Abstract
Everyone knows that because two things are associated statistically, it does not mean that one causes the other. The comedian Frankie Howerd proved this when he explained that the rheumatism in his thigh was the result of drinking – ‘not the alcohol but the wet change I keep putting in my pocket’. My statistics lecturer used to offer a more sober example that the amount of damage caused by a fire correlates with the number of fire engines attending, but it doesn’t mean that firefighters are vandals.
Foster care and adoption have long been prone to causal claims drawn from numerical associations. Poor outcomes among looked after children are frequently attributed to failings of the care system but while services may not be perfect, it is a bit churlish to demolish them completely without considering other explanations. Even if things turn out badly, they might have been worse had the child not entered care – something we can never know. These alternative propositions are irritating as they complicate easy explanations. In a classic comic cockney song, a resident of London’s crowded East End bemoans that he’d have a lovely view of countryside from his back yard ‘if it wasn’t for the ’ouses in between’.
While there is an abundance of child care research showing that A is associated with B, there is less on the processes that explain it. Intensive analysis is fiddly and often dreary and inconclusive. Sixty years ago, it was fashionable for psychologists to study contrasting groups, for example delinquent and non-delinquent boys, to tease out the distinguishing variables. Alas, nothing definite emerged from this work as although some factors were salient, none offered a comprehensive explanation. Sociologists then waded in saying that it was all a matter of social structure, but were thrown by variation among individuals in similar social situations. Subsequent studies have been narrower, looking at the interaction between factors, how protective ones reduce risks and the ‘meaning’ surrounding concepts like permanence and deprivation. Unfortunately, the deeper the delving, the greater the complexity revealed.
Three articles in this edition explore these inner workings, one emphasising parental stress as an undercurrent of presenting problems, another looking at maternal marital satisfaction as a source of difficulties and a third questioning assumptions about child care in West Africa. They all explore important connections but inevitably come over as rather dense and with results that can only be tentative.
The need to focus on innards also applies to the care system. For example, the article by Harris-Waller and colleagues reveals a familiar picture whereby many children and families do not get the help they need. Although this finding provides good material for a ‘shock/horror report’, it also raises professional and moral questions that need deeper consideration. One recently put to me by a politician hearing about this mismatch between needs and services was: Does it matter?
My initial reaction was flabbergast that anyone could think like that. Despite protestations about how the Every Child Matters philosophy demands that we should never give up on children whatever their circumstances, he was adamant that when situations or conditions are ‘untreatable’, only minimal services should be provided. Anything extra has no beneficial effect and consumes resources better used for those likely to respond. Beyond a certain threshold of effort, the gap between needs and services is irrelevant.
But even if some severe disabilities and psychological disorders are intractable, there are proven benefits from manipulating the environment in which the young people live. This involves a ‘wraparound’ approach to help them cope, providing aids to living and creating opportunities as well as supporting and educating families and friends – all of which make life easier for everyone and improve general well-being. This forms the basis of much social work and I guess is widely supported; after all, isn’t this what we would expect in a civilised society?
Finally, and most important for this discussion, are situations where interventions have been shown by research to be helpful, whether they involve therapies for specific problems or ‘holistic’ actions like taking children into care. If these are denied or unavailable to those who need them, this must rank as a professional and moral scandal as well as a blatant denial of human rights.
So whether it is children, families or systems that are under scrutiny, there is little point in stopping at establishing statistical associations and accepting them as eternal truths. On the contrary, they should be pointers to further inquiry. I hope that journal readers will find a reasonable balance between engaging generalities and the drier explanatory and moral discussions that are necessary if simple statistics are to contribute to practice and policy, and that they will find the mixture interesting.