Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

Abstract   Purpose – One purpose is to update the core data set of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice.   Design/methodology/approach – Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from SAR findings and recommendations is presented.   Findings – Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence-base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change.   Research limitations/implications – There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice.   Practical implications – Answering the question “how to create sustainable change” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.   Originality/value – The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to embed change in policy and practice.     Keywords: Safeguarding adult reviews, change, self-neglect, action plans   Paper type: Research pape

Doing research with children and young people who do not use speech for communication

Despite emphasis in policy on participation of disabled children, we still know relatively little about how to obtain the views of disabled children with significant communication impairment and their views are often overlooked in planning and service provision. This article describes how the views of children who do not use speech were accessed in research aiming to identify disabled children and young people's priorities regarding outcomes of social care and support services. The main challenge was to develop a method that was reliable, non-threatening, enjoyable and relevant to individual children, as well as enabling children to think beyond their everyday life and express what they aspire to

Balancing Autonomy Rights and Protection:Children’s Involvement in a Child Safety Online Project

Researchers who involve children in their research are faced with the challenge of choosing between differing theoretical approaches which can prioritise children’s autonomy rights or their ‘vulnerability’ and their need to be protected. Somewhat confusingly, ethical guidelines seem to reflect a combination of these approaches. Even when researchers have settled on their preferred approach, they may find that this then has to be modified in accordance with gatekeeper requirements. In the context of children’s involvement in a child safety online project, this paper highlights the difficulties encountered because of a tension between children’s autonomy rights, educational norms in a school setting and child protection concerns, and considers whether an appropriate balance was achieved

Returning children home from care: What can be learned from local authority data?

International Human Rights and child rights conventions as well as U.K. wide legislation and guidance require that children in care should be returned home to one or both parents wherever possible. Reunification with parents is the most common route out of care, but rates of re‐entry are often higher than for other exit routes. This study used 8 years of administrative data (on 2,208 care entrants), collected by one large English local authority, to examine how many children were returned home and to explore factors associated with stable reunification (not re‐entering care for at least 2 years). One‐third of children (36%) had been reunified, with adolescent entrants being the most likely age group to return home. Three quarters (75%) of reunified children had a stable reunification. In a fully adjusted regression model, age at entry, being on a care order prior to return home, staying longer in care, being of minority ethnicity, and having fewer placements in care were all significant in predicting chances of stable reunification. The results underline the importance of properly resourcing reunification services. The methods demonstrate the value to local authorities of analysing their own data longitudinally to understand the care pathways for children they look after

Risk of vicarious trauma in nursing research:a focused mapping review and synthesis

AIMS AND OBJECTIVES: To provide a snapshot of how vicarious trauma is considered within the published nursing research literature. BACKGROUND: Vicarious trauma (secondary traumatic stress) has been the focus of attention in nursing practice for many years. The most pertinent areas to invoke vicarious trauma in research have been suggested as abuse/violence and death/dying. What is not known is how researchers account for the risks of vicarious trauma in research. DESIGN: Focused mapping review and synthesis. Empirical studies meeting criteria for abuse/violence or death/dying in relevant Scopus ranked top nursing journals (n = 6) January 2009 to December 2014. METHODS: Relevant papers were scrutinised for the extent to which researchers discussed the risk of vicarious trauma. Aspects of the studies were mapped systematically to a pre-defined template, allowing patterns and gaps in authors' reporting to be determined. These were synthesised into a coherent profile of current reporting practices and from this, a new conceptualisation seeking to anticipate and address the risk of vicarious trauma was developed. RESULTS: Two thousand five hundred and three papers were published during the review period, of which 104 met the inclusion criteria. Studies were distributed evenly by method (52 qualitative; 51 quantitative; one mixed methods) and by focus (54 abuse/violence; 50 death/dying). The majority of studies (98) were carried out in adult populations. Only two papers reported on vicarious trauma. CONCLUSION: The conceptualisation of vicarious trauma takes account of both sensitivity of the substantive data collected, and closeness of those involved with the research. This might assist researchers in designing ethical and protective research and foreground the importance of managing risks of vicarious trauma. RELEVANCE TO CLINICAL PRACTICE: Vicarious trauma is not well considered in research into clinically important topics. Our proposed framework allows for consideration of these so that precautionary measures can be put in place to minimise harm to staff

Violent and victimized bodies: sexual violence policy in England and Wales

This paper uses the notion of the body to frame an archaeology of sexual violence policy in England and Wales, applying and developing Pillow’s ideas. It argues that the dominant construction is of sexual violence as an individualized crime, with the solution being for a survivor to report, and with support often instrumentalized in relation to criminal justice objectives. However, criminal justice proceedings can intensify or create further trauma for sexual violence survivors. Furthermore, in addition to criminalizing the violent body and supporting the victimized one, there is a need for policy to produce alternative types of bodies through preventative interventions. Much sexual violence is situated within (hetero) sexual dynamics constructing a masculine aggressor and a feminine body which eventually yields. Prevention must therefore focus on developing embodied boundaries, and narratives at the margins of policy could underpin such efforts

Under-five mortality and child-abuse-related-deaths in the former USSR. Is there an under-reporting of abuse-related deaths?

The study explores the former USSR countries `Under-fives’ Child Mortality Rates (CMR) and Child-Abuse-Related-Deaths (CARD), since the end of the Soviet Union and asks whether there has been an `under-reporting’ of CARD? W.H.O. under-five mortality rates per million (pm) were extracted for 1988-90 compared with 2008-10 for CMR and confirmed and possible CARD. Possible CARD are Undetermined Deaths(UnD) and Ill-Defined Signs & Symptoms (IDSS) and as these categories have been linked to under-reporting of CARD. CMR and CARD odds ratio calculated and correlated to determine possible underreporting of CARD. Seven countries met the UNICEF objective of reducing CMR; five halving their previous USSR rate. Russian CARD at 29pm is highest but six countries rates were less than 10pm. Undetermined Deaths (UnD) increased in Kazakhstan 13-fold, Belarus 8 times, Ukraine seven and in Russia more than four. Ill-defined deaths trebled in Belarus, and rose more than 25% in Kazakhstan, Georgia and Ukraine. CARD significantly correlated with UnD but not with CMR. Odds ratios of CMR to CARD categories were substantial, more than 4.1:1 in Belarus, Kazakhstan, Russia and Ukraine, indicating possible under-reporting of CARD. Despite CMR improvements, this first-ever study of former USSR countries should alert the authorities of Belarus, Kazakhstan, the Russian Federation and the Ukraine to the extent of possible child abuse

‘Perceptions of non-accidental child deaths as preventable events: The impact of probability heuristics and biases on child protection work'

Anxiety about the possibility of non-accidental deaths of children has had a major influence on child care policy and practice over the last 40 years. The formal inquiry reports and media coverage of these rare events serve to maintain the perception that these are regular incidents that happen far too often and that they could have been prevented. This focus on individual events tends to distort a clear view of the actual probability of non-accidental deaths and serves to reinforce the notion that potentially all child care cases are risky and that any social work practitioner could be involved in such a case. As a result, work with children has become highly risk averse. However, in statistical terms, the probability of non-accidental child deaths is very low and recently has averaged about 55 deaths a year. Children are at considerably higher risk of being killed on the roads. This paper examines the way in which perceptions of the ‘high’ level of risk of possible child deaths are maintained despite the very low statistical probability of such incidents. It draws on thinking from behavioural psychology and, in particular the work of Kahneman and Tversky, to consider some of the biases in probability reasoning affecting people’s perception of risk and explores how inquiry reports into single past events reconfirm risk perceptions. It is suggested that recognition of the essentially unpredictable nature of future non-accidental child deaths would free up childcare professionals to work in a more positive and less risk-averse manner in the present

On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

Purpose: One purpose is to update the core data set of self-neglect serious case reviews and safeguarding adult reviews, and accompanying thematic analysis. A second purpose is to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/Methodology/approach: Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards and from contacts with SAB Independent Chairs and Business Managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards, with implications discussed for Safeguarding Adult Boards. Findings: Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications: There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of serious case reviews enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications: Answering the question “why” is a significant challenge for safeguarding adult reviews. Different approaches have been recommended, some rooted in systems theory. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Social implications: Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting safeguarding adult reviews by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned

‘If parents are punished for asking their children to feed goats’: supervisory neglect in sub-Saharan Africa

Summary: In the United States and the United Kingdom supervisory neglect of children is premised on a construction of childhood which characterises children as essentially vulnerable and in need of constant care and protection by parents. This Western conception has been transmitted to the countries of the sub-Sahara via the Convention on the Rights of the Child. However, the socio-economic and cultural context of African countries differs significantly from those of the United Kingdom and the United States. The incorporation of a Western hegemonic idea of childhood into the national laws of African countries creates fundamental contradictions in the application of criteria for adjudging the adequacy of parental supervision in the sub-Sahara. Drawing on secondary data, this article explores these contradictions and proposes alternative considerations in the conceptualisation and assessment of supervisory neglect. Finding: The combined effects on households in the sub-Sahara of economic conditions, ascribed gender roles and the reciprocal duties held by children to assist their families, contest established indicators and thresholds for supervisory neglect. The concept of societal neglect together with the application of the Haddon Matrix provides a more apposite framework for reducing the risk of significant harm to children. Application: All African countries, excepting Somalia, have introduced the Convention on the Rights of the Child through domestic legislation. The findings of this study are pertinent to policy-makers and social workers in the sub-Sahara. They also invite Western scholars to critically engage with dominant notions of supervisory neglect and re-appraise its applicability in cross-national contexts