Promoting effective working with parents with learning disabilities

The children of parents with learning disabilities are increasingly coming to the attention of child protection and children in need services. The current framework within which services are delivered identi?es the need to work cooperatively both across agencies and with parents themselves. The decisions taken by practitioners in the course of their assessment and support work should be in?uenced by a recognition of where the risks to this group of children lie and which factors are most likely to be associated with positive outcomes. This paper outlines risks to children associated with the parents' dif?culty in accessing appropriate antenatal care and the risk of developmental delay arising from both genetic and environmental in?uences. This group of children are also more likely to experience behaviour problems and language delay. Research has indicated a risk of neglect, but abuse, where it does occur, is more likely to be associated with partners or relatives. It is also clear that some children are more at risk than others, and intellectually able children, as well as those with high levels of dependency, may be the most vulnerable. Risks can be reduced when parents have access to good family and social support networks and professional support which is acceptable to them. Maintaining a small family size can also be helpful. If parents have had positive childhood emotional experiences, their chances of successful parenting are increased. Copyright © 2004 John Wiley & Sons, Ltd.     

The unique relations between early homelessness and educational well-being: An empirical test of the Continuum of Risk Hypothesis

This study examined the Continuum of Risk Hypothesis by assessing the unique relations between early homelessness and educational outcomes while controlling for co-occurring risks. An integrated data system was used to account for multiple co-occurring early risk factors for an entire cohort of first grade students in a large urban school district and municipality (N = 8267). Multilevel linear regression models indicated that the presence of some co-occurring risk factors explained the relation between homelessness and academic engagement problems in school. However, after controlling for co-occurring risks, an experience of homelessness was found to be uniquely related to social engagement problems in first grade. These results support the Continuum of Risk Hypothesis and stress the importance of early intervention for children with an experience of homelessness to foster their social development.     

Teacher–child relationships in the context of poverty: the role of frequent school mobility

Children's relationships with their teachers are critical for classroom-based learning, but children growing up in poverty may be at risk for lower-quality relationships with teachers. Little is known about how changing schools, one poverty-related risk, affects teacher–child relationships. Using growth curve models that control for a host of other poverty-related risks, this study explores the association between children changing schools frequently (defined as three or more school moves) between preschool and third grade and the quality of their relationships with their teachers over these five years in a low-income, ethnic-minority sample. Children who frequently moved schools were reported to be less close to their teachers in third grade and experienced steeper declines in closeness than children who did not change schools frequently. Moreover, the effects of frequent school mobility at third grade were robust to other poverty-related risks, including residential mobility, parental education risk, family income, and single-parent households. Changing schools was unrelated to children's conflict with teachers. We discuss these findings in the context of policies that support students’ transitions when changing schools.     

Mix and match: planning to keep looked after children safe

The risks which children run from other children in substitute care have received little attention. However, if children's safety in care is to be maximized, then placement planning will need to focus on the risks and vulnerability of both the child to be placed and others already in the setting. It should also ensure that full information is given to the caregivers. In an interview sample of 40 looked after sexually abused and/or abusing young people aged 10 or over, most of the young abusers were placed in foster care and the majority of the sexually abused young people went into children's homes. However, in fewer than a third of these placements was consideration given to how the young person would fit in with others in that setting. This meant that the potential risks which that child posed to others or vice versa were not addressed. More worrying still, in just under half of the sample, no information about the young person's history of sexual abuse or abusing behaviour was given to the caregivers. This meant that caregivers were unable to plan to provide the level of supervision which might have averted a number of instances of abuse. When the whole histories of the sexually abused young people in the study were examined, it was found that half of them had abused another child at some stage, generally another child in care. This evidence suggests that the experience of sexual abuse should be regarded as an important risk factor in the later development of sexually abusing behavior and that local authorities need to fashion policies which emphasize the prime importance of social workers providing full information about children's backgrounds when placements are made. Copyright © 1999 John Wiley & Sons, Ltd.     

Structured risk assessment procedures: instruments of abuse?

Child protection services in Australia and elsewhere face increasing internal and external demands. As a response to these pressures, in part at least, services are increasingly implementing some form of risk assessment procedures. This article examines the practice implications of the increasing use of risk assessment instruments in child protection services. It highlights the complexity of the concept of risk as the basis for a future‐oriented assessment activity. The authors suggest that this change of time frame (from what has happened to what might happen) may be detrimental to children. Through a critical review of the literature, the authors question whether risk prediction is possible and discuss the limitations of risk assessment instruments which omit some risk factors and may ignore the perspective of the child. The authors challenge the validity of risk assessment instruments in statutory settings and suggest that the protection of the organization may be a major objective in their implementation. Copyright © 1999 John Wiley & Sons, Ltd.     

Understanding service provision and utilization for vulnerable youth: Evidence from multiple informants

Research has demonstrated that the ability of children to cope well with risk exposure can be partly attributed to the social ecology that surrounds them, including their access to resources. Few studies however have explored the interaction of services that many vulnerable children receive in relation to surrounding risks and available resources. This study reviews data of a paired sample of 166 Canadian multiple service using youth (at least using two of five public service systems) and a youth-nominated person most knowledgeable (PMK) focused on the contextual risk factors, service use variables, and pscychosocial outcomes of youth participants. Despite low to moderate correlations between youth and PMK (the person who is most knowledgeable about youth's lives) reports, findings showed that both PMKs and youth perceive service provision as a mediator between risk and pscychosocial outcomes. For youth however, better quality of service provision is key to improved developmental outcomes. Furthermore, the more risk factors youth face at home and at school, the less likely they are to perceive their services as helpful or appropriate to their needs. Youth data also reflects far more complex interactions between risks, service provision and outcomes than PMK data. Greater sensitivity is needed to both an adult and youth's perceptions of risk and related service needs if service access is to be provided optimally.     

Systems approaches to risk assessing healthcare, how far have we come?

Systems approaches and their relevance to risk assessment are considered through an examination of a number of recent applications in England. The importance of visual mapping of systems is emphasised. This approach encourages participation from those within the system with less technical knowledge but with important information to add to a risk assessment. Other advantages outlined include the ability to readily identify system boundaries, map processes and record both strengths and weaknesses of existing or planned system changes. The use of risk assessment methods with this approach should be cautious, as any one method may only identify a sub-set of all risks.     

Household incarceration in early adolescence and risk of premarital first birth

In the second half of the 20th century, the United States experienced a massive increase in incarceration. In response to this growth, a burgeoning scholarship has sought to explore the collateral consequences of incarceration for young children. However, this scholarship has less frequently explored the impact of incarceration on long-term outcomes, how incarceration experienced in periods other than early childhood impacts children, and whether the incarceration of family members other than parents has negative implications for children. Using data from the children of the mothers in the National Longitudinal Survey of Youth, I explore whether household incarceration experienced in early adolescence is associated with a child's risk of growing up to have a premarital first birth. The results suggest that, even after including a rich set of covariates, children who experience household incarceration in early adolescence are at greater risk of having a premarital first birth, particularly when the father or an external household member is incarcerated.     

Off-label medication use

Prescribing medications for off-label uses is not illegal. Off-label prescribing includes using medications for unapproved indications; using a drug outside of the recommended dosage range or duration of use; using a drug in certain unapproved patient populations, such as those defined by age, sex, or particular clinical parameters; or intentionally using a medication in a patient who has a known contraindication. Medications would be considered appropriate for off-label use based on their known clinical pharmacology, evidence from clinical studies, and sometimes from the personal experience of the prescriber. The decision to use a drug off label should be based on a careful assessment of the patient's treatment history and the drug's potential risks and benefits. Patients should be given adequate informed consent about how the drug is being used off label and why, along with appropriate information about known risks and side effects.     

Learning risk assessment in South Africa: Issues of language power and imperialism

This article seeks to explore some of the issues that underpinned the development and teaching of a course in risk assessment in child protection in South Africa. University College Chichester and the Institute of Child and Family Development at the University of the Western Cape are involved in an ongoing programme of co-operation that began in 1997. As part of this programme the course was taught by the author, a female, white, English, ex-social-worker academic to a majority black South African multiprofessional audience. The article explores some of the issues this raises and asks whether it is possible for a white English educator to teach black South African students a western model of risk assessment using English as the language of teaching. Secondly, is there enough common ground to mitigate some of the impact of the differences of race and culture, particularly the power differences that emanate from an imperialist legacy? In seeking to address these questions the article argues that teaching methodology is crucial to the student experience. The author writes in the first person in recognition of the fact that she presents one face of a multifaceted experience and argues that, to protect children, we must learn from each other and find a way to work through history rather than be paralysed by the past.     

Significant harm: making professional judgements

Judging whether a child is suffering or is likely to suffer significant harm has become a critical task for professionals working with children and their families in England and Wales. Yet little guidance is available about what the phrase means in its entirety and how it should be applied in practice. This study set out to examine how the phrase was used in practice by a selected sample of experienced health and social work staff. The evidence collected suggests flaws in the general approach adopted by professionals to identification and assessment in child protection cases. The data indicate a heavy concentration of attention on the weaknesses of families being assessed rather than their strengths and on parents rather than children. Problems are identified in responding effectively to long-term, chronic abuse such as emotional abuse and neglect. The study recommends changes in practice based on these findings which have been implemented by a wide range of practice agencies within the study area. © 1998 John Wiley & Sons, Ltd.     

Child protection and welfare: cultures,policies, and practices

Child protection and welfare have become international issues in a globalized world. Ideas about childhood and the upbringing of children vary widely, depending upon the prevailing economic, socio-cultural, religious, and political contexts. These have had dramatic effects on the way societies value children, and the role acquired by the state in their protection and advancing their well-being. Children, however, remain at risk. They are placed at risk by the breakdown of extended family systems as a result of urbanization, and as a result of impaired functioning of some nuclear families, in the absence of kinship safety nets. Some traditional cultural practices place children at risk, especially girl children. Poverty creates risks for all children but it can create specific catastrophic risks for girls. Countries can enact visionary laws intended to protect children, but they will be ineffective against entrenched social attitudes, especially if only limited resources can be provided to implement and enforce them. This is the ultimate challenge that the world community must address if the vision of the United Nations Convention on the Rights of the Child is to be realized.     

Training care managers in risk assessment: Outcomes of an in-service training programme

Despite a recognition that social service workers require training in risk assessment, it would appear that there currently exists minimal information regarding appropriate models for risk assessment to underpin care managers' practice and, as a result, minimal discussion to inform considerations regarding appropriate training in this area. To date, not one study has appeared in the literature specifically examining whether in-service training provided to care managers actually results in changes to their work practices. This study provides results from an evaluation of an in-service training programme in risk assessment and demonstrates that the training had minimal impact on trainee behaviours. A number of reasons are offered as to why the training failed to transfer to practice; chief amongst these being insufficient time to learn the content of the training and factors associated with the specific work environment. Importantly, the particular model of risk assessment taught on the training programme was considered by care managers as far too time consuming and complicated to use, given the demands on their time and heavy workloads. It is suggested that if this particular risk assessment model is to be adopted by care managers, social services departments must ensure that such training is of appropriate duration to enable skills to be learnt, and that workplace contingencies are addressed to facilitate rather than hinder the use of training. These findings are considered to have practical significance for the design of similar short duration training programmes within social services.     

A toolkit for MSDs prevention--WHO and IEA context

Many simple MSD risk management tools have been developed by ergonomists for use by workers and employers with little or no training to undertake injury prevention programs in their workplace. However, currently there is no "toolkit" which places such tools within an holistic, participative ergonomics framework and provides guidance on how best to use individual tools. It is proposed that such an holistic approach should entail initial analysis and evaluation of underlying systems of work and related health and performance indicators, prior to focusing in assessment of MSD risks stemming from particular hazards. Depending on the context, more narrowly focused tools might then be selected to assess risk associated with jobs or tasks identified as problematic. This approach ensures that biomechanical risk factors are considered within a broad context of organizational and psychosocial risk factors. This is consistent with current research evidence on work- related causes of MSDs.     

Risk,Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination, and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. Therefore it is argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery-based approaches, which promote supported decision-making and inclusion; and the assessment of a person's ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.     

Displacement,caregiving, and the ecological system of youth in foster care: a theoretical perspective

Children involved in the child welfare (i.e., foster care) system are at a greater risk for numerous negative outcomes in adolescence and adulthood (e.g., lower educational attainment, higher risk for a criminal record). For children in foster care who experience placement disruption (i.e., removed from a foster home and placed in another nonpermanent placement), the risks significantly increase. Informed by the ecological systems model, the authors propose a theoretical perspective to explain the unique aspects of a foster child’s development and discuss how this framework informs child welfare practice and intervention for foster children at risk for placement disruption. This perspective has the potential to provide a framework that has implications for foster caregivers and child welfare professionals and to inform future policies.     

McCance‐Katz urges school reopenings

During a week when more and more schools decided not to open up classes for this fall, concerns about the welfare of children isolated at home, without the benefit of their peers or teachers, mounted as well. Elinore McCance‐Katz, M.D., Ph.D., assistant secretary for mental health and substance abuse of the Department of Health and Human Services, opined in USA Today that not opening schools would harm the mental health of children. In the limelight due to many changes in substance use disorder treatment due to the pandemic, McCance‐Katz sided with President Trump and Education Secretary Betsy DeVos in saying that ignoring these casualties would harm children more than the risks of COVID‐19. The schools should reopen, and parents should decide for themselves whether they want their children to attend, she wrote.     

Co-production of ICT and children at risk: The introduction of the Child Index in Dutch child welfare

This article studies the construction of children at risk in the introduction process of a novel ICT system in Dutch child welfare, the Child Index. This early warning electronic information system enables early reporting of children at risk to stimulate multidisciplinary collaboration among the different professionals involved with a particular child. We followed the introduction of the Child Index in practice. Our empirical analysis provides insight into the co-production of this ICT system and risk in child welfare practices. The analysis shows that the interaction between local and national, and disciplinary and organisational differences induces various constructions of risk, making the decision to signal and the act of signalling risk complex and the status of a signalled risk vague. Moreover, the analysis illustrates that the Child Index's goal of early signals for all children at risk does not fit professionals' daily practices and highlights the need to discuss whether the risk signalling ambitions of the Child Index are not a larger risk to children than the risks that are being targeted.     

Media Representations of Sexual Abuse Risks

What are the risks associated with child sexual abuse? Who is at risk? From whom? For professionals working in the field of child abuse, the main answers to such questions are straightforward. There is a broad consensus that children are at risk from adults (and young people), often from men (and sometimes women) that they know. Fathers, step-fathers, uncles and brothers are often implicated. This is not, however, the focus of news coverage. Abductions, paedophile rings and abuse in children's homes attract intermittent but occasionally intense media attention. In contrast, sexual abuse of children within their own families is rarely front page news—except, that is, where the accusations are contested. Almost as soon as the existence of widespread abuse within ‘ordinary’ homes became public knowledge, this was over-shadowed by a series of high-profiled ‘scandals’, such as Cleveland, Rochdale and Orkney. The focus turned to questions of misdiagnosis, inappropriate intervention and the supposed coaching of children to make false accusations. More recently ‘false memory syndrome’ has hit the headlines suggesting that some adults' accounts of abuse can also be discredited. The news coverage often gives the impression that the main risks are not tochildren, but to parents, particularly fathers. How has this come to be the focus of public debate? Why is it that these risks have proved so much more ‘newsworthy’? This paper examines the media profile of the risks associated with sexual abuse and draws on interviews with journalists to seek to explain the shape of the coverage.     

Children in dual-residence arrangements: Exploring discourses of fairness and children's best interest in Norway

In many countries, dual residence is increasingly common for children when parents separate. This works well for many children, but opinions differ on whether or not it should be the norm. In analysing interviews with 35 nine- to 19-year-olds with dual-residence experience in Norway, undertaken in 2018, we find clear traces of prevailing discourses in society. Claims of equality and fairness and claims of children's rights both emerge, the latter being particularly visible in the participants' recommendations to other children. Children value spending much time with both parents, but may still want more flexibility than their parents realise.