This blog is written by Jason Strelitz, Director of Public Health at the London Borough of Newham
At this time of rising concern for the welfare of our young people, how best do we keep them safe? There are no easy answers, but the insights from contextual safeguarding, that the broader ecosystem of young people’s lives are critical to thinking about their welfare, are a vital part of the jigsaw. That ecosystem, of school, of peer groups, of parks and high streets, of leisure centres and youth clubs, and online, the worlds young people inhabit may be important as sites of intervention; as much as the family home.
This understanding mirrors a public health approach; identifying the sources of exposure to risk in the community and trying to address these (easier said than done). However, beyond that insight that context matters, in that synergy between contextual safeguarding and public health approaches there are other potentially important insights. Among these, three seem important to keeping our young people safe:
Our awareness of unidentified risks experienced by people in the population
The role of strategies that positively “shift the curve” of risk for all young people
Considering the potential cumulative impact of exposure to risk at community level
Public health approaches ask us to think about the overall prevalence of health risks in a population, not just those who are known; the child with unidentified speech and language difficulties, the hidden heavy drinkers, the undiagnosed diabetics. Those people who are at risk and are known to services are almost always canaries in coalmines for those who are not known, and often do not know of the risk they themselves face. Put in a safeguarding context if we are concerned about the community context of young person “a”, it is very likely a number of other young people will be equally exposed to the same risks. The evidence for this is that harm frequently occurs to young people not being actively supported by safeguarding or mental health services. Therefore, if we only take steps aimed to protect young person “a” through an individualised lens, we may miss opportunities to address the same risks faced by the other young people.
If we believe that there is hidden risk, and we are committed to reducing harm, we need broader strategies, not just for those known to services. One response of public health to unidentified need is screening programmes, targeting potentially at-risk populations with a tool that tries to identify those who may be affected; what we call secondary prevention. Screening programmes play an important role in many instances but they are fraught with difficulties. Among many challenges they need to be able to reach a significant proportion of the at-risk population. They require a screening tool to be good at identifying those genuinely at risk (lots of true positives) and be good at screening out those with low risk (few false positives). Screening tools need to do significantly less harm, than good, a risk in many instances, including if we were routinely screening vulnerable young people, where there are potential harms of labelling and negative identity reinforcement. Furthermore, screening programmes need to have an effective intervention in place for those who are identified as at risk, otherwise the screening itself lacks purpose.
An alternative approach is to try to address risks at source; to make the whole population safer. Rather than identify all car drivers who might be risky, we lower speed limits and make the streets safer; everyone’s risk is reduced. So a contextual safeguarding approach leads us to asking; what will make my school, my parks, my high streets safer for all young people and what interventions in the peer group will make things safer not just for the young person with whose responsibility I am charged but for all young people?
Finally we need think about the cumulative impact of risk across the community. Increasingly the impact of trauma is being considered not just through a medicalised, individual lens, but sociologically at a community level. Where a community is repeatedly exposed to violence, how does this change attitudes and behaviours in ways which may heighten risk? For example, perception of safety breaks down in a community so that more weapons are carried out of a sense of self-protection, heightening risk for everyone; feelings that opportunities are lacking, create a recruiting ground for criminal exploitation; relationships of trust breaking down between community members and police, social workers, teachers, mental health professionals, making it harder for them to provide support and protection.
Of course, the great meta-context, too often the elephant in the room, is poverty and exclusion. Like so many of the health issues we face as a society, youth safety can be mapped onto a social gradient, where the conditions into which young people are born and grow, fundamentally affect their life chances and risks of harm. These issues of inequality must continue to shape our thinking about how to protect young people. This is not about “diversion”, getting young people off the streets, but genuinely broadening their life chances, throughout childhood, so they have reason to believe that opportunities are available to them.
Contextual safeguarding has reminded us that the broad ecosystem matters – that people’s risks, experiences and behaviours – are shaped by the wider world in which we live. Public health approaches always tell us the same; community risks are never tackled just by focussing on better treatment of individuals, but on strategies that make the environment safer for all. These insights therefore are a call to action not just for social workers and the networks that support individual children to consider context further but for broader public health approaches that engage public health professionals and leaders of place more broadly to develop effective strategies which promote safe and secure environments which support young people to thrive.
Author : Destiny Dejean
Published : 7th June 2019
