Book review

While the 1989 Children Act has been in effect in Great Britain for several years. Social Workers in Northern Ireland could be forgiven for feeling that legislative change is still some considerable time away with one delay compounding another. As we anticipate die Children (N.I.) Order it might be useful to examine aspects of the Great Britain legislation given that our own Order will be largely identical. Additionally the Children Act produced a considerable volume of case law which in turn will be persuasive on our own legal jurisdiction. Surprisingly one of the difficulties in respect of both of the above would be the sheer volume of publication on the 1989 Act. The Childrens Act 1989 “Putting it into Practice” is a book that may appeal to many practitioners in this context. Written by Mary Ryan and published by Arena under the auspices of the Family Rights Group “Putting it into Practice” is designed for those in the frontline of Child Protection work with specific emphasis on the responsibilities of Local Authorities.     

Message from the experience of child observation

“Messages from the Experience of Child Observation Training”

The following are the text of presentations delivered at the conference by two of the six participants in the first Northern Ireland group to undertake the Child Observation Training developed by the Tavistock Clinic.     

Assessment of environmental worry in health-related settings: Re-evaluation and modification of an environmental worry scale

The aim of this article was to re-evaluate and possibly modify the standardized Environmental Worry Scale (EWS) by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] with regard to its content and structure. In order to do this, 161 participants were chosen as a reference group to take part in a survey. The data were analyzed and a factor analysis yielded two instead of one component of worry, namely “personal” and “general” environmental worry, leading to a new evaluation method. This revised evaluation method was then applied to patients (n=227) with or without self-reported multiple chemical sensitivity (MCS) and thus used in the context of reported health complaints. The outlined results indicate that the assessment of worry as proposed by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] should be elaborated by the newly developed evaluation method with which a ratio determined by “personal” and “general” worry can be calculated. In addition to analyzing the absolute quantity of worry, the calculated ratio allows to draw conclusions on the structure of worry. It will be discussed to what extent the results present new insights into the role of worry among patients suffering from environmental diseases.     

Indexes and boundaries for “quantitative significance” in statistical decisions

Boundaries for S, representing a “quantitatively significant” or “substantively impressive” distinction, have not been established, analogous to the boundary of , usually set at 0.05, for the stochastic or probabilistic component of “statistical significance”. To determine what boundaries are being used for the “quantitative” decisions, we reviewed pertinent articles in three general medical journals. For each contrast of two means, contrast of two rates, or correlation coefficient, we noted the investigators' decisions about stochastic significance, stated in P values or confidence intervals, and about quantitative significance, indicated by interpretive comments.

The boundaries between impressive and unimpressive distinctions were best formed by a ratio of 1.2 for the smaller to the larger mean in 546 comparisons, by a standardized increment of 0.28 and odds ratio of 2.2 in 392 comparisons of two rates; and by an r value of 0.32 in 154 correlation coefficients. Additional boundaries were also identified for “substantially” and “highly” significant quantitative distinctions.

Although the proposed boundaries should be kept flexible, indexes and boundaries for decisions about “quantitative significance” are particularly useful when a value of δ must be chosen for calculating sample size before the research is done, and when the “statistical significance” of completed research is appraised for its quantitative as well as stochastic components.     

Children: Rights, education and equal opportunity

The point of departure in this paper is the concept of RIGHTS. Whereas most countries accept that children have rights as is evidenced in the UNO Declaration of Rights of the Child (1959), such rights are statements, not laws. Statements advocating benefits, care, love, education etc. are goals or beliefs. Few countries have legalised rights; consequently, children may be at risk. In countries where there is discrimination of some degree in respect of race, colour, sex, religion, national or social origin, financial standing in society, level of education and so on, the right to “rights” as stated in the UNO Declaration is further jeopardised. The implications for educational provision from early childhood and onwards in countries where “rights” are not entrenched in statutes or where child advocacy is not forceful enough for all people are examined in this paper. Consequently, the chances for equal opportunity in life are reduced in situations where the child did not receive the benefit of education. Such a child may not perish as he might as a result of being deprived of food, but “the deprivation and injustice, the degradation of an individual and the setting of his vital interests at naught would at least approach in gravity the act of allowing him to die for the want of food” (1981, Wringe). In this paper, the author argues for the Rights of the Child, particularly where discrimination and inequalities exist and where provision for early education has to contend with excessive population growth.     

The organisational and professional context of the first acpc conference

The theme of today's conference “Partnership in a Changing Environment” is highly significant and could be adopted for almost any major conference in the health and personal social services field. “Partnership” is an “in” word, and like quality and other euphemisms it has become part of our rhetoric. Its definition and translation into practice at different points in our organisations, is however more problematic. For example in the area of child protection there has been a tendency to think of partnership as based around case conferences, but that is too far into the process to be of value to families or professionals. Partnership starts at policy making and today's conference is an attempt at bringing together the principal partners who should influence policy, as well as what happens further into the system when parents and children become engaged. The second part of today's theme “a changing environment” also applies throughout the public service. In recent years we have become accustomed to rolling organisational change. The most recent manifestations of this in Northern Ireland have been the introduction of general management throughout the services, the separation and redefinition of purchaser and provider functions, and more recently, the establishment of HPSS trusts. But change to the environment within which partnership in child protection takes place is influenced by forces other than organisational development. Research in child care over the last 15 years, the introduction of the Children Act 1989 in Great Britain and the prospect of similar legislation here within the next year or two, the impact of major reports, sometimes focusing on tragic events and the publication by the Inspectorate of the investigation into the case of Martin Huston have served to perpetuate change.     

The controversial controversy of a passionate controversialist

Alvan Feinstein was among the pioneers who perceived the need to apply epidemiologic principles and methods to clinical medicine. In his attempt to convert his peers to his own views, he was very liberal in criticizing the work of others. Epidemiologists still recall his 1988 article in Science entitled “Scientific Standards in Epidemiologic Studies of the Menace of Daily Life,” in which he criticized observational epidemiology for its lack of scientific rigor. In this context, Feinstein's work has also been the center of controversies. One in particular, related to the fact that he carried out research and consulted for industries, in particular the tobacco industry, has tainted the last years of Feinstein's career. My purpose in this article is to discuss Feinstein's relationship with the tobacco industry. It is not to judge the validity of his work. Against this background, a question of historic relevance, one that can be discussed on the basis of some evidence, is whether Feinstein, world-reknowned epidemiologist and editor of this journal from 1982 until his recent death, helped the tobacco industry to publish articles minimizing the deleterious effects of smoking in the Journal of Chronic Diseases and (since 1988) the Journal of Clinical Epidemiology. To address this question I have searched the articles related to the effects of tobacco that were published in the Journal since 1978. The tobacco industry has had the opportunity, via its consultants, to defend its own ideas in the “Variance and Dissent” section. Perhaps in hindsight Feinstein could be criticized for not having clearly indicated the sponsorship of the tobacco industry behind these publications, of which he was fully aware. However, this does not suffice to infer that he was the tobacco industry's “man.” Feinstein's attitude in matters of publication appears balanced.     

The efficacy of the parent-teacher “partnership” of the 1990s

The 1990s are times of rapid social and technological change. There are many unknowns that face both adults and children. We all have problems that need resolution. The time when adults “knew” the answers and children learned by “watching” echo faintly in the whirl of scientific change which is impacting on most aspects of our daily life. As early childhood teachers we have to learn to enquire, to listen, to think together with children, their families and society. The concept of negotiation is central to communication while the basic tenet of the process focusses not on the person but the issue. It is in these times of rapid change that we need to deepen our understanding of the family and further our professional insights by “tapping” the wealth of crucial kndowledge that parents have about their children. Hurst asserts that the partnership of parents in issues of their children's education:

“is probably the greatest single opportunity for educational advance open to teachers today”.

Hurst: 1987; 109     

From early to late adolescence: alcohol use and anger relationships

Purpose: To evaluate the longitudinal relationship of alcohol use in early adolescence to anger in late adolescence.

Methods: Data were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Fifty percent of the 1201 students were female, 75%, white, and 69%, low socioeconomic status, who were surveyed in grades 6/7, 9/10, and 11/12. Subjects were asked four anger-related questions: “When I have a problem, I get mad at people,” “When I have a problem, I do bad things or cause trouble,” “When I have a problem, I say or do nasty things,” and “I am a hotheaded person.” Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios (OR) were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence.

Results: Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grade 6/7 increased the odds in grade 11/12 of saying or doing nasty things (OR = 8.23, p < .01), self-reported hotheadedness (OR = 9.72, p < .01), and high anger on a composite anger scale (OR = 4.84, p < .05). Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness (OR = 6.17, p < .05) and high anger on the anger scale (OR = 3.20, p < .05) in grade 9/10 and doing something bad to cause trouble in grade 11/12 (OR = 24.97, p < .01). For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble (OR = 2.79, p < .05), saying or doing nasty things (OR = 2.02, p < .05), and self-reported hotheadedness (OR = 2.51, p < .05).

Conclusions: The present study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. The findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior.     

The criminal justice (children) (northern ireland) order: A long time coming; was it worth the wait?

The Report of the Children and Young Persons Review Group (the Black Report) was published in 1979. It was commissioned in 1976 by the then Labour government. Over 20 years later the new Labour government will pass the Criminal Justice (Children) (NI) Order through an order in council. Between these two events a radical and reforming Conservative government has changed the political and economic landscape. The new legislation has been a long time coming. Harold MacMillan is said to have remarked, when faced with a major policy decision “die best thing to do is do nothing and do it for as long as possible.” Given the constant changes in the criminal justice system the government has imposed in England and Wales without any tangible benefits, this might not have been a bad plan. However, is the legislation based upon outmoded 70's thinking or is it relevant to today's problems and solutions?     

“Omics” research,monetization of intellectual property and fragmentation of knowledge: can clinical epidemiology strengthen integrative research?

An analysis of the contributions of “omics technologies” to human health and clinical care needs to address the relationships between internal issues (e.g., methodological shortcomings in “omics” research and clinical biology) and external influences. Among the latter, monetization of intellectual property (IP) appears to be a powerful force favoring methodological limitations and an excessive reductionism and fragmentation of biological knowledge. Following economic successes in other industries (semiconductors, software, and “dot-coms”), monetization of IP tries to market small fragments of big research “puzzles”; the strategy seems partly responsible for the biotech industry having underperformed methodological, clinical, and economic expectations. Hence, internal, purely scientific reasons can hardly explain failures in the application of long-proven principles of clinical epidemiology to the discovery and validation of diagnostic and prognostic tests. Nevertheless, this paper also sketches methodological proposals that may help integrate microbiological, clinical, and environmental evidence. Clinical and epidemiological reasoning, knowledge, and methods need to be applied on a much wider scale than until now by “omics” studies that aim at making inferences relevant for human beings. Rather than adopting the values and norms of “science business,” “omics research” could apply a diversity of clinicoepidemiological models favoring integrative research.     

International year of the family 1994: Family and gender equity in education

“Building the smallest democracy at the heart of society,” is the motto of the International Year of the Family being celebrated during 1994. The year 1994 has been designated by the United Nations to highlight issues concerning families locally, nationally, and globally during the year and to suggest recommendations for changes in policies and programs.

Since 1975, when the world celebrated International Women's Year, and again, in 1979 during International Year of the Child, evidence has been accruing regarding gender disparities in all countries. It is discouraging, yet perhaps not surprising, that in 1994 the world still awaits gender equity, even though a considerable amount of progress has been made since 1975.     

Child Abuse Prevention: A Challenge Accepted

The Pennsylvania State Education Association, in response to new laws regarding child abuse, has undertaken a project to acquaint educators and other school personnel with their responsibilities under the revised laws. The project has also sponsored establishing parenting courses or units of study in the home economics curricula of 250 of the state's 505 school districts. The project has revealed important lessons about success factors in education for the detection and prevention of child abuse. During its first two years the project has reached all 100,000 members of the PSEA with informative workshops and articles, and has presented the program “Prevent Child Abuse and Neglect” to 750 education majors.     

儿童语言发育迟缓的智能发育现状及影响因素分析

目的 分析语言发育迟缓儿童智能发育现状及影响的相关因素,为早期干预提供依据。方法 采用北京首都儿童研究所“0～6岁儿童神经心理发育量表”对2018年1-6月佛山市妇幼保健院儿童保健科174例首诊语言发育迟缓的患儿进行智能发育测查,并自制问卷对可能影响语言发育的出生高危史,语言发育迟缓家族史等先天因素与家庭环境因素进行调查分析。结果 首诊年龄越大,各能区发育商(F=4.999、5.479、25.546、16.401、13.733)和总发育商(F=22.716)下降越明显,差异有统计学意义(P＜0.01);家庭环境因素单因素分析中留守儿童的语言发育商低于非留守儿童,差异有统计学意义(t=3.182,P＜0.05);多元线性分析中显示非父母为主要抚养者和留守儿童影响儿童语言发育(β=3.606、8.088,P＜0.05)。结论 语言发育与家庭环境因素密切相关,评价儿童家庭环境中潜在的影响因素,有利于指导家长创造积极的语言环境,促进儿童语言发育。     

Child poverty as public policy: direct provision and asylum seeker children in the Republic of Ireland

This paper evaluates responses to asylum seeker children in Ireland from a child poverty perspective and from that of the United Nations Convention on the Rights of the Child. It draws upon research undertaken in early 2001 on behalf of the Irish Refugee Council among asylum seeker families with children in Cork, Limerick and Ennis on their experiences of poverty and social exclusion. The research was primarily qualitative. Interviews with adult members of households and some children were triangulated with data on benefit entitlements and take-up, household consumption, accommodation and amenities. The research sought to ascertain levels of income poverty and material deprivation. A range of indictors of child poverty and social exclusion were also employed. The research found that asylum seeker children experienced extreme income poverty, material deprivation, housing deprivation and social exclusion in considerable part due to the imposition of a system of lesser welfare entitlements, known as “direct provision”, introduced in April 2000. The paper argues that state-fostered social exclusion of asylum seeker children resulting from “direct provision” is contrary to Ireland's obligations under the United Nations Convention on the Rights of the Child, the goals of the National Children's Strategy and the goals of the National Anti-Poverty Strategy.     

Child Life Workers: Who Are They and What Are They Doing?

The survey responses from 152 U S and Canadian Child Life Programs are presented to describe the backgrounds of Child Life workers and the services they are currently offering to pediatric patients and their families The majority of Child Life workers tend to be females with training in Child Development, Education, or Recreation Therapy Although there is variation between Child Life Programs versus those with other titles the “core” activities of Child Life workers tend to be supervising the activity room, preparing patients/families for medicai and surgical procedures, and attending interdisciplinary meetings The survey findings are used to raise questions for consideration in the further development of the Child Life profession.     

Conference report the children (ni) order - challenges ahead

The long awaited new Children (NI) Order has yet to be implemented but there is no doubt about the significance in relation to providing an important watershed for the future development of Child Care Services in Northern Ireland. The recent conference organised by BASW (NI) in association with the Children (NI) Order Group provided a forum for the dissemination of information of the experiences of local authorities and judiciary in England since the Children Act 1989- This unique blend of the social work/legal context coupled with the keynote presentation and overview by Baroness Faithful offered the first major conference in the Province to address the main issues posed by the legislation. The conference attracted over 250 delegates from a multidisciplinary background and key Department of Health and Social Services personnel. The programme content included conference speakers from England and Northern Ireland and reflected the key roles played by the judiciary, social services management and the social services inspectorate. Baroness Faithful is well known in child care circles and recognised as a major contributor to the development of the Children Act. Her services for families and children in Northern Ireland and the potential strengths to be gained from its implementation set the tone for the conference. She also indicated the necessity of extending training to three years would be raised agin for debate. This was by An Overview of the English Experience of the Children Act 1989 with speaker Kay Birch from the Lord Chancellor's office, Mary Barnard J.P., Chairman of the Family Proceedings Committee and Judge Nigel Fricker Q.C., Designated Family Judge. They highlighted the importance of interdisciplinary training and partnership, the development of good information systems, the significant change in culture required by such aspects as the “non intervention” policy and the role of lay magistrates and the changes in court procedures.     

Social skills and attitudes associated with substance use behaviors among young adolescents

Purpose: To examine how adolescents’ attitudes and social skills affect current substance use and intentions to use substances in the future.

Methods: An anonymous questionnaire was administered to 2646 seventh graders in their classrooms. The questionnaire was developed to measure the frequency of tobacco, alcohol, and other substance use, anticipated use, positive attitudes toward drug use, self-efficacy to say “no,” decision-making skills, advertising-viewing skills, anxiety-reducing skills, communication skills, drug-resistance skills, perception of peer substance use, and weapon-carrying behavior. Ethnicity classified respondents as “white” or “students of color” and family structure indicated one vs. two-parent families. Data were analyzed with Spearman’s r, analysis of variance, and multiple linear regression.

Results: Forty-one percent of students were minority, 50.6% female, over 90% were either 12- or 13-year-olds, and 69.9% lived in two-parent families. A multiple linear regression model demonstrated that self-efficacy to say “no, positive attitudes toward drug use, perception of peer substance use, male gender, weapon-carrying, and fighting accounted for 51% of the variation in the current use multiple substance scale. Anticipated substance use during the subsequent year was significantly associated with current substance use, positive attitudes toward drug use, self-efficacy to say ”no, drug-resistance skills, weapon-carrying, and fighting behavior. This model accounted for 73.9% of the variance in anticipated substance use.

Conclusions: In today’s world, where drug use is common, building adolescents’ drug-resistance skills and self-efficacy, while enhancing decision-making capacity, may reduce their use of illegal substances.     

Traditional medicine and lead-containing preparations in Nigeria

Traditional medicine, its preparations and practices, plays a major role in the health care of the community of Nigeria. In many cases the native doctor (“Babalawo”) and the local herbalist (“Eleweomo”) are the only practitioners available for the treatment of illness. Even in the towns where allopathic medicine is available the limited facilities it offers make many patients rely on traditional methods. Little is known of the pharmacological action of these traditional remedies which the native doctor prescribes. Our own studies have concentrated on the metal content of such materials. Here we report on the material known as “tiro” which is used for the treatment of eye infections and disease as well as an “eye cleaner” and cosmetic. On analysis we found that all samples of tiro measured contained lead ranging from 12·8 to 81·1% (w/w), with a mean concentration over all samples determined of 50·1% (w/w). In addition, it was also found that tiro is used by some members of the Nigerian community in Britain and is brought in in decorative containers as a gift. The extent of use in this country still remains to be determined, however. The use of lead-containing preparations^* in traditional practices presents a significant health hazard to a substantial section of the world's population. We suggest urgent steps are required to encourage governments to establish education programmes to eliminate this avoidable source of morbidity among their populations.     

Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management

Just as maps are reissued when new roads are built and rivers change course, this Nutrition Care Process and Model reflects recent changes in the nutrition and health care environment. It provides dietetics professionals with the updated “road map” to follow the best path for high-quality patient/client/group-centered nutrition care.