Pointers for Practice: Establishing the Daily Lived Experience of Family Members

There are considerable advantages to establishing the lived experience of the child and their parent: as this example demonstrates:

Duty to report from GP

Concerns that Marc 11 years old suffers from poor dental hygiene he has tooth decay and has constant infections because of a failure on the part of his mother to take him to a dentist or complete courses of medication

Whilst identifying a concern this report does not provide a clear picture of the impact of the dental neglect on Marc and the degree of urgency in getting him dental care. Consequently, the report may result in no further action or a care and support plan. However, by considering a day in the life of a child and using professional expertise to identify the impact, one gains a much clearer account, with evidence of the specific ways the abuse or neglect is affecting the child. This makes assessment much more precise and child-focused.

In Marc’s case, for example, as practitioners ask Marc about his day, as part of the assessment, they learn about his experience of toothache.

He describes sleepless nights because he is in pain. He rarely eats as it hurts so he tends to live on fizzy drinks at home and if he’s at school he cannot eat his school dinner. He often does not go to school as he frequently gets infections and feels ill or his tooth ache means he finally falls asleep in the early hours and therefore does not wake up in time for school. If he stays at home, he tries to sleep on the sofa. As he is irritable he annoys his mum and they end up arguing. When that happens, he will go and sit in the park for a bit. If he does go to school, he is usually late, really tired due to lack of sleep and therefore lacks ability to concentrate, feels miserable, is irritable and gets into fights easily. Also, his breath smells and other children tease or bully him. He finds the pain is worse in the evenings and is increasingly helping himself to mum’s vodka as he’s learnt this numbs the pain for a bit and helps him sleep.

Drawing on the above it becomes apparent that most aspects of Marc’s health and development are affected by dental neglect.

His general health is clearly affected.
His educational needs are as his school attendance is poor and his ability to learn when at school means he is falling behind.
His social presentation is affected as his teeth look unpleasant and he smells.
His self-esteem is low particularly as others tease or bully him.
His behaviour is erratic; he is aggressive because of the pain he is in. Drinking vodka is also likely to impact on his behaviour.
His relationships are also affected because of his irritability.

However, to begin to identify why the needs of the child are not being met it is also necessary to understand a day in the life of the parent/s as the two are inextricably linked. Practitioners can only begin to appreciate how daily parenting is impacting on a child if they know about both the parent/s day and their approach to meeting the needs of the child during the day.

When asked about her day Marc’s mother, Megan, a single parent describes:

Megan knows the flat is a mess and she never gets around to cleaning-up or washing etc. She struggles to get up in the morning as she is on anti-depressants and has often been up in the night to look after her 4-month-old baby. By the time she does get up it is mid-morning, so she never knows if Marc has gone to school or not, what he is wearing and whether he has washed or eaten something. If he hasn’t gone to school, she has not got the energy to argue with him and just lets him be. By the time she’s got herself up and sorted out the baby it’s usually one-ish and she is exhausted. She rarely bothers to get dressed and has no appetite. If she has money she gives Marc some to get her vodka and himself food, but she has little idea what he buys. She spends the afternoon in-front of the TV and has usually had a couple of vodkas so she’s able to have a snooze. She finds Marc is always moaning and irritable and gets really cross if she asks him to mind the baby. She knows he has toothache and that she should sort it out, but the days just seem to fly past and she never gets around to making an appointment for him at the dentist.

It is only by understanding the lives of both parent/s and each individual child in a family that one can begin to understand why the needs of the child are not being met and what would need to change for those needs to be met. For example, in the case of Marc there would be little point in just saying to Megan she needs to take Marc to the dentist and ensure he brushes his teeth.

To gather information about the daily lived experience of family members consider the following:

Create a positive environment for the conversation by considering the location, time of day, length of the session and who needs to be there.
Family members may be guarded so, it is important to explain to the child or carer what is happening, why you are there and what your role is.
Try to create an open, honest and respectful relationship from the beginning.
Think about the individual characteristics of the family member: their age, capacity, ethnicity and current stress levels.
Be mindful of other important influences on family life as well as support networks.
Try to record the actual words used.
Use age appropriate tools: clocks, strip cartoons.
Do not let children become bored: you might need to have breaks and do this over a couple of sessions.
Some family lives are so chaotic there is no typical day. Asking about the previous day can work.
Find out how life varies at week-ends, school holidays, with different carers and people in the house.
Ask open questions: don’t take anything for granted.
Don’t jump to conclusions, for example, presuming children have breakfast.
Elicit information about the lives of young children through observation and finding out about their day from carers.

It is crucial that practitioners do not pressurise children and young people into discussing their daily lived experience. It is important to bear in mind:

Whether the child is keeping 'safe' by not telling professionals things
Whether the child has learned to minimise the situation and it’s impact
The child is blaming themselves for the problems and/or do not want to get their parent/s into trouble.

(Horwath 2019)

Further information:

Horwath, J. (2016) Making a Difference to the Neglected Child’s Experience in Gardiner, R. Working with Child Neglect. London: Jessica Kingsley. pp.70-93.

Horwath, J. and Platt D (2019) The Child’s World. The Essential Guide to Assessing Vulnerable Children, Young People and their Families London: Jessica Kingsley