At last – something sensible on FII
Allegations by professionals that families are guilty of FII (Fabricated or Induced Illness) appear to be proliferating as do training programmes that seek to alert social care and health professionals to the risks of this very rare ‘condition’.
Into this bleak medicalised ‘parent blame’ discourse drops an immensely encouraging analysis: the publication by the British Association for Social Work and Social Workers of Practice Guidance’ – namely C Long, J Eaton, S Russell, F Gullon-Scott and A Bilson Fabricated or Induced Illness and Perplexing Presentations: Abbreviated Practice Guide for Social Work Practitioners (BASW 2022).
The guidance should be mandatory reading for all local authority and NHS children’s services’ professionals. In effect, it represents a strong ‘push back’ on 2021 guidance issued by the Royal College of Paediatrics and Child Health (RCPCH).
As the report’s authors note:
- from the many families we know who have been wrongly accused of FII, it can be so easy to ‘get it wrong’, and the effects of such can be devastating. Therefore, let each of us be the practitioner who questions, challenges and uses our professional curiosity to do all we can to get it right.
In our research we too have come across many families who have been falsely accused of FII: parents who never get over the trauma of such allegations.
Key recommendations in the report include the need for social workers:
- to exercise professional curiosity when a referral is made suggesting a child has a perplexing presentation or FII.
- to be aware of the lack of evidence for currently used indicators for FII and perplexing presentations and the high incidence of these indicators identifying children where illness is neither fabricated or induced.
- to be aware that the behaviour of autistic and neurodivergent parents and children is easily mistaken for FII as is the case in multisystemic conditions such as Myalgic Encephalomyelitis and Ehler’s Danlos Syndrome.
- to understand that complex presentations in suspected FII can often be due to rare or misdiagnosed illnesses so it is essential to work with parents/ caregivers and children to determine what support is required and to ensure specialists with knowledge of relevant conditions are involved.
- to accept the potential for interprofessional differences about FII and be confident in their knowledge and skills to promote a social perspective.
- to use reflective supervision to support their own learning and confidence in FII, identifying the potential for their own biases and limitations in their understanding of different conditions/presentations.
- to refer to the BASW Code of Ethics to ensure their practice aligns with the principles of human rights, social justice, and professional integrity
The Cerebra Legal Entitlements and Problem-solving (LEaP) research project is currently undertaking research concerning the prevalence of FII claims made by statutory bodies.
 RCPCH Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children RCPCH Guidance (RCPCH 2021).
Posted 11 May 2022