Editorial perspective: Facilitating access to mental health research participation for children in care: Lessons from the ReThink project

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.

BackgroundThe responsibility of local authorities in England to provide children in care with stable, local placements has become increasingly difficult due to the rising number of children in need of care and a shortage of available placements. It is unclear if the trend of outsourcing children's social care to private companies has exacerbated this challenge. This paper examines how the outsourcing of children's social care to the private market has influenced placement locality and long-term stability over time. MethodsWe created a novel dataset of multiple administrative data sources on the outsourcing, placement locality and stability, and characteristics of children in care between 2011 and 2022. We conducted time-series fixed-effects regression analysis of the impact of for-profit outsourcing on placement locality and stability from 2011 to 2022. ResultsOur fully adjusted models demonstrate that for-profit outsourcing is consistently associated with more children being placed outside their home local authority and greater placement instability. We found that an increase of 1 % point of for-profit outsourcing was associated with an average increase of 0.10 % points (95 % CI 0.02–0.17; p = 0.01) more children experiencing placement disruption, and 0.23 % points (95 % CI 0.15–0.30; p < 0.001) more children being placed outside their home local authority. We estimate that an additional 17,001 (95 % CI 9015–24,987) out-of-area placements can be attributed to increases in for-profit provision. DiscussionOur analyses show that placement stability and distance have deteriorated or stagnated over the last decade, and that the local authorities that rely most on outsourcing have the highest rates of placement disruptions and out-of-area placements.

Unmet social needs lead to adverse health outcomes and contribute to health inequities. Efforts to screen for social determinants of health (SDOH) have occurred primarily within primary care. Here, we describe the feasibility of implementing a workflow for SDOH screening within 2 urology clinics in Charlotte, North Carolina. Our pilot was adapted from the WE CARE Model, which integrates a referral to community resources for patients identified with social needs and an optional followup with a navigator for additional assistance. Patients were screened with the validated Healthy Opportunities SDOH tool to assess food, housing, utilities, transportation and physical safety needs; 40 patients were screened at 2 urology clinics, totaling 80 patients. Surveys were sent to 16 clinicians and staff who participated in the pilot to assess feasibility of implementation. In all, 24/80 patients (30%) were screened for 1 or more social needs, with food and housing being the most frequent; 20/24 patients with social need (83%) successfully received a community resource guide, and 13 of those patients also requested a referral. All survey respondents either agreed or strongly agreed that screening was valuable and allowed them to better understand the needs of their patients. They also felt that understanding SDOH aligns with departmental goals and mission. Our results suggest that SDOH screening within a urological setting is feasible, and dedicated support staff should be available to ensure adequate followup for patients with unmet needs. Future work is needed to expand resources for patients and optimize workflow for clinicians.

PurposeThe research reported here forms part of a study of children’s participation in children in care reviews and decision making in one local authority in England. The purpose of this paper is to outline the views of 11 social workers and 8 Independent Reviewing Officers (IROs) and explores their perceptions of children’s participation in reviews. The paper considers the barriers to young people participating meaningfully in decision making and how practice could be improved in this vital area so that children’s voices are more clearly heard and when possible acted upon by professionals.Design/methodology/approachThe data reported here derive from a qualitative cross-sectional study in one English local authority. The entire study involved interviewing children in care, IROs, social workers and senior managers about young people’s participation in their reviews. Findings from the interviews with young people and senior managers have been reported elsewhere (Diaz and Aylward, 2018; Diazet al., 2018); this paper focusses on the interviews with social workers and IROs. Specifically, the authors were interested in gaining insight into their views about the following research questions: To what degree do children and young people meaningfully participate in reviews? What are the barriers to participation? What can be done to improve children and young people’s participation in reviews?FindingsDuring this process seven themes were identified, five of which concerned barriers to effective participation and two which concerned factors that appeared to support effective participation. These are summarised below and explained further in the following sections. Barriers to effective participation: social workers and IROs’ high caseloads and ensuing time pressures; high turnover of social workers and inexperienced staff; lack of understanding and training of professionals in participation; children and young people’s negative experiences of reviews and consequent reticence in taking part; and structure and process of the review not being child-centred. Factors which assist participation: quality of the relationship between the child and professionals; and the child or young person chairing their own review meeting.Research limitations/implicationsAlthough these findings reflect practice in one local authority, their consistency with other research in this area suggests that they are applicable more widely.Practical implicationsThe practice of children chairing their own reviews was pioneered by The Children’s Society in North West England in the 1990s (Welsby, 1996), and has more recently been implemented with some success by IROs in Gloucestershire (see Thomas, 2015, p. 47). A key recommendation from this study would be for research to explore how this practice could be developed and embedded more widely. Previous research has noted the tension between the review being viewed as an administrative process and as a vehicle of participation (Pertet al., 2014). This study highlighted practitioner reservations about young people chairing their own reviews, but it also gave examples of how this had been done successfully and how it could improve children’s participation in decision making. At the very least, it is essential that young people play a role in deciding where the review is going to take place, when it will take place, who is going to be invited and what will be included on the agenda.Social implicationsThe paper highlights that in this Local Authority caseloads for social workers were very high and this, combined with a high turnover of staff and an inexperienced workforce, meant that children in care struggled to have a consistent social worker. This often meant that young people were not able to build up a positive working relationship with their social worker, which negatively impacted on their ability to play a meaningful role in decision making.Originality/valueThere have been very few recent studies that have considered professionals’ perspectives of children’s participation in key meetings and decision making, so that this provides a timely and worthwhile contribution to this important area of work.

Addressing domestic violence and abuse (DVA) requires effective multiagency family safeguarding to protect vulnerable children and adult victims, whilst challenging perpetrator behaviour. This article examines how family safeguarding in the context of DVA was implemented across social care in a local authority (LA) in England. The LA was selected for inclusion based on its innovative approach to implementing family safeguarding in the context of DVA. Qualitative interview data were collected via video conferencing from twenty-two senior leaders, managers, and frontline professionals working across statutory and voluntary organizations in the LA. The mechanisms employed by the LA to integrate social care response to DVA were a community-based intervention to help avert escalation of risk, DVA training for professionals across statutory and voluntary services, and the employment of Independent Domestic Violence Advisors in key roles. Practitioners reported that these mechanisms strengthened multi-agency coherence and collaboration and facilitated culture change. Outcomes impacting on families directly included supporting adult victims of abuse alongside affected children and working with low-risk perpetrators where possible. Implications for social care practice are that multi-pronged approaches supported by DVA specialists can successfully link prevention and response mechanisms when responding to DVA.

BackgroundInequalities in the proportion of children experiencing abuse and neglect or a children's social care intervention have become a research focus in the last decade. One almost unexplored factor of growth in rates of children in out-of-home care is local party politics. ObjectiveWe assessed whether growth in rates of out-of-home care in England varied by local authority party political control. MethodsWe collated administrative data on the 152 local authorities in England between 2015 and 2021. We used Bayesian parallel process latent growth models to assess whether growth in rates of children in care in English local authorities has been equal across Labour, Conservative, No Overall Control, and no political majority councils before and after adjusting for trends in child poverty, household income from employment, and expenditure on preventative services. ResultsPrior to adjusting for trends in child poverty, average household income, and expenditure, we find little evidence for differences in trends; once adjusted, we find that trends in Labour authorities were lower (−1.125 children looked after per 10,000 per year) than in Conservative authorities. Had growth in family and local authority economic factors remained constant, our findings suggested out-of-home care rates would have, on average, been stable or decreasing in Labour local authorities but would have continued to rise elsewhere. ConclusionsThe contribution of local party politics to growing rates of out-of-home care remains under-theorised and under-researched, but there are potentially substantial differences along party lines that are masked by unequal exposure to changes in poverty.

Parental substance misuse is a significant child welfare issue and associated with increased risk of child maltreatment. The aim of the present study was to understand what social care outcomes children who live with parental substance misuse have, and to assess factors associated with those social care outcomes over a two‐year period. The paper reports on a retrospective longitudinal study of 299 children all living with parental substance misuse and referred to one local authority in England. Data were collected from children's social work case files about procedural social care outcomes and factors which may be associated with those outcomes.Using cluster analysis, a new typology of children's longitudinal trajectories through the children's social care system was developed, consisting of five distinct types. Analysis indicated that some children received too little intervention from children's social care despite ongoing concerns, while other children were potentially unnecessarily caught up in the social care system. Factors associated with children having the poorest outcomes were: caregiver instability resulting from substance misuse, parenting capacity and household instability. The study's findings indicate that some children who live with parental substance misuse are at significant risk of harm, but others are not and may be better supported through non‐statutory services such as early help.

The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. The study is registered as NIHR CRN Portfolio (42900). This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

141 Background: Cancer patients experience significant symptom and psychosocial burden (Temel JS, et. al. N Engl J Med. 2010 Aug 19; 363(8):733-42. Early palliative care for patients with metastatic non-small-cell lung cancer.). Integration of supportive oncology programs within cancer centers has developed since the findings of Temel and Jackson. Addressing a growing need to manage patients comprehensively, the Northwell Health Divisions of Geriatric and Palliative Medicine and Hematology and Oncology partnered to initiate a community-based supportive oncology program. A needs assessment was completed of the providers staff, and important stakeholders. Methods: A sixteen-question survey was created and distributed to the staff at the cancer center. Questions focused on providers’ need for support in fifteen areas. The target audience included physicians, fellows, mid-level providers, registered nurses, social workers, dietitians, and care navigators. A student intern administered surveys over a six-week period. Results: A total of 61 surveys were collected. Of these, 30 were completed by registered nurses, 13 by physicians, 9 by mid-level practitioners, and 3 by social workers. Physicians expressed the highest level of need (&gt; 4.5/5) related to nutritional status, psychosocial factors and pharmaceutical review. Mid-level providers expressed highest level of need related to pain and depression. Nurses expressed highest level of need related to psychosocial factors, pain, depression, fatigue and pharmaceutical review. The average level of need across all areas and all respondents was 4.2 on a 5 point scale. The biggest challenge identified was lack of time to perform comprehensive assessments of patients. Conclusions: A high level of need for a supportive oncology program was identified. Per our assessment, providing comprehensive care with an emphasis on symptom control, nutritional and psychosocial support, and pharmaceutical review would benefit both providers and patients. Time constraints were identified as an issue by all practitioners and staff. The survey results supported the need for an added level of multi-disciplinary support for oncologists to care for cancer patients in the community.

Caregivers at risk of involvement in the child welfare system report high levels of need for multiple types of services, and their children have high levels of mental health need. Caregivers from families with more service needs, as well as unmet needs, are less likely to be engaged with child welfare services and may have diminished capacity to care for their child. This study takes a family‐centered approach by using latent class analysis to identify patterns of both caregiver and child service needs among families at risk of child welfare involvement. Using data from the LONGSCAN consortium (N = 957), we identified 4 classes of service needs among child welfare‐involved families. We then examined differences between the 4 classes based on demographics, maltreatment histories, unmet service needs, and caregiver–child relationship. The caregivers were split fairly evenly among the 4 classes: low needs, medical needs, poverty support, and high needs. There were significant differences between classes on assessed variables, with higher levels of needs associated with diminished caregiver–child relationships.

Summary This study evaluated the feasibility of ‘Social Workers in Schools’, an intervention that involved social workers being based within schools across three local authorities in England (SWIS). Schools make a large number of referrals to Children's Social Care and play an important role in recognizing risks to children and protecting them from harm, but it is unusual for social workers to be based in schools in the U.K. and to do statutory work. We evaluated the pilots on the basis of the feasibility of implementing SWIS, how promising it was in terms of reducing the need for statutory intervention, and the extent to which it be scaled. We used a mixed methods approach, with a process evaluation and a difference in differences analysis of indicative impact on key social care outcomes. In addition, we estimated the cost of implementing and maintaining SWIS. Findings We found high levels of acceptability among those involved, and examples of how SWIS enhances the way safeguarding issues are addressed. There was also some evidence that it may reduce the need for social care interventions, though this needs ratifying with more and better data. Applications The study suggests that SWIS is a promising intervention. Both the qualitative and quantitative findings suggest it may have the intended policy impact, but this needs to be tested on a larger scale and with a more rigorous counterfactual comparison. Such a study—a randomized-controlled trial involving 21 local authorities—was commissioned in 2020.

Social and medical care of preschool children with epilepsy in Croatia: Population-based survey

There is scant research on the experiences and needs of lesbian, gay, bisexual, trans and queer/questioning young people growing up in care in the UK. This article reports on a national survey of local authorities (LAs) in England, which aimed to explore what data LAs collect relating to sexual orientation and gender identity, as well as exploring existing LA policies and practices in relation to LGBTQ+ young people growing up in out-of-home care. The survey asked about policy, recording, support and training. Respondents were senior managers in LAs with responsibility for looked after children. The survey response rate was 78 per cent (n = 118). The survey found a lack of specific policy relating to this population and little central recording of sexual orientation and gender identity (SOGI) data, although most LAs suggested information would be recorded in individual case records. LAs described a variety of ways in which they supported LGBTQ+ young people in practice at both individual and organisational levels but highlighted a lack of staff knowledge and confidence. Training provision was more likely to be provided for social workers than for foster carers or residential staff. Implications for practice are discussed.

This paper re‐examines the principles, priorities and practices of teaching child care law on UK social work qualifying programmes. It identifies four key lessons from the past for teaching and learning child care law, and proposes additional priorities for the future. It draws on research into the way that social workers and local authority solicitors work together in child care cases, suggesting how the lessons from this study of inter‐professional working can be applied in social work education and practice. The project involved over 50 interviews with social workers and lawyers in six local authorities in England. The interviewees' comments highlight the stresses and satisfactions of court work; the tensions and potential of their inter‐professional relationship; perceived weaknesses of social workers' written work; and the challenges of contemporary child care practice. In the light of these findings, the new priorities focus on preparing students for working in the courts and with lawyers, for developing analytical skills and for survival in hard pressed social services departments. They also call for realism about what can be achieved on qualifying courses, and for an active role for social work educators in promoting wider understanding of the challenges of social work with children and families.

Introduction NHS dental treatment for pregnant and nursing mothers with children aged less than 1 year is free for the patient. The rationale being women during this time are more susceptible to dental disease. By providing this free service it is hoped that access rates will increase by removing barriers in inequality and therefore reducing dental disease prevalence.Aim Identify variations in the uptake of free NHS dental treatment by nursing mothers during pregnancy across different local authorities in England and investigate possible factors linked to this variation.Methodology Public Health NHS Business Services Authority (BSA) data on mothers' exemption forms was compared to a three-year average from Office for National Statistics (ONS) birth data in 2016, 2017 and 2018; the percentage uptake of free dental care for nursing mothers was derived for lower tier local authorities (LTLAs) in England. Using Local Health (Public Health England) mapping data, this was compared to markers of deprivation and other indices to illustrate poor areas of uptake.Results The proportion of mothers accessing dental care ranged from 28-61%. Correlations between access and socioeconomic and ethnic backgrounds within local authorities are illustrated.Conclusion The general low uptake of free dental services among nursing mothers shows more can be done to improve access for this vulnerable group.