Potential contradictions between service styles

It is evident from the previous chapter that while the service responses required to address the five conditions (or type of ill-being) may help to foster a rich service or policy mix, and so arguably increase the chances of improving child well-being, they also exist in tension and potentially contradict one another. Initiatives to address one condition may inadvertently impair efforts to tackle another, thereby creating or perpetuating problems. Moreover, they will almost certainly use resources to generate apparently successful outputs and outcomes, which, measured in terms of another condition, are actually of limited value, even damaging. The first part of this chapter therefore takes services for each condition in turn and discusses possible contradictions as they affect children and families who receive the service.

Services to meet need

Services to meet children's need exist in tension with rights-driven responses in at least four respects. First, the flexibility or discretion that is innate to responses to unmet need tends to generate guidance (rather than rules) that can be interpreted such that someone who technically is not entitled to assistance receives it (and vice versa) – a point made by Donnison (1982) in relation to state benefits. From a rights perspective this might be perceived as an insecure basis for distributing welfare resources to children and families, because it allows proper forbearance and assistance to be withheld at discretion.

Second, because a needs approach is inclined to treat children as passive objects, it generally draws more on the evidence of ‘what works’ than does a rights-orientated response, which views children as social actors and therefore pays greater attention to user opinion. In medicine, for example, children with chronic illnesses may have their right to influence decisions about receipt of drugs or surgery overridden by well-meaning adults on the basis of research studies supporting proven interventions. Although it might be argued that this is in the patients’ best interests, such an approach is vulnerable to criticisms of being authoritarian or paternalistic.

Third, whereas a needs approach is more inclined to provide limited services for children and families, and to expect that this will be sufficient and welcomed, rights protagonists tend to be concerned with countering structural problems and so empowering clients to lead more autonomous lives (Barnes, 1998).