British Journal of Social Work (2011) 41, 820836

doi:10.1093/bjsw/bcq116 Advance Access publication December 13, 2010

Re-Thinking Harm and Abuse: Insights from a Lifespan Perspective

Brigid Daniel* and Alison Bowes
Brigid Daniel, MA (Hons), Ph.D., CQSW, is currently Professor of Social Work at Stirling University in the Department of Applied Social Science and is head of the Social Work section, which delivers undergraduate and postgraduate qualifying social work programmes as well as a range of continuing professional development courses. She is chair of the advisory group for the Scottish Child Care and Protection Network and member of the steering group for the Multi-Agency Resource Service. Her research interests and publications are in the areas of child development, childcare and protection, work with fathers, child neglect and childrens resilience. Alison Bowes is Professor of Sociology and currently holds the Chair in Dementia Research at the University of Stirling. She leads dementia research in DSDC and in the Dementia Cluster, a cross-university, multidisciplinary group of researchers. She has an extensive record of research with older people, particularly those from excluded groups, such as people with dementia and minority ethnic groups. She has recently published research on free personal care in Scotland with David Bell (Joseph Rowntree Foundation) and on mistreatment of older people in BME communities (Age Concern Scotland). *Correspondence to Brigid Daniel, SASS, Collin Bell Building, University of Stirling, FK9 4LA. E-mail: b.m.daniel@stir.ac.uk

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Abstract
The scope of protection from harm and abuse is rapidly expanding, and practice frameworks have tended to transfer and adapt child protection procedures for the protection of other groups. However there has been little in-depth analysis of the theoretical perspectives that underlie interventions within particular fields and almost nothing across areas such as significant harm to children, elder abuse and domestic violence. Scant attention has been paid to different time periods and national contexts. This paper, which draws on material presented and discussed during an Economic and Social Research Council (ESRC) seminar series, adopts a lifespan approach to understanding harm and abuse and explores how this can reveal insights for a more generic understanding and practice in protection services. The paper provides varying social constructions and varying recognition of concepts of harm and abuse, not least by victims, who frequently reject that role. Examining responses to harm and abuse suggests that formal systems tend to assume clear victims and perpetrators and that service categories can be unhelpful as they may not reflect experiences or address the wider contexts in which these are embedded. The lifespan approach provides a means for comparing and contrasting issues raised within specific areas of need and service delivery. It is an

# The Author 2010. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.

Re-Thinking Harm and Abuse 821

orientation which raises new questions about understanding harm and abuse and helpful insights which have implications for both policy and practice. Keywords: Lifespan, harm, abuse, protection

Accepted: November 2010

Introduction
Issues of harm and abuse are at the core of social work practice. Although protection from harm and abuse is increasingly described as a multidisciplinary activity, social workers retain key responsibilities for ensuring protection. The territory of harm and abuse, and by extension, the scope of protection activity is currently rapidly expanding. Whilst policy and legislation mandating state intervention in order to protect children has a long history, more recently policy, guidance and (in some jurisdictions) legislation are emerging to mandate state intervention to protect adults. To date, translation of practice frameworks across different fields of operation has consisted largely of taking well-established (although not unchallenged) child protection procedures and modifying them for the protection of adults. The justification for such simple trans-location is influenced by some apparently similar features that drive state concern. These tend to be associated with a concept of elevated vulnerability and include issues of lack of capacity, limited communication and physical frailty related to youth, older age or impairment. However, the extent to which these apparent vulnerability factors operate in different circumstances has not been fully explored. There appears to have been remarkably little in-depth comparative analysis of either the underlying theoretical perspectives or the practice frameworks that drive intervention with children and adults who may need protection from harm (Bowes and Daniel, 2010). There may be a case for adopting similar approaches to harm and abuse across different stages of the lifespan and in relation to different circumstances but trans-location based upon relatively superficial assumptions about vulnerability is limiting. This widening of state concern offers an opportunity to re-visit and re-analyse features of harm and abuse at different stages of the lifespan and in relation to different circumstances. From this we may be able to identify different (and perhaps deeper) ways of understanding that could inform the formation of a more nuanced and flexible system of protection. We have proposed the concept of lifespan as a helpful lens through which to interrogate this issue (Bowes and Daniel, 2010). This argument underpinned an ESRC funded seminar series Interrogating harm and abuse: protection and citizenship across the lifespan run at Stirling University (2008-2010). The aim was to promote sophisticated academic analysis of how issues of risk of harm and abuse are

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

822 Brigid Daniel and Alison Bowes

conceptualised at different stages of the lifespan and in relation to different groups of people, such as users of mental health services or people with learning disabilities with a view to improving understanding of, and informing, the development of appropriate and effective protective responses at the level of individual, family, community and state. This paper addresses some of the emergent insights into:
the nature of the problem: i.e. current understandings of the nature and aetiology of elevated risk of harm and abuse associated with different ages, relationships and groups seen as vulnerable; the most effective response: i.e. existing evidence about the most effective protective response at individual, family, community and state levels to harm and abuse across the lifespan, and the role of the state as protector and/or controller.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

It draws on a set of papers presented and discussed at an Economic and Social Research Council (ESRC) seminar series. Some of these follow in this issue of the BJSW and others have been published in Social Policy and Society (2010, 9(2)). We suggest that there is some promise in a lifespan approach in that it highlights some fruitful themes which could form the basis of the development of principles that could, in turn, help shape a broader protective system. Further, we argue that the development of a response informed by lifespan thinking contributes to current debates about the challenge of providing more personalised and individualised responses, because the analysis of the problem and planning for the solution becomes less driven by the need to locate the service user into a service delivery category.

Overview of concepts of lifespan

We adopt the term lifespan (used primarily by psychologists) and see it as interchangeable with the term lifecourse which is used more by sociologists (Baltes, 1987). Baltes (1987) propositions about the lifespan perspective have been influential; he argues: The life-span perspective offers a unique opportunity as a forum for transdisciplinary integrative efforts (p.622). He describes the considerable variability within age cohorts and the extent to which development is historically embedded. At the same time he is careful not to claim the approach as one overarching and unifying theory, but suggests that it is a metatheoretical world view that supports a theoretical orientation towards considering development as a life long process. Seeing it as a perspective rather than a theory he urges intellectual modesty amongst proponents of lifespan approaches. It is in this modest vein that we argue for the benefits of a lifespan approach to harm, abuse and protection both for analysis at the micro level of the individual and at the macro, structural level.

Re-Thinking Harm and Abuse 823

At a micro-level the lifespan approach offers potential for richer analysis of an individuals circumstances. It entails gaining understanding of the many layers of influence at any one time in an individuals circumstances and of the impact of prior and anticipated factors over time. In principle, social work theory should be able to encompass both aspects in relation to harm and abuse. For example, systems theories (e.g. Pincus and Minahan, 1973) and ecological theories (e.g. Bronfenbrenner, 1989) support analysis of the person within different layers of influence at a snapshot in time and over time. At the macro level an existing powerful critique of current approaches to risk and protection argues that instead of focusing on individual vulnerability (or indeed resilience) state intervention should instead focus upon the structural factors that elevate the risks for particular groups and communities (Baldwin and Spencer, 2005). We argue that structural analysis of harm and abuse to date has some limitations. Structural analyses of child abuse, elder abuse, abuse of disabled people and domestic abuse tend to fall into very discrete and separate streams of study and to seek distinct explanatory frameworks. In addressing harm and abuse in relation to a specific individual, it is not necessarily straightforward to identify how structural factors come into play because people can simultaneously fall into different categories. Clearly, not every older person experiences abuse, nor every child from a deprived background. Research on ethnicity and health is instructive here, as it offers means of understanding how social divisions can interact. Critical of research which has associated minority ethnicity and poor health in simplistic ways, Nazroo (1997) analyses data from the Fourth National Survey of Ethnic Minorities and demonstrates that whilst ethnicity is influential for health outcomes, it interacts with social class, and that the primary determinant of poor health is lower socioeconomic group. Thus, in some cases, minority ethnicity compounds social class effects, but it is not in itself determinant and can have no effect. Thus, what difference differences make has to be separated from assumptions and expectations about them, to move away from stereotyping or deterministic perspectives. At the macro-level, therefore, the introduction of overt comparative analysis across the lifespan has the potential to enrich structural analysis in relation to each separate stream of study. It also offers the potential for developing a more nuanced approach to personalisation.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Themes emerging from a lifespan approach: the nature of the problem

We now consider the problem of harm and abuse from the point of view of experience, both of victims and perpetrators, and explore different types of abuse and cultural contexts pertaining to victims and their construction (or non-construction) as social problems.

824 Brigid Daniel and Alison Bowes

Johnson et al. (2010) reviewed existing literature that has taken a comparative lifespan approach to issues of harm, abuse and protective responses. They sought papers comparing models of abuse and protection at each stage of the lifespan and papers exploring continuities and change in an individuals risk of abuse across the lifespan. Interesting discontinuities and continuities emerged. For example, in relation to theoretical analysis they note a tendency for researchers to more readily compare elder abuse with child abuse rather than with domestic abuse. An emergent continuity was the pivotal role of isolation in heightening vulnerability regardless of age or circumstance. The literature on revictimisation appeared to hold potential for fuller exploration of continuities of experience of harm across the lifespan although it requires greater synthesis and meta-analysis. Overall the review showed that existing attempts to take a lifespan approach have begun to generate some potentially useful insights which could be taken much further.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Rejection of the role of victim

One emergent theme from the series was the extent to which individuals, who might be regarded as victims of harm and abuse, either overtly or implicitly reject the role of victim. This was most explicitly expressed by one of the respondents in Donovan and Hesters study of domestic abuse in same-sex relationships:
Id never really thought of myself as a victim of domestic abuse . . . I dont feel like a victim, cos I think victim is a very passive, allowing it to happen, although at the time I was, in that relationship. So it might be the right term for that, but it almost suggests you cant do anything about it. (Donovan and Hester, 2010, p.285).

The bulk of research on child maltreatment traditionally focused on analysing the negative impact upon development. Indeed, the language of victimhood was central to the argument for prevention of abuse. However, this discourse was challenged by many who experienced abuse in childhood who preferred the term survivor (Kelly et al. 1993). Neither term may fully capture the subtleties and extent of variation of individual response to such experiences, and the concept of resilience emerges as potentially providing a helpful way to capture some of the subtleties of individual response to harm and abuse (Daniel, 2010). The literature on resilience has, itself, moved away from clear demarcations between invulnerability and vulnerability towards a far more nuanced analysis that views resilience relatively (Benard, 2004; Luthar, 2005; Rutter, 2000). Rutter has summarised the current evidence thus:
. . . childrens resistance to stress is relative, rather than absolute; the origins of stress resistance are both environmental and constitutional; and the

Re-Thinking Harm and Abuse 825 degree of resistance is not a fixed individual characteristic. Rather resistance varies over time and according to circumstances (Rutter, 2000, p651).

Respondents in a study of adolescents involved in prostitution did not see themselves as victims and did not act like victims (Williams, 2010). Williams suggests that throughout the lifespan new strengths and new vulnerabilities can emerge in relation to different challenges and that the development of resilience can be conceptualised as a spiral of harm and coping, recovery and resilience (p.252). Reviewing literature on resilience and deaf children Young et al. (2008) highlight the dangers inherent in conceptualising deafness as an adversity overcome by resilient individuals, partly because it reinforces the normal low expectations that society holds, such that achievement is seen as exceptional. Again they suggest a more subtle approach, which resonates with the idea of a spiral of resilience:
. . . the successful navigation of being deaf in a world which faces them with countless daily hassles and that may commonly deny, disable or exclude them, is a key definition of resilience. For such successful navigation to occur, a range of protective resources and repertoires of skills developed through challenging experiences of risk and responsibility have to be promoted (p. 52).

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Finally, Kelly (2010), in her ethnographic study of 14 people with dementia living in locked long-term hospital wards, also identified examples of apparent resistance in the face of abusive care which could be seen as a form of resilience. All these examples suggest that more comparative analysis of resilience across the lifespan is merited with a view to developing more subtle understandings of the range of experiences and responses of those experiencing harm and abuse with a view to providing a more effective position from which to engage with people experiencing harm and abuse.

Relationships and interactions

Relationships between the alleged perpetrator (whether a paid carer or informal or family carer) and the alleged victim can be complex. Hogg et al.s (2009) research on adult protection practice identified numerous examples of complex relationships within families where there were also allegations of abuse. Attachments and bonds were often strong and interdependence was a feature. Similarly, in a synergy with the rejection of the label of victim as described above, the concept of perpetrator is not always accepted either: . . . the nice side of her outweighed the ugly side of her (Donovan and Hester, 2010). The more common theoretical explanations of adult abuse and domestic abuse, based on carer strain or on abuse of power, do not really capture the full nuance of these situations. That relationships are often complex in situations where there are allegations of child abuse is a given in much of the child abuse literature. For

826 Brigid Daniel and Alison Bowes

example, attachment theory has been drawn upon heavily in analyses of the breakdown of the caring relationship between parent and child (Howe, et al, 1999; Turney and Tanner, 2001). Perhaps the concept of inter-dependence between the adults and children in the family would bear further exploration in relation to child abuse and perhaps concepts of adult attachment would be helpful in analysis of adult abuse. Donovan and Hester (2010) found that in same-sex relationships where there was domestic abuse, those at the receiving end of the physical or emotional violence often saw themselves as taking responsibility for the aggressor and for nurturing the perceived perpetrators self-esteem with proof of love. Whilst domestic violence in heterosexual relationships is usually explained theoretically on the basis of gender-based abuse of power, this explanation does not work for same-sex relationships without assuming a crude adoption of stereotypical gender roles within same-sex relationships. Donovan and Hesters findings, therefore, throw more light on the extent to which love and complexity may play a part in the victim response in heterosexual relationships. Cavanagh et al (2001) examine how violent men construct expiatory accounts of their own violence which attempt to deny the experiences of their female partners and to control womens interpretations of what has occurred. However, the study showed that understandings and constructions of violence in such relationships are dynamic, as men attempt to reconstruct, but women resist their accounts of violence. Here attention is again drawn to interpersonal dynamics and their impact on understandings of violence. Kelly (2010) indicates that the complexity of human relationships extends to professional relationships with service users, drawing on Sabats Selfs 1-3 framework for an enduring self in dementia (2001) as a basis for exploring staff-patient interactions. Self 1, expressed in terms such as I and me is the least vulnerable to the viewpoint of others and the effects of dementia. Self 2, comprising personal characteristics and attributes is vulnerable to others viewpoints, and the extent to which it is viewed positively or negatively can be enhanced or eroded by the way others respond to the manifestations of dementia. Self 3, expressed in public roles and social identities, is the most vulnerable to erosion when others fail to co-construct social identity. Many examples of abusive and demeaning interactions suggested that ward staff did not recognise the Selfs 1 3 of the patients. Although developed for a study of people with dementia, there is potential for further analysis of how respectful and non-abusive relationships are underpinned by mutual recognition of selves across the lifespan and in a range of circumstances. The theme of complex relationships appears, therefore, to have salience at all stages of the lifespan and better understandings of this would assist better practice.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Re-Thinking Harm and Abuse 827

Themes emerging from a lifespan approach: the nature of the response

Our consideration of policy and practice responses moves away from constructions of marginalised groups in society as requiring specialist intervention which may simply control, rather than addressing the fundamental causes of harm and abuse. Johnson et als review (2010) provided some pointers, for example, lifespan comparisons at the structural level suggested that ageism can influence differential responses to children and older people. At the family level, there were indications that caregivers of older people are viewed differently by services than parents of children. In relation to disability the comparisons showed considerable continuity in that disabled people were disadvantaged within services from childhood to older age and in relation to domestic abuse services.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Need for a victim and a perpetrator

Ironically, whilst the analysis of the nature of harm and abuse suggested resistance to the label victim, analyses of the response emerging from the series suggested that formal helping systems tend to be constructed around the concepts of victims and perpetrators at all lifespan stages. In relation to access to services this can prove problematic if people do not construct themselves as victims. As Williams suggests in relation to adolescent prostitutes:
. . . this victim label may do them a great disservice in the long run because the portrayal of the weak, innocent, helpless victim is directly challenged by the teen the police or a would-be service provider encounters . . .. Instead of a sad-eyed victim, they confront a strong, wilful, survivor who looks and acts quite differently from the victims portrayed in the media. (Williams, 2010, p.251)

The system can also find it difficult to deal with subtlety in construction of perpetrators. People on the Protection of Vulnerable Adults (POVA) list held by the Secretary of State are considered unsuitable to work with vulnerable adults in England and Wales. A study of decisions to place people on the POVA list (Stevens and Manthorpe, 2007) noted the binary outcome a person is either placed on the list or not which suggests a clear-cut process. It is not possible to be partly unsuitable. In reality, though, a complex balance of emotional reactions, moral judgements and mitigating factors underpinned the decisions. From her study of child contact with fathers after separation due to domestic violence, Holt (2010) also found that the system could not really contain the idea of a man who was a partly good and partly bad father.

828 Brigid Daniel and Alison Bowes

Service categories are unhelpful

The lifespan perspective highlighted the extent to which service is delivered via categories that do not necessarily match individual circumstances or self-perception. The need to label people and fit them into boxes was evidenced at all stages of the lifespan. For example, deaf children need to be diagnosed to receive specialist services; inverted commas may be used in a case file to denote that an adult has learning difficulties and to facilitate a protective response; intervention in child abuse depends on defining sufficiently serious harm and so on (Young et al. 2008; Hogg et al. 2009; Lockyer, forthcoming). Whereas being in a category did at least facilitate access to a service, those who did not fit into a recognisable category found it difficult to access a protective service at all, for example adults experiencing domestic abuse in same-sex relationships (Donovan and Hester, 2010), teenagers engaged in prostitution (Williams, 2010), or minority ethnic older people experiencing abuse (Manthorpe and Bowes, 2010). Beyond this relatively straightforward need for labels were issues posed by individuals who simultaneously occupy more than one category and/or move from one category to the next. Service delivery categories mask both internal differentiation and experiences and characteristics that endure across the lifespan, for example, a disabled child becomes a disabled adult. The lifespan approach starkly highlighted the illogicality of someone being a victim of child abuse one day and adult abuse the next (Hogg et al. 2009) or of domestic abuse one day and elder abuse when older (Johnson et al. 2010). Hester (this volume) offers a graphic perspective on this in the context of children and domestic abuse, describing the child protection, contact and criminal justice systems as akin to three different planets each with different approaches to violent men and their children and making different and sometimes contradictory decisions. The theme of mismatch between service delivery categories and individual needs resonates with the many layered debate about the relative merits of genericism and specialism in social work. Themes include whether the focus is on social workers as individuals with specialist or generic professional knowledge and skills, upon the structure and function of agencies for service delivery or upon the needs of the recipient of services. Debate swirls around issues of the conceptual underpinning of social work as a discipline and about the efficient and practical delivery of social services. In a seminal paper Vickery (1973) argued that there will always be a need to divide tasks into manageable packages but that this division should not be based upon administrative convenience, and instead should carefully consider spheres of knowledge and skill that are required and the need for these to be linked with the concept of advanced practice. Current practice, we suggest, may still be shaped around administrative convenience.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Re-Thinking Harm and Abuse 829

This theme also weaves together the strands of resistance to the label victim and the need the system has for victims. Lifespan comparisons showed a common theme of failure to engage with peoples own views about the nature of the concern and an apparent difficulty the system has with hearing that a person may not see themselves as a victim and may have a different version of the circumstances. Both Helm (2010) and Holt (2010) give graphic insights into the extent to which childrens views are either not heard or are overridden. Helm argues that adults hold the microphone and fail to listen to the childs point of view when making assessments, not necessarily because they do not wish to, but because they lack the tools to be able to make sense of childrens comments. Adult thinking, which is full of assumptions about what children want, how they think and what is good for them, always trumps childrens thinking. To some degree, failure to engage fully with the views of children can be linked with a range of factors specific to the childhood part of the lifespan. Certain skills and techniques may be needed to communicate effectively with children. By the same token, specialist skills or support may be needed to communicate with disabled people, adults with dementia or those whose first language is different from the majority language. But when making comparisons across the lifespan it appears that there is more to the lack of engagement with users views than problems of communication: the differential appears to be more universal and perhaps more related to the professional (or expert)/service user differential. The notion of harm and abuse services as the domain of experts is raised by Harbison (2008), who identifies that older people are reluctant to get involved in supporting other older people who may be experiencing abuse. She sees their reluctance as related both to the notion that they prefer to avoid facing challenging issues that are for them close to home, and also to the hegemony of experts in the field which makes it difficult for the perspectives of older people themselves to be taken into account. Expert definitional activity seems to impede rather than promote support. Finally, a lack of engagement with peoples own self-protective activities is a common feature. For example, Donovan and Hester (2010) pointed to the extent to which the agency of a person in resisting or coping with the experience domestic abuse is often denied or overlooked. Certainly, individual coping strategies can sometimes be counter-productive, for example, research on parental problematic drinking suggests that young people who find ways to escape from the chaos associated with drinking, such as going to a different room, do better in the long run, but that some ways of escaping can be unhelpful, for example if young people make an unplanned transition into unstable adult situations (Velleman and Orford, 1999). Effective individualised practice would go with the grain of the individuals coping strategies to maximise their efficacy and minimise any potential unhelpful side-effects.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

830 Brigid Daniel and Alison Bowes

Structural factors and intervention

In considering ways to identify potentially effective interventions, the strengths and limitations of structural analysis need to be considered. Given an appreciation that environmental factors and characteristics are significant, and that individual experiences and circumstances are also influential, it should be possible for a lifespan approach to allow understanding of the interaction of structural factors with individual experiences. It could bring together analysis of individual lifespan and an understanding of the impact of cross-cutting structural factors on that development. It could also facilitate a critical perspective on services that are available. There is a history of recognition of some shortcomings of a focus on categories of people in administrative systems and in the provision of services which is perhaps associated with shortcomings of a pure structural approach. For example, it has been recognised that categories may be too broad and have the effect of stereotyping people. In order to increase sensitivity to the needs of the individual, structural approaches may promote more and more refinement of the categories. This can be illustrated most obviously by attempts to refine ethnic identity such that the categories within which people are located become increasingly qualified. However, refinement does not necessarily overcome some of the inherent problems of categorisation. These include the tendency for ethnicity to change over time, the artificiality and even derogatory nature of some ethnic categories, the differences between ethnicity as perceived by the person concerned and by the observer (Bradby 2003, ONS 2003). Attempts of these kinds to capture diversity are driven by sound aims to identify, and therefore overcome, discrimination based upon negative views of specific groups. Ironically, the more categories are sub-divided and refined the closer one moves towards an individualised description for each person, such as female, between 40 and 49, African-Caribbean, heterosexual, divorced, moderate disability. Thus, attempts to capture diversity may be rendered rather pointless by the very diversity of the population and the difficulty of identifying the most salient source of potential discrimination. In making sense of abuse of older people in the context of services for older people in Finland, Topo (this volume) uses an argument focusing on structural factors and how these can interact to produce harm. She sees the occurrence of abuse as one of structural discrimination relating to older age, poverty and the experience of ill-health without access to care and support. Her perspective is important for highlighting that experiences of abuse are not merely unfortunate encounters with bad people, but are more likely given certain environmental factors. These may include structures and processes promoting disadvantage and social exclusion, constraining individuals resources and life chances. Considering older womens experiences of domestic abuse, Scott et al (2004) suggest that

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Re-Thinking Harm and Abuse 831

older generations of women hold cohort-specific attitudes about marriage and domestic violence that make them more inclined to keep silent about it and not seek help, often in the belief that the violence is an issue within the home only, to which services will not respond. As much of the pioneering work on domestic abuse attested (e.g. Dobash and Dobash 1979), the service response was indeed coloured by similar assumptions. Divisions within services can reflect and reproduce wider social divisions. As we have already noted, Hesters conceptualisation of different service arenas as different planets (this volume) reflect some of the ways in which the environments of abuse divide people and services along the lines of wider structural divisions. Furthermore, Mackay (this volume) highlights that the whole organisation of services can compound social divisions: she argues that social work clients frequently experience diminished citizenship rights and that recent legislation on mental health in particular in England has tended to diminish these yet further.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

What would a lifespan approach look like? How could it improve policy and practice?
Structural and individual factors
In some ways, a lifespan approach clearly and immediately calls attention to the interactions of individual and structural factors in situations of harm and abuse: for example, it alerts us to continuities of experience across the lifespan, such as experience of domestic abuse that persists throughout a marriage into older age. In that particular case, it also exposes some of the ineffectiveness of and discontinuities in services as services themselves prove unable to respond effectively for older women. Similarly, attention is drawn to the discontinuities experienced by young people who transfer, from one day to the next, between childrens services and adult protection which until recently barely existed. Thus, lack of continuity of support and the absence of long term consistent support are emphasised, and service deficiencies exposed. For the individual, the structure of services is dissonant with the continuity of experience and personal development. The lifespan approach also encourages consideration of policy and practice lessons which may be transferable across the lifespan. In the material we have considered, several examples can be found. For example, the focus on staff-service user interactions and their impact in relation to the failure to identify and respond to the self discussed in Kellys (2010) study of people with dementia in locked wards suggests potential ways to overcome some of the barriers to understanding childrens perspectives that Helm (2010, 2011) identifies. In Kellys study, the staff seem to trump the people with dementia in the ways that Helm sees social work adults as trumping children. Helm suggests that the way professionals

832 Brigid Daniel and Alison Bowes

make judgements can mitigate against hearing childrens views. Daniel (2010) highlights that harm to children is considered to have particular impacts because of children being perceived as becoming and developing. Her work suggests that in other areas of the lifespan, becoming and development are important too. Harbison (2004) refers to the dread of the fourth age (equated with decrepitude and decline) as an obstacle to people supporting one another: it could be argued that this perspective reflects wider ageism in society and failure to perceive that becoming, such as in the sense of self realisation, dignity and self respect, needs to be seen as a lifelong process. Interestingly, this echoes the Equality and Human Rights Commissions (EHRC) position on realising potential rather than delivering care for deficit, discussed below.
Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Legislation and/or human rights?

The diversity of legislation relating to harm and abuse seems to have been driven by notions of distinct issues and needs at different life stages, as we have identified. Importantly, legislation has frequently been enacted in response to new recognition of issues previously considered to be private an issue that is highlighted in relation to children and parenting by Parton (this volume). The issue of domestic violence is the most obvious of these, as it came to be recognised as an issue requiring legislation during the 1970s. Similar, as Harbison (2008) points out, elder abuse was discovered in the USA and Europe in the 1970s. Many of the changes in child abuse legislation have been stimulated by particular incidences of child abuse and subsequent enquiries. Most recently, the enquiry into the death of Baby P led to discussions about whether specialist child protection social workers were needed, to promote focus on child abuse and to prevent similar cases emerging. Notably, the subsequent social work taskforce has not recommended this (see http://www.dcsf.gov.uk/swtf/). In terms of our argument, such a move would have increased the refinements in classification and the divisions of issues of harm and abuse of which we have been critical. In other areas, legislation has been moving in different directions. The establishment of the EHRC in 2007 following the Equality Act 2006 replaced formerly separate commissions for racial equality, equal opportunities (gender) and disability. The Commission covers England, Scotland and Wales, and there is a separate Equality Commission for Northern Ireland, established following the 1999 Belfast Agreement. The EHRC (2009) has argued that an orientation towards equality and human rights can shift thinking in relation to the provision of care and support services. This echoes Manthorpe and Bowes (2010) suggestion that elder abuse issues for people from black and minority ethnic groups resonate beyond safeguarding legislation into much wider areas

Re-Thinking Harm and Abuse 833

of policy. The EHRC (2009) argues that a rights approach to service provision shifts emphasis from deficit and needs towards one of recognition of the individual, and towards measures enabling people to have control and choice in the services they receive and to be supported to realise their potential, rather than being presented as a burden on society and/or their families. It is possible that other legislation may interact with harm and abuse legislation to provoke change, and there are suggestions that services will be pushed towards using a lifespan rather than a lifestage approach. The Equality Act 2010, in force from October 2010 onwards, covers England, Scotland and Wales. One of its important elements is to include new protection from discrimination in relation to age. Furthermore, the equality duty for public bodies, which requires them to take heed of equality issues in their work, is extended to cover issues of age (from 18 upwards), sexuality, religion and pregnancy and early motherhood. It is possible that the Act will have particular consequences for harm and abuse services. For example, domestic violence services which are geared towards younger women with children may face challenges relating to the necessity to consider making their service accessible for older women. Similarly, people with learning disabilities who develop dementia at relatively young chronological ages may challenge the dementia services they encounter which are primarily orientated towards older people. This focus on opportunity and contribution rather than deficit echoes the comments in many of the papers we have reviewed on the active participation of those constructed as victims in addressing harm and abuse. Many contributors have referred to agency in terms of presenting oneself not as a victim but as an active agent, and others have discussed the concept of resilience. It would be possible to argue that an over-emphasis on resilience and/or agency could serve to suggest that strong victims do not really need services and can therefore be left to their own devices. This is not our view. However, if services started from a perspective emphasising respect for the individual rather than a victim-perpetrator one, the possibilities for engaging the agency and resilience of people using services would more likely be recognised. Such an approach would involve respecting peoples own constructions of their situations and working with them to improve things, rather than predefining someone as an abused woman who needs a refuge or a victim of elder abuse who needs an advocate.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

Conclusion
Across all stages of the lifespan the discussion suggested that, as agents of the state, practitioners are increasingly bound by regulation which does not reflect the complexity of peoples private lives and that service-led responses

834 Brigid Daniel and Alison Bowes

often fail to meet users needs. Although further analysis and development is required, these initial comparisons have offered some promising pointers, especially for moving away from simple translocation based on concepts of vulnerability. In relation to the nature of the problem:

theoretical explanations in one sphere could be enhanced by testing their application to other spheres, for example, across the domestic abuse and elder abuse spheres; lifespan analysis and comparisons across spheres may highlight some fundamental, universal factors associated with elevated risk of harm such as isolation, re-victimisation and lack of recognition of selfhood; similarly, there are a number of factors that may help with understanding the complexity of the contexts of harm, including inter-dependence, love, attachment and resilience and agency; lifespan comparisons suggest that theoretical explanations need to be sufficiently flexible to encompass fluidity of victim/perpetrator statuses.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

The themes reinforce current demands for more personalised services and suggest some aspects that need to be incorporated into a nuanced personalised response. This would be a good time for the social work profession in particular to re-examine the type of specialism that is required that relates more to professional knowledge and skill rather than to administrative convenience. Service delivery, for which social work can be a key driving discipline, should be sufficiently flexible in a range of ways. Practice needs to counter the tendency for some circumstances, especially disability, to be associated with elevated risk of receiving an impoverished service at any stage of the lifespan. Service delivery also has to be structured such that it can cope with more fluid definitions of victim and perpetrator or move beyond these categorisations as a basis for practice. Our systems must be sufficiently flexible to encompass the fact that people can occupy several simultaneous categories and/or can move between categories during their lifespan. Whilst it has always been important to hear the views of people who use services, the themes stressed the particular importance of hearing peoples own analysis of their circumstances and engaging with their agency and existing coping strategies. We still need to refine our capacity to assess and understand the interaction between structural and individual factors. At a very basic level a lifespan approach suggests the need for continuity of services across the lifespan. Finally, a lifespan approach may suggest a need for one basic set of legislation to cover all harm and abuse and a set of service delivery structures that is more responsive to the complexity of our lives.

Re-Thinking Harm and Abuse 835

References
Baldwin, N. and Spencer, N. J. (2005) Economic, cultural and social contexts of neglect, in J. Taylor and B. Daniel (eds.), Child Neglect: Practice Issues for Health and Social Care, London, Jessica Kingsley Publishers. Baltes, P. (1987) Theoretical propositions of life-span developmental psychology: on the dynamics between growth and decline, Developmental Psychology, 23, pp. 611 626. Benard, B. (2004) Resiliency: What Have We Learned? San Francisco, WestEd. Bowes, A. and Daniel, B. (2010) Introduction Interrogating harm and abuse: A lifespan approach Social Policy and Society, 9, 2, 221 229. Bradby, H. (2003) Describing ethnicity in health research Ethnicity & Health, 8(1): pp. 5 13 Bronfenbrenner, U. (1989) Ecological systems theory, Annals of Child Development, 6, 187 249. Cavanagh, K., Dobash, R. E., Dobash, R. P. and Lewis, R. (2001) Remedial work: Mens strategic responses to their violence against intimate female partners, Sociology 35(3):695 714. Daniel, B. (2010) Concepts of adversity, risk, vulnerability and resilience: a discussion in the context of the child protection system Social Policy and Society, 9, 2, 231 241. Dobash, R. E. and Dobash, R. P. (1979) Violence Against Wives: a Case Against the Patriarchy, New York, Free Press. Donovan, C. and Hester, M. (2010) I Hate the Word Victim: An Exploration of Recognition of Domestic Violence in Same Sex Relationships, Social Policy and Society, 9(2), 279 289. Equality and Human Rights Commission (2009) From Safety Net to Springboard: a new approach to care and support for all based on equality and human rights, http://www.equalityhumanrights.com/fairer-britain/care-and-support/from-safetynet-to-springboard/ (accessed 19th April 2010). Harbison, J., Coughlan, S., Karabanow, J. and VanderPlaat, M. (2004) Offering the help thats needed: responses to the mistreatment and neglect of older people in a rural canadian context, Rural Social Work 9:147 157. Harbison, J. (2008) Stoic heroines or collaborators: Ageism, feminism and the provision of assistance to abused old women, Journal of Social Work Practice, 22(2), 221 234. Helm, D. (2010) Making Sense of Child and Family Assessment: How to Interpret Childrens Needs, London, Jessica Kingsley Publishers. Helm, D. (2011) Judgements or assumptions? The role of analysis in assessing children and young peoples needs. BJSW this volume. Hogg, J., Johnson, F., Daniel, B. and Ferguson, A. (2009) Interagency Collaboration in Adult Support and Protection in Scotland: Processes and barriers. Volume 1: Main Report, Dundee, White Top Research Unit, University of Dundee. http://www. scotland.gov.uk/Topics/Health/care/adult-care-and-support/legislation/Resources/ Collaboration Holt, S. (2010) The Contact Conundrum: Exploring Childrens Experiences of PostSeparation Contact with Domestically Abusive Fathers,thesis submitted in fulfilment of the requirements for the degree of PhD, Dublin, Trinity College Dublin. Howe, D., Brandon, M., Hinings, D. and Schofield, G. (1999) Attachment Theory, Child Maltreatment and Family Support, London, MacMillan Press.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013

836 Brigid Daniel and Alison Bowes Johnson, F., Hogg, J. and Daniel, B. (2010) Abuse and protection issues across the lifespan: reviewing the literature Social Policy and Society, 9, 2, 291 304. Kelly, F. (2010) Abusive interactions: research in locked wards for people with dementia. Social Policy & Society 9, 2, 267 277. Kelly, L., Regan, L. and Burton, S. (1993) Beyond victim to survivor: The implications of knowledge about childrens resistance and avoidance strategies, In H. Ferguson, R. Gilligan and R. Torode (eds.), Surviving Childhood Adversity: Issues for Policy and Practice, Dublin, Social Studies Press. Lockyer, A. (forthcoming) Young people as active political citizens, in B. Crick and A. Lockyer (eds) Active Citizenship: What Could it Achieve and How? Edinburgh, Edinburgh University Press. Luthar, S. (2005) Resilience in development: A synthesis of research across five decades, in D. Cicchetti and D. J. Cohen (eds) Development Psychopathology: Risk, Disorder and Adaptation (2nd ed, Vol 3), New York, Wiley. Manthorpe, J. and Bowes, A. (2010) Age, Ethnicity and Equalities: Synthesising Policy and Practice Messages from Two Recent Studies of Elder Abuse in the UK, Social Policy and Society, 9(2), 255 265. Nazroo, J. Y. (1997) The Health of Britains Ethnic Minorities, Londo, Policy Studies Institute. Office for National Statistics (2003) Ethnic group statistics: A guide for the collection and classification of ethnicity data, London, ONS. Parton, N. (2011 this volume) Child protection and safeguarding: changing and competing conceptions of risk and their implications for social wFork BJSW [this volume] Pincus, A. and Minahan, A. (1973) Social Work Practice: Model and Method, Itasca, IL, Peacock. Rutter, M. (2000) Resilience reconsidered: conceptual considerations, in J. P. Shonkoff and S. J. Meisels (eds), Handbook of Early Childhood Intervention (2nd ed), Cambridge, Cambridge University Press. Sabat, S. (2001) The Experience of Alzheimers Disease: Life through a Tangled Veil, Oxford: Blackwell Publishers. Scott, M., McKie, L., Morton, S., Seddon, E. and Wasoff, F. (2004) And for 39 years I got on with it: Older Women and Domestic Violence in Scotland, Edinburgh: Health Scotland Stevens, M. and Manthorpe, J. (2007) Barring inappropriate people? The operation of a barring list of social care workers: an analysis of the first referrals to the Protection of Vulnerable Adults list, Health and Social Care in the Community 15,4:285 294. Turney, D. and Tanner, K. (2001) Working with neglected children and their families, Journal of Social Work Practice, 15, 2, 193 204. Velleman, R. and Orford, J. (1999) Risk and Resilience: Adults Who Were the Children of Problem Drinkers, Amsterdam, Harwood Academic Publishers. Vickery, A. (1973) Specialist: Generic: What Next? Social Work Today, 26(July), pp. 262 266. Williams, L. (2010) Harm and resilience among prostituted teens: broadening our understanding of victimisation and survival, Social Policy and Society, 9(2), 243 254. Young, A. M., Green, L. and Rogers, K. D. (2008) Resilience and deaf children. A literature review, Deafness and Education International, 10(1), pp. 40 55.

Downloaded from http://bjsw.oxfordjournals.org/ by guest on November 27, 2013