The French puéricultrice

SUMMARY. This paper looks at the French equivalent of the British health visitor—the puéricultrice. Through consideration of the role of the State in child surveillance and official social policy regarding children, it explores the hypothesis that the work of these two sets of workers (and hence their perspectives) is to a large extent socially constructed. The paper is based on an exploratory study conducted in 1987 and funded by the Institute of Education, London. Data on health visitors are drawn from a recent research project at Thomas Coram Research Unit, ‘Parents and Professionals—perspectives on child health care’, carried out by the author together with Berry Mayall. The Economic and Social Research Council funded the study from 1985–1988.     

Worker skill and client outcome in child protection

The research in child protection and in work with other involuntary clients suggests that the use of certain skills by child protection workers is likely to be related to positive client outcomes. In particular, effective practice involves: helping clients and client families to understand the role of the child protection worker; working through a problem‐solving process which focuses on the client's rather than the worker's definitions of problems; reinforcing the client's pro‐social expression and actions; making appropriate use of confrontation; and using these skills within a collaborative client/worker relationship. This study attempts to identify the extent to which child protection workers make use of these skills and how these skills relate to client outcomes. Data were sought through 50 interviews with child protection workers and 282 interviews with family members. The child protection workers provided information about 247 client families. It was clear that when workers used the skills, their clients had better outcomes—the workers believed their clients showed better progress, the clients were more satisfied with the outcomes and the cases were more likely to have been closed 16 months later. Copyright © 2002 John Wiley & Sons, Ltd.     

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses

This article presents the findings of a small pilot study which examined the needs of 13 mothers with severe mental health problems whose children were involved in the child protection system. The use of the diagnosis of ‘personality disorder’ in relation to this group of women is discussed and the finding that all these women had experience of domestic violence is considered in the context of other research findings. The extent to which child protection social workers and mental health professionals worked together on these cases was explored and only limited evidence of good communication and collaboration was found. The need for effective inter‐professional and inter‐agency coordination is argued, but differing conceptions of maternal mental health problems and their relationship to children's needs may make for difficulties in professional communication and decision‐making. The article seeks to identify the differing approaches to maternal mental health problems which appear to be developing out of different groups of research studies and argues that practitioners need to be explicit in identifying their perspectives on the associated issues of maternal mental health problems and child protection. Copyright © 1999 John Wiley & Sons, Ltd.     

GPs' and health visitors' participation in child protection case conferences

This study was conducted in two related but separate phases. Phase one compared the frequency and type of participation by general practitioners and health visitors in child protection case conferences. Two hundred consecutive case conferences involving 83 general practitioners from 33 practices were independently reviewed and scored to assess the level of general practitioner and health visitor participation, whether by written report and/or by attendance. Health visitors showed a far higher level of participation in case conferences than general practitioners and their attendance was more often rated essential by the social worker than that of the general practitioner. There was no evidence in those cases where social workers rated the general practitioner's attendance as essential that this resulted in increased general practitioner participation. General practitioners were equally unlikely to participate in initial, first review and subsequent review case conferences. Most importantly, general practitioner participation/non-participation was not related to length of notice given. In phase two, 76 general practitioners from the sample of 83 were interviewed in order to elicit factors underlying their decision on participation in child protection case conferences. Personal and practice characteristics and attitudes towards the case conference and towards social workers were examined and subsequently analysed. No significant associations were discovered apart from a link between previous training in child protection and a less negative attitude towards communication with social workers and the belief that the general practitioner's participation in the case conference helps him/her in the subsequent management of the case. Personal contact between local social workers and the primary health care team was seen as likely to be helpful in the establishment of a climate of trust which would facilitate the flow of sensitive information in both directions. Health visitors were often regarded by general practitioners as fulfilling the role of delegate to the case conference without having any formal remit to carry out this task.     

A case study of failure to thrive and inter‐agency work

Social workers and medical professionals have an ambiguous relationship. Though expected to work together within the child protection regulations of the Children Act 1989, there are many tensions. In general, social workers and health visitors enjoy close working relationships, but tensions are frequently experienced as one proceeds higher up the medical hierarchy. The reasons for this may be numerous, but in practice may obstruct speedy action in detection and prevention of disease which is social in aetiology — yet all professionals have an important role. I hope to demonstrate this in the following case study, where ‘failure to thrive’ took 18 months to evidence but, without inter‐agency working, might have proved fatal to the child. Copyright © 2000 John Wiley & Sons, Ltd.     

Double trouble: maternal depression and alcohol dependence as combined factors in child and family social work

This study, part of a large programme of research incorporating four child and family care teams, focuses on the combined effects of alcohol dependence alongside clinical depression in mothers. A comparison is made between women who were clinically depressed and women who were both clinically depressed and alcohol dependent. The latter group had significantly higher levels of difficulty in social relationship, health, child, and particularly parenting problems. When considered alongside the intensity, duration and range of intervention required, the results indicated that there is considerable concern about the ‘dangerousness’ of this particular group with major implications for policy and practice. Copyright © 2002 John Wiley & Sons, Ltd.     

Out of the wilderness and into the fold: the school nurse and child protection

This paper argues that there has been a major change since the mid‐1980s in the extent to which other workers involved in child protection recognize the value of the contribution of school nurses. Evidence for this is drawn from a longitudinal study in an English shire county using a vignette approach to explore workers' perceptions of the handling of child protection issues. While in part the greater recognition of the role of the school nurse can be attributed to the adoption of child protection procedures, this provides only a partial explanation. School nurses in the 1990s were better qualified and more experienced, while other workers such as school heads and social workers recognized the need to work with others, such as the school nurse, in order to meet their own objectives. The paper concludes that there is a case for more formal recognition of school nurses in child protection because, like health visitors, with whom they have a follow‐on colleague relationship, they are often the most significant health workers for children who may be neglected or abused. Copyright © 2000 John Wiley & Sons, Ltd.     

Health Care Providers' Experiences with Problem Gamblers

The purpose of this study was to document health care providers' awareness of problem gambling and frequency of recognition and treatment. An exploratory survey was designed to collect data on awareness and knowledge of problem gambling. A structured questionnaire was completed anonymously by 180 health care providers (nurses, physicians, social workers, and other allied health professionals). Almost all respondents (96%) reported knowledge of problem gambling, and 30% reported asking clients about gambling problems when they presented with stress related symptoms. A third of the respondents reported identifying and treating clients for a gambling problem. The most frequently reported intervention was referral to counseling and other gambling resources. Respondents were generally interested in learning more about gambling problems, particularly those providers who have had a client discuss gambling related concerns. There were no significant differences in findings between provider groups.     

Economic Pressure, Maternal Depression, and Child Adjustment in Latino Families: An Exploratory Study

The goal of this study was to investigate the impact of poverty and economic pressure upon the adjustment of mothers and children in immigrant Latino families. Participants included 56 first generation Latina mothers who completed questionnaires addressing economic difficulties, depression, social support, and behavior problems exhibited by their children (30 boys, 26 girls) who ranged in ages from 4 to 13. Results indicate that maternal depression mediates the relationship between maternal economic pressure and child adjustment. Social support was found to further moderate the relationship between maternal depression and child internalizing problems. Gender differences indicated that relations were stronger among mothers of boys than mothers of girls.     

Talking about culture in social work encounters: immigrant families and child welfare in Finland

This article aims at analysing the ways in which people talk about ‘culture’ in social work encounters involving child welfare in immigrant families. The empirical material includes conversations between immigrant clients, their social workers and co-operating professionals at six Finnish social service offices, as well as interviews with the persons participating in these meetings. The theoretical and methodological frames of reference are social constructionism and discourse analysis. The study suggests three ways in which the concept of ‘culture’ is used by social workers and their clients: firstly, as a means of explaining ‘the ordinary and normal ways’ of raising children; secondly, as ‘a difficulty’ in the interaction between social workers and clients; and thirdly, as ‘a methodical tool’ in creating dialogue with clients. As far as the practical implications for social work are concerned, it is emphasized that in order to avoid ethnocentric practice or ‘culturalization’ of problems, it is important for social workers to be conscious of the various meanings of ‘culture’ both in their own practice and in the ways their clients employ cultural symbolism.     

Parental Depression in the Context of Divorce and the Impact on Children

The impact of divorce on children has been well documented over the past 30 years. Divorcing parents who are also experiencing clinical depression often have a compromised ability to parent well and to give the children needed support. Children are then impacted both by the divorce itself and the effects of parental depression. They are at higher risk of numerous problems including poorer physical health, deficits in academic performance not attributable to intellectual limitations, poor social functioning, conduct disorder and other disruptive behavior problems, phobias, and other anxiety disorders. Because children of depressed parents are at higher risk for depression themselves, they should be monitored for depressive symptoms. If there are concerns, the child should be assessed by a mental health professional.     

Stigmatizing Clients with Mental Health Conditions: An Assessment of Social Work Student Attitudes

Research suggests that stigma plays a major role in discouraging clients from participating in mental health treatment. Because social workers provide a significant amount of such services, this study investigates social work student stigma as a function of their willingness to treat clients with alcohol dependence, nicotine dependence, depression, and Alzheimer's disease. Students' held higher levels of stigma toward nicotine dependent clients and less toward those with depression. Personal histories of depression and student age - but not smoking or alcohol use - were predictive of higher stigma levels towards nicotine dependent clients. Implications for social work are discussed.     

Parental Depression and Anxiety and Early Childhood Behavior Problems Across Family Types

Using the Fragile Families and Child Wellbeing Study, we examine the association between parental major depressive and generalized anxiety disorders and child behavior problems across family types: married, cohabiting, involved nonresident father, and noninvolved nonresident father. Among 3‐year‐olds in all families, maternal anxiety/depression is associated with increased odds of anxious/depressed, attention deficit, and oppositional defiant disorders (N = 2,120). Paternal anxiety/depression has no significant association with these problem behaviors; father’s illness, however, exacerbates anxious/depressed behaviors in young children if both parents are ill and he is coresident. The findings underscore the importance of maternal mental health for child well‐being and suggest that a negative interaction between parent illnesses is most likely when parents and children share the same disorder.     

Looking at engagement and outcome from the perspectives of child protection workers and parents

This paper reports a study that sought to understand what facilitates engagement between parents and child protection workers and to ascertain the relationship between such engagement and intervention outcome. Quantitative and qualitative data were gathered through personal interviews with 131 worker-parent dyads (workers and corresponding parents receiving service) from 11 child protection agencies in Ontario, Canada. Measures included scales for engagement, parental well-being (depression and stress), and worker well-being (burnout, job satisfaction, stress). Outcome measures included perception of child safety, changed parenting practices and satisfaction. A relationship was found between workers' perception of parent engagement and parents' perception of their own engagement, as well as between the perceptions that workers and parents had around their own respective engagement. Workers who were satisfied with service outcomes were significantly more engaged than those who were unsatisfied. Parents thinking that their children were safer as a result of intervention were significantly more engaged than parents who thought that their children were less safe. The strongest reason given by parents for positive change was being able to trust their worker (p < .001) and believing that their worker was knowledgeable about parenting (p < .01). Qualitative data suggested that parents valued experienced workers because they thought such workers could better understand their problems and how to deal with them. Correspondingly, workers felt that experience enabled them to better understand clients' problems and provide more effective support. No relationship was found between parent engagement and parental depression or stress, but the mean depression score for parents placed them at risk of clinical depression. There was a negative correlation between worker stress and engagement. The study demonstrates that engagement between clients and workers is related to positive outcomes (as reported by workers and parents) and supports the contention that promoting engagement is integral to a successful child protection intervention.     

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns.MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained.ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation.ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.     

The role of child care social work in supporting families with children in need and providing protective services—past,present and future

This article examines the way in which child care social work with deprived families has changed and developed since the inception of Children's Departments in 1948. It is argued that between 1948 and 1970 child care social workers enjoyed a fair measure of social support. A variety of reasons are considered for explaining this—specialization, smallness of size, privacy and a consensus about the needs of children. From the early 1970s it is argued that broader societal changes, including a shift away from social solidarity towards individualism, organizational changes and the advent of child abuse as a public concern, resulted in con?icting demands on child care social workers and a subsequent loss of credibility and con?dence. The 1990s have seen a return to emphasis on family support policies which has been further accelerated in the new millennium by New Labour's stated commitment to eliminating child poverty and creating better life opportunities for all children. The implications of these new developments for child care social workers engaged in meeting the needs of children living in highly disadvantaged families are considered. Copyright © 2006 John Wiley & Sons, Ltd.     

Maternal Care and Control as Mediators in the Relationship Between Mothers’ and Adult Children’s Psychosocial Problems

The current research investigated the relationship between mothers’ and adult children’s psychosocial problems through two different aspects of maternal interactions. Data were collected from family triads (N = 286), including a mother, a child, and a sibling. Mothers and their adult children completed measures of depression, loneliness, and self-esteem. The assessment of the maternal interaction variables (i.e., maternal care and maternal control) involved the perspectives of a sibling to minimize common method variance. Results partially supported the hypothesized model, wherein maternal care (but not maternal control) mediated the relationship between mothers’ depression, loneliness, and self-esteem to that of their children. Specifically, mothers who reported higher levels of psychosocial problems had children who reported that their mothers were less caring and, in turn, less maternal care was associated with higher levels of psychosocial problems in their young adult children.