Investigating the involvement of disabled children in using In My Shoes as a family-finding tool: a pilot project.

Cousins, Jennifer ; Simmonds, John

Introduction

If asked to identify the essence of good family-finding practice, most people would highlight the need to engage with and understand the child. Based on a comprehensive assessment, the crucial planning and family-finding documents will be drawn up, namely the Child's Permanence Report (1) and the all-important Child's Profile, which can be key in capturing the attention of a potential family. If the assessment is poor or the profile is sketchy, partial or inaccurate, permanence for that child may forever be elusive (Cousins, 2008).

Disabled children, especially those with communication difficulties, have always been at particular risk in this process. Firstly, their wishes and feelings about their past and future may be overlooked, notably where the staff (2) member is unskilled in specific communication methods. The requirement to consult children is unequivocally enshrined in UK legislation (3) and good practice; and in Article 12 of the UN Convention on the Rights of the Child which states:

You have the right to say what you think should happen when adults are making decisions that affect you, and to have your opinions taken into account.

It is recognised by all that especial efforts must be made with disabled children: (4) 'Direct work with children is an essential part of the assessment ... This applies to all children, including disabled children [our emphasis]' (Department of Health, 2000, p 43). Nevertheless, despite these high-profile good intentions, all is not well:

... disabled children and young people are rarely consulted or involved in decisions about their care ... workers do not feel they have the necessary skills or experience to communicate with them. (Joseph Rowntree Foundation, 1999, p 3)

The second reason why disabled children are at risk of being sidelined in the family-finding process is that they tend to be identified predominantly by their medical diagnosis or impairment: a dominant medical model that is hard to shift. The diagnostic labels become the prominent feature and can be off-putting to potential new families while other aspects of the child--a more rounded picture--remain obscured.

Given these two factors, therefore, it is important to find ways of engaging meaningfully with children, especially with disabled children, in order to prepare and support them through the precarious and emotive business of family-finding, and to secure permanence without undue delay.

The context

The role of BAAF's Opening Doors Disability Project, established in 2003, includes developing new ideas about improving the adoption and permanence chances for disabled children. The current national context arose originally from a government initiative to increase by 50 per cent the number of adoptions (then at 3,200) by the year 2005/06 (Performance and Innovation Unit, 2000)--a target that fell short by 21 per cent, with numbers continuing to fall (Ward, 2011). However, information about the adoption of disabled children has never been available. Indeed, there is a continuing, much lamented dearth of comprehensive data about disabled children--in the community, in the looked after system and in the family-finding process (Read and Harrison, 2002; Mooney et al, 2008), although there is some evidence that disabled children wait proportionately longer for permanence than their not-disabled counterparts (Cousins, 2006, p 5). Children with severe medical problems are known to wait twice as long for adoption as others; and prospective adopters are three times more likely to accept a child who has been sexually abused than a child with a physical disability, and five times more than a child with a 'mental disability' (Ivaldi, 2000). (The figures given by Ward (2011) from her year 2003 sample appear in places to be more optimistic.)

It is also known that a disproportionately large percentage of disabled children are looked after, compared with their not-disabled counterparts, and (depending upon definitions) may comprise as much as a quarter of the looked after population. (5) However, on the whole they enter the care system primarily following abuse and neglect (Gordon et al, 2000, p 158; Cousins, 2006) and not because of impairment. It is thought that between four and seven per cent of children placed for adoption have a 'significant disability' (Rushton and Dance, 2002, p 69; Simon and Dance, 2006, p 1). There are also anecdotal suggestions that there may be a disproportionately smaller percentage of disabled children for whom the active plan is adoption or permanence. The official adoption statistics do not shed light on these issues and there are no equivalent fostering data, so it remains very difficult to draw sound conclusions. Without a good information base, it is to be questioned how sensible planning can take place.

In this context, and with a brief to improve the permanence chances for disabled children, the Opening Doors team were concerned that the patchy nature of the data, coupled with prejudice and misunderstandings, were all contributing to blight the life chances of these young people. In particular, the team concluded that the preoccupation with impairment was preventing a more holistic view of the child and seriously compromising successful family-finding.

It was our contention that the application of the social model of disability, where disabled children could be seen as people instead of labels, would help prospective carers to make the all-important connection with a child.

Featuring children through video clips (Grant, 2010) was one important initiative developed by Opening Doors. Another is the current piloting of 'placement activity days' (6) where real children meet prospective families. Also central to Opening Doors' objectives is promoting disabled children's participation and, through finding new ways to gain fresh insights into each child's thoughts and feelings, enhancing the quality of assessments and profiles. It is this aspect which has led to the exploration described in this article.

The study

In collaboration with the organisation Child and Family Training, a project was devised to investigate the potential of their interactive computer programme or 'interview', In My Shoes (occasionally referred to in the text as IMS) (Calam et al, 2005), with disabled children awaiting permanence. Computer technology, although shown to enable adults to share sensitive and personal information, and widely used in education, is a relatively unexplored tool in assessment and therapy with children. However, Douglas (1991) showed that computers can increase the potential for children to express emotions; and other researchers have demonstrated the efficacy of computer-based activities in facilitating communication--even compared with the use of toys with very young children, and in work with severely disturbed adolescents.

There are many advantages in using computers with children: first, they are increasingly their medium of choice, giving them the opportunity to demonstrate their confidence and mastery; second, the 'triangle' provided by the computer, the child and professional (each with a mouse) reduces the intensity of the usual face-to-face and one-to-one interview situation; third, exploration of issues can be structured by the adult but the pace can, if necessary, be controlled by the child; fourth, the automatic recording of responses reduces the burden of note-taking and increases the reliability of the record.

In My Shoes is not alone in providing computer-based opportunities of this kind, as Calam et al (2000) acknowledge; indeed, several interactive CD ROMs are available through BAAF (eg Information Plus, 1998; Betts and Ahmad, 2003; Ball and Betts, 2004; Betts, 2004). However, what the In My Shoes team also offered to this project was a well-developed training course which would enable the team to train social workers to use the tool with 'their' child and for us to witness the results. The course was over two days with an interval between to allow experimentation and practice. This action learning approach is particularly important when introducing and reinforcing complex new skills (Morrison,1993, pp 43-52; Trivette et al, 2009).

This was the context for the project described here. It should be stated at the outset, however, that the research met with unpredicted difficulties and broadly failed to meet its prime objectives. The reasons will be discussed later. However, the lessons learned have considerable significance and relevance to the field of children's services.

The In My Shoes interview

As already described, In My Shoes uses accessible and child-friendly images, aiding communication between worker and child. It is suitable for children aged three plus, and has been demonstrated to engage children who have a wide range of abilities (Calam et al, 2005). The interview is organised in a series of modules with scenes covering everyday situations at home, school and play. Having selected a figure to represent themselves from a menu of multi-ethnic possibilities, the child identifies emotions represented by a gallery of faces with iconic expressions. These are used later as a language of feelings.

With the prerequisites that the adult has advanced interviewing skills and has been formally trained in the use of the programme, an extensive range of the child's experiences can be accessed.

There is a videoed voice-over guide ('Mary') who, using English or signed language, helps the child to move through the modules. Throughout, there are opportunities to use speech bubbles to record what people are saying and put messages in a box. The saved records have proved valuable in making accurate notes about the child's reactions and responses, and have been accepted as valid during investigations and for court purposes. The programme can be accessed over several sessions, in response to time and concentration constraints with any particular child.

Only professionals who have successfully completed a two-day action-learning course (available through Child and Family Training, www.child andfamilytraining.org.uk/) can become registered In My Shoes interviewers.

Aims of the project

The intended focus of this project was on disabled children. The definition of disability employed was a broad one: any child whose intellectual, physical or sensory impairment was thought to have a significant impact on daily living or on family-finding.

In line with a commitment to involving disabled children in the processes of finding a permanent family, the overall aim was to explore In My Shoes as a method for facilitating this; and to see if this particular computer interview could enhance assessment and profiling. (However, although the initial criterion for inclusion in the project was disabled children awaiting permanence, it will be seen that the children who were finally located tended to be either disabled or awaiting permanence, but not both.)

More specifically, the project aimed to explore:

1. whether the use of In My Shoes enhanced the relationship between worker and child;

2. whether the child's ability to communicate feelings and opinions about their situation was enhanced;

3. whether new and/or important information emerged through In My Shoes, which enhanced the worker's capacity to make appropriate plans and to feature the child effectively in the quest for a new family;

4. whether the interview added value to work with disabled children;

5. whether the programme itself needed to be adapted according to either the needs of disabled children or this particular family-finding context.

The findings will be presented to focus on each of these aims.

Methodology

The project proceeded in two parts. Stage one

During the first stage, the social workers observed the project's psychologist, Sheila Groth Larsen, using In My Shoes with 'their' child. The aim was to test whether those responsible for finding a new family for a child would see the interview as potentially beneficial to disabled children. They were asked to:

a) note anything that they had not known before about the child;

b) particularly to note anything that they had not known before about a disabled child;

c) identify anything in the programme which should be modified for disabled children;

d) note anything that might contribute to the processes of family-finding, for example, writing profiles, preparing a child for permanence, formulating 'matching considerations', planning contact, and so on;

e) report how they felt about the In My Shoes interview and the use of a computer as a tool.

A further consideration was whether the training programme proposed for the second-stage participants needed to be modified to fit the family-finding or disability context.

Eight social workers for 12 identified children observed the child's interview for approximately one hour. The social worker was then de-briefed.

Stage two

During the second stage, the social workers themselves conducted the computer interview. A group of 16 social workers from four local authorities were trained to use In My Shoes and were subsequently required to use the interview once with six children within a six-month time-scale, and to complete two short online questionnaires (one before the computer interview and one afterwards). Intensive follow-up advice, consultation and support were provided, including an additional day's refresher training.

Limitations of the project

There were severe limitations to each stage of the project. For the first (observational) stage, nine agencies were approached and consulted, but only four finally participated owing to critical staff shortages and insurmountable IT deficiencies. In addition, those agencies which participated found it difficult to follow through the arrangements for the interviews: the psychologist's attempts were frustrated by staff sickness, absence from the office, failure to return calls and lack of access to computers. There was also a serious problem in locating disabled children who were waiting for permanent families.

For the second (practical) stage, staff again struggled to identify children who met the main criteria, were overburdened with other work and did not have access to laptops (or permission to use them outside the office); the bigger the time gap between completing the training and beginning the In My Shoes interviews, the more the staff member's confidence with the IT waned. A variety of extra help and support was offered and a follow-up refresher training day was provided, but only three people attended. Even where interviews took place, staff did not always complete the online pre-interview questionnaire nor, in at least two cases, the post-interview questionnaire. All these setbacks occurred despite the stated enthusiasm for the programme. Nevertheless, a substantial amount of data emerged and the article now focuses on what was learned.

Stage one: findings

The children

The ages of the 12 children who were interviewed by the psychologist ranged from three to nine, with a weighting towards the younger end (there were four 4-year-olds). One child's age was 'unknown'. There were eight boys and four girls.

As described above, the most serious difficulty was in locating disabled children awaiting permanence--or even disabled children per se--despite this having been agreed at the outset as feasible. Of the 12 children who were interviewed, two had moderate learning difficulties and one had a complex range of significant impairments. The other nine were not disabled, although there was a discrepancy between the social worker's and psychologist's assessments.

Seven children had adoption plans, two had fostering plans and one was recommended for fostering should rehabilitation fail. For a further child it was planned that he would remain with his current foster carer, and for the final child the plan was an unspecified 'permanence'. All the children were living in foster care and, broadly, were likely to be en route towards permanence.

In terms of the relationship between family-finding and disability, the two moderately learning disabled children were the ones who had unequivocal plans for fostering; and the severely disabled child was the child whom it was intended should stay with his current foster carer.

a) The workers learned new things about the children (7,8)

All the social workers reported that they learned new things about the child, even where they had known him or her for a long time:

His French was new to me! (W, aged 8 1/2)

... he presents to his carers as quite obstructive. It was new that he likes them! We can now say that he may not give you [new carers] obvious feedback, but he does become fond of people/make attachments. (P, age unknown, with Special Educational Needs [SEN] in mainstream education; query Autistic Spectrum Disorder [ASD])

Surprised at how able she was. Language better than I have heard before. Amazed at how well she engaged... Usually relies on sister but [the child] on her own was quite capable--this was a new aspect of her. Sheila9 picked up that her understanding is poor. I didn't really know this before.

[Re potential contact] She is more confused overall than I had realised. Not able to locate herself in foster family ... Stronger attachment to birth family. (B, aged 4, with some speech and language delay)

Some of these insights altered the worker's perception of the child significantly. Of one child, the social worker had commented: 'In family-finding we have been saying "mild autism"--this has put people off.' However, having observed the interview, she said:

He expressed his emotions ... he could distinguish between the different faces--mimicked them and made eye contact with Sheila ... Very articulate. Loads of eye contact. I always said he didn't make eye contact ...

... All the school reports say 'concentration limited'--I can update the Form E now. Prior to this I thought he would need a lot of support--behavioural support in school, which would have to be continued. (J, aged 41, with query Asperger's Syndrome)

The child's social worker planned to rewrite the profile based on the new information.

Another example of the emergence of important information was from the interview with a chronically neglected child who had some speech and language delay:

We have [also] learned that more work needs to be done for moving her because her understanding of who is where is confused and we need to separate out the [siblings] because they work at different levels. (B, aged 4)

Of two severely neglected children, the social worker said:

I was surprised at his verbal skills. I didn't think he was that intelligent--he had been reported as not knowing his colours--but he was brilliant. I was amazed by him and how he interacted ... He understood a lot--much more than what the foster carer has said to me about his understanding. (LS, aged 4 1/2)

She has been so clammed up! She was able to be a different child. I got a real insight into her background--her itinerant lifestyle, her siblings--what she had suffered. (KT, aged 6/)

This last worker described the level of detail that emerged about the child's wishes and feelings as 'amazing'.

In another interview the child indicated that a card from his mother had been passed to him during a contact session with his father:

He thinks mum is in hospital: she will be coming out of prison in May. He has no contact with his mother, but told us he had a card. This must have been secretly passed over from his dad yesterday in the contact. (LE, aged 7)

b) The workers learned new things about the disabled children

The first two illustrations are from interviews with brothers (D and CN) who have similar levels of moderate global developmental delay and learning difficulties:

Surprised that he did not once mention his brother--who has been with him all the time, even with mild prompts from Sheila. Not sure about the significance of this. Would definitely use some of this info in the CPR [Child's Permanence Report]. If I'd known about it sooner I would have used it for the court process. (D, aged 8)

To the social worker's surprise, the nine-year-old sibling substantiated an incident of being hit by his father 18 months previously, which had been unclear to staff at the time:

I was shocked at the clarity of his description of being hurt ... We couldn't get this degree of clarity from the paediatrician at the time. When Sheila said, 'How did that make you feel?', he delivered exactly what he said to his dad: 'Don t ever do that again, Daddy! I was surprised at the passion in the delivery of the line--it was so vivid. He wasn't distressed by it but was just so clear, a) about the incident and b) the feelings and anger.

... In terms of a review this would be really helpful stuff to put in a review record: in fact it's done a fair proportion of my review record for me! (CN, aged 9)

Important incidental information also emerged from the most severely disabled child in the project:

He did say he likes to see his mum and dad and it makes him happy. I didn't know this beforehand--it has made me think, 'Ooh gosh, maybe I've been a bit negative about contact.' (KY, aged 7/ with severe impairments: severe learning difficulties, cerebral palsy, vision impairment and epilepsy)

The social worker also learned how settled this child felt in foster care:

Under 'identify and belong' he identified the house number--this place 'made him happy' [current foster carers]. He is quite clear about this. This will be helpful at panel when we are able to say, 'I am confident that he does like being there. He views his home as with [the foster carer]. He sees his life there.'

Then came the bombshell:

[I] was shocked about him mentioning ['B'--name of town]. He should not know where [sibling] is being placed. The prospective adopters will go mad; he must have heard his foster carer talking about that. I think that for a boy deemed SLD, it is very interesting he even knows that there is a place called 'B'!

c) Suggested modifications if In My Shoes were to be used widely with disabled children

Although the relative lack of disabled children meant that this was not widely tested, a useful number of points were made from the interviews with both disabled and not-disabled children:

His concentration difficulties meant that he was over keen to click the mouse to 'see what would happen next'--and his control of the mouse was not very good. When Sheila disconnected the mouse [the child] was encouraged to point instead. However, his fine motor skills were a bit wobbly and with the small screen it was not easy to see where he intended to point ... (D, aged 8, with moderate global developmental delay and learning difficulties)

She found the mouse difficult. Sheila had the track ball for her to use. She clearly had not used the mouse before. The interview ... did not seem to work ... environmental factors? Mood? [The child] is four but not used to a computer. Can it really be adapted for younger children? (H, aged 4)

Here the worker clearly had doubts about the value of the interview with such a young child, with implications for children who are developmentally delayed. However, where the child's level of ability is known, other technological adaptations, such as a computer with a touch screen, can be arranged.

d) Using In My Shoes in the family-finding context

There were a number of positive comments:

At the moment he does not know that he has to move on, and the IMS would be useful for this. (LE, aged 7)

[Re contact] IMS could be very useful in establishing what the children want re contact with birth parents. The court has asked for this. It did open my mind to ways of working with [the child] on this issue. We are never completely sure if we are getting the child's view. (D, aged 8, with moderate global developmental delay and learning difficulties)

She wants to see dad and [full sib], however impractical this may be. (KT, aged 6 1/2)

e) The computer as a tool

One reaction was highly enthusiastic:

Fantastic! Can see all kinds of uses. So many children are computer literate. Better than drawing--all kinds of uses. (LE, aged 7)

Other responses were more measured:

This gave her the tools for being more spontaneous re expressing wishes and feelings. Amazing. The child did not look like [name]--so relaxed. She could pretend she was someone else--having no eye contact helped. (KT, aged 6 1/2) I can say a lot more now to potential parents and give a new family much more idea of what he is like. He was very appealing--little imaginary stories [invented two rabbits with made-up names; said the spider could be helped to climb by using the web]. (LS, aged 4 1/2)

When I visit him in the foster home he goes to play in the garden so I don't really see him for a block of time. He was on task, with good concentration; followed instructions, understood things. I witnessed this so it's my evidence. (J, aged 4 1/2)

Only one worker's response was cautious:

He needed half a dozen sessions--and even then, how reliable was the information? (D, aged 8, with moderate global developmental delay and learning difficulties)

In summary, during this first stage, the participants who observed the In My Shoes interview were enthusiastic about its potential and most said they would like to be trained to use it. New information emerged about the children, including those who were disabled, which was of benefit to the family-finding process. The standard training programme was judged to be appropriate without modification.

Stage two: findings

In the second stage, 16 staff were finally identified and trained to use In My Shoes. They were required to undertake six interviews (one each with six children) over a six-month period and complete a pre-interview and post-interview questionnaire.

Staff and children

The staff

Of the 16 staff who completed the training, only 11 used the In My Shoes interview at least once during the (extended) research period and submitted the follow-up questionnaire. Seven of these workers were qualified social workers, of whom two were senior practitioners and four were family support workers.

Of the 11 workers who submitted the follow-up questionnaire, only one completed the full six required interviews/questionnaires and one completed five. Four completed three, one did two and four did one. Out of 96 expected interviews/questionnaires, 29 were submitted--a response rate of 30 per cent.

The children

Of the 29 children who were interviewed, there were 15 boys and 14 girls. The majority (15) of the children were in the seven to ten age-range; seven were between four and six, and seven between 12 and 15. The youngest two children were four and the oldest two were 15.

The disability element The project used a very wide definition of disability. The descriptions given of the children by the workers were largely impressionistic despite the availability of assessments by psychologists or paediatricians. When a robust description was lacking, an assessment was made by the BAAF project consultant on the evidence available, using the following scale: no disability, minor disability, moderate disability and severe disability.

Overall, 15 of the 29 children were described as having some form of disability or special need that was likely to impact negatively on their chance of finding a family. Of these 15 children, the needs of ten were rated 'moderate' or 'severe'. The remaining five (of the 15) appeared to have fairly minor difficulties (eg heart murmur, speech delay). Eight were on the autistic spectrum, with six of these eight being described as moderately or severely affected. Two had moderate levels of other difficulties plus 'autistic traits'. Only two children had a severe or moderate disability unrelated to autism (severe cerebral palsy and severe brain injury). Four children had a statement of special educational need (SEN) and were in mainstream schools. No disabled child was the subject of family-finding in this group, though a family was being sought for a six-year-old whose speech was described as 'quite under developed' and for a nine-year old with 'night epilepsy'.

In summary, it was of concern for the research that none of the children met the project criteria of being disabled and needing a new family. This is further discussed below.

The family-finding element Two-thirds (19) of the children were in foster care (the others were at home) and family-finding was in process for four of them. Life story work was being or had been conducted with 15 children. Profiles before and after the In My Shoes interview were requested but few were available (and no completed ones). From these limited data it was therefore not possible to evaluate the direct impact of In My Shoes on family-finding tools such as profiles, although its potential impact can be inferred. A few descriptive 'profiling' details emerged in the case of 11 children.

What the staff learned

The social workers' views of In My Shoes were extremely positive. In 28 of the 29 interviews, the programme was deemed successful:

He has a speech problem and often only says part of a word. It is sometimes difficult to understand him, especially when he is very excited. This enabled me to calm him down and go at a slower speed. (TJ, aged 6)

Children are able to express their wishes and feelings without having to verbalise them. The emotions pallet is an excellent tool to establish feelings and expand on through discussion. (NF, aged 12)

She loved the programme and being able to take the lead. She was pleased to be able to focus on her current placement as previous chats with professionals have focused on her past. She was able to relay what was a priority agenda for her rather than [for the] workers involved. IMS gave her [a] platform to express her wishes openly without fear of being judged or having to say what she felt was expected of her. In her being able to go through the interview at her own pace she felt more in control of the situation. We hope that we can use IMS to plot [the child's] views over time. (BT, aged 10)

Using the programme was seen as more effective than traditional means of engaging children:

I have found it difficult to keep her attention, as she has been distracted by watching other people in the coffee shop. IMS kept her focused throughout. (NW, aged 15, with mild developmental delay and SEN mainstream)

He found this technique far easier than my attempts at conversation alone. (KK, aged 13, with SEN mainstream)

One of the social workers, who completed all interviews, wrote:

I am delighted to have been part of the programme ... and look forward to continuing, even though it s been difficult at times to fit the interviews in around other demands. Thank you.

Specific findings

As explained earlier, the project had five specific aims. Each of these is now addressed:

1. Is In My Shoes a medium which enhances the worker/child relationship?

To build a relationship constrained by infrequent and brief social work visits is quite a challenge for some children and it can even be difficult for the child to remember the social worker's face from one visit to the next:

It can help children express themselves easily in otherwise difficult situations with practitioners who have no existing relationship. (LP, aged 9)

For a worker meeting the child for the first time, IMS is a great icebreaker and a far more relaxed way for the child to share information. It was an excellent way of getting to know the child. (SD, aged 6)

Even where the relationship has been in place for some time, In My Shoes can be helpful:

Although I have known him for several years, he has always found it hard to communicate unless he has been very angry. The IMS engaged him and he filled in the text boxes without being prompted. (KK, aged 13, with SEN mainstream)

Her social worker commented that she had never known her so openly chat before so is also keen to revisit IMS before the final court hearing in a couple of months. (BT, aged 10)

In this session the young person continues to chat after we had worked through the modules: it was as if the programme acted as a catalyst. (NW, aged 15, with mild developmental delay and SEN mainstream)

2. Is the child's ability to communicate enhanced by In My Shoes?

In 27 of the 29 interviews the unthreatening external focus of the computer screen was said to have enhanced communication. In two-thirds of these cases this was to a moderate or significant degree:

She was very definite in wanting in the future to be the only child in placement so she could have all the attention ... She was very angry in her tone and expressions throughout and the faces she chose. Very negative and unable to identify fun or nice things. (DT, aged 4)

Was able to be very clear that she wanted to stay where she was and not move placement. Identified through using IMS that her loyalties to her mother were not as strong as first thought. She had bonded with her current carers and wished to get on with her life there. (CHH, aged 7)

Using the faces he was able to communicate his sadness. (BC, aged 6, with severe cerebral palsy and mild developmental delay)

3. To what extent does new and/or important information enhance the family-finding plan?

New information emerged in 27 interviews. In 19 cases, the amount of new information was rated as 'quite a lot' or 'a lot':

I was surprised to find out how happy he is with his foster carers, whilst acknowledging that his first choice would be to be at home. (KK, aged 13, with SEN mainstream)

The experiences this child has had include being shown her dead baby [sibling] hanging off the bed. She told me in graphic detail about what she saw when her birth mother called her in the room. She told me about the drugs in the house and the nasty people who came there; how she had to forage for food behind a supermarket. (EJ, aged 8)

Some of this new information would be of particular value in updating the child's profile for family-finding purposes. This was the case for seven of the children. For example:

He needs a family that can ... support contact between him and his grandmother who he shares a positive relationship with. (NN, aged 5)

He is very sensitive about being in care, and through IMS has said that he has been bullied because of this. It is important for school to be aware of this. (KK, aged 13, with SEN mainstream)

Significant information emerged from 25 interviews, of which 20 revealed material which was regarded as 'quite' or 'very' significant:

She is extremely settled in her placement and she has little understanding of why she lives there, therefore [it] is going to need a lot of preparation work in line with family-finding. (AB, aged 4, with mild developmental and speech delay)

Her unhappiness at being in care was evident throughout. We must remain highly aware of her wishes to be with her mother. (NW, aged 15, with mild developmental delay and SEN mainstream)

She was interested in the somatic experiences module and quickly related to the pain indicators. She indicated through the module that she gets lots of headaches. (CP, aged 13)

He called his birth mum a 'bag head and showed anger about her drug dependency. (RL, aged 10)

He really wanted a picture of the dog to kiss goodnight and say hello to in the morning. (AS, aged 7, with mild to moderate developmental delay)

In the following instances, the information is so significant that planning may be affected:

He was clear throughout that his wish is to be united with his parents. Given the very clear wishes of the child and the positive nature of the supervised contacts, there will be serious consideration given to reuniting this child with an existing order whilst the assessment continues. (ND, aged 10, with moderate global developmental delay and autistic traits)

He was very focused on his father who had not seen him for over four years ... His birth father has since been in touch and has visited several times. (RN, aged 13, with severe brain injury; very limited mobility, no speech, fully dependent)

The overriding message, which was not expected, was that she wishes to stay with her current carers where her basic needs are now being met and not return to her parents. The social worker will be feeding her wishes and feelings in her court care plan. She is also now going to push family placement into accepting that this child should stay in current placement and not be moved. (BT, aged 10)

4. Does the In My Shoes interview add value to work with disabled children?

The interviews with the ten children described by their workers as moderately or severely disabled were scrutinised to identify the added value of using In My Shoes in facilitating children's communication. Six of the ten children were on the autistic spectrum, with two more having other difficulties plus 'autistic traits'. Two had severe disabilities which were not related to autism.

Workers learned of children's feelings and opinions:

With regard to living with his grandparents he volunteered, 'I have a great life now, and put percentages to this: 'I am 98 per cent happy and two per cent unhappy. His mother had been telling me she thought his emotional needs were not met, so this was good evidence to present to her. (CC, aged 10, with moderate Asperger's Syndrome, ADHD and ASD)

She identified that she often feels left out at school--separate. The reason for this feeling is that her presence can be disruptive to other pupils as her concentration is limited. (BM, aged 8, with moderate learning difficulties, ADHD and autism)

He was able to identify that sometimes his father is angry with him when he feels sad. (EM, aged 6, with severe autism)

He expressed how sad he was that he had lost his friend [another child who had been at the same placement]. He was able to use the pictorial medium to prompt communication. (BC, aged 6, with severe cerebral palsy and mild developmental delay)

In some cases, new and important information emerged:

I learned that he had a distorted idea of why he had been excluded at his previous school, which I was able to share with the head teacher so he could begin to address this. (CC, aged 10, with moderate Asperger's Syndrome, ADHD and ASD)

He had started to blame [foster carer] for taking him away from his mother. He was confused as to how he came to live with [foster carer] and who this lady called 'Mum was who visits once a month. (RN, aged 13, with severe brain injury, very limited mobility, no speech, fully dependent)

There emerged both benefits and negatives from using In My Shoes with children on the autistic spectrum and with learning difficulties. First the benefits:

His disability includes rigid thought patterns and easy distractibility. The computer is a favourite occupation and therefore ideal to aid concentration. I found it really valuable for this particular child ... (CC, aged 10, with moderate Asperger's Syndrome, ADHD and ASD)

It provided a medium which did not involve face-to-face discussion, which suited this little boy as he did not have to make eye contact. (EM, aged 6, with severe autism)

One worker commented that for a child with communication difficulties:

If this programme was being used with a child on the autistic spectrum, it would enhance the child s concentration and reduce the impact of exploring some painful experiences face to face. (EM, aged 6, with severe autism)

Another saw the value of In My Shoes for children with learning difficulties:

During this process you are also able to ensure that they have a full understanding of the reasons for the plan. It is very effective. (TM, aged 9, with mild to moderate developmental delay and SEN mainstream)

The following responses highlighted the difficulties when working with children on the autistic spectrum: For example:

He was unable to focus on the session and he verbalised his feelings about not wanting to engage in the process. He became very agitated throughout, with the session ending after he started to bang his head against the cupboard behind him. (BD, aged 9, with moderate SEN, autistic traits, ADHD and epilepsy)

He found the programme boring and said it was for people who are not very clever. He didn't want to talk about anything. He just wanted to rush through it. (CHS, aged 15, with moderate developmental delay and autism)

5. Does the In My Shoes interview need to be adapted for disabled children or for family-finding?

One worker from a disabled children's team, who had technical difficulties with the agency's laptop, found the interview repetitive, too complex and overly structured. This person recommended bigger text and pictures, including specialist communication symbols.

Further In My Shoes training

From feedback, it became clear that more emphasis in the training should be given to the importance of taking the interview at the child's pace, especially where disability or developmental delay was an issue, or with very young children:

Had to work very hard to keep child engaged. At times the programme was too long for her level of concentration and some scenes could have been halved to still get the same level of info. (DT, aged 4)

Here, it would be recommended that several shorter sessions would be more effective. In general, with practice, a more assured use of the tool would lead to a helpful flexibility in responding to the unexpected, such as here, where the title In My Shoes confused a child who had very rigid thought patterns:

She was very distracted by the title In My Shoes. Mum and I spent lots of time trying to explain why it was called this to move things forward, but she was very worried that I wanted to look at and even wear her shoes. (RH, aged 9, with moderate autism and severe speech delay).

Conclusions

Locating disabled children

Initially, we draw attention to our concern throughout this project that so few disabled children could be identified as suitable for inclusion. Workers and managers on disabled children's teams believed that many of the children would be 'too disabled' to participate, although the use of the interview with three of the most disabled children (KY, RN and BC) demonstrates that this assumption requires further exploration.

Of the 29 children in the second stage, no disabled child was the subject of family-finding. This raises important questions which need more investigation: does the planning for disabled children follow the same trajectory as for not-disabled children? Are some disabled children being denied the chance to be adopted or permanently fostered because they have not been referred to family-finding teams? The experience from this project might suggest that, despite the high numbers of disabled children in public care, there could be a disproportionately smaller percentage for whom the active plan is adoption or permanence. This is a matter which requires urgent investigation.

The value of In My Shoes

From the evidence available, In My Shoes, even in relatively inexperienced hands, seems to offer an important creative tool for working with children. The ease with which children were able to communicate via the computer interview was outstanding--enhanced by the triangular relationship of the child and worker sitting together facing the screen. It proved to be a positive 'ice-breaker', and a great deal of new and significant information emerged, even where the worker knew the child quite well.

Because In My Shoes is a visual tool, young people with language difficulties or conceptual thought problems could name their feelings and share information in ways less easily achievable through conventional interview methods. Where children were on the autistic spectrum or had attention difficulties, the structure of the interview could be helpful in engaging an easily distracted child; or in situations where avoiding direct eye contact was preferable for the child. But, as the case examples indicate, there is scope for further thinking about the use of In My Shoes with autistic children, and possibly more training. Some children were already very comfortable with computers, which was an asset.

Directly testing the use of In My Shoes in family-finding was limited as active family-finding was ongoing for only four children in the second stage of the project. However, significant insights emerged which are important, especially where the voice of the child was clearly heard:

I have seen how willing the young people are to engage with this programme. [They] have said to me how fed up they get about 'all these people coming to ask me about my feelings!' IMS gives young people of all ages [a way] to communicate on their terms ... (CP, aged 13)

The tool also emerged as having potential for use in life story work with displaced children, as different people, locations and domestic situations can all be readily accessed.

There were some disadvantages. Familiarity with the technology is essential: the focus must be on the child, and children soon lose interest if there are technical hitches. Some of the barriers to effectiveness resulted from an over-rigid application of the programme, but again, this is largely a matter of skill in using the tool flexibly to suit the child and the situation. Some case-by-case modifications for use with physically disabled children may be necessary but are easily made, for example, a tracker ball, joy stick or a larger screen.

In general, however, In My Shoes recommends itself as an original and thoughtful way of engaging children in complex, emotionally charged and significant work. The fact that it proved problematic to demonstrate this fully is cause for concern.

Obstacles

Organisational and capacity issues

Several lessons learned through this project went beyond those anticipated.

Engaging agencies was a huge initial problem. This resonates with other research (Dance et al, 2009) where the response rate of around 50 per cent was reported as broadly in line with other similar surveys. Subsequently, we found that keeping the self-selected workers pro-active was also very difficult: there was a big discrepancy between the stated enthusiasm for the programme and the number of completed interviews. It was our impression that managers were particularly difficult to engage, and some did not support their staff in prioritising the project. As we have no real data about this, we can only conjecture that the hurdle posed by any perceived 'extra' work was too high. This leads us to ask about management and worker overload: what creates this and how it is experienced. We had the clear sense of a workforce struggling with immense demands.

Specifically, we found that critical staff shortages and staff sickness all created further barriers to effective engagement in using the In My Shoes tool. There are also particular issues where the use of technology is required. We found insurmountable technological deficiencies (some staff did not have ready access to a laptop) and poor IT confidence and skills. As we all know, becoming familiar with new technology takes time and repeated practice, and without this the new skill will atrophy. In addition, staff who do not spend regular time with children will have limited opportunities to become comfortable with In My Shoes and might be inclined to revert to more routine methods of working. This could be a major disincentive to using new forms of practice which make initial demands on overstretched workers.

Overall, the relatively poor response to this project and the barriers encountered by staff highlight organisational, resource and practice issues which also form the subject of extensive discussion in the Munro Review (Munro, 2011a, 2011b), the Social Work Reform Board and in the development of the College of Social Work. In general, there seem to be major barriers to the development of practice, especially when this is not prompted by policy or regulation.

Professional issues

Some of the difficulties which staff seemed to experience in integrating In My Shoes into practice may also relate to a lack of confidence and time allocated to direct work (Luckock et al, 2006, p 105). It was concerning that there was some evidence that workers spent little meaningful time with children (authors' emphasis):

[Re emotions] he showed them, demonstrated them. I didn't realise before that he could do this as I only see him for a few minutes usually.

When I visit him in the foster home he goes to play in the garden so I don't really see him for a block of time.

I feel very uncomfortable doing direct work with him as I don't have time to build a relationship first.

In some instances, the social worker had made poor use of formal assessments by other professionals. In one example, the child's plan was proceeding under the social worker's erroneous label of autism, (10) where a specialist assessment would have led to a more accurate profile and possibly a more positive outcome. One description said 'front part of his brain is missing'--a judgement which lacks professional precision and would be difficult for anyone to interpret. The consequences for family-finding when these are enduring problems could be significant.

Afterpiece

Blame is easy when things do not work out and no blame is intended or implied in what is reported here. Managers and practitioners often feel powerless in the face of the demands of the social work task, and attempts to change that scenario through organisational and practice innovation are clearly not straightforward.

Direct practice--and creating the conditions that enable direct practice--is back on the agenda as an important and worthwhile goal. It is hoped that the lessons from this project are noted and further steps towards achieving that goal can be made.

Acknowledgements

The authors are very grateful to Rachel Calam and colleagues for permission to make substantial use of their paper 'Assessment and therapy with children: Can computers help?' (Calam et al, 2000) in the introduction of this article.

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(1) Child's Permanence Report (CPR) in England; the Child Assessment Report for Adoption (CARA) in Wales; the Form E in Scotland and Northern Ireland.

(2) Occasionally the terms 'staff' or 'social workers' are used to cover a variety of practitioner roles unless there is a need to be specific.

(3) Children Act (England and Wales) (1989) Part 1 Section 1(3) a): 'a court shall have regard in particular to--the ascertainable wishes and feelings of the child concerned (considered in the light of his age and understanding)'; similarly in Northern Ireland and Scotland (1995).

(4) For excellent DVDs and workbooks on communicating with disabled children, see NSPCC (2001) and Marchant et al (2009).

(5) However, nearly half of all the disabled children who were looked after showed behavioural disabilities alone (Gordon et al, 2000, p 254), which demonstrates the difficulty posed by definitions.

(6) An 'adoption activity day' project is being piloted in conjunction with a consortium of adoption agencies.

(7) The quotations which follow relate to specific children. The initials given were allocated according to research coding and do not relate to the child's name.

(8) The quotations given in stage one were noted by the researchers as nearly verbatim as possible during the debriefing. In stage two they are the words as written by the workers.

(9) Sheila Groth Larsen, psychologist and member of the In My Shoes development team.

Jennifer Cousins is a trainer and consultant to BAAF's Opening Doors Disability Project, BAAF Midlands, Birmingham, UK

John Simmonds is Director of Policy, Research and Development, BAAF, London, UK

In addition to the authors, the project team consisted of: Liza Bingley Miller, Sheila Groth Larsen and Phil Jimmieson from the In My Shoes development team. Advice was received from Rachel Calam, Antony Cox and David Glasgow.