A critical reflection on the involvement of 'experts by experience' in inspections

Recent research conducted in the UK for the Commission for Social Care Inspection (CSCI) suggested that there was no evidence to indicate that the involvement of service users and lay assessors in service inspections improved the quality of inspections. However, recently, CSCI has initiated a project to involve ‘experts by experience’ in their service inspections. Here, the term ‘expert by experience’ has been adopted to describe users of social care services. However, the appropriateness of this usage has not been without some challenge and various conceptual difficulties have been raised in how the term is used. Reflecting on reports published by CSCI, this paper considers whether the choice of the word ‘expert’ in this context is really appropriate and also whether, although well intentioned, the involvement of ‘experts by experience’ is too confused in its rationale to actually empower the people using the services being inspected. The paper concludes by suggesting that the current inspection body—the Care Quality Commission—would do well to review both the terminological and conceptual confusion in respect of this practice

The effect of ice rubble on ice-ice sliding

Ice deformation processes in the Arctic can generate ice rubble. Many situations arise where ice fragments of varying size separate sea ice floes. While the shear forces between sea ice floes in direct contact with each other are controlled by ice-ice friction, what is not known is how the slip of the floes is affected by the presence of rubble between the sliding surfaces. We present the result of field experiments undertaken on sea ice in the Barents Sea. A doubledirect-shear experiment was done on floating sea ice in the field, with the addition of rubble ice between the sliding surfaces. This was achieved by pulling a floating ice block through a cut channel of open water 3m long, where broken ice filled the gap between the block and the channel sides. The displacement of the block and the force needed to move the block were measured. The time that the block was held motionless to allow the rubble to consolidate was recorded - this ranged from seconds to several hours. We found that the 'hold time' controls the maximum force needed to move the block. The relation between hold time and force is highly non-linear from which we deduce thermal consolidation is the controlling mechanism

The effect of ice rubble on ice-ice sliding

Ice deformation processes in the Arctic can generate ice rubble. Many situations arise where ice fragments of varying size separate sea ice floes. While the shear forces between sea ice floes in direct contact with each other are controlled by ice-ice friction, what is not known is how the slip of the floes is affected by the presence of rubble between the sliding surfaces. We present the result of field experiments undertaken on sea ice in the Barents Sea. A double-direct-shear experiment was done on floating sea ice in the field, with the addition of rubble ice between the sliding surfaces. This was achieved by pulling a floating ice block through a cut channel of open water 3m long, where broken ice filled the gap between the block and the channel sides. The displacement of the block and the force needed to move the block were measured. The time that the block was held motionless to allow the rubble to consolidate was recorded - this ranged from seconds to several hours. We found that the 'hold time' controls the maximum force needed to move the block. The relation between hold time and force is highly non-linear from which we deduce thermal consolidation is the controlling mechanism

Paradoxical evidence on ethnic inequities in child welfare: towards a research agenda

This paper aims to compare developments in theory and evidence about ethnic disparities in the USA with findings from the Child Welfare Inequalities Project in England with a view to identifying key issues for a future research agenda. It has a particular focus on the relevance of the concept of the Hispanic Paradox for disparate intervention rates between ethnic populations in England. Three key theoretical dimensions for explaining such disparities are identified and outlined: artefactual, demand and supply factors. Findings from the study in England are then introduced to explore the relevance of these dimensions in a data set of over 14,000 individual children who were either on child protection plans (with substantiated child abuse or neglect) or who were ‘looked after children: in out-of-home care, at the 31st March 2015. While some ethnic populations were experiencing much more difficult average socio-economic circumstances (SEC) than others (using deprivation scores for small neighbourhoods as a proxy measure of family SEC), such factors were only a partial explanation for differential intervention rates between ethnic groups. Overall, large differences in intervention rates were found between ethnic categories and sub-categories which also confounded simply attributing disparities to either cultural differences, such as family patterns, or to individual or institutionalised discrimination. The potential for cost saving if intervention rates could match those ethnic groups with the lowest levels of service use would be considerable. More research is needed to ensure that data is comprehensive, reliable and valid, that there is better understanding of how socio-economic factors affect service demand and what characteristics of different ethnic populations and different approaches to service provision contribute to differential intervention rates. Key elements of such a research agenda are identified

The effects of social service contact on teenagers in England

Objective: This study investigated outcomes of social service contact during teenage years. Method: Secondary analysis was conducted of the Longitudinal Survey of Young People in England (N = 15,770), using data on reported contact with social services resulting from teenagers’ behavior. Outcomes considered were educational achievement and aspiration, mental health, and locus of control. Inverse-probability-weighted regression adjustment was used to estimate the effect of social service contact. Results: There was no significant difference between those who received social service contact and those who did not for mental health outcome or aspiration to apply to university. Those with contact had lower odds of achieving good exam results or of being confident in university acceptance if sought. Results for locus of control were mixed. Conclusions: Attention is needed to the role of social services in supporting the education of young people in difficulty. Further research is needed on the outcomes of social services contact

Pragmatic trials of non-NHS interventions: experiences from a Randomised Controlled Trial of the Strengthening Families 10-14 UK Programme (SFP10-14 UK)

Background: Pragmatic trials of public health interventions outside the NHS are relatively scarce, much needed and face particular challenges. These include funding, of intervention costs in particular; trial implementation in professional and organisational cultures unused to randomised trial procedures, including randomisation, maintaining the counterfactual, recruitment; and relevance of findings for and translation into policy and practice. Objectives: The current NPRI funded trial of SFP 10-14 UK is presented as a case study to discuss these issues, solutions and remaining barriers. The SFP 10-14 UK programme aims to strengthen areas of family life that protect against substance misuse, for example, parenting, communication, and young people’s resilience skills. The SFP 10-14 UK is being delivered by statutory and voluntary agencies in six local authority areas across Wales, and is offered to mixed groups comprised of families from the general population, and families who may experience/present challenges within a group setting. Methods: The trial aims to recruit 748 families, 374 of whom will be randomised to receive the usual services available to families within their local area. 374 families will receive the SFP 10-14 UK in addition to usual care. Families are identified by staff employed within the statutory services and voluntary sectors and referred to embedded research staff for recruitment. Results: Challenges encountered related to a lack of awareness of the randomised trial as a research paradigm among staff and key referring agencies, related concerns about the ethics of randomisation and the maintenance of the counterfactual among the usual care group, and challenges regarding the maintenance of recruitment and intervention fidelity. Whilst a challenge in itself, partnership working with delivery agencies, programme trainers, and the Welsh Assembly Government at all stages of the development, funding and conduct of the trial has proved an important strategy to overcome these issues. Conclusions: This trial seeks to generate evidence on the effectiveness and cost effectiveness of the SFP10-14 UK which is of direct relevance to policy makers, commissioners and practitioners. The trial highlights that strategic partnership working, the winning of ‘hearts and minds’ regarding the ethics and operationalisation of randomisation, and maintaining the balance between internal and external validity are key areas of focus for the successful conduct of pragmatic trials in non-NHS settings. The lessons learnt from its implementation will be important for future multi-sector/agency policy trials and for role out of the intervention if found to be efficacious

Sea Ice Dynamics: The Role Of Broken Ice In Multi-scale Deformation

Realistic models of Arctic Ocean behaviour should capture the influence of broken ice acting as a fault gouge between sliding floes. We performed double-direct shear friction tests on floating saline ice floes in the HSVA ARCTECLAB, Large Model Basin, Hamburg. We have focused these experiments on angularity and size to determine fault gouge characteristics. In our experiments the displacements and deformation of ice gouge were characterized during on-going frictional slip for the first time. Both stable sliding and stickslip behaviour were displayed. It appears that there are controls on behaviour according to gouge angularity. By measuring local stress, strain and acoustic emissions along the sliding interfacial fault we have captured the mechanics of the propagation of slip from slip initiation to dynamic propagation for the first time in the presence of broken ice

Ethical considerations when involving older people in public service participation processes

In the United Kingdom, as in many other countries, New Labour governments have heavily promoted different forms of ‘service-user involvement’ in decision making about public services. The current orthodoxy would appear to be that involvement activities carry with them de facto benefits that are both affirmative and empowering. However, relatively little research has been carried out into considering the real impact (emotional or otherwise) of involving citizens in such processes. In this paper, the findings from a small-scale qualitative study led the authors to reflect that when outcomes of consultation are undesired and that when the precise role of those involved is left unclear in terms of purpose, responsibility and accountability, people can be left with powerful, often uncomfortable, feelings. The ethical dimensions of involving people without adequate, prior preparation or ongoing support are discussed, with suggestions made as to how public organisations can take an ethically sound approach to participation. Drawing on research ethics, and informed by the ethics of care, methods through which the potentially harmful effects of involvement can be mitigated are proposed

Untangling child welfare inequalities and the ‘Inverse Intervention Law’ in England

This article addresses some potential limitations of key findings from recent research into inequalities in children’s social services by providing additional evidence from multilevel models that suggest the socioeconomic social gradient and ‘Inverse Intervention Law’ in children’s services interventions are statistically significant after controlling for possible confounding spatial and population effects. Multilevel negative binomial regression models are presented using English child welfare data to predict the following intervention rates at lower super output area-level: Child in Need (n = 2707, middle super output area [MSOA] n = 543, local authority [LA] n = 13); Child Protection Plan (n = 4115, MSOA n = 837, LA n = 18); and Children Looked After (n = 4115, MSOA n = 837, LA n = 18). We find strong evidence supporting the existence of a steep socioeconomic social gradient in child welfare interventions. Furthermore, we find certain local authority contexts exacerbate this social gradient. Contexts of low overall deprivation and high income inequality are associated with greater socioeconomic inequalities in neighbourhood intervention rates. The relationship between neighbourhood deprivation and children looked after rates is almost five times stronger in local authorities with these characteristics than it is in local authorities with high overall deprivation and low income inequality. We argue that social policy responses addressing structural determinants of child welfare inequalities are needed, and that strategies to reduce the numbers of children taken into care must address underlying poverty and income inequality at both a local and national level