Letting the Future In

Tricia Jessiman, Research Associate in the School for Policy Studies, reports on a study of therapeutic support for children affected by sexual abuse.

It has at times felt difficult to keep up with overlapping high profile Child Sexual Abuse (CSA) scandals dominating the UK headlines in recent years. Jimmy Saville, Operation Yewtree, Rotherham, the ‘Westminster Paedophile Ring’ – the headlines have kept coming in. There has been rather less media coverage on the impact of sexual abuse on those children who experience it. The academic literature tells us that CSA is associated with a range of psychological and behavioural symptoms in both childhood and adulthood including post-traumatic stress (PTSD), depression, alcohol and drug misuse, suicide, and self-harming behaviour. Children who have been sexually abused need help – but it may not be readily available. The NSPCC’s current campaign, It’s Time, seeks to highlight the scarcity of therapeutic support in the UK for children who have experienced abuse.

Even were it more widely available, it is unclear ‘what works’. Research on the effectiveness of therapeutic support for CSA is limited. Colleagues in the School for Policy Studies have published two Cochrane systematic reviews of the effectiveness of therapeutic interventions. Geraldine McDonald led a review of cognitive-behavioural interventions (CBT), and concluded that “…CBT may have a positive impact on the sequelae of child sexual abuse, although most results were not statistically significant.” Most of the 10 studies in the review were American, and the most recent was published in 2004. William Turner’s review of psychoanalytic/psychodynamic psychotherapy for CSA failed to find a single study that met the inclusion criteria.

Hence we are delighted to see the publication today of our evaluation of ‘Letting the Future In’ (LTFI), a therapeutic service for children affected by sexual abuse. Led by Professor John Carpenter, the study was conducted with colleagues at Durham University and is the first impact evaluation of a therapeutic service for CSA published in over a decade. It’s also a rare example of the use of a randomised control trial in social work research with children and families in the UK (and we certainly learned just how much time, effort and goodwill is required to conduct one).

LTFI was developed by the NSPCC and at the time of the study delivered across 20 service centres in England, Wales and Northern Ireland. It is available to children aged between four and 17 without a diagnosed learning difficulty who have been affected by sexual abuse. Children are offered up to four therapeutic assessment sessions followed by up to 20 intervention sessions (extended up to 30 if necessary) with a children’s services practitioner (CSP). CSPs delivering the intervention vary in their background, training and experience but most commonly are qualified social workers with additional training in therapeutic work with children. At the same time, the child’s safe carer (typically the non-abusing parent, but sometimes a grandparent or foster carer) is offered up to eight sessions to help them process the impact of discovering that their child was sexually abused, and to support the child in their recovery.

We conducted a randomised control trial (RCT) with waiting-list control of LTFI, as well as a process evaluation of its implementation by NSPCC teams, and qualitative case studies with 15 children and young people who received the intervention. A total of 242 children took part in the RCT, making it the largest trial of a CSA intervention ever conducted. Three quarters of them were girls and most had experienced contact sexual abuse – inappropriate touching or penetration. Unlike the high profile headlines would have us believe, the children in our study were not abused by strangers or celebrities. They were almost twice as likely to have been abused by someone in their family as by someone outside it and in four out of ten cases where the perpetrator was known, they were also a child under 18 years of age.

The study confirms that children who have experienced CSA need support. When they were referred to LTFI, over half of the children and young people over eight years old in our study reported ‘clinical’ level scores on a standardized measure of psychological and behavioural symptoms, rising to 70% when one or more ‘significant difficulties’ were included. Parents/carers reported ‘clinical’ or ‘significant difficulty’ level scores for nine out of ten younger children under eight. Many of the children in our sample had also experienced three or more other types of victimization, such as physical and verbal abuse at home and bullying by other children, in addition to sexual abuse.

Did receiving LTFI help? We won’t give too much away, because the findings of the study are published today and we want you to read them. In short, the impact evaluation revealed that LTFI had a significant effect on older children and young people (broadly speaking, those aged eight years and older) after six months. The report provides a detailed account of the service delivered, the evaluation design and results, as well as details of how much it costs to deliver LTFI. It also has a strong service-user element; our qualitative research with children and their families who had received the intervention revealed that they valued it hugely, in particular the bond or ‘alliance’ that developed between NSPCC practitioners and the children. One of the young people we spoke who had this to say about LTFI:
“If you’re in a really bad place like I was, they will definitely bring you out of it and you’ll see there’s so much more to life. It’s probably one of the best decisions I made to do LTFI. Before I met them I was really quiet, withdrawn, wouldn’t really talk to anybody. Now since finishing with them, I’m such a more positive, outgoing person and I have a lot of confidence. They did their job.”

This blog post is based on Carpenter, J., Jessiman, T., Patsios, D., Hackett, S. & Phillips, J. (2016) Letting the Future In: a therapeutic intervention for children affected by sexual abuse and their carers: An evaluation of impact and implementation. NSPCC
https://www.nspcc.org.uk/services-and-resources/research-and-resources/2016/letting-the-future-in-evaluation

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From the narrative of failure to the narrative of potential?


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David Berridge, Professor of Child and Family Welfare at the School for Policy Studies, considers the process of making an impact on policy and practice by discussing his research on looked after children. 

It is interesting, and advisable, at the completion of a research project to reflect on how it went.  There can be a tendency to delay this process, encouraged by feelings of relief as well as no doubt the need to catch-up with other responsibilities that are now overdue.

These thoughts were with me at the end of 2015 on the conclusion of our joint-research with the Rees Centre, University of Oxford, funded by the Nuffield Foundation, on the Educational Progress of Looked After Children in England.  We were certainly pleased to complete what for us was a major piece of work. There were many challenges in the work (to borrow a well-used euphemism), including: obtaining and analysing large government databases; negotiating access to six contrasting local authorities; contacting groups of older teenagers in care, their social workers, carers and teachers; obtaining and analysis large amounts of qualitative data; and writing-up the results.

Social researchers are familiar with these processes, with varying degrees of success. But we also give particular attention to the dissemination of research and trying to ensure that it impacts on the worlds of policy and practice.  These stages need proper planning throughout the research process, not just at the end.

We were certainly pleased with our research results, which we feel contain important, new messages.  Comparing large groups of children in care who took their GCSEs in 2013 with ‘children in need’ (receiving social work support at home) and the wider pupil population, we found that, once controlling for a wide variety of factors, those in care (particularly foster care) made greater educational progress than did children in need.  This is despite, one would assume, having less acute problems.  Generally, therefore, the care system appears to operate as an educational protective factor.

This is a new message as commentators in the past have generally focused on the often disappointing attainments of young people in care (exam/test results etc), rather than their educational progress after becoming looked after – an important distinction. Indeed, there was an overwhelming view from the young people interviewed that leaving home and entering care had benefited them educationally. Furthermore, it was mainly late adolescent entrants to care who experienced particular educational problems.  Clearly, we should not overlook that high attainment is important and our research is intended to contribute to this by a detailed examination of the nature of the problem and its causes.

Other important findings include that children’s emotional and behavioural problems often underlie educational difficulties.  Taking into account pupil variation and school effectiveness, there was little difference between Councils in the educational progress of children in care.  Responses of school and care systems were important, including the level of stability provided.  Nonetheless, this questions aspects of a ‘league table’ approach and of the OFSTED inspection framework.  Other results are available on the website, including the individual technical reports.

We were grateful that the Minister for Children and Families, Ed Timpson MP, spoke at our launch event at the Nuffield Foundation.  He concluded his speech by repeating the statement made by Robbie Gilligan earlier in the day, that we need to move ‘…from the narrative of failure to the narrative of potential’.  This is an important observation and it is interesting to reflect on what it means and its implications. The statement is ambiguous. On the one hand it could be referring to the fact that we should not label individual children in care as unintelligent or incapable, as their school performance has been hampered by their social and emotional development and poor parenting.  On the other, the ‘narrative of potential’ comment could denote the need to recognise that the care and school systems makes positive progress with these disadvantaged pupils, especially when there it a reasonable period of time for there to be an effect. The statement could have both micro and macro meanings; although for me ‘narrative’ usually has broad application.

In his autumn 2015 Conservative Party conference speech the Prime Minister referred to the poor outcomes for children in care: ‘These children are in our care; we, the state, are their parents – and what are we setting them up for…the dole, the streets, an early grave?  I tell you: this shames our country and we will put it right’.

A fortnight after the launch of our research the Prime Minister announced further proposals to take over failing local authority children’s services: reported to be as transformative a policy as the Academisation programme in the last Parliament.  It is unclear if children’s services’ failures relate specifically to child protection and child tragedies, to poor outcomes for children in care, or to both.  The Prime Minister’s conference speech located it in a section on entrenched family poverty.

Reform of children’s services, therefore, is signalled as a flagship policy for this Conservative administration.  We hope that our research findings, and other sources of evidence, are allowed to contribute to this debate: to help pinpoint the exact nature of child welfare problems, their complexity and the effectiveness of responses. It will be interesting to see if a narrative of potential or a narrative of failure will be maintained 2016.

 

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Keeping children in care out of trouble

Dr Jo Staines outlines the Hadley Centre for Adoption and Foster Care Studies’ involvement in ‘Keeping children in care out of trouble’, an independent review of looked after children in the criminal justice system.

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Some statistics that cause concern: only 3% of children in the community offend in any one year, yet over twice this number of looked after children do so (7.9%, Department for Education, 2011a). Furthermore, despite less than 1% of the UK’s child population being in care (looked after by local authorities), almost 50% of the children in custody are, or have been in care. And, while girls constitute only 5% of the youth justice secure population, 61% are, or have been, in care compared with 33% of boys (Prison Reform Trust 2014).

Along with professional associations, service user groups, academics and practitioners working across the care and youth justice systems in England and Wales, we have been invited to join the Prison Reform Trust’s recently established review of looked after children in the criminal justice system.

We have nine months to explore the intersection of the care and youth justice systems, and how involvement in one correlates with involvement in the other. This will encompass a broad range of care settings, from foster care to local authority residential care and private care settings. To do this we will synthesise and analyse existing research, both national and international; identify current good practice and local protocols; and seek the views of children and young people, their families, foster carers and residential staff about their experiences of both care and justice.

From this evidence base, the review will develop recommendations for national policy and practice and, importantly, an implementation strategy to ensure that the findings of what promises to be a significant review are widely disseminated and embedded within practice.

The State has a legal and moral duty of care to these looked after children, but it is clear that their needs are not always met nor their rights upheld.  This duty of care continues until the young person reaches the age of 21 but many looked after children move into independent or semi-independent care much earlier, and may be at a heightened risk of becoming involved in offending behaviour during this period of transition to adulthood.

Understanding the relationship between care and youth offending is complex: many of the risk factors for involvement in offending behaviour are the same as those that precipitate entry into the care system, such as the experience of abuse, neglect or violence, family instability and poor parenting, disadvantage and deprivation.

However, research also indicates that becoming looked after can both reduce and increase the likelihood of being involved in offending behaviour – the former through providing high-quality, stable placements that promote children and young people’s resilience (Schofield et al, 2012), the latter through looked after children being inappropriately drawn into the youth justice system through processes that may ultimately label and criminalise them for what, in other situations, would be considered ‘normal’ teenage rebellion.  Practitioners are able to cite many examples where looked after children have caused damage to their foster or residential home, or their carers’ property, and have been charged with criminal damage or other offences – action unlikely to be taken by parents against children in their own families (Schofield et al 2014).

Rates of recidivism (repeat offending) for children and young people, particularly post-custody, are high, suggesting that involvement in the justice system itself can exacerbate, or at least fail to address, the difficulties and disadvantage that these children experience.  The need to alternative ways of responding to children who offend is clear and the review will also consider how approaches such as early intervention and restorative justice can be used with looked after children to limit their involvement in offending behaviour.

The key challenges facing the review include maintaining a sharp focus within the intricacies of the two systems, both of which operate within complex and changing legislative frameworks.  Both are bound by the welfare principle embedded within the Children Act 1989 and are guided by the United Nations Convention on the Rights of the Child, but other aspects of welfare and justice legislation may, at least at a surface level, appear to be contradictory and to have competing aims.  Tensions exist between promoting the welfare of the child and upholding principles of justice, victims’ rights and public safety, but it is imperative that we find a way to realise this balance both in policy and in practice.

References:

Department for Education (2011a) Outcomes for children looked after by local authorities in England year ending March 2011

Department for Education (2011b) Children looked after by local authorities in England year ending March 2011

Prison Reform Trust (2014) Bromley Briefings Summer 2014, London: PRT

Schofield G, Biggart L, Ward E, Scaife V, Dodsworth J, Haynes A and Larsson B (2014) Looked after children and offending: Reducing risk and promoting resilience, London: BAAF

Jo Staines is a Senior Lecturer and Director of the BSc Childhood Studies programmes and a member of the Hadley Centre for Adoption and Foster Care Studies in the School for Policy Studies, University of Bristol.    She is a member of the Prison Reform Trust’s independent review of looked after children in the criminal justice system, and author of ‘Youth Justice’ (Palgrave Macmillan, 2015).

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We need to help children in care treasure the objects that tell their life story

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Debbie Watson, Senior Lecturer in Childhood Studies at the School for Policy Studies has recently published a piece in the Guardian.

It is about the importance of mementoes, objects, and other articles which help to anchor adopted children emotionally and provide a connection to their past.

 

 

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How rethinking residential care can help safeguard children against sexual exploitation

In light of how vulnerable looked-after children are to abusers, it’s time to rethink our approach to residential care, argue Tom Rahilly and David Berridge

Tom Rahilly is Head of Strategy and Development, NSPCC, and David Berridge is Professor of Child and Family Welfare, University of Bristol

Not that it has ever gone away, but the government’s recent intervention in Rotherham council brought back into the public eye the horrendous events in which a reported 1,400 children were sexually exploited. The serious case review into sexual exploitation in Oxfordshire shows the problem is not restricted to one area alone. Alexis Jay’s report into Rotherham showed widespread failures. While there were many individual practitioners trying their best, they came up against a wall of denial.

It’s clear that we urgently need to find a better way of safeguarding our most vulnerable children. Children who were abused included those living at home with their families as well as children in care. However, there seems to be a pattern in abusers targeting those who are particularly vulnerable such as in residential care.

Challenge

No-one should under-estimate the challenge of tackling this. Children may yearn for adult affection and be less adept at recognising true motives and exploitation. Numerous girls made comments such as, ‘I know he really loves me’, or, ‘I was special to him’. It is harrowing when individuals will settle for so little, or feel that they are entitled to no better.

Residential care is often misunderstood and most homes work hard to provide stability and boundaries for young people who have led unsettled and troublesome lives. Children arrive with established harmful patterns of behaviour and undesirable contacts. Dealing with this in local, open units is a challenge and residential workers have to be very creative in gathering intelligence, fragmenting social groups and offering alternatives.

Under-professionalised

Despite these efforts, it is clear that there are long-term and structural problems with residential care in England. These relate to role and status. We still expect our most troubled children to be looked after by an undervalued workforce that is the least well qualified, lowest paid and not given the support it needs. In other words a workforce that is ‘under-professionalised’. It doesn’t need to be this way. It is different to this in much of continental Europe.

The government has taken action to address some of the shortcomings. Attention has focused on children placed long distances and the problem of residential homes located in unsafe areas.

There has been a debate about responses to children who go missing. A new set of quality standards is planned. And whilst we need to go further, useful steps have been taken to tighten-up qualifications for the residential sector. This is a reasonable start but, alone, none of this will resolve current problems.

Rethink the nature of residential care

We need to develop a more nuanced, and individual approach to safeguarding children in care; a relational approach. Research shows that it is the relationship that children have with the carer and other professionals that is critical to effective safeguarding. Children need someone they trust; someone that they turn to for support. Alongside improving qualifications – which is critical – we must focus on supporting the quality and stability of the relationships that young people in care have with those there to support and protect them.

Achieving this requires us to rethink the nature of residential care. We must ensure the management of residential care build a positive culture in the home where children and young people know that their needs are understood and that their views and experiences are valued and listened to. We must, for example, eliminate inflexible shift patterns and ways of working that mean that children cannot develop meaningful, trusting relationships over the longer term.

Residential children’s homes as anomalies

Though it may never be the same, residential care should resemble family care as closely as possible.

Most human service professions are now graduate entry: children’s residential homes are, therefore, anomalous. Some councils pay and perceive heads of homes at social worker team leader-level, which seems more commensurate with the level of responsibility and expertise required, but practice remains variable. We are now dependent on a large independent residential sector and the economics of care are a problem.

Hopefully the next government will continue to develop the children’s residential sector, building on the work that has started and based on what we know works. How all this squares with a five-year, average, reduction in council budgets of 37% remains to be seen.

But as the messages from Rotherham and elsewhere have shown us, we cannot afford not to act.

This piece is based on chapter three from the NSPCC’s book, ‘Promoting the wellbeing of children in care’, which was launched om 6/3/15.

This piece was first published on communitycare.co.uk

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Driving outcomes

David B photoDavid Berridge reflects on some older and newer research that he has undertaken on children’s residential care

Over my research career I’ve undertaken several studies of children’s residential care in England.   Like others, I sometimes wonder why I select the topics that I do, although research funding being as it is, you often have to take the opportunities as they come along.  As a young graduate my first jobs in the late 1970s were in residential settings with teenagers.  I’m not sure that we were particularly effective; we didn’t know exactly what we were trying to do and the knowledge base was much less developed than now.  At least I tried to offer professional friendship (there’s an interesting concept, similar to what continental European social pedagogues aspire to) as well as introducing young people to a wider range of interests, sports and situations.

On becoming a researcher, my first main study of children’s homes in 1985 (long out of print) entailed me undertaking fieldwork and living for a week in 20 different homes.  All this happened in the first year I was married, which didn’t make me especially popular.  Others  have followed (studies rather than marriages).  Residential care is now a small service in England compared with many other European countries but caters for a very troubled minority.  It continues to attract negative publicity, including the sexual exploitation of residents by groups of local men.  Whatever its other shortcomings, to its credit the current UK Coalition government is taking some positive steps to strengthen children’s residential services.

The latest project that I finished recently is a somewhat unusual one – Driving Outcomes:  Resilience, Learning to Drive and Young People Living in Residential Care.  It entailed a small pilot which offered driving lessons to a group of six older adolescents living in a group of residential homes in Bristol.  Raising funding took time but the project and a qualitative evaluation proceeded thanks to the generosity of the AA Charitable Trust, British Academy and University of Bristol.  Readers can find out more about the research here but it is interesting to reflect on some of the issues.  A journal article should  be available later in the year once it grinds its way through the academic peer review process.

In a nutshell, although only one of the six young men had so far passed his driving test, pupils, professionals and heads of homes  interviewed felt that the initiative had been very successful.  The person who passed said that it had changed his life.  For others, there were perceived benefits in raising self-esteem and self-confidence, as well as in encouraging close relationships with supportive adults.  These stand out in the resilience literature as important in helping young people overcome the effects of early adversity, including abuse, neglect, family breakdown and parental rejection.  Learning to drive may help combat some of the stigma associated with being in care and social exclusion, as well as an important symbolic transition to adulthood, which children in care may otherwise find difficult.  I keep explaining that you wouldn’t expect driving and cars to be a panacea (‘silver bullet’) for complex personal, social and structural problems.  However, the limited evidence, and theoretical justification, suggest that driving may be of disproportionate benefit.

Furthermore, it is often commented that it is unacceptable that the State doesn’t provide for children separated from their families and living in care in the same way as we would for our own children.  Examples include the low educational attainment and the inadequate support (‘accelerated transitions’) for care leavers.  The statement is rarely (never?) questioned.  How realistic is it?  For example, our son or daughter may ask us to look over and help with a school essay; would we do so with the same commitment and conscientiousness as a foster carer, residential worker or social worker?  This is one reason why adoption works particularly well as parents are more likely to provide the limitless support or ‘unconditional love’ that children need.  How else can the State replicate this in more temporary legal and social work circumstances?  How can it be expressed for adolescents in care?  What is a close approximation?  A useful article helps unpick some of these issues.

On reflection, starting off the driving lesson initiative was one effort in this direction.  Providing opportunities is no doubt more straightforward than guaranteeing care and emotional support. We often arrange driving lessons for our own children, so why shouldn’t we do the same as ‘corporate parents’?  In England at least, this has so far been unusual for residential settings, although foster carers may have made their own arrangements.  What other experiences might there be that could have a similar effect to strengthen resilience?  High educational attainment is probably best.  No doubt sports, caring for animals, music and drama work for some.  Another might be seeking part-time work, which is very uncommon if not unknown from my past residential studies.  Getting involved in advocacy work for children in care/Care Councils could work too.

It would be interesting to know what others think.

David is Professor of Child and Family Welfare in the School for Policy Studies at the University of Bristol.

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