In the last of our safeguarding series, Catherine Rushforth considers practitioners who must tackle difficult issues with troubled parents.
In this article I will focus on children who might 'appear' to have additional needs and the attendant professional responsibility to safeguard, protect and promote their well-being.
Key points to consider are:
- The practitioner's journey with a parent in coming to terms with additional needs in their child, including the possibility of emotionally 'holding' them through a possible stage of denial.
- Over-protective or disengaged parents, who may be fabricating illness in their child.
- The need for expanded professional thinking around the assessment process.
A vulnerable child?
Imagine a two-and-a-half-year-old boy. He sits alone, quiet and rocking in the very place that his mother left him in that morning. He shows no interest in other children or adults and has no verbal communication.
As a practitioner, what explanations might you provide for his presentation?
The first response will possibly be that this child has additional needs, exhibiting behaviour that suggests Autistic Spectrum Disorder.
However there may be other considerations, outside of 'additional needs'.
The practitioner may wish to ask:
- Is the child showing signs of acute emotional neglect and abuse?
- Does he have a secure and reliable attachment with his parent?
- Is he a child who is being medicated or sedated in order to be compliant and easy to manage?
Striking a balance
I propose that on occasions, practitioners and managers might rely too much on the 'additional needs' route before fully reflecting on how a variety of factors may fit together to affect the child.
The capacity to hypothesise, or consider a number of possible explanations, is vital to conducting a comprehensive assessment, as identified in the Assessment Framework 2000 Guidance.
The setting's observation records should be the tool for capturing quality snapshots for this purpose. It should also be noted that failing to enter into this process with children and their families over time, could also be considered as a professional abuse and, indeed, a mark of a neglectful organisation.
Striking a balance between professional 'mindfulness' that causes purposeful, thought-through interventions with the parent, and a professional 'sitting on the safe side', where potentially difficult conversations with parents are avoided, is a dynamic that should be addressed in settings in the modern era.
Failure to do so is, in my opinion, essentially a professional practitioner's failure to fulfil the expectations of their profession. It is this dynamic, however, that is encountered in many instances surrounding abuse of children, where there needs to be recognition and response to additional needs in children and disagreements or conflicts in all combinations of relationship. This 'growing up' or maturing of professional practice in managing all manifestations of potential or actual conflict is the route to honest, reflective and high standards of professional practice. This is what true partnership working with parents is all about.
Backing off at the first sign of conflict or passing the difficult conversation to another practitioner, either within the setting or on to another professional service, is really not an option in our current climate of transparent practice. It is out of step with working across the entire 'safeguarding spectrum' of service.
CASE STUDY
A highly competent and successful team of family support workers in south London has demonstrated a sensitive and sophisticated approach to negotiating difficult situations with parents. One practitioner recently walked a rocky path with a quite depressed and isolated mother, who had a small child who appeared to genuinely have an ASD problem.
Her first challenge was to get the mother out into the community, accessing services with her child. She embarked on a slow, step-by-step approach, attending stay-and-play sessions, helping to bring a focus and routine to everyday life. They attended sessions together and as the mother's emotional health and mental health state started to improve and her level of confidence grew, they looked at how her little boy was progressing and how he behaved in comparison to his peers. There was a slow but stepped approach to a dawning recognition that her little boy had difficulties.
At this point, this mother, like many parents, was frightened by what this might mean for her and her future life with her son. The family support worker nearly lost her nerve here too. But she stepped aside from her worries and contacted her manager, expressing her fear and feelings of incompetence in the situation. Her manager coaxed her into speaking honestly and plainly to the parent, appealing to her best interests for her child - which she then did.
Another rocky but brief phase followed, during which the mother wanted to deny her frank conversation with the practitioner. The worker 'stuck in there', repeating what she had said (supported by the manager). In just a few weeks they attended a specialist clinic together. At this appointment the worker supported the mother in hearing some difficult things about her son - which at the same time answered some deep-seated questions.
Over the last few months an effective Team Around the Child approach to the mother and son has been put in place, including completion of a Common Assessment Framework. As the practitioner had completed her work with the family and started to move away, the mother had nothing but praise for her, in the way she held her hand through a challenging period. This family support worker is justifiably proud of confronting her personal anxieties and growing professionally. The family support service is also building a strong reputation with the authority.
I suggest we encounter this dilemma of 'sitting on the safe side' or 'stepping into meaningful dialogue' with parents on a regular basis with settings. Competent and confident practitioners are willing to embrace potential for conflict, and work it through with the parent. They are generally reflective practitioners who are fully aware that they entered into this kind of work in the first place to make a difference for children and their families.
They actively choose the 'meaningful' dialogue option and with the support of committed managers or lead persons for safeguarding, are effective in identifying and working through complex situations.
This kind of practitioner is one who has finely honed their assessment skills and has a capacity to hypothesise, reflecting on what a complex picture may be telling them.
Fabricated illness
Recognition and acting on 'clues' to fabricated illness in children is an example of this. The parent might present as very caring and protective, perhaps over-protective. The practitioner may get a sense from the parent that the more complex or unusual a diagnosis of illness in the child - or the more confounded specialists are in the treatment of him or her - the more apparently 'special' the parent feels by association.
This dynamic - formerly referred to as Munchausen Syndrome by Proxy - is a knotty one to unravel. It is, however, an area in which practitioners should be informed to a basic awareness level.
Similarly, those children who have a recognised additional need require practitioners' close attention and care to ensure that they are not over-medicated or sedated nor their specific needs neglected on a fundamental level.
The early years practitioner who 'steps into a meaningful dialogue', as the clear advocate for children with additional needs, is vital, for they play a key role in promoting the safety and protection of the most vulnerable children.
FURTHER INFORMATION
Catherine Rushforth is director of Catherine Rushfroth & Associates Training and Consultancy, which runs a number of workshops addressing issues to do with safeguarding. E-mail: Catherine.rushforth@ntlworld.com