The impact on deaf children and their families of changing structures of social care provision

1
The impact on deaf children and their families of
changing structures of social care provision

• Professor Alys Young
• Social Research with Deaf People group (SORD)
• University of Manchester
• alys.young_at_manchester.ac.uk

2
Drawing on 3 research studies

• National evaluation of the introduction of
  newborn hearing screening in England (Young et
  al., 2004 2005)
• Integrated childrens services and deaf children
  and families (Young et al., 2008 2009)
• The case for specialist social workers with
  d/Deaf people (Young et al., 2008)

3
Acknowledgements and co-authors
Ros Hunt Rosie Oram Carole Smith Helen
Tattersall John Bamford Wendy McCracken
Steve Vaughan Linda Cox Brian Gale
4
Context and trends

• Deaf children average age of identification now
  9 weeks (not 26 months) in English programme
• Over 90 born to hearing families
• NHSP quality assurance standards contains only 1
  in relation to social care provision
• In Wales no social care representation in quality
  standards protocols or on task and finish group
  on communication development.

5
Context and trends

• Deaf children are 3.4 times more likely to
  experience abuse than hearing children
• Over 40 will have mental health difficulties in
  childhood/early adulthood
• Deaf school leavers depressed reading age has
  not substantially improved from the 1979 recorded
  average of around 9 years old.
• Significant evidence of unemployment and
  underemployment amongst d/Deaf people

6
Context and trends

• DH (2005) recommended Area Child Protection
  Committees (now LSCB) should review child
  protection arrangements for deaf children (not a
  single one in England has done so)
• Move to integrated childrens services in both
  England and Scotland
• Potential disaggregation of Adults and Childrens
  provision
• Traditional model of specialist teams/services
  working with d/Deaf people forced into change

7
Some basic challenges

• Establishing communication between parents and
  children of enough quality and quantity to
  enable
• optimal language acquisition, emotional
  relationships, learning as a child within a
  family
• Effective reciprocal communication in social,
  educational and community contexts to assist
• psychological development, socialisation,
  identify formation, confidence and social
  competence.

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• For reasons of (i) responding to these
  challenges (ii) the increased vulnerability of
  deaf children
• Social work and social care services have a
  significant role
• Its not an issue of ears and education
• But what is happening to service provision?

9
Study of social work and deaf childrens services
in England

• Phase I in depth case studies/ interviews/
  document review in 5 Local Authorities
• Phase II structured phone questionnaire with 52
  Local Authorities
• Largest and most comprehensive study ever
  undertaken in this area of practice
• Context is integrated education/social care
  Childrens Services and Childrens Trust
  arrangements (involving health and the voluntary
  sector)

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Service arrangements (n52)

• 4 had no formally designated service arrangements
  at all in respect of deaf children and their
  families.
• 6 had specialist deaf children and families teams
  (5 led by Education, but in 2 there were no sw
  qualified staff)
• 22 CDTs had designated responsibility but in only
  12 was there any deaf child related expertise
  (and that included v basic expertise)

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Service arrangements

• 6 officially provided through specialist d/Deaf
  Adult services (but with training and systems
  issues)
• 6 contracted out to voluntary organisations (but
  with limits)
• 8 other (e.g. shared between Authorities but at
  least 2 with no qualified social workers)

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• Why should variation in service arrangements
  matter?

13
With specialist team/team arrangements

• Clear referral pathways for both families and
  other professionals/agencies
• Social care professionals were far more likely
  routinely to be involved within the multi agency
  service matrix, rather than brought in only when
  there was a crisis, or only if necessary.
• There was a strong preventative focus to social
  care provision for both the deaf young person and
  their family

14
With specialist team/team arrangements

• There was a largely unquestioned acceptance that
  deaf children met the definition of children in
  need under the Children Act 1989
• Referrals routinely resulted in at least an
  initial assessment
• High eligibility criteria for service provision
  amongst Childrens Services was not considered a
  barrier

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Without specialist team/team arrangements

• For both families and other professionals there
  were highly ambiguous referral routes, with
  little or no clarity about where designated
  responsibility might lie
• Social care involvement only at points of extreme
  crisis health and education professionals not
  confident that a knowledgeable social are
  response was possible or likely.
• Marooned specialists in Adult services, finding
  ways and means

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Without specialist team/team arrangements

• Referred deaf children and their families
  unlikely to receive even an initial assessment
• Eligibility criteria effectively excluded most
  referrals because the presenting circumstances
  were rarely identified as meeting thresholds
• A problem had to escalate to a crisis before a
  social care response was triggered and became
  recognisable as critical by other standards
• Preventative work was rarely undertaken and not
  seen as a primary focus

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Qualified social workers?

• Over a quarter (28.3, n13) of the Local
  Authorities did not employ any qualified workers
  who were specialist working d/Deaf adults and/or
  deaf children. In no case can this result
  accounted for by the Authorities concerned having
  contracted out arrangements whereby a specialist
  voluntary organisation for example, provides
  services.
• In 46 (n23) of the Local Authorities there were
  no qualified social workers who worked with deaf
  children and their families either as officially
  part of or as the whole of their job remit.
• The median staff complement of qualified social
  workers working with deaf children and their
  families was 0.25

18
From large survey

• 50 of Authorities - no systematic arrangements
  for ensuring that deaf children and their
  families receive a joint assessment involving
  health, education and social care, nor a defined
  multi-disciplinary pathway for planning and
  service provision.
• Over 50 of Authorities - no formal referral
  arrangements between social work and education
  professionals where deaf children and their
  families may require assessment and/or service
  provision
• Nearly 45 of Authorities - no formal referral
  arrangements between social work and health
  professionals where deaf children and their
  families may require assessment and/or service
  provision

19
From large survey

• Just over a third of Authorities were of the view
  that education colleagues were responsible for
  the needs of deaf children and their families
  (including social care needs) unless referral was
  appropriate at particular points in time (e.g.
  transition), or some exceptional circumstance
  occurred)
• Even if a deaf child was formally identified as a
  child in need, only two thirds of the LAs would
  that child and family be offered even an initial
  assessment (drops to fewer than half where there
  is no specialist team arrangement)

20
From the large survey

• Over a quarter of LAs said they rarely or never
  provided preventative social care services for
  deaf children and families.
• Of those who did, very few distinguished these as
  potentially different from those that would be
  provided to all disabled children. strongly
  medical model understanding
• In a specific case example, of a profoundly deaf
  minor, school excluded, not age appropriate
  language and displaying abusive behaviour, 10 of
  LAs would not have responded at all.

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Specifically re child protection

• Only a third had any kind of co-working
  arrangements in place between specialist social
  workers and child protection teams
• Nearly 20 had no co-working arrangements
• The rest described ways of getting specialist
  help but none of this involved specialist
  social workers and most assumed the only issue
  was interpreting provision and that solved all
  the problems.

22
Specialist professionals required?

• Professionals with direct work experience of deaf
  children and families (or had been got at by
  those who did)
• Very articulate about why specialist social
  work/social care was required
• Others without such experience
• Tended to see the arguments for the specialism as
  anti inclusionist
• Saw no evidence of need

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Specialist professionals required?

• Argument for distinctiveness of social work (in
  comparison with sister professions)
• Fundamental focus on family not the child
• The family/social/community/economic context as
  the starting point for professional activity
• Concern with the childs development in a broad
  sense, not with developmental problems attributed
  to deafness

24
Specialist professionals required?

• A concern with key values and principles guiding
  assessment and defining desirable outcomes.
• the promotion of autonomy
• the nurturing of independence
• the facilitation of choice within decision making
  processes (and allied to that how to challenge in
  situations where it might appear a service user
  was not aware of a range of potential choices)
• and the fostering of social inclusion.
• Other professionals may recognise these but they
  do not have the same primacy

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From Young, Hunt, Smith (2008)

• I see the role of the social worker as
  supporting, empowering, informing, helping them
  make choices, being alert to any safety issues
  and that can be in its widest possible sense from
  say traditional safeguarding and child abuse
  issues right the way through to life stage work
  so if you know that a child is just moving from
  primary to secondary school, are they Ok with
  road safety, when they are moving up to teenage
  stage, are they ok about the community, do they
  know that they themselves can get to their GP,
  can they use interpreters, that sort of thing.
  So its empowering at different life stages for
  the child, informing, supporting the family when
  youre thinking of the whole family.

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Additionally from study in Wales

• Diverting away from social work involvement
• Advocacy within the organisation to make all
  parts accessible
• Making systems work for Deaf member families
• How to fill gaps but not be a gap-filler

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But

• No recognised specialist training pathway for
  social workers wishing to work with d/Deaf
  children and adults
• The level of BSL skills amongst specialist social
  workers remains extremely worrying (1997, 18 SWs
  Stage 3 or equivalent 2002 39) (Young et al.,
  2004)
• Evidence of reorganisation in England showing the
  disappearance of the specialism/recognition of
  its need
• Evidence in Wales questioning what is the case
  for the specialism

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Our conclusion to the 2008/2009 reports

• Despite evidence of pockets of exceptional good
  practice and comprehensive provision.
• There is clear evidence on a widespread basis of

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• poor integrated childrens services arrangements
  in respect of deaf children and their families
• a lack of specific attention to deaf children
  and families social care rights and needs
• poor recognition of need and provision of
  assessment
• severely limited ability to work preventatively
  within a broad understanding of safeguarding

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• ambiguous pathways of service provision
• responsiveness only in situations of acute need,
  (the escalation of which may have been
  preventable)
• lack of focus on the psycho-social developmental,
  linguistic and cultural challenges and
  differences of the full diversity of deaf
  children.

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• In these circumstances, and with specific
  reference to social care, there is strong
  evidence to suggest that the statutory duty on
  Local Authorities to co-operate within Childrens
  Services to promote the well being of children is
  being significantly compromised in relation the
  well being of deaf children and their families.

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References

• Young, A.M., Hunt, R., Smith, C., Oram, R.
  (2009). The impact of integrated Childrens
  Services on the scope, delivery and quality of
  social care services for deaf children and
  families. Phase II Report. London NDCS.
• Young, A.M., Hunt, R. (2009). The role,
  contribution and training requirements of
  specialist social workers with d/Deaf people.
  Commission for Social Care Inspection, Wales.
• Young, A.M., Hunt. R., Smith, C. (2008). The
  impact of integrated Childrens Services on the
  scope, delivery and quality of social care
  services for deaf children and families. London
  NDCS. http//www.ndcs.org.uk/news/ndcs_news/social
  _care_radar.html
• Young, A.M., McCracken, W., Tattersall, H. (2005)
  Interprofessional working in the context of
  newborn hearing screening Education and Social
  Services Compare Challenges. Journal of
  Interprofessional Care, 19 (4), 386-395
• Young, A.M., Tattersall, H., McCracken, W.,
  Bamford, J. (2004) The Impact of Universal
  Newborn Hearing Screening Education Perceiving
  the Role of Social Services. Qualitative Social
  Work 3 (4), 367 387.

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Additional social work and d/Deaf people related
publications

• Young, A.M., Hunt, R., McLaughlin, H. (2007)
  Exploring models of D/deaf service user
  involvement in translating quality standards into
  local practice. Social Work and Social Sciences
  Review 12 (3), 25 39.
• McLaughlin, H., Young, A.M., Hunt, R. (2007).
  Edging the Change. Action research with social
  workers and Deaf and hard of hearing service
  users to achieve Best Practice Standards.
  Journal of Social Work 7 (3), 288 306.
• Young, A.M., Hunt, R., Loosemore-Reppen, G.,
  McLaughlin, H., Mello-Baron, S. (2004) A profile
  of 15 social work services with deaf and hard of
  hearing people in England. Research, Policy and
  Planning, 22 (1), 31 46.
• McLaughlin, H., Brown, D., Young, A.M. (2004)
  Consultation, community and empowerment lessons
  from the deaf community. The Journal of Social
  Work, 4 (2), 153-165.