‘It felt like there was always someone there for us’: Supporting children affected by domestic violence and abuse who are identified by general practice

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.     

Changing landscapes in safeguarding babies and young children in England

The importance of safeguarding children from violence is internationally recognised. However, detecting, intervening and protecting children from abuse both within the family and in institutions is complex. This paper specifically focuses on safeguarding in England and how workforce reform in the early years offers the opportunity to forge new partnerships with families and professionals. These relationships have the potential to support more positive outcomes for babies, young children and families who are ‘in need’ or where the children are at risk of significant harm or abuse has occurred. The paper draws on the findings from research exploring the impact of workforce reform in the early years and how the changes impact upon the wider safeguarding agenda. It will argue that the introduction of an inter-disciplinary graduate professional in the early years has afforded an opportunity to forge new partnerships that have the potential to significantly impact on child maltreatment.     

Making the links between domestic violence and child safeguarding: an evidence‐based pilot training for general practice

We describe the development of an evidence‐based training intervention on domestic violence and child safeguarding for general practice teams. We aimed – in the context of a pilot study – to improve knowledge, skills, attitudes and self‐efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two‐stage consensus process with a multi‐professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co‐ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi‐agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice‐based domestic violence training.     

Listening to children: gaining a perspective of the experiences of poverty and social exclusion from children and young people of single-parent families

This paper reports on the experiences and views of children and young people of single-parent families, as findings from a European Union-funded research project undertaken in England, Greece and Cyprus. The objectives of the research project were to investigate how children and young people of single-parent families understand and experience their worlds as members of these families: whether and to what extent they experience poverty and social exclusion and how they cope with the challenges that this confronts them with. Methodology was replicated in each of the countries; however, this paper draws on the English experiences. Semistructured interviews (40) and focus groups (four) were undertaken with children of single parents. In addition, focus groups were undertaken with children of two-parent families (four), focus groups with single parents, focus groups with two-parent families (four) and individual interviews with key professionals. Detailed discussion guides were followed, with open-ended questions to allow participants to express their feelings and ideas in their own words. The research sample included children from single-parent and two-parent families, aged 6 years to 16 years, balanced in terms of age, gender and geographical location. Findings demonstrate the children's and young people's understanding of the impact of poverty and social exclusion on their family life and their everyday experiences. The positive benefits of being in a single-parent family are highlighted, with 'time poverty' raised as a significant issue. Children and young people are aware of their poverty and how it influences exclusion from friendships, play, leisure and community activities. Policy needs to take account of the systematic reality of children's experiences; alliances with adults that support meaningful involvement and participation by children and young people will make a significant contribution to this.     

Listening and facilitating all forms of communication: disabled children and young people in residential care in England

ABSTRACT

Little research has been undertaken into how children with complex communication needs living in residential care are encouraged to express their views, be involved in decision-making, and importantly, make it known when they are unhappy. This group are often placed a long distance from home and can be some of the most vulnerable children in the care system. Ensuring they have access to a communication method, people who understand their communication and support to empower them to grow their capacity is not only a right and a safeguarding mechanism, it is also important in preparation for adulthood and for leaving care. This unique paper reports on the English arm of a European project, which aimed to devise the first international monitoring system to prevent abuse of disabled children in residential settings. Trained professionals examined how disabled children were heard, and encouraged to be involved in decision-making within 10 case-study residential settings. To aid international development of good practice, this paper focuses on positive aspects of practice. Examples are used to illustrate how all forms of communication can be encouraged and used positively to both protect and empower disabled children in residential care. Implications for practice are presented to support practitioners to create positive communication environments.     

The impact of exposure to domestic violence on children and young people: a review of the literature

The impact of exposure to domestic violence on children and young people: a review of the literature
Holt, S. , Buckley, H. & Whelan, S. ( 2008 ) Child Abuse & Neglect , 32 , 797 – 810 . Objective This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well‐being of children and young people. Impact is explored across four separate yet interrelated domains (domestic violence exposure and child abuse, impact on parental capacity, impact on child and adolescent development and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. Method A comprehensive search of identified databases was conducted within an 11‐year framework (1995–2006). This yielded a vast literature that was selectively organized and analysed according to the four domains identified above. Results This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioural problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother. Conclusion Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. Practice implications This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child‐centred approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience and responsive to their individual needs.     

The participation of children and young people in care: insights from an analysis of national inspection reports in the Republic of Ireland

ABSTRACT

The term “participation” is widely used to refer to the involvement of children and young people in decision-making on issues that affect their lives. The Health and Information Quality Authority (HIQA) is the national inspectorate for social care in Ireland. HIQA monitors Tusla, Ireland’s child and family agency, for compliance with national children’s standards, including standards on children and young people’s participation rights. This paper outlines findings of a secondary analysis of data in relation to participation standards in HIQA foster care, residential care and special care inspection reports over a two-year period from 2013 to 2015 (n?=?40). The thematic analysis explores the degree to which the reports found that children in care are provided with the opportunity to influence decisions in relation to their everyday lives, to participate in child in care reviews, receive information, avail of advocacy services and have access to a complaints mechanism. While there is much evidence of good practice across all sectors, some notable differences between the realisation of participation standards in residential care and foster care were found. This baseline analysis was undertaken prior to the implementation of a comprehensive participation strategy by Tusla across the organisation and highlights areas in which practice can be improved or mainstreamed in this work programme.     

Breaking down barriers: exploring the potential for social care practice with trans survivors of domestic abuse

There is increasing recognition that domestic abuse takes place outside the heteronormative paradigm of social life. This paper presents a discussion of the findings of doctoral research which explores trans people's experiences of domestic abuse, their social care needs and whether these are met by domestic abuse agencies. This paper foregrounds debate on the intersections of domestic abuse, trans communities and social care provision as this research, and previous studies, suggests that trans survivors do not seek out or benefit from social care intervention. Qualitative data, collected via narrative interviews, were collected during 2012 from participants mainly located in the United Kingdom (two participants were based in the United States). A total of 24 interviews were undertaken with trans people (n = 15) and social care practitioners (n = 9). Data were examined using a voice‐centred relational technique. The findings reveal that barriers are multiple and complex but work could be undertaken to encourage help‐seeking behaviours. Barriers include expectations of a transphobic response and ‘Othering’ practices; lack of entitlement felt by trans people; lack of knowledge/misunderstandings about trans social care needs; heteronormative bias of existing services; and practitioner attitudes fixed to notions about gender as binary. The paper ends by proposing a framework for practice with trans survivors which incorporates a person‐centred, narrative approach.     

Prevention of violence,abuse and neglect in early childhood: a review of the literature on research,policy and practice

Today, levels of mistreatment of children are internationally reported as having reached epidemic proportions. Throughout recorded history babies and young children have suffered acts of violence by parents, care providers and others. However, ‘some believe that, for the first time in history, we are beginning to face the true prevalence and significance of child abuse’ (Hopper, J. (2010). Child abuse. Statistics, research and resources. Retrieved December 10, 2011, from http://www.jimhopper.com). In this review of the literature, we will use ECVAN (early childhood violence, abuse and neglect) to refer to violence, abuse and neglect of children, birth to eight years, in harmony with the UN Convention on the Rights of the Child (1989). The review has been undertaken using a comprehensive series of data bases across all major disciplines which have regard to the heath, well-being and development of young children from birth to 8 years – and beyond wherever appropriate. The paper is guided by a socio-ecological model of contexts, participants and interactional complexity. There is no simple explanation for the abuse of young children – sometimes systemic in particular cultures – as there is no simple mechanism for the early identification of possible abusers and hence preventative practice. A wide range of contemporary research literature has enabled us to draw out significant issues related to abuse and abuse prevention. Central to all this we suggest is community engagement with the issue of child health, the establishment or refinement of public health policies and practices which through routine surveillance, parent support, education and multisectoral actions bring best practice to the fore within and on behalf of families and communities.     

Safeguarding and Protecting Children in Maternity Services: Implications for Practice

This article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or are at risk of abuse, and in subsequent intervention and protection services. Assessing domestic violence as a safeguarding issue has been relatively slow in gaining health professional acceptance even though the international evidence suggests that there are irrefutable links between domestic violence and child abuse. Domestic violence increases during pregnancy and the postpartum period, and is significantly related to all three types of child maltreatment up to the child's fifth year, with children under one year being at the highest risk of injury, or death. However, midwives need greater exposure to and familiarity with recommended safeguarding good practice; and must be able to identify and support abused women and children with a joined-up approach that has adequate resources and the support of health service managers. Close inter-agency liaison is required with midwives who are accountable and not afraid to challenge historical working practices, and who are willing to work across traditional boundaries to promote and maintain child safety.     

Adult disclosures of childhood sexual abuse and section 3 of the child care act 1991: past offences,current risk

In the Republic of Ireland Section 3(1) of the Child Care Act 1991 places an obligation and legal duty upon the State child protection services “to promote the welfare of children in its area who are not receiving adequate care and protection.” This article focuses on a specific element of this duty; the social worker’s responsibility to accept and assess retrospective reports of childhood sexual abuse. Retrospective disclosures of abuse are referrals made by adults of experiences they encountered as children. This article argues that current social work practice in this area lacks clarity and cohesion and while new policy and practice approaches are emerging ultimately there is a sense of confusion for both social workers and those adults affected by childhood abuse who come forward to disclose. This article presents an examination of the key judgement of Justice Barr in M.Q. v. Robert Gleeson and Ors [1998] 4 IR 85 and subsequent, related, precedents and how they relate to current Irish social work policy in this area. Adult disclosures of childhood abuse have the potential to bring alleged abusers to justice and thereby protect current and future children from harm. This article seeks to provide clarity, to social workers and those working with adults affected by abuse, regarding the Irish legal framework relating to adult disclosures of abuse as it stands. The article ultimately argues that further research and policy guidance is required.     

Recognising and referring children exposed to domestic abuse: a multi‐professional,proactive systems‐based evaluation using a modified Failure Mode and Effects Analysis (FMEA)

Failure Modes and Effects Analysis (FMEA) is a prospective quality assurance methodology increasingly used in healthcare, which identifies potential vulnerabilities in complex, high‐risk processes and generates remedial actions. We aimed, for the first time, to apply FMEA in a social care context to evaluate the process for recognising and referring children exposed to domestic abuse within one Midlands city safeguarding area in England. A multidisciplinary, multi‐agency team of 10 front‐line professionals undertook the FMEA, using a modified methodology, over seven group meetings. The FMEA included mapping out the process under evaluation to identify its component steps, identifying failure modes (potential errors) and possible causes for each step and generating corrective actions. In this article, we report the output from the FMEA, including illustrative examples of the failure modes and corrective actions generated. We also present an analysis of feedback from the FMEA team and provide future recommendations for the use of FMEA in appraising social care processes and practice. Although challenging, the FMEA was unequivocally valuable for team members and generated a significant number of corrective actions locally for the safeguarding board to consider in its response to children exposed to domestic abuse.     

Enabling talk and reframing messages: working creatively with care experienced children and young people to recount and re-represent their everyday experiences

ABSTRACT

The educational experiences and outcomes of care experienced children and young people is of longstanding concern. The pervasive inequalities they face suggest that current policies have been unable to respond fully to the complex causes of the problem. This paper reflects on a qualitative study into the educational experiences and aspirations of children and young people who are looked after in Wales. The project worked with care experienced peer researchers and drew on visual, creative and participatory techniques to explore 67 children’s and young people’s experiences of education and, importantly, their opinions on what could be done to improve it. This multimodal approach allowed space for participants to think through their subjective, mundane, but important, experiences that operate alongside, and interact with, more structural challenges. A range of films, magazines, artwork, and music outputs were developed to ensure that the project recommendations could reach wide and diverse audiences. This paper argues the voices of children and young people need to be given a platform to inform policy and practice. For this to happen researchers need to be creative in their approaches to both fieldwork and dissemination; harnessing the power of the arts to make positive changes in the everyday lives of children and young people.     

Young people who sexually abuse: A framework for initial assessment

The issue of young people who sexually abuse is on the political and practice agenda, although this profile lacks any coherent policy, procedures or practice guidance to make it effective. Many competent, experienced practitioners remain anxious and dis-abled when faced with this area of work.

Conceptual frameworks to guide the evolutionary path of this work are emerging (see Calder, 1997, 1999), although operational frameworks to translate aspiration to service delivery are frequently absent. This paper focuses on an operational framework for the initial assessment of young people who sexually abuse.     

The ‘risk gradient’ in policy on children of drug and alcohol users: Framing young people as risky

Parental drug and alcohol problems can have a profound impact on children. There is a growing policy and practice focus on this topic in the UK. Most is concerned with children of primary school age and younger. Older children tend to be neglected in the debate, and young people of age 16 years and over are mostly absent from it. It is argued here that this reflects, and is reflected in, the construction of a ‘risk gradient’ in policy and practice. An analysis of Hidden Harm, the report of the Advisory Council on the Misuse of Drugs' inquiry into the impact of parental drug misuse, and related documents, is used to illustrate this. In the risk gradient, children are constructed as being at risk when younger, and becoming risky to themselves and others when older. The risk gradient stigmatizes young people as manifesters of risk, diminishes ongoing difficulties they face, and denies their coping strategies. The definition of risk as manifesting in institutional settings and services underscores this. It encourages a focus on parent – child risk transfer, to the detriment of other difficulties the child or young person may be facing, and renders the young person invisible when they leave service contexts. Finally, the culturally and legally established distinction between illicit drugs and alcohol tends to isolate families with alcohol problems. Most of the response to parental substance use has focused on illicit drugs, rendering the difficulties of young people affected by alcohol problems less visible except when they are manifesters of risk.     

Non-infant adoption from care: lessons for safeguarding children

Aim To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. Method A cohort of 130 children was identified for whom adoption was recommended in 1991–1996 at a mean age of 5.7 years (range 3–11). All were in local authority care for child protection reasons. Background information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent–Child Communication Scale were completed. Results All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty‐six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty‐seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional ‘phoniness’ and rejection affected closeness. At follow‐up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty‐eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. Conclusions This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional responsibilities in supporting it need to be acknowledged and adequately resourced. Dysfunctional hypothalamus‐pituitary‐adrenal axis programming may contribute to persisting difficulties. Supporting substitute care should be considered integral to safeguarding children.     

Rethinking place and the social work office in the delivery of children's social work services

Limited attention has been given to the concept of place in social work research and practice. This paper draws on the national evaluation of social work practices (SWPs) in England undertaken between 2009 and 2012. SWPs were pilot organisations providing independent social work services for children in out‐of‐home care in five sites. One factor distinguishing some of these pilots was their attention to place. The evaluation employed a mixed methods approach and we use data from interviews with 121 children and young people in out‐of‐home care, 19 birth parents and 31 interviews with SWP staff which explored their views and experiences of the SWP offices. Children and young people were alert to the stigma which could attach to social work premises and appreciated offices which were planned and furnished to appear less institutional and more ‘normal’. Daily interactions with staff which conveyed a sense of recognition and value to service users also contributed to a view of some SWP offices as accessible and welcoming places. Both children and parents appreciated offices that provided fun activities that positioned them as active rather than passive. Staff valued opportunities for influencing planning decisions about offices and place was seen to confer a value on them as well as on service users. However, not all the SWPs were able to achieve these aspects of place, and engaging children and families in place was less likely when the service user population was widely dispersed. Recognising the importance of place and how place is constructed through relationships between people as well as through the physical environment appeared to be key to creating offices that combated the stigma attached to out‐of‐home care. Those leading and managing children's services should explore ways of involving local communities in planning social work offices and turn attention to making these offices accessible, welcoming, places.     

“I’ve changed so much within a year”: care leavers' perspectives on the aftercare planning process

ABSTRACT

Increasing the participation of children and young people in matters related to their care and aftercare is regarded as international best practice. While research demonstrates that children and young people benefit from involvement in care-related processes, participation continues to pose challenges for social work practitioners. Studies to date have tended to focus on in-care engagement and, consequently, relatively little is known about the experiences of young people as they age out of care, particularly in terms of their perceived involvement and engagement in the planning-to-leave care process. This paper examines young people’s experiences of the aftercare planning process in Ireland drawing on data from the first phase of a qualitative longitudinal study of young people leaving care. Sixteen participants were recruited at baseline and interviewed in-depth. The approach to interviewing was flexible and encouraged participants to talk about their experiences of care and the aftercare planning process. The findings indicate considerable diversity in how young people experience and attach meaning to the transition out of care. They also reveal complexities surrounding youth participation in the leaving care planning process and uncover a number of distinct facilitators and barriers to participation. Conclusions are drawn and the implications for practice are discussed.     

The participation of children and young people in decisions about UK service development

BACKGROUND: The involvement of children and young people in decisions regarding service development is well supported in government policy and underpinned by the UN Convention on the Rights of the Child. Information on the extent, nature and outcomes of children and young people's participation can inform further development in this area. METHODS: Systematic literature searches, plus contact with professional networks, were used to gather and review evidence on children and young people's participation. RESULTS: There is a rapidly developing body of information describing and analysing innovative practices in this field. However, there is also a smaller, but substantial, amount of evidence demonstrating the limited extent of current involvement. A good deal of guidance is now available about how to promote the involvement of children and young people. However, the basis of this advice is not always clear, and more evidence about children's views and their experience of participation in public decision-making is required. Issues identified as barriers to change included adult attitudes and intransigence, lack of training for key adults, lack of clarity leading to tokenism, the nature of organizations (i.e. their formality, complexity, bureaucracy and internal politics) and the short-term nature of much funding. The evidence suggests that good practice includes a listening culture among staff, clarity, flexibility, adequate resources, skills development and training for staff and participating children and young people, inclusion of marginalized groups, feedback and evaluation. There is only limited evidence that children and young people's involvement in public decision-making leads to more appropriate services, although there is evidence that participating children and young people benefit in terms of personal development and that staff and organizations learn more about their views. CONCLUSIONS: The value of the participation of children and young people in public decision-making is now well accepted, and is recognized in the standards set in the Children's National Service Framework. However, there is an urgent need for internal and external evaluations of children's involvement.     

How acceptable is adolescent self-consent for the HPV vaccination: Findings from a qualitative study in south-west England

BackgroundHuman Papillomavirus (HPV) vaccination programmes have the potential to reduce the incidence of cervical cancer. The preferred age for HPV vaccination is 12–13 years for optimal benefit. The legal framework in England allows adolescents to be vaccinated without parental consent if they are assessed as competent. A ‘South West Template Pathway on Self Consent for School Aged Immunisations’ was developed to improve uptake of immunisations in south-west England.Study aimTo examine how acceptable the new procedures are to the young women, parents and carers, school staff and immunisation nurses involved.MethodsThe research was undertaken in two local authorities in south-west England during the 2017/18 and 2018/19 programme years. Semi-structured digitally recorded interviews were undertaken with 53 participants: one health service manager, three immunisation nurses, five staff at alternative education providers, three staff at mainstream schools, 19 young women and 22 parents. All recordings were transcribed verbatim and thematic analysis was undertaken, assisted by NVivo software.ResultsMost participants were not fully aware of the legal framework that enables a young person to self-consent to vaccination. There was a strong presumption that parents should make decisions affecting the health of their children. The preferred age at which the HPV vaccination is administered (12–13 years) contributed to reluctance in endorsing self-consent which was thought to have the potential to break down trust between parents and school staff, and within families. In practice, formal self-consent was rare.ConclusionUnresolved issues in relation to adolescent self-consent include public and professional perceptions of young people’s rights and abilities to take responsibility for decisions affecting their health, and concerns about the impact of self-consent on relationships both within families and between professionals and the families they serve.