Putting it onto paper: Recording and report writing

Putting it onto paper:

Recording and report writing

Patrick Ayre

Department of Applied Social Studies

University of Bedfordshire

Park Square, Luton

email: [email protected]

web: http://patrickayre.co.uk

Learning from enquiries

Those who cannot learn from history are doomed to repeat it

(George Santayana)

Learning from enquiries The importance of recording is not always

understood We don’t always think enough about Why?

and Who? Information not accessible Incomplete or out of date Facts and judgments not distinguished Little assessment and analysis Oppressive language Managers not always fully engaged

Comments from ‘Recording with Care’

A Director Says:‘My staff are good at what they do, not what they write down’

A Social Worker Says:'I didn't become a social worker because I wanted to be a typist or a computer programmer. I want to work with people, not waste my time in front of a machine’

On the other hand

A Team Manager Says:‘I couldn't believe the information wasn't there! I kept thumbing through the file, trying to find it. I know we've talked about lots of things in supervision. I just thought it was being written down - but I don't have time to check!‘

Lord Laming says:

‘The case file is the single most important tool available to social workers and their managers when making decisions as to how best to safeguard the welfare of children under their care.’

Framing your writing

You will want to consider the usual questions: How, Who, What, When, Where and Why.

In the planning phase, start with Why (are you writing this)? Who (for whom is it intended)?

For whom are we recording?

Service users Social workers Managers Legal advisers Other agencies Insurers Councillors

Why record? History Support partnerships Provide continuity Facilitate reflection, analysis and planning Support professional development Evidence for resources Management monitoring Evidence for enquiries and investigations Evidence of acceptable standards

Formal reportsMay seem like a chore BUT: Can get everything down (less risk of forgetting

something or missing it out) You can check the information and make sure it is

accurate. You can spend time thinking about how you

express things The other parties will read in advance, so may

spend less time presenting orally:– Should only be asked about disputed parts of the report – The other side may not need to ask questions or may

even fold!

Selling you opinion

What would you look for yourself?

Selling you opinion

What would you look for yourself?

Presentation

Content

Presentation

Make it pretty and easy to read– Neat – Double spaced– One side only– Numbered paragraphs and pages

Language

Good grammar Good sentence construction Simple sentences No unnecessary, unexplained jargon Appropriate tone (formal so no slang, no

contractions, no use of first names for adults)

Sensitively phased (but not watered down)

Content problems

Incomplete

Biased

Conclusions and recommendations poorly argued and justified (or absent altogether)

The chain of reasoning

Facts

Analysis/summary

Conclusions and recommendations

What do they want to know?

Who you are Why you are reporting The facts of the matter The conclusions to be drawn from the

facts

The facts

‘It is the task of practitioners to share, sift, search for and weigh the significance of their information’ (Morrison 2009)

The facts

Family composition (attach a genogram) Background history (family and

individual) Recent events

The facts

Tell the story chronologically without too much editorialising

Facts sufficient support your argument and also to refute counter arguments

First hand evidence is best but give source of any information

Make sure that you have put information as fully and accurately as possible (Checklist: Who, what, when, where, how)

Seeking strong evidence

Information may be: Ambiguous Missing Assumption-led

But can become ‘firm-ground’ if further enquiries are made or it is explored further

Bias and Balance

Include information favourable to the other side as well as that favourable to yours

It is your job to make judgements but: – avoid empty evaluative words like

inappropriate, worrying, inadequate – Give evidence for descriptive words like

cold, dirty and untidy Beware the danger of facts

Bias and Balance

Born in 1942, he was sentenced to 5 years imprisonment at the age of 25. After 5 unsuccessful fights, he gave up his attempt to make a career in boxing in 1981 and has since had no other regular employment

Lies, damned lies and killer breadResearch on bread indicates that More than 98 percent of convicted felons are bread users. Half of all children who grow up in bread-consuming

households score below average on standardized tests. More than 90 percent of violent crimes are committed within

24 hours of eating bread. Primitive tribal societies that have no bread exhibit a low

incidence of cancer, Alzheimer's, Parkinson's disease, and osteoporosis.

In the 18th century, when much more bread was eaten, the average life expectancy was less than 50 years; infant mortality rates were unacceptably high; many women died in childbirth; and diseases such as typhoid, yellow fever, and influenza were common.

Incomplete or out of date

Can you trust a snapshot?

Information handling Picking out the important from a mass of

data Interpretation Decoyed by another problem False certainty; undue faith in a ‘known fact’ Discarding information which does not fit First impressions/assumptions Too trusting/insufficiently critical Distinguishing fact/opinion

Department of Health (1991) Child abuse: A study of inquiry reports, 1980-

1989, HMSO

Fact or opinion?1. There are inadequate play and stimulation

opportunities available. 2. The bruise and swelling are consistent with hitting his

head on the door. 3. This is the first incident of abuse to the child. 4. The flat is unsuitable for bringing up a young child. 5. Mrs Green is good at keeping her flat tidy. 6. Experienced professionals are better at dealing with

child protection issues.7. Children who were abused usually become abusers. 8. The child said his dad hit him. 9. I saw Peter playing with his toys when I last visited. 10. Mrs Green does not display appropriate parenting skills

when relating to her son

Assessments

Assessment work is complex and emotionally demanding

Collation and analysis of large bodies of information from multiple sources

Continuous series of mini-decisions about what to collect, how to collect

Each mini-decision has an impact on the assessment

Assessment Pitfalls

When faced with an aggressive or frightening family, professionals are reluctant to discuss fears for their own safety and ask for help

Attention is focused on the most visible or pressing problems and other warning signs are not appreciated

Parents’ behaviour, whether co-operative or uncooperative, is often misinterpreted

Not enough weight to information from family friends and neighbours

Not enough attention is paid to what children say, how they look and how they behave

In Cleaver, H, Wattam, C and Cawson, P Assessing Risk in Child Protection, NSPCC, 1998

Child centred assessment

The purpose of assessment is to understand what it is like to be that child or young person (and what it will be like in the future if nothing changes)

Assessment pitfalls

Rule of optimism

Start again syndrome

Natural love

Cultural relativism

Too much

not enough

Analysis

Studies (and SCRs) highlight problems in the quality and level of analysis

Assessments too static and descriptive, resulting in an accumulation of facts that are not analysed in a way that offers an explanation of the situation (Brandon 2008)

But what is analysis?

You have gathered lots of information but now what?

All you need to do is ask yourself my favourite question:

“So what?”

You have collected all this data, but what does this mean, for the young person, for the family and for the authority?

Analytic thinking

‘a conscious and controlled process using formal reasoning and explicit data and rules to deliberate and compute a conclusion’ (Munro, 2007)

‘Analysis should be seen as acting like a good secretary keeping a check on the products of intuition, checking them for known biases, developing explanatory theories and testing them rigorously’ (Thiele, 2006)

Intuition and Analysis

Intuitive thinking – unconscious process that allows the integrations of a large amount of information to produce a judgement in an effortless way

Gut feelings: ‘take advantage of the evolved capacity of the brain and are based on rules of thumb that enable us to act fast and with astonishing accuracy’ (Gigerenza, 2007)

Intuition versus Analysis

It is the combination of intuitive and analytic modes that produces the kind of evidence-based practice by which social work knowledge establishes its relevance, expertise and authority

Morrison 2009

Decision making, intuition and bias

‘Often a decision is made first and the thinking done later’ (Thiele, 2006)

As humans, we resort to simplifications, short cuts and quick fixes!

We reframe, interpret selectively and reinterpret.

We deny, discount and minimise We exaggerate information especially if vivid,

unusual, recent or emotionally laden and We avoid, forget and lose information

Good assessments are... Clear about the purpose, legal status and potential

outcomes Based on a clear theoretical framework Clear about context and value base Collaborative and promote accessibility for service

users Based on multiple sources of information Value the expertise and understanding service users

bring to their situation Clear about missing information

Good assessments… Identify themes and patterns Generate and test different ways of understanding the

situation Give meaning to themes, using knowledge based on

experience/research Lead to an evidence-based conclusion Use supervision to assist reflection, hypotheses and

objectivity Are able to record and explain outcomes Are reviewed, updated & amended in light of new

information

Learning from Past Experience Major themes from SCR reviews of the 90s:

Collecting and interpreting information

Importance of comprehensive family assessments, especially male figures

Failure to give sufficient weight to relevant case history

Understanding thresholds, especially the importance of neglect and emotional deprivation and the need to accumulate evidence











Assessment and analysis Suspected injuries and unconfirmed bruises over

limbs - not explained. Previous history of abuse by older sibling - off Child

Protection Register Single mother and new boyfriend Concern by school staff about negligence in hygiene,

clothing and school attendance Growth at the third centile - no medical reason Uncle visiting - ex-convict Mother was abused as a child Financial problems - on social security

Assessment and analysis

“He is a young boy who is confused about his current situation. Until the child care planning meeting confirms the long-term future plans for him he will effectively remain in limbo. This is affecting his ability to feel secure. He is noticeably anxious at school on Mondays prior to contact at home and he therefore learns very little on that day. By Wednesday of each week he calms down again”


Problems:

Unsupported assertions or judgements

Inability or unwillingness to analyse and draw conclusions


Summarise the main issues and the conclusions to be drawn from them. (The facts do not necessarily speak for themselves; it is your job to speak for them.)

Define objectives as well as actions Draw conclusions from the facts and

recommendations from the conclusions Explain how you arrived at your conclusions

(Have you demonstrated the factual/theoretical basis for each?)

Conclusions and recommendations In drawing conclusions be aware of the

extent and limitations of your own expertise. Conclusions may be supported by research

(Don’t go outside expertise; be careful with new or controversial theories; be aware of counter arguments)

Your recommendation should usually be specific (not either/or)

Remember: conclusions may be attacked in only two ways– founded on incorrect information– based on incorrect principles of social work

Inaccessible information

‘it may be that a contributory factor in the failure of various professionals involved in Victoria’s case to read the file was that the information was not presented in a sufficiently convenient and accessible way...This is one of the reasons why I regard the inclusion in any case file of a clear, comprehensive and up-to-date chronology as absolutely essential’

Inaccessible information

Files very long

Records very badly structured

Patterns missed and ‘chronic abuse’ overlooked

Capturing chronic abuse

Judging the quality of care is an essential component of any assessment but how well do we do it?

Judgements subjective and prone to bias

Intangible: Difficult to capture and compare

High threshold for recognition

Cumulativeness and acclimatisation

The pattern of neglect: atypical

The pattern of neglect: typical

Intervention Intervention

The pattern of neglect

'G ood enough' level


The pattern of neglect


'G ood enough' level

Intervention ceases

A pattern of decline

Cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE N

EGLECT

NEGLECT

NEGLECT

Failure of cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE

NEGLECT

NEGLECT

NEGLECT

NEGLECT

What’s the problem?

Chronic abuse and the principle of cumulativeness Incidents scattered through files

The problem of proportionality

Acclimatisation

Inclusive recording

How would I feel if this was written about me?

What would a lawyer make of this?

Managers not fully engaged

No comprehensive recording policy

No reading and signing of files

No recording of decisions and advice/instructions on files

Inadequate auditing

Micromanaging assessment and reporting

Format: Endless predetermined tick boxes and text boxes

Content: Repetitive and disaggregated

Concept: Routinised and mechanistic

Purpose: Well, what is the purpose?

?Understanding what it is like to be that child, and what it will be like if nothing changes

Micromanaging assessment and reporting

Recording guidelines

Be clear about the purpose of the record

Describes what has happened, what you have done and why

Complete and contemporaneous

Distinguish facts from opinion

Remember to be accurate, relevant and concise while still providing a complete record.

Use clear and unambiguous language.

Recording guidelines

Demonstrate assessment and judgment Use language that is respectful. Give due consideration to diversity issues Sign and date each piece of written

information, including messages. Be aware of confidentiality. Indicate who or where the information has

come from.

Involve service users at all stages

Managing the task Recognise importance, not just for the

agency but for the service user or carer. See recording as an integral and important

part of your practice. Plan your recording. Allocate time to record

and minimise interruptions and diversions. Record information as you go along. Don’t let

it build up! When planning a significant contact with a

family or individual include recording as part of your time allocation.

Legal underpinnings Data Protection Act 1998: Guidance to Social

Services, Department of Health, March 2000

Children and families should be:– informed of their right to access their records– encouraged to contribute to records and check

their accuracy – informed about information held about them and

when that information is to be shared with others– reassured of confidentiality and that their records

are kept in a safe, secure place

Confidentiality

All personal information is confidential Need to know One purpose Disclosure without consent

– to protect children, individuals or the public – to prevent, detect or prosecute a serious crime– to meet legal requirements, such as a subpoena.

Inform service users of disclosures Security of data

Framework for Assessment of Children in Need and their Families

‘a systematic way of analysing, understanding and recording what is happening to children and young people within their families and the wider context of the community in which they live’

( DH 2000)

Framework for Assessment



Stresses the need for interagency co-operation

Builds on responsibilities under section 47 of the CA 1989

Based on the following:

Legislative basis Protocols/procedures Lead responsibility Involvement of child and family Information sharing

Principles Child-centred Informed by child development theories Ecological in approach Equality of opportunity Involvement of child and family Builds on strengths as well as identifying

difficulties Interagency approach A continuous process (not single event) Grounded in evidence-based knowledge

Documents

Putting it onto paper: Recording and report writing