Trevor Spatt Br J Soc Work-2009-Spratt-435-50

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Identifying Families with MultipleProblems: Possible Responses from Child

and Family Social Work to Current PolicyDevelopments

Trevor Spratt

Dr Trevor Spratt is Director of the Batchelor of Social Work (Relevant Graduate Route) and a

Senior Lecturer in Social Work at the School of Sociology, Social Policy and Social Work at

Queens University, Belfast.

Correspondence to Dr Trevor Spratt, School of Sociology, Social Policy and SocialWork, Queens University Belfast, 6 College Park, Belfast BT7 1LP, Northern Ireland.Email: [email protected]

Summary

In the development of family policy under New Labour there has been a growing ten-

dency to identify groups who are likely to be high in lifetime costs to the state. Invest-

ment in such groups is seen as crucial. Whilst the economic case for current investment is

compelling, idenitiying one of these groups, families with multiple problems raises

complex research problems and ethical issues. Reseach indicates that families with mul-

tiple problems may be identified on the caseloads of child and family social worker and

there are claims that key events such as the registration of a child on the child protection

register may indicate such multiple problems. This offers new opportunities for child and

family social work to embrace less incident based ways of working in favour of longer

term provision of services to address longer term risks.

Keywords: child welfare, social policy, child protection, investment state

Introduction

In the ten-year span of the New Labour Government, social policy with

respect to children and families has moved beyond an initial concern withmodernization and efficiency to establishing a much more ambitious setof goals which co-join social and economic agendas in a future-orientatedinvestment strategy, informed by social science research and economic

# The Author 2008. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.

British Journal of Social Work (2009) 39, 435450doi:10.1093/bjsw/bcm150Advance Access publication February 22, 2008

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theory (Lister, 2003). In identifying sub-populations who are predictedto be high in social and economic costs and low in the production ofsocial and economic capital, the tone of the debate surrounding thesocially excluded has shifted from one of intervention as moral good to

economic imperative (Skinner, 2003). The philosophical antecedents tothis shift may be found in the work of the social and economic theorist,Anthony Giddens (1998). His Third Way thesis, wherein requirementsfor economic growth and social protection might be developed within anew set of relations between government and citizenry, has more recentlyreceived new impetus via developments in social science research and ineconomics which have made the future more calculable.

Current developments in New Labour social policy are concerned withthe identification of high-cost and low-productivity populations, targeting

these with a series of investment strategies which co-join social andeconomic goals within a fiscalized social policy (Bashevkin, 2000,p. 2). In line with the Third Way principle of no rights without respon-sibilities (Giddens, 1998, p. 65), such investment strategies are character-ized by both incentivized and punitive interventions. This has heraldeda new kind of interest in the population receiving the attentions ofchild-care social workers. Where once the governing concern was forsocial workers to differentiate between a minority of actual and potentialchild abusers (wherein the key task was to protect children from abuse)

and the majority of families who required some form of support (whereinterventions were designed to be helpful but often had nebulous goals),harm to children is now located as much in the future as it is in thepresent and is diffused over a greater range of signifiers (James andJames, 2004).

In relocating the risks with regard to children away from narrowconcerns to prevent the occurrence or reoccurrence of abuse, and withina more sophisticated appreciation of how the experience of presentproblems may be associated with poor outcomes across a number ofdomains in later life, the social policing function of social workers(which grew out of and was sustained by concerns on the part of thepublic to manage the phenomenon of child abuse) becomes subsumedwithin new priorities to strategically invest in children and families. Thisraises a number of questions, among them: Where are social workerslocated within strategies to invest in children and families? How wellplaced are social workers to manage both present child protection priori-ties and future-orientated investment strategies? The answers to thesetwo questions provide some speculative indication as to whether or notchild and family social work will collapse into a narrow residual niche

concerned with the management of child abuse or become part of amuch wider inter-professional enterprise identifying high-cost/low-productivity populations, providing intervention and tracking outcomesover time and across domains.

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The social investment state

A number of social work academics have located current social policy withrespect to children and families within the theoretical framework of the

social investment state (Fawcett et al., 2004; Featherstone, 2006; Parton,2006). Derived from a term used by Anthony Giddens, it refers to invest-ment in human capitalwherever possible, rather than the direct provision ofeconomic maintenance. In place of the welfare state, we should put in the social investment state, operating in the context of positive welfaresociety (Giddens, 1998, p.117). At its heart, it represents a linkage ofsocial and economic projects (Featherstone, 2006), signalling a shift frominvestment in the demand side of the economy (a key feature of Keynesianeconomics) to the supply side. This involves creating a workforce ready for

participation in a global economy characterized by fluctuating markets,rapid relocation of capital and demand for workers prepared and able toadapt to changing conditions and requirements (Jenson and Saint-Martin,2002). With the state unable to control the global economy, the best itcan do for its citizens is to prepare them for participation in the global mar-ketplace. Whilst the old welfare state sought to protect people from themarket, a social investment state seeks to facilitate the integration ofpeople into the market (Fawcett et al., 2004, p. 41).

In the Third Way, the task of the state is to prepare people for the market

as well as protecting them from its vagaries. Social and economic policyconsequently becomes co-joined in a symbiotic relationship of co-dependency. As a recent Irish Government publication put it, several ofthe major improvements in social protection now required to addresspeoples needs more effectively will prove to be economic assets and con-tribute directly to reinventing the economy; for example, ending childpoverty, stemming educational disadvantage, tackling social exclusion. . ..In fact, the boundaries between traditionally separate economic andsocial policy domains have become increasingly blurred (National Econ-omic and Social Council, 2005, p. xiv). Central to this strategy is a realign-ment of the relationship between the state and its citizens, reflecting,especially in the UK context, no rights without responsibilities(Giddens, 1998, p. 65). Within this notion of conditional entitlement isthe idea that citizens need to be proactive in seeking employment, withthe role of government being to help build economic and social capitalthrough a series of investment strategies, whilst reducing the welfare func-tions of the state from the meeting of needs to the more limited manage-ment of risks (Giddens, 1994). This is achieved through paralleldevelopments in economic and social policy, such as changes to the tax

and benefits systems, designed to make work pay whilst ensuring thatcitizens receive lifelong education and training opportunities to enhancetheir employability in a changing marketplace (Jones-Finer, 2004).

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Within the social investment state model, it is recognized that somegroups are restricted in their ability to utilize economic and social opportu-nities. Consequently, much of New Labour policy has concentrated on par-ticular investments in socially excluded populations. These range from

general support for all parents with children, through changes in the taxand benefits system, specific and targeted help for poorer families toenable their participation in the labour market and special initiatives tar-geted at disadvantaged children who are at particular risk of social exclu-sion (Lister, 2003). This last group of children have been in receipt of anumber of community-based service initiatives designed to offer particularhelp at different stages of their development. The Sure Start programme isdesigned to offer extra help to children prior to them starting school, theChildrens Fund is targeted at specific initiatives to help children in the

five-to-thirteen age range and Youth Connexions helps with the transitionfrom education to work (Millar and Ridge, 2002). The targeting of suchservices to communities most at risk of social exclusion is in line withKamermans (2005) observation that the issues tend to be framed associal and community exclusion. Whilst those who live in such communitiesmay derive benefit from targeted service provision, Buchanan (2007, p. 200)has cautioned that We need to remember that many disadvantagedfamilies are just beyond the reach of zoned areas and have limitedaccess to new services. Consequently, there is a need to develop new

ways of identifying those families not captured by community-based initiat-ives, often involving a refocusing of existing services to recognize constella-tions of problems in families already known to a range of service providers(Axford and Little, 2006).

These developments reflect a recognition of the consequences of socialexclusion for children including poor educational attainment, poor health,increased risk of criminal behaviour, increased risk of unemployment inthe future, and economic deprivation (Mason et al., 2005, p. 132). AsEsping-Anderson (2003) has noted, such investments are central to a strat-egy of increasing concentration on targeting investment on children, withtheir early years seen as particularly important. In a model shaped asmuch by economic as social considerations, return on investment iscrucial to the calculation, as investments made in the present may only berealized in the future (Jensen and Saint-Martin, 2001). Whilst the notionof investment in children is not new (Hendrick, 1994), in modern times, ithas acquired a more central place in social policy. Holtermann identifiesthe essential duality of such policy, designed to produce mutual benefits.Todays children . . . are tomorrows adults, and investment in our childrenis an investment in our future as well as theirs. Investment in children will

determine the shape of Britains future society and economy (Holtermann,1996, pp. 4, 9). Children, who are most malleable and possess longer poten-tial futures, consequently become the primary investment site, as thebenefits of investment are repaid over an extended time in economic

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productivity and reduction in cost to society through decreased demands onservices, including health, social security and criminal justice (Kurtz, 2003).Consequently, identifying which children need extra help becomes animperative. This is not simply because such children will need extra invest-

ment to become productive workers of the future, but more negatively, toprevent them becoming citizens who disproportionately demand much ofthe future share of service provision.

In New Labour rhetoric, there has been a diminution on the privileging ofparticular family forms and concentration on the task of parenting as key toinvestment strategy (Fawcett et al., 2004). However, Daniel et al. (2005)note that the contexts in which contemporary parenting is carried outand the differing positions of mothers and fathers which can render theuse of gender term such as parent problematic (Daniel et al., 2005,

p. 1344). Key to such differences is positioning within the labour market,where women are expected to be in paid employment despite dispropor-tional child-care responsibilities (Featherstone, 2006). The tendency towrap up issues of gender, ethnicity (Doherty et al., 2003) and other differ-entiating features in the broad sweep of policy has the effect of neutralizingthese within a discourse that privileges the identification of sub-populationsexperiencing multiple problems.

Recent policy developments have made it clear that there must be prior-itization of service provision through a process of differentiation of particu-

larly problematic sub-populations and targeting these for specialintervention (Blair, 2006). The Government, as elaborated in the EveryChild Matters (Department for Education and Skills, 2003) agenda, envi-sage a three-tier system of service delivery, with universal services suchas health visiting and early years services located at a universal level; tar-geted services for families with identified needs (for example, help withspeech and language) and more complex problems (for example, parentingsupport) at an intermediate level; and specialist services (for example,social services for children at high risk) located at level three (Departmentfor Education and Skills, 2003). The Government has also identifiedLooked After Children, children with disabilities and families with multipleproblems as sub-populations requiring specialist interventions by the state(HM Treasury and Department for Education and Skills, 2007). It is the lastgroup which is of particular interest here.

Identifying families with multiple problems

In the recently published Policy Review of Children and Young People: A

Discussion Paper (HM Treasury and Department for Education andSkills, 2007), a number of risk factors experienced in childhood and associ-ated with poor adult outcomes are identified. These include: low income,low attainment, poor social and emotional skills, poor parenting, low



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birth weight, poor parental mental health and living in a deprived neigh-bourhood. Whilst universal services and targeted services are designed toaddress the needs of populations who require both general and specificinterventions to promote positive outcomes for their children, such preven-

tative measures are inadequate in addressing the needs of children atgreater risk. For these children, it is not the particular combinations of indi-cators that are predictive of poor outcomes, but the number of indicatorspresent. Using findings from the UK Birth Cohort Study, Feinstein andSabates (2006, p. ii) found that For higher levels of adult deprivation . . .the probabilities of experiencing 10 or more of the 32 [negative] outcomesare 1% for the low risk group, 12% on average and 51% of the high riskgroup [the 5% most at risk]. This highlights the very strong relationshipbetween high childhood risk and multiple adult deprivation. Feinstein

and Sabates (2006) estimate that 5,000 families in the UK experienceseven or more problems, with some 140,000 experiencing five or more(Cabinet Office Social Exclusion Taskforce, 2007).

Systems to locate such families have not yet been developed. As Hughesand Fielding (2006) have noted in relation to the evaluation of the Chil-drens Fund, mapping of need typically relied on data collected for otherpurposes and thus the development of proxies for identifying riskamongst populations . . . such data is invariably conflated to produceindices of need based upon multiple indicators purported to illustrate

those most at risk (Hughes and Fielding, 2006, p. 84). Whilst programmessuch as SureStart have relied on aggregated data at locality level to identifythose communities most in need, such methods do not capture families andchildren with similar needs who do not reside in such communities(National Evaluation of SureStart, 2004). To identify families with multipleproblems, risk factors must be identified from other sources. As Hansenand Plewis (2004) observe, the reasoning behind the adoption of an atrisk approach is that it is possible to identify a group who are clearly atrisk (Hansen and Plewis, 2004, p. 24), whilst acknowledging that from apolicy perspective it is important to pinpoint those children most at risk.They note that determining specific risk factors is extremely difficultbecause negative outcomes are the end product of the complex relationshipbetween a large number of inter-related factors [including resilience](Hansen and Plewis, 2004, p. 18).

Claims have, however, been made by some social work professionals thatthey can predict which families on current caseloads will suffer poor futureoutcomes with reference to their experience of key events. These includethe exclusion of a child from school, the initiation of child protection orcare proceedings, involvement of a young person with the criminal justice

system or in persistent anti-social behaviour and the registration of a childon the child protection register (HM Treasury and Department forEducation and Skills, 2007, p. 80). Such claims are given some credence byretrospective studies which examine adult populations with poor social

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and economic outcomes and which seek to identify common experiences inearly life which may be associated with these (Buchanan and Hudson, 2000).

Farrington and Welsh (2007) identify five family characteristics as beingassociated with adult offending behaviour. These are: criminal or antisocial

parents; large family size; child-rearing methods which include poor super-vision, poor discipline, coldness and rejection; experience of family disrup-tion; and experience of child abuse or neglect. In relation to the finalcharacteristic, Farrington (2007) cites the work of Maxfield and Widom(1996), who used court records in Indianapolis to identify more than 900children abused or neglected before the age of eleven. Compared with acontrol group matched on all characteristics except the experience ofabuse or neglect, over a twenty-year period, the children who had experi-enced abuse were more likely than the controls to be arrested in adoles-

cence and in adulthood.Links between experience of childhood maltreatment and welfare depen-dency in later life have been found by researchers. For example, Derr andTaylor (2004) conducted research into the childhood experiences of 280women who had been in receipt of welfare benefits for three years ormore. They found that two-thirds of these women had experienced physical,sexual or emotional abuse in childhood, with a majority of this group (70per cent) experiencing more than one type of abuse. The researchers specu-late that being in long-term receipt of welfare benefits may be a conse-

quence of experience of abuse in childhood.The work of Felitti and his colleagues (1998) has established an associ-ation between adverse childhood experiences and adult morbidity and mor-tality. The links between risky health behaviours and damaging lifestylechoices (for example, smoking, poor diet, etc.) leading to poor health andearly death being understood, the researchers set out to examine thefactors associated with such behaviours. With a cohort of 13,494 patientsreferred to a Californian hospital, the researchers used a detailed question-naire to ascertain what adverse experiences subjects might have encoun-tered in childhood. Adverse Childhood Experiences (ACEs) werecategorized as follows: experience of physical, sexual or psychologicalabuse, violence perpetrated against the mother, living in a householdwhere there were substance abusers or mentally ill care-givers and havinga parent who had served a prison sentence. Data from the 9,508 respondentswere compared with their adult health records. The researchers found thatthere was a strong graded relationship between exposure to ACEs and thedevelopment of adult diseases, including heart disease, cancer and liverdiseaseconditions which are, in turn, associated with early death.

The co-joined social and economic case for prevention and early inter-

vention is based on a range of research similar to that cited above, associ-ating adverse circumstances encountered in childhood with a range ofpoor adult outcomes across a number of domains. These include crimi-nality, unemployment and poor physical and mental health. Whilst we do



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not know exactly which particular members of identified sub-populationswill go on to exhibit the health and lifestyle choices that become mediatedinto poor social and economic outcomes, targeting service provisiontowards such populations nevertheless represents sound economic invest-

ment. This is based on the assumption that provision of relativelylow-cost services may prevent some group members progressing to leadhigh-cost lives characterized by risky health behaviours and poor lifestylechoices.

How should intervention be targeted?

Arguing for greater use of risk-focused prevention of offending pro-

grammes, Farrington (2007) states that such programmes should beoffered at a level of intervention targeted at identified neighbourhoodsand not at individuals or families identified as being at particular risk. Oncurrent modelling by the Audit Commission (2004), provision of effectiveearly intervention to one in ten potential young offenders would save100 million per year. There is a strong economic case for providing inter-ventions which, although they may only influence outcomes for a minorityof participants, nonetheless remain cost-effective. For example, Feinsteinand Sabates (2006, p. 42), using the example of teenage pregnancy, estimate

that the social cost of a teenage pregnancy is 60,000 (comprising economic,social and educational hardship). Whilst the risk in the eligible population isonly 5 per cent, a programme of intervention (involving training teenagersin the realities of parenthood) delivered to the eligible population at a costof 1,000 per participant would only have to achieve an effectiveness rate of4 per cent to be cost-effective (the programme has an actual effectivenessrate of 80 per cent).

The calculations are somewhat different for those families at highest risk.Here, precise economic and social costs are more difficult to calculatebecause they are located across a number or domains. As the CabinetOffice Social Exclusion Task Force observe, The costs associated withpoor outcomes for children and families are difficult to estimate(Cabinet Office Social Exclusion Task Force, 2007, p. 6). We can,however, identify with some accuracy those populations who will be lowin economic productivity and high in social costs in adulthood. Feinsteinand Sabates observe that those with multiple deprivation in terms of 2 ormore of 5 outcomes at age 30 can be predicted in 87.1% of cases usingdata to age 10, with a false positive rate of 1.1% (Feinstein and Sabates,2006, p. ii). And, whilst the composite make-up of global costs are hard

to calculate (which individuals experiencing multiple problems in childhoodwill go on to criminal careers or to develop mental health or healthproblems and in what combinations is difficult to predict), we knowthat such costs will be very high. Heckmanthe Nobel Prize winning

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economisthas calculated that the universal provision of pre-schoollearning-enhancement programmes in the USA would generate cumulativenet benefits to society of over $400 billion (Heckman and Mastrov, 2004).

For those 140,000 families presenting five or more problems in the UK,

there is a strong economic case for early and high-cost investment toprevent the occurrence of predictable poor social and economic outcomes(high-cost in terms of service uptake and low economic productivity ascalculated by tax returns). The Government policy paper Building onProgress: Families provides a calculation of current service provisioncosts Families experiencing five or more disadvantages can cost thestate between 55,000 and 115,000 per yearbut is less specific withregard to future costs, noting, however, that The costs of failure are alsoborne by society more widely, for example through lost economic contri-

bution, poor health and the effects of anti-social behaviour and poorsocial cohesion (Cabinet Office, 2007, p. 46). The calculus for deciding atwhat level high-cost investment may be justified in economic terms can,of course, be reconfigured to include a greater number of families. Forexample, children in families experiencing four problems or more have a70 per cent risk of experiencing multiple disadvantages at age thirty(Cabinet Office Social Exclusion Task Force, 2007). Even with the inevita-ble increase in identification of false positives involved in lowering thetariff, the offer of services to the minority of families who will turn out

not to have needed them may be more than counterbalanced by the poten-tial return on investment in families whose children become low in futuresocial and economic costs and high in economic productivity.

Translations into policy

New Labour have indicated that they intend to begin the process of identi-fication and investment in families with multiple needs by an initial concen-tration on families within the Respect Agenda aimed at tackling anti-socialbehaviour. The then Prime Minister, Tony Blair, made this position clear ina speech to the Rowntree Foundation. Locating the boundary between thestate and the family, he said that he was not talking about . . . interferingwith normal family life. I am saying that where it is clear, as it very oftenis, at a young age, that children are at risk of being brought up in a dysfunc-tional home where there are multiple problems, say of drug abuse oroffending, then instead of waiting until the child goes off the rails, weshould act early enough, with the right help, support and disciplined frame-work for the family to prevent it. . .. You can detect and predict the children

and families likely to go wrong. The vast majority offered help, take it. . .

[However] about 2.5 per cent of every generation seem to be stuck in a life-time of disadvantage and amongst them are the excluded, the deeplyexcluded. . .. We have identified four groups [one of these is] families



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with complex problemsthe Respect Task Force identified 7,500 suchfamilies (Blair, 2006). The range of remedies suggested for such familiesblends those associated with family support initiatives, such as extensionof the provision of Childrens Centres and Extended Schools together

with designated Pathfinders, to delivery of integrated support packageswith more coercive strategies. Where there is non-compliance, the threatof sanctions or use of sanctions provides both a way of curbing bad beha-viour and also helps persuade people to accept and co-operate fully withoffers of support (Respect Task Force, 2006a). Such families are viewedas requiring assertive engagement, utilizing contract-based work agree-ments, with Parenting Orders designed to secure the co-operation of thenon-compliant.

Whilst the case for compulsory intervention in family life may, it could be

argued, be most readily achieved in a population already associated withthe criminal justice system, the recognition that the experience of multipleproblems may be expressed in ways other than by anti-social behaviour hasled the Government to indicate that they wish to broaden the net. In recog-nition that early prevention policies do not capture those families who arealready experiencing multiple problems, families caught in a cycle of lowachievement are identified as a small minority of families with multipleproblems leading to particularly harmful outcomes for the children in thefamily (HM Treasury and Department for Education and Skills, 2007,

p. 2). In a section entitled Rights and responsibilities of service users,the success of the Respect Action Plan in dealing with families resistantto intervention shows that activation/mutual obligation approachescan be successful in providing supports alongside strong incentives for theindividuals to follow programme requirements [such incentives include]. . . eviction, Anti-Social Behaviour Orders, or children being taken intocare [authors emphasis] (HM Treasury and Department for Educationand Skills, 2007, p. 87). The discussion paper goes on to extol the virtuesof linked support and enforcement services to create maximum effect.Effect is measured in terms of change in parental behaviours, which isseen as the key determinant in securing better outcomes for children. Inthis regard, traditional forms of family support are called into question:It is important to make clear that effective parenting programmes arenot the same thing as parenting support . . . schemes such as Home Startuses volunteers to befriend and support parents but does not improve par-enting skills and does not have measurable effects on childrens behaviour(Respect Task Force, 2006b).

Discussion

At its conclusion, the Policy Review of Children and Young People: A Dis-cussion Paper attempts to further differentiate the stock of families

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already regarded as high cost, high harm; those at high risk of moving intothis situation and those cycling in and out of this category, posing key ques-tions, including Who are these families? How can we define them and howmany of them are there, Can we better align services to improve identifi-

cation of these families earlier on and before they become high cost, highharm? and What is the appropriate balance between support and sanctionsfor these families? (HM Treasury and Department of Education and Skills,2007, p. 98).

In suggesting some tentative answers to these questions, it is useful todraw on some of the research evidence cited above. The answer to thefirst question is perhaps the most straightforward but raises complexethical issues. The research suggests that children from families who experi-ence a multiplicity of problems are likely to experience poor outcomes

across a range of domains in adulthood. This population suffer many ofthe general features of social exclusiona shorthand term for what canhappen when people or areas suffer from a combination of linked problemssuch as unemployment, poor skills, low incomes, poor housing, high crimeenvironments, bad health and family breakdown (Social Exclusion Unit,quoted in Levitas et al., 2007, p. 13). As noted above, it is not particularcombinations of difficulties, but the multiples of these which become pre-dictive of poor outcomes. With regard to how many such families thereare, this is a product of where the line is drawnessentially, a societal con-

struct. For example, we may identify some 5,000 families as experiencingseven or more problems or some 140,000 as experiencing five or more(Cabinet Office Social Exclusion Taskforce, 2007).

If we utilize retrospective research such as that carried out by Felitti andhis colleagues (1998) within the domain of health, we may isolate certainchildhood experiences which, in combinations of four, become highly pre-dicative of poor health outcomes in adult life. It is not known how manychildren there are in this population because data are not routinely col-lected on these indicators. The lower the multiples, the less predictivethey become of poor adult outcomes, but this does not necessarily under-mine the economic case for intervention, as lifetime costs are so high asto make it worth investing heavily in families, even where the increase infalse positives decreases the strike rate. The difficulty is essentiallyethical, as intensive interventions directed at multi-problem families willinevitably identify some families who may meet the target number of pro-blems but whose children will not go on to experience poor adult outcomes.This presents a number of hazards, including that some families may be stig-matized through the process of identification and selection and, conversely,as Feinstein and Sabates observe, where intervention is of a more positive

kind, involving the extra expenditure of resources, then those at risk andothers may experience or perceive a benefit from adding to risk ratherthan reducing it, in order to benefit from the additional resource (Feinsteinand Sabates, 2006, p. vii).



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With regard to the question of alignment of services to improve identifi-cation of multi-problem families, if this were to be premised on numbers ofproblems experienced rather than on particular flags of concern, then thenew technologies of the Common Assessment Framework and the Identifi-

cation, Referral and Tracking system (Department for Education andSkills, 2003) might be adapted to offer the prospect of more systematic col-lection and collation of data to identify families with multiple problemsbefore these become expressed as a crisis in functioning. It is unlikely,however, that simple multiples, whilst offering the most empirically vali-dated predictive indicator, will be sufficient to suggest intervention in allcases. In particular, we need to know more about how multiple problemsbecome translated into poor outcomes. In their Multi-Dimensional Analysisof Social Exclusion, Levitas et al. (2007, pp. 12 13) recommend that quali-

tative research work using in-depth interviews and life history techniquesbe undertaken with those groups at particular risk of social exclusion. . ..Such qualitative work should use biographical methods to explore theexperience of social exclusion and the nature and sequence of precipitatingevents and interventions that reduce or prevent exclusion.

There is indeed a clear need for such research, but even if it werecurrently available, it would pose a real challenge, in England andWales, for Local Children Safeguarding Boards to turn both quantitativeand qualitative research into protocols based on prediction, rather than

actual events for professionals to follow in tailoring interventions forfamilies. The key difficulty here is public intolerance in relation to verypoor outcomes triggered by events such as the abuse of a child (Butlerand Drakeford, 2003), but rather less public pressure to promotepresent interventions to prevent poor outcomes in the next generation.This can result in local responses becoming event-led rather thanresearch-driven.

This brings us to the final question, which resurrects what Parton refersto as the central dilemma for the liberal statehow to both protect chil-dren and protect the family from unnecessary intervention (Parton, 2006,p. 103). As we have observed in government rhetoric, there are deepambiguities involved in the approach to engaging families with multipleproblems. Indeed, it is likely that a new combination of carrot andstick (beyond that utilized in the Respect Agenda) will be developed.The suggestive nudge in relation to the threat to take children into carenoted above may indicate that an emphasis on the calculation of futuresignificant harm to children will become based on a refusal to accept ser-vices in which a multiplicity of problems are indicated. This begins tolocate the issues more firmly in the province of child and family social

work. Respondents to the Policy Review of Children and Young PeopleCall for Evidence 2006 (HM Treasury and Department for Educationand Skills, 2007) claimed that key events, including being involved inchild protection or care proceedings or the registration of a child on

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the child protection register, were potential indicators that these childrenwere at risk of experiencing poor outcomes in later life. Clearly, there is arequirement for further research into these populations to see if they, aswe might expect, feature multiple problems bequeathing intergenera-

tional outcomes. Certainly, the retrospective research referred to abovesuggests a strong association between the experience of abuse orneglect in childhood and poor outcomes in adult life across a range ofdomains.

However, it may be that the key events cited above are not the onlyproxies for the prediction of poor outcomes, as respondents have suggested.Research by the author into comparisons of categorization of familysupport and child protection cases (Spratt, 2000, 2001) suggested thatboth types of cases bore similar features and that there was an arbitrary

element in how families came to have their circumstances understoodand categorized by social workers. It might, therefore, be profitable toresearch the wider population of children in need who are in receipt ofsocial services to ascertain how many of these families have multiple pro-blems. There is some evidence to suggest that such families in 2001 com-pared with those in 1995 [are] a much needier group on a range ofindicators (Buchanan, 2007, p. 197, citing earlier work by Buchanan andRitchie, 2002). Whilst the larger proportions of children in such familiesare also looked after and/or have their names included on child protection

registers, there are some who may experience multiple problems; whilsttheir circumstances may not indicate present crisis, their predicted long-term outcomes remain poor.

Conclusion

The appliance of science to the population traditionally served by socialworkers provides new challenges to local authorities to measure harm toservice users over the life course rather than as indicated by key events.Whilst Every Child Matters (Department for Education and Skills, 2003)seeks to franchise the response of the state to family difficulties across arange of agencies, local authority social services are likely to remain cen-trally involved in the processes of identification, assessment, tracking andmanagement of cases. In response to such challenges, two possible pathsare indicated; in the manner of street-level bureaucrats (Lipsky, 1980),social workers may adapt their practices to further refine their skills inengaging a less than willing clientele through a subtle blend of care andcontrol techniques, in much the same way as families who attract pro-

fessional concerns are responded to outside the official child protectionsystem (Spratt, 2001; Spratt and Callan, 2004). Whilst such a responsewould address the issue of engagement, it would not address the morecomplex and central issue of provision of services to change the pattern



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of future outcomes. Alternatively, child and family social work could mod-erate its claims to protect children in the present and become more con-cerned with prevention of poor future outcomes. Paradoxically, thelessening of immediate pressures to do something might actually mean

that something is done, namely needs become assessed against futurerisks, leading to the provision of services. If this path were taken, socialworkers could then become like other professionals in education andpublic health, intervening to provide services to help realize futurebenefits. How local authority social services position themselves inrelation to these two choices will indicate whether or not social work asa profession has the confidence to base its modus operandi withinscience-informed investment strategies or prefers to default to social poli-cing. How families with multiple problems are currently recognized and

understood, together with the potential for services to meet their needs,is explored in a companion piece in this journal (Spratt and Devaney,2008).

Accepted: November 2007

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Documents

Trevor Spatt Br J Soc Work-2009-Spratt-435-50