Protecting children: the central role of knowledge

Following the deaths of Victoria Climbié and of Peter Connelly (Baby P) the media has raged about social work competence, the public have expressed dismay and the government has responded with proposals designed to alter practice procedures. Altering procedures gives the appearance of change without necessarily improving practice. Do social workers have sufficient knowledge to make the decisions that they are responsible for? This paper examines whether a restricted knowledge base contributes to social workers missing or misjudging signs of maltreatment. The paper also looks at evidence suggesting that social workers are resistant to developing new ways of working. A more positive approach to developing expert knowledge and engagement with the inter-professional knowledge base is proposed

Exposure to excess Phenobarbital negatively influences the osteogenesis of chick embryos

Phenobarbital is an antiepileptic drug that is widely used to treat epilepsy in a clinical setting. However, a long term of phenobarbital administration in pregnant women may produce side effects on embryonic skeletogenesis. In this study, we aim to investigate the mechanism by which phenobarbital treatment induces developmental defects in long bones. We first determined that phenobarbital treatment decreased chondrogenesis and inhibited the proliferation of chondrocytes in chick embryos. Phenobarbital treatment also suppressed mineralization in both in vivo and in vitro long bone models. Next, we established that phenobarbital treatment delayed blood vessel invasion in a cartilage template, and this finding was supported by the down-regulation of vascular endothelial growth factor in the hypertrophic zone following phenobarbital treatment. Phenobarbital treatment inhibited tube formation and the migration of human umbilical vein endothelial cells. In addition, it impaired angiogenesis in chick yolk sac membrane model and chorioallantoic membrane model. In summary, phenobarbital exposure led to shortened lengths of long bones during embryogenesis, which might result from inhibiting mesenchyme differentiation, chondrocyte proliferation, and delaying mineralization by impairing vascular invasion

Approaches to working with children and families: a review of the evidence for practice

This paper explores a range of approaches to working with children and families within Children's Services and Children's Social Care, in a UK local authority context. There are a variety of established approaches, supported by different concepts and theories. Given the substantial recent and developing changes in the political, social and economic context for supporting families in need, collating academic and practical evidence to inform both theory and decision making is vital. The article has a practice focus for Children's Services, but it is also relevant and has implications for a much wider readership. Evidence was gathered through a purposive and rapid review, and aggregated with practice evidence from various sources. An array of issues is considered relating to the context, theory, application, implementation and evaluation of taking one or several approaches. Overall, there is a very limited evidentiary basis, either from research or local authority practice, for adopting any one, wholesale approach to working with children and families in a local authority context over another, but there is emerging evidence of the benefits that certain models and approaches could have, and anecdotally the decision to adopt one formal model appears to be increasing

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Living in several languages: Language, gender and identities

Living in several languages encompasses experiencing and constructing oneself differently in each language. The research study on which this article is based takes an intersectional approach to explore insider accounts of the place of language speaking in individuals’ constructions of self, family relationships and the wider context. Twenty-four research interviews and five published autobiographies were analysed using grounded theory, narrative and discursive analysis. A major finding was that learning a new language inducted individuals into somewhat ‘stereotyped’ gendered discourses and power relations within the new language, while also enabling them to view themselves differently in the context of their first language. This embodied process could be challenging and often required reflection and discursive work to negotiate the dissimilarities, discontinuities and contradictions between languages and cultures. However, the participants generally claimed that their linguistic multiplicity generated creativity. Women and men used their language differences differently to ‘perform their gender’. This was particularly evident in language use within families, which involved gendered differences in the choice of language for parenting – despite the fact that both men and women experience their first languages as conveying intimacy in their relationships with their children. The article argues that the notion of ‘mother tongue’ (rather than ‘first language’) is unhelpful in this process as well as in considering the implications of living in several languages for systemic therapy

Social workers' attitudes towards female victims of domestic violence: A study in one English local authority

This paper aims to explore childcare social workers' attitudes towards female victims of domestic violence in England. The study discusses the concept of “mothering” and the processes through which mothers are potentially denigrated rather than empowered. Semi‐structured interviews were conducted with social workers in a single child protection agency to investigate their perceptions of domestic violence, its gendered nature, and the implications for their practice. Participants' responses were coded using thematic analysis. The results demonstrated social workers' cognisance of the challenges domestic violence poses for abused mothers in terms of the ability to safely parent their children. Although the study is not without its limitations, it nevertheless indicates the need for a more holistic approach to safeguarding children within domestic violence settings. Moreover, it underscores the necessity for improving awareness about the prevalence and importance of domestic violence as a child safeguarding concern within social work training. Indeed, improved training would help to develop social workers' knowledge and understanding of service provisions and partner agencies, thus potentially improving practice in this critically important area