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Classifying families where children are suffering, or likely to suffer, significant harm: The Risk Classification

Framework

Before their first birthdays all but one of the children were assessed as suffering, or likely to suffer, significant harm and were in receipt of statutory interventions to safeguard and promote their welfare as a consequence. At around this time, birth parents were not only dealing with the usual emotional stress of pregnancy and child birth, but were also experiencing substantial difficulties including: domestic abuse, problem alcohol and drug use, mental health problems, learning disabilities, consequences of abuse in their own childhood, experiences of trauma and loss following the permanent removal of older children (see Neil et al., 2010). Most were experiencing complex combinations of these problems. They were also living with the day to day stresses of housing problems including homelessness, financial problems including bankruptcy, and the problems of living in impoverished and sometimes violent neighbourhoods (see Ward et al., 2012a).

Making decisions concerning which children can safely remain at home and which require temporary or permanent out of home placements is complex, involving an exploration of the children’s needs, their parents’ circumstances and an assessment of parental capacity to change. There is often a complicated interplay between the presence of risk factors such as domestic abuse, substance misuse and mental health problems, and protective factors such as a supportive partner or relatives, effective professional support and interventions and parental capacity for change.

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The research team designed a risk classification framework to facilitate an analysis of this interplay and to aid an understanding of the varying trajectories that the children have followed over a prolonged period. The Risk Classification Framework (Brown, forthcoming) is currently being piloted as a practice tool by the NSPCC (Hyde-Dryden et al., 2014).

The Risk Classification Framework makes extensive use of Hindley, Ramchandani and Jones’ (2006) and White, Hindley and Jones’ (2014) systematic reviews of empirical studies investigating factors associated with maltreatment recurrence in children. The 2006 review examined sixteen studies which were published prior to December 2002 and met strict inclusion criteria. The 2014 review updated the original review to include empirical studies published between 2003 and 2009, and widened the original scope by including unsubstantiated as well as substantiated cases of child maltreatment. Fifteen studies met the rigorous inclusion criteria of this review, all of which were from the USA. Factors which increased the likelihood of recurrent maltreatment and harm to the child were identified from each study.

The table below sets out ‘those factors which were found to be associated with an increased likelihood of future harm, contrasted with those where the likelihood is decreased following identification of significant harm to an index child’ (Jones, Hindley and Ramchandani, 2006). The table combines the results from both the reviews. Items in italics were most strongly associated with recurrent maltreatment;

the other factors were identified by the studies in the reviews but were less strongly associated with recurrence.

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Table 5: Factors associated with future harm10 11

10 Table adapted from: Jones, Hindley and Ramchandani (2006) White, Hindley and Jones (2014) Reproduced following discussion with David Jones (david.jones@psych.ox.ac.uk).

11 Items in italics most strongly associated with recurrent maltreatment.

Factors Future significant harm more

likely Future significant harm less

likely Abuse Severe physical abuse including

burns/scalds Neglect

Severe growth failure Mixed abuse

Previous maltreatment

Sexual abuse with penetration of a long duration

Child Developmental delay with special needs

Mental illness

Very young – requiring rapid parental change

Abuse in childhood – not recognised as a problem

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The Risk Classification Framework is a very simple methodology which utilises evidence concerning the risk and protective factors shown in the table above to distinguish between those families where the likelihood of children suffering harm appears to be higher or lower, with particular weight given to evidence of parental capacity for change. The framework consists of four groups:

Severe Risk: Families showing risk factors, no protective factors and no evidence of capacity to change.

High Risk: Families showing risk factors and at least one protective factor but no evidence of capacity to change.

Medium Risk: Families showing risk factors and at least one protective factor including evidence of capacity to change.

Parenting and parent/child interaction

Disordered attachment Lack of empathy for child Own needs before child’s

Family Inter-parental conflict and violence Family stress

Lack of social and family support networks and lone parenthood

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Low Risk: Families showing no risk factors (or families whose earlier risk factors had now been addressed), protective factors including evidence of capacity to change.

Data collected from case files and interviews with birth parents and social workers at identification were scrutinised for evidence of these factors. Two members of the research team then independently allocated each of the sample children to one of four groups according to the evidence concerning these factors. Their independent judgements agreed in the majority of cases, but where they did not, the data were further scrutinised and discussed until a consensus was reached. The classification was undertaken at identification and then repeated at ages three, five and eight.

Where children had re-entered the study, and thus had not always been included in each of the follow-up samples, the classification was made retrospectively using children’s social care case file data.