Challenging the cost of clinical negligence

Healthcare professionals in South Africa (SA) are facing challenging times. As the clinical negligence claims environment in SA deteriorates, the impact is being felt by healthcare professionals, but also by the wider public owing to the strain that costs place on the public purse. The authors look at the current claims environment, and explain why a debate about reform is so important

Inter-parental conflict, domestic violence and children's psychological adjustment : the role of children's perceptions of parental behaviour

The research presented in this thesis applies a process-orientated perspective to understanding children's emotional and behavioural adjustment in the context of hostile and violent inter-parental conflict. The studies presented examined the relationship between inter-parental conflict and the quality of parent-child relations, and the role that dysfunction in these family relationships may play in determining children's psychological adaptation. In particular, the primary focus of this research was concerned with children's perceptions, or social cognitive processing, of these family relationships as a primary mechanism through which exposure to inter-parental conflict ranging in severity, influences children's psychological wellbeing. Using data from three separate samples of children and parents drawn from community and clinical settings in the United Kingdom, a set of four interlocking studies was conducted. First, using a sample of over 200 children and parents, the quality of parent-child relations was found to play a mediating role in the relationship between parents' reports of marital conflict and children's immediate and longer term externalising behaviour. Recognising the need to examine the interrelationships between the marital and parent-child relationship from the child's perspective, the second study considered the joint role'played by children's appraisals of both inter- parental conflict and parent-child relationship quality in explaining children's adaptation in the context of varying levels of conflict. Children's appraisals of both relationships were found to be important in conveying effects to children's psychological adaptation across the spectrum of inter-parental behaviour, although there was some variation in processes underpinning children's development as a function of conflict severity and the index of adjustment considered (internalising symptoms, externalising problems). Next, the role of younger children's appraisals of family relationships was examined. Children's appraisals were found to play an intervening role in the relationship between hostile inter-parental conflict and adjustment, although children's internalising symptoms were found to be affected directly through children's appraisals of threat relating to parents' marital conflict, whereas children's externalising problems were found to be affected indirectly, through children's respective appraisals of both the inter-parental and parent-child relationships. Finally, children's appraisals of multiple family relationships were examined as a mechanism through which very hostile forms of inter-parental conflict influenced children's concurrent adjustment. Broad agreement was found with the previous studies, where children's appraisals of the inter-parental relationship seemed to be particularly important in accounting for children's internalising symptoms in the context of high inter-parental conflict, whereas children's views on the quality of relations with parents were more important in accounting for children's externalising problems. Collectively, these studies represent a process-orientated account of how inter- parental conflict across the spectrum of severity affects children's adjustment, and in particular locates children's understanding of family relationships as a primary mechanism through which hostile and violent inter-parental conflict impacts on children's psychological functioning. These findings are of relevance to researchers, practitioners and policy makers seeking to understand how interparental conflict and domestic violence affects children.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Inter-parental conflict, domestic violence and children's psychological adjustment: The role of children's perceptions of parental behaviour

The research presented in this thesis applies a process-orientated perspective to understanding children's emotional and behavioural adjustment in the context of hostile and violent inter-parental conflict. The studies presented examined the relationship between inter-parental conflict and the quality of parent-child relations, and the role that dysfunction in these family relationships may play in determining children's psychological adaptation. In particular, the primary focus of this research was concerned with children's perceptions, or social cognitive processing, of these family relationships as a primary mechanism through which exposure to inter-parental conflict ranging in severity, influences children's psychological wellbeing. Using data from three separate samples of children and parents drawn from community and clinical settings in the United Kingdom, a set of four interlocking studies was conducted. First, using a sample of over 200 children and parents, the quality of parent-child relations was found to play a mediating role in the relationship between parents' reports of marital conflict and children's immediate and longer term externalising behaviour. Recognising the need to examine the interrelationships between the marital and parent-child relationship from the child's perspective, the second study considered the joint role'played by children's appraisals of both inter- parental conflict and parent-child relationship quality in explaining children's adaptation in the context of varying levels of conflict. Children's appraisals of both relationships were found to be important in conveying effects to children's psychological adaptation across the spectrum of inter-parental behaviour, although there was some variation in processes underpinning children's development as a function of conflict severity and the index of adjustment considered (internalising symptoms, externalising problems). Next, the role of younger children's appraisals of family relationships was examined. Children's appraisals were found to play an intervening role in the relationship between hostile inter-parental conflict and adjustment, although children's internalising symptoms were found to be affected directly through children's appraisals of threat relating to parents' marital conflict, whereas children's externalising problems were found to be affected indirectly, through children's respective appraisals of both the inter-parental and parent-child relationships. Finally, children's appraisals of multiple family relationships were examined as a mechanism through which very hostile forms of inter-parental conflict influenced children's concurrent adjustment. Broad agreement was found with the previous studies, where children's appraisals of the inter-parental relationship seemed to be particularly important in accounting for children's internalising symptoms in the context of high inter-parental conflict, whereas children's views on the quality of relations with parents were more important in accounting for children's externalising problems. Collectively, these studies represent a process-orientated account of how inter- parental conflict across the spectrum of severity affects children's adjustment, and in particular locates children's understanding of family relationships as a primary mechanism through which hostile and violent inter-parental conflict impacts on children's psychological functioning. These findings are of relevance to researchers, practitioners and policy makers seeking to understand how interparental conflict and domestic violence affects children

Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity

Aims. Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether and how ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. Methods: We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children’s Anxiety and Depression Scale (RCADS). Results: Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support and 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, the cumulative ACE score was significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI) 1.29–1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI 1.37–1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI 1.17–1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI 0.84–0.93) as well as perceived unmet need (aOR=1.32; 95% CI 1.21–1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI 0.78–0.91). Conclusions: Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible, and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations

Professional support for children bereaved by domestic homicide in the UK

PurposeChildren bereaved by domestic homicide face unique challenges that are likely to require professional interventions. In this study, the theoretical lens of candidacy, which considers the dynamic factors that affect service eligibility and access, is employed to evaluate current service provision in the United Kingdom.MethodWe conducted a mixed methods survey (n = 90) and semi-structured interviews (n = 7) of professionals working in the children and families sector. Thematic analysis was used to interpret qualitative data, while descriptive and parametric statistics were used for the analysis of quantitative data.ResultsQuantitative results showed that a majority of professionals reported that the current service provision is not meeting the specific needs of children bereaved by domestic homicide, and that professionals reported low levels of confidence in working with the topic, regardless of professional background. This article reports on two key themes identified in the qualitative data: unmet needs and the barriers to candidacy, and developing a more effective provision.ConclusionsUsing the theoretical lens of candidacy, this study identified factors which were found to limit children’s access to appropriate services, indicating the need for a specialist service which provides long-term input, support for caregivers, and access to peer-support

Child maltreatment and parental domestic violence and abuse, co-occurrence and the effect on lifetime outcomes in the Avon Longitudinal Study of Parents and Children (ALSPAC)

Exposure to child maltreatment (CM), and parental domestic violence and abuse (DVA), impose considerable adverse life outcomes in both the short and long term, yet, the extent and effects of their co-occurrence on outcomes have not been comprehensively quantified. This study describes the analysis of data from the Avon Longitudinal Study of Parents and Children, quantifying the prevalence of CM, parental DVA, co-occurrence rates, and the impact of different combinations of childhood exposures on life outcomes (health, economic, and likelihood of perpetrating intimate partner violence as a young person). Childhood exposure prevalences were estimated at 41.7% for any form of CM, 19.3% for parental DVA, and 49.0% for exposure to at least one form of CM and/or parental DVA. Co-occurring parental DVA was reported in 21%-42% of CM-exposed households. Sexual abuse was reported in 2% of parental DVA-exposed households, whilst co-occurrence of other forms of CM ranged between 19% and 41%. Co-occurring CM and parental DVA exposures were associated with increased risks of drug use, anxiety, depression, smoking, unemployment, social welfare use, and perpetration of intimate partner violence as a young person - highlighting the intergenerational effects of exposure. Increased risks across a wider range of adverse outcomes were associated with child-reported awareness of parental DVA, compared to parent-reported DVA exposure. The high cumulative prevalence of childhood exposure to CM and/or parental DVA, and the scale of the resulting adverse impacts emphasise the need for policies and family interventions sensitive to the possibility of co-occurring forms of abuse

Association of Interparental Violence and Maternal Depression With Depression Among Adolescents at the Population and Individual Level

Importance: Parental intimate partner violence (IPV) and maternal depression are associated with increased risk of depression in children at the population level. However, it is not known whether having information about these experiences can accurately identify individual children at higher risk of depression. Objective: To examine the extent to which experiencing parental IPV and/or maternal depression before age 12 years is associated with depression at age 18 years at the population and individual level. Design, Setting, and Participants: This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK population-based birth cohort, which initially recruited pregnant mothers with estimated due dates in 1991 and 1992. Data used in this study were collected from 1991 to 2009. Data analysis was performed from February to March 2022. Exposures Mother-reported parental IPV was assessed on 8 occasions (child age, 1-11 years). Maternal depression was assessed via the Edinburgh Postnatal Depression Scale or by the mother taking medication for depression, as reported by the mother on 8 occasions (child age, 2-12 years). Main Outcomes and Measures: Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) and Clinical Interview Schedule–Revised (CIS-R) when the child was aged 18 years. Binary indicators of a case of depression were derived the cutoff point of 11 points or above for the SMFQ and 12 points or above for the CIS-R. Results The study included 5029 children (2862 girls [56.9%]; 2167 boys [43.1%]) with a measure of depressive symptoms at age 18 years. IPV only was associated with a 24% (adjusted risk ratio, 1.24; 95% CI, 0.97-1.59) higher risk of depression at age 18 years, exposure to maternal depression only was associated with a 35% (adjusted risk ratio, 1.35; 95% CI, 1.11-1.64) higher risk, and exposure to both IPV and maternal depression was associated with a 68% (adjusted risk ratio, 1.68; 95% CI, 1.34-2.10) higher risk. At the individual level, the area under the receiver operating characteristic curve was 0.58 (95% CI, 0.55-0.60) for depression according to the SMFQ and 0.59 (95% CI, 0.55-0.62) for the CIS-R, indicating a 58% to 59% probability (ie, 8%-9% above chance) that a random participant with depression at age 18 years had been exposed to IPV and/or maternal depression compared with a random participant who did not have depression. Conclusions and Relevance: In this cohort study, parental IPV and maternal depression were associated with depression in adolescence at the population level. However, estimation of an individual developing depression in adolescence based only on information about IPV or maternal depression is poor. Screening children for maternal depression and IPV to target interventions to prevent adolescent depression will fail to identify many children who might benefit and may unnecessarily target many others who do not develop depression

Towards an ecological understanding of readiness to engage with interventions for children exposed to domestic violence and abuse: Systematic review and qualitative synthesis of perspectives of children, parents and practitioners.

Children who grow up in homes affected by domestic violence and abuse (DVA) are at risk of poor outcomes across the lifespan, yet there is limited evidence on the acceptability and effectiveness of interventions for them. A recent review of child-focused interventions highlighted a gap in understanding the factors influencing the willingness of parents and children to engage with these programmes. We conducted a systematic review of qualitative evidence on the experiences of receiving and delivering interventions with the aim of identifying factors at different levels of the social-ecological context that may influence parent and child readiness to take up interventions. We searched literature till April 2016 and found 12 reports of eight programmes. Two authors independently screened papers for inclusion, extracted data and identified the first- and second-order constructs. The third-order constructs were derived and fitted to the ecological framework to inform a picture of readiness to engage with interventions. Three key findings emerged from this review: (a) parent and child readiness is influenced by a complex interplay of individual, relationship and organisational factors, highlighting that individual readiness to take up child-focussed interventions must be viewed in an ecological context; (b) the specific process through which women become ready to engage in or facilitate child-focussed interventions may differ from that related to uptake of safety-promoting behaviours and requires parents to be aware of the impact of DVA on children and to focus on children's needs; (c) there are distinct but interlinked processes through which parents and children reach a point of readiness to engage in an interventions aimed at improving child outcomes. We discuss the implications of these findings for both practice and research