Normalisation in Practice

Residential Care for Children with a Profound Mental Handicap

Andy Alaszewski, Pauline BN Ong

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317360704
• Edition: 1
• Topic: Social Sciences
• Subtopic: Disabilities in Sociology
• Index: Social Sciences

First published in 1990, this book was the first informed study to focus on care within the voluntary sector. Written with the child in mind, it is a sensitive work which explores the administration, strategy, and problems facing carers in children's homes, at that time.

Centring on small, community-based facilities, the authors discuss the processes involved in setting up and running such facilities. They examine the difficulties of evaluating progressive services that are influenced by the philosophy of normalisation, and highlight the lessons from which other providers of services are able to learn.

Written by experienced researchers with contributions from service managers, Normalisation in Practice offers pragmatic advice on managing innovation efficiently without neglecting the needs of the child. Detailed interviews are combined with theoretical insight to provide an important guide for students and practitioners and a model for academics undertaking evaluative research. Although written at the start of the 1990s, this book contains discussions and material that are still very relevant to the subject today.

1 The Development of Residential Care for Children with a Mental Handicap

ANDY ALASZEWSKI AND HEATHER ROUGHTON

In this introductory chapter, we set the scene for our discussion of the Croxteth Park Project by examining the development of theory and practice of the residential care of children with a mental handicap. We divide our account into three sections. In the first we examine the development of residential care within child care services. In the second we consider the impact of these developments on children with a mental handicap. In the third we consider the development of normalisation as an alternative source of ideas for the theory and practice of care.

1.1 The Development of Residential Practice in Children's Services

Before the Second World War the initiative in developing care for children lay with the voluntary agencies, such as Dr Barnardo's and the National Children's Homes, which had, at the end of the 19th century, been concerned mainly with children who had been abandoned by their parents in the growing industrial conurbations. Services were mainly based on residential provision in institutions such as the "village developments" of cottage homes. Barnardo's Barkingside site was a classic example of this form of residential care. Children lived in houses under the care of houseparents. All their social, educational and spiritual needs were catered for in the village community through its homes, school, chapel and community centre. The children's lives were dominated by an institutional regime. For example they often wore a village uniform and were often discouraged from having social contacts outside the community.

The development of child care practice in the post-war period was influenced by the psycho-analytical studies of Burlingham, Freud and Bowlby. Burlingham and Freud researched the institutional nurseries that were set up during the Second World War. They stressed the importance of children's ties to their mothers for their emotional well-being and the damage which resulted from a disruption of these ties (Burlingham and Freud, 1944a and Burlingham and Freud, 1944b). Bowlby in his study of children displaced by the war (1951) argued that the mental wellbeing of children was dependent on the warm, intimate and continuous relationship with their mothers. He used the term bonding to describe the development of this relationship (1965 and 1979). In an article originally published in 1940 he stated that:

Prolonged breaks in the mother-child relationship during the first three years of life leave a characteristic impression on the child's personality. Such children appear emotionally withdrawn and isolated. They fail to develop loving ties with other children or with adults and consequently have no friendship worth the name.

(cited in Bowlby, 1965, p.39)

These studies were extremely influential in the development of child care practice. However, they had two, rather contradictory, effects on the development of residential care. They provided an impetus to and theoretical rationalisation for a change in the pattern of residential provision for children. If residential care was necessary, it should be provided in small community-based, residential facilities which would function as substitute homes in which children could develop warm supportive and stable relations with substitute parents. However, the work of Freud and Bowlby also tended to marginalise the role of residential care. Care outside the family was second best.

In 1944, Lady Allen of Hurtwood initiated a public debate about the nature of child care by publishing a letter in The Times calling for a public inquiry. She suggested that many children in care were

isolated from the main stream of life and education, and few of them know the comfort or security of individual affection.

(cited in Heywood, 1978, p. 230)

This debate was given added impetus in 1945 by the death of Dennis O'Neill while in the care of foster parents. The government decided to appoint an inter-departmental committee chaired by Miss Myra Curtis to review the care of children who had been deprived of normal home life.

The Committee broadly endorsed the finding of researchers such as Freud and Bowlby. They found that institutional care had a damaging effect on the development of children. For example, the Committee found:

in many Homes.... a lack of personal interest in and affection for the children which we found shocking. The child in these Homes was not recognised as an individual with his own rights and possessions, his own life to live and his own contribution to offer. He was merely one of a large crowd, eating, playing and sleeping with the rest, without any place or possession of his own or any quiet room to which he could retreat. Still more important, he was without the feeling that there was anyone to whom he could turn who was vitally interested in his welfare or who cared for him as a person. The effect of this on the smaller children was reflected in their behaviour towards visitors, which took the form of an almost pathological clamouring for attention and petting. In the older children the effect appeared more in slowness, backwardness and lack of response, and in habits of destructiveness and want of concentration. Where individual love and care had been given, the behaviour of the children was quite different. They showed no undue interest in visitors and were easily and happily employed in their own occupations and games.

(Curtis Committee, 1946, para. 418)

The Committee felt that care in a substitute family through adoption or "boarding out" was the best option for children who could not be cared for by their parents. However, it accepted that such placements were limited and therefore:

the need tor institutional care must be faced, with the aim of making it as good a substitute for the private home as it can possibly be.

(Curtis Committee, 1946, para. 476)

It was important that this care should provide children with the "warmth of affection and motherliness" (para. 344). Therefore the Committee recommended the establishment of small family group homes of a maximum of eight boys or girls.

The main recommendations of the Curtis Committee were implemented in the 1948 Children's Act. The Home Office took over responsibility for the development of services for children who had been deprived of normal home life. Children's Departments were established in local authorities to provide leadership in the provision of child care.

The new Children's Departments generally accepted the case against large institutions and in the 1950s developed alternatives. The group home model was one alternative that was particularly popular in the North-West of England. Heywood, in a history of child care, described these homes in the following way:

They are mostly to be found on post-war housing estates and they are indistinguishable in appearance from the rest of the houses there. They accommodate eight or less children who are in the care of a married house-mother paid by the local authority and whose husband goes out daily to his employment as a father normally does... These small Homes ... have the advantage of providing care which is very similar to that given in the foster-home - close feeling with the parent substitutes, closer attention to the personal difficulties of the children, and more consistent handling of them than can be provided in the larger Children's Home:

(Heywood, 1978, pp.170-1)

Although some Children's Departments developed group homes as an alternative to large institutions, in others the emphasis was on family placement through adoption or fostering. Initially the preference tended to be pragmatic; family placement was cheaper than residential care. However in the 1960s the criticisms directed at large institutions were increasingly directed at all residential facilities. As Jones pointed out in 1979:

From the 1950s onwards a new orthodoxy was becoming prevalent to the effect that residential establishments of all kinds were incurably institutionalizing and that we would therefore do better to try to keep people out of them.

(cited in Potter, 1986, p. 5)

Prosser summarised attitudes towards residential care in the mid 1970s in the following way:

in terms of bringing up children in circumstances that approximate most closely to those of a normal family, residential care would seem to offer the most costly and least beneficial alternative.

(Prosser, 1976, p.25)

Morris (1984) has traced the development of attitudes and policies in the 1970s from a position in which the family was seen as the best locus of care to one in which the family was seen as virtually the only locus of care. Morris cited as an example of this shift the following statement by Adcock made in a British Association for Adoption and Fostering publication:

No child should be deprived of an opportunity to grow up either in his own family or in a new family which he can legally call his own, unless there is a very strong reason to justify this.

(Morris, 1984, p.11)

Within social work, residential care tended to be marginalised. The main emphasis was on field work such as preventative work with families and the family placement of children. Residential placement was seen as primarily short-term; either to assess children or to prepare them for family placement. Only children who were difficult to place would require longer-term residential care. This marginalisation can be seen in report of the Seebohm Committee (1968). The Committee placed its major emphasis on the development of services with a community orientation. It "said little about residential work and even less about training for it" (Barr, 1987, p. 38).

By the 1980s, residential workers had lost self-confidence. The Barclay Committee on the role of social workers said it had seen "much evidence of competent, imaginative and innovative practice" (1982, p.55) and cited the pioneering work of Barnardo's in the 1970s. However it also accepted that there were serious problems, including the predominance of fieldwork assumptions, the assumption that family life is necessarily best, the high level of staff turnover and low proportions of staff with formal qualifications.

The Barclay Committee suggested that the dominance of fieldwork assumptions meant the contribution of residential workers to the care of clients was often undervalued:

When residential services are planned or evaluated the central importance of tending and nurturing ... is often overlooked. Sometimes treatment is regarded as the sole function of an establishment rather than as one component of life for those within it. Reviews of residents' progress may be dominated by fieldwork assumptions and thinking, playing down the insights of residential staff into personal issues such as religious choice.

(Barclay Committee, 1982, p.56)

The Barclay Committee also challenged the view that family life is always best;

Despite the emotional damage that may be caused within nuclear families, these family units are generally esteemed more highly than "institutions" by the public and fieldworkers. The saying "a bad home is better than a good institution", simple, yet misleading, still has its adherents. It is possibly for this reason that fostering is assumed unquestioningly to be better than other substitute placements, even though many residents in homes, including some we met, do not share this view.

(Barclay Committee, 1982, p.57)

It felt that residential care had a particular role to play, especially for

a number of deeply damaged children who cannot cope with the demands of fostering, and who can best be helped by very highly skilled residential work over a number of years.

(Barclay Committee, 1982, pp. 69-70)

Despite the recommendations of the Barclay Committee, residential work remains marginalised in most social service departments. The Social Services Select Committee in its 1984 report on children in care saw the position in the following way:

Residential care is going through an intensely difficult period, which may be optimistically typed as being a process of transition but less optimistically viewed sometimes looks like a gradual process of destruction.

(cited in Potter, 1986, p.4)

In 1985, the Secretary of State responded to the widespread anxieties about residential care by asking the National Institute for Social Work to set up a committee of inquiry. The Committee provided the following description of state residential work:

The Review was set up at a time when there was wide agreement that residential services, particularly in the statutory sector, were in a demoralised state, too often used as a service of last resort and seen to be of low status

(Wagner, 1988, p.1)

Comment

The development of child services has gone through distinctive phases. In the 19th century concerns about the care and control of children led to the development of institutional care. These institutions came to be seen as a problem and the next phase was the development of alternatives. Initially the alternative was smaller residential facilities but more recently it has been seen as community services such as family placement. In the next section we shall show that services for children with a mental handicap have gone through similar phases, albeit at a slower place.

1.2 The Development of Care of Children with a Mental Handicap

Until 1971 the services for children with a mental handicap had different financial, administrative and legal frameworks from services for other children. While Children's Departments of local authorities were moving away from the institutional provision of residential care in the late 1940s and 1950s, mental handicap hospitals remained the basis of residential provision for children with a mental handicap. Indeed as late as 1975, Tizard estimated that

in England and Wales about one-fifth (9,200 out of an estimated 45,000) of all severely subnormal children are in institutional care; 7,400 in mental subnormality hospitals and 1,800 in local authority, voluntary or privately run hostels.

(Tizard, 1975, p.53)

Successive governments were aware of the damaging effects of institutional care on children with a mental handicap. For example, the Curtis Committee found the existing provision for children with a mental handicap was "one of the most serious p...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Original Title
• Original Copyright
• Dedication
• Contents
• List of Tables and Figures
• List of Contributors
• Acknowledgements
• Foreword
• Preface
• Introduction
• 1. The Development of Residential Care for Children with a Mental Handicap
• 2. Researching the Croxteth Park Project
• 3. The Selection and Transfer of the Children
• 4. The Selection and Training of the Staff
• 5. The Selection, Purchase and Conversion of the Bungalows
• 6. Providing Child Care
• 7. Staff Management and Support
• 8. Relatives, Neighbours and Volunteers: Mobilising the Informal Sector of Care
• 9. Education and Health: Co-ordinating Services
• 10. The Psychological Development of the Children
• 11. The Children's Quality of Care
• 12. The Economic Costs
• 13. Lessons from the Croxteth Park Project
• Bibliography
• Index