Learning together to safeguard children: developing a multi-agency systems approach for case reviews

Putting it into practice - Introduction

The success of the systems approach depends on translating into a logical process all the aspects of the theory described in Section 2. How to apply the model that we have developed is described in detail this section, but this summary of the process acts as a quick reference guide and shows accompanying tools that are available in the appendices.

The first pilots of the SCIE model have just completed in the North West of England. Initial findings are very encouraging. A report on this experience is available now. SCIE is collaborating with three other areas to conduct further pilots in order to develop, implement and evaluate the Learning together model.

Colleagues interested in being actively involved should contact Sheila Fish, Senior Research Analyst at SCIE - email sheila.fish@scie.org.uk, tel 020 7089 7110.

Findings from the pilots in north west England are now available.

Summary of aspects of the process and accompanying tools

  Aspects of process> Accompanying tool
Preparation Identifying a case for review  
Selecting the review team  
Identifying who should be involved  
Preparing participants Introductory letter (Appendix 1)
Data collection Selecting documentation  
One-to-one conversations

Example of explanatory communication to participants (Appendix 2)

Conversation structure (Appendix 3)

Organising and analysing data Producing a narrative of multi-agency perspectives  
Identifying and recording key practice episodes and their contributory factors

Template for table of key practice episodes (Appendix 4)

Framework for contributory factors (Appendix 5)

Reviewing the data and analysis  
Identifying and prioritising generic patterns Typology of underlying patterns (Appendix 6)
Making recommendations  

Attending to the quality of process: demonstrating a respectful attitude toward practice and acknowledging uncertainty

  • A respectful attitude towards practice is fundamental to the systems approach.
  • This includes acknowledging the lack of categorically right and wrong decisions and the prevalence of uncertainty.
  • To reflect this we suggest speaking of good and problematic practice and only a careful use of the words ‘error’ and ‘mistake’.

The systems model is a collaborative one. The review team should be aiming to make the review process as much of a joint exercise as possible. Those directly involved in the case under review, from across all agencies, need to be centrally and actively involved in the analysis. The quality of the learning depends largely on the extent to which participants can engage openly in the process. Consequently, reviewers need to take a fundamentally respectful approach to practice experience. 

Compared with engineering and health, the knowledge base of child welfare work is less developed. Much of the decision making is ‘moral and contestable’ (Taylor and White, 2006: 945). There are very few clear-cut standards of ‘correct’ performance that hold for every single child and family in every circumstance: ‘There will be some instances in which the “right” answer is clear, but there will be many others where a number of different actions could plausibly be followed, the “rightness” of which may only be retrospectively obvious (Taylor and White, 2006: 938). In recognition of this we suggest that reviewers use only a limited use of the language of error and mistakes, and talk also of good and problematic practice.

In this section