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• Abuse & neglect are often a feature of a range of family difficulties and problems
• Often compounded by poverty, house moves & eviction• Cumulative harm• A wicked problem• Reconceptualisation
Bunting & Toner (2012); Devaney & Spratt (2009)
• Adverse Childhood Experiences & their relationship to Adult Health and Well-Being– Child abuse & neglect– Growing up with domestic violence, substance
abuse, mental illness, crime.– 18.000 participants– 10 year study
Anda, R., & Felliti, V., (2010) The Adverse Childhood Experiences (ACE) Study: www.acestudy/org
Top 10 Risk Factors:
•smoking, •severe obesity, •physical inactivity, •depression, •suicide attempt, •alcoholism, •illicit drug use, •injected drug use, •50+ sexual partners, •history of STD (sexually transmitted disease).
Adverse Childhood ExperiencesAdverse Childhood Experiences
Social, Emotional, & Cognitive Impairment
Adoption ofHealth-risk Behaviors
Disease, Disability
EarlyEarlyDeathDeath
The Influence of AdverseChildhood Experiences Throughout Life
Death
Birth
• Importance of ecological frameworks• Mirroring: families and agencies• Exclusion of fathers• Fixed thinking• ‘Start again syndrome’• The rule of optimism• Silo practice• Disguised compliance• Vulnerability of older children and adolescents
• Sidebotham, P., (2012) What do serious case review achieve? Arch Dis Child 97 (3): 189-192
• Family Characteristics• Minority previously known to CSC• The invisible child• Failure to interpret the information• Poor recording of information and decisions• Decision making• Relations with family• Thresholds
Sidebotham, P., (2012) What do serious case review achieve? Arch Dis Child 97 (3): 189-192
Domestic Abuse
•Domestic abuse is a major issue and accounts for 25% of all recorded violent crime (police statistics)
•On average 2 women a week are killed in England and Wales by partners - ex partners ( home office)
•24.8% 18 to 24 yr. olds witnessed DV
at some time during childhood
Children are affected
Children who live with domestic abuse are significantly affected and this can be manifest in a number of ways, including,
• Physical injury• Disruptive behaviour• Difficulties at school• Depression, resentment, anger• Sleep disturbances• Sense of loss• Bed wetting and nightmares• Guilt, confusion, sadness, self blame• PTSD
• 300,000 children in the UK (Scotland 59,600)• Conflation of ‘substances’• 1100 children pa die as a direct result• Children four times more likely to develop a dependency• Prevalent in cases of DA and child protection• Strong links between alcohol and violence• Little evidence that substance use alone is a risk factor• SG Statistics (2011); Best (2011) Scottish Drug Recovery Consortium; ACMD 2007; Forrester and• Harwin (2008)
• Effects on Parents• Physical Ailments (e.g. infections, injuries)• Psychological impairments
– Withdrawal symptoms– Psychoses– Serious memory lapses
Most short lived
Manifestation: mental health; psychological impact of drug; self- expectations; personality; type, dosage, admin method
• Neglect• Physical abuse, sexual abuse etc• Exposure to dodgy adults• Unstable and violent environment• Feel second to drugs• Exposure to noxious hazards• Criminality• Health issues
• About on in four adults is affected by mental illness• Most cases will be mild or short lived• Sometimes severe (e.g. schizophrenia or manic depression)• Many more live with long term personality disorder or long
term depression• 40-60% of people with a severe mental illness have children• Around a third of children subject to CPP (CPR NI &
Scotland)
• The Psychiatrist (2003) 27: 117-118 doi: 10.1192/pb.27.3.117
• Separations• Insecure relationships• Neglect• Maltreatment• Carer role• Upset , frightened, ashamed• Bullied • Hear unkind things• Risk of mental illness• Revenge Killing
FEDUP (Family Environment Drug using Parents)
• A family approach to supporting children who live with parental substance misuse
• Group work programme with children• Individual work with parents• Come together for safety planning
• Based on the Erica Pitman Programme• Twin track programme working with children
and their parents to reduce the risk of harm to children who live with parental mental ill health.
Specific aim Tool Perspective
To enhance parents’ protective parenting/ to improve the safeguarding of children & young people.
Child Abuse Potential Inventory (CAPI) &Evaluation Wheel
Parent
To enable children and young people to feel better about themselves.
Self Esteem Scale (based on Rosenberg)
Child
To reduce children and young people’s emotional & behavioural problems.
Goodman’s Strengths and Difficulties Questionnaire (SDQ)
Child/ Parent
HoNOSCA Practitioner
To enable children and young people to process their thoughts and feelings.
Evaluation wheel Children
Overall aim: To improve the well-being of children and young people and reduce isolation
Overview of the evaluation tools
To enhance parents’ protective parenting/ to improve the safeguarding of children & young people.
• For both FED UP and Family SMILES there has been a decrease in total CAPI score between T1 and T2 which is statistically significant for both programmes. This indicates that for both programmes parents are reporting a positive change in their parenting behaviours related to improving the safeguarding of their children.
• The change in five out of seven subscales on the CAPI was statistically significant for FED UP suggesting that parents’ levels of distress, unhappiness, problems with the family, loneliness and ego strength have all improved. For Family SMILES , the distress, unhappiness and ego strength subscale are statistically significant
Interim Findings ( October ‘11 to February ‘13)
Note: For both FED UP and Family SMILES number of Time 1 and Time =19, Statistical significance at 95% confidence levels using a one tailed test
To enhance parents’ protective parenting/ to improve the safeguarding of children & young people: Evaluation wheels with parents
FED UP
Note: The rating of 1 to 5 where 1 is low and 5 is high
To enable children and young people to feel better about themselves
Levels of self esteem amongst children as reported on the adapted Rosenberg scale increases on both programmes. In Family SMILES, this change is statistically significant.
FED UP Family SMILESN = 28 (T1 and T2) N = 20 (T1 and T2) Mean at T1 = 19.6, Mean at T2 = 20.8 Mean at T1 = 19.05, Mean at T2 = 21.5
P value = 0.102 (one tailed t-test) P value = 0.009 (one tailed t-test)The change is not statistically significant The change is statistically significant
To reduce children and young people’s emotional & behavioural problems.
FED UP Family SMILES
Self Report SDQ No statistical significance between T1 and T2 (n=27)
No statistical significance between T1 and T2 (n=29)
Parent completed SDQ
No statistical significance between T1 and T2 (n=18)
No statistical significance between T1 and T2 (n=9)
HoNOSCA ( completed by practitioner)
Statistically significant change from Time 1 and 2
No statistical difference
At present the evaluation is not showing any statistically significant change in reducing emotional and behavioural problems as reported on the SDQ on either the FED UP or the Family SMILES programmes. Practioners on FED UP have reported change that is statistically significant using the HoNOSCA
To enable children and young people to process their thoughts and feelings: Children’s evaluation wheels
FED UP Family SMILES
The world is a dangerous place to live. Notbecause of the people who are evil, butbecause of the people who don’t do anythingabout it(Albert Einstein)
Thank You for ListeningDi [email protected]
AcknowledgementsProfessor Julie TaylorDr. Prakash Fernandes