The Osiris Handout: "The Meaning of Analysis"

The following is a fragment (taster) from the The Osiris Meaning of Analysis handout which is supplied to all participants on Analysis and Assessment training. A special version of this Guide is supplied on Court Work & Court Process training where it is called The Osiris Guide to the Language of Evidence.

IMPROVING OUTCOMES FOR CHILDREN – FOOD FOR THOUGHT

What is meant by outcomes?

What is meant by improving outcomes?

Defining an outcome – various outcome models available and most are not very good

Predicting outcomes – non-intervention and intervention – what will happen?

Strategic Children’s planning (housing, education, oppression, CAMHS etc)

Societal issues which affect outcomes – e.g. Bebbington and Miles, race issues and Care Service planning (fostering, individual case planning)

Good and bad outcomes

How prevalent are bad outcomes in what we do?

Examples: death on caseload p = 0.0067% which is a gross over-estimate; Looked After Child leaves caseload for mental hospital, prison, homeless, unemployable or adult person known to SSD re childcare problems approx probability = 40%. Now that is a bad outcome!

Why do we get bad outcomes? Answer is how we deal with false negatives and false positives, error theory and resultant resource allocation in social care or rather how it isn't dealt with.

The role of Attachment Theory as a suitable measure of emotional significant harm

Planning the base for improving outcomes

Assessment the base for the plan – each dimension / sub-dimension MUST be baselined in terms of what is happening NOW and the “similar child test” used to compare what would’ve been if parenting were “good enough” with what is now. The analysis is the story of how and why.
Analysis and Assessment - Junk in – junk out is too often what is seen in reports.
Using knowledge and theory to predict what will happen if we do nothing and timescales to this set of outcomes
Using knowledge and theory to predict what will happen if we do THIS or THAT etc
And the timescales of achieving desired outcomes. Can the child afford to wait?

Quality of analysis is the key

Knowledge and skills of Change work the key to improving outcomes – JUNK IN - JUNK OUT
Co-operational and motivational assessment – neglected altogether or assumed as easy and it most certainly ain’t.
Types of change work – family / individual / practical
Intervention Methods: Behavioural, Psychodynamic, CAT, CBT, Brief Therapy, NLP, family therapy variants, medical model (pharmacology), contracts and agreements, addiction programmes, community based interventions etc
Who does the change work? Do they know enough? Are they skilled enough?
Supporting the change agent(s) – exactly as above.
Factors of success of change work – and back to outcome models and evaluation.
qualities of the change agent (most important of all)
supporters of change agent supervision (e.g. managers, social workers
consistency
planning (detail outcomes

WRITING REPORTS:

1 FACTS

a) Accuracy

b) Interpretation

c) Observable / empirical

d) Completeness

Inaccurate facts are not facts – check them all. A fact on its own is quite meaningless – it is up to you to interpret its significance using practice wisdom, research or theory. What is seen, heard, felt, tasted or smelt counts for more than any other kind of evidence. Included in this is empirical (looking at the real world) research evidence. Be as complete as you can. Facts that are half-interpreted will not impress. Don’t forget to include strengths. It is sheer bias if you leave them out.

2 NUMBERING

a) Separate out the facts and arguments

When writing a report for Court always use paragraph numbers even if you also use headings. Each paragraph should have its own unique number. Within each paragraph use numbering / lettering to make points but don’t overuse this technique.

3 ALTERNATIVE INTERPRETATIONS

a) Predict other side’s arguments

b) Have counter arguments or evidence ready

What counter examples are the other side going to come up with? If you were in their shoes how would you go about demolishing your own case? Think Possibility! If you don’t – they will. Collect your alternative hypotheses and gather your counter- arguments and evidence. And change your mind if they are right and you are wrong!

4 VAGUE TERMS

a) Jargon

b) Behavioural statements

c) ‘Hey Judge, come and look / listen ....’

Don’t use jargon, or if you do, explain what it means in ordinary language. Better not to use it in the first place. Don’t use nominalisations (conceptual terms) when talking about behaviour. “Tommy’s behaviour improved”. How did it? What did you SEE relative to what you SAW before? What you doing is inviting the reader to see what you saw, hear what you heard, feel what you felt and so on. Use what the Neuro Linguistic Programming (NLP) therapists call sensory based language (see, hear, feel, .taste and smell) when describing your evidence and you won’t go far wrong but don’t neglect to interpret evidence either.

5 INTERVENTIONS

a) Value

b) Prior experience

c) Less drastic

What was good about the intervention? Was it better than no intervention? How? Why? What was there before? Was this intervention the less drastic alternative than leaving things as they were? Was it the optimal intervention? If not, why not? Answer all these points.

6 THEORIES

a) Falsifiable

b) Demonstration

c) Definitions

d) Statistics

Sir Karl Popper (1959) in his The Logic of Scientific Discovery said that if a theory is not falsifiable then it is not a proper theory at all. Many have claimed that Marxism is not a proper theory by this standard and some have said the same about Freud. Popper’s dictum is very highly thought of in scientific and legal circles so be wary about using controversial theories. Does your theory help demonstrate your case? If it doesn’t why are you using it? Does it enable the case to be located easily within the theory’s basic definitions? Is there (empirical) statistical information available to support your claims?

7 FUTURE

a) Expectations

b) Action

c) Rationalise

This is the risk question. What is the outcome going to be? Have baseline outcomes been clearly delineated? What will happen if nothing is done? What will happen if your plan is adopted? What will happen if an alternative plan is adopted? What makes your plan better than other plan(s) that might be proposed? Now do you see why you have to consider all the options? How will you action your plan? Who does what, how, when and where? What happens if it all goes pear shaped (this is why you need a contingency plan)? What is the overall rationale behind your plan?

8 CREDIBILITY

a) Objectivity

b) Experience

c) Reasonable

Have you ensured your objectivity? How have you done this? What is your level of knowledge / experience in dealing with this type of case? Is it sufficient? If not, what steps have you taken to nullify or at least mitigate your inexperience? Have you being reasonable? Is what you propose reasonable?

9) STRENGTHS AND WEAKNESSES AND RISK ASSESSMENT

Strength = positive benefit = positive risk (strange way of talking but true)

Weakness = negative disbenefit (harm) = negative risk

The above represents one of the most profound misunderstandings about the nature of risk and which bedevils virtually all social care understanding on what risk is. When you do a “Risk Assessment” do you list “risk factors” – a list of negative possibilities? Yes? Many social care workers do this. It is completely wrong! A professional risk analyst would throw this “assessment” back at you and tell you to do it again but properly this time. It is only HALF an assessment! Assessing the strengths has to be done because sometimes strengths can mitigate weaknesses. This is particularly the case for weaknesses by omission. For example, one parent not doing something they should but which is mitigated / cancelled by the other parent or another member of the family circle. Sometimes, the overall strengths of the family are so great that, all considered, the weight of the strengths is judged to mitigate the one incident of weakness e.g. in a single incident physical harm case. Furthermore, knowing which strengths exist means that the family can be given credit; and lastly, knowing about strengths might mean some can be utilised within interventions.

The analysis: "Weaknesses minus Strengths = Weaknesses left over" is the Assessment (as it is normally understood) of negative possible harms. It requires more than this, however, to be a “risk assessment.” What is required is a determination of the probability of the possible harms – which might not be the same in each case. (see Note on Probability earlier - not in this "taster"). For example, a one off single incident physical abuse case but which is also characterised by constant criticism of the child might have a low probability of further physical harm but a high probability of further emotional harm.

In any event, two things need to be determined:

1) What is the probability of harm(s) given no intervention.

2) What is the probability of harm(s) given intervention?

Various timescales need to be considered. Immediate or near harm, shorter term (months) and then longer timescales – 2 years, 5 years and 10 years or more given the age of the child. Bear in mind that emotional harm will take between 3 – 7 years before its inevitable impact may become “significant”. But by then, it is too late.

The usual procedure is to scale the level of your subjective (justified by evidence) degree of belief about the mooted outcome:

0 – 9%

10 – 19%

20 – 29%

30 –

39%

40 –

49%

50 –

59%

60 –

69%

70 –

79%

80 –

89%

90 –

100%

If you do this, you have an objective "realisation" of your subjective belief and you can argue for it and be challenged on it. If you just say “I’m reasonably certain” or “I think it’s likely” who knows what you mean? I don’t – does the service user? Does anyone apart from you? Such scaling is rarely done in social care but is considered mandatory by professional risk analysts within industry. Indeed, a business planning meeting (e.g. Case Conference) would not be allowed to proceed unless all participants engaged in scaling their judgements. So why don’t you? Yes, you must evidence your scaling. What are your reasons for your belief? The lessons from Brief Therapy tell us that service users value this and it enables a productive discussion to be had on differing perspectives and what might the family do to change your scaling? In other words, it gets you right into the intervention plan which is the whole (and ONLY – leaving aside no action) purpose of the assessment!

10) DYNAMICS AND SYSTEMS:

A major fault with assessments is that they tend to be static and descriptive. The analysis should show the dynamics of inter-relationships. When we used the example of Tommy earlier (not in this taster) we referred to the dynamic interplay of repeated emotional abuse. Please remember that it is the emotional component of physical, neglectful or sexual abuse which screws children up much more than the (physical aspects) abuse itself. It is emotional harm which causes (in the longer run) the MOST harm leaving aside cases of fatal or disabling injury. Note the finding of Glaser et al (2001) that emotional harm cases stayed on casework files an average of 4.06 years before CP registration. In terms of Attachment Theory the damage has all been done by this time. Any worthwhile intervention is going to be harder to achieve by several orders of magnitude.

Genograms are very useful tools to represent and analyse dynamics within family systems. Genograms should not simply be seen as “handy diagrams” with which to preface a case file. A genogram is a tool which is primarily designed to be used by you WITH family members. The symbols of genograms which are most useful in terms of representing dynamics are those which indicate substance abuse / mental illness and, in particular, those symbols which characterise relationships between people. You need to say WHY you characterise as you do and this is where theory knowledge is again useful. For example:

Close relationship: this might indicate a secure attachment or something which goes beyond this. You will need to evidence (all the better in discussion with the service user) what it is that brings you to believe that the relationship is “close” . A closed but hostile relationship would indicate high levels of ambivalent attachment (dependent but hateful in part).

A “Fused Relationship” is something which has gone well beyond “closeness” and might be indicative of high levels of insecure attachment (can manifest in avoidance or ambivalence attachment) where behaviour is especially placating (avoidance) or highly emotionally (ambivalence) dependent. “Fused hostile” would indicate serious insecure attachment which is likely to be ambivalent but not necessarily so. For instance, an avoidant partner might feel trapped in a relationship. Distrustful and hostile relationships can be represented on their own but note the reasons why.

“Focused on” is an indicator that picks up on scapegoating or any “over attention” on a person. “Cut off” is the inverse of this where a focus exists but the person is “frozen out” of the relationship. This happens in cases that exhibit what Gregory Bateson (1957), in his causal communication theory of Schizophrenia, termed “marital schism” or “marital skew”. In the former, a partner is “cut off” and in the latter, the partner is “diminished” or “elevated” in importance to a distorted level.

Attachment Theory may enable you to evidence how and why you think this. You don’t have to use Attachment Theory. You can use Cognitive Behavioural Theory, Psychodynamic Theory or some other theory that encapsulates psychological functioning. You can use the systems definitions on their own. But don’t forget the interplay with environment either. How does the school figure in terms of the functioning of the family system, neighbours, community resources, finance and so on?

Remember what was said earlier about mono-causal and multi-causal explanation. Family problems are almost never mono-causal. Read the strengths / weaknesses comparisons within the Framework as linked dynamic sub-systems linked to dimensions and then to domains and use them to explain and predict non-intervention and what you need to do within interventions to correct weaknesses.

11) NEW FACTS

Always be open to new facts and new interpretations. A CLOSED MIND IS A STUPID MIND. More than one child has died because of fixed viewpoints. See Error Theory.

Click here to return to Child Care Courses