Child protection and risks from Covid-19: Home visits and the challenges of social distancing
Since lockdown measures were introduced on 23rd March 2020 in the UK, while a minority of vulnerable children attend school, and school staff have worked hard to stay connected, social workers and family support workers have been some of the few safeguarding professionals visiting families in their homes and often the only ones to do so regularly. I this blog post, Professor Harry Ferguson asks - How, then, are social workers and families managing the risks from COVID-19 that home visits carry?
‘Children being safe is as important as Covid’
Our research into child protection and social distancing during Covid-19 began in April at the height of the lockdown. Emerging findings, which we discuss at length elsewhere, show that social workers are navigating significant personal risk in order to visit families at home. The following quote is typical of the value-base many have articulated that drives their practice:
Children being safe is as important as Covid, I can’t not go into houses, I can’t not see children on their own. That is the, you know, that can’t stop because of Covid. That still just like feels so crucial and that is taking more risk probably than lots of other people, but we don’t have a choice at this point.
Just what choice safeguarding practitioners do, or should, have and how they exercise it is one of the most difficult ethical dilemmas caused by COVID-19.
The impossibility of social distancing on many home visits
The creative use of on-line technology to make ‘virtual home visits’ to families where risk and need are lower have been key to avoiding entering homes. When it is felt that the risks and complexity of need are such that children must be seen in person, ‘doorstep visits’ and ‘garden visits’ are being used creatively, enabling the interactions to go on outside while attempting to maintain two metre social distancing.
Once they enter the home, practitioners have described maintaining social distancing as impossible when younger children are present. Some children are used to having tactile contact as part of the therapeutic help they are receiving and seek it out by sitting on the practitioner’s knee, or climbing all over them, giving them full hugs, holding their hands and so on. Most practitioners respond by humanely providing the connection and nurture children need. Even some older children and teenagers who do understand the need for distancing on occasion don’t practice it because they too want to be close to the worker. Social distancing is also compromised when visiting families living in temporary accommodation and cramped flats and houses where there is no room to keep two meters apart.
Managing risks
Our findings support calls for better recognition of the risks social workers are exposed to on home visits. Personal Protective Equipment (PPE) is critical to keeping workers safe and we have outlined the evolution of DfE guidance relating to its use during home visits elsewhere. In essence, guidance advises social distancing and handwashing, with PPE to be used when Covid-19 symptoms are reported and a distance of 2 metres cannot be maintained. In practice we found different interpretations of the guidance, both within and between regions where the availability of gloves, masks and aprons varies. Workers dislike wearing PPE, especially the mask, which they find a barrier to communication and relationships with children and some report experiences of masks scaring children. Some social workers routinely wear PPE, while others do not.
There are also concerns – expressed by both families and workers - that the risk of spreading the virus could be increased by entering multiple homes without changing clothes. Management advice in some areas to go home and change clothes between visits is impractical in many instances and they end up, as one put it, doing “back-to-back-to-back” visits. One worker reflected on the anxieties raised by having to work from home and bring their work into the heart of their personal life:
I do worry driving home in my clothes, wondering what I am carrying. … [a colleague] and me removed 2 children and they sat in my own children’s car seats You couldn’t get closer to my family, I’d probably do it again … I had the gloves on, one was 4 months the other 3 yrs and had to be lifted into the car. … I work [from home] in the bedroom because there is nowhere else and I work on my bed, so my writing pad that I’ve had on visits and my pen are put onto the bed and my bag which has been into 8 families. … I’ve got 3 children and I worry about it because the youngest is at nursery and the older two at school, … we are potentially super spreaders.
Some black and minority ethnic workers are telling us that the higher rates of COVID-19 deaths of people from BAME backgrounds and risks to them are not being sufficiently recognised.
Selflessness, leadership and accountability
These findings show how, as ethical public servants, social workers are acting with selflessness and integrity to help vulnerable children and families. However, many feel their choices in how best to do this are highly constrained by systemic issues. Our emerging findings suggest that decisions about whether or not to conduct in-person visits, enter homes and wear PPE are influenced by the interaction between:
Professional values
Understanding the complexity of home visits and workers’ and families’ safety concerns, needs and well-being.
Government guidance and how it is interpreted
Availability of PPE
Standards of IT provision and smart phones for staff
IT provision for families
Skill and confidence levels using virtual communication
Leadership and management culture, including openness to trying new things
Anxiety about Ofsted inspection, organisational failure and blame
Through the interactions between these variables, different cultures of safety and risk taking have emerged in different places. For instance, the use of virtual visiting by digital means has varied across the country and in areas where local authorities do not provide their staff with good quality smart phones and no efforts have been made to support families’ digital access (with smart phones or tablets, data or electricity credit) video calls are much less frequent. In effect, poor IT provision pushes workers and families into having face-to-face encounters that increase risk of transmission of the virus. If this happens in combination with poor availability of PPE then the risks are greater still.
In terms of leadership, accountability and organisational culture, some workers have told us about managers worrying about ‘Ofsted lingering’ and how this increases pressure from management for performance data and for frontline workers to complete statutory visits to children in-person, within timescales and to extensively write them up, even at a time of global pandemic. Although Ofsted inspection visits are currently suspended, the disruption to normal practices caused by the pandemic can increase anxiety in anticipation of future inspections. Some have spoken of this pressure leaving them with feelings of failure.
The message needs to be that the complexity and risks of the work are fully appreciated and that keeping children and families safe, including from COVID-19, requires that the emotional as well as physical well-being of frontline workers and managers and leaders receive thoughtful attention in supervision and other forms of organisational support.
Social work staff need clear direction and ongoing conversation with their organisation’s leaders in working through assessing personal risks, but our analysis is suggesting that a range of systemic factors can reduce the choice practitioners feel they have and are given. As we emerge from lockdown, critical attention needs to be given to the culture of safety and risk taking that has emerged in each local system.
Social workers and family support workers also need to feel that at a time when they can’t get as close to children and families in their practice as they normally would, the public will appreciate their hard work, courage and skill and the risks they are taking every day.
Harry Ferguson is a Professor of Social Work at the University of Birmingham. For more information about this work please visit: https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/publications/research-briefing-1-child-protection-risks-covid-accessible.pdf