Safeguarding Child Development

In our 2009-11 biennial review of Serious Case Reviews, Marian Brandon and I highlighted the crucial importance of an understanding of child development to effective safeguarding of children. This is not a new perspective however, and the relevance of such understanding spans a range of areas, including:

recognition of the influence of development on vulnerability towards abuse
recognition of developmental delay as a possible indicator of abuse or neglect
the influence of children’s development on our interpretation of the signs and symptoms of abuse
the long-term impact of abuse and neglect on children’s development and how we may intervene to improve developmental outcomes, and
the particular vulnerability of disabled children.

These are all themes that have been explored within Child Abuse Review over the years.

We have now published a new virtual issue which picks up on some of the themes through a selection of some of the most important papers on the theme, particularly from recent years.

The virtual issue with a full editorial and seven papers is freely available for download from the Child Abuse Review Website

Virtual Issue on Child Development and Safeguarding

Contents

Why Have We Made Neglect So Complicated? Taking a Fresh Look at Noticing and Helping the Neglected Child
(Volume 24, Issue 2, 2015)
Brigid Daniel

Health, Developmental and Support Needs of Vulnerable Children – Comparing Children in Foster Care and Children in Need
(Volume 23, Issue 6, 2014)
Shanti Raman and Sharmishta Sahu

Out-of-Home Care versus In-home Care for Children Who Have Been Maltreated: A Systematic Review of Health and Wellbeing Outcomes
(Volume 25, Issue 4, 2016)
Miriam J. Maclean, Scott Sims, Melissa O’Donnell and Ruth Gilbert

Prevention of Child Abuse and Neglect and Improvements in Child Development
(Volume 18, Issue 1, 2009)
Mogens Nygaard Christoffersen and Diane DePanfilis

Child Abuse, Child Protection and Disabled Children: A Review of Recent Research
(Volume 21, Issue 1, 2012)
Kirsten Stalker and Katherine McArthur

The Connections between Disability and Child Abuse: A Review of the Research Evidence
(Volume 1, Issue 3, 1992)
Liz Kelly

November 17, 2016November 16, 2016

Evidence-informed Practice, Practice-informed Research

This Friday, 18th November, we are celebrating 25 years of the journal Child Abuse Review with a special anniversary conference in Birmingham.

To mark the occasion, we have launched a virtual issue of Child Abuse Review which is freely available to download from the journal website:

Child Abuse Review

Evidence-informed Practice, Practice-informed Research

In this virtual issue we have pulled together a selection of papers from across the 25 years of the journal’s publication within the four conference themes of neglect, child sexual exploitation, domestic violence, and research into practice. We include papers by each of our four keynote speakers, as well as papers by several of the other free-paper authors who are speaking at the conference.

Over the 25 years of the journal, we have seen an increasing emphasis on evidence-informed practice: ‘the application of appropriate evidence, combined with the experience of the practitioner and their responsiveness to the current context’ (Sidebotham, 2013). Equally important is the emphasis on research being informed by and relevant to practice.

Neglect

Neglect is one of the most prevalent and most challenging forms of child maltreatment. Our keynote speaker, Marian Brandon, is well known for her work on Serious Case Reviews, and has given a lot of thought to the role of neglect in child fatality and serious injury (Brandon, Bailey, Belderson, & Larsson, 2014). She points out that while neglect is rarely the direct cause of a child maltreatment fatality, it is a contributory factor in a much larger proportion of cases, and we need a more nuanced understanding of the different forms of neglect and their potential impact on the child. Given all that we know about the prevalence and impact of neglect, it is perhaps surprising that this topic is relatively under-represented in published research. One of our other conference speakers, Katherine Kloppen, undertook a systematic review of prevalence studies of child maltreatment in Nordic countries and found only one study reporting on the prevalence of neglect (Kloppen, Mæhle, Kvello, Haugland, & Breivik, 2015). Within Child Abuse Review, we have been able to publish a number of original research articles focusing specifically on neglect, including our 2014 special issue, from which we would particularly highlight the papers by Elaine Farmer, another conference speaker: (Farmer & Lutman, 2014).

Child Sexual Exploitation

Child sexual exploitation (CSE) has come to prominence more recently, although it is clearly not a new phenomenon, as was pointed out by Nina Biehal, another conference speaker, in her 1999 paper on the risks associated with going missing from substitute care (Biehal & Wade, 1999) and in a highly cited review of CSE by Elaine Chase and June Statham (Chase & Statham, 2005). Our conference keynote speaker on this theme, Jenny Pearce, has been a leading advocate for appropriate responses to dealing with the issues raised by sexual exploitation, as highlighted in an early discussion paper (J. Pearce, 2006) and a more recent review of how Safeguarding Children Boards work to protect children from sexual exploitation (J. J. Pearce, 2014).

Domestic Violence

Our awareness of the impact of domestic violence on children has similarly grown over the years, and it is now much more clearly recognised as always being harmful to children. Part of this has involved the recognition that children are harmed even if they are not directly involved in the violence, and that the ongoing context of coercive control may be as damaging to children (if not more so) as any physical incidents. In a landmark paper published earlier this year, Emma Katz explores these issues and considers how we as practitioners can respond more appropriately (Katz, 2016). Preventing and responding to domestic violence presents huge challenges to practitioners, particularly where children are involved. In a systematic review available online through our Early View function, William Turner and colleagues searched for evidence on the effectiveness of interventions to improve the response of professionals (Turner et al., 2015). They found good evidence of training interventions improving knowledge, attitudes and clinical competence, but less evidence around system level interventions. One of the biggest challenges in this area is how to work with fathers, and this is an issue which Stephanie Holt, our keynote conference speaker, has specifically explored in her research (Holt, 2015).

Research into Practice

Our fourth topic of research into practice is addressed by one of the former editors of Child Abuse Review, Kevin Browne. Kevin has been a leading advocate for child protection services, particularly in Eastern Europe, and his paper comparing institutional care and international adoption between Romania and Lithuania is published online through Early View (Chou & Browne, 2016). Translating research into practice isn’t always easy and the paper by Helen Buckley and colleagues exploring the factors that may influence practitioner uptake of research is well worth reading (Buckley, Tonmyr, Lewig, & Jack, 2013). They highlight particular ways in which practitioners can both access and use research evidence to inform their practice, and get involved in further study and research, thus promoting the full circle of evidence-informed practice and practice-informed research.

You can access all the papers from the 25th anniversary virtual issue by clicking on the link below:

Child Abuse Review 25th anniversary virtual issue

Content of the Child Abuse Review 25th Anniversary Virtual Issue

Neglect

The Role of Neglect in Child Fatality and Serious Injury
(Volume 23, Issue 4, 2014)
Marian Brandon, Sue Bailey, Pippa Belderson and Birgit Larsson

Prevalence of Intrafamilial Child Maltreatment in the Nordic countries: A Review
(Volume 24, Issue 1, 2015)
Kathrine Kloppen, Magne Mæhle, Øyvind Kvello, Siren Haugland and Kyrre Breivik

Working Effectively with Neglected Children and Their Families – What Needs To Change?
(Volume 23, Issue 4, 2014)
Elaine Farmer and Eleanor Lutman

Child Sexual Exploitation

Taking a Chance? The Risks Associated with Going Missing from Substitute Care
(Volume 8, Issue 6, 1999)
Nina Biehal and Jim Wade

Commercial and sexual exploitation of children and young people in the UK—a review
(Volume 14, Issue 1, 2005)
Elaine Chase and June Statham

Who needs to be involved in safeguarding sexually exploited young people?
(Volume 15, Issue 5, 2006)
Jenny Pearce

‘What’s Going On’ to Safeguard Children and Young People from Child Sexual Exploitation: A Review of Local Safeguarding Children Boards’ Work to Protect Children from Sexual Exploitation
(Volume 23, Issue 3, 2014)
Jenny J. Pearce

Domestic Violence

Beyond the Physical Incident Model: How Children Living with Domestic Violence are Harmed By and Resist Regimes of Coercive Control
(Volume 25, Issue 1, 2016)
Emma Katz

Interventions to Improve the Response of Professionals to Children Exposed to Domestic Violence and Abuse: A Systematic Review
Early View: First Published 29 June 2015
William Turner, Jonathan Broad, Jessica Drinkwater, Adam Firth, Marianne Hester, Nicky Stanley, Eszter Szilassy and Gene Feder

Post-separation Fathering and Domestic Abuse: Challenges and Contradictions
(Volume 24, Issue 3, 2015)
Stephanie Holt

Research into Practice

The Relationship over Time between International Adoption and Institutional Care in Romania and Lithuania
Early View: First Published 14 July 2015
Shihning Chou and Kevin D. Browne

Factors Influencing the Uptake of Research Evidence in Child Welfare: A Synthesis of Findings from Australia, Canada and Ireland
(Volume 23, Issue 1, 2014)
Helen Buckley, Lil Tonmyr, Kerry Lewig and Susan Jack

August 5, 2016

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

July 11, 2016

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

February 2, 2016February 4, 2016

#itsnotok: Sexual abuse and sexual violence awareness week

This week is the inaugural Sexual Abuse and Sexual Violence Awareness week ‘#itsnotok’ (1-7 February 2016), a national awareness campaign supported by BASPCAN, the NSPCC, NAPAC and other organisations.

In support of this, we have published a special virtual issue of Child Abuse Review:

Child Sexual Abuse and Children’s Rights

This collection of eleven papers, all of which are available on open access, has been selected from a much larger body of work that BASPCAN has published in Child Abuse Review over the past 24 years. Each paper has helped to stimulate the ongoing debate in respect of child sexual abuse and children’s rights to better protection and therapeutic services.

In an accompanying editorial, Jonathan Picken, Independent Consultant; and Chair, Education and Learning Sub-Committee, BASPCAN points out the timeliness and importance of this issue:

Papers published during this period helped shape professional practice and supported colleagues who were often severely criticised for their attempts to bring the scandal of such abuse and exploitation to the attention of the public. It is apt, therefore, that the recent critical assessment of child sexual abuse (CSA) in the family network, ‘Protecting children from harm’ (Office of the Children’s Commissioner, 2015) should highlight the true prevalence of sexual abuse across England and help continue the campaign to ensure rights enshrined within the United Nations Convention on the Rights of the Child (UNCRC) are fully recognised and protected.

I would encourage you to read Jonathan’s editorial and the associated papers of the virtual issue. Sexual abuse and sexual violence are crucially important issues that are not going to go away. Perhaps more than any other kind of maltreatment, sexual abuse hits at the core of a person’s identity, and leaves deep scars. We owe it to women and children the world over to take this seriously and to continue to strive to improve our responses to sexual abuse and violence, working to prevent such violence and to support those affected by it.

Like many other authors whose work has helped inform our understanding of CSA, authors of these 11 papers have contributed much to the ongoing battle to end such abuse and exploitation. Their work is celebrated here in the hope that it will continue to provoke debate across the coalition of partner organisations coordinating #itsnotok and efforts to raise awareness of sexual abuse and violence and the services available. The associated week of action comes at an opportune moment as the Independent Inquiry into Child Sexual Abuse chaired by Justice Goddard progresses its work. The need for similar investigations across the five nations perhaps finally vindicates the efforts of BASPCAN members and other colleagues who have continued to highlight the needs of those affected.

Virtual Issue Contents

The pattern of child sexual abuse in Northern Ireland
(Volume 1, Issue 2, 1992)
M. T. Kennedy and M. K. C. Manwell

Pornography and the organization of intrafamilial and extrafamilial child sexual abuse: developing a conceptual model
(Volume 6, Issue 2, 1997)
Catherine Itzin

Prevention of sexual abuse in children with learning disabilities
(Volume 7, Issue 5, 1998)
Ana Maria Martorella and Ana Maria Portugues

The neglected priority: sexual abuse in the context of residential child care
(Volume 8, Issue 6, 1999)
Meg Lindsay

Assessment and intervention in cases of suspected ritual child sexual abuse
(Volume 10, Issue 4, 2001)
Bernard Gallagher

Commercial and sexual exploitation of children and young people in the UK – a review
(Volume 14, Issue 1, 2005)
Elaine Chase and June Statham

Twenty-first century party people: Young people and sexual exploitation in the new millennium
(Volume 22, Issue 3, 2013)
Margaret Melrose

Dealing with a problem that doesn’t exist? Professional responses to female perpetrated child sexual abuse
(Volume 16, Issue 4, 2007)
Lisa Bunting

In Demand: Therapeutic services for children and young people who have experienced sexual abuse
(Volume 21, Issue 5, 2012)
Debra Allnock, Lorraine Radford, Lisa Bunting, Avril Price, Natalie Morgan-Klein, Jane Ellis and Anne Stafford

Disclosure of child sexual abuse: Delays, non-disclosure and partial disclosure. What the research tells us and implications for practice
(Volume 24, Issue 3, 2015)
Rosaleen McElvaney

Social work intervention to protect children: Aspects of research and practice
(Volume 1, Issue 1, 1992)
Olive Stevenson

July 17, 2015November 23, 2015

Learning To Listen: To Young People, Parents, Perpetrators

I don’t want to talk about it… It’s too horrible. But in the end I became so frightened of her I used to start shaking when she came into the room.

So said Matilda’s teacher, Miss Honey, in Roald Dahl’s classic children’s book (Dahl and Blake, 1989, p. 198). In a simple children’s story, Dahl poignantly captures just how difﬁcult young people (and adults) ﬁnd it to talk about the abuse they experience:

I have found it impossible to talk to anyone about my problems. I couldn’t face the embarrassment, and anyway I lack the courage. Any courage I had was knocked out of me when I was young (p. 195).

The reality of that is captured in the ﬁrst paper in the latest issue of Child Abuse Review. In a review of research on disclosure of child sexual abuse, Rosaleen McElvaney (2015) highlights both quantitative data on the prevalence of non-disclosure and delays in disclosure, and qualitative data exploring the complexity and individuality of issues around disclosure. McElvaney concludes that ‘signiﬁcant numbers of children do not disclose experiences of sexual abuse until adulthood and adult survey results suggest that signiﬁcant proportions of adults have never disclosed such abuse’ (p. 161)

Continue reading “Learning To Listen: To Young People, Parents, Perpetrators”

February 14, 2015November 23, 2015

Child abuse in fact and fiction: Seminar notes from ethics and children’s literature event, Warwick University, 2015

All children, except one, grow up.

So said JM Barrie in the opening words of Peter Pan. Only it isn’t true. The reality is that far too many children never get the opportunity to grow up; or have to grow up before their time; or find that childhood isn’t the wonderful experience portrayed by Peter Pan, and all because of abuse or neglect suffered at the hands of their parents.

Right from the beginning they started beating him for almost no reason at all. They never called him by his real name, but always referred to him as ‘you disgusting little beast’ or ‘you filthy nuisance’ or ‘you miserable creature’… His room was as bare as a prison cell.

Roald Dahl. James and the Giant Peach, p8.

The food would be cold and would be given to her on a piece of plastic while she was tied up in the bath. She would eat it like a dog, pushing her face to the plate. Except, of course that a dog is not usually tied up in a plastic bag full of its excrement.

Neil Garnham, QC – Victoria Climbié Inquiry

Victoria spent much of her last days, in the winter of 1999–2000, living and sleeping in a bath in an unheated bathroom, bound hand and foot inside a bin bag, lying in her own urine and faeces. It is not surprising then that towards the end of her short life, Victoria was stooped like an old lady and could walk only with great difficulty

He found the cause of death to be hypothermia, which had arisen in the context of malnourishment, a damp environment and restricted movement. He also found 128 separate injuries on Victoria’s body, showing she had been beaten with a range of sharp and blunt instruments. No part of her body had been spared. Marks on her wrists and ankles indicated that her arms and legs had been tied together.

Child abuse is a reality, an unimaginable reality, for many children. A reality that goes way beyond the imagined worlds we see in children’s fiction.

These notes are from a seminar I gave recently on child abuse and children’s literature. I’d be really interested in any views/comments on the issues raised.

Continue reading “Child abuse in fact and fiction: Seminar notes from ethics and children’s literature event, Warwick University, 2015”