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Expert’s Corner: Terence Simmons on evidence based assessments

Terence Simmons, independent social worker, trainer and quality assurance consultant at WillisPalmer says, “it is unethical not to use evidence based practice when deciding if a child should be removed from home”. 

“Children come to the attention of local authorities because somebody somewhere wanted to alert child protection services about a child being potentially in need. It is the task of children’s services to see if that child needs a service or protection,” said Terence Simmons, Independent Social Worker and expert in evidence-based assessments. “The determination of whether there is a need should be based on evidence that suggests an identified need exists balanced against other evidence that may suggest there is no reason for the local authority to be concerned.” As such, evidence-based practice should be integral to children’s services, Terence asserts.

Terence, who has worked in child protection throughout his career, said that the ongoing nature of working with children that follows should all be evidence based from the initial assessment through to continually re-assessing the child’s needs and ensuring the interventions are appropriate for the child at that time.

“You cannot just go with your gut instinct, it may well be accurate, but best guessing is not good enough when you are deciding whether a child should be allowed to live at home with their family or removed from them. It is unethical not to argue your case based on the evidence before you,” said Terence.

Social workers need to be able to sift through what is important

“Evidence based assessments should be second nature to social workers working with children and their families. They are a combination of informing oneself about culture and how different cultures view the parenting task, gathering evidence from as wide a variety of sources as possible, understanding personal biases and applying well-researched knowledge or theories that are clearly understood by the practitioner,” says Terence, whose own specialist area of knowledge is attachment theory.

“You need to be able to evaluate your own clinical and professional experience in a way that can be used across situations. You need to be able to identify whether patterns of behaviour are repeated, evaluate the evidence before you and rationally decide - and be able to argue - what is important in the case and what is peripheral to the debate. Social workers need the ability to sift out what is important to the question that needs to be answered which, in parenting assessments, tends to be ‘is the parenting I observe adequate to meet the needs of these children?’” he added.

In child protection social work, Terence says that all parenting assessment should be evidence based.  He explains: “If you need to make decisions about the application of services, whether to institute proceedings, or how resources should be used, you need an evidence base from which to make those decisions.”

“In children’s services the big question is can these children live with these parents? To answer it, and avoid a tough time during cross-examination, practitioners need to be able to provide evidence to support their point of view which will assist the court with determining what the facts of the matter are,” he adds.

Research is not the whole story

Terence currently works as an independent social worker, consultant, trainer and mentor. As an ISW he is often called as an expert in the field. Terence says: “In parenting assessments, there is the parents’ view, the local authority’s view, the guardian’s view, other professionals’ views and you have to say ‘out of all these explanations, this is the view I favour and these are the reasons why’”.

While he reads a lot of current thinking, Terence says he shies away from quoting research in his assessments and advises practitioners not to rely too heavily on research alone – “often, it only relies on statistical probability and, while important, it is not the whole story”. And, for every piece of research in support of a proposition, there is likely to be another that presents a contrary view. That is, research is only a partial answer.

He explains: “For example, if you only apply Attachment Theory, you are likely to think that all problems come from a poor attachment but that may not be the case. There may have been family difficulties, trauma or illness that are more causal in a child’s current presentation; assumptions can be dangerous.”

Indeed, he adds, problems don’t always reside in the individual. For example, if a family moves 15 times, it is easy to assume that they have difficulty paying the rent and spend the money on other things.  However, it could be that the family has been in a series of short-hold tenancies and the landlords wanted the properties back each time. “While investigating these problems you need to look at how many of the difficulties are situational and how many are the fault of the family.” In this respect the Framework for the Assessment of Families provides a valuable resource, directing social workers to balance information from a wide number of sources.

In what area would I like to become an expert?

Terence explains that during assessments, he tends to concentrate on the relationships that children have with their parents and between adult partners to see if there are any repetitive patterns such as relationships forming and breaking down in the same way. He will also carry out some background research into their culture and beliefs and compare what they say about themselves with their known history to see if they are “congruent”.

Instead of being overly-reliant on theory, Terence believes the most valuable information comes from seeing how people interact with their children and the professional’s ability to analyse the observed parenting is “critical”. Terence uses the Parent/Child Game to enable him to analyse parental interaction and decide if there are any areas of concern, although he points out there are other models that practitioners can use.

In Terence’s opinion: “The best practitioners develop a real insight into a few core skills in understanding how people behave in relationships, particularly with their children. I’ve concentrated on attachment theory which lends itself to understanding trans-generational patterns of parent/child interaction and when used with the Parent/Child Game gives me a method of observing that I can score and use to provide additional evidence to support an attachment-based explanation” said Terence.

“There are a large number of ways of looking at human behaviour and it is impossible to learn all of them. It is therefore important that practitioners develop a range of skills at which they become well-versed so that they can argue from a specific perspective,” he explains. “I always say to NQSWs ‘invest in your own future and think in what area would I like to become an expert.’ Inexperienced social workers who have come straight from education with little practice experience will have not yet developed a framework of understanding people and relationships and without a solid theoretical base are almost guessing what the problem is and what the intervention should be.  Terence adds that evidence based practice “inevitably” comes with experience, but needs to be fine-tuned by setting experience in a theoretical framework.

Defending yourself

Terence says that social workers have to be able to defend themselves and following any high-profile case where a child is badly injured or killed, new policies and procedures are introduced to protect children, the social work profession and the government. This can be effective but only if followed rigorously.

“The problem for me is that social workers are under such pressure with high caseloads that it is quite easy for things to lose their rigour,” said Terence. “To defend yourself, in situations where tragedies occur, such as Baby P, you need to be able to say ‘I followed the procedures rigorously and within that statutory framework I was formulating my view of the problem and analysis of what needed to be done based on balancing the evidence’”.

He says you also need to keep an open mind to avoid the pitfalls of deciding too early what the nature of the problem is.  “Once that has happened it creates the problem of what to do with evidence that contradicts it,” Terence says. “Ignoring the evidence would be unethical and unfair and practitioners have to develop the skill of balancing the pros and the cons so that they can convincingly argue why their understanding of the meaning behind what they see is the one to be preferred in a situation of competing views about the same events.

Becoming an expert in evidence-based practice takes time, effort and good quality supervision, says Terence. While initially sceptical about the ‘Reclaiming Social Work’ model, Terence says he is impressed by their focus on supervision, especially in one London Borough, where they employed psychologists to lead supervision sessions for social workers “to lift supervision from line management and into the hands of professionals with clearly formed theories”.

“You need to have a system, make sure you have heard from everyone you need to hear from and received reports from all the necessary parties. You then need to organise all your evidence into a logical, well-researched argument that applies a theoretical framework, backed by third party evidence and ensure that you’ve taken into account all the available evidence,” Terence summarises.

Finally, Terence says it is also vital for practitioners to use professional journals, the internet and other sources of information to keep abreast of developments in research, thinking and social policy. Being able to write clearly and set out their thoughts concisely in a logical order is also crucial, he concludes

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