Social Work Assessment of Children and Families

UK Children and Families

Homeless families are generally defined as adults with dependent children who are briefly accommodated by voluntary agency, local authority or housing association hostels in the United Kingdom (Vostanis 2002). They are taken in from a few days or several months, often four to six weeks and generally provided with bread and breakfast. Although this broad definition does not include children who have lost homes and live with friends and relatives, it is estimated that there are 140,000 such displaced families in the UK today. The average family consists of a single mother and at least two children. Trends show that these families become homeless again within a year from being housed by agencies. Domestic violence and harassment from the neighborhood are the most frequent cause behind their homelessness. The volume of homeless refugee families among them has dwindled in the late 90s, mostly confined in the London area, but recently they have spread throughout the UK (Vostanis).

Most of these homeless children and families have gone through some types of chronic family conflict, violence and breakdown, with the mothers often victimized as children and into adulthood and their own children now becoming at-risk on account of the neglect and physical and/or sexual assault prospects they face (Vostanis 2002). Their most common needs include low birth weight, anemia, dental caries, delayed immunization, short stature and nutritional stress. They are also more vulnerable to accidents, injuries and burns. Studies also indicate that these health problems increase as homelessness persists. These children also suffer from developmental delays when compared with children who were not homeless. Specific developmental delays include receptive and expressive language and visual, motor and reading skills, general skills and educational status.

Studies reveal the high prevalence of emotional and behavioral disorders among children in the pre-school and primary age groups among these families (Vostanis 2002). Among these disorders are sleep disturbance, feeding or eating problems, aggression and hyperactivity, in many cases coinciding with emotional or developmental dysfunction or deficiencies. Anxiety and post traumatic stress disorder develop in most of them after witnessing tragic family events. Their mothers' experience of abuse or mental illness has been the strongest predictors of the children's disorders, which persist with the absence of effective intervention. This appears to link these children's mental ill health strongly with poor family and social support network delivery service (Vostanis).

Homeless adolescents and street youth have their own set of problems. Two major studies conducted in London revealed the high incidence of depression, attempted suicide, drug abuse and HIV / AIDS among them (Vostanis 2002). The subject youngsters received residential care, experienced family discord and breakdown and had low-level educational attainment. The studies also connected the subjects' typical sexual-risk behavior, drug dependence, and mental or emotional dysfunction to their mothers' own psychiatric disorders at a high 45-50%.

Child care services in the UK evolved from the concept on the rights of children and the responsibility of their families and the state in the rearing of children (Nixon). The Children Act of 1989 aimed at "constructing a new consensus (Parton 1991 as qtd in Nixon)" on children's rights and their families' and the state's responsibilities and at balancing these rights through greater inclusiveness and collaboration with families.

The Act was an attempt at influencing not only the appropriate line and kind of thinking about families and also child care practices as a consequence. But, in time, partnership approaches appeared lacking under the Act, so that in 1990, family rights groups in the UK invited a group of New Zealand practitioners from whom UK patterned its own family group conferences or FGCs to fill in the gap left by the Act in the area of implementation of its principles. A national pilot group was established two years later to connect pilot projects and enable them to share advice and support from one another through policy materials and practice ideas at a high level of cooperation. Their projects were drawn from either the grassroots level or by management and implemented by hard-driving leaders. Although the purview of FGCs over child care was largely marginal, interest in their formation increased from 4% to more than 60%. (Nixon).

Decision-making for social work professionals was not an easy or fast goal to achieve. It required skills, wisdom, compassion and steadfastness. It was a balancing act for these professionals that had to take into account parental views on surrendering control to the powerless (Cleaver and Freeman 1995 as qtd in Nixon) and this was a complicated ground to reach, especially in the UK. The philosophy of the Children Act did not suit the practice and procedures for inclusion under the FGC and the outcome was a slow acceptance of the approach. It was soon discovered that FGCs tended more to conflict decision-making processes than to complement or enhance them. The usual decision-making function was derived or grounded on the acquisition of specialist knowledge, which professionals were perceived to have the best of. Professionals were, therefore, supposed to know more about these subject families than the families knew about themselves. These professionals' perspectives, in turn, were legally mandated by society's expectations (Ryburn 1991 as qtd in Nixon).

The agencies' relationship with the community was made possible and under the control of systems, which the agencies' professionals themselves conceived of and dominated (Nixon) and, instead, they made the subject families' responses fit the preordained professional methods and forums, which in, turn oppose the FGC philosophy or concept (Nixon). Although the inclusion provision did not hand over power from professionals, they still resisted. The fact was that these professionals could assert power through their own working systems, structures and resources, which, in the first place, effectively denied the full participation of the families. The point was that, even with the best intentions, FGCs inclusive practices would not empower the subject families: the only extent in which these families could really share in decision-making could be determined only by the context of the action.

In the UK, FGCs were interpreted by professionals as a last-resort intervention when all other options had failed and as a mode of squeezing resources out of families (Nixon).

Forces have been attempting to move FGCs from their reactive stance to another more central in practice and viewpoint and towards winning the "hearts and minds" of professionals than educating or changing systems. The present disagreements and departures on child care policy and planning could be reduced to differences in values as to the amount of responsibility the families should exercise in the decision-making processes involving their children (Ryburn 1997 as qtd in Nixon). FGCs drew much attention to these issues, but with the turnover of decision-making to families and communities, child welfare and youth justice entities got shaken (Marsh and Crow 1998 and Jackson 1998 as qtd in Nixon). Traditional decisions on these issues have always taken the entire family in context. Family values and structures would influence traditional viewpoint on collective responsibility and the consequent patterns of parenting behavior. That consequence would eventually become apparent to the subject families but not so easily to professionals (Giovannoni and Becerra 1979 as qtd in Nixon).

Access to services was another feature of the current state of child welfare service delivery in the UK. Homeless children and their families cannot access mainstream health and social care because of their mobility between different health and local sectors. These children and families change addresses frequently or urgently and are not likely to be registered with a general practitioner like families staying in permanent addresses. (Vostanis 2002). As a result, they have reduce access to medical care, immunization and preventive care heath procedures and just take recourse to accident and emergency departments for treatment and medication. Or else they get admitted in hospitals.

Homeless children also tend to drop out of school to evade a pursuing violent parent or because of the distance of the hostel to where they live (Vostanis 2002). Parents had to wait to be re-housed before they could register their children in schools. These schools also have limited vacancies and with a high rate of pupil turnover, resulting in high cost. The situation is worse in the case of refugee children. In the overall, children lose their only source of social stability -- their peer, routines and a sense of achievement, which are important protective factors for them in their condition.

In addition to the difficulty of accessing services due to organizational problems in the agencies, these subject children are disadvantaged by the lack of continuity and information transfer due in turn to their mobility in different parts of the country (Vostanis 2002). Local services departments were not always aware of their previous history or not promptly informed about it. These gaps had significant impact especially on mental health services. The negative impact may not be too obvious adults with mental disorders, but because they had no fixed dwellings, health care agencies would assume that the volume of these referrals was large and increasing and thus need extra resources. The agencies tended to target these referrals as a single homeless population, many of whom were afflicted with severe mental illness. It was more difficult to cover and handle parents with depressive or anxiety disorder, self-farm or drug addiction. Research in the previous year showed that 49% of homeless mother were afflicted with psychiatric disorders but had only 11% contact with mental health services and 30% of homeless children faced similar problems but had only a 3% contact with child and adolescent mental health services or CAMHS.

But these CAMHS have been expanding their services and expanding their accessibility. They found that they needed to evolve a service model for homeless children who could not access services structured around stability and waiting lists for assessment and treatment (Vostanis 2002). A new plan that addressed these complex realities of child and family mental health and their needs should be incorporated into the inter-agency new policy with clearly stated objectives, reviewing mechanisms and built-in evaluation process. Because of these characteristics, these children should be classified under all groups providing care for children in contrast with a group that required special services. The service should include health improvement pans, social services quality Protects and local educational authority standards (Vostanis). Primary care providers and housing departments should also develop local strategies so that their beneficiaries would not get lost in the greater network or would not be missed when new resources became available. Local strategies would also avoid additional professional burden in the event of additional casework load. Initiatives from the central or local government could augment or relate with or provide these new resources to complement the function and effort of the local CAMH, instead of the CAMH performing the function alone. Examples of initiatives given were a health action zone and grants for urban regeneration. The new service should adopt clear, specific and attainable objectives. It should identify children with mental problems and disorders as coming under a high-risk category. Unlike children in stable conditions, these homeless children did not have general practitioners, teachers or pediatricians. It was the mental agency or this new service that must install and operate the referral mechanisms without the benefit of previous records. This could lead those behind the new service to discover new or other child protection concerns, special education needs, existing social welfare involvements, and physical or mental disorders in these children that could respond to treatment. All agencies working for homeless children and families should coordinate because developmental, physical health, education and social care needs coexist and correlate. Such coordination was likewise a pre-requisite in determining the agency's involvement in the families' next relocation area and would need services in cases of domestic violence, adult mental health and educational welfare, or a health visitor, parenting groups, social service access group and the local CAMH (Vostanis).

Two models have been tried. The first was the outreach child mental health service model where a child psychiatry nurse gave outreach sessions at pre-determined centers for the homeless in Birmingham (Vostanis 2002). Children served by this model were found to have fewer behavioral problems after re-housing within the 6-month follow-up, as compared with children who were not served by the model. The second was the family support service model that performed a group of services -- detection of the full range of problems occurring at the time, dealing with these problems, provision for parenting-training -- while supporting and training the hostel staff, coordinating with similar agencies and establishing continuity after re-housing the children and their families by insuring their intake by appropriate local services. Workers are based at the hostel.

The principles of service for homeless children and their families should extend to socially excluded groups and, considering their different needs, such an extension would require systematic coordination with child and adult mental agencies (Vostanis 2002). The cumulative and coordinated service should be structured and performed within the CAMH in order to insure continuity of treatment after re-housing. But CAMHs should pay attention to the distinctive mobility and psychosocial characteristics of these families and apply the suitable model in treating specific psychiatric disorders. The preferred model appears to be one that would use mainstream agencies rather than a specialist and isolated posts or teams. CAMH professionals may contribute their inputs on a session basis only. A family support worker should initially survey, filter and assess the social, educational and health needs of the homeless children and their families. And then this family support worker should give behavioral therapy and parenting training (Vostanis). This post and function could establish continuity within 6 months of the families' resettling somewhere else. This position is what the current welfare service lacks.

There was also an observed lack of local and national coordination in developing health care services to these families (Vostanis). Installing a national mechanism for advising, monitoring and developing services for these families and setting up a national database for clients and services should be pursued by the central and local governments. Cultural and local organizational distinct characteristics must be recognized so that a whole new range of suitable service models could develop within a national framework. Ongoing research evaluation should be in that direction and become an integral part of the new service (Vostanis).

Current health and welfare providers lamented critics' tendency to over-focus on the extreme end of the entire child protection service continuum, while making conclusions on the present system as a whole (Harrisona et al. 2001). While they admitted to flaws in implementing the Children Act of 1989, but attention should not be concentrated on children with the most serious or severe conditions or confronting the most serious dangers, because there are as yet no sure tests for determining or identifying such children. The current system deals with all children considered at risk of significant harm and the conduct of its processes cannot perform decisive intervention while dealing with other children outside the extreme category within the system. This system places pressure on a non-abusing parent, often the mother. There are also situations that warrant the separation of the parents and the children, although in most situations, a cooperative working relationship with a parent or another family member proves to be the best option for the subject children. It is when parents are treated with respect and recognition to their rights that their cooperation is obtained. The balancing task is not easy to perform. When child protection systems in the world are compared, UK's system stands out as a strong one, even in handling severe or extreme cases of subject children and families in the continuum (Harrisona et al.). Persistent neglect and emotional abuse, the extent of child sexual abuse and the low-level capability of the current system to deal with "organized" abuse, and domestic violence towards women and children point to the fact that primary prevention lacks the resources.

The Human Rights Act of 1998 went into effect on October 2, 2000 and was incorporated into the UK law (Harrisona et al. 2001). Article 8 requires respect for family life and allows intervention only when it is legally endorsed and only to the extent that it is necessary for the protection of children's welfare. Case law in the European Court of Human Rights is guided by the principle, which limits childcare interventions and focuses on family solidarity and reunification. This position renders the law and practice of child protection of the 80s unacceptable. This European stance is a philosophical one that emphasizes the importance of parents to their children and vice versa as well as recognizes the deficiency or defects of state care provision.