Special developmental needs of children in relation to childhood disability and critically evaluate, the role of social work in meeting these needs
Disabled children face multiple barriers making it difficult for them to achieve their developmental outcomes. Social Services have a legal duty under The Children Act 1989, section 17, to identify, safeguard and promote the welfare of children who are in ‘need’. ‘Children in need’ is defined in developmental terms and disabled children are included in this category because their disability poses a vulnerability such that they are unlikely to achieve a reasonable standard of development without the provision of services.
Despite the legal duty placed upon on the role of the social worker to promote their development and well-being, disabled children and their families report a high level of unmet needs, stress, isolation and 24% of disabled children live in poverty. Out of 4% of the families who are supported by social services, a report by the Audit Commission in 2003 found that services and social work support are a ‘lottery of provision’ and rarely based on the ‘priorities and needs of individual families’.
This essay will critically examine the role of the social worker in meeting the ‘special’ developmental needs of disabled children. Models of disability: From the medical model to the Assessment Framework The way disability is understood and defined determines how the developmental needs of disabled children will be assessed and met by social workers. The traditional medical model of disability locates the disability within the child and in his/her limited physical functioning and psychological losses. This model explains that disabled children are disadvantaged because of their impairment.
Services and social work intervention focuses on correcting the child’s impairment to restore normality and normal development. At odds with anti-oppressive and anti-discriminatory social work practise, this model considers disabled children as ‘victims of biological tragedy’ (Shakespeare & Watson, 1998) and their ‘special’ developmental needs as a direct consequence of their impairment, whilst ignoring other development needs such as inclusion and participation in the social world, building relationships and healthy development of identity.
Thus, the medical model, Thompson (2002) argues not only fails to challenge discriminatory assumptions of disability, but is also in danger of pathologising disabled children as defective whilst ignoring the cultural and structural oppressive forces that hinder their developmental process. In contrast to the medical model, the newer social model, underpinned by the concept of ‘disablism’ locates disability in the disabling cultural and structural forces that marginalise, oppress and exclude disabled children from participating in mainstream activities that facilitates their development.
Thus, a distinction is made between an impairment and disability; the former being a physical limitation and the latter being the disabling environment that excludes the disabled from mainstream society. The term ‘special’ developmental needs of disabled children becomes questionable under this model. Thompson (2002) argues defining disabled children’s needs as ‘special’, draws ‘an arbitrary line between those with an impairment and those without’ and can itself be disabling.
Thus, the social model highlights that the developmental disadvantages faced by disabled children are rising out of their marginalised status in society and their restricted citizenship rights and not because of their physical impairment. Social workers working within this model, will meet the disabled children’s developmental needs by removing barriers to accessing mainstream services such as schools, social organisations and by challenging structurally discriminatory practises that seek to exclude disabled children.
However, social work intervention under both models are limited in scope; the social model neglects the child’s physical impairment whilst the medical models ignores the structural oppressive forces that ‘dis-ables’ and excludes the child from mainstream society. A holistic and an integrated assessment of need is provided by the Framework for the Assessment of Children in Need and their Families (2000).
The Assessment Framework which is based on the Ecological Approach moves away from the dichotomist positions taken by the social and the medical models, instead it seeks to understand disabled children’s lives within the context of the child’s family and of the community and culture s/he is growing up in. A social worker undertaking an assessment using the Assessment Framework will consider the stresses and supports for the child and will also emphasis the child’s subjective experience of his/her disability.
The Assessment Framework is tri-dimensional; it focuses on the child’s developmental needs, the carer’s parenting capacity to respond to those needs and the wider family and environmental factors whilst also considering how these factors will interact with each other. The Assessment Framework identifies seven dimensions of ‘universally recognised’ (Howarth, 2002) child development needs which all children should progress along if they are to achieve well-being in adulthood.
The developmental needs are; health, identity, family and social relationships, social presentation, emotional and behavioural development and self-care skills. Although, the criteria for normative development may not apply to children with extensive disabilities, attempts to identify ‘special’ developmental needs may not be possible whilst also being discriminatory as it may promote the assumption that disability in one area will restrict a child’s developmental progress in others.
For an example, learning difficulties may restrict a child’s cognitive development but not his/her physical development and therefore developmental needs at a physical needs will need to be age appropriate. This is also keeping in within the legal framework of The Children Act 1989, which recognises that all children are ‘children first’ and services should be responsive to basic child care principles, despite the level of disability. Parenting capacity and family and environmental factors
Within a supportive and caring family children’s universal need for being loved and valued as well as most other developmental needs will be met. Thus disabled child’s family environment will have the most ‘powerful and long-lasting’ (Howarth, 2002) influence over his/her development and future life chances. The Assessment Framework regards the parent’s capacity to meet their children’s developmental needs as; basic care, ensuring safety, emotional warmth, stimulation, guidance, boundaries and stability.
Emotional development, one of the key developmental need of children is determined by the quality of attachment the child forms with his/her primary caregiver. Attachment theorist such as Ainsworth and Bowlby will explain that children construct their inner working model based on their interactions with their parents which becomes part of their personality providing a prototype for later relationship; thus impacting on their social development too.
Parents with disabled children may find their child’s disability disappointing and difficult to deal with and in some cases this may affect the quality of attachment developed. At the same time, Bee (1997) points out the child’s disability can reduce its repertoire of attachment behaviours such as smiling, eye contact, responsiveness to care which can also hinder the ‘affectional’ bonding process between child and care giver. A failure to develop a secure attachment with the primary care-giver leaves the disabled child with a higher risk of abuse.
Research evidence suggests that for disabled children there is a real risk of abuse as they are three times more likely to experience abuse than non-disabled children. (Bee, 1997) This will have an important implication for the social worker’s assessment of the attachment relationship between the child and carer. At the same time, research evidence suggests that parenting capacity of parents/carers is significantly reduced (and in some cases leading to child abuse) when life conditions are highly stressful. Bee, 1997)
Caring for disabled children places demands on parents that exceeds what is expected of parents of non-disabled children. Looking after a child with disability can be physically exhausting, time consuming, complicated and emotionally difficult. Not surprisingly, research evidence identifies that families with disabled children experience high levels of ‘stress, psychological and physical’ problems. (Oliver, 1991) In addition to this, for instance the need for specialist equipment and housing adaptations to meet the child’s physical needs will add a financial strain on the family’s budget.
Research evidence points to a strong correlation between poverty and poor developmental and health outcomes and 24% of disabled children in the UK live in poverty. (Audit Commission, 2003) Thus, cumulative effect of adverse circumstances faced by families with disabled children will increase the likelihood of the child’s health and development becoming impaired. In recognition of this, the carers and Disabled Children Act 2000 provides parents the right to receive an assessment of their own needs, including the need for help in the home.
Equally, the role of the social worker under the Assessment Framework and the legal confines of The Children Act 1989, which places a duty upon the social worker to promote the upbringing of a child within their families will need to be based on the principles of partnership and empowerment. An holistic social work intervention that is inline with anti-oppressive social work values will aim to strengthen parenting capacity by working in partnership with parents to address their emotional and physical capacity to meet their children’s developmental needs.
Howarth (2002) argues a failure to address the wider needs of the parents, limits the extend to which the child’s welfare can be promoted within the family and the child’s ‘protection from abuse cannot be assured’. In practise, however, research by Middleton (1998) points out that social work intervention tends to focus on the tangible physical needs of the parent’s whilst ignoring their emotional needs and hence their emotional capacity to meet their children’s needs.
One parent speaks of the lack of emotional support from her social worker thus; ‘If I could ask for something, I would ask for someone to listen to what we are saying’. Middleton, 1998) The limited scope of current social work practise confined to meeting the physical needs of parents also extends to those that of the child’s. One mother speaks of her child’s social worker thus; ‘she always asks how he is, is he sitting up yet… never is he happy’ (Middleton, 1998). This type of social work intervention echoes the medical model of disability discussed earlier in the essay where all other developmental needs expect the physical needs of the child are ignored.
Perhaps, as argued by Middleton (1998) this is a symptomatic of the culture of statutory social work practise which is ‘more bureaucratic rather than family casework’. More worryingly, majority of families with disabled children are excluded from having any social work support at all as only 4% are supported by social services. The Audit Commission (2003) reports that most disabled children and families are considered ineligible for services based on ‘arbitrary decisions’ and generally either the ‘most articulate’ or the most ‘troublesome’ family get services.
The OPCS report found that a significant number of disabled children who came to be under the care of the local authority could have remained at home had the supportive services been made available to their families. Families in desperate need of support are forced to exaggerate their child’s level of impairment to secure social work support which Middleton (1998 ) argues ‘creates a vicious dynamic which not only pathologises the family as abnormal, but casts the child in the role of a family burden’. Being considered a ‘family burden’ will adversely affect the disabled child’s development of identity and self- esteem.
Social exclusion: Impact on disabled children’s developmental needs A vital part of developing a healthy identity depends on a child’s sense of being valued, respected and listened to. Children are likely to feel confident if they feel accepted by their family and by the wider society, which will help them develop a strong sense of individuality and a confident view of their abilities. Equally, a child’s social development depends on his/her opportunity to participate in the social world and build social relationships.
Taking in part in play, youth and leisure services which are vital to cognitive, social and emotional development of a child are not a given for disabled children as they are for their non disabled peers. Research evidence suggests 35% of disabled children in comparison to the 12% of the non-disabled children mentioned loneliness, lack of social confidence, poor self esteem as a problem as well as ‘high incidence of depression and a feeling of stigma and rejection because of their disability’. Oliver,1991)
Research by University of York (2007) into disabled children’s participation in social services reveals that social workers are also adding to the marginalised status of disabled children. For an example, going against the legal requirement under The Children Act 2004, which re-enforces the child’s rights to be listened, the social workers working in particular with disabled children with communication impairments did not involve them in care planning.
The research concludes with recommendations for social workers to undertake training in methods of communication with children who do not use speech. Concluding thoughts: The way forward The social model of disability discussed earlier in the essay provides a framework for understanding the substantial barriers to participation in the every activities faced by disabled children which will hinder their developmental progress and life opportunities.
Empowerment rather than ‘adjustment'(Thompson, 2001) is becoming aware and then challenging social work practises that ‘objectifies’ (Beresford & Wilson,1998) disabled children, by making them social work cases to be worked on. A progressive and inclusive social work practise grounded in anti-oppressive values will be based on the premise of partnership, where disabled children are viewed and treated as equal citizens. A key element of citizenship is participation.
This begs the question as raised by Beresford & Wilson (1998), ‘ If the aim is to address, indeed challenge, social exclusion, then is there not a fundamental problem if those included in the category are not fully included in the discussion about it? ‘ Social workers have a valuable role to play in this process. By enabling disabled children to have their voices heard and their needs expressed through channels such as social service’s participation panels and service user consultation, disabled children can themselves challenge discriminatory social work practises that do not meet their developmental needs.