Doing child-protection social work with parents: what are the barriers in practice?

For many social workers, participatory practice may seem an unachievable goal, particularly in the field of child protection. In this paper, we discuss a significant programme of change in one London local authority, as part of which we undertook 110 observations of practice and provided more than eighty follow-up coaching sessions for workers. Through these observations, we saw many examples of key participatory practice skills such as empathy, collaboration and involvement in decision making. We also saw many examples of reducing autonomy and excluding parents from decision making. Often, we found the same worker would adopt a participatory approach with one family and a non-participatory approach with another. Through coaching sessions, we explored how and why workers used different approaches and discussed the barriers to adopting a more consistently participatory approach. These discussions led us to reflect on fundamental questions relating to the purpose of child-protection social work, how social workers can best help families and what the limits might be of participation in situations of high risk. We argue that truly participatory child-protection social work requires not simply better training or different tools, but an innovation in the value base of children’s services

A randomized controlled trial of training in Motivational Interviewing for child protection.

There has been interest in developing more evidence-based approaches to child and family social work in the UK in recent years. This study examines the impact of a skills development package of training and supervision in Motivational Interviewing (MI) on the skills of social workers and the engagement of parents through a randomized controlled trial. All workers in one local authority were randomly assigned to receive the package (n = 28) or control (n = 33). Families were then randomized to trained (n = 67) or untrained (n = 98) workers. Family meetings with the worker shortly after allocation were evaluated for MI skill. Research interviews gathered data including the WAI. Follow-up interviews 20 weeks later repeated the WAI, and other outcome measures including Goal Attainment Scaling (GAS) and rating of family life. Between group analysis found statistically significant difference in MI skills, though these were not substantial (2.49 in control, 2.91 MI trained, p = .049). There was no statistically significant difference between groups in any other outcome measures. The package of training and supervision did not create sufficient increase in MI skills to influence engagement or outcomes. Implications for understanding the relationship between skills, engagement and organizational change are discussed

What is the relationship between worker skills and outcomes for families in child and family social work?

Communication skills are fundamental to social work, yet few studies have directly evaluated their impact. In this study, we explore the relationship between skills and outcomes in 127 families. An observation of practice was undertaken on the second or third meeting with a family. Practice quality was evaluated in relation to seven skills, which were grouped into three dimensions: relationship building, good authority and evocation of intrinsic motivation. Outcomes at approximately six months were parent-reported engagement (Working Alliance Inventory), Goal Attainment Scaling (GAS), an eleven-point family life satisfaction rating, the Family Environment Scale and General Health Questionnaire and service outcomes from agency records including children entering care. Relationship-building skills predicted parent-reported engagement, although good authority and evocation had stronger relationships with outcome measures. Where workers visited families more often, relationships between skills and outcomes were stronger, in part because workers had more involvement and in part because these families were more likely to have significant problems. The relationship between skills and outcomes was complicated, although the findings provide encouraging evidence that key social work skills have an influence on outcomes for families

Detection of Low Frequency Multi-Drug Resistance and Novel Putative Maribavir Resistance in Immunocompromised Pediatric Patients with Cytomegalovirus.

Human cytomegalovirus (HCMV) is a significant pathogen in immunocompromised individuals, with the potential to cause fatal pneumonitis and colitis, as well as increasing the risk of organ rejection in transplant patients. With the advent of new anti-HCMV drugs there is therefore considerable interest in using virus sequence data to monitor emerging resistance to antiviral drugs in HCMV viraemia and disease, including the identification of putative new mutations. We used target-enrichment to deep sequence HCMV DNA from 11 immunosuppressed pediatric patients receiving single or combination anti-HCMV treatment, serially sampled over 1-27 weeks. Changes in consensus sequence and resistance mutations were analyzed for three ORFs targeted by anti-HCMV drugs and the frequencies of drug resistance mutations monitored. Targeted-enriched sequencing of clinical material detected mutations occurring at frequencies of 2%. Seven patients showed no evidence of drug resistance mutations. Four patients developed drug resistance mutations a mean of 16 weeks after starting treatment. In two patients, multiple resistance mutations accumulated at frequencies of 20% or less, including putative maribavir and ganciclovir resistance mutations P522Q (UL54) and C480F (UL97). In one patient, resistance was detected 14 days earlier than by PCR. Phylogenetic analysis suggested recombination or superinfection in one patient. Deep sequencing of HCMV enriched from clinical samples excluded resistance in 7 of 11 subjects and identified resistance mutations earlier than conventional PCR-based resistance testing in 2 patients. Detection of multiple low level resistance mutations was associated with poor outcome

THE SOCIETY FOR ACADEMIC PRIMARY CARE’S REGIONAL/NORTH CONFERENCE

The regional SAPC conference for the North will take place on UCLan’s main campus in Preston on 28th and 29th of November 2019. The SAPC conferences are the main venues for discussing improvements in Primary Care provision in the UK. The Society provides a clear voice for Academic Primary Care in the complex and ever-changing Primary Care environment and offers a point of reference and contact for those seeking academic solutions to the problems in Primary Care and working for the advancement of Academic Primary Care

A Molecular Epidemiological Study of var Gene Diversity to Characterize the Reservoir of Plasmodium falciparum in Humans in Africa

BACKGROUND: The reservoir of Plasmodium infection in humans has traditionally been defined by blood slide positivity. This study was designed to characterize the local reservoir of infection in relation to the diverse var genes that encode the major surface antigen of Plasmodium falciparum blood stages and underlie the parasite's ability to establish chronic infection and transmit from human to mosquito. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the molecular epidemiology of the var multigene family at local sites in Gabon, Senegal and Kenya which differ in parasite prevalence and transmission intensity. 1839 distinct var gene types were defined by sequencing DBLα domains in the three sites. Only 76 (4.1%) var types were found in more than one population indicating spatial heterogeneity in var types across the African continent. The majority of var types appeared only once in the population sample. Non-parametric statistical estimators predict in each population at minimum five to seven thousand distinct var types. Similar diversity of var types was seen in sites with different parasite prevalences. CONCLUSIONS/SIGNIFICANCE: Var population genomics provides new insights into the epidemiology of P. falciparum in Africa where malaria has never been conquered. In particular, we have described the extensive reservoir of infection in local African sites and discovered a unique var population structure that can facilitate superinfection through minimal overlap in var repertoires among parasite genomes. Our findings show that var typing as a molecular surveillance system defines the extent of genetic complexity in the reservoir of infection to complement measures of malaria prevalence. The observed small scale spatial diversity of var genes suggests that var genetics could greatly inform current malaria mapping approaches and predict complex malaria population dynamics due to the import of var types to areas where no widespread pre-existing immunity in the population exists