Social Care Involvement Research Articles

Factors associated with the school exclusion gap for children with social work involvement: A retrospective cohort study using national administrative data

Abstract Children who receive social care services are known to have higher exclusion rates than those without social care involvement. However, there is limited evidence on which groups of children are most at risk of this exclusion gap. This article reports on a retrospective analysis of administrative data from the National Pupil Database in England, covering two age-based cohorts of children (n = 1.2 million) who took standardized tests in 2019. Children receiving social care services within the previous five years were compared with those with no social care involvement, focusing on rates of exclusion within a 12 month period. Regression models were estimated to examine how the relative likelihood of exclusion was associated with a range of covariates, including demographic characteristics, special educational needs and disabilities, categories of social care need, and various aspects of provision. Results showed that the gap in exclusions was wider for children with multiple episodes of social care involvement, some—but not all—types of special educational needs and disabilities, and for certain categories of social care needs. Implications for policy and practice are discussed, particularly with respect to children with behavioural difficulties.

Perinatal healthcare for women at risk of children’s social care involvement: a qualitative survey of professionals in England

BackgroundWomen with complex health needs are more at risk of having children’s social care involvement with their newborns than other mothers. Around the time of pregnancy, there are opportunities for...

Working with women affected by children’s social care involvement in pregnancy and early motherhood: Insights from recent Birth Companions work

Children’s social care (CSC) involvement during pregnancy and the first two years of a child’s life – the period known as the ‘1001 critical days’ – can have a significant impact on the mental health and wellbeing of both mothers and infants. By putting bonding and attachment between mothers and their babies at risk, this can pose long-term implications for children’s emotional and psychological development.Drawing on findings from Birth Companions’ recent projects with women with lived experience of CSC involvement, this article offers insight into the mental health impacts of assessment and/or care proceedings during the first 1001 days.The article also outlines key principles for all those working with women in these circumstances, published in the form of theBirth Companions Birth Charter for women with involvement from children’s social care(2023c). This aims to embed improved practice across all systems and services working with women with CSC involvement.Key recommendations focus on the significance of trauma-informed care for women, and the centralisation of pregnancy and early motherhood in multi-agency practice. Birth Companions is calling for this to be driven forward in the form of a joint national health and social care pathway for pregnant women and mothers of infants who are subject to pre-birth or parenting assessment, or child protection proceedings, to guide the care and support they receive up to their child’s second birthday.

Confronting intergenerational harm: Care experience, motherhood and criminal justice involvement

Abstract Prior research highlights how criminalized mothers may be particularly at risk of negative judgements, but little work to date explores how criminalisation, care experience and motherhood may intersect to produce multi-faceted structural disadvantage within both systems of care and punishment. This paper attends to this knowledge gap, drawing on interviews with imprisoned women who have been in care (e.g. foster care or children’s homes), care-experienced girls and young women in the community, and professionals who work with them. Key findings include: a desire to break cycles of intergenerational stigma and social care involvement; lack of support and a fear of asking for help, and the care-less approach to pregnancy and motherhood that may be faced in prison and beyond.

What Are the Sociodemographic and Clinical Characteristics and Needs of Mothers Who Access Acute Postpartum Psychiatric Care and Have Children’s Social Care Involvement?

Mothers with severe postpartum psychiatric diagnoses are more likely to have children’s social care involvement with their infants, but little is known about the needs or experiences of this group of women. With input from a lived experience advisory group, we carried out secondary analysis of data collected from 278 mother-infant dyads where the mother accessed acute psychiatric care in England or Wales postnatally. We explored the characteristics, needs, and service use experiences of mother-infant dyads with (n = 99) and without (n = 179) children’s social care involvement. We found that mothers with social care involvement were often experiencing wider adversity and inequity across multiple areas of their lives. These mothers were also less satisfied with their mental health care and had more unmet needs after discharge from acute services. We built multivariable logistic regression models to examine factors associated with children’s social care involvement during the acute admission and one year later. We found that having social care involvement during an acute postpartum admission was associated with being deprived, reporting a maternal history of childhood trauma, experiencing domestic abuse, having a diagnosis of personality disorder or schizophrenia, and having a history of previous psychiatric admissions. At one-year follow-up, factors associated with children’s social care involvement included deprivation, experiencing childhood trauma, having been single at the time of the postpartum admission, and having been readmitted to acute psychiatric services following the postpartum admission. Our findings suggest that mothers with children’s social services involvement in the context of an acute postpartum psychiatric diagnosis may have high levels of support needs, but services may struggle to meet their needs fully. We argue that an increased focus on supporting mothers with histories of trauma, adversity, and deprivation, along with greater collaboration between mental health, children’s social care, and third sector services may help improve experiences and outcomes.

Young, gifted and black: the intersectionality of race, intellectual disability and neurodivergence

This article critically examines the impact of health and social care provision on separated categories of race, disability and neurodivergence. It deconstructs the racist impacts of the neoliberal individual budgets agenda as experienced by a young Black African person with intellectual disabilities and autism, living as a second-generation migrant in the UK. This article highlights intersectional methodological and practice implications for health and social care provision within England and Wales. The erasure of intersectional race, intellectual disability and neurodivergent identities in UK health and social care policies and practice procedures results in the invisibility, misrecognition and consequential misdiagnosis of the intersectional complexities of the needs and entitlements of young black people. The convergence of racist, disablist and elitist neoliberal agendas is identified as leading to increased risks of incarceration for young black people with intellectual disabilities and autism. The specificity of the individual needs of young black people with intellectual disabilities and autism demand anti-racist approaches that confront the assumption that Black African families in the UK ‘look after their own’ and require minimal social care involvement.

Reflections from the COVID-19 pandemic on inequalities and patient and public involvement and engagement (PPIE) in social care, health and public health research.

Patient and public involvement and engagement (PPIE) has evolved to become widely established practice in social care, health and public health research in the UK. The COVID‐19 pandemic has caused rapid change in practice in PPIE, notably in moving from face‐to‐face meetings to virtual ones. This has opened a space for reflecting on established PPIE practice, but there is a risk this is conducted too narrowly, such as only weighing our preferences and the relative pros and cons with regard to in‐person versus virtual meetings. The pandemic has also demonstrated the wide inequalities in society, and hence, we argue that an inequalities lens ought to guide a deeper and wider reflection on PPIE practice. We do not seek to criticize practice pre‐ or during the pandemic, but to encourage using the inequalities lens as a means of encouraging debate and focusing energy on a more rigorous review of PPIE practice to widen involvement in social care, health and public health research.

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

AbstractParental 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.

Would Shared Health Visitor and Emergency Department Records Improve Recognition of Child Maltreatment within the Emergency Department? A Prospective Multicentre Study

Burns are common causes of paediatric emergency care attendance; approximately ten per cent result from maltreatment. Following emergency department (ED) attendance with a burn by 232 under five‐year‐olds, 11 risk factors for maltreatment were collected via health visitor (HV) telephone surveys. Three of these risk factors (domestic violence, social care involvement and developmental impairment) were also available in ED records, and information collected was compared between the two. Non‐parametric Fisher's exact tests were applied. Fifty‐nine per cent of children lived in families with risk factors for maltreatment. Prominent risk factors known by HVs included: prior injuries (n = 55, 23.7%), carer/parent mental health problems (n = 48, 20.7%), domestic violence (n = 47, 20.3%) and social care involvement (n = 45, 19.4%). A total of 158 cases had complete data for all 11 risk factors: 49 (31.0%) lived in households with one factor, 22 (13.9%) with two factors and 27 (17.1%) with three or more risk factors. In cases where HVs recorded the following risk factors as present, EDs recorded five of 47 (10.6%) for domestic violence, ten of 45 (22.2%) with social care involvement and four of 23 (17.4%) with developmental impairment. Many risk factors that were known to HVs were not identified by EDs staff despite being part of a standardised proforma. Maltreatment risk assessment could be improved if EDs staff had access to HV information.Key Practitioner Messages Fifty‐nine per cent of pre‐school children who attended an ED with a burn live in a family with one or more maltreatment risk factors, as identified by HV records. ED staff should be able to access a child's HV record electronically at the time of presentation, to identify known maltreatment risk factors. The lack of integration of community and acute setting health records is a barrier to comprehensive assessment and treatment decisions for children in EDs, especially in relation to safeguarding risks.

Signs of Safety: The View From Early Help

ABSTRACT Signs of Safety is a strengths-based approach to work with children and families where there are concerns about abuse or neglect. Signs of Safety is widely used in the UK and internationally, and there is a growing range of empirical research exploring its use within statutory children’s social work. However, there is little research exploring how, and to what effect, Signs of Safety is being used by other childcare professionals. This paper reports on an independent evaluation of the use of Signs of Safety by an early help agency in the South West of England. At time of evaluation, the agency was commissioned by the local authority to support children and families with multiple and complex needs who did not meet the threshold for statutory children’s social care involvement. The study was multiple methods with two strands. To better understand the work that the agency did, data were collected from case files, to develop a profile of families engaging with the agency. Interviews were undertaken with five practitioners about their experiences of using Signs of Safety. Saliency analysis was used to explore the qualitative data. Overall practitioners felt that Signs of Safety was accessible, supported clear communication with children and families and aided critical reflection. However, existing tensions—relating to statutory threshold decisions and multi-agency relationships—were reflected and magnified via the Signs of Safety tools. The implications of these findings are discussed, providing original insights about an issue highly relevant to national and international audiences.

Project 20: Midwives’ insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how

IntroductionContinuity of care models are known to improve clinical outcomes for women and their babies, but it is not understood how. A realist synthesis of how women with social risk factors experience UK maternity care reported mechanisms thought to improve clinical outcomes and experiences. As part of a broader programme of work to test those theories and fill gaps in the literature base we conducted focus groups with midwives working within continuity of care models of care for women with social factors that put them at a higher chance of having poor birth outcomes. These risk factors can include poverty and social isolation, asylum or refugee status, domestic abuse, mental illness, learning difficulties, and substance abuse problems. ObjectiveTo explore the insights of midwives working in continuity models of care for women with social risk factors in order to understand the resources they provide, and how the model of care can improve women’s outcomes. DesignRealist methodology was used to gain a deeper understanding of how women react to specific resources that the models of care offer and how these resources are thought to lead to particular outcomes for women. Twelve midwives participated, six from a continuity of care model implemented in a community setting serving an area of deprivation in London, and six from a continuity of care model for women with social risk factors, based within a large teaching hospital in London. FindingsThree main themes were identified: ‘Perceptions of the model of care, ‘Tailoring the service to meet women’s needs’, ‘Going above and beyond’. Each theme is broken down into three subthemes to reveal specific resources or mechanisms which midwives felt might have an impact on women’s outcomes, and how women with different social risk factors respond to these mechanisms. Conclusions/implications for practiceOverall the midwives in both models of care felt the service was beneficial to women and had a positive impact on their outcomes. It was thought the trusting relationships they had built with women enabled midwives to guide women through a fragmented, unfamiliar system and respond to their individual physical, emotional, and social needs, whilst ensuring follow-up of appointments and test results. Midwives felt that for these women the impact of a trusting relationship affected how much information women disclosed, allowing for enhanced, needs led, holistic care. Interesting mechanisms were identified when discussing women who had social care involvement with midwives revealing techniques they used to advocate for women and help them to regain trust in the system and demonstrate their parenting abilities. Differences in how each team provided care and its impact on women’s outcomes were considered with the midwives in the community-based model reporting how their location enabled them to help women integrate into their local community and make use of specialist services. The study demonstrates the complexity of these models of care, with midwives using innovative and compassionate ways of working to meet the multifaceted needs of this population.

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis.

BackgroundEchoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care.MethodsUsing realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0).ResultsThree themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships.ConclusionsThe findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.

Qualitative analysis of clinician experience in utilising the BuRN Tool (Burns Risk assessment for Neglect or abuse Tool) in clinical practice

IntroductionThe BuRN-Tool (Burns Risk assessment for Neglect or abuse Tool) is a clinical prediction tool (CPT) aiding the identification of child maltreatment in children with burn injuries. The tool has been derived from systematic reviews and epidemiological studies, validated and is under-going an implementation evaluation. Clinician opinion on the use of this CPT is a key part of its evaluation. ObjectivesTo explore the experience of emergency clinicians use of the BuRN-Tool in an emergency department (ED). MethodsThree focus groups were conducted over a six-week period by the research team in the ED in the University Hospital of Wales; 25 emergency clinicians attended. A semi-structured approach was taken with pre-determined open-ended questions asked followed by a series of case vignettes to which the CPT was applied. The focus groups were recorded and transcribed verbatim. Thematic analysis was conducted for identification of pre-set and emergent themes. All data were double-coded. ResultsAll participants said that it was acceptable to use the BuRN-Tool to aid in the decision-making process surrounding child maltreatment. All participants said that the BuRN-Tool was helpful and straight forward to use. All participants said that the tool was clinically beneficial, particularly for junior staff and those who do not always work in a paediatric environment.The clinical vignettes identified subjectivity in interpretation questions around adequate supervision, previous social care involvement and full thickness burns. This resulted in some variation in scoring. ConclusionsThis study confirms that the BuRN-Tool is acceptable in an ED setting. The focus groups demonstrated a homogenous and positive attitude regarding the layout, benefits and use of the BuRN-Tool. The subjective interpretation of some variables accounts for the non-uniformity in the scores generated. Clarification of questions will be made.

Family experiences of children’s social care involvement following a social work change programme

Social work change programmes rooted in a particular practice theory and design are increasingly a fixture of UK local authority social work and the focus of a small but developing body of research. However, in this research to date, there has been a lack of engagement with the perspectives of families. In this article, we detail findings from 23 family interviews undertaken as part of an independent evaluation of a social work change programme in a single local authority. These findings afford insight into the positive influence change programmes can have on engaging families and re-routing practitioners to work in a relationship-based way. They also illustrate the limitations for reshaping practice in the context of rising levels of need, a paucity of supportive provision, and administrative burdens remaining the same as before the introduction of a change programme. As part of the article, we offer some brief reflections on the recruitment of families for evaluative study to assist other researchers and local authority professionals who may be involved in comparable evaluations in future.

Social circumstances and medical complications in children with intestinal failure

Although most children discharged on home parenteral nutrition (HPN) will achieve enteral autonomy, some remain parenteral nutrition dependent; those who develop life-threatening complications may undergo small bowel transplantation (SBTx). The...

What Users Have to Say about their own Organisations: A Local User‐Controlled Study

Based on the experience of Wiltshire and Swindon Users' Network, this article presents findings from a small user‐controlled study of members' perceptions of their own organisation. Peer support, information provision and speaking with a ‘collective voice’ emerged as key aspects of their involvement which members valued. Although WSUN provided a range of opportunities for involvement in social care and health services, members identified training and recruitment of professionals and presentations as areas for greater involvement. The study calls for greater recognition of the important role that usercontrolled organisations can play in empowering users on a personal level, as well as bringing about change in social care and health services through effective user involvement.

Men as Minority

• Summary: Although social care employees are predominantly women, there have always been men involved in the work, particularly as managers or where there is a control element. The academic writing on men's involvement in social care lacks an empirical base and this article presents an examination of the characteristics, distribution and routes into social care of 585 men who took part in a UK study of 2031 statutory social services employees. • Findings: The respondents were a heterogeneous group of men, employed throughout social care, mostly but not exclusively in jobs associated with traditional male roles. Men constitute 14 percent of the UK social services workforce and predictably are disproportionately represented in management. However, the majority (three-fifths) are employed in basic grade field, residential and home care jobs. • Applications: This is an important issue for social care employers: men face particular sets of difficulties in social care employment. With the decline in traditional employment opportunities, men may increasingly diversify into less traditional areas of work, including health and social care.

Social care and the role of the general practitioner

United Kingdom general practice is taken as a case study of the way in which new areas of concern come to be seen as within the sphere of competence of doctors. In defining the themes of general practice, prominent U.K. practitioners have pointed to a social orientation which distinguishes general practice from other areas of medicine. This loosely defined social orientation appears to include several themes. On the one hand there is an awareness of social relationships, social factors in disease and illness behaviour, and of the social causes of disease, and on the other, a feeling for a responsibility for caring for the social consequences of diseases, for social welfare problems, and for socio- or psychotherapeutic care. An involvement in social care raises certain questions about the role of the general practitioner which have not been explored by those doctors who have discussed this social orientation. At one level there are practical problems of the conflict between the provision of medical and social care and the relationship with other care workers, but at a more basic level there is a fundamental question concerning our socio-political approach to social problems.