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Following the Paper Trail All the Way to Hell!

July 13, 2012

With this blog I wanted to give an insight into the world of Social Work, an insight into the process of Social Work – how we do what we do, why we do what we do. Central to the process of modern social work is the paper trail, our case notes and other forms, to the extent it sometimes feels like all we do.

A few quick examples of the paper trail, but by no means all:

  • Case notes – everything we do should be written down, everything. Every phone call, every conversation with other staff relevant to a case, everything. If it’s not in the cases notes it didn’t happen – an idea I will come back too
  • Referral forms – every time we need a service for our clients it means a stack of forms to fill out, this is very frustrating when it is a HSE service, or indeed the childcare workers on our own team as it feels more about control than providing a service. Looking for private services outside the HSE mean a funding request, private procurement application with three quotes and the agencies own referral form – the result being that when an service is needed as soon as possible, as soon as possible turns into a six  weeks.
  • Standardized Business Forms. – The HSE in a well intentioned attempt to deal with the lack of consistency and clear standards across the country have introduced standardized process, and a dozen forms to back them up. While the aim is good (and discussed below) the reality means more paperwork with deadlines and stats (intake form in 24 hours, initial assessment in 20 days, and how many done in that time scale measured and monitored)
  • Court reports – never use “could” “would” or “should” unless you want to get an earful from the judge. Never copy and paste from the previous report (even if nothing has changed) unless you want an earful from the judge. Get them in 3 working days in advance, unless you want an earful from the judge (spotting a pattern here?). And certainly have them ready before every other professional so that they can copy and paste from your report!
  • Statistical returns – The numbers and the data have begun a big thing for the HSE but in all the wrong ways. Either way, we now have a load of forms to fill in showing how much of our targets we are hitting.

 

The simple fact is that every week there seems to be more and more paperwork; but like many things in Social Work isn’t a black and white issue.

 

Why so much paper work? If it’s not on paper it didn’t happen. You could have done an in depth productive and effective piece of work with a client, but if you don’t write it down it never happened. So the paper work provides on one side increased oversight and increased transparency. What you did and why becomes real, is there for all to see. It becomes easier to track decisions of Social Workers, to follow the history of a case, to understand what workers, what didn’t and what needs to be done. Given a long history of scandals and inquiries this can only be a good thing. However, this breeds a defensive reaction, a fear that everything must be written down, not to record the nuances of a case, but to protect the worker. Every little conversation with a Team Leader becomes an email or a joint case note. Every time a child or parent sneezes, it becomes a case note so that no one can say the Social Worker didn’t do their job. The recent reports into deaths of children in care highlighted the importance of this, they were solely based on reviews of the files, and any work not recorded was not seen. A Social Worker could have been criticized for not doing something that was in fact done. This defensive practice will only be made worse when registration is in full swing, as every Social Worker is open to personal liability in their cases. Getting the balance right between these two sides can be hard, and depends on so much beyond the control of the Social Worker. A well supported Social Worker on a high morale team will probably be less defensive and as a result more engaged with the work, and the reality is good cases notes make the work easier and make court reports and indeed giving evidence easier.

 

Coupled to much of the new and increasing paper work is stats and targets. This is an issue I looked at in a previous post (Lies, Damn Lies, and Statistics…Social Work by Numbers) and since that time it feels like things have got worse. Stats are not being used to provide an insight into the work and understanding why or why not things happen, they are targets to hit regardless of quality and effectiveness. The pressure and the political game come from the top and roll all the way down the bureaucratic chain. Social Workers and Social Work teams have to struggle to keep the client, i.e. the child, at the centre of things instead of being about numbers on a graph. This is where effective leadership in managers shows, in Team Leaders, and more so in Principal Social Workers, as they try and maintain the right balance.

 

So, where does all of this leave the coal face Social Worker? More importantly where does this leave Social Work?

 

How the individual Social Worker handles this depends a lot on them and their personality and how organized and efficient they are in themselves. However, even the best will feel that pressure, that weight of responsibility that comes with the job and the undone case note. This is counter balanced by the pressure of the undone home visit, the visit you couldn’t do because you were so busy with the paperwork. Sometimes it feels like time management and efficiency at paperwork are more important than interpersonal skills! It can be stressful, it can be frustrating but I think most Social Workers understand the importance of good paperwork; good case notes and accept it as part of the job.

 

So what about Social Work as a practice? If we accept on the one side time with clients and building relationships and accept on the other hand the importance of proper paper work than an optimal balance must be found. The case notes and the direct work aren’t mutually exclusive with a proper caseload that allows time for both, but the reality is that most teams are so under resourced both in terms of workers and in terms of admin support that caseloads become too big to manage both competing elements of the work. This is dangerous for clients and for children as inevitably one of the two important parts will suffer. This is also dangerous for Social Work as new or potential Social Workers decide they want to work with people not paper and look elsewhere.

 

Oh, and I haven’t even touched on the most annoying part of the paperwork, our decaying and outdated IT systems, which as the Standardized Business Processes are rolled out will come under increasing pressure and will move closer to outright collapse.

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Children’s Rights are Right for Families…Guest Post for Campaign For Children

March 23, 2012

The post below is a guest post that I wrote for the  – http://www.campaignforchildren.ie/

We have been promised a stand alone referendum of the subject of children’s rights, before the end of 2012. Enshrining the rights of children is important to improving standards and services for families. Despite what you will be told children’s rights will not undermine families.

Check out the Campaign for Children’s website and get involved.

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I’m a child protection social worker. I work on the coal face of child protection in Ireland, an issue that has been a contentious and at times controversial area of Irish life.

It’s an area often shrouded in confusion, unseen by the general public and only discussed in time of scandal. Yet the child protection problems that modern Ireland face ask deep questions about us as a society.

As a child protection social worker I spend my days dealing first hand with the results of inequality and social exclusion, the root causes of most of the problems that social workers deal with.

A full and concrete acknowledgement of children’s rights in Ireland will make my job as a social worker easier. This is not because it will undermine families, but because it will hopefully mean that children and families will begin to need less intervention from social workers in the first place.

Root problems

When we examine the reasons children come into care we can learn a lot. Of the four categories of abuse child protection social workers deal with, neglect is the number one cause of children being taken into care, ranking far above sexual abuse, physical abuse and emotional abuse.

The neglect of children in families stems from the neglect of their families as a whole, and the neglect of the communities they live in on a wider scale. It’s widely acknowledged that for most children the best place for them is in a loving family environment.

If we believe this to be true, it’s imperative that we support families and strengthen communities in order to protect children.

Best interests of children

The virtual invisibility of children in the Irish Constitution means that every day children and their families fail to get the supports they need. The best interests principle means that all decisions that are made that directly affect the lives of children will be required to take the best interests of the child into consideration. This principle, if enshrined in our Constitution, will mean strengthening families.

It’ll mean that the children and families who DO need social work intervention will be better supported by the recognition of children’s rights. As it currently stands, the HSE has long been shown to provide a patchwork service, with resources, services and even models of service delivery spread around the country at random.

All children and all families deserve the best services this State can manage. We need services to be driven by the best interests of children and their families and not by resource allocation.

Even if we make family supports more widely available and improve and streamline social work intervention, a minority of cases will remain in which families will not be able to provide a safe environment. These children will need to be taken into care.

But these children too will benefit from clear and strong children’s rights. At every step of the way, from court, to placement, to foster care, to aftercare – the best interests of the child and their own individual rights should be centre stage, allowing their needs to be at the centre of service delivery.

All children deserve to have their rights respected. In my role as a social worker however, I have seen with my own eyes that it’s the most vulnerable children in this country who most urgently need a strong declaration of their rights.

Only then can they and their families get the support and protection they need and deserve.

A Child Centred Supreme Court?

February 29, 2012

Whatever the final wording, if the coming Children’s Right referendum passes it will mark a new phase in Irish Family law and Irish jurisprudence. Whatever the wording new and novel cases and legal arguments will heard, and old ideas will be questioned in this new light. In times like this the courts, particularly the Supreme Court, take on a central role.

 

It is with this in mind that I note with curiosity the news that the Hon. Mr. Justice John MacMenamin has been appointed by the government to the bench of the Supreme Court.

 

The Hon. Mr. Justice John MacMenamin previously presided over the Minors list in the High Court, which includes all special care applications. Justice MacMenamin has shown an interest in child law, special care, children’s rights and unmarried fathers, often contributing to seminars and publishing papers on these areas. Justice MacMenamin has show an awareness of the rights of the child, perhaps this is most infamously seen in his judgement in the High Court in the Baby Anne case. This judgement was of course over turned by what were then his superiors in the Supreme Court.

 

It is impossible to know how or if his judgements will be effected by his promotion, but I for one will watch with interest how this plays out.

 

Of parallel interest is the fact that in her judgement in the Baby Anne case, Supreme Court Justice Catherine McGuinness stated that given the law as it was she had to overturn the high court verdict, but did so reluctantly. Of course, with any referendum these restrictions may no longer apply.

 

It would foolish of me to make any serious predictions, but a constitutional amendment, a new judge, and an old one given new scope guarantee that things will at least be interesting.

Aftercare…or just care after the fact?

February 15, 2012

When we take children into care we do so to make their lives better, we do because we have a duty to “promote the welfare of children…who are not receiving adequate care and protection” and we do so because they “require care or protection which they are unlikely to receive unless the court makes an order”. The hardest part of the job is that we aim to make lives better but so often fail to do so. Sure we can stop things getting worse, but when we set ourselves such lofty aims is that good enough? This is something that comes back to me when reflecting on my work, and can be seen in so many aspects of our work. Aftercare provides a good place to see this dynamic in action – by the time the young person is in aftercare they are an adult, and we can reflect on the long years in care and the effect they have had, for good or for bad.

The legal basis for after care is grounded in Section 45 of the Child Care Act which states “Where a child leaves the care of a health board, the board may assist him for so long as the board is satisfied as to his need for assistance and he has not attained the age of 21 years.” This is in turn supported by a National Policy on After Care and Leaving Care detailing the processes and procedures.  There has been some criticism of this set up, in that by stating that the health board “may”, and not “shall” the law does in fact provide little guarantee of support and services once a child turns 18. The political fig leaf on this issue has been provided by Subsection (4) which states that “In providing assistance under this section, a health board shall comply with any general directions given by the Minister” and has been used by Former Minister for Children Barry Andrews to direct the HSE to formulate and implement a comprehensive aftercare policy to provide services to all children leaving care. Despite this, it remains, as described by Geoffrey Shannon, a “hollow promise”, with supports subject to funding and resource availability, which all too often are not in fact available. There are still plenty of cases without an allocated Aftercare Social Worker.

On the ground aftercare is generally provided by an Aftercare Social Worker, who handles most, if not all, of the aftercare cases on the team. This creates a huge caseload of young adults needing support and help, a caseload that like any overly large caseload begs the question how good can these supports be when they are spread so thin. This is not to denigrate the hard work and commitment of after care workers, it is more a comment on the over burdening of frontline staff that the HSE goes in for. In fact the work of the Aftercare Social Worker can be even harder given that the young adults who are the clients can drift in and out of services and can be some of the hardest to engage. Getting a child to engage with the reality that their life is about to be turned upside down as supports disappear can be frustratingly difficult, particularly when it is a child who will be getting very little from the service. Despite what Helen Buckley patronizingly says, it’s not just a matter of “just trying harder”, for some kids turning 18 means freedom from Social Worker, from residential units and the freedom to go out and destroy themselves. In reality most support, both practical and financial, is only available to people in education or training.  If you are in education there is a lot of support, assistance with fees, assistance with rent, and assistance with the cost of living. If you’re not, you are left to rely on social welfare.

The research both here and overseas shows time and time again the poor outcomes for children in aftercare and for children with care history. A lot of time and energy is being spent to improve aftercare services. Courts and Guardians Ad Litem are paying more and more attention to aftercare provision to obtaining commitments to support and funding. More and more policy documents and reports stress the importance of aftercare, and rightly so. Consider the fact that so many of us don’t leave home till closer to 25 instead of getting thrown out at 18. Even when we do finally leave there is a social safety net there for us which is not there for young people leaving care unless the HSE improve services!

However, there is a certain air futility to all of this. The young people we are dealing with in aftercare come from deeply damaging and destructive backgrounds, and are often just that, deeply damaged. They have also been through care, which brings with it its own trauma and harm. Given all this hurt it’s not surprising that so many don’t prosper at all. Compare them to the other children in the communities most of these kids come from, that is lower socioeconomic areas (a polite way of saying lower class really, but we cant talk about class can we) where educational attainment is low and social exclusion and unemployment are high. The majority of kids in these areas will struggle in life and education, few of them will end up as doctors, barristers, politicians, bond traders or chairman of some financial consulting agency. When measured that way, kids in care don’t do relatively bad, but is that really good enough? Given the pompous rhetoric of Social Work making life better it’s not good enough. Given the amounts of money spent on Social Work it’s not good enough. Given the fact equality should a central value of any society it’s not good enough. That young people in care do as well as some of their peers in marginalized communities shows there is something much deeper wrong, both with our society and with our care system and it is something that starts long before the young person gets anywhere close to 18.

Here’s the rub, Social Work is treating symptoms, and doing so badly. We need to start treating the root causes, the root causes of the social exclusion and poverty that drives of many of our referrals and their negative outcomes. That is a challenge that is perhaps beyond the scope of the individual Social Worker, drowned as they are under deadlines, caseloads, court reports and case notes. However there are avenues for collective action in social work, our union, the Irish Association of Social Care Workers and their Children and Families special interest group. Of course, outside of social work there are even more ways to engage with the political system and to work for social change, but who has the energy for that after a long day in the trenches?

All The Stuff You Might Have Missed!

February 7, 2012

I have (finally) updated the Archive page – https://fullcareorder.wordpress.com/archive-index/

Since my article was picked up by the Guardian Social Care Network Blog I picked up one or two extra followers but I haven’t had much time to write new articles yet. figured an easy link to my previous work might keep you all interested until I get some new content up.

Thanks for the interest in this blog, there are quite a few things I want to get off my chest so more posts will be coming, plus as I read back through the stuff I wrote early on I see there are several promises of work that I have not lived up to!

I am tempted to indulge myself with observations about the art of blog publishing but that would be truly off topic, so I will just thank you all for reading the blog and for your patience while waiting for updates, which will be coming very soon!

Access, family contact, and some ultimate truths about social work

January 4, 2012

Access.

Access is an ordeal for all involved and can be one of the most overtly confrontational parts of the job. Like court, depending on your cases it can be a little or a lot, but there will ALWAYS be access somewhere along the line. Access is a horrible legal word for contact between parents and their children in care. While it should be called contact or something a little more human (without going so far as something patronizing like “family time”), changing the name does very little to change the process of what happens.

Access take many shapes and forms depending on the particulars of each case, differing in how often, how long, where it happens, if its supervised by a social worker or not. Who attends access can also vary, it can be both parents together or only one parent, sometimes with wider family, sometimes just siblings and no parents. All these factors are dictated by the individual needs of each case.  Beyond this the local social work set up can influence it. Some areas are blessed with excellent facilities, others are not and this can mean seeing your child in a private house designed for access or seeing your child in a small pokey room with bad lighting and full of broken toys.

While I describe it above as an ordeal, it can have its positive moments. Young children playing, smiling, laughing and sharing that joy are a wonderful thing to see. An infant’s smile will melt the coldest of hearts. Watching positive interaction between parents and children, watching kids simply have fun is heart warming. Although it is rare, seeing parents improving in their interaction and parenting can make the job feel worthwhile (its just a pity its so rare).

However, these positives are temporary. Even the best access is ultimately bitter sweet, and the dark side is always there.

For an access to be good it has to happen, and happen on time. However, given the chaotic lifestyle of some parents that we deal with even getting to the access can be a challenge. Regularly kids will be stood up by parents and left waiting and wondering why. In cases like this no access can be less harmful than inconsistent access. The emotional upheaval caused by been ignored and abandoned by parents can be carried into the rest of the kids life, and any acting out behavior, unless properly understood and managed, can cause trouble in school, in placement or in other relationships. It can be just as bad when chaotic parents do show up, and show up drunk or stoned or picking fights with each other, or with the foster parents and social workers, or even with the child themselves. This is why some accesses end up supervised, cut back or even cancelled all together.

Few things cause as much confrontation as access, the frequency, the location, the supervision. When a case is at the height of tension in the courts, this tension spills out in the access room. Parents use access to undermine the foster carers or the residential unit, trying to keep the child theirs and loyal to their family. However this can confuse and upset children and ultimately undermine placements, putting a child at more risk. Yet, when this is pointed out and you ask parents to stop it can be the start of another argument and one more reason to hate the social workers. On more occasions than I have had hot dinners, I have spent an entire access reminding parents that this is their time with their kids and that they can discuss the case with me after the access. I have been screamed at for not letting drunk parents see their child when to do so would be traumatic for the child. I understand this anger though and the pain behind it, as I said at the start access is an ordeal for everyone. While getting threatened or assaulted by an angry parents can be bad, I have no doubt it is little compared to the pain of losing a child to the state.

Even the best access is somewhat artificial, being removed from the natural relationship sand interactions of children and parents. This is thrown into sharp relief when the access is supervised, imagine having a stranger sitting constantly in the corner of your living room as you try and play with your kids. One client told me she wanted to stop coming to access as she felt like a monkey in the zoo, being watched the whole time. While I understand her discomfort given her tendency to show up drunk or to upset the child there was no way it would be unsupervised! The most artificial part of it all is the temporary nature of it all, every access has to end. As the children leave and go to a different home, the reality of the situation slaps you, the child and the parents in the face. Yes, these children are in care for a reason, to protect their safety and welfare, but just because you do the right thing doesn’t make it easy or pain free.

This piece was born as I spent the run up to the holidays squeezing in the Christmas access for all my families, the last access before Christmas, when gifts are exchanged and a party is sometimes had. The Christmas spirit simply exaggerates everything, making the good better, the bad worse, and the sadness that normally drips from access even more poignant. Access can be an ordeal, but Christmas access is worse.

It’s not so much the access itself that gets me down, that is so torturous, or that had ideas spinning around my head, it’s what lies behind it, the deeper and more obscure issues that are given passing solidity in the access room.

The aim of social work services is too protect children and to promote their safety, welfare and well being. It is widely acknowledged that this is best done in the child’s own family and care is a last resort. But care still happens, you work with a family and you help the parents as best you can and sometimes that’s not enough. When a child comes into care they continue to be provided with as much supports and services as the budget will allow. But it can be a very different story for the parents, who are as traumatized and hurt and confused as the child by the process of care, but with none of the supports. Despite their faults and their failings, these parents are no less deserving of respect and dignity; many of them are themselves a product of the sort of trauma and neglect that they have created. Their pain at losing their children is very real. However, these are child protection and welfare services, and the services follow the child, and when the child leaves the home the support for the parents can leave too. We are child protection services and we are right to consider the child’s needs as paramount, but just because you do the right thing doesn’t make it pain free.

This in turn highlights two other fundamental issues in child protection, both of which deserve deeper exploration and constant reflection. These are nuggets of ultimate truth that float around in my head, never quite revealing themselves completely, so be warned I may get a bit wooly here.  Firstly, there are no good decisions in social work. There are clearly better decisions, or perhaps less bad decisions, but they always come with risks and a human cost, and they can leave scars that may never heal. It is often choosing what course of action will cause the least harm becuase none is without harm – choosing to seek to take a child into care or not is perhaps the most obvious. Secondly, we can’t fix people. We are not mechanical machines that can be repaired; we carry our emotional wounds with us for life. Sometimes we learn to live with them and thrive regardless, other times they drag us down and we recreate the chaos and hurt that caused them in the first place. The corollary of this truth is that prevention and early intervention are vital, yet when all we have are reactive services that are so drowned in referrals and so deprived of resources can you expect anything apart from fire fighting?

Schrödinger’s Cat, Pandora’s Box and the Duty Social Worker….

December 1, 2011

I started this blog to give insights into the world of social work. While a lot of the time it is a place for me to vent, I do want to try and share the job with those not familiar with it,  share how it feels to be on the coal face of child protection. Having looked at a day in court already, I felt it might be interesting to share that first home visit to a new referral.

The office receives referrals from a variety of sources, phone calls from schools or concerned relatives, Garda Notifications, faxes of standardized forms a youth projects has pulled from Children First. Each one needs to be followed up at least in some way. While some can be dealt with on first sight, and hopefully closed or passed to another area, some do need a greater response, including  if appropriate, an unannounced home visit, calling to the house and knocking on that door with no prior appointment.

Social work predominantly deals with families at the lower end of the socioeconomic scale, dealing with neglect, alcohol abuse and drug use. Invariably as the social worker you find yourself standing outside a house or a flat owned by the local council, in a rundown deprived area. The street is well known to the office, half the street has been referred in at one point or another, usually more neglect, drugs, and alcohol. This is the real presence of poverty and social exclusion. Often the house will be unkempt, with what passes for a garden overgrown with weeds and rubbish. Discarded bags, cans, washing machines, even broken down cars littering the front. Not every house in the neighborhood will be like this, some will be but not all. Nevertheless, the house you have received concerns about probably is.

You stand there, a fish out of water, because while the client list is dominated by the lower end, the staff list is very much from the middle of the socioeconomic scale. This is not a criticism, it’s just a fact. Some social workers deal with this better than others, some handle it so bad you wonder how the hell they can continue to be a social worker if that are so disgusted by the reality of our clients’ lives. There are enough other things to fuel your anxiety though. The uncertainty of what you’re going to find on the other side of the door. Will they be strung out, or aggressive, or violent? Will there be a child at immediate risk and in need of a section 12? On top of all this weighs your statutory responsibility, and the defensive practice that goes with it; will this a family you will be talking about in front of some future inquiry into social work failures? Again some deal with this better than others, some are so used to working in this mix that it becomes normal and seeps into the rest of your life, others an anxious wreck every home visit. Depending on your confidence in your own skills, standing there on the doorstep is when you most question yourself as a practitioner and ability to get the job done.

As you ring that door bell one of two things can happen. First is nothing. This is the Schrödinger’s cat moment. Sure you can get the hell out of there, you have a one line case note (Home Visit – No Answer at door) and you leave it for the next duty worker. However, this is when the anxiety steps up. What IS on the other side of that door, is it a baby at immediate risk? Is it a child home alone? Is it a mother too wasted to answer the door? You can’t know until that door opens, and until it opens anything is possible. The second thing is the door could open, and the social worker lifts the lid on Pandora’s box to have a look inside…..

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