Wellbeing outcomes for children and young people.

This is the second in a series of research reports on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parent(s) (home CSOs). Home CSOs are the most common type of CSO made by Children’s Hearings, which was 4,270 children and young people in 20181. Over recent years, concerns have been raised about the effectiveness of home CSOs and outcomes for children and young people looked after at home. However, there has been little research on this and if the intervention of home CSOs has any effect on wellbeing outcomes. Part of the reason for this was the lack of a way of measuring overall wellbeing on an aggregated basis and at different points in time. This part of the research tries to address this gap through the development of a wellbeing concerns measurement tool to allow comparison of different groups, and over time on CSOs. The wellbeing concerns measurement tool is based on the Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, and Included (SHANARRI) indicators that are part of the Getting It Right For every Child (GIRFEC) approach to improving the wellbeing of children and young people in Scotland. In this research, each these overarching indicators was further defined by a series of individual indicators of wellbeing concern – a total of 94 for young children and 104 for young people. The cases of 172 young people (12 years or more) and 171 young children (under 3 years) were examined - split into: three groups of young people looked after at home (1. with offence grounds, 2. with education non-attendance grounds, 3. with grounds not related to offending or non-attendance – control); and two groups of young children (1. with home CSO, 2. with CSO away from home – control). Each case was examined at three time points (i.e. when CSO first made, after a year, and after two years) using the information held by SCRA, with reduction in numbers of concerns implying improvement in wellbeing outcomes. This part of the research aimed to answer two questions: 1. Does the intervention of a home CSO improve children and young people’s wellbeing outcomes? 2. Are there differences in young children’s wellbeing outcomes between those first placed on home CSOs and those first placed on CSOs away from home

Care planning and interventions.

This is the third in a series of reports on research on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parents (home CSOs). Home CSOs are the most common type of CSO made by Children’s Hearings and accounted for 45% of all CSOs in place in 2018, which is 4,270 children and young people. Questions have been raised about the quality of planning for children and young people who are looked after at home and the delivery of interventions to support them. To help answer these questions, the documents provided to Hearings for 343 children and young people were examined to find out the extent to which there were care plans that met statutory requirements, and if services were available to deliver these plans. There were 172 young people and 171 young children research sample: Three groups of young people aged 12 or more with home CSOs (1. with offence grounds, 2. with education non-attendance grounds, 3. with grounds not related to offending or non-attendance – control group); and Two groups of young children under 3 years old (1. with home CSO; 2. with CSO away from home – control group). In addition, 14 focus groups were carried out with social workers, Children’s Reporters and Children’s Panel Members to gain their views on care planning. Findings: There are five main findings from this research: F1. Children with home CSOs were not treated differently from their peers who were accommodated in terms of provision of care plans for their Hearings. Up to a third of young children with home CSOs and those with CSOs away from home had no plans for their care provided to their Hearings. F2. The requirements of National Guidance and the Children & Young People (Scotland) Act 2014 Act were not being met for around a third of children and young people with CSOs (both at home and away from home) on the basis that there were no plans for their care presented to their Hearings. F3. The majority of Hearings made decisions on the basis of short term care plans or no plans at all for children and young people. Only a fifth of children and young people had care plans with clear timescales. There were few children and young people in this study where there were plans of over six months for their care and support. This is despite the importance that practitioners told us they place on clear plans for their decision making. F4. Corporate Parents cannot evidence that they are meeting their statutory responsibilities for looked after children and young people, as there were no plans for the longer term futures of the children and young people in this study. F5. Most children and young people with home CSOs and who had care plans, and their families, were being offered and/or provided with a range of services to meet their identified needs. However, the majority of these parents and young people did not fully engage with the services offered. Conclusion: In this part of the research we sought to find out for young people with home CSOs, young children with home CSOs, and young children looked after away from home: were the child’s needs and interventions to address them identified and were there clear timescales for delivery? In the majority of cases the child or young person’s needs and their those of their parents were identified, and supports were available. What was lacking in most cases were plans with clear timescales and that went beyond the short term. This raises questions about Hearings decision making and the extent to which Corporate Parents are meeting their statutory responsibilities to looked after children and young people

Residence and contact conditions.

This is the first in a series of research reports on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parent(s) (home CSOs). Home CSOs are the most common type of CSO made by Children’s Hearings, accounting for 45% of all CSOs in 2018, which is 4,270 children and young people. There is very little information on if and how home CSOs are being used to specify who a child or young person should live with and/or regulate their contact with individuals who are risk to them. We aimed to answer two questions: 1) To what extent are home CSOs being used to restrict contact with a parent or other person(s) who presents a risk to the child? 2) To what extent are home CSOs being used to secure residence with fathers? The research went wider than these aims including the use of contact conditions for children looked after away from home, other conditions in CSOs, and length of CSOs. The research was in two parts: a) Analysis of Hearings decisions and CSOs for 343 children and young people’s when CSO first made, after a year, and after two years – for three groups of young people with home CSOs (i.e. 1. young people with offence grounds, 2. young people with education non-attendance grounds, 3. young people with grounds not related to offending or non-attendance) and two groups of children under 3 years old (i.e. 1. with home CSO; 2. with CSO away from home). b) The perspectives of social workers, Children’s Panel Members and Children’s Reporters. This involved 14 focus groups with a total of 78 participants

Professional trust and relationships in Children's Hearings.

This is one of a series of reports on research on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parents (home CSOs). This report explores the impact of the dynamics in a Children’s Hearing between those involved in it. Effective decision making in child protection is a complex issue, and one with significant implications for achieving good outcomes for children. It is widely accepted that good professional relationships are essential in child protection – where agencies work together, the best decisions and outcomes for the child are realised. Previous studies have found that professional respect and trust can impact on the effectiveness of decision making in Hearings. This research explores this further from the perspectives of those in the Hearing (Children’s Panel Members, Children’s Reporters, social workers and parents), and from data on Hearings decisions and reasons. In focus groups, social workers described how they felt that their professionalism was not always respected and their reports not taken fully into account by Panel Members. There was also a more general view amongst practitioners in this research that safeguarders have disproportionate influence on decision making by Hearings. These perceptions were not fully borne out when children’s cases were examined. In almost all cases Hearings’ decisions agreed with the social work or multi-agency recommendations. The perception that Hearings do not always focus on or trust social worker’ assessments and recommendations in making decisions is of long standing and has been repeatedly found in research. This perception is therefore very real for professionals, especially social workers. This research shows that the level of trust placed on the information (both written and verbal) considered in Hearings decision making is heavily dependent on the professional relationships between practitioners, particularly between social workers and Panel Members. It is also very dependent on the format and quality of reports presented to Hearings. The findings are not unique to Hearings decisions on home CSOs and, as found in previous studies, illustrate a wider issue in the Hearings System on perceptions of trust and respect between different practitioners and the evidence they provide to support decision making

Decision making in Children's Hearings.

This is one of a series of reports on research on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parents (home CSOs); also known as being looked after at home. There has been criticism of the use of home CSOs. It has been claimed that they are being used inappropriately and that Children’s Hearings are disproportionately influenced by the availability of resources in making decisions. Yet there is limited information on why Children’s Panel Members decide to make a home CSO. This is the first study to examine Hearings decision making on home CSOs. It did so through a combination of examination of Hearings reasons for making, continuing or terminating home CSOs and the views of social workers, Panel Members and Children’s Reporters. Four main factors were found to influence Hearings decisions – 1. availability and quality of evidence; 2. child’s age in terms of attachment, resilience, and ability to express their views; 3. cumulative vs. acute risks and thresholds of intervention; and 4. communication between professionals, with children and parents, and within the Hearing. The emphasis on the evidence for Hearings is not new. Panel Members described their sense of responsibility in deciding whether a child could be supported at home with a CSO. Having information that is clear, accurate and factual ensures that their decision is evidence based and proportionate to the child’s needs. The child’s age emerged as a major factor in whether a home CSO was made and how long it would last. Older children were viewed as more resilient and statutory interventions taken after an accumulation of risk. Whereas for younger children interventions were made more immediately at points of crisis. The visibility of older children to universal services was described as a protective factor that may influence earlier termination of their home CSOs. This raises questions about how the early and effective intervention approach is being applied to older children. Are these children being exposed to risks for too long before statutory interventions are considered necessary and made? Attachment of a child to family members was an important consideration in deciding whether a child could remain at home with support of a CSO. Decision makers had to weigh up if the detriment to a child would be greater being removed from parents and siblings than from remaining in a poor home environment. Engagement of parents was described as being key in this decision - if they would accept support then a home CSO may be best for their child. The availability of resources and supports was not raised as important making, and this supports the findings in another part of this research that children and factor in decision the majority of young people with home CSOs and/or provided with a range of services. The factors found to influence Hearings and who had care plans were being offered decision making on home CSOs are no different to their considerations when deciding to make CSOs away from home. It was clear that Panel Members, Reporters and social workers are striving to make decisions that are in the best interests of the child

Reverse engineering of gene regulatory networks governing cell-cell communication in the microenvironment of pancreatic cancer

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer death, with a five-year survival rate of <5% and a median survival of 6 months. Extensive desmoplastic reaction is a characteristic feature and a prognostic factor of PDAC, which conveys its resistance. Desmoplastic stroma accounts for approx. 90% of tumor volume and consists predominantly of non-malignant fibroblasts (pancreatic stellate cells, PSC). Previous studies have revealed the PSC mesenchymal origins, capacity to switch between quiescent and activated states, proinflammatory features, expression of soluble factors, ability to migrate, and phagocytize. State of the art: Abundance of stroma has sparked previous attempts to dissect the interactions between PSC and tumor cells (TC) producing a common picture of a microenvironment supporting PDAC development. Unfortunately, focus on snapshot-like analysis has proven difficult to translate into therapeutical advances, as it discards the dynamic interactions in the microenvironment, as well as the temporal dynamics of gene expression itself. Gene regulatory networks (GRN) adapt to environmental cues by rewiring connections between genes, those induced modulations effectively lead to state-transitions e.g. PSC activation, or produce mutually exclusive cell-fate decisions e.g. differentiation, senescence, or death. We recognize that cell-specific assignment of stimuli, identification of genes forming the GRNs, as well as the identification of cellular state-changes remain undiscovered. We hypothesize that at an early stage, the quiescent → activated PSC transition yields a steady state PSC gene regulatory network (GRN), but the subsequent succession of impulse responses along TC→PSC→TC interaction axis drives both cell types into unstable states maintained only for the duration of the direct TC-PSC contact. Aims: Through the application of a high-throughput complexity reduction approach and in silico modeling I aim to reconstruct the GRNs underlying the cell-cell communication, and identify key soluble factors shaping the double-paracrine interactions. I aim to use the models to gain a mechanistic and functional insight into how the cues are integrated and how they affect GRN maintenance. I hope to capture cell-fate decisions and identify key dynamic changes with the ultimate goal of finding genetic markers to aid development of novel therapeutic options for this deadly malignancy. Results: We have individually stimulated PSC and TC with conditioned supernatant from the respective other cell type and recorded a time-series (1-24h) from which genome-wide microarray expression data has been generated. In this dissertation I used the time-resolved expression profiles to identify significant gene kinetics through an approach-involving gene ranking, filtering, and clustering followed by gene ontology and pathway analysis. I identified key gene interactions using a genetic algorithm embedded in a continuous time recurrent neural network (CTRNN) modeling scheme. Then I used the derived GRN’s to produce a picture of unique intercellular interactions. Through in silico simulations with the created models, and subsequent data analysis and interpretation I delivered targets for experimental testing on the inter- as well as intra-cellular levels. Experimental validation of the selected gene targets using gene silencing and qRT-PCR confirmed the in silico predicted TC network behavior; validation of the intercellular connections confirmed their dependence on the identified networks

Educational attendance and offending outcomes.

This is the last in a series of seven research reports on the effectiveness of Compulsory Supervision Orders where the child remains at home with their parent(s) (home CSOs). In the Children’s Hearings System, the most common legal measure made for 12 to 16 years olds is to be ‘looked after’ at home on a CSO. In 2020, home CSOs accounted for 46% of all the 8,875 CSOs in place, meaning that 4,071 children in Scotland were looked after at home. The most common reasons for these home CSOs to be made are that the child is not going to school or is committing offences. This research looked at the effectiveness of home CSOs in improving school attendance and in reducing the volume and gravity of offending. The sample comprised of 172 children from across Scotland. Data on school attendance, numbers of offences and gravity of offences were collected at three time points – pre-home CSO and one and two years after it was made - and analysed using inferential statistics. There was a significant increase in school attendance from a mean of 45% attendance before the home CSO to 57% after a year. There were no significant changes in the volume and gravity of children’s offending after their home CSOs were made. The circumstances of these children are more complex than them simply not going to school or committing offences. There were concerns for these children across all aspects of their wellbeing, some of which were about the children’s own behaviour but most related to how they were cared for and treated by others. For the children in this study, their home CSOs were made when their truancy or offending were already entrenched. That their home CSOs resulted in significant improvements in school attendance indicates that this intervention can be successful. It is more difficult to determine the efficacy of home CSOs in addressing children’s offending