Planning Carefully

Promoting excellent outcomes for the children of Barnet

Jo Fox BSW

Consultant Social Worker

A social worker … once said to me, “I have no time for planning.” …

Without a plan, how do we know where we are going, what we are trying to achieve. Although planning for every scenario, every action one might take in life would leave little room for flexibility or surprises, not planning at all might be regarded as leaving too much to chance or even reckless. Planning can reduce “fire fighting,” … having to constantly respond to crisis. Planning can increase opportunities to anticipate problems that are likely to occur or needs that subsequently arise. Decisions can be made on how to handle situations or in some cases may help to avert a potential crisis.

(Sheree Kane, ncb, 2007)

Care Plan – what is it?

• Plans informed by high quality assessments• The assessment and plan should determine what is

in the child’s best interests eg. to become looked after or whether other support services would be able to meet their needs

• Sets the framework for the services provided to the child and family to enable the desired goals and outcomes to be achieved for the child

Care Plan – who is it for?

• Child – care plan or child’s plan?• All those with parental responsibility• Social workers/case managers• Carers• All those working with the child – effective

multi-agency working crucial to outcomes• Agencies re collation of need – met/unmet

What makes a good one?

• Needs-based assessment• Child participates• Participation of all those with parental

responsibility, and carers• SMART• Focused• Proactive• Brings together other plans• Has a contingency plan

• Service led• Not understood by the child• Non-participation of other agencies, of all

those with parental responsibility, carers not involved• Not specific concerning who is responsible for what action, outcomes cannot be evaluated, not achievable nor realistic, no timescales • Lacks direction• Reactive• Separate from other plans• No contingency plan

What makes a bad one?

The fundamentals of all plans SMART principles Motivation is key You must take the journey together Choices must be clear and options available Contingencies must be made Steps must be incremental and purposeful

Principles for an effective ‘team around the child’ approach to planning Ensure there is clarity on lead professional role. Joint planning early Clear channels of communication No jargon Shared information Shared understanding of confidentiality and

consent Understand each others role and interests.

Messages from research

• Research– Social workers too optimistic about the

likelihood of parental change– Majority of changes of plans were from a plan

to return home to one for adoption– Placement moves caused by setting

unrealistic timescales

Ward and Skuse (2001)

Harwin and Others (2003)

Promoting diversity

• ‘… it is clear that all of the local authority’s duties relating to partnership, planning, family support, placement, contact and aftercare must be read in conjunction with the Race Relations Act. Local authorities therefore have a responsibility to ensure that every aspect of service provision for children and their families is non-discriminatory.’

(Richards and Ince 2000)

Timescales

‘All the professional thoroughness and care in the world can be nullified if the child’s emotional resources are over-taxed and capacity to form a healthy attachment is damaged.’

(Lowe and Murch 1999)

Detail

The more detail in the plan the more likely the plan was to be fulfilled.

• How the child’s needs might be met• Services to be provided • Type and details of proposed placement• Arrangements for contact and reunification

(Harwin and Owen 2002)

14

Sequence of professional judgements

Taken from Ann Hollows essay in Calder, M,

This staged decision making is congruent with the planning tasks.

Beyond risk management We often plan intensely to protect the child from

significant harm, and how to support families to change We do not spend enough time looking at how to build the

child and families resilience and how to maintain change once it has been achieved.

Our pre-occupation with risk pushes us into harm minimisation instead of planning pro-actively.

We become re-active or worse still, passive – letting the events unfold and overtake our plans.

Beyond Risk managementReparation = making amendsReconciliation = accept, adjust, settle

differencesRestoration = bring back to original

state by repairing or re- building

Reparation Children under 4 need us to focus on attachment in our

planning Social and emotional competency is critical to learning

and is very difficult to achieve even if all the odds are in your favour

As a child with a damaged attachment the pre-occupation with managing their feelings often overwhelms their ability to manage cognitive tasks

How do we help a small child learn to trust their main care giver and see adults as a dependable and safe source of comfort and care?

Reparation - Children over 4 need us to focus on improving parents

capacity for warm and sensitive care giving and address specific family issues.

As children start to interact with other adults on a regular basis and begin to develop a sense of self – they need congruence and affirmation from their parents/carers to support this newly developed independence.

How do you plan to build a child’s sense of self and support their parents/carers to behave with congruence towards them as they explore and learn?

What works to improve parenting? Relational practiceAuthenticity, openness, mutual respect, responsiveness, presence

(Freedberg, 2008) Reflective practiceCritically aware, curious, analytical, ethical(Crawshaw, 2008) Partnership practiceActive involvement of parents and practitioners, equality with

regard to decision making, complementary expertiseNegotiation and agreement, mutuality and respect

Reconciliation How can we help children and their families find ways to

forgive each other? Parents who cannot resolve their own past parenting issues

will find it hard to manage the emotions and challenges of parenting their own children. They need support to reconcile themselves with their past and move on into a different parenting future.

What plans can we make to support parents to reconcile with their own past?

Children who cannot live with their parents grapple with the rejection and hurt – how do we support them to accept their parents as they are instead of what the child would have them be?

Restoration Challenge the assumption that :placement = bad / discharge = good Studies suggest that social workers can promote reunion by

engaging parents in joint planning, supporting them to maintain excellent contact that repairs as well as safeguards.

For which child is a return home likely to be beneficial? What needs to change for them to return home? How much time does the child have for that change to

happen? What do we need to do in the short, medium and long term to

support this restoration?

Tools to use in planning Backward chaining – setting parents and children up to

succeed and then building in the difficult steps Behaviour modification – looking at changing the

environment to artificially stimulate change Cognitive therapy – working with the parent to separate

their issues from their child’s needs Brief solution focused therapy - providing short term

goals that can be measured and achieved and built on Di Clemente & Procheska cycle of change – focusing

constantly on the parents capacity and motivation in planning and reviews.

Parallel planning with family Shared goals and values - check out assumptions

Look for information that will test potential ways of understanding and helping

Also be open to new ways of understanding and helping that are rooted in the information that is emerging

Plan to build resilience within the family

Reflexivity Process where we are critically aware of the impact of

ourselves and our belief systems on the assessment and the service-users’ response to this

Includes, gender, race, professional status, agency culture dominant theories

Check out constantly that you are not verifying, assuming or confirming your own bias in planning.

Building hypothesis

Hypothesis is a testable proposition

Understanding the family situation and the best way forward

How difficulties are experienced (particularly by child)

May include antecedents

Sources of hypothesis

Service-user explanations – listen and take seriously

Practitioners explanation, practice wisdom

Evidence-based practice, wide reading of research

Theory, having and using ideas

partnership working Constantly check out views with others Clear expectations of behaviour and outcomes Supervision critical Consultations with other agencies as part of planning

process Avoid groupthink Share the load – everyone should be working towards

the agreed outcome.

NEEDS /OUTCOMES/ SERVICE/REVIEW1) NEEDS/STRENGTHS

What children and young people require to thrive for their health and development in order to maximise their opportunities to reach their full potential as they move towards adulthood and beyond.

The NEED belongs to the CHILD. If you start the plan with the child’s name it helps keep you clear on the aim of the plan – to secure the child’s health and well being through a series of actions usually carried out by the responsible adults to support that child to achieve ATTACHMENT, REGULATION and COMPETENCY in their life.

OUTCOMESThe outcome is the miracle question – if this child had:

warm available care that promoted a good attachment;

was able to learn how to self regulate their emotions in a safe environment;

and develop a competence sense of themselves as someone who could make choices in their life –

WHAT WOULD THEY LOOK LIKE?

SERVICES Services are tasks carried out by the adults who should be

supporting the child. A service can be a person like a foster carer doing a

particular task i.e listening to a child about their concerns or it could be an organisation providing or doing a particular task/s that can meet a particular need i.e a counselling service providing trauma counselling.

PARENTS are part of the SERVICE package offered to children. Meeting their needs, and the needs of the larger family should be seen as part of the package that will serve the child.

Reviews Part of the continuous assessment process, the review

should focus on what is working, what has changed, what needs to be adjusted and what does the child look like now?

It should focus on the ongoing development of the child through each cycle and adjust the plan accordingly.

It should monitor parental change and motivation and the ability to sustain this behaviour against the child’s needs.

ARE WE MAKING A DIFFERENCE FOR THIS CHILD – not this is what we have done.

UNMET NEED It is extremely important to record needs that have been

identified and have not been met or cannot be met and the reasons for this. This information is important for the strategic planning and highlighting issues affecting the ability to meet identified needs.

Make it clear It is important that the child and family are able to understand the plan. Social

work jargon can be confusing and vague, which is why we try to avoid using it when talking to families. We should also try to avoid writing it in the plans that families have to understand. For example, rather than:

The class teacher has informed that CHILD A’s ability to form appropriate peer attachments is significantly affected by the aggressive attitude and behaviour that she frequently displays. Subsequently she is isolated which is hindering her social and emotional development.

It is unlikely that you would say this to a family, so keep it simple:

CHILD A’s class teacher has said CHILD A is isolated. She has no close friends in school, because she hits other children and they tend to avoid her as a result.

Reaching conclusions

Reaching saturation point – drawing conclusions

Never going to be indisputable

Conclusions that look forward rather than back (solution-focused)

Flexible to changing circumstances

Views of reviews

‘They weren’t frightening, they were boring more than anything. They were boring because you just sit. But I used to find that they’d talk over me and not to me, that was the main thing.’

‘Sometimes it is not that child that can’t talk it’s adults that don’t understand.’

Views of reviews (cont.)

‘I feel that reviews do help in a way if you understand what is going on. You have to make sure that you know what you want, you make your decisions and you have to make sure that they are carried out. It’s a good time to get things off your chest.’

(Lanyon and Sinclair 2005)

Children’s Participation

‘The routine fact of their attendance should not be taken as a sign of participation. There is a sense in which their attendance has become an administrative norm rather than something that has led to changes in the meeting format…’

‘Further thought needs to be given to new ways in which young people can be given a more central, informed and comfortable role in the review process.’

(Grimshaw and Sinclair 1997)

What would make the meetings easier? Preparation Support and familiarity Informality

activities food toys

Getting away from sitting around talking ‘You have a right to a reason for every decision,

whatever age you are.’(Lanyon 2005)

Children should expect To receive all the help possible to identify how they feel about

what has happened to them and what they want to achieve in the future.

To have their views heard and any decisions made explained to them.

To have access to an advocate or other supporter. To have important relationships preserved for them and to

have people around them that they can trust and who will remain in their lives.

(Voice for Child in Care 2004)

Six aspects of participation 'the choice which the child has over his or her participation the information which s/he has about the situation and her or

his rights the control which s/he has over the decision-making process the voice which s/he has in any discussion the support which s/he has in speaking up the degree of autonomy which s/he has to make decisions

independently.'

(Thomas 2000)

A model of levels of participation

Children/young people make autonomous decisions

Children/young people’s views are taken into account

Children/young people share power and responsibility for decision-making with adults

Children/young people are involved in decision-making (together with adults)

Kirby, Lanyon, Cronin & Sinclair (2003) Building a Culture of Participation, DfES.

Reviewing & Monitoring ProgressHow do we know we’ve made a difference? Assessment Framework IRO Plans as “live” tools Multi-agency working Involve the child