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Reflections on retirement 7: Wholeheartedly on my bike

I cycled in to the University today – perhaps for the last time. The sun was shining, the sky was blue, the first frost of autumn was shimmering on the grass, a shadowy mist hovered over the duck ponds, and the mothers and children were skipping on their way to school. Actually, the children were grumbling and the mothers getting stressed (this was Tile Hill after all!) but I smiled cheerily at them nevertheless.

 

I had started the morning with a reflection from one of my 21st century gurus, Richard Rohr:

‘Much of a man’s life is spent going to work, running errands, cleaning house, mowing the lawn, waiting in lines, attending meetings, and tending to the necessary but endless minutiae that make up life. We know that we can’t live as if we’re in the middle of an Indiana Jones adventure. We know that much of life is rather dull and repetitive. That’s why it’s so important to be fully present to the ordinary things that keep us going: a movie, a concert, dinner with a friend. Anything you do fully gives you joy. Anything done halfheartedly will bore you. People do not tire from overwork nearly as much as from halfheartedness. Wholeheartedness requires that a person be fully present. And people who are present are most ready to experience the Presence.’ – Richard Rohr, On the threshold of transformation, p186.

 

I reflected that that has been my experience in the amazing 36 years of my career. When I have been fully present, wholeheartedly engaged in the task in hand, I have felt fulfilled, energised, inspired. When I’ve been distracted, halfheartedly engaged, my mind on other things, I’ve ended up bored or frustrated.

I guess I have been blessed by being involved in work which lends itself to fulfilment: clinics; teaching; inspiring research… But it has had its share of routine, repetitive tasks: management meetings, governance reports… Surprisingly, though, even those things which carried the potential to be tedious and uninspiring have turned out to be fulfilling when I was able to engage with them wholeheartedly. One of the most rewarding parts of my job over the past few years has been chairing our local serious cases subcommittee. I have loved this work – partly, I’m sure, because of the great team of people who have formed the committee; but also because I have been able to carve out the time to focus on the work in hand, to see its importance in terms of children’s lives, and to think creatively about how we learn from these cases.

And so, getting in to my office, I was once more privileged to be able to throw myself wholeheartedly into the tasks before me: editing some journal papers; feedback to students; supervising one of my PhD students; supporting another PhD student through her viva (successfully so – well done Jumana! A great bonus for my final week at work); and doing some final clearing out of my office.

‘That was the best defended thesis I have ever examined’ – Julie Taylor, external examiner

 

So I was feeling fulfilled and not at all tired when I closed my office door and walked out to my bike for the long cycle ride home. Only to find that some other dopey (I will give them the benefit of the doubt that it was dopiness rather than malice, or some warped attempt to keep me at the Medical School) cyclist had padlocked my bike to theirs!

Fortunately it was just through the brake cable, so an hour later, when Lois came to rescue me in the car, complete with a set of Allen keys, I was able to free my bike and get home. And the added bonus was that in the intervening time, I had managed to finish clearing my office and say goodbye to room B028 at Warwick Medical School. And while the sun was no longer shining, the sky was nevertheless crisp and clear with golden tints of an autumn evening.

 

 

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Reflections on retirement 6: Bereavement and Transition

The other day I walked through the corridors of Warwick Hospital for what may be my last time as an NHS employee. I thought back on all those days and nights – many years ago now – walking (and at times running) through similar long, pre-fab corridors as a junior house officer. Those days (and nights) are long gone now, and I can’t say that I miss them – certainly not the horrendous long hours and the relentless intrusions of the dreaded bleep – but I do look back with a bit of a sense of nostalgia.

 

Bereavement and transition

It is often said that retirement is a kind of bereavement. Looking ahead to my retirement, though, it doesn’t feel so much a bereavement as a transition. I guess I am privileged: privileged to have had a career that has been worthwhile and fulfilling; privileged to have also had meaning and worth in my life outside my work; and privileged to be retiring at a stage when I am able to look forward to all the new things I will be able to do.

But any transition also involves loss, and I recognise that for many that can be acutely painful. Particularly where retirement is accompanied by a sudden or gradual loss of significance.

So as I go through this change in my life, how do I make it a positive transition rather than a painful loss? There are three questions which I have found helpful in facing any kind of transition, which can be summarised in the three concepts of mourning, meaning and moving.

 

Mourning: How do I let go of all that has gone before?

For me, this has been a gradual process: stepping back from hospital work and nights and weekends on call; dropping my clinics to focus more on my academic and specialist work; and now leaving paid employment with the NHS entirely. As I look back there is so much I am grateful for: my colleagues; the families I have worked with; the things I have achieved in my career. I can recognise and celebrate the contributions I have made to protecting children, supporting families, and encouraging and empowering other professionals – both locally and nationally. At the same time, I can accept the things I haven’t achieved; the mistakes made; the unfulfilled dreams: the closure of our child health MSc; the doors closed on a return to Cambodia; my lack of promotion to an academic chair; my failure to establish a sustainable local team for responding to unexpected child deaths. And I can acknowledge that there will be aspects of my work that I may miss: the interaction with my colleagues, children and families; inspiring teaching sessions with motivated students; chairing our local serious cases sub-committee…

 

Meaning: how do I make sense of this transition?

In a way this, for me, is quite an easy question. And in this I recognise, again, just how privileged I am. I can look back on the journey my career has taken, and see lots of meaning and purpose in it. While at the time there were aspects which were perhaps harder to make sense of – my repeated failure to pass my MRCP exams; the traumas we faced in Cambodia; the gradual disintegration of our academic child health team; the frustrations of unsuccessful grant applications – overall, there has been a sense of purpose, of doing something worthwhile, and now, being able to move on to new opportunities. Looking back I can see how my life and work have had meaning, and how it has unfolded in a path that has brought me to where I am now, with all the skills and experience I have gained along the way. And I am blessed in now being able to take that expertise and apply it in new areas – both nationally and internationally, as well as, perhaps, developing new areas of interest and engagement.

Moving: how can I make the most of this new phase of my life?

For me retirement is a wholesome and positive moving forward. I am looking forward to the new opportunities it brings. To be able to take the skills and experience I have gained over these years and use them in new and inspiring ways. And to enter into a more gentle pace of life, one where there is no longer the pressure to achieve or be productive. There is so much I am looking forward to: being more involved in the rhythm of life at Breathing Space; working from home, looking out at the beauty of our garden; morning toast and coffee with Lois; helping create the house and garden as a place of peace and serenity; pursuing other projects here in the UK and abroad; starting a PhD; spending time with family and friends…
And, for now at least, no longer walking down long, pre-fabricated hospital corridors.

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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!

CAR Impact Factors 2011-17

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.

Artwork by Harry Venning
Artwork by Harry Venning

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:

 

  1. 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)

 

  1. 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)

 

  1. 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.

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My adorable paper!

 

I was delighted this morning to receive a warm and convivial email from Ms. Veronica, the managing editor of EC paediatrics, an ‘internationally profound journal’ that is delighted to publish my ‘wonderful and adorable’ paper in their archive. Having seen my ‘immense track research in neonatal care and child health’ their warm wishes ‘nourishes our precious relationship that started all the way through LinkedIn!’

In spite of the dizzying heights of superlative obsequiousness reached by her email, I fear the reality that I haven’t published any research on neonatal care means I am going to have to disappoint dear Ms Veronica.

Am I just a callous ivory-tower academic with no ounce of warm-hearted feelings to such a precious relationship?

 

Dear Dr. Peter Sidebotham,

Pleased to convey our warm wishes from EC Paediatrics, that nourishes our precious relationship that started all the way through LinkedIn!

We at ECPE, an Internationally profound journal carries out thorough Double blinded peer review; Gives prompt acknowledgement after acceptance of article for peer review; Performs Rapid publication after the article is peer reviewed; Accepts and Publishes papers with excellence, novelty and originality; Issues Publication Certificate to author; Provides high visibility of your published work through Google Scholar.

Having seen your immense track research in neonatal care and child health, we are aspiring to publish your wonderful article in the archive of EC Paediatrics.

Therefore, it is our delight to have your adorable paper by September 20, 2017.
With pleasure, we are always ready to clarify your queries!

Hope to work with you soon!
With Kind Regards,
Ms. Veronica
Managing Editor

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Making an Impact: Child Abuse Review

2016 Journal Impact Factors

The 2016 journal Impact Factor results were released on Wednesday and we were really pleased to find that the Impact Factor for Child Abuse Review has increased from 0.941 to 1.543. This is fantastic news and it exceeds our strategic goal which was 1.2 by 2017.

2016 impact factors
The journal now ranks 19/43 in Family Studies and 9/42 in Social Work.

We are really proud of the progress we have been able to make with the journal. Ultimately, that comes down to the quality of the papers that are submitted, the hard work of the editorial and publishing teams, and the support of all our readers, reviewers, editorial board, and Diane our tireless manager.

 

Inspiring Research

Looking back over the past couple of years, we have been able to publish some extremely important research which is clearly having an impact, not just on journal metrics, but on policy and practice in the UK and around the world. Highlights for me have been

However there are so many more of relevance to academics and practitioners alike. Many of our papers are freely available online through our virtual issues, so do take a look at the journal website and be inspired!

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International Day for the Elimination of Violence against Women

Today, 25th November, has been designated by the UN as an international day for the elimination of violence against women.

 

“Violence against women and girls is a human rights violation, public health pandemic and serious obstacle to sustainable development. It imposes large-scale costs on families, communities and economies. The world cannot afford to pay this price.” — Ban Ki-moon, UN Secretary-General

 

In my work in the field of child abuse, I have increasingly become aware of the huge tragedy of violence against women, the awful scars it causes to the women themselves, and to their children. It is also a scar across the whole of humanity – something Elaine Storkey has explored in her powerful book, Scars Across Humanity. We must do more to stop it.

 

Violence against women harms their children too.

In the three years from April 2011 to March 2014, Local Safeguarding Children Boards in England carried out a total of 293 Serious Case Reviews (SCRs) (1). Each one of these concerned a child or children who had died or been seriously harmed as a result of abuse or neglect. In a review of these SCRs, we found that in 54% of cases, there was documented evidence of domestic violence in the parents’ relationship. This included 70 children who had died within a context of domestic violence in the family.

It is now abundantly clear from research that living with domestic abuse is always harmful to children. This was emphasised in a recent special issue of the journal Child Abuse Review (2). At its extreme, this may result in the death of a child, the risks for which may continue even after separation. However, far more children continue to live in households where domestic violence is a part of ‘normal’ family life. The myth that because the children are in a different room and so don’t witness any actual violence, they aren’t harmed by it, has been very clearly shown to be a myth. Children pick up on the stress their parents feel; they experience the fear and terror when their mother is being hit or shouted at; they suffer from the controlling, threatening behaviour, the isolation and intimidation that are imposed on their mothers (for the reality is that, in most of these cases, it is the mother who is the victim).

Over the past few years, there has been huge progress in how we as a society, and as child welfare professionals, recognise and respond to domestic violence, including a growing recognition of the impact on children of living with domestic violence. However, there is still much to do. In our research we identified the importance of police, health and social care professionals carefully considering the needs of children in a family whenever there is evidence of domestic violence; of recognising that domestic violence should not be seen solely in terms of violent incidents, but also within the context of ongoing coercive control and the impact of this on the parent and children; and that controlling behaviour may continue to pose risks to mothers and children, even following separation.

By recognising these risks, and taking action to protect women and children from domestic violence, perhaps we could prevent some of those 70 deaths and many more of the cases of serious harm and children and women living in fear.

 

The full research report, Pathways to harm, pathways to protection, is freely available for download from Research in Practice: http://seriouscasereviews.rip.org.uk

The special issue of Child Abuse Review is available via the BASPCAN website: http://www.baspcan.org.uk/child-abuse-review/

 

 

 

 

  1. Sidebotham P, Brandon M, Bailey S, Belderson P, Dodsworth J, Garstang J, et al. Pathways to harm, pathways to protection: a triennial analysis of serious case reviews 2011 to 2014. London: Department for Education; 2016.
  2. Humphreys C, Bradbury-Jones C. Domestic Abuse and Safeguarding Children: Focus, Response and Intervention. Child Abuse Review. 2015;24(4):231-4.

 

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Parental mental health problems and child protection

Our recent triennial review of Serious Case Reviews found a high proportion (53%) of parents whose children died or were seriously harmed through abuse and neglect had mental health problems. This finding is in keeping with other research from the UK and elsewhere which has shown links between parental mental ill-health and child maltreatment.

This, however, presents us with a dilemma: while the prevalence of parental mental ill-health in this population (parents of children seriously or fatally harmed through abuse and neglect) is high, and undoubtedly higher than in the general population, the numbers are small (31 per year) in comparison to the overall numbers of adults with mental illnesses. So, for example, the UK Biobank study, which assessed 172,751 adults from 2009-10, found that 27% met criteria for a mood disorder (major depression or bipolar disorder)[1]; extrapolating this to the 13,887,000 parents with dependent children living in the UK[2], suggests that there will be at least 3.7 million parents with a current or previous mood disorder. If you extend that to include lower levels of anxiety, depression, and other mental health problems, the numbers are likely to be even higher.

So while it may be true to say that children who suffer severe or fatal child maltreatment have a high likelihood of having a parent with a mental health problem, it does not follow that any parent with a mental health problem is likely to abuse his or her child.

 

Hence the dilemma. Parents with mental health problems need care and support, including support around managing their mental ill-health and support in their parenting. This will not be helped by taking a stigmatising approach, nor by assuming they are not able to effectively parent their children. The vast majority of parents with mental health parents are undoubtedly good parents who love and care for their children. Nevertheless, there will be some for whom the nature or severity of their mental health problems, or the interaction between their mental health problems and other factors, do affect their ability to care for their children.

Our research identified the co-existence of parental mental ill-health with domestic violence, with substance misuse, with social isolation, or with criminal activity all as contributing to presenting risks to children. In particular, the presence of domestic violence, when combined with mental health problems in either parent, may increase the risk to the child, even (and perhaps especially) after separation. Likewise, there may be indicators in the nature or severity of the mental illness itself. So, those parents with a history of attempted suicide, or with delusional thoughts, or who had expressed some intent to harm the child may pose a distinct risk.

So the message of these Serious Case Reviews is not to label all parents with mental health problems as potential child abusers, but rather to consider what impact their mental health may be having on the child, to work with the parent to fully explore any additional risks, and to offer respectful, supportive care for the parent and the child.

Learning to respond appropriately to parents with mental health problems is a challenge for professionals. In our research report we consider some of the implications of this and how we can facilitate better quality child- and family-oriented care. In our journal, Child Abuse Review, we have recently compiled a virtual issue bringing together a number of papers from 1999-2014 which explore some of these issues in greater depth. All of these papers are freely available online for a limited period on the journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-0852

Contents The articles below are freely available online until 31 August 2016.

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses (Volume 8, Issue 1, 1999) Nicky Stanley and Bridget Penhale

Parental mental health as a child protection issue: data from the NSPCC national child protection helpline (Volume 8, Issue 3, 1999) Vanessa Lewis and Susan J. Creighton

Building bridges: the interface between adult mental health and child protection (Volume 8, Issue 3, 1999) Charmian Tye and Gretchen Precey

Parental mental health and child protection — making the links through training (Volume 12, Issue 2, 2003) Jennifer Pearce

The experiences of children living with and caring for parents with mental illness (Volume 15, Issue 2, 2006) Jo Aldridge

The mental health of mothers of physically abused children: the relationship with children’s behavioural problems — report from Japan (Volume 15, Issue 3, 2006) Tsuneo Takei, Hiroshi Yamashita and Keiko Yoshida

Maternal mental health and faltering growth in infants (Volume 16, Issue 5, 2007) Laura Dunne, Helga Sneddon, Dorota Iwaniec and Moira C. Stewart

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in Northern Ireland (Volume 21, Issue 3, 2012 Gavin Davidson, Joe Duffy, Liz Barry, Patsy Curry, Eithne Darragh and Judith Lees

Making Decisions about Parental Mental Health: An Exploratory Study of Community Mental Health Team Staff (Volume 21, Issue 3, 2012) Khadj Rouf, Michael Larkin and Geoff Lowe

 

 

[1] Smith DJ, Nicholl BI, Cullen B, Martin D, Ul-Haq Z, Evans J, et al. (2013) Prevalence and Characteristics of Probable Major Depression and Bipolar Disorder within UK Biobank: Cross-Sectional Study of 172,751 Participants. PLoS ONE 8(11): e75362. doi:10.1371/journal.pone.0075362

 

[2] http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/bulletins/familiesandhouseholds/2015-11-05#families

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Adolescent harm from abuse and neglect

New research from the University of Warwick reveals an increase in the number of adolescents who died or were seriously harmed as a result of abuse or neglect.

The research was commissioned by the Department for Education and is based on an analysis of 293 serious case reviews (SCRs) carried out in England between 2011-2014.

Serious Case Reviews

The research was led by Dr Peter Sidebotham, Associate Professor of Child Health of Warwick Medical School and Professor Marian Brandon, Professor of Social Work and Director of the University of East Anglia’s Centre for Research on Children and Families of the University of East Anglia.

The study Pathways to Harm, Pathways to Protection: A Triennial Analysis of Serious Case Reviews 2011-2014 is the fifth consecutive analysis of serious case reviews in England undertaken by the same research team dating back to reviews from 2003-2005. A serious case review (SCR) takes place after a child dies or is seriously injured and abuse or neglect is thought to be involved. It looks at lessons that can help prevent similar incidents from happening in the future

Adolescents

Their research showed a small but significant increase in fatalities and non-fatalities among two age groups 11-15 year olds and 16-17 year olds. In the current review 28% of SCRs were within the two older age groups compared to previous years when the figure was 22-25%.

Dr Sidebotham said: “Often people don’t associate abuse and neglect with adolescents and most cases involve infants and younger children, but people don’t recognise that there is a second peak in risk during adolescence.

“The increase in SCRs involving adolescents is a worrying trend. By adolescence the impact of long-standing abuse or neglect may be present in behaviours which place the young person at increased risk of harm.”

Professor Marian Brandon commented: “We found that the vulnerability of adolescents was often overlooked because they were considered to be already adult or thought to be resilient when taking time to listen to them or to understand their behaviour would have revealed the extent of their difficulties. This was often the case with the young people who were sexually exploited and also of many of the young people who took their own lives”

Drug and alcohol misuse

The research highlighted that almost two thirds of the young people aged 11-15 and 88% of the older adolescents had mental health problems. Some responded to adversity by engaging in risk-taking behaviour including drug and alcohol misuse and offending. Others were placed at risk of sexual exploitation.

Dr Sidebotham added: “This group of adolescents may find themselves particularly vulnerable to online grooming. On a positive note we found that being at school can promote good overall development and a buffer against adversities. Children not regularly in school due to poor attendance, home schooling or exclusion can be vulnerable due to their ‘invisibility’ and social isolation.”

The research has been reported in Science Daily and other online news sources.

The full report and other resources are available on the Research in Practice Serious Case Review website