British Journal of Social Work (2009) 39, 435450

doi:10.1093/bjsw/bcm150 Advance Access publication February 22, 2008

Identifying Families with Multiple Problems: Possible Responses from Child and Family Social Work to Current Policy Developments
Trevor Spratt
Dr Trevor Spratt is Director of the Batchelor of Social Work (Relevant Graduate Route) and a Senior Lecturer in Social Work at the School of Sociology, Social Policy and Social Work at Queens University, Belfast. Correspondence to Dr Trevor Spratt, School of Sociology, Social Policy and Social Work, Queens University Belfast, 6 College Park, Belfast BT7 1LP, Northern Ireland. Email: t.spratt@qub.ac.uk

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Summary
In the development of family policy under New Labour there has been a growing tendency to identify groups who are likely to be high in lifetime costs to the state. Investment in such groups is seen as crucial. Whilst the economic case for current investment is compelling, idenitiying one of these groups, families with multiple problems raises complex research problems and ethical issues. Reseach indicates that families with multiple problems may be identified on the caseloads of child and family social worker and there are claims that key events such as the registration of a child on the child protection register may indicate such multiple problems. This offers new opportunities for child and family social work to embrace less incident based ways of working in favour of longer term provision of services to address longer term risks. Keywords: child welfare, social policy, child protection, investment state

Introduction
In the ten-year span of the New Labour Government, social policy with respect to children and families has moved beyond an initial concern with modernization and efficiency to establishing a much more ambitious set of goals which co-join social and economic agendas in a future-orientated investment strategy, informed by social science research and economic

# The Author 2008. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.

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theory (Lister, 2003). In identifying sub-populations who are predicted to be high in social and economic costs and low in the production of social and economic capital, the tone of the debate surrounding the socially excluded has shifted from one of intervention as moral good to economic imperative (Skinner, 2003). The philosophical antecedents to this shift may be found in the work of the social and economic theorist, Anthony Giddens (1998). His Third Way thesis, wherein requirements for economic growth and social protection might be developed within a new set of relations between government and citizenry, has more recently received new impetus via developments in social science research and in economics which have made the future more calculable. Current developments in New Labour social policy are concerned with the identification of high-cost and low-productivity populations, targeting these with a series of investment strategies which co-join social and economic goals within a fiscalized social policy (Bashevkin, 2000, p. 2). In line with the Third Way principle of no rights without responsibilities (Giddens, 1998, p. 65), such investment strategies are characterized by both incentivized and punitive interventions. This has heralded a new kind of interest in the population receiving the attentions of child-care social workers. Where once the governing concern was for social workers to differentiate between a minority of actual and potential child abusers (wherein the key task was to protect children from abuse) and the majority of families who required some form of support (where interventions were designed to be helpful but often had nebulous goals), harm to children is now located as much in the future as it is in the present and is diffused over a greater range of signifiers (James and James, 2004). In relocating the risks with regard to children away from narrow concerns to prevent the occurrence or reoccurrence of abuse, and within a more sophisticated appreciation of how the experience of present problems may be associated with poor outcomes across a number of domains in later life, the social policing function of social workers (which grew out of and was sustained by concerns on the part of the public to manage the phenomenon of child abuse) becomes subsumed within new priorities to strategically invest in children and families. This raises a number of questions, among them: Where are social workers located within strategies to invest in children and families? How well placed are social workers to manage both present child protection priorities and future-orientated investment strategies? The answers to these two questions provide some speculative indication as to whether or not child and family social work will collapse into a narrow residual niche concerned with the management of child abuse or become part of a much wider inter-professional enterprise identifying high-cost/lowproductivity populations, providing intervention and tracking outcomes over time and across domains.

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The social investment state

A number of social work academics have located current social policy with respect to children and families within the theoretical framework of the social investment state (Fawcett et al., 2004; Featherstone, 2006; Parton, 2006). Derived from a term used by Anthony Giddens, it refers to investment in human capital wherever possible, rather than the direct provision of economic maintenance. In place of the welfare state, we should put in the social investment state, operating in the context of positive welfare society (Giddens, 1998, p.117). At its heart, it represents a linkage of social and economic projects (Featherstone, 2006), signalling a shift from investment in the demand side of the economy (a key feature of Keynesian economics) to the supply side. This involves creating a workforce ready for participation in a global economy characterized by fluctuating markets, rapid relocation of capital and demand for workers prepared and able to adapt to changing conditions and requirements (Jenson and Saint-Martin, 2002). With the state unable to control the global economy, the best it can do for its citizens is to prepare them for participation in the global marketplace. Whilst the old welfare state sought to protect people from the market, a social investment state seeks to facilitate the integration of people into the market (Fawcett et al., 2004, p. 41). In the Third Way, the task of the state is to prepare people for the market as well as protecting them from its vagaries. Social and economic policy consequently becomes co-joined in a symbiotic relationship of codependency. As a recent Irish Government publication put it, several of the major improvements in social protection now required to address peoples needs more effectively will prove to be economic assets and contribute directly to reinventing the economy; for example, ending child poverty, stemming educational disadvantage, tackling social exclusion. . .. In fact, the boundaries between traditionally separate economic and social policy domains have become increasingly blurred (National Economic and Social Council, 2005, p. xiv). Central to this strategy is a realignment of the relationship between the state and its citizens, reflecting, especially in the UK context, no rights without responsibilities (Giddens, 1998, p. 65). Within this notion of conditional entitlement is the idea that citizens need to be proactive in seeking employment, with the role of government being to help build economic and social capital through a series of investment strategies, whilst reducing the welfare functions of the state from the meeting of needs to the more limited management of risks (Giddens, 1994). This is achieved through parallel developments in economic and social policy, such as changes to the tax and benefits systems, designed to make work pay whilst ensuring that citizens receive lifelong education and training opportunities to enhance their employability in a changing marketplace (Jones-Finer, 2004).

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Within the social investment state model, it is recognized that some groups are restricted in their ability to utilize economic and social opportunities. Consequently, much of New Labour policy has concentrated on particular investments in socially excluded populations. These range from general support for all parents with children, through changes in the tax and benefits system, specific and targeted help for poorer families to enable their participation in the labour market and special initiatives targeted at disadvantaged children who are at particular risk of social exclusion (Lister, 2003). This last group of children have been in receipt of a number of community-based service initiatives designed to offer particular help at different stages of their development. The Sure Start programme is designed to offer extra help to children prior to them starting school, the Childrens Fund is targeted at specific initiatives to help children in the five-to-thirteen age range and Youth Connexions helps with the transition from education to work (Millar and Ridge, 2002). The targeting of such services to communities most at risk of social exclusion is in line with Kamermans (2005) observation that the issues tend to be framed as social and community exclusion. Whilst those who live in such communities may derive benefit from targeted service provision, Buchanan (2007, p. 200) has cautioned that We need to remember that many disadvantaged families are just beyond the reach of zoned areas and have limited access to new services. Consequently, there is a need to develop new ways of identifying those families not captured by community-based initiatives, often involving a refocusing of existing services to recognize constellations of problems in families already known to a range of service providers (Axford and Little, 2006). These developments reflect a recognition of the consequences of social exclusion for children including poor educational attainment, poor health, increased risk of criminal behaviour, increased risk of unemployment in the future, and economic deprivation (Mason et al., 2005, p. 132). As Esping-Anderson (2003) has noted, such investments are central to a strategy of increasing concentration on targeting investment on children, with their early years seen as particularly important. In a model shaped as much by economic as social considerations, return on investment is crucial to the calculation, as investments made in the present may only be realized in the future (Jensen and Saint-Martin, 2001). Whilst the notion of investment in children is not new (Hendrick, 1994), in modern times, it has acquired a more central place in social policy. Holtermann identifies the essential duality of such policy, designed to produce mutual benefits. Todays children . . . are tomorrows adults, and investment in our children is an investment in our future as well as theirs. Investment in children will determine the shape of Britains future society and economy (Holtermann, 1996, pp. 4, 9). Children, who are most malleable and possess longer potential futures, consequently become the primary investment site, as the benefits of investment are repaid over an extended time in economic

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productivity and reduction in cost to society through decreased demands on services, including health, social security and criminal justice (Kurtz, 2003). Consequently, identifying which children need extra help becomes an imperative. This is not simply because such children will need extra investment to become productive workers of the future, but more negatively, to prevent them becoming citizens who disproportionately demand much of the future share of service provision. In New Labour rhetoric, there has been a diminution on the privileging of particular family forms and concentration on the task of parenting as key to investment strategy (Fawcett et al., 2004). However, Daniel et al. (2005) note that the contexts in which contemporary parenting is carried out and the differing positions of mothers and fathers which can render the use of gender term such as parent problematic (Daniel et al., 2005, p. 1344). Key to such differences is positioning within the labour market, where women are expected to be in paid employment despite disproportional child-care responsibilities (Featherstone, 2006). The tendency to wrap up issues of gender, ethnicity (Doherty et al., 2003) and other differentiating features in the broad sweep of policy has the effect of neutralizing these within a discourse that privileges the identification of sub-populations experiencing multiple problems. Recent policy developments have made it clear that there must be prioritization of service provision through a process of differentiation of particularly problematic sub-populations and targeting these for special intervention (Blair, 2006). The Government, as elaborated in the Every Child Matters (Department for Education and Skills, 2003) agenda, envisage a three-tier system of service delivery, with universal services such as health visiting and early years services located at a universal level; targeted services for families with identified needs (for example, help with speech and language) and more complex problems (for example, parenting support) at an intermediate level; and specialist services (for example, social services for children at high risk) located at level three (Department for Education and Skills, 2003). The Government has also identified Looked After Children, children with disabilities and families with multiple problems as sub-populations requiring specialist interventions by the state (HM Treasury and Department for Education and Skills, 2007). It is the last group which is of particular interest here.

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Identifying families with multiple problems

In the recently published Policy Review of Children and Young People: A Discussion Paper (HM Treasury and Department for Education and Skills, 2007), a number of risk factors experienced in childhood and associated with poor adult outcomes are identified. These include: low income, low attainment, poor social and emotional skills, poor parenting, low

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birth weight, poor parental mental health and living in a deprived neighbourhood. Whilst universal services and targeted services are designed to address the needs of populations who require both general and specific interventions to promote positive outcomes for their children, such preventative measures are inadequate in addressing the needs of children at greater risk. For these children, it is not the particular combinations of indicators that are predictive of poor outcomes, but the number of indicators present. Using findings from the UK Birth Cohort Study, Feinstein and Sabates (2006, p. ii) found that For higher levels of adult deprivation . . . the probabilities of experiencing 10 or more of the 32 [negative] outcomes are 1% for the low risk group, 12% on average and 51% of the high risk group [the 5% most at risk]. This highlights the very strong relationship between high childhood risk and multiple adult deprivation. Feinstein and Sabates (2006) estimate that 5,000 families in the UK experience seven or more problems, with some 140,000 experiencing five or more (Cabinet Office Social Exclusion Taskforce, 2007). Systems to locate such families have not yet been developed. As Hughes and Fielding (2006) have noted in relation to the evaluation of the Childrens Fund, mapping of need typically relied on data collected for other purposes and thus the development of proxies for identifying risk amongst populations . . . such data is invariably conflated to produce indices of need based upon multiple indicators purported to illustrate those most at risk (Hughes and Fielding, 2006, p. 84). Whilst programmes such as SureStart have relied on aggregated data at locality level to identify those communities most in need, such methods do not capture families and children with similar needs who do not reside in such communities (National Evaluation of SureStart, 2004). To identify families with multiple problems, risk factors must be identified from other sources. As Hansen and Plewis (2004) observe, the reasoning behind the adoption of an at risk approach is that it is possible to identify a group who are clearly at risk (Hansen and Plewis, 2004, p. 24), whilst acknowledging that from a policy perspective it is important to pinpoint those children most at risk. They note that determining specific risk factors is extremely difficult because negative outcomes are the end product of the complex relationship between a large number of inter-related factors [including resilience] (Hansen and Plewis, 2004, p. 18). Claims have, however, been made by some social work professionals that they can predict which families on current caseloads will suffer poor future outcomes with reference to their experience of key events. These include the exclusion of a child from school, the initiation of child protection or care proceedings, involvement of a young person with the criminal justice system or in persistent anti-social behaviour and the registration of a child on the child protection register (HM Treasury and Department for Education and Skills, 2007, p. 80). Such claims are given some credence by retrospective studies which examine adult populations with poor social

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and economic outcomes and which seek to identify common experiences in early life which may be associated with these (Buchanan and Hudson, 2000). Farrington and Welsh (2007) identify five family characteristics as being associated with adult offending behaviour. These are: criminal or antisocial parents; large family size; child-rearing methods which include poor supervision, poor discipline, coldness and rejection; experience of family disruption; and experience of child abuse or neglect. In relation to the final characteristic, Farrington (2007) cites the work of Maxfield and Widom (1996), who used court records in Indianapolis to identify more than 900 children abused or neglected before the age of eleven. Compared with a control group matched on all characteristics except the experience of abuse or neglect, over a twenty-year period, the children who had experienced abuse were more likely than the controls to be arrested in adolescence and in adulthood. Links between experience of childhood maltreatment and welfare dependency in later life have been found by researchers. For example, Derr and Taylor (2004) conducted research into the childhood experiences of 280 women who had been in receipt of welfare benefits for three years or more. They found that two-thirds of these women had experienced physical, sexual or emotional abuse in childhood, with a majority of this group (70 per cent) experiencing more than one type of abuse. The researchers speculate that being in long-term receipt of welfare benefits may be a consequence of experience of abuse in childhood. The work of Felitti and his colleagues (1998) has established an association between adverse childhood experiences and adult morbidity and mortality. The links between risky health behaviours and damaging lifestyle choices (for example, smoking, poor diet, etc.) leading to poor health and early death being understood, the researchers set out to examine the factors associated with such behaviours. With a cohort of 13,494 patients referred to a Californian hospital, the researchers used a detailed questionnaire to ascertain what adverse experiences subjects might have encountered in childhood. Adverse Childhood Experiences (ACEs) were categorized as follows: experience of physical, sexual or psychological abuse, violence perpetrated against the mother, living in a household where there were substance abusers or mentally ill care-givers and having a parent who had served a prison sentence. Data from the 9,508 respondents were compared with their adult health records. The researchers found that there was a strong graded relationship between exposure to ACEs and the development of adult diseases, including heart disease, cancer and liver diseaseconditions which are, in turn, associated with early death. The co-joined social and economic case for prevention and early intervention is based on a range of research similar to that cited above, associating adverse circumstances encountered in childhood with a range of poor adult outcomes across a number of domains. These include criminality, unemployment and poor physical and mental health. Whilst we do

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not know exactly which particular members of identified sub-populations will go on to exhibit the health and lifestyle choices that become mediated into poor social and economic outcomes, targeting service provision towards such populations nevertheless represents sound economic investment. This is based on the assumption that provision of relatively low-cost services may prevent some group members progressing to lead high-cost lives characterized by risky health behaviours and poor lifestyle choices.

How should intervention be targeted?

Arguing for greater use of risk-focused prevention of offending programmes, Farrington (2007) states that such programmes should be offered at a level of intervention targeted at identified neighbourhoods and not at individuals or families identified as being at particular risk. On current modelling by the Audit Commission (2004), provision of effective early intervention to one in ten potential young offenders would save 100 million per year. There is a strong economic case for providing interventions which, although they may only influence outcomes for a minority of participants, nonetheless remain cost-effective. For example, Feinstein and Sabates (2006, p. 42), using the example of teenage pregnancy, estimate that the social cost of a teenage pregnancy is 60,000 (comprising economic, social and educational hardship). Whilst the risk in the eligible population is only 5 per cent, a programme of intervention (involving training teenagers in the realities of parenthood) delivered to the eligible population at a cost of 1,000 per participant would only have to achieve an effectiveness rate of 4 per cent to be cost-effective (the programme has an actual effectiveness rate of 80 per cent). The calculations are somewhat different for those families at highest risk. Here, precise economic and social costs are more difficult to calculate because they are located across a number or domains. As the Cabinet Office Social Exclusion Task Force observe, The costs associated with poor outcomes for children and families are difficult to estimate (Cabinet Office Social Exclusion Task Force, 2007, p. 6). We can, however, identify with some accuracy those populations who will be low in economic productivity and high in social costs in adulthood. Feinstein and Sabates observe that those with multiple deprivation in terms of 2 or more of 5 outcomes at age 30 can be predicted in 87.1% of cases using data to age 10, with a false positive rate of 1.1% (Feinstein and Sabates, 2006, p. ii). And, whilst the composite make-up of global costs are hard to calculate (which individuals experiencing multiple problems in childhood will go on to criminal careers or to develop mental health or health problems and in what combinations is difficult to predict), we know that such costs will be very high. Heckmanthe Nobel Prize winning

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economisthas calculated that the universal provision of pre-school learning-enhancement programmes in the USA would generate cumulative net benefits to society of over $400 billion (Heckman and Mastrov, 2004). For those 140,000 families presenting five or more problems in the UK, there is a strong economic case for early and high-cost investment to prevent the occurrence of predictable poor social and economic outcomes (high-cost in terms of service uptake and low economic productivity as calculated by tax returns). The Government policy paper Building on Progress: Families provides a calculation of current service provision costs Families experiencing five or more disadvantages can cost the state between 55,000 and 115,000 per yearbut is less specific with regard to future costs, noting, however, that The costs of failure are also borne by society more widely, for example through lost economic contribution, poor health and the effects of anti-social behaviour and poor social cohesion (Cabinet Office, 2007, p. 46). The calculus for deciding at what level high-cost investment may be justified in economic terms can, of course, be reconfigured to include a greater number of families. For example, children in families experiencing four problems or more have a 70 per cent risk of experiencing multiple disadvantages at age thirty (Cabinet Office Social Exclusion Task Force, 2007). Even with the inevitable increase in identification of false positives involved in lowering the tariff, the offer of services to the minority of families who will turn out not to have needed them may be more than counterbalanced by the potential return on investment in families whose children become low in future social and economic costs and high in economic productivity.

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Translations into policy

New Labour have indicated that they intend to begin the process of identification and investment in families with multiple needs by an initial concentration on families within the Respect Agenda aimed at tackling anti-social behaviour. The then Prime Minister, Tony Blair, made this position clear in a speech to the Rowntree Foundation. Locating the boundary between the state and the family, he said that he was not talking about . . . interfering with normal family life. I am saying that where it is clear, as it very often is, at a young age, that children are at risk of being brought up in a dysfunctional home where there are multiple problems, say of drug abuse or offending, then instead of waiting until the child goes off the rails, we should act early enough, with the right help, support and disciplined framework for the family to prevent it. . .. You can detect and predict the children and families likely to go wrong. The vast majority offered help, take it . . . [However] about 2.5 per cent of every generation seem to be stuck in a lifetime of disadvantage and amongst them are the excluded, the deeply excluded. . .. We have identified four groups [one of these is] families

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with complex problemsthe Respect Task Force identified 7,500 such families (Blair, 2006). The range of remedies suggested for such families blends those associated with family support initiatives, such as extension of the provision of Childrens Centres and Extended Schools together with designated Pathfinders, to delivery of integrated support packages with more coercive strategies. Where there is non-compliance, the threat of sanctions or use of sanctions provides both a way of curbing bad behaviour and also helps persuade people to accept and co-operate fully with offers of support (Respect Task Force, 2006a). Such families are viewed as requiring assertive engagement, utilizing contract-based work agreements, with Parenting Orders designed to secure the co-operation of the non-compliant. Whilst the case for compulsory intervention in family life may, it could be argued, be most readily achieved in a population already associated with the criminal justice system, the recognition that the experience of multiple problems may be expressed in ways other than by anti-social behaviour has led the Government to indicate that they wish to broaden the net. In recognition that early prevention policies do not capture those families who are already experiencing multiple problems, families caught in a cycle of low achievement are identified as a small minority of families with multiple problems leading to particularly harmful outcomes for the children in the family (HM Treasury and Department for Education and Skills, 2007, p. 2). In a section entitled Rights and responsibilities of service users, the success of the Respect Action Plan in dealing with families resistant to intervention shows that activation/mutual obligation approaches can be successful in providing supports alongside strong incentives for the individuals to follow programme requirements [such incentives include] . . . eviction, Anti-Social Behaviour Orders, or children being taken into care [authors emphasis] (HM Treasury and Department for Education and Skills, 2007, p. 87). The discussion paper goes on to extol the virtues of linked support and enforcement services to create maximum effect. Effect is measured in terms of change in parental behaviours, which is seen as the key determinant in securing better outcomes for children. In this regard, traditional forms of family support are called into question: It is important to make clear that effective parenting programmes are not the same thing as parenting support . . . schemes such as Home Start uses volunteers to befriend and support parents but does not improve parenting skills and does not have measurable effects on childrens behaviour (Respect Task Force, 2006b).

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Discussion
At its conclusion, the Policy Review of Children and Young People: A Discussion Paper attempts to further differentiate the stock of families

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already regarded as high cost, high harm; those at high risk of moving into this situation and those cycling in and out of this category, posing key questions, including Who are these families? How can we define them and how many of them are there, Can we better align services to improve identification of these families earlier on and before they become high cost, high harm? and What is the appropriate balance between support and sanctions for these families? (HM Treasury and Department of Education and Skills, 2007, p. 98). In suggesting some tentative answers to these questions, it is useful to draw on some of the research evidence cited above. The answer to the first question is perhaps the most straightforward but raises complex ethical issues. The research suggests that children from families who experience a multiplicity of problems are likely to experience poor outcomes across a range of domains in adulthood. This population suffer many of the general features of social exclusiona shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown (Social Exclusion Unit, quoted in Levitas et al., 2007, p. 13). As noted above, it is not particular combinations of difficulties, but the multiples of these which become predictive of poor outcomes. With regard to how many such families there are, this is a product of where the line is drawnessentially, a societal construct. For example, we may identify some 5,000 families as experiencing seven or more problems or some 140,000 as experiencing five or more (Cabinet Office Social Exclusion Taskforce, 2007). If we utilize retrospective research such as that carried out by Felitti and his colleagues (1998) within the domain of health, we may isolate certain childhood experiences which, in combinations of four, become highly predicative of poor health outcomes in adult life. It is not known how many children there are in this population because data are not routinely collected on these indicators. The lower the multiples, the less predictive they become of poor adult outcomes, but this does not necessarily undermine the economic case for intervention, as lifetime costs are so high as to make it worth investing heavily in families, even where the increase in false positives decreases the strike rate. The difficulty is essentially ethical, as intensive interventions directed at multi-problem families will inevitably identify some families who may meet the target number of problems but whose children will not go on to experience poor adult outcomes. This presents a number of hazards, including that some families may be stigmatized through the process of identification and selection and, conversely, as Feinstein and Sabates observe, where intervention is of a more positive kind, involving the extra expenditure of resources, then those at risk and others may experience or perceive a benefit from adding to risk rather than reducing it, in order to benefit from the additional resource (Feinstein and Sabates, 2006, p. vii).

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With regard to the question of alignment of services to improve identification of multi-problem families, if this were to be premised on numbers of problems experienced rather than on particular flags of concern, then the new technologies of the Common Assessment Framework and the Identification, Referral and Tracking system (Department for Education and Skills, 2003) might be adapted to offer the prospect of more systematic collection and collation of data to identify families with multiple problems before these become expressed as a crisis in functioning. It is unlikely, however, that simple multiples, whilst offering the most empirically validated predictive indicator, will be sufficient to suggest intervention in all cases. In particular, we need to know more about how multiple problems become translated into poor outcomes. In their Multi-Dimensional Analysis of Social Exclusion, Levitas et al. (2007, pp. 12 13) recommend that qualitative research work using in-depth interviews and life history techniques be undertaken with those groups at particular risk of social exclusion. . .. Such qualitative work should use biographical methods to explore the experience of social exclusion and the nature and sequence of precipitating events and interventions that reduce or prevent exclusion. There is indeed a clear need for such research, but even if it were currently available, it would pose a real challenge, in England and Wales, for Local Children Safeguarding Boards to turn both quantitative and qualitative research into protocols based on prediction, rather than actual events for professionals to follow in tailoring interventions for families. The key difficulty here is public intolerance in relation to very poor outcomes triggered by events such as the abuse of a child (Butler and Drakeford, 2003), but rather less public pressure to promote present interventions to prevent poor outcomes in the next generation. This can result in local responses becoming event-led rather than research-driven. This brings us to the final question, which resurrects what Parton refers to as the central dilemma for the liberal statehow to both protect children and protect the family from unnecessary intervention (Parton, 2006, p. 103). As we have observed in government rhetoric, there are deep ambiguities involved in the approach to engaging families with multiple problems. Indeed, it is likely that a new combination of carrot and stick (beyond that utilized in the Respect Agenda) will be developed. The suggestive nudge in relation to the threat to take children into care noted above may indicate that an emphasis on the calculation of future significant harm to children will become based on a refusal to accept services in which a multiplicity of problems are indicated. This begins to locate the issues more firmly in the province of child and family social work. Respondents to the Policy Review of Children and Young People Call for Evidence 2006 (HM Treasury and Department for Education and Skills, 2007) claimed that key events, including being involved in child protection or care proceedings or the registration of a child on

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the child protection register, were potential indicators that these children were at risk of experiencing poor outcomes in later life. Clearly, there is a requirement for further research into these populations to see if they, as we might expect, feature multiple problems bequeathing intergenerational outcomes. Certainly, the retrospective research referred to above suggests a strong association between the experience of abuse or neglect in childhood and poor outcomes in adult life across a range of domains. However, it may be that the key events cited above are not the only proxies for the prediction of poor outcomes, as respondents have suggested. Research by the author into comparisons of categorization of family support and child protection cases (Spratt, 2000, 2001) suggested that both types of cases bore similar features and that there was an arbitrary element in how families came to have their circumstances understood and categorized by social workers. It might, therefore, be profitable to research the wider population of children in need who are in receipt of social services to ascertain how many of these families have multiple problems. There is some evidence to suggest that such families in 2001 compared with those in 1995 [are] a much needier group on a range of indicators (Buchanan, 2007, p. 197, citing earlier work by Buchanan and Ritchie, 2002). Whilst the larger proportions of children in such families are also looked after and/or have their names included on child protection registers, there are some who may experience multiple problems; whilst their circumstances may not indicate present crisis, their predicted longterm outcomes remain poor.

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Conclusion
The appliance of science to the population traditionally served by social workers provides new challenges to local authorities to measure harm to service users over the life course rather than as indicated by key events. Whilst Every Child Matters (Department for Education and Skills, 2003) seeks to franchise the response of the state to family difficulties across a range of agencies, local authority social services are likely to remain centrally involved in the processes of identification, assessment, tracking and management of cases. In response to such challenges, two possible paths are indicated; in the manner of street-level bureaucrats (Lipsky, 1980), social workers may adapt their practices to further refine their skills in engaging a less than willing clientele through a subtle blend of care and control techniques, in much the same way as families who attract professional concerns are responded to outside the official child protection system (Spratt, 2001; Spratt and Callan, 2004). Whilst such a response would address the issue of engagement, it would not address the more complex and central issue of provision of services to change the pattern

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of future outcomes. Alternatively, child and family social work could moderate its claims to protect children in the present and become more concerned with prevention of poor future outcomes. Paradoxically, the lessening of immediate pressures to do something might actually mean that something is done, namely needs become assessed against future risks, leading to the provision of services. If this path were taken, social workers could then become like other professionals in education and public health, intervening to provide services to help realize future benefits. How local authority social services position themselves in relation to these two choices will indicate whether or not social work as a profession has the confidence to base its modus operandi within science-informed investment strategies or prefers to default to social policing. How families with multiple problems are currently recognized and understood, together with the potential for services to meet their needs, is explored in a companion piece in this journal (Spratt and Devaney, 2008).
Accepted: November 2007

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