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Susie Essex

Susie Essex. Working With Denied/Disputed Child Abuse Concerns The Resolutions Approach. Consultation to own cases. 1. If this case were to have the perfect/ miracle outcome what would that look like? 

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Susie Essex

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  1. Susie Essex Working With Denied/Disputed Child Abuse Concerns The Resolutions Approach susie essex 2010

  2. Consultation to own cases. 1.If this case were to have the perfect/ miracle outcome what would that look like?  • 2.List the main components for safety in that perfect/miracle, what would they be, what would you see family members doing. ( Think of the literature relevant to this area ie causes, grooming, risk factors, triggers etc and make into a positive doing things.). • 3.If parents/carers were to ask “what do we need to do to show you our children are safe?” • 4.List with specificity and detail what they would need to do. susie essex 2010

  3. Consultation to own cases cond. • 5.Of these safety factors which are most important? • 6. Which do you think would be easiest to achieve (not necessarily the same as above) and what would you or a colleague need to do to help make it happen? • 7. Of the remaining safety factors which would be most difficult to achieve, leave that for Susie to try in a role play.  • 8.Of the slightly easier ones what might you do differently that would have an impact on the family to help them move forward, how might you join them to create a context of combined problem solving to demonstrate safety factors. susie essex 2010

  4. The Munro Review, Interim Report 2011 ‘It’s all about relationships. We are talking about dealing with people with problems, with painful stuff. You have to know someone, trust them. They must be reliable and be there for you if you are going to be able to talk about the things you don’t want to. The things that scare you.’ Parent Family Perspectives on safeguarding and relationships with children’s service The Children’s Commissioner for England, June 2010 susie essex 2010

  5. Resolutions Risk Reduction Programme Child and Family Solutions susie essex 2010

  6. Overview • 1. Thinking about denial • 2. Assessment restraints • 3. Treatment / Resolutions / Future Safety susie essex 2010

  7. The child protection context • According to Home Office statistics children under one year are 6 times at risk of being killed by a parent or carer as children aged 1 year to 5 years, and 11 times at risk compared to children aged 5 years to 16 years. • The NSPCC estimates that 100 children a year are killed by their parents / carers. • OFSTED reported that serious case reviews were initiated following the deaths of 81 children who died during 2007. • Serious Case Review Summary 2005 highlighted the increased risk of suicide following longer term hidden abuse. susie essex 2010 John Gumbleton 2009

  8. Child Protection Practice • “There was a small group of cases of physical abuse, neglect and emotional abuse which presented special dilemmas to social workers. They were the ones where neither partner had admitted responsibility for abusing the child. …. without an admission the worker could feel uncertain about how to proceed.” • Farmer E. & Owen M. Child Protection Practice: Private risks and public remedies, (1995) Pg 229 susie essex 2010

  9. Social work attitudes • “Amongst the social workers a significant proportion regarded denial as a barrier to the formulation of a child protection plan (other than removal of the child) and in the development of partnership with families. They also believed acknowledgement to be a prerequisite to the commencement of any work towards rehabilitation.” • Gumbleton & Lusk “Child Abuse: Rehabilitation without admission - A new way forward” Family Law (Dec 1999) pg822 susie essex 2010

  10. Denial/Disputed - Professional dilemmas • We can’t always identify the perpetrator/s • We can’t be sure how the abuse happened • We don’t know the precise antecedents to the abuse • We can’t easily identify behavioural / contextual triggers • We don’t know if the child’s carers are telling the truth • It’s difficult to be certain what we’re dealing with • Should we risk further harm to the child by attempting reunification? • What if the child/young person wants to go home? • What if the parents have another baby? susie essex 2010

  11. Chldren’s and Young Peoples views. • Check back with the family....... • Don’t be overly negative....... • Make sure children have someone outside the family to talk to. • Take what young people say seriously. • I don’t like to be kept in the dark explain things more. • Don’t get too involved – let the family try to solve it. “Don’t make assumptions” March 2011 www.childrenscommissioner.gov.uk Susie Essex 2011

  12. Exercise : Thinking about denial Participants’ ideas and experience of denial/disputed/discrepant explanation cases In two’s discuss your dilemma’s in cases of denial/dispute, be prepared to feedback one or two points. Eg. In a case of sexual abuse, if a parent said they had done the abuse and said they were very sorry, how much would you rely on this admission in planning your work , what might this parent say in other contexts? susie essex 2010

  13. Parents’ responses • “The issue of ‘denial’ is a thorny and complicated one because there is no reliable way to distinguish accurately the behaviour of a parent who genuinely denies responsibility when wrongly suspected from that of a parent who denies in an attempt to avoid detection of actual culpability.” • Dale et al “Fine Judgements” (2005) Pg 129 susie essex 2010

  14. The concept of “denial” • “In a similar way, the concept of ‘denial’ in investigations and assessments of serious suspicious physical injuries to infants is biased toward an assumption that parents are deliberately concealing conscious awareness of maltreatment, and that their refusal to confess is confirmatory evidence of this.” • Dale et al “Fine Judgements” (2005) p140 susie essex 2010

  15. Reasons why parents might deny/dispute, (word-storm with partner why you might deny a difficulty) • They may be innocent/ it might be someone else • Memory impairment due to drugs, alcohol or a neurological condition • Shame /Guilt • Family repercussions • Social repercussions • Criminal repercussions • Child protection repercussions. • All act as significant restraints to accepting responsibility- it might seem the stakes are too high. susie essex 2010

  16. Assessment and Denial Recent Developments need to entertain greater complexity whilst maintaining the focus on Safety. • “ .. the conclusions must take into account all aspects of the family's functioning and not focus exclusively on the presence or absence of denial, which is only one element of a much larger assessment.” • Bentovim.A. in Reder and Lucey (eds) “Studies in the Assessment of Parenting” (2003) pg 255 susie essex 2010

  17. The Three Domains Child Parenting Capacity Child’s Developmental Needs Safeguarding and promoting welfare Family and Environmental Factors Susie Essex 2011

  18. Assessment - Risk Factors • Domestic violence/history of Domestic violence • Drug / alcohol abuse/mis-use • Mental health difficulties • Learning Disabilities • Parental denial/dispute • Previous suspicious injuries • Parents with history of abuse as children • Unwillingness / inability to engage with professionals • Isolation/sense of isolation from kinship and Community, None of these are predictors on their own, they are factors that need to be considered and discussed. susie essex 2010

  19. Assessment - Strengths / Positives • An acknowledgement of the concerns, (or an understanding of agencies right to be concerned). • A history of co-operation with professionals • Willingness to accept services including therapeutic work to address concerns • A viable support network/ kinship system • Good Community links • Good health • A lack of other risk factors • Employment and stable income • Suitable Housing susie essex 2010

  20. Content and Process • The way that workers approach families and how they engage with them is as important as the nature of the work undertaken. • Therapists are aware that the therapeutic alliance counts for 40% of success and technique/mode of intervention for only11%. • Co-operation based on the concerns is the key task. susie essex 2010

  21. Professionals/managers and Court Family/wider kinship Position of the worker/therapist susie essex 2010

  22. Reasons why parents might deny/dispute • They may be innocent/ it might be someone else • Memory impairment due to drugs, alcohol or a neurological condition • Shame /Guilt • Family repercussions • Social repercussions • Criminal repercussions • Child protection repercussions. Do we have a a legal and socialcontext that encourages responsibility. (Ian Leslie, Born Liars , 2011) Susie Essex 2011

  23. Beyond Assessment - Resolutions • Building future safety around children • Developing a working partnership based on the concerns • Developing support networks based on the concerns • Co-constructing safe increasing contact leading to overnight stays and a full return home( assessing risk at every stage) • Words and pictures to explain the concerns for children and safety network • Co-constructing family safety guidelines • Working in the “similar but different” to look at literature and research informing concerns • Focus on future communication, in particular, about difficult feelings and emotions. susie essex 2010

  24. Resolutions attempts to: • Reinforce and foster a sense of self agency with the possible non-abusing carer and/or key safe people in the childrens lives. • Build on and/or strengthen the bond between the safe adults and the child/children • Restrict and control the possible misuse of power of the alleged abuser • Creating openess by involving helpful significant adults in keeping children safe, taking account of race, culture, religion, class and ability. susie essex 2010

  25. Support Networks • “A recurrent theme for families is the reluctance of social services to recognise the value of extended family / kinship resources alongside ‘worst scenarios’ regarding the level of risks, and lack of resources for more constructive reunification programmes.” • Dale et al “Fine Judgements” (2005) pg 94 susie essex 2010

  26. The Wall of Denial/Dispute susie essex 2010

  27. Partnership • “Failure to achieve this level of co-operation helps to explain why some children remain safe when others do not. The quality of the relationship between parents and professionals was found to be the main reason: a recurrence of abuse was less common in those families where some agreement had been reached between professionals and family members about the legitimacy of the enquiry and the solutions adopted.” • DoH “Child Protection: Messages from Research” (1995) pg 45 susie essex 2010

  28. Aspects of Future Safety Timescale, based on research Rota of active help to address key aspects of literature Significant people, know the concerns Safety network, prepared to be active and proactive over a reasonable time scale. Professional network prepared to be active Network members, give active support and a non-critical gaze Other practical issues, day care, meals, snacks, medicines, medical appointments etc All safety measures MUST be focussed on the Concerns. susie essex 2010

  29. DVD Case Example Alex and Kate Smith have two children, Jake 4 years and Chloe 8 months. Chloe is presented at hospital having allegedly been dropped by Alex whilst in his sole care. Medical examination reveals linear bruising to Chloe’s cheek, rib fractures of different ages and subdural haematomas, which the doctors think are non-accidental in origin. The family are not known to Social Services and the Health Visitor reports positively about the parenting and care of the children until this time. Jake is placed in foster care and Chloe joins him when she is allowed to leave hospital. Alex and Kate are allowed contact with the children five days per week supervised by social workers. The matter is put before the Court which has to decide what should happen to the children. Further assessments reveal no other concerns and both parents deny they have injured Chloe. susie essex 2010

  30. Film clip The Family’s Perception of the issues + Sarah Jim Norman Kate Alex Chloe Jake susie essex 2010

  31. DVD case example Julia and Gerry • A pre-school girl from Sunday School (Kelly), where Gerry helped as Leader, alleged that Gerry had sexually abused her. The matter was not taken to court but Social Services “substantiated” the allegations based on the detail of oral abuse in the girl’s report. As a result of this Social Services were concerned for the current and future safety of Gerry and Julia’s 3 year old daughter Emma. Julia’s sister Sharon and Julia’s mother have been helpful during the investigation. Susie Essex 2011

  32. Genogram Julia and Gerry + MGM Julia Sharon Gerry Emmaage 3 Kellyage4 Susie Essex 2011

  33. Resolutions Programme Summary 1. Preparation 2. Engagement 3. Words and Pictures 4. Family Safety Guidelines 5. Similar but different - role play 6 .Family Safety Plan 7. Future safety Communication and follow up. Child and Family Solutions susie essex 2010

  34. Resolutions Programme Terms LP - the likely perpetrator LNAC - the likely non-abusing carer CPW - child protection worker FSG - Family Safety Guidelines Support Network - safe adults around the child Child and Family Solutions susie essex 2010

  35. RESOLUTIONS PROCESS: STAGES AND USUAL SESSIONS OVERVIEWAndrew Turnell and Susie Essex susie essex 2010

  36. Resolutions Programme 1. Preparation Child and Family Solutions susie essex 2010

  37. Resolutions Programme 2. Engagement Child and Family Solutions susie essex 2010

  38. Resolutions Programme 3. Words and Pictures Child and Family Solutions susie essex 2010

  39. Resolutions Programme 4. Family Safety Guidelines Child and Family Solutions susie essex 2010

  40. Resolutions Programme 5. Similar but Different - role play Child and Family Solutions susie essex 2010

  41. Resolutions Programme 6. Family Safety Plan Child and Family Solutions susie essex 2010

  42. Resolutions Programme 7. Follow up Child and Family Solutions susie essex 2010

  43. Engagement • How do we create a context for the work. • How do we create an atmosphere of collaboration and co-operation. • How do we bear in mind time as an important aspect of our work. • M.Friedlander, V.Escudero,and L.Heatherington 2006 Chapters 10,11, and 12. • “Do not.... Interpret rejection as ill will. Tell clients that their behaviour reflects dysfunction/psychopathology. • Do...Explore family dynamics prompting reluctance. Thoroughly analyse the context to understand mistrust. Renegotiate the context and meaning of treatment to enhance all aspects of the alliance. susie essex 2010

  44. Questions for engagement in the first meeting • What do they think today’s meeting is about? • What have they been told and by whom? • What are they hoping will come out of today’s meeting? • Who is most concerned at present, what are they concerned about, who else is concerned and what are they concerned about? • Who has been most helpful to date? • Who or what has made most sense so far? susie essex 2010

  45. Questions about Problem Solving Styles and Resources • Can you give me an example of how your family of origin dealt with, or overcame a difficulty or worry, how did they try to sort it out, whose help did they seek, and what ideas did they seem to find most helpful back then? • How would you tackle that worry or difficulty now, what would you do the same what would you do differently, who would you seek out for help? How do worries currently get raised, talked about and resolved? • Is talking about worries a helpful idea, if they are not talked about how do they get resolved? • How would you like your children to remember you as parents, what do you hope they will be proudest/pleased about? susie essex 2010

  46. Questions regarding children at the engagement stage • What do they think their child X(however young) makes of what is happening? • What makes them think she/he knows or thinks that? • What has she/he been told? • What questions has he/she asked or what has she/he seen or heard? • What stories might he/she be telling himself? susie essex 2010

  47. Questions regarding children at the engagement stage • What do they think their child X(however young) makes of what is happening? • What makes them think she/he knows or thinks that? • What has she/he been told? • What questions has he/she asked or what has she/he seen or heard? • What stories might he/she be telling himself? susie essex 2010

  48. Risk Reduction Future Focused Safety Work The empirical evidence is that lack of compliance, rather than denial, is the best indicator of re-abuse. (E Farmer, M Owen 1995) By leaving denial relatively unchallenged the Resolutions approach allows families to comply, in cooperation and partnership with agencies, about the future safety of their children. Partnership is based on • Openness • Respect susie essex 2010

  49. Respect, in child protection based on Rigour and Grace For further reading to understand the stance in a risk reduction program see chapter 3 in ‘Working with ‘Denied’ Child Abuse, The Resolutions Approach.’ Susie Essex and Andrew Turnell Based on • Not being rude • Not getting in their way • No gratuitous opinions Conversation with George Walker and Helen Young 1998 susie essex 2010

  50. Parents in middle Exercise • How to talk to them susie essex 2010

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