Assessing the Feasibility of Using an Actuarial Risk Assessment Tool to Identify Risks in Child

379 Pages·2012·3.64 MB·English

by  Heather Wood

Assessing the Feasibility of Using an Actuarial Risk
Assessment Tool to Identify Risks in Child Protection Cases
One volume
Heather Wood
In partial fulfilment of a Doctorate in Philosophy
Bournemouth University
30 November 2011
Academic Thesis : Declaration of Authorship
I, Heather Wood, declare that this thesis and the work presented in it are my own
and it has been generated by me as the result of my own original research.
Assessing the Feasibility of Using an Actuarial Risk Assessment Tool to Identify
Risks in Child Protection Cases
I confirm that:
This work was done wholly or mainly whilst in candidature for a research degree at
Bournemouth University;
Where any part of this thesis has been previously submitted for a degree or any other
qualification at this University or any other institution, this has been clearly stated;
Where I have consulted the published work of others, this is always clearly
attributed;
Where I have quoted from the work of others, the source is always given. With the
exception of such quotations, this thesis is entirely my own work;
I have acknowledged all main sources of help;
Where the thesis is based on work done by myself jointly with others, I have made
clear exactly what was done by others and what I have contributed myself;
None of this work has been published before submission.
Signed:

Heather Wood
21 April 2011
This copy of the thesis has been supplied on condition that anyone who consults it is
understood to recognise that its copyright rests with its author and due
acknowledgement must always be made of the use of material contained in, or
derived from, this thesis.
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Acknowledgements
This work was funded by a full time PhD studentship awarded by Bournemouth
University.
I am very grateful for the wisdom and expertise of my supervisors, Professor Colin
Pritchard and Professor Jonathan Parker and for the access to Serious Case Review
reports granted by the Welsh Assembly Government Department for Health, Social
Services and Children.
.
I should like to thank Mary Taylor for her help in proof reading and correcting the
text and Bill and Rovena Harris, Claire McDonald and Ronald Howard for their
valuable practical and moral support.
My husband, Graham Wood, has been my mainstay throughout everything.
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Contents
Abstract.....................................................................................................................21
Chapter 1: Introduction.........................................................................................24
1.1 The purpose of this study....................................................................................24
1.2 Aims ...................................................................................................................26
1.3 The background to this study............................................................................27_
Chapter 2: The Social Policy Context of Child Protection in England..............29
2.1 Introduction..........................................................................................................29
2.2 The family and the state.......................................................................................29
2.2 The scope of child neglect and abuse..................................................................32
2.3 The history of child protection.............................................................................35
2.4 The Children Act 1948 and Children’s Departments..........................................38
2.5 Support for families and ideas about the family..................................................44
2.6 The child within the family .................................................................................47
2.7 The Ingleby report and the Seebohm Report: Failing Families...........................48
2.9 The child abuse Inquiries of the 1970s and 1980s...............................................52
2.10 The Cleveland Inquiry and the Children Act 1989............................................55
2.11 The United Nations Convention on the Rights of the Child and Children’s
Rights …...................................................................................................................62
2.12 Children’s needs and family welfare.................................................................66
Chapter 3: Literature Review: Theoretical Background to Risk Assessment in
Child Protection.......................................................................................................79
3.1 Theoretical perspectives on risk assessment........................................................79
3.2 A positivist approach to risk assessment.............................................................80
3.3 Risk assessment: the research approaches in Britain and North America...........81
3.4 Measurement of risks as public policy................................................................86
3.5 Risk assessment in other complex systems..........................................................88
3.6 Risk of child neglect and abuse within populations............................................90
3.7 Bio-psycho-social effects of child neglect and abuse on child development......91
3.8 Risk assessment and decision making in English child protection teams...........95
3.9 Problems with risk assessment in current English child protection practice.......97
Chapter 4: Formal tools for risk assessment in child protection......................104
4.1 Checklists in decision making...........................................................................104
4.2 Use of statistically based risk assessment tools.................................................109
4.3 The search strategy............................................................................................116
4.4 Scope of the formal risk assessment literature...................................................117
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4.5 Sources of the literature ....................................................................................117
4.6 Contexts of risk assessment in child protection.................................................118
4.7 Types of risk assessment in child protection.....................................................118
4.8 Types of methods used......................................................................................120
4.9 Reviews of other studies on risk assessment.....................................................121
4.10 Cohort studies, mixed data sources..................................................................123
4.11 Evaluative studies of risk assessments.............................................................125
4.12 Excluded studies..............................................................................................127
4.13 Summary .........................................................................................................128
4.14 The hypotheses ...............................................................................................130
Chapter 5: Methods and Materials......................................................................131
5.1 Access to data for research................................................................................131
5.2 Data security......................................................................................................133
5.3 The Serious Case Review reports......................................................................133
5.4 Data collection...................................................................................................135
5.5 Data analysis......................................................................................................137
Chapter 6: Findings from the Serious Case Reviews: the Thirteen Counties
Study (T.C.S.).........................................................................................................140
6.1 The Thirteen Counties Serious Case Reviews (SCRs)......................................140
6.2 Missing information...........................................................................................140
6.3 Ensuring anonymity...........................................................................................142
6.4 Reliability of the FRAAN risk assessment scores.............................................142
6.5 Demography of the T.C.S. Study Cases............................................................143
6.6 Age and sex of the T.C.S. index children .........................................................143
6.7 The Family Risk Assessment for Abuse and Neglect (FRAAN) scores...........145
6.8 The T.C.S. neglect factors across the whole T.C.S. sample .............................148
6.9 FRAAN neglect risk factors subcategories........................................................150
6.10 Neglect risk factor subcategory findings.........................................................150
6.11 Abuse risk factors ...........................................................................................153
6.14 Case outcomes: comparing Deceased and Survived cases..............................159
6.15 Correlation between Deceased versus Survivor neglect scores.......................159
6.16 Correlation between Deceased and Survivor cases for neglect subcategory
factors …............................................................................................................. 162
6.17 FRAAN abuse risk factors frequencies: correlation between Deceased and
Survivor cases..........................................................................................................163
6.19 Abuse risk assessment question sub-category findings...................................174
6.20 Other differences between the Deceased and Survivor Groups......................176
6.21 Causes of child deaths .....................................................................................176
6.22 Relationships of the abusers and index children..............................................177
6.25 Overlapping problems in the T.C.S. cases.......................................................183
6.25 Co-occurring parental characteristics in T.C.S. fatal cases ............................187
6.26 Co-Occurring parental factors in T.C.S. non-fatal cases .............188
6.27 Sensitivity of the FRAAN risk assessments ...................................................192
6.29 Key risk factors ...............................................................................................194
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Chapter 7: External Validation Comparator Studies versus T.C.S. findings..196
7.1 Section 1: The Brandon team study ..................................................................197
7.2 Demographics of the Brandon study cases........................................................198
7.3 Section 2: The Ofsted review of Serious Case Reviews (2009-2010)...............203
7.4 Section 3: The Wessex study of child homicide cases ....................................208
7.5 Comparisons between the studies......................................................................211
7.6 The Brandon team study of 189 Notified Cases and 40 Intensive Cases .........211
7.7 The Ofsted report on Serious Case Reviews ....................................................216
7.8 The Wessex study of child homicide cases ......................................................221
7.9 Overall findings.................................................................................................225
7.10 Summary of key findings.................................................................................229
Chapter 8: Discussion............................................................................................231
8.1 Limitations to this study....................................................................................231
8.2 US and UK approaches to risk assessment in child protection..........................233
8.3 Feasibility of using the FRAAN risk assessment in British child protection cases
….............................................................................................................................236
8.4 Hypothesis 1: Identification of high risk cases..................................................237
8.5 Hypothesis 2: Identifying High Risk cases with a risk of fatal maltreatment...239
8.6 Effects of violence in Serious Case Review cases.............................................243
8.7 Effects of parental mental illness and substance misuse...................................248
8.8 Implications for knowledge and evidence based practice in child protection...251
8.9 Implications for policy on Serious Case Reviews.............................................253
8.10 How the FRAAN risk assessment could incorporate risk factors for serious
neglect, abuse and child homicides..........................................................................256
8.11 Implications for child protection practice .......................................................257
8.12 Handling self inflicted child deaths ................................................................258
Chapter 9: Conclusions.........................................................................................260
9.1 The practical value of the study.........................................................................261
9.2 Contribution to knowledge ...............................................................................262
9.3 Contribution to policy development..................................................................263
9.4 Future research directions..................................................................................264
Appendix A: Chronology of Child Care Legislation and Policy 1948-2008.........266
Appendix B: The Michigan Family Risk Assessment for Abuse and Neglect
(FRAAN) Risk Assessment Tool............................................................................282
Appendix C: Access to Serious Case Review reports............................................284
Appendix D: Publications on Risk Assessment in Child Protection in North
America and Britain during the 1990s.....................................................................318
Appendix E: Case List............................................................................................325
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List of Tables
Table 4-1 Typology of studies .............................................................................. 120
Table 6-1 T.C.S. Sex of index children ..................................................................143
Table 6-3 Risk factor scores for Survivor Cases using the FRAAN risk assessment
to identify risks known to the agencies before precipitating incident ................... 146
Table 6.4 Risk factor scores for Deceased cases using the FRAAN risk assessment
to identify risks known to agencies before precipitating incident …..................... 147
Table 6-5 T.C.S. Neglect Risk Factors Rank Ordered by Frequency .....................148
Table 6-6 Neglect Sub-Category Scores Rank Ordered By Frequency ..................152
Table 6-7Abuse Risk Factors Rank Ordered By Frequency ...................................155
Table 6-8 Abuse Risk Sub-Category Scores Rank Ordered By Frequency ...........158
Table 6-9 FRAAN Neglect Risk Factors Frequencies: Correlation Between The Two
Outcome Groups......................................................................................................161
Table 6-10 Neglect Sub-Categories: Correlation between Deceased And Survivor
Cases........................................................................................................................163
Table 6-11 FRAAN Abuse Risk Factors Frequencies: Correlation between Deceased
and Survivor Cases..................................................................................................165
Table 6-12 Abuse Sub-Categories: Correlation Between Deceased and Survivor
Cases........................................................................................................................168
Table 6-13 Chi Square Goodness of Fit Test for Neglect Risk Factors..................171
Table 6-14 Chi Square Goodness of Fit Test for Abuse Risk Factors.....................171
Table 6-15 Chi Square Goodness Of Fit Test For Neglect Risk Assessment Question
Sub-Category Findings............................................................................................173
Table 6-16 Chi Square Goodness of Fit Test for Abuse Risk Assessment Question
Sub-Category Findings............................................................................................175
Table 6-17 Child Deaths and Causes.......................................................................177
Table 6-18 Relationship of Known Abusers to Index Child in T.C.S. Cases .........178
Table 6-19 Relationship of Abusers to Index Child in T.C.S. Cases......................179
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Table 6-20 T.C.S. Family related factors ................................................................181
Table 6-21 T.C.S. Additional Family Related Factors In Deceased And Survived
Cases........................................................................................................................183
Table 6-22 Frequently Identified Overlapping Family Factors in the T.C.S. Sample
.................................................................................................................................184
Table 6-23 Characteristics of the Perpetrators in Fatal and Non-Fatal Cases ........187
Table 6-24 Co-Occurring Family Factors in Fatal Cases........................................190
Table 6-25 Co-Occurring Family Factors in Non-Fatal Cases................................191
Table 6.28 The low scoring cases (false negatives) .............................................. 193
Table 7-1Age Group at Time Of Incident of the Notified Children and the Intensive
Sample ....................................................................................................................199
Table 7-2 Gender and age of the Brandon Notified cases ......................................199
Table 7-3 Case Outcomes within the Intensive Group ..........................................200
Table 7-4 Causes of Death in Brandon Study Fatal Notified Cases .......................200
Table 7-5 Child and Family Characteristics of the Brandon Team’s Intensive Group
of Cases....................................................................................................................202
Table 7-6 Age Distribution of Children in the Ofsted (2010) Cases.......................204
Table 7-7 Case Outcomes within the Ofsted Cases ................................................204
Table 7-8 Ofsted Age profile of children who died ................................................204
Table 7-9 Causes of Death in the Ofsted Fatal Cases..............................................205
Table 7-10 Child and Family Characteristics of the Ofsted Group of Cases .........207
Table 7-11 Age and Sex of the children in the Wessex homicide study ...............209
Table 7-12 Types of Assailants in Wessex Child Homicide study..........................209
Table 7-13 Comparing Frequencies of Individual Factors between the Brandon
Team Study and the T.C.S. Study............................................................................213
Table 7-14 Case Outcomes of Intensive Group and Brandon Intensive and Notified
Samples....................................................................................................................214
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Table 7-15 Comparison between Factor Frequencies for the Ofsted (2010) and
T.C.S. Cases.............................................................................................................219
Table 7-16 Comparing the Relationships with the Index Child in Wessex
Intrafamilial Homicide Assailants and the T.C.S. Fatal Abusers ...........................222
Table 7-17 Characteristics of Intrafamilial Assailants in Wessex Child Homicide and
T.C.S. studies ..........................................................................................................224
Table 7-18 Age distributions of Wessex study and T.C.S. Deceased Children......225
List of Figures
Figure 5-1 Types of cases included in the Serious Case Review process 126
Figure 5-2 FRAAN scores for Question N8 …………………………… 128
Figure 5-3 FRAAN scores for Question N9 …………………………… 129
Figure 5-4 The Expanded Data Set including Sub Categories ………… 130
Figure 6-1 Total Risk Scores for Survivor Children …………………… 183
Figure 6-2 Total Risk Scores for Deceased Children …………………... 184
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Definitions of terms used in this study
Actuarial risk assessment tool: a formal risk assessment tool based on a large scale
statistical analysis of those risk factors which are more closely correlated with the
subsequent occurrence of the adverse outcomes which the tool is designed to predict.
Child abuse: a form of maltreatment of a child (i.e. a person who has not yet
reached their 18th birthday). It may take the form of physical bodily maltreatment or
psychological or emotional actions which cause distress and hurt, or exposure to, or
involvement in, sexual activities to which the child cannot give valid consent
without duress and where they may not fully understand the implications of their
involvement. It may also take the form of actions which induce physical illness, or
create the appearance of fabricated illness in a child. Emotional abuse also includes
peer bullying and the exploitation or corruption of children.
Child maltreatment: any form of abuse or neglect of a child which either results in
significant harm, or is likely to do so.
Child neglect: is a form of maltreatment which takes the form of persistent failure
to meet a child’s basic physical and/or psychological needs, resulting in significant
harm. It includes maternal lack of care for a foetus during pregnancy, such as
substance misuse, and also failure to seek necessary medical attention or treatment.
Child protection: this unction is seen as a part of the overall social and legal
responsibility to safeguard and promote the welfare of children. Child protection
services apply to those children who are suffering, or are likely to suffer significant
harm.
Consensus based assessment tool: a formal assessment tool based on factors (with
or without weighting) which have been agreed by a group of experts in the area to be
assessed as the most important in determining risks likely to result from their effects.
Decision making: the process of making a decision
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