Reflections on retirement 4

A few things I’m really looking forward to:

8 days’ silent retreat at Mirfield

8 weeks’ holiday in Laos and New Zealand

Being able to ‘work’ from home in our lovely annexe, looking out on the Breathing Space garden

Getting more involved in Breathing Space – retreats and quiet days, spiritual direction…

Regular mid-morning coffee, toast and marmalade with Lois

Getting stuck into some exciting new projects

No more mandatory training on manual handling, infection control and preventing deep vein thrombosis

Designing a national child death review system for Jordan

Starting a PhD

Gardening, DIY, walks in the countryside

No more appraisals

Finishing my book on Rembrandt’s Bathsheba

Painting

Just enjoying the peace and beauty of Breathing Space…

July 29, 2018July 29, 2018

Reflections on retirement 3: Longing for a world where children don’t die

Last week I received an email from one of our administrative team at the medical school, reminding me that I have just over two months to fully clear my office – to shred or archive all old research papers and data, get rid of the mountain of books and files, empty my filing cabinet, clear my hard drive, and hand back all my IT and other equipment.

Once I’d got over my initial shock and the reactive ‘I can’t possibly do that, there’s far too much, and what about all that academic stuff I want to keep on?’ I realised that perhaps it wasn’t such a bad thing after all. I do need to wake up to the fact that, come October, I will no longer be a paid employee of the University with all the benefits (and responsibilities and frustrations) that brings. It is also high time I had a good clear out of all the accretions of 13 years as an academic.

When was the last time I opened that file of research interviews I did back in the late 1990s?

So, taking the bull by the horns, I started work on one of my filing cabinet drawers. After filtering through each file, I think I ended up with just two or three papers worth keeping.

This particular drawer held all my case notes from the South West Infant Sleep Scene study I did with Peter Fleming in the early 2000s. As I started shredding the interviews from those early home visits to bereaved families, I reflected on the blessing it has been to meet with, and hopefully offer some support to, so many amazing families.

Longing for a world where children don’t die

The dramatic drop in SIDS rates in the 1990s has been one of the most impressive successes of epidemiological research this century. I have been immensely privileged to meet and work with many of the leading researchers from around the world who contributed to this work, and in my small way, to contribute to ongoing research, teaching and practice that has seen SIDS death rates continue to fall to this day.

At times it has been truly heart-breaking to meet with families in the horrendous trauma of their child’s death. But it has also been encouraging to know that the work we did in Bristol and elsewhere has contributed to more compassionate and thorough responses to unexpected child deaths. I have, over the years, had many expressions of thanks from bereaved families who have appreciated the care and support they have received from my colleagues in health, police, and social services.

And, even more encouragingly, over the course of my career, I have seen the numbers of children’s deaths decrease.

When I started my medical training in 1982, nearly 8,000 children in England and Wales died before their fifth birthday. By the time I started work as a consultant, that figure had fallen to less than 4,500. Now, as I retire, the figure is just over 3,000. Just looking at the past two decades, that suggests there are 15,000 children and young people alive today who might not have been if our mortality rates had stayed at the 1997 level.

Has my work contributed to that fall?

Perhaps I will never know, but I like to think that, in some small way, my research and teaching and the little steps I have taken to engage with individual parents and children might have made a difference to some. And perhaps, with so many others making their small contributions, we may just be moving towards a world where children don’t die.

July 21, 2018July 21, 2018

Child Sexual Abuse: Ethics and Evidence

‘Over the last 40 years, child sexual abuse (CSA) has become a regular, if discomforting, focus of public concern and attention. A constant stream of news items, investigations and arrests, public inquiries and statements from politicians and authorities can leave the impression that child sex offending is being countered by the full opposition of the state and community. This impression is deceptive. There have been, of course, meaningful advances in child protection and therapeutic responses to victimised children and adult survivors, and improvements in public awareness and understanding of CSA. Nonetheless, the challenges that CSA have always posed to child protection, health services, law enforcement and society at large – including the prevalence and secrecy of CSA, the complexities of prosecution and the multiple impacts on victims – remain with us today. Meanwhile, patterns of sexual offending against children continue to evolve with the development of new technologies and strategies for sexual exploitation.’

Child Sexual Abuse: Ethics…

The latest issue of Child Abuse Review is a themed issue focusing on the ethics and evidence of child sexual abuse. In an accompanying editorial, freely available online, our Australian associate editor, Michael Salter, explores some of the issues raised by the papers.

We include a paper by David Pilgrim which provides a powerful check on impulses towards the minimisation of CSA. The tendency to minimise the abhorrence of child sexual abuse is thoughtfully challenged by Pilgrim, and is addressed later in the issue in a paper by Ethel Quayle and colleagues analysed material from the International Child Sexual Exploitation database. One of their disturbing findings was an increase in self-produced images (sexting), and the high levels of coercion involved in such activity. This adds a challenging new dimension to the ongoing effort to protect children from such abuse.

‘Two‐thirds of self‐produced images involved coercion, challenging the view that self‐produced images are less concerning than those taken by others. Manipulating or coercing a child to produce a nude or sexual image emerges in this study as a common and harmful strategy among online child sex offenders, casting debates on so‐called ‘sexting’ in a new light.’

… and Evidence

Two helpful reviews in the issue provide up-to-date research evidence on the causes of CSA (Estelle Clayton and colleagues) and structural brain abnormalities associated with it (Damyan Edwards). The themed issue also includes new research on multi-agency responses to CSA (Lindsay Voss and colleagues) and on the impact of sexual abuse on boys and men – typically an under-researched and overlooked group (Madelaine Ressel and colleagues).

‘The impact of sexual abuse on boys and men is a prominent and ongoing concern’’

Click on the link below to see the full table of contents, read Michael Salter’s editorial and for details of online access.

Child Abuse Review Volume 27, Issue 3

Editorial: Child Sexual Abuse: Ethics and Evidence. Michael Salter.

Reviews

Academic Disputes about Adult‐Child Sexual Contact: A Critical Realist Appraisal. David Pilgrim.

The Aetiology of Child Sexual Abuse: A Critical Review of the Empirical Evidence. Estelle Clayton, Christine Jones, Jon Brown, Julie Taylor.

Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes. Damyan Edwards.

Original Research

Multiagency Response to Childhood Sexual Abuse: A Case Study that Explores the Role of a Specialist Centre. Lindsay Voss, Helen Rushforth, Catherine Powell.

Children in Identified Sexual Images – Who Are they? Self‐ and Non‐Self‐Taken Images in the International Child Sexual Exploitation Image Database 2006–2015. Ethel Quayle, Linda S Jonsson, Karen Cooper, James Traynor, Carl Göran Svedin.

Abuse Characteristics, Multiple Victimisation and Resilience among Young Adult Males with Histories of Childhood Sexual Abuse. Madelaine Ressel, Jennifer Lyons, Elisa Romano.

Training Update: Eradicating Child Sexual Abuse (online toolkit) by the Lucy Faithfull Foundation, 2016. reviewed by Sarah Nelson

Book Review: Dark Secrets of Childhood: Media Power, Child Abuse and Public Scandals by Fred Powell and Margaret Scanlon, Policy Press, Bristol, 2015. reviewed by Marguerite L Donathy and Nicole Horton

July 13, 2018

Reflections on retirement 2: 35 years in the NHS

The NHS at 70

By the time I retire in September, if you include my years as a medical student and exclude my year abroad in Cambodia, I will have spent 35 years as part of the British National Health Service: exactly half the time it has been in existence.

What a privilege to have been able to serve in what I still believe to be one of the best health systems in the world. In a recent poll, readers of the BMJ voted “providing care based on need and free at the point of delivery” as the NHS’s greatest achievement in its 70 years (https://www.bmj.com/content/361/bmj.k2809). I fully agree. Having seen people in Cambodia die because they haven’t been able to access proper health care, and families go into irrecoverable debt to pay for worryingly poor hospital treatment, I am incredibly grateful for the care we receive from the nurses, doctors, cleaners, porters and all the other dedicated, hard-working staff I’ve had the privilege to work alongside.

“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community” Aneurin Bevan.

There are, of course, countless other achievements of our national health service:

General practice as the foundation of care
Limiting commercial influence on patient care
Pioneering evidence-based practice
A comprehensive childhood vaccination programme
Free contraception for all women

To name but a few.

As one commentator put it though, ‘perhaps the NHS’s greatest achievement is its sheer survival’. In spite of political interference, budget freezes, almost constant reorganisations, rising public demand, and media criticism, the people who make up the NHS continue to offer a great service.

Survival and change

In the years that I’ve known it, the NHS has changed. Gone (I trust) are those days of traipsing down a ward with my fellow medical students in the wake of an arrogant surgeon who would then proceed to humiliate both us as students and the patients under his (invariably it was a he) care. Gone are those not-so-halcyon junior doctor days of being on call for upwards of 72 hours and struggling to keep our eyes open long enough to write out a prescription or calculate the fluid requirements of one of our patients. Gone (to a large extent) are those days of treating patients according to a consultant’s whim rather than following protocols based on sound evidence.

But I wonder whether, with some of that, we have also lost something of the heart of the NHS? Of the camaraderie of those evenings on call, where we would linger with the nurses over a cup of hot chocolate on the children’s ward; of the small cottage hospitals where everyone called each other by their first name; of the sense of fulfilment when you had cared for a patient right through from their initial clerking in the emergency department to writing (by hand) their discharge letter as they walked out once more happy and healthy; of the art as well as the science of medicine?

Who knows?

Whatever the changes, and whatever may lie ahead for the NHS, as I retire from it, I feel incredibly proud and grateful to have been a part of what it is.

June 30, 2018

Reflections on retirement 1

A new stage in life

So, it is finally happening. In three months’ time I will be retiring. So I thought it would be a good opportunity to reflect on what this is like; what it means for me; my experiences of 31 years in the NHS, 21 years as a consultant paediatrician and 13 years in academia; and on what lies ahead for this next stage of my life.

Pausing to contemplate this recently, it felt to me that this wasn’t so much retiring from work as moving on to a new stage in life, developing further my unique sense of calling or vocation, and embracing new opportunities, freed from some of the constraints of paid employment.

I do feel privileged to have been able to pursue a career in paediatrics and more recently academic child health, and to have worked in what remains one of the best health institutions in the world. It has been a great blessing to have built up expertise in a field I enjoy and feel passionately about, and to be able to use some of that expertise for children and families. And now it feels even more of a privilege and blessing to be able to retire from paid employment and develop further in these and other areas.

What am I on the planet for?

One of Lois’ favourite questions as a spiritual director is ‘what are you uniquely here on the planet for?’ As I reflected on this recently at a Retreat Association conference in Derbyshire, it seemed to me that the answer to this revolved around two core motivations which are working out in three key areas of my life.

Belovedness

The first core motivation revolves around a deepening sense of my own belovedness: recognising myself as a beloved child of God, unique, valued, and (in spite of my weaknesses and imperfections) with much to contribute, much to enjoy and much to learn; and from that, longing that others, too, might know something of that same belovedness and worth.

Hope

The second core motivation is one of hope: a longing for a world in which there is no more death or crying or mourning; where there is no more violence and abuse.

So how do these two motivations work out in the different dimensions of my life?

Safeguarding children

A search to better understand abuse and neglect and how we as a society can better protect children and support families
Using my experience and knowledge to support others in the challenging work of child protection
Continuing to work that out through my ongoing research into child abuse; continuing my involvement with BASPCAN and Child Abuse Review; offering my expertise to the new National Safeguarding Practice Review Panel; and as a new opportunity, exploring the possibility of a PhD in theology, focused on a deeper understanding of abuse and neglect

Preventing child deaths

Seeking to better understand the circumstances and systems that lead to children’s deaths, to learn from them, and to work to prevent future children’s deaths
Supporting professionals and strengthening systems for child death review
Supporting families who are coping with the death of a child
Working this out with my ongoing input to the Lullaby Trust and SUDC-UK, and continued engagement with others in this country and overseas who are involved in child death review; and in a new opportunity, working with UNICEF and the National Council for Family Affairs in Jordan to develop a child death review system for their country

Creating breathing space

With Lois, to develop Breathing Space as a safe, sacred space where any who come can experience peace and beauty, and know something of their own belovedness
Sharing something of the blessings with which we ourselves are blessed
Seeking to live sustainably with respect and care for creation, and a commitment to justice and peace
Working this out through our home, retreat house and garden; our involvement in spiritual direction; running retreats and quiet days; being able to study and write, to be creative, and to enjoy the goodness and joy of our families and friends

Quite how all this will pan out remains to be seen, but at this stage, with the prospects of a more relaxed pace of life, and new opportunities opening up to me, it feels good. Roll on October!

June 29, 2018

Child Abuse Review: Rising to new heights with our 2017 Impact Factor

I’m not usually one to boast, but as a co-editor of Child Abuse Review I’m feeling really pleased with the latest news from the journal.

2017 Thomson Reuters Journal Impact Factor

The 2017 Thomson Reuters Journal Impact Factors were released this week, and I’m really proud to report that our impact factor for Child Abuse Review has shot up from 1.543 to 2.253!

This is particularly encouraging as we had set our target, in our 2014-19 business plan to increase it to 1.2 by 2017.

The result places the journal 4th out of 42 social work journals and 9th out of 46 in family studies.

Publishing high quality research that has an impact on practice

While journal impact factors have their limitations, I think this is a recognition of the fact that we are managing to publish really important, high-quality research in child protection, and that this research does have an impact on practice.

This was also reflected in the 2018 Wiley prizes for the best papers published in Child Abuse Review, which were announced at the BASPCAN congress in April:

First Prize – Beyond the Physical Incident Model: How Children Living with Domestic Violence are Harmed By and Resist Regimes of Coercive Control by Emma Katz (Liverpool Hope University) – Published in Volume 25 Issue 1 (2016)

Second Prize – The Prevalence of Child Maltreatment across the Globe: Review of a Series of Meta‐Analyses by Marije Stoltenborgh, Marian J. Bakermans‐Kranenburg, Lenneke R.A. Alink and Marinus H. van IJzendoorn (Leiden University) – Published in Volume 24 Issue 1 (2015)

Third Prize – Risk and Protective Factors for Physical and Emotional Abuse Victimisation amongst Vulnerable Children in South Africa by Franziska Meinck (University of Oxford), Lucie D. Cluver (University of Oxford, and University of Cape Town), Mark E. Boyes (University of Oxford), Lodrick D. Ndhlovu (Tintswalo Hospital) – Published in Volume 24 Issue 3 (2015).

All three of these papers are freely available online for the next year, as are all our editorials and many other papers, so do take a look.

All this could only have been achieved through the hard work of our editorial team, Diane Heath, our editorial manager, the publishing team at Wiley, and, of course, our authors, reviewers and readers. Thank you all.

May 3, 2018

Ooty to Marlimund Lake: a walk in the Nilgiris

The jungle

The metaphor of a jungle seems to fit India really well: a tangled mass of life, jostling upwards. Chaotic, vibrant, dark, mysterious. After a flight and a three hour taxi ride, we had replaced the hot urban jungle of Delhi, with the cooler but equally chaotic human jungle that is Ooty. The climb itself echoed the frantic struggles of life in India. While the dark jungle stretched, impenetrable, on either side of the road, our taxi driver joined the countless other trucks, buses, jeeps and motorbikes careering around the hairpin bends, fighting for that extra few inches of road space.

The tourist season had started and Ooty was heaving. Vehicles honked their way round Charing Cross, and crowds of people flocked to the botanical gardens and the evening Tibetan market at its side: colour, noise, laughter, life.

Our second day dawned bright and clear, the oppressive thunderstorms of the night before swept away by a cooling breeze. We had decided to seek out Marlimund lake – a small reservoir 6km to the North West of Ooty. Setting off from Jo and Mark’s house just up past Modern Stores, we climbed up a short lane to the YWCA Guest House Road, and so to the main Snowdon Road. As we climbed we marvelled at the cacophony of colours on the houses clinging to Ooty’s steep slopes: violet and pink, turquoise, red, purple and blue, orange, green, yellow – a frightening assault on our aesthetic senses.

The Snowdon Road itself zigzagged upwards, past faded colonial bungalows, new air-conditioned tourist resorts, and a host of other dilapidated buildings. In typical Indian fashion, Shiva and Ganesha, Mary and Jesus sat side by side in neighbouring roadside shrines and chapels. The bustle of the city gradually gave way to a more open, gentle ambience, just as the breeze blew away the rancid dust and grime of the inevitable piles of uncleared rubbish. We looked back over the sweeping spread of the Ooty valley, and ahead to the rolling hill country, brown terraces waiting for planting with the next rotation of carrots, potatoes and leafy vegetables. Further afield patches of tea plantations shared the space with spreading forests of eucalyptus.

Reaching Marlimund, we found a small gate off the road and scrambled down to the water’s edge, enjoying a snack and admiring the beauty of some simple water lilies, their pure white flowers, just tinged with purple and a splash of yellow stamens. It was good to sit there, enjoying the cool breeze, the clear skies, and the stillness of the countryside. We managed to find a way around the lake, appreciating the soft grass under our feet and the beauty of the scene. Not a soul was in sight as we walked – just us, some cows, and the wonders of nature. Countless melodies burst forth from the surrounding natural aviary. We were hampered by the absence of a bird book or binoculars, but nevertheless identified egrets, a wagtail, and the charming red-whiskered bulbuls, their little black crests sticking up proudly as they sang. We wandered up to the head of the lake and stretching valleys of eucalyptus, before picking our way through gorse bushes and reed marshes to return on the other side. Sitting on the grass, beside the lake, we paused once more, savouring the stillness, before setting off once more to head back.

We found a little paved track just beyond Sunrise – an old colonial residence lavishly restored to something of its former glory – which brought us down to the Havelock Road, and a quiet, gentle meander back to the waiting jungle of Ooty.

April 29, 2018April 29, 2018

Ten things to do in Delhi when it’s 42 degrees outside

Take a complete break from planning and running the BASPCAN 10^th International Congress
Visit Qutub Minar early before it gets too hot
Babysit Lois’ grandchildren
Meet up with a friend from Manchester (thanks Steve)
Browse the stalls at Dilli Haat
Relax with a couple of good books (Tolstoy and PD James for starters)
Try to identify some of the birds outside (I think we’ve seen Drongos, Bee-Eaters, Red-vented Bulbuls, Lapwings, a Hornbill, and Summer birds among the usual Mynahs, Parakeets, Crows and Pigeons and the majestic soaring Kites)
Build a den with Maya and Talia
Build a train track with Toby
Write a project proposal for the National Council of Family Affairs in Jordan (well you wouldn’t want to get bored would you!)

Author: Peter Sidebotham