"The time for no debate is over.
It is time to debate all the latest evidence
about children, sex and gender"
Brigid Daniel, Professor emerita, expert in child protection
Introduction by Carolyn Brown, Convenor of ScotPAG:
This blog publishes an important article about social work practice, and emphasises a particular responsibility that lies with adults, to consider the evidence base when formulating guidance and procedures for children’s services. Children’s rights must be balanced with the adult responsibility to protect them, and to create safe and nurturing environments for children’s education and development. Otherwise, we will have lost all sight of the principles of The Promise. Furthermore, looked after children have been particularly identified as one of the groups most in need of protection from poor developmental outcomes. Scotland, currently an outlier with its wholesale integration of the ‘affirmation’ model into children’s services policy, is guilty of creating significant safeguarding concerns.
Is the concept of ‘no debate’ dead? Are we at a point now where professional staff can discuss issues of concern, robust research, and what is meant by evidence & efficacy? Safe practice flourishes in a climate of transparency, openness and responsiveness to new evidence as it emerges. In the current Scottish context, Scotland has a way to go.
Children, sex, gender: Evidence for practice in Scotland
by Brigid Daniel, Professor Emerita
(with acknowledgements to: Mary Howden, Retired Social Work Manager, Jane McLenachan, Retired Social Work Manager, and Maggie Mellon, Independent Social Worker)
The Background: Scotland has been at the vanguard of a number of significant policy, legislative and cultural developments regarding sex, gender and identity issues. From these have flowed debates about specific issues and implications, including inclusion and fairness in sport, sex-based services, sex and gender-based violence, free-speech and academic freedom, criminal justice systems and appropriate language for official documentation. Regardless of personal views and perspectives on the range of issues, it is unarguable that these developments are having an impact on human services and their delivery. Organisations are revising internal policies and have been introducing new guidance for the workforce consistent with the prevailing Scottish Government perspective. Following an initial period when there was a dominant message of ‘no debate’ about the direction of travel, these developments are now beginning to evolve and procedures are being shaped by legal challenges, employment tribunal cases, lobbying by different interest-groups, public polls, and media coverage. A wider range of different perspectives are increasingly helping to shape the refinement of human service responses to sex and gender.
In relation to adults it may be appropriate to allow such social developments to evolve over time. However, when it comes to children, and in particular looked after children who are amongst the most vulnerable to poor health and wellbeing outcomes, a particular responsibility lies with adults to consider the evidence base when formulating guidance and procedures for children’s services. This responsibility includes a requirement to maintain a flexible approach that allows for emerging agency and maturity as children and young people develop. Children’s rights to self-determination must also be balanced with adult responsibility to protect them from decisions that may be based on partial information. The right to have views heard and taken account of is only one of many rights. Adults with responsibility for children’s services policies and procedures need to use their mature capacity and resources to source and weigh up all the available evidence on behalf of children, whilst supporting young people to gradually develop the skills they will need to weigh up evidence for themselves. Those working with children who are looked after also need to be supported to deliver evidence-based practice that places child wellbeing and protection at the centre, whilst taking their views into account. Adults need to create safe and nurturing environments for children’s education and development.
The history of policy and practice in relation to child wellbeing and protection shows us clearly that there can be no ‘no debate’ areas. Safe practice flourishes in a climate of transparency, openness and responsiveness to new evidence as it emerges. There needs to be an ethos that encourages curiosity and uncertainty. Adults and young people must never be afraid to challenge or express concerns about issues. Looked after children have been identified as one of the groups most in need of protection from poor developmental outcomes. Since initial sex and gender identity policies, procedures and guidance were written for those working in children’s services the evidence base has expanded rapidly. Scotland is currently an outlier with its wholesale integration of the ‘affirmation’ model into children’s services policy. Thus, it is timely to take stock of current practice to ensure that it is congruent with the very latest evidence
Child self-determination
There is a strong commitment to Children’s rights in Scottish policy, coupled with legislative requirements to have due regard to children’s wishes and feelings. At the same time, the legislative environment presents a complex and ambiguous position as to when childhood ends. For different circumstances different cut off points are used, for example sentencing policy is based on a view that full maturity is not reached until 25 whereas a young person aged 16 is considered to have sufficient maturity to make the decision to marry. This raises real questions about when a young person can be considered to have sufficient maturity to make the life-changing decision to embark on gender re-assignment social and medical processes. Therefore it is important to consider the latest developmental evidence on sex and gender identity development and cognitive capacity to understand the implications of decisions on longer term outcomes, especially in the context of childhood trauma and disrupted home circumstances.
Interrogating the driving forces
Regardless of personal beliefs about the extent to which sex is biologically determined, and fixed for life, it is important to recognise that increasing numbers of children and young people are expressing a wish to make such changes. The huge rise has been attributed to many possible forces, including the unleashing of previously hidden unmet need to a wave of social contagion that requires a public health response. A range of social, financial and psychological factors have been proposed including rejection of rigid gender stereotypes, location of wider mental health issues onto one apparent solution, the influence of the pharmacological industry, the impact of particular social media influencers and advances in gender reassignment healthcare. Looked after children, whose experiences are axiomatically affected by trauma and loss, may be particularly vulnerable to a range of such influences. Equally, it could be argued that their need for support with identity development may be overlooked. Therefore, it is important to untangle the various strands of argument about the psychological and social forces that shape identity, identify evidence, including gaps in evidence and pinpoint any particular risks to looked after children and ways in which children’s services can best help children to navigate them.
Service providers and the workforce
The social care workforce is recognised to be relatively low paid and to be under severe pressure due to staff shortages and lack of resources for training and support. Staff are reliant upon clear and transparent guidance for practice, particularly if they are expected to undertake complex risk assessments in relation to sex-based facilities and identity issues within residential settings. Staff working with looked after children – at home or away from home – are in a position of having to navigate the range of different forces described above. They also need to be alert to risks to children in their care from any of these forces. In a context where people have been disciplined or lost their jobs for questioning the current approach there is a danger that people will feel unable to question practices they consider to be risky to the children in their care.
Organisations need to be confident that their guidance and protocols are underpinned by the best evidence, particularly given the rise of litigation across the world by service users who consider their care to have been less than optimal. Organisations need to be confident that they have safe and robust policies in this fast evolving area of practice.
Brigid Daniel has published widely on child development, children’s resilience, child neglect and the child protection system.
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