New approaches to parental substance misuse

This article is made available through the Brunel Open Access Publishing Fund - Copyright @ 2011 HarwinParental substance misuse is a major social problem. No-one knows exactly how many children are growing up in families where one or both parents have a drug or alcohol problem, or misuse both substances. Hidden Harm, the report by the Advisory Council on the Misuse of Drugs (2003), 1reported that at least 2-3% (200-300,000) of children under 16 in England and Wales live with one or two parents misusing illegal drugs. Up to 9% (1.3 million) children are estimated to be affected by parental alcohol misuse

Parental substance misuse and child welfare: Outcomes for children two years after referral

This article is available open access through the publisher’s website through the link below. Copyright @ 2007 The Authors.This paper reports on placement and welfare outcomes for children allocated a social worker where there was a concern about parental misuse of drugs or alcohol. All files going for allocation for long term work in four London boroughs over on average one year were examined (290 families). Of the 290, 100 families with 186 children involved concerns about parental substance misuse. File studies were carried out at allocation and two years post-referral for these children. At follow-up only 46% of the children remained with their main carer, with 26% living in the wider family and 27% in the formal care system. Logistic regression found the factors associated with children remaining at home were parental heroin misuse, violence and one or more parents being a first generation immigrant; factors associated with children moving were the child being a baby identified as at risk of harm and particular combinations who misused and family structure. A rating of welfare outcome was made based on educational, emotional/behavioural and health development. At follow-up, 47% of children had no problems, 31% had continuing problems and 22% had problems in more areas than at allocation. Regression analysis found the factors associated with poor welfare outcome were children remaining at home, domestic violence, alcohol misuse and being a boy. The combination of a high proportion of children moving carer and poor outcomes for those at home suggests that attention needs to be paid to improving outcomes in this area.The Nuffield Foundatio

Capturing the scale and pattern of recurrent care proceedings: initial observations from a feasibility study

This article reports the initial findings of a feasibility study that has captured the scale and pattern of recurrent care proceedings. Although frontline professionals have reported long-standing concerns about the repeat clients of public law proceedings, prior to the study we report, the scale of the problem has been unknown. With funding from the Nuffield Foundation and support from the Child and Family Court Advisory Service (CAFCASS) and the President of the Family Division, the research team has arrived at a first estimate of prevalence, confirming that recurrence is a sizeable problem for the English family court. Based on cases that completed during the observational window 2007-2013 (calendar years), 7,143 birth mothers appeared in 15,645 recurrent care applications concerning 22,790 infants and children. Moreover, the study most likely underestimates recurrence, because reliable data concerning completed cases is not available before 2007. Initial observations are that the spacing between recurrent care proceedings is very short, which raises searching questions about prevention. Where episodes of care proceedings follow in swift succession, most likely prompted by the birth of another infant, this affords mothers little opportunity to effect change. Unless, this ‘status quo’ is tackled, it is difficult to envisage how vulnerable birth mothers can exit this cycle. Preliminary recommendations are made in respect of policy and practice change

The family drug & alcohol court (FDAC) evaluation project

This report presents the findings from the evaluation of the first pilot Family Drug and Alcohol Court (FDAC) in Britain. FDAC is a new approach to care proceedings, in cases where parental substance misuse is a key element in the local authority decision to bring proceedings. It is being piloted at the Inner London Family Proceedings Court in Wells Street. Initially the pilot was to run for three years, to the end of December 2010, but is now to continue until March 2012. The work is co-funded by the Department for Education (formerly the Department for Children, Schools and Families), the Ministry of Justice, the Home Office, the Department of Health and the three pilot authorities (Camden, Islington and Westminster). The evaluation was conducted by a research team at Brunel University, with funding from the Nuffield Foundation and the Home Office. FDAC is a specialist court for a problem that is anything but special. Its potential to help break the inter-generational cycle of harm associated with parental substance misuse goes straight to the heart of public policy and professional practice. Parental substance misuse is a formidable social problem and a key factor in around a third of long-term cases in children’s services in some areas. It is a major risk factor for child maltreatment, family separation and offending in adults, and for poor educational performance and substance misuse by children and young people. The parents’ many difficulties create serious problems for their children and place major demands on health, welfare and criminal justice services. For these reasons, parental substance misuse is a cross-cutting government agenda. FDAC is distinctive because it is a court-based family intervention which aims to improve children’s outcomes by addressing the entrenched difficulties of their parents. It has been adapted to English law and practice from a model of family treatment drug courts that is used widely in the USA and is showing promising results with a higher number of cases where parents and children were able to remain together safely, and with swifter alternative placement decisions for children if parents were unable to address their substance misuse successfully. The catalysts for the FDAC pilot were the encouraging evidence from the USA and concerns about the response to parental substance misuse through ordinary care proceedings in England: poor coordination of adult and children’s services; late interventions to protect children; delays in reaching decisions in court; and soaring costs of proceedings, linked to the cost of expert evidence.The work is co-funded by the Department for Education (formerly the Department for Children, Schools and Families), the Ministry of Justice, the Home Office, the Department of Health and the three pilot authorities (Camden, Islington and Westminster).1 The evaluation was conducted by a research team at Brunel University, with funding from the Nuffield Foundation and the Home Office

Courts, care proceedings and outcomes uncertainty: the challenges of achieving and assessing ‘good outcomes’ for children after child protection proceedings

The professed aim of any social welfare or legal intervention in family life is often to bring about ‘better outcomes for the children’. But there is considerable ambiguity about ‘outcomes’, and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009-10, and the others in 2014-15. The paper considers the challenges of achieving and assessing ‘good outcomes’ for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of ‘normal’ child development; and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings

A Column Generation Approach for Locating Roadside Clinics in Africa based upon Effectiveness and Equity

Long distance truck drivers in Sub-Saharan Africa are extremely vulnerable to HIV and other infectious diseases. The NGO North Star Alliance aims to alleviate this situation by placing so-called Roadside Wellness Centers (RWCs) at busy truck stops along major truck routes. Currently, locations for new RWCs are chosen so as to maximize the expected patient volume and to ensure continuity of access along the routes. As North Star's network grows larger, the objective to provide equal access to healthcare along the different truck routes gains importance. This paper considers the problem to locate a fixed number of RWCs based on these effectiveness and equity objectives. We come up with a novel, set-partitioning type of formulation for the problem and propose a column generation algorithm to solve it. Additionally, we propose and analyze several state-of-the-art acceleration techniques, including dual stabilization, column pool management, and accelerated pricing, which solves the pricing problem as a sequence of shortest path problems. Though the facility location problem is strongly NP-hard, our algorithm yields near-optimal solutions to large randomly generated problem instances within an acceptable amount of time. Our analysis of the trade-off between the equity criterion and North Star's current criteria shows that solutions that are close to optimal with respect to each of the effectiveness and equity objectives are likely to be attainable

Development of a wearable assistive soft robotic device for elbow rehabilitation

The loss of motor function at the elbow joint can result as a consequence of stroke. Stroke is a clinical illness resulting in long lasting neurological deficits often affecting somatosensory and motor cortices. More than half of those that recover from a stroke survive with disability in their upper arm and need rehabilitation therapy to help in regaining functions of daily living. In this paper, we demonstrated a prototype of a low-cost, ultra-light and wearable soft robotic assistive device that could aid administration of elbow motion therapies to stroke patients. In order to assist the rotation of the elbow joint, the soft modules which consist of soft wedge-like cellular units was inflated by air to produce torque at the elbow joint. Highly compliant rotation can be naturally realised by the elastic property of soft silicone and pneumatic control of air. Based on the direct visual-actuation control, a higher control loop utilised visual processing to apply positional control, the lower control loop was implemented by an electronic circuit to achieve the desired pressure of the soft modules by Pulse Width Modulation. To examine the functionality of the proposed soft modular system, we used an anatomical model of the upper limb and performed the experiments with healthy participants

Modelling the air-gap field strength of electric machines to improve performance of haptic mechanisms

The air-gap of electro-magnetic (EM) actuators determines key operating parameters such as their ability to generate force. In haptic devices these parameters are not optimised for the conditions typically seen in operation and include the heat produced in the air-gap, the volume of the air-gap, and the intensity and direction of the magnetic field. The relationship between these parameters is complex thus design decisions are difficult to make. This paper considers the role of the radial magnetic field in cylindrical electric motors, a type often used in haptic devices. Two models are derived and compared with experimental measurements. The first model is a closed form solution, the second is a classic Poisson solution to Ampere's equation. These models are shown to be valid for making more general design decisions in relation to haptic actuators, and in particular allow an evaluation of the trade off between the volume of the air-gap, the resulting radial magnetic field and hence heat generated and the resulting forces