4. Thinking the Unthinkable

It is difficult to see opportunities consequent upon the dire economic outlook. What might be good for children will be bad for somebody else, whether in terms of jobs or salary or simply having to work in a different way.

Most of what we have presented to date in this series of blogs about cutting and learning have been silver linings to relatively benign clouds.
 
But thunderstorms loom. What benefit can we draw from them? Part of the challenge in children’s services in the next five years will be to think the unthinkable.
 
In an article in the journal Adoption and Fostering we have asked the question about the necessity of traditional children’s services such as foster and residential care. Could we do without them altogether? In a way the question is meant to be rhetorical, getting the reader to reflect on how much state care we really need. But maybe it could be eliminated altogether?
 
There are even stronger candidates for a radical re-think in the social care world. There is much affection for Family Group Conferences but what little outcome evidence exists suggests that they produce worse, not better, outcomes for children. Can they be supported in difficult economic times?
 
Another sacred cow could be universal health visiting for newborns. Many parents must feel an emotional connection to their health visitor. But how much value is added to the lives of competent families?
 
Perhaps it is time to try innovation through subtraction, or what we call a ‘reverse RCT’ - described more in our next contribution to this blog. Basically it is an experiment where a universal intervention is removed at random from potential beneficiaries. If the trial finds that children or parents suffer as a result of being denied a health visitor then there is proof of benefit. If not, there may be ground for diverting some of the resources elsewhere.
 
How about trying something similar with the arrest of young people? There is reasonable longitudinal evidence indicating that arrest increases anti-social behaviour in adolescence. Many young people offend. Few are caught. More of those who are caught continue their delinquency than those who evade the police. How about reducing arrest rates in some constabularies to see what happens not only to crime but to underlying patterns of anti-social behaviour?
 
A more threatening proposal still might be to select the workforce on their ability to deliver better outcomes for children. We know from studies into fidelity of implementation that there is considerable variation in practitioners’ ability to deliver a proven model such as Cognitive Behavioural Therapy or Functional Family Therapy.
 
Moreover, even when some well-trained and committed practitioners do as they are asked they still fail to achieve good outcomes. Should this evidence be taken into account in deciding on how to scale back the children’s services workforce?