JOURNAL ISSUE 9

2004/2005

 

 

RISK AND HUMAN BEHAVIOUR: ITS RELEVANCE TO SOCIAL WORK

A contribution to the Symposium on Social Work and Risk
for the Course Social Work Theories and Methodologies
Sonia Jackson & Thomas Coram Research Unit,
Institute of Education, University of London UK

Summary

 

            We live in an increasingly risk-aversive society and the study of risk in all its aspects has become a major field of study across many disciplines. There is much research to show that perception of risk may bear little relation to the actual likelihood of the feared event occurring but may still have an enormous influence on how people and organizations behave. In many different fields, such as work with offenders, mental health, and people with learning difficulties, policies are determined not by the needs of clients and service users, but by the overriding preoccupation with risk.

 

            Nowhere is this more evident than in social work with children and youth, and particularly in the field of child protection, where it has been shown repeatedly that the best means of reducing the incidence of child maltreatment is to provide generous and appropriate support for families. However in many countries, especially the UK and USA, the focus has been on investigation and reporting, resulting in large numbers of children being drawn into the substitute care system with its notoriously poor outcomes. This lecture suggests that a better understanding of risk-related behaviour could result in a more effective use of social work resources and a shift towards preventive policies.

 

 

            The study of risk and risk behaviour is an increasing preoccupation of our society and has generated a huge academic industry particularly over the last fifteen years.  The concept is no longer used simply as a means of understanding the likelihood that a particular event will occur but has become increasingly sophisticated and elaborated.  The journal Risk Analysis publishes papers on a wide range of activities and contexts. Risk has personal, social and cultural aspects and touches every corner of our lives. Every day we make thousands of small decisions which involve calculating and balancing risks, but most of them we don’t notice because the activities they concern are carried out at an automatic, pre-attentive level.  In the UK alone there are 150,000 workplace accidents causing injury every year, 90 percent of them due to “human error”, or in other words, unconscious risk-taking (Wagenaar, 1992). Every time we get into a car and hurtle down a motorway at 100 km an hour we are taking a risk, yet we seldom feel any serious apprehension. On the other hand fear of flying is quite common—many people’s lives are circumscribed by unwillingness to get into an aeroplane although the risk of any kind of accident is negligible.

 

The risk-aversive culture

 

            Of course the assessment of risk has always been central to some professions. Engineers have to calculate the risk of a bridge collapsing in different circumstances (and even now sometimes get it wrong). Actuaries, on the other hand, are concerned with the risk of people living too long rather than dying too soon. But recently the concept of risk has become a much more central aspect of everyday life. Instead of accepting that risk is inseparable from everyday living we seem obsessed by an urge to eliminate it. We can see that this is driven by the myth of accountability—that whenever anything goes wrong someone must be to blame—and by the self-interest of the legal profession. The no-win, no-fee system has now spread from America to the UK with the result that huge amounts of public money are diverted from health and social care into the pockets of insurance companies and lawyers. We can also see the effects in defensive medical practice and a large increase in unnecessary investigations.

 

            Preoccupation with risk has spread into many areas where it was not previously perceived to be an issue. For example, the UK Charities Commission now requires all NGOs to carry out a comprehensive risk assessment. In the case of one small charity of which the author is a Trustee this ran to seven closely typed pages and absorbed many hours of staff time that might have been better spent on the objectives of the organization, which were to help children and young people in out-of-home care.

 

            However, social work with children and families is crucially concerned with the assessment and management of risk. It is arguable that the actions of all professionals who participate in the system are principally governed by what they regard as the most important risks and how they assess them.

 

            This paper considers how risk perception and risk communication influence the way services are offered to children and families and how these influences are mediated, especially in the UK, by public inquiries and by the media.

 

Perception of risk

 

            Research on perception of risk in many different fields has shown that it often bears little relation to the probability of a particular event or undesired outcome occurring. For example, a recent study found that most mothers of young children were very anxious that they might become victims of pedophiles if they were not under constant supervision. In fact, the vast majority of reported incidents are trivial (Gallagher,Bradford & Pease, 2002). Serious sexual abuse by strangers is extremely rare—over 80 percent of known sexual abuse of children is by close relatives or family friends. Children are ten times more likely to be injured in an accident than to be attacked by someone they do not know. The risk to their health of obesity due to being confined indoors and driven to school by car instead of walking is far greater but has only recently been recognized.

 

Perception of risk

           

HIGH PROBABILITY

 

LONG-TERM CONSEQUENCES

          

LOW PROBABILITY

 

CATASTROPHIC  EVENT

 

 

            In terms of public policy the bottom half of this table has far greater influence than the top half. For instance, it has taken 50 years for the health risks of smoking to be taken seriously by governments or to have any influence on people’s behaviour, whereas since 9/11 the fear of terrorist acts, which is actually very small in most parts of the world, has permeated every aspect of our lives. To give two trivial examples, there are no refuse bins in UK railway stations and to fly to New York from London you now have to check in four hours before the flight is due to leave. In other contexts, saving time is a high priority. Billions of pounds are spent on constructing roads to shorten journey times by a few minutes in the interests of economic efficiency while the protests of environmental campaigners are dismissed as marginal. These are examples of how perception of risk overrides other considerations normally given importance.

 

            The impact of risk assessment and risk perception on social policy and social work has been studied in relation to different fields such as crime, mental health, care of elderly and disabled people, management of addictions and many others; here I want to focus on the area of child welfare.

 

Three types of risk

 

            Three types or levels of risk can be identified in child welfare work: obviously there is the risk of harm to the child, secondly there is the risk of violence towards social workers involved in child protection (since it arouses intense emotions in those concerned) and there is a third risk of the public disgrace of the professionals when something goes seriously wrong. In the US there is the fear of litigation also. In this paper I suggest that in all child welfare systems, but especially those in English-speaking countries, there is a tendency to focus on certain kinds of risk and to ignore others, leading to a concentration on particular kinds of activity with consequences that run counter to the declared objectives of the system as a whole.

 

Risk perception and public policy

 

            Child maltreatment is certainly not a new problem—the British National Society for the Prevention of Cruelty to Children was founded in 1890—but Parton (1985) has argued that it only became a focus of social work activity in Britain as a result of the death of a seven-year-old girl, Maria Colwell, in 1973. Before that child abuse was experienced by social workers as “marginal to their everyday practice” and attracted little attention in the media or among the general public. Afterwards it became established as a major social problem and has absorbed ever-increasing amounts of social work time. However, it was not primarily the child’s death, shocking though it was, that had this effect, but the Public Inquiry which followed it and set the pattern for the numerous similar inquiries throughout the next thirty years. Maria was removed from the care of her father’s sister, who seems to have looked after her well enough, and returned to her birth mother and stepfather who starved, beat and finally murdered her. But by the time the inquiry took place her stepfather was serving a prison sentence and public anger focused not on the killer but on the social worker, Diana Lees, who had made the decision that Maria should go back to live with her mother. No one who was employed as a child welfare social worker at that time will ever forget her name.

 

              Reder, Duncan and Gray (1993) analysed 35 inquiry reports and found many common features, such as failures in communication between professionals, the interaction between events in the parents’ lives, their own unmet psychological needs and their ill-treatment or neglect of the children. However, they also highlight the influence of random factors. Many fatal attacks on children occurred at weekends or evenings when social workers were not available. Crucial information was not recognised because the worker was distracted by the demands of other cases which seemed at the time equally urgent.

 

              The demonization of social workers seems to be a uniquely British phenomenon, exacerbated by the quasi-judicial nature of public inquiries. The majority of child abuse inquiries have been chaired by lawyers and conducted in an adversarial style with the object of finding who was to blame for failing to prevent the tragedy. The result has been to create a climate of fear in which social workers and their managers become more concerned about protecting themselves than promoting the welfare of the children for whom they are responsible. It has also created a vicious circle in which social work with children and families comes to be seen as high risk and fewer people want to do it. The shortage of social workers puts more pressure on those who remain, resulting in a high incidence of stress-related illness and still fewer people to do the work.

 

              In these circumstances what is given priority is child abuse investigation. This is a clear instance of the risk perception fallacy (low probability–catastrophic consequence) since most social workers will not encounter a child abuse fatality in their entire career and even when a child dies it rarely attracts more than a small paragraph in a local newspaper. However, the few cases during the 1980s that became the subject of public inquiries dominated the headlines and destroyed the careers and lives of the social workers who were held responsible.

 

              The UK Department of Health commissioned a series of research studies which showed conclusively that the vast majority of child protection investigations led nowhere and resulted in no improvements to children’s lives. These were summarised in an influential publication, Child Protection: Messages from Research (Dartington Social Research Unit, 1995) which suggested “refocusing” children’s services on enhancing welfare rather than detecting abuse. However, there is no evidence that this occurred for the reasons given above.

 

The role of the media

 

            Ian Butler and Mark Drakeford have charted the process by which the exposure of some undesirable event or practice is turned into a scandal by press attention, provoking the demand for an inquiry, which then attracts continuing media headlines and, provided thinking is moving in that direction anyway, results in a shift in public policy. (Butler and Drakeford, 2003). Perceptions of risk in child protection by professionals are inextricably linked with the media interest in the issue. Newsworthy cases and trials of offenders may be briefly reported on radio or television, but by far the most significant influence in the UK is exerted by press reports, particularly by those in the tabloid newspapers. Here are a few examples in connection with two children, Malcolm Page who died of malnutrition and hypothermia, and Lucie Gates who was left alone in the house with her siblings and died, after months of chronic neglect, when an electric fire fell on her.

 

Malcolm Died as He Lived – Freezing Cold, Starving and Surrounded by Social Workers (Daily Mirror)
Early Victim of Do-Nothing Welfare Team (Daily Mail)
Doomed Girl “Failed” by Welfare Worker (Daily Mail)
Why “Little Angel” Lucie Need Not Have Died (Daily Mirror)

 

            The popular press consistently presents a picture of social workers as incompetent, idle and easily duped. A Welsh newspaper reported the severe physical abuse of a baby who was found on admission to hospital to have forty-four bones in her body broken as well as a cigarette burn and a scald on her face.The headline was “All You Had To Do Was Keep Knocking”. However Reder, et al., found that a typical trajectory in fatal abuse cases in the later stages was what they called “closure” when the family withdrew from all professional contacts and rejected all attempts to gain access to the child.                                                                                                                   

 

Can child abuse be prevented?

 

            There have been numerous attempts to predict which families are most likely to abuse their children and it is all too easy with hindsight to believe that in those cases that result in the child’s death the level of risk should have been obvious. However, although each week one or two children die at the hands of their parents in the UK, this is a tiny proportion of the many thousands of families whose care of their children gives rise to professional concern.  Some commentators, such as Colin Pritchard, have argued that although the overall number of deaths is an important indicator of the effectiveness of the child protection system, which individual children will die is randomly determined and unpredictable.

 

             It has often been observed that there is a pendulum effect in child welfare services, with sometimes the rights of parents given most prominence and sometimes the wellbeing of children. The scandal–inquiry–legislation sequence described by Butler and Drakeford (2003) is well illustrated by the Cleveland affair, when large numbers of children were removed from their parents on suspicion of sexual abuse and kept in unsuitable conditions in a hospital. This time the media frenzy extended to the paediatrician as well as the social worker held responsible. The inquiry that followed, chaired by Dame Elizabeth Butler-Sloss, led directly to the Children Act 1989, which attempted to shift the balance from coercion to partnership with parents, and for the first time made family support an official policy. However, as there was a Conservative government at the time no money was available to make it a reality. The Act introduced a new category of “children in need,” very loosely defined as those whose development might be significantly impaired without the provision of services.

 

            The Act initiated ever more complex procedures and regulations designed to detect and prevent child abuse and there was a shift from large scale public inquiries to local reviews held in private. By this time, though, most social workers perceived the risk of missing a serious case of child maltreatment as overwhelming. They recognized that supporting families and providing practical help was the most effective way of enhancing children’s welfare, but they felt they had no alternative to prioritizing child protection, which left no resources for anything else. Families on low incomes living in poor environments but trying to do their best for their children were well aware that threatening to hit them was almost the only way to get any help (Colton, Drury and Williams, 1995). Paradoxically the vast majority of child abuse investigations result in no action: only five percent of children are removed from their families in the UK (though a much larger proportion in the United States). The experience of the investigation is traumatizing for the families but in most cases no service is offered (Cleaver and Freeman, 1995).

 

How risk perception influences policy development

 

            As I have shown, the media exerts powerful influences. Newspaper reports raise public awareness of the problem, but more significantly they define the problem, its origins, and its remedies. Research on child maltreatment has shown that numerous factors are involved: each parent’s own developmental history and personality, marital relations, living conditions, the family’s social network, the child’s characteristics, and stage of development (Belsky, 1988). Yet the media continues to perceive child abuse, and especially child homicide as a product of professional incompetence. Child protection agencies have responded by providing more and more resources for child protection investigations and developing more and more detailed and structured methods for assessing the risk to children. They have accepted the agenda of the media which translates into an assumption that child protection must be targeted at individuals, even if that focus is at the expense of resources deployed to reduce deprivation and provide family support within the community.

 

            Managers seek to avoid condemnation by enforcing strict procedures to govern professional behaviour. It is assumed that if it can be shown that clear procedures were established and communicated to staff and that managers took action to ensure compliance with those procedures, they will then be in a good position to defend themselves against blame if something goes wrong. They may also convey to staff the message that their own best defence in a crisis will be to demonstrate that they followed established procedures.

 

            As well as limiting the possibilities for family support, the constant flow of new referrals makes it difficult for social workers to spend any time getting to know children who are looked after away from home or to act as effective advocates for them. I found that this was as true in Australia, New Zealand and Massachusetts as it is in the UK. Once child protection procedures have been followed through, the spotlight moves off the child. In my current research very few young people in care have named their social worker as a significant person in their lives; more usually they comment on how seldom they see them and how often they change.

 

              Following the election of a Labour government in 1997, children’s services in Britain entered a more hopeful phase. There has been a real drive to reduce the child poverty that had increased appallingly under the Thatcher regime, and numerous initiatives to improve child care, educate parents, and regenerate deprived communities. Children in out-of-home care were targeted in a comprehensive programme called “Quality Protects” and for the first time their health and education became the focus of attention (Social Exclusion Unit, 2003). The Sure Start programme is designed to provide day care and other kinds of family support to people with children under four in deprived communities. More recently, all children’s services have been brought into the mainstream by being transferred from the Department of Health to the Department for Education and Skills.

 

The Climbie Inquiry

 

            But only three years after the government was elected another major scandal hit the headlines, the effects of which are still being worked through. This was the horrific murder of a child called Victoria Climbie by her great aunt and partner. In some ways it was a very atypical case. Victoria came from the Ivory Coast. Her parents had entrusted her to the aunt, who lived in Paris, in order to give her the opportunity of a better education. The aunt brought her to London where she died just over a year later after months of appalling abuse. She spent her last few weeks in the winter of 1999-2000 living and sleeping in a bath in an unheated bathroom, bound hand and foot inside a black bin bag, being fed like a dog by pushing her face to the plate. The paediatrician who admitted her to hospital the day before she died, bruised, deformed and malnourished, said it was the worst case of child abuse and neglect that she had ever seen.

 

               There were many peculiar aspects of this case, including the involvement of a minister who told Victoria’s aunt that she was possessed by a devil, but there were also many similarities with previous such events. The inquiry that followed was held in public and once again social workers had to give evidence and were vilified by the press for their failures. Victoria and her aunt were known to three housing authorities, four social services departments, two police service child protection teams, a specialist NSPCC centre, and two different hospitals. The Counsel to the Inquiry, Neil Garnham, listed 12 key occasions when the relevant services had the opportunity to intervene.

 

            Ironically, the inquiry, chaired this time not by a lawyer but by a former Chief Inspector of Social Services, concluded that the agencies with responsibility for Victoria gave a low priority to the task of protecting children. However, reading the report one might come to a different conclusion. The professional failures vividly described were clearly due in part to the inadequate staffing resulting from the shortage of social workers caused by their negative image in the media and the perception of work with children as a highly risky business. Moreover, the artificial distinction between children in need of services and children in need of protection set up by the Children Act 1989, and exacerbated by the failure of the government of the time to provide resources to make family support a reality, played a very important part in the failure to save Victoria. No proper assessment was ever made but somewhere along the line she acquired the label of a “child in need”. As a result, she was classified as a low priority case and the obvious signs of abuse were ignored.

 

            It is noteworthy that social work was not the only profession to be criticized in Lord Laming’s report, and arguably the person most to blame was the paediatrician who misdiagnosed the marks on the child’s body as scabies, but it was once again the social worker, Lisa Arthurworrey and her line manager, Carole Baptiste, who attracted the most hostile press comment.

 

            The Report is described as “a vivid demonstration of poor practice within and between social services, the police and the health agencies” (Laming, 2001, p.13) and concludes with 108 recommendations, many of which were accepted by the government, which declared its intention to put “supporting parents and carers at the heart of its approach to improving children’s lives”. A Minister for Children, Young People and Families was created to coordinate policies across government and a programme to recruit and train more social workers (Parliamentary Paper 2003). The Children Act of 2004, based on the government report Every Child Matters,  will appoint a Children’s Commissioner for England (the other UK nations already have Commissioners).

 

            Will these measures fulfil the hope that “this must never happen again” that we have heard so often?  It should certainly make it less likely, but as Macdonald and Winkley (1999, p.146) have observed, “child protection workers cannot eliminate child abuse any more than the police service can eliminate crime”.

 

Conclusion

 

            The attraction for the media of stories about child abuse is that they evoke powerful emotional reactions: horror, pity, anger and blame which can easily be targeted at individuals. However, this interest would not be sustained, especially in the quality press, if it did not reflect genuine public concern, nor would politicians and decision-makers be willing to allocate ever-increasing resources to child protection.

 

            The theoretical perspective which best explains this phenomenon is the cultural theory of risk. Its basic tenet, usually derived from Mary Douglas’s classic work Purity and Danger (1966), is that social organisations emphasise dangers that reinforce the moral, political or religious order that holds the group together. Violence or sexual abuse by parents against their children threatens the most fundamental bond in our society and violates the natural order. Thus it is perceived as a much more serious risk to children’s wellbeing and development than the objectively far greater risk that they will be killed in a road accident or suffer chronic ill-health due to damp housing.

 

            The current focus on particular kinds of risk to children and the preoccupation of professionals with the avoidance of blame has led to the creation of systems, both in Britain and other countries, where the overall welfare of children becomes a secondary consideration. Within child welfare systems, resources are channelled into investigatory procedures experienced as punitive by families when they might be better employed in supporting the efforts of parents to care for their children in difficult circumstances. However, the situation is unlikely to change so long as agencies perceive no possibility of public criticism for failure to plan strategies for prevention or treatment services and the assignment of blame to individuals serves the political purpose of distracting attention from the inequalities in society which lie at the root of family failure and children’s stunted development.

 

 

  

References

Bullock, R. and Little, M. (2002) ‘The Contribution of Children’s Services to the Protection of Children’ in Browne, K.D., Hanks, H., Stratton, P. and Hamilton, C. Early Prediction and Prevention of Child Abuse: a Handbook, Chichester, Wiley

 

Butler, I. and Drakeford M. (2003) Social Policy, Social Welfare and Scandal: how British Public Policy is Made. Basingstoke: Palgrave Macmillan

 

Colton, M., Drury, C. and Williams, M. (1995) Children in Need, Aldershot UK, Avebury

 

Dartington Social Research Unit (1995) Child Protection: messages from research. London: HMSO

 

Laming, Lord (2003) The Victoria Climbie Inquiry Cm 5730, London, The Stationery Office

 

Reder, P., Duncan, S. and Gray, M. (1993) Beyond Blame: child abuse tragedies revisited. London: Routledge.

 

Sanders R., Jackson, S. and Thomas N. (1997) Policy Priorities in Child Protection: Perception of Risk and Agency Strategy, Policy Studies, 18(2) pp139-158

 

Parliamentary Paper (2003) Every Child Matters: Presented to Parliament by the Chief Secretary to the Treasury Cm 5860 London, The Stationery Office

 

Wagenaar, W.A. (1992) Risk taking and accident causation in Yates, J.F. (ed.) Risk Taking Behaviour. Chichester:Wiley

 

 

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