Search

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR) = 2.68, P < 0.01), risky behaviours such as binge drinking (OR = 2.15, P < 0.05) and self-harming (OR = 2.86, P < 0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR = 1.88, P < 0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR = 2.21, P < 0.05) and loss of friends/family contact (OR = 2.73, P < 0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care., (© 2021 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

People with intellectual disabilities are more likely to experience adverse childhood experiences than those in the general population. Additionally, the conceptualization of 'trauma' is far broader than traditionally understood in order to encompass the far reaching relational nature of people with intellectual disabilities traumatic experiences. This reflective account details the first steps one service took to embrace trauma-informed care as a whole systems approach. The paper is a response to calls following conference presentations about our work, to share the process of the beginning of this journey, it also aims to provide key learning points, practical considerations and questions for reflection in order to support other services to begin their own relationships with trauma-informed care.

This paper draws on work undertaken to inform the alternative Children's Right Impact Assessment (CRIA) undertaken by the Observatory for Children's Human Rights Scotland (the observatory) in the early months of the impact of COVID-19 in the UK. With reference to children who are at risk of neglect and abuse, potentially subject to statutory intervention in family life, or living in care, the paper focuses on the purpose, process and value of children's rights impact assessments (CRIAs). It argues that wider understanding of the limitations of policy-making processes and close attention to existing limitations of CRIAs can help to enhance their effectiveness in achieving the realisation of children's rights in practice. [ABSTRACT FROM AUTHOR]

The construction of parents' cannabis use in the context of child protection has far‐reaching implications for how their parenting is perceived and assessed and for the decisions made regarding their children's lives. Yet little is known about the meanings various stakeholders in child protection processes attribute to parents' cannabis use. This paper aims to explore constructions of parents' cannabis use in child protection court proceedings and position them within a political and social context. A qualitative data mining method was used to examine 32 Family Court judgements in care proceedings that involved parents using cannabis in England and Wales. The analysis of the judgements revealed that most portrayed parents' cannabis use as a negative, deviant and harmful activity. Three constructions of cannabis use were identified: cannabis use as a risk to children, cannabis use as proof of parents' deficits, and cannabis use as (responsible) self‐medication. The discussion considers the findings in light of two social and political processes that underpin child protection policy and practice: the adoption of a risk perspective and the manifestation of othering processes. Implications for policy and practice highlight the importance of developing a critical framework for responding to parental cannabis use. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to critically examine the current state of literature on peer parental advocacy, offering practical insights and ideas for researchers and practitioners interested in this evolving field. Design/methodology/approach: This narrative review is a comprehensive, critical and objective analysis of the current knowledge on peer parental advocacy. Findings: Parental peer advocacy (PPA) has seen growing interest, with increasing research detailing the benefits and challenges. It is now being considered within children's services across the UK, drawing upon the success of similar initiatives, especially in the USA. There is a compelling case for PPA, not least as it may contribute to resolving the longstanding challenges within children services of families having the opportunity to meaningfully participate in decision-making (Corby et al., 1996; Muench et al., 2017; Bekaert et al., 2021). Research limitations/implications: Parental advocacy (PA) continues to be an evolving area of academic research and policy development both in the United Kingdom and internationally. Emerging research suggests a compelling case for an expansion in PPA within child welfare and protection systems, specifically in case, program and policy advocacy. Practical implications: PA continues to be an evolving area of academic research and policy development both in the United Kingdom and internationally. Emerging research suggests a compelling case for an expansion in PPA within child welfare and protection systems, specifically in case, program and policy advocacy. Originality/value: To the best of the authors' knowledge, this is one of the first UK-based narrative reviews that critically analyses the research, highlighting the limitations and strengths of adopting PPA as an approach. [ABSTRACT FROM AUTHOR]

This paper reviews 26 reports into deaths and serious abuse of children in families who were subject to the No Recourse to Public Funds (NRPF) rule. Our analysis illustrates vulnerabilities caused by exclusionary policies, exacerbating social deprivation and isolation experienced by the children and families and making it more difficult for professionals to respond in ways which safeguarded children's welfare. Drawing upon a social model for protecting children that requires recognition of the social determinants of harm and the economic, social and cultural barriers faced by families, we examine the experiences of children and families with NRPF who were the subject of a serious case review, and the responses of agencies responsible for safeguarding child welfare. We conclude with recommendations for practices aimed at promoting the rights and well‐being of children and families subject to NRPF rules. [ABSTRACT FROM AUTHOR]

This paper reports on a feasibility study for an evaluation of a UK primary school‐based prevention programme that addresses multiple forms of abuse and neglect, identifying research design and ethical issues and exploring research practice. For this feasibility study, 194 children aged 6–11 years completed a baseline survey and 113 did so following the intervention. Eight focus groups were undertaken with 52 children and nine interviews with school staff. We highlight key considerations for conducting large‐scale mixed‐method research on sensitive topics with younger children, a focus that is largely absent from the extant research methods literature. The feasibility study showed that younger children can contribute their views on sensitive topics in ways that are measurable, replicable and reliable, contesting ideas that certain topics are too sensitive to explore with younger children. [ABSTRACT FROM AUTHOR]

Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper, we quantify for the first time the economic costs of fatal and nonfatal child maltreatment in the UK in relation to several short-, medium-, and long-term outcomes ranging from physical and mental health problems to labor market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Aging with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of nonfatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health, and long-term labor market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it., (© 2021 John Wiley & Sons Ltd.)

Fabricated or induced illness (FII) and perplexing presentations (PPs) are the terms used by the Royal College of Paediatrics and Child Health (RCPCH) in the UK. FII is presented as if synonymous with Munchausen syndrome by proxy, a rare presentation which is now known in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition as factitious disorder imposed on another (FDIoA). However, FII is not a diagnosis, and the definition is far broader than FDIoA. RCPCH admit that there is a limited evidence base for the prevalence, specificity or sensitivity of FII and the associated 'alerting signs', and yet local authorities across the UK have Child Protection Policies developed directly from the RCPCH guidelines. An increasing number of families of children with neurodevelopmental presentations (such as autism), or presentations of complex or less well-known conditions such as Ehlers–Danlos syndrome, are finding themselves being investigated for FII by Social Services, and consequently labelled as potential 'perpetrators' of child abuse, on the basis of FII guidelines. The present article discusses the issues relating to FII and PP, how current guidelines are creating implicit and explicit bias against certain kinds of families and the implications for Social Services. [ABSTRACT FROM AUTHOR]

Childhood maltreatment (CM) leads to a lifelong susceptibility to mental ill-health which might be reflected by its effects on adult brain structure, perhaps indirectly mediated by its effects on adult metabolic, immune, and psychosocial systems. Indexing these systemic factors via body mass index (BMI), C-reactive protein (CRP), and rates of adult trauma (AT), respectively, we tested three hypotheses: (H1) CM has direct or indirect effects on adult trauma, BMI, and CRP; (H2) adult trauma, BMI, and CRP are all independently related to adult brain structure; and (H3) childhood maltreatment has indirect effects on adult brain structure mediated in parallel by BMI, CRP, and AT. Using path analysis and data from N = 116,887 participants in UK Biobank, we find that CM is related to greater BMI and AT levels, and that these two variables mediate CM's effects on CRP [H1]. Regression analyses on the UKB MRI subsample (N = 21,738) revealed that greater CRP and BMI were both independently related to a spatially convergent pattern of cortical effects (Spearman's ρ = 0.87) characterized by fronto-occipital increases and temporo-parietal reductions in thickness. Subcortically, BMI was associated with greater volume, AT with lower volume and CPR with effects in both directions [H2]. Finally, path models indicated that CM has indirect effects in a subset of brain regions mediated through its direct effects on BMI and AT and indirect effects on CRP [H3]. Results provide evidence that childhood maltreatment can influence brain structure decades after exposure by increasing individual risk toward adult trauma, obesity, and inflammation. [ABSTRACT FROM AUTHOR]

There is appetite in the UK to better measure the impact of domestic violence and abuse (DVA) interventions on children. The spread of outcomes-based commissioning means outcome measurement is no longer just the territory of academic researchers but is now firmly within the purview of practitioners and policy makers. However, outcomes measured in trials only partially represent the views of those delivering and using services with respect to how success should be defined and captured. Even within trials there is huge inconsistency in the definition and measurement of important endpoints. This yields a body of evidence that is difficult to make sense of, defeating the ends for which it was produced - to improve the response to children and families who have experienced abuse. Development of Core Outcome Sets (COS) is seen as a solution to this problem, by establishing consensus across key stakeholder groups regarding a minimum standard for outcome measurement in trials, and increasingly in service delivery contexts. To date COS development has addressed outcomes relating to health conditions or interventions, with limited application to public health challenges. We reflect on our efforts to develop a COS to evaluate psychosocial interventions for children and families experiencing DVA. We highlight the value of COS development as a mechanism for improving evidence quality and the response to families experiencing abuse. Finally, we make recommendations to researchers and COS guideline developers to support this broader application of COS methodology. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and associated public health 'stay at home' restrictions have intensified familial risk factors. Children would appear to be at increased risk of harm and abuse, yet administrative data from the early months of the pandemic showed falling cases of child maltreatment. Using weekly administrative data from Scotland, UK that span the first 17 months of the pandemic, this article found that child maltreatment activity levels fluctuated as 'stay at home' restrictions changed. During lockdown periods, the number of children subject to Inter-agency Referral Discussion fell but a higher number of children were placed on the Child Protection Register. When restrictions were eased, the number of Inter-agency Referral Discussions increased but the number of children placed on the Child Protection Register fell. To explain the fluctuations, the article asserts that the pandemic's impact on services' ability to engage directly with children and families has been critical, but the limitations of administrative data in providing an accurate measure of child maltreatment levels also need to be recognised. The article advocates that analysis of administrative data is best done in tandem with wider quantitative and qualitative sources in order to understand the impact of crisis events on children and families. [ABSTRACT FROM AUTHOR]

This article investigates the hidden and under-researched phenomenon of child/adolescent-to-parent violence and abuse (CAPVA). Despite the attention given to spousal and child abuse, very little is known about why children abuse their parents or what can be done to prevent it. This article explores how this issue is explained, its effects on parents and carers and the different interventions that have emerged to tackle it. Based on in-depth focus groups with parents, grandparents and practitioners participating in a 'Who's in Charge' intervention in the United Kingdom, this article explores the complex intersection of parenting skills, intergenerational violence, gender, neurodiversity and the associated response (or lack thereof) from education and law enforcement. The article concludes with important new recommendations on 1) the need for better referral routes, 2) greater emphasis on neurodiversity, 3) very early intervention, and 4) the benefit of online platforms used during the COVID-19 lockdown for engaging parents and grandparents. [ABSTRACT FROM AUTHOR]

Bondage/discipline, dominance/submission, and sadism/masochism (BDSM; "kink") are frequently pathologized as derivatives of abuse. Although the link is unsubstantiated, some kink-identified people who happen to be survivors of trauma may engage in kink, or trauma play, to heal from, cope with, and transform childhood abuse or adolescent maltreatment. The present study sought a thematic model (Braun & Clarke, Qualitative Research in Psychology, 3(2), 77–101, 2006) of trauma recovery through kink using a critical realist, inductive approach to inquiry. Participants were eligible if they had experienced early abuse, were adults, and practiced kink. Six superordinate themes were generated from semi-structured interviews with 20 participants from five countries: cultural context of healing (e.g. using BDSM norms and previous therapy to reframe kink and trauma), restructuring the self-concept (e.g. strengthening internal characteristics which had been harmed or distorted), liberation through relationship (e.g. learning to be valued by intimate others), reclaiming power (e.g. setting and maintaining personal boundaries), repurposing behaviors (e.g. engaging in aspects of prolonged exposure), and redefining pain (e.g. transcending painful memories through masochism). Notably, participants only reported retraumatizing experiences prior to learning about the structural safeguards of BDSM. Research and clinical implications are discussed by drawing on general models of trauma recovery. [ABSTRACT FROM AUTHOR]

Background: There is evidence that child maltreatment is associated with shorter telomere length in early life. Aims: This study aims to examine if child maltreatment is associated with telomere length in middle- and older-age adults. Method: This was a retrospective cohort study of 141 748 UK Biobank participants aged 37–73 years at recruitment. Leukocyte telomere length was measured with quantitative polymerase chain reaction, and log-transformed and scaled to have unit standard deviation. Child maltreatment was recalled by participants. Linear regression was used to analyse the association. Results: After adjusting for sociodemographic characteristics, participants with three or more types of maltreatment presented with the shortest telomere lengths (β = −0.05, 95% CI −0.07 to −0.03; P < 0.0001), followed by those with two types of maltreatment (β = −0.02, 95% CI −0.04 to 0.00; P = 0.02), referent to those who had none. When adjusted for depression and post-traumatic stress disorder, the telomere lengths of participants with three or more types of maltreatment were still shorter (β = −0.04, 95% CI −0.07 to −0.02; P = 0.0008). The telomere lengths of those with one type of maltreatment were not significantly different from those who had none. When mutually adjusted, physical abuse (β = −0.05, 95% CI −0.07 to −0.03; P < 0.0001) and sexual abuse (β = −0.02, 95% CI −0.04 to 0.00; P = 0.02) were independently associated with shorter telomere length. Conclusions: Our findings showed that child maltreatment is associated with shorter telomere length in middle- and older-aged adults, independent of sociodemographic and mental health factors. [ABSTRACT FROM AUTHOR]

Research has identified an association between poverty and the likelihood of children suffering from abuse. What is less clear is how the experience of living in poverty links to this abuse. This qualitative study investigated individual stories of child abuse and the role of poverty in their lives. Through interpretative phenomenological analysis explanations why children had been abused were elicited from parents and professionals. Poverty as an abstract concept was articulated by parents describing their lived experience, breaking it down into its constituent parts. Social health and environmental contexts and the personal consequences of this emerged from the data. Professionals missed poverty at a macro level by focussing on the micro processes, leading to explanations of the abuse as personal inadequacy rather than systemic issues. [ABSTRACT FROM AUTHOR]

Parenting can be impacted by substance misuse, and children can be at risk of maltreatment, leading to their removal from their mothers. Successful treatment of substance abuse relies on these women gaining effective support from services. Previous research has demonstrated the impact working in this field can have on staff, including high staff turnover, vicarious trauma, and burnout. The present study further explores the experience of staff members working in a Drug and Alcohol Recovery Service in Scotland who work with mothers who have had their children removed. Six interviews with nurses and social care workers were analysed using interpretive phenomenological analysis (IPA). Two superordinate themes were developed from the data: (1) complexity and tension within working relationships and (2) emotional experiences and attempts to resolve them. Participants described the complexity of their roles, including the dual role of supporting mothers while also being involved in the child removal process by providing reports and evidence and how they respond and work with mothers after removal and conflicts with the wider system. They also highlighted their attempts to cope with the emotional impact of being part of this process and the empathy they have with mothers, especially when they are parents themselves, and described the complexities of trying to cope and manage when working in this challenging area. Clinical implications, including training needs and requirements, are discussed. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse (CSA) can result in devastating and long lasting consequences. Differences in the nature of the abuse differ for males and females and this difference potentially influences recovery. However, studies of recovery from CSA, especially among men, are relatively few, especially for ethnic minority men. The study explored the lived experience of recovery from CSA among African-Caribbean Black male survivors of CSA living in Canada, the United Kingdom and the United States. The theoretical framework was the transactional model of stress and coping, which proposes that stress is an ongoing transaction between the demands of life and a person's psychological ability to address those demands. The study was qualitative in design, using an interpretive phenomenological approach, involving purposeful sampling, in-depth semi-structured interviews, and interpretive phenomenological analysis of the data informed by a critical race theory lens. The results showed that Black male survivors are situated in unique historical/sociocultural interrelationships that complicate recovery from CSA, including institutional racism and discrimination, restrictive narratives of masculinity, and other cultural norms. These findings can be used to influence policy makers, service providers, and communities, to more effectively support and address the needs of CSA survivors and their affected families. [ABSTRACT FROM AUTHOR]

This article discusses the unequal impact of Covid‐19 on the lives of the children of survivors of modern slavery, child victims of exploitation and children at risk of exploitation in the UK. It draws on research that has analysed the risks and impacts of Covid‐19 on victims and survivors of modern slavery. It explores how pandemic responses may have hindered these children's rights to education, food, safety, development and participation and representation in legal processes. It suggests that the pandemic should be used as an impetus to address inequalities that existed pre‐Covid‐19 and those that have been exacerbated by it. [ABSTRACT FROM AUTHOR]

Forced marriage is recognised as a form of child abuse in the UK. Despite evidence that this is a growing problem, there is little current research concerning the responses of child protection practitioners. This article is based on a study that explored the views and experiences of a range of practitioners who had been involved with safeguarding children with respect to forced marriage. Ten semi‐structured interviews were carried out, followed by two focus groups (n = 13); these explored the challenges and best practice related to working with children at risk of or in forced marriage situations. The findings highlighted the complex nature of the work and the particular vulnerability of children affected by forced marriage. The study found that practitioners struggled to respond effectively when guidance was unclear or when they had limited knowledge and experience of forced marriage. Effective practice was associated with a high standard of interagency work locally and with practitioners who had confidence and experience and were able to work proactively and assertively. Key Practitioner Messages: Effective practice responses to forced marriage require clearer national and local policy and guidance.Knowledgeable, confident and proactive staff enable good‐quality risk assessments and service responses.Practitioner training and development should include enhancing cultural competence and confidence when working with marginalised/BME families.Forced marriage is a nuanced, complex and diverse issue affected by high levels of vulnerability in children and young people. [ABSTRACT FROM AUTHOR]