Safeguarding in Treatment Services:Everybody’s Business

Adfam, DDN, CRI, Indivior-Birmingham November 2015

‘Healthy Scepticism’ – What lies Beneath assessment

Joy Barlow MBE Independent Consultant

Formerly Head of STRADA

“ About suffering they were never wrong, the Old Masters; how well they understood its human position; how it takes place while someone else is eating or opening a window or just walking dully along;

“How everything turns away quite leisurely from the disaster” (W.H.Auden – “Musee des Beaux Arts”)

Summary of Presentation • Assessment • The Challenge of engagement • Risk• Partnership• Implications for Recovery• Parenting capacity and problem substance use• Conclusions

DefinitionsAssessment:

‘The act of judging or deciding the amount, value, quality, or importance of something, or the judgement or decision that is made.’

Scepticism

‘doubt as to the truth of something’

Cartesian Scepticism:

‘Certain knowledge is impossible’

Assessment• What – wider than drug/alcohol misuse – strengths based – used as an

intervention

• Why – determine risk; nature of intervention

• When – single agency; multi-agency

• By whom – universal and specialist services

• How? - interagency

• Incorporate “respectful uncertainty” and “compassion” with “sustained and dogged professional challenge… rigorous, systematic thinking and analysis.” (Brandon, 2007-9)

• Demonstrating empathy and acceptance are important but this needs to be balanced with healthy dose of scepticism. (C4EO)

• Information of various kinds is:

• Collected• Sifted• Synthesised• Analysed

• Informed by “respectful uncertainty and a • research mentality” – (Milner & O’Byrne 1998) • In turn harnessed to a clear value base

(Milner and O’Byrne 1998)

“Practitioners need to find the middle ground and not be either collusive or confrontational.” (C4EO)

Research has identified an ‘adversarial dynamic’ in which both practitioner and family avoid acceptance of responsibility for lack of change and blame each other for the failure. This results in denial, resistance and blame and a professional view of families who either ‘co-operate’ or ‘resist’. (Morrison, in Horwath, 2010)

The Challenge of Engagement

Unresponsiveness to treatment/Disguised Compliance

The Challenge of engagement • Consider the interaction between numerous factors, such as: • Present context, including additional stress factors • Past history – early experience of parenting and attachment, internal working

models (unconscious)• Beliefs (conscious)• Needs, especially emotional and psychological needs, feelings and desires. • Stressors and supports, including the quality of the relationship with the

worker• Expectations• Abilities (physical and cognitive)

What do we mean by risk? • Physical • Emotional• One off events• Cumulative events • Insipient concerns• Significant?

Management of Risk • Interventions – evidence based and methodologically sound• Ownership by ‘systems’• Understanding of common thresholds of vulnerability• Action after assessment• Partnership with parents – what does this mean?• Assessment – thresholds, integrated, timeous and on-going

DefinitionsPartnership to be one of a pair on the same side of a game. A person who shares or takes part with another, especially in a business firm with shared risks and profits.

Collaboration – cooperate traitorously with an enemy, work jointly.Concise Oxford Dictionary 1992

Effective partnership working requires…“respect, genuineness, empathy, humility, quiet enthusiasm, personal integrity, attunement and technical knowledge.” RiP 2010

“Then you should say what you mean”, the March Hare went on. “I do” Alice hastily replied, “at least…at least I mean what I say – that’s the same thing you know”.

(Lewis Carroll(1885) ‘Alice in wonderland’ chp.7) Quoted by Reder & Duncan(2003) ‘Understanding Communication in Child Protection Networks’ Child Abuse ReviewVol.12

Implications for/of the Recovery Agenda• Individualised, personalised respectful approach/treatment delivery• Hearing the voice of the person involved• Identifying signs of change in an individual as opportunity for

intervention• Assertive engagement with the ambivalent/long term support of

those ‘in recovery’• Quality of therapeutic engagement• Quality of assessment – change and advice• Family and the ‘recovery’ community!

Gendered Recovery

‘When sorrows come, they come notsingle spies, but in battalions’

Claudius in ‘Hamlet’ Act IV. Sc.V William Shakespeare

Conclusions• It’s about people:

• Practice dilemmas• Reflection on and in practice• Communication• Over optimism• ‘the long haul’

Thank you and Acknowledgements