A signs of safety approach to assessing children with sexually concerning or harmful behaviour

The Junction is a Barnardo's children's service based in northern England that provides assessment and intervention in the lives of children and young people who have sexually concerning or harmful behaviour. It is developing methods of assessment that move away from more established approaches to provide a service that attempts to address more comprehensively the circumstances of individuals and families, utilizing a Signs of Safety approach. The principles and methods of this approach are outlined with examples of practice. Copyright © 2005 John Wiley & Sons, Ltd.     

Ticking Boxes and Changing the Social World: Data Collection and the New UK General Practice Contract

The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article reports the results from an ethnographic study of the early stages of the new contract in two general practices. As expected, electronic data collection had increased in importance in both practices, with consequences both for clinician–patient interactions and for the structures and processes in the practices, as uniform data collection instruments are put in place that privilege ‘hard’ biomedical data that can be easily coded above ‘softer’, more patient-centred information. Roles and responsibilities had been changed to reflect the needs of the new systems, and new software applications allowed increased surveillance of both doctors’ and nurses’ performance; both of these had an impact on patterns of authority in our study practices. Furthermore, the structural changes that were found acted to embed the new ways of working, ensuring their reproduction in the future. In spite of these effects, we found little opposition to or critical reflection on the changes, and the doctors in our study continued to view their improved computer systems as neutral recording devices. The implication of these findings is discussed.     

Patterns of Change in Families Following Severe Head Injuries in Children

After severe head injuries, children can display behavioural problems for many years. Factors related to the individual have been discussed in other articles, and authors have also suggested that resulting behaviour problems may affect the family. This paper assesses the direct effect of the injury and events around it on the family. The reaction of the family may contribute to the persistence of the behavioural change, rather than just be a result of it. This paper describes the effect of the accident on family relationships and discusses the behaviour of the identified victim in terms of the stage of the family life cycle. The family as a whole, and not just the child, is a victim of the event, and therefore the use of family therapy is an important and appropriate part of treatment. A comparison of family and individual therapy is made, and the problem of assessing whether behavioural changes are related to organic brain injury is addressed.     

SOLUTION-FOCUSED THERAPY: TOWARD THE IDENTIFICATION OF THERAPEUTIC TASKS*

Brief therapy has often been regarded as “problem solving therapy.” This article discusses the development of a solution-focused approach to clinical practice. Solution-focused therapeutic tasks and interventions are described.     

An evaluation of the fidelity of implementation of a school-based drug abuse prevention program: project toward no drug abuse (TND)

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project Towards No Drug Abuse (TND). Two theoretical content components of the curriculum were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: cognitive perception information curriculum, cognitive perception information + behavioral skills curriculum, or standard care (control). These curricula were delivered to both regular and continuation high schools students (n=2331) by trained project health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvements in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permit the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, our findings indicate that Project TND can be implemented effectively with low and high risk youth in a general environment as well as with high risk youth in a more specialized environment.     

Brief Family Therapy: A Metaphorical Task

This article presents a therapeutic procedure designed to prescribe, in metaphorical form, the family's troublesome behavior pattern. Particular attention is paid to using a compliment to precede delivering a task assignment as a method of increasing the likelihood that the family will perform the task, and thus change will be promoted. A case example is used to illustrate the use of this procedure to help make change less painful.