Can ‘tracking’ children reduce the harm of poverty?

A national database containing details of all children – from addresses and schooling, to what services they and family members have had dealings with – is being proposed in the Children Bill. It would enable wider access by professionals to currently restricted information, in an effort to improve the identification of needs and be able to provide help more quickly. Eileen Munro assesses the adequacy of this approach and whether it will make any real difference to the life chances of children in poverty.

The Children Bill
Identifying needs
Interpreting information
Identifying the risk of developing problems
Lacking resources to help in all cases
Potential dangers of the database
Conclusion

This country is still one where life chances are unequal. This damages not only those children born into disadvantage, but our society as a whole. We all stand to share the benefits of an economy and society with less educational failure, higher skills, less crime, and better health. We all share a duty to do everything we can to ensure every child has the chance to fulfil their potential.[Footnote 1]

This quote from the recent Green Paper, Every Child Matters, emphasises the damage done to children by poverty. The Government goes on to announce its goal that no children should be ‘prevented by economic disadvantage from achieving their full potential in life’. This looks like good news for the three to four million children being brought up in poverty. Poverty is the biggest single predictor of poor outcomes for children. As the Government points out in the Green Paper, for example, by the age of 10, children from a poor background who had a high developmental score at 22 months have fallen behind children from richer families who had a low score at 22 months.

The Children Bill
When we look at how the Government proposes to achieve its ambitious goal, however, optimism quickly fades and anxiety grows. The Children Bill, currently being debated in Parliament, offers no significant solutions to the devastating impact of poverty but introduces new measures for monitoring families that look oppressive and intrusive.

The Bill contains the standard reorganisation of children’s services. This seems a reflex response to any problem on a local and national level; you would think that by now the Government might have noticed that none of the myriad reorganisations have led to significant improvements for children. There is also a proposal for a Children’s Commissioner for England, albeit with weaker powers than the Scottish and Welsh Commissioners who have the authority to start their own investigations.

But the Bill also includes a proposal that will radically alter the power balance between families and professionals, an intrusive change that families on low incomes will experience far more than middle class families, since they have more contact with services. The Government plans to remove all families’ rights to confidentiality in their contacts with teachers, doctors and social workers and to introduce a computerised national database to ‘track’ children’s development so that professionals can monitor families, without their consent, and decide if intervention is needed.

Why should such a wholesale surveillance system be necessary to help children fulfil their potential? What grounds are there for deciding we can no longer trust parents to keep track of their own children’s welfare so that the State must watch them?

Identifying needs
The Government has reached the conclusion that children have been failing to get the help they need because professionals have not shared information enough, leading to poor identification of need. Except in cases of suspected abuse or neglect, doctors, teachers and social workers have been restricted by parents’ and children’s right to confidentiality, so the legislation will remove this barrier. A national database will be set up, containing details of all 11 million children. In addition to facts such as address, GP and school, the system will allow professionals to enter a ‘flag of concern’, an indication to any other professional in contact with a child that they have some worry about an aspect of the child’s development or home circumstances. Others can then contact them to discuss the family in more detail. So, to use an example suggested by the Children’s Minister Margaret Hodge, a nursery nurse could flag up that she was concerned that a toddler looked miserable. The child’s GP might be concerned that the child was underweight, and this system would enable them to put the two concerns together.

The intention is to identify children’s needs more quickly and offer help while the problems are still low level and more amenable to being solved. Such a result would be impressive and worth achieving but, unfortunately, it is not likely to be attained because the Government has not addressed the reasons why children are currently not receiving prompt and effective help.

Talking about children’s needs at a general level obscures the fact that there are several different subgroups of needs that pose significantly different problems. The following three goals, all included in the Children’s Green Paper, are all important but distinct:

1. Improving child protection services so that children like Victoria Climbié receive the help they need.
2. Identifying children at risk of developing seri-ous problems at an earlier stage when help may be more effective.
3. Improving outcomes for all children so that they do not suffer adverse effects from the economic or social disadvantages of their birth.

The current failure of children’s services to provide a high standard of service on all three goals is due to a mixture of shortages: of skills, knowledge and resources. A lack of information is, in itself, not a significant issue.

Take a look at services to protect children from abuse, an area where the importance of sharing information has been recognised for 30 years (since the death of Maria Colwell). [Footnote 2] Despite clear policies and procedures for communication, it still remains a problem and it shows how the issues involved are far more complicated than the mere technical issue of how data is moved around.

In the recent case of Victoria Climbié, many professionals had worrying information about what was happening to her. When we see all this information drawn together in the official inquiry report, it looks obvious that, if it had been put together at an earlier stage, Victoria’s life could have been saved. But why was it not put together while she was still alive? There are no restrictions on sharing information without consent if a professional thinks a child is being abused. There is a very well developed set of child protection procedures detailing how the professionals should work together to make a thorough assessment of a child’s danger. All of the numerous professionals involved knew each other’s addresses, phone numbers, fax numbers and email addresses. They knew who to contact and how to communicate.

Interpreting information
The crucial problem was that people failed to understand the significance of the information they had. Victoria’s key social worker failed to carry out a thorough child protection investigation because she failed to see that it was necessary. She had classified Victoria’s needs as primarily for housing, not for protection, and when she received information suggestive of abuse, she interpreted it in a benign way and did not register any concern. For instance, the nurses in the hospital where Victoria had been admitted with injuries reported that Victoria looked frightened when her great-aunt visited her on the ward. The social worker interpreted her behaviour as indicative of the formality and respect that children showed towards adults in African cultures, hence did not see it as cause for worry. When the paediatrician reported that the injuries were due to scabies, the social worker was further reassured.

It is hard to see how a national database would have improved Victoria’s chances of being protected. There was an abundance of fragments of information being shared in the system; there was a lack of competence to interpret that information. A computer programme cannot rectify this problem; it requires skilled human beings. Victoria needed a social worker who had the time to talk to her, the skill to make her feel safe enough to say what was happening to her, and the knowledge to look at the broader picture, assess the significance of what was revealed and decide how to help Victoria.

Identifying the risk of developing problems
Since there are already no restrictions on sharing information in cases of abuse, perhaps the new database will improve the identification of and response to children in the second category listed above, those at risk of developing seri-ous problems. It would be wonderful if we were able to identify and help these children at an early stage. Not only would they suffer less distress but it would be likely that their problems would be easier to solve.

With hindsight, it looks as if we should be able to identify these children earlier. When you look into the histories of teenagers with serious problems, you can often see a pattern of numerous minor concerns over the years, slowly escalating in severity. The trouble is, though, that we lack the scientific knowledge to pick out this smaller group from the many thousands of children who show some problems at some stage in their development but for whom it turns out to be a minor hiccup, rather than the start of a slide down into serious trouble.

Development is complex and children with apparently similar circumstances can turn out radically differently in adulthood. One child’s tough home life may motivate him to work hard and succeed while another can react by feeling alienated and hopeless. However comprehensive the data collected about all children, we cannot predict with reasonable accuracy which children will develop major difficulties.

Any claim to be able to predict, for example, which children will become delinquent needs to be tested rigorously and its level of inaccuracy revealed because crude predictions can have devastating effects. Innocent children can be labelled as the delinquents of the future. Besides the moral repugnance of giving them a bad name before they have done anything wrong, it carries the danger of being a self-fulfilling prophecy – of people expecting the worst and overreacting to any slight misbehaviour as proof that the prediction was right.

In practice, the group of children who go on to develop serious problems cannot reliably be separated from the larger group of children with minor problems. We cannot realistically target services at just those few. One solution to helping them is to help all children who have problems. This should fit with the Government’s policy since its third goal listed above is that all children should fulfil their potential.

But are children currently not getting help with low level problems because professionals are not sharing information enough? Is a tracking system and erosion of confidentiality the answer to better identification of need and provision of help?

The message from families is a resounding no. Parents and children themselves are the ones who generally know first that a problem is developing. They are better than professionals in recognising a child’s misery. For them, the problem is not a failure to see the need, or a reluctance to take help, but a lack of services to turn to. Many parents and children have the experience of asking for help and being turned away because their problems are not serious enough yet.

Lacking resources to help in all cases
With professionals, the problem is not so much that they fail to identify need because of lack of information but that they are reluctant to recog-nise it because they can offer no useful response. Even when they recognise need, they often fail to refer minor issues on to the relevant service because they know how high is the threshold for providing a service. Child psychiatric problems, for instance, are steadily rising but there is a major shortage of child psychiatrists and child psychologists in the UK so that even when a child has become suicidal s/he can face a long wait for an appointment.

Well resourced, easily accessible services for all families to turn to for help would improve outcomes for all. They would have a particular impact on children from low-income families since they face more hazards than most. Universal services, however, are expensive and this option does not seem to have been seriously considered by the Government.

Potential dangers of the database
The proposed database and abolition of confidentiality are not only ineffective solutions to the problems in children’s services today but are sources of new dangers in themselves.

We can expect that some families will become more reluctant to look for help and to be honest with professionals, knowing that any sensitive information they confide to a professional may become common knowledge among the various services in contact with them.

Teenagers want privacy as they mature into independent adults. They often also want advice, so services until now have taken care to offer them confidentiality. A 15-year-old girl can ask her GP for contraceptive advice secure in the knowledge that he will respect her privacy. How many will be deterred knowing that there is no legal obstacle to this sensitive information being shared with every professional in their lives?

There has been a lot of media attention recently on the ruling that a doctor can carry out an abortion on a girl of 15 without her parents’ knowledge. While people have been debating whether this is in the girl’s long-term interests, they have failed to notice that, if the Children Bill is passed unchanged, then her parents will be the only people in her life who are kept in the dark: details of the operation could be shared with every professional with whom she has contact. This imbalance of information is likely to lead to serious problems in working with families.

We already have evidence from maternity services that mothers with postnatal depression are concealing their problems from health visitors because they are scared of being reported to the child protection system as an abusive parent. As another example, will parents with drink problems be worried about asking a GP for advice, knowing their children’s schools may get to know about it?

A further danger is that the system will generate such a deluge of minor concerns that the time absorbed in screening them will lead to an even greater shortage of services. Moreover, it is likely that children with serious problems, such as Victoria Climbié, will be harder to spot as they are hidden within this torrent of small worries.

Conclusion
Developing a database to keep track of all children’s development is a proposal based on an unconvincing argument. It fails to differentiate between the different categories of need: the parent whose child has severe learning difficulties and who is crying out for help needs a different response from the parent who is abusing her/his child and trying to keep it secret. It is based on the misconception that children with small problems are not receiving help primarily because their need is not being identified by professionals when, in reality, the major problem is that resource shortages mean only serious problems get attention. It is also based on the misconception that professionals have the ability to pick out the small number of children with small problems who will go on to develop major problems later so that services can remain restricted and can be targeted at the high-risk group.

A final misconception is overconfidence in the ability of professionals to solve children’s problems. Even if we had universal services offering help for every minor concern, we would have only a limited impact on the devastating effects of poverty. Our therapeutic efforts are very limited; the pervasive harm of poverty is hard to neutralise. The Sure Start schemes, for instance, which are the leading light of current policy, are not counteracting all the adverse effects that children suffer from social and economic deprivation.

The Government wants every child to fulfil his or her potential and is keen to develop preventive services but, for children living in poverty, the only true prevention is to end child poverty.

Eileen Munro is Reader in Social Policy at the London School of Economics and Political Science

Footnotes

1. Department for Education and Skills, Every Child Matters, HMSO, 2003, p6 [back to text]
2. Department of Health and Social Security, Report of the Committee of Inquiry into the Care and Supervision Provided in Relation to Maria Colwell, HMSO, 1974 [back to text]

Poverty 119, Autumn 2004