Ethics of witnessing in clinical case notes of children in state care: From data extraction to narrative care

Clinical case notes provide researchers with a rare yet unsettling insight into the intimate realities of children’s mental health. These records capture fragments of lived experience that demand rigorous ethical attention in how they are accessed, interpreted, and re-presented. This paper examines the ethical tensions between data extraction and narrative witnessing through the reflections of a Social Work practitioner, through a collaboration wth professionals, and Experts by Experience. Drawing on a year-long reflexive study of clinical case notes from children in state care, this paper explores how professional language, institutional framing, and systemic pressures influence both the production and interpretation of such records. Divergent professional positions and discourses often collide, shaping children’s representation and obscuring their voices within clinical and administrative documentation. The analysis also considers the emotional labour and moral unease experienced by researchers when encountering recorded suffering, including the risks of vicarious trauma and moral distress. By reframing clinical case notes as testimonies rather than data alone, the paper argues for the practice of narrative care, an approach that prioritises attentive anonymisation, reflexive interpretation, and dignified representation. Narrative care acknowledges the methodological and emotional dimensions of engaging with trauma-saturated texts, enabling ethically responsive research that bears witness to children’s experiences. In doing so, this study highlights how researchers can uphold humanity within the constraints of research governance, transforming analysis into an act of ethical witnessing that recognises, rather than erases, the suffering and resilience contained within clinical records.