Understanding Risk and Resilience in young people

1. Understanding Risk and Resilience in young people A one day workshop by Child Centred Practice

2. What is Assessment for? • The assessment of needs? • Judgement about eligibility? • A calculation of the match between need and available resources? • 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)

3. 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)

4. Decision making in assessment Developing a sound approach

5. people's beliefs 'are remarkably resilient in the face of empirical challenges that seem logically devastating' (Kahneman, 1990, p.144).

6. Classic Decision Making theory • 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

7. Using Intuition in decision making • 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

8. Shortcuts to avoid • 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.

9. Shortcuts to avoid • 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.

10. Analysis, intuition and the nature of expertise 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 Taken from Dalzell and Sawyer, Putting Analysis into Assessment, NCB, 2007.

11. Intuition Strengths 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.

12. Analytical reasoning Strengths 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

13. However... 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

14. Knowledge and skills (Munro. E, 2002)

15. What makes therapy successful? Kieran McKeowan A guide to what works in family support services for vulnerable families (Dublin, 2000)

16. Adolescent Development

17. 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.

18. 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.

19. 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.

20. 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)

21. 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.

22. 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.

23. 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.

24. Risk & resilience in adolescence

25. 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.

26. Signs of a resilient young person Playing a bad hand well, rather than getting a good hand

27. 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.

28. 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).

29. 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)

30. 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

31. 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

32. How to support young people

33. 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.

34. Managing risk Session Three

35. 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)

36. 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)

37. 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.

38. 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.

39. 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).

40. 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

41. 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

42. 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

43. Risk management as a concept Risk management means maximising potential benefits. These benefits should form part of any intervention

44. 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

45. 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

46. Difference between risk and safety Important concepts with different emphasis along the continuum of the assessment process.

47. Signs of Safety One 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)

48. 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.

49. 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

50. Some common indicators of danger Violent Caregivers or Others in the Household Caregiver Makes Child Inaccessible Caregiver Lack of Self Control Caregiver Has Distorted Perception of a Child Caregiver Fails to Supervise/Protect Caregiver Threatened/Caused Serious Physical Harm to a Child Caregiver Will Not/Cannot Explain a Child's InjuriesChild Provokes Maltreatment Fearful Child Caregiver Is Unwilling/Unable to Meet Immediate Needs of Child