Every Child Matters outcomes: What Do They Mean for Disabled Children and Young People?

To date, little attention has been paid to the appropriateness of the Every Child Matters (ECM) outcomes framework to disabled children. This article reports findings from a research project which sought the views of disabled children and their parents about their desired outcomes. Twenty-nine children and 90 parents were interviewed. The findings indicate that ECM outcomes are appropriate to disabled children but can have different meanings. In addition, the need to recognise the importance of maintaining outcomes, as well as progress, is highlighted

Key worker services for disabled children: what characteristics of services lead to better outcomes for children and families?

Background: Research has shown that families of disabled children who have a key worker benefit from this service and recent policy initiatives emphasize the importance of such services. However, research is lacking on which characteristics of key worker schemes for disabled children are related to better outcomes for families. Methods: A postal questionnaire was completed by 189 parents with disabled children who were receiving a service in seven key worker schemes in England and Wales. Path analysis was used to investigate associations between characteristics of the services and outcomes for families (satisfaction with the service, impact of key worker on quality of life, parent unmet need, child unmet need). Results: The four path models showed that key workers carrying out more aspects of the key worker role, appropriate amounts of contact with key workers, regular training, supervision and peer support for key workers, and having a dedicated service manager and a clear job description for key workers were associated with better outcomes for families. Characteristics of services had only a small impact on child unmet need, suggesting that other aspects of services were affecting child unmet need. Conclusions: Implications for policy and practice are discussed, including the need for regular training, supervision and peer support for key workers and negotiated time and resources for them to carry out the role. These influence the extent to which key workers carry out all aspects of the key worker's role and their amount of contact with families, which in turn impact on outcomes

Supporting the Participation of Disabled Children and Young People in Decision-making

Increasing children's and young people's participation in decisions, about their own care and about service development, is a policy priority. Although in general participation is increasing, disabled children are less likely to be involved than non-disabled children and it is unclear to what extent children with complex needs or communication impairments are being included in participation activities. This article presents research exploring factors to support good practice in participation and discusses policy and practice implications

Heir-apparent or Outsiders? An Exploration into Educational Psychologists' Sensemaking of their Role in Mental Health

Children and young people’s (CYP) mental health have been a growing public health concern in the UK (Department of Health & Department for Education, 2017). The aim of this research was to explore educational psychologists’ (EP) sensemaking of their role in mental health with a focus on two main questions: ‘What are EPs’ sensemaking accounts of their role in mental health?’ and ‘What are some of the key factors influencing EPs’ sensemaking of their role in mental health?’ A novel qualitative methodological approach was adopted involving a metaphorical analysis of metaphors elicited in EPs’ sensemaking accounts of their role in mental health. Semi-structured interviews were conducted with sixteen participants from four different local authorities (LAs). The metaphors generated were categorised into two main themes: Heir-apparent and Outsider. The two themes illustrated the paradoxical identity construction of the EP role in mental health. It was also found that EPs’ sensemaking accounts were shaped by three critical factors: personal, contextual and mental health discourses. One conclusion from these findings was that the nature of EPs’ sensemaking could enhance and/or reduce EPs’ self-esteem, self-efficacy and role satisfaction. Additionally, the identity construction of Heir-apparent and Outsider symbolised a wider dilemma faced by other non-medical mental health professionals

Assessing parental capacity when there are concerns about an unborn child: pre-birth assessment guidance and practice in England

Assessment where there are concerns that an unborn child is likely to suffer significant harm is one of the most difficult tasks that social workers undertake; the legal and ethical context makes the process of assessment and intervention during this period complex. This paper explores pre-birth assessment guidance and practice in England. Local safeguarding guidance in 147 English localities was accessed and analysed, and interviews were conducted with 22 practitioners involved in pre-birth assessments. The findings showed that while most local safeguarding guidance was more detailed and explicit than the national guidance, legal and ethical issues were rarely addressed. Interview data showed that, in general, guidance to support social work assessments during the pre-birth period was insufficient, and that few practitioners used standardised tools to aid assessment. Some practitioners regarded pre-birth assessments as less urgent than cases involving infants/older children, thereby increasing delays in decision-making. It is concluded that existing guidance and practice with regard to pre-birth assessment are inadequate

Participation of disabled children and young people in decision making within social services departments: A survey of current and recent activities in England

A survey of all social services departments in England was undertaken in order to identify and investigate current work concerning the participation of disabled children within decision making regarding their own care and in service development. Developing a culture of, and good practice in, children's participation is integral to government policy. Results demonstrate that disabled children are being involved in a range of decision-making areas; however, participation is not yet embedded or sustained across all social services departments, and the involvement of disabled children at a higher strategic level is still rare. The participation of disabled children needs further development including more evidence on which factors can support and promote disabled children's effective participation

Cities for children: the effects of car use on their lives

9-11 June 2004 In Britain, children are walking less than they used to. A major factor causing this decrease is the growth in car use. These trends are reducing children’s quantity of physical activity, with serious implications for their health. The purpose of this paper is to explore these themes using results from a 3-year research project entitled ‘Reducing children’s car use: the health and potential car dependency impacts’ which has been carried out in the Centre for Transport Studies at University College London in collaboration with others including Hertfordshire County Council, with fieldwork being carried out in Hertfordshire, an area immediately north of London. A major component of the project was a study of 200 children aged between 10 and 13 years of age using motion sensors coupled with the use of a travel and activity diary over four days. The sensors measured movement in three dimensions which was converted to activity calories, a measure of physical activity. Events from the travel and activity diaries were mapped onto the data from the sensors so that it was possible to isolate and analyse specific time periods, events and journeys. From these data, the comparative effects of different forms of transport on children’s physical activity have been established, producing clear evidence of the benefits of walking compared with car travel. It is found that the use of the car is linked to particular types of activity. For example, structured out-of-home activities, such as clubs and sports lessons tend to be reached by car while informal activities such as playing, are associated more with walking. This means that the shift from the latter to the former is one of the factors underlying children’s increasing use of the car. The motion sensors have facilitated the calculation of the intensity of various activities in terms of using activity calories. Walking is second only to physical education (PE) or games lessons in intensity. It was found that, for the older children, walking to and from school for a week used more activity calories than two hours of PE or games lessons, which is the recommended standard in Britain. It was also found that children who walk to activities are more active when they arrive at activities than those who travel by car, particularly in the more energetic activities, which suggests that walking brings wider health benefits than is generally recognised. Another strand of the project upon which this paper is based is the evaluation of walking buses. From the various surveys in the study it appears that about half of the trips on walking buses were previously walked, but there is not an equivalent decrease in the number of car trips because many of the children were being dropped at school in the course of a longer trip by a parent

Transitions of care from child and adolescent mental health services to adult mental health services (TRACK Study) : a study of protocols in Greater London

Background: Although young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London. Methods: A questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis. Results: Forty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0–70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0–50, SD 9.5, n = 33). In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS. Conclusion: At least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol-sharing organisational units and transition process suggest that practice may vary. There is discontinuity of care provision for some patients who 'graduate' from CAMHS services but are not accepted by adult services

Can general practitioner commissioning deliver equity and excellence? : Evidence from two studies of service improvement in the English NHS

Objectives: To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services. Methods: Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009. Results: Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system. Conclusions: This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity