Smoking and looked-after children: a mixed-methods study of policy, practice, and perceptions relating to tobacco use in residential units

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population

Enablers of help-seeking for deaf and disabled children following abuse and barriers to protection: a qualitative study

Research internationally has highlighted the increased vulnerability of deaf or disabled children to abuse and the frequently inadequate response of services. However, first-hand accounts of deaf or disabled children have rarely been sought. This paper reports selected findings from one of the first studies exploring deaf and disabled children’s experiences of help-seeking following maltreatment. Innovative and sensitive research methods were employed to support ten deaf or disabled people (children and adults) to take part in guided conversations. The study identifies three enablers of help-seeking of deaf or disabled children: the capacity of adults to detect abuse and respond to disclosures, supportive relationships or circumstances which facilitate disclosure; and, for Deaf children, access to registered interpreters. Barriers to protection related to these are also discussed. Recommendations directed at policy makers, practitioners and families include: education and awareness raising amongst practitioners, children, parents and carers; addressing deaf and disabled children’s social isolation; providing comprehensive support services that address the needs of the child holistically; ensuring the voice of the child is heard; routine access to registered interpreters for Deaf children within mainstream and specialist services and measures to address disablism at a local and institutional level

Black girls navigate the physical and emotional landscape of the neighbourhood: Normalized violence and strategic agency

This article considers how young Black women living in gang-affected neighbourhoods in an urban area in England, UK navigate their safety in public and private spaces, and how these spaces overlap and intersect. Drawing on a project with 18 participants aged 14–19, the research seeks to understand how the participants inhabit, navigate and strategize for their safety through their narratives of life and survival in an unsafe neighbourhood. Findings indicate that they experience sexual harassment in public spaces and gang-associated sexual and physical violence as common, accepted aspects of their everyday realities, from as young as 12. The narratives suggest that participants navigate complex friendship groups to protect each other and their families through tight codes of trust, secrecy, privacy and conflict-management strategies. This article seeks to bring attention to how young women utilize their agency to illuminate the coping strategies they draw on to navigate their physical environments. The article concludes with a discussion of the implications for interventions

A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa

BACKGROUND: Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.METHODS: The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.RESULTS: Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.CONCLUSIONS: This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.TRIAL REGISTRATION: Current Controlled Trials ISRCTN11275465 ; Registered 29 January 2007 (retrospectively registered).</p