer Panel Report, HSE West, p. 9 9 Child Care Regulations (1995), Dublin DOH, Article 18(4) 10 Jamieson, op. cit., pp. 4-5 11 National Standards for Foster Care (2003), Dublin DOHC 12 Brophy, S (2005), Independent Evaluation: National Care Planning Project, HSE West 13 Feely, A (2005), National Care Planning Project: Composite Report, HSE West, pp. 74-5 14 O’Brien, G and McMahon, C (2004), Report on Findings of Evaluation of Care Planning Review Process, HSE West 15 Brophy, op. cit., pp. 28-30 16 Child Care Regulations (1995), Dublin DOH, Article 4 17 Howe, D (1992), Child Abuse and the Bureaucratisation of Social Work, Sociological Review 40, 18 Houston, S (2003), A Method from the ‘Lifeworld’: Some Possibilities for Person Centred Planning for Care, Children & Society 17, pp.57-70 19 Braye S, Preston-Shoot M (1998), Social Work and the Law, in Social Work: Themes, Issues and Critcal Adams, Dominelli, Payne (Macmillan, London) 2

Supplement,

pp.491-508 Children in Debates, ed.