Gavin Davidson

The impact of adversity in childhood on outcomes in adulthood: research lessons and limitations

• Summary: Current UK Government policy is concerned with the possible connections between childhood adversity, social exclusion and negative outcomes in adulthood. Understanding the impact of adverse childhood experiences on outcomes in adulthood is therefore key to informing effective policy and practice. In this article, the research on the impact of childhood adversity on outcomes in adulthood is reviewed in the broad categories of: mental health and social functioning; physical health; offending; service use; and economic impact. The literature on resilience that focuses on those who experience adversity, but do not have associated negative outcomes is also briefly considered. The strengths and limitations of the range of research methods used are then examined. • Findings: Previous studies have tended to focus on specific forms of adversity, predominantly abuse and neglect, and either: specific populations and specific outcomes; specific populations and general outcomes; or general populations and specific outcomes. This means there may be incomplete understanding of the inputs (the range of adverse experiences in childhood), the processes (how these may affect people) and the outcomes (across domains in adulthood). • Applications : It is concluded that it is important for social work researchers to engage in the current debate about how to prevent harmful childhood adversity and there is an important gap in the research for more interdisciplinary large-scale general population studies that consider the full range of childhood adversity and associated impacts across time and the possible processes involved.

A Longitudinal Study of the Effects of Childhood Trauma on Symptoms and Functioning of People with Severe Mental Health Problems

This study examines the relationship between childhood trauma and the psychiatric symptoms and psychosocial functioning of adults with severe mental health problems. Participants (n = 31) were recruited from the caseloads of community mental health services in Northern Ireland and assessed at baseline, 9 months, and 18 months. More than half had a history of childhood trauma (n = 17). There were no differences between the no childhood trauma (n = 14) and childhood trauma groups on psychiatric symptoms, but a significant relationship was found between trauma history and all aspects of social functioning. Those with no history of trauma showed improved psychosocial functioning over time, whereas those with a history of trauma deteriorated. These findings have implications for current service provision.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a persons wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past 30 years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice.

Risk, Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

ABSTRACT Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination, and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. Therefore it is argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery-based approaches, which promote supported decision-making and inclusion; and the assessment of a persons ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.

Sexuality and Dementia: Law, Policy and Practice

This article explores the current law, policy and practice issues relevant to sexuality and dementia, particularly in care home settings. These issues include: the assessment of the sexual needs of people with dementia; how decision-making capacity about sex is considered and supported; the rights-based issues for service users and carers; how sexual relationships within care homes may be facilitated; and some of the complexities in practice. It is argued that these issues have not been appropriately addressed in the past and identifies some of the possible societal, cultural and individual barriers to people in care settings, especially those with dementia, expressing their sexuality. There is an increasing need to consider these issues due to: demographic changes; developments in legal and policy frameworks; and better understanding of people’s rights and capacity to make decisions. The article focuses on services in Northern Ireland where a proposed new legal framework, the Mental Capacity (Health, Welfare and Finance) Bill, will have important implications for future practice in this area. The immediate implications for practice are also discussed and recommendations are outlined for: assessment; person-centred approaches; strategies for intervention; training and support; and policy development.

Applying the recovery approach to the interface between mental health and child protection services

ABSTRACT There is a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This article proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.

Exploring the impact of mindfulnesss on mental wellbeing, stress and resilience of undergraduate social work students

Abstract Mindfulness is becoming more popular as emerging research demonstrates its benefits for self-care, by cultivating calmness and decreasing stress or anxiety. This pilot study aimed to measure the impact of a six-week Mindfulness course, modelled on the manualised treatment programme developed by Kabat-Zinn on the mental well-being, stress and resilience of undergraduate social work students in Northern Ireland. This was a mixed methods study involving two groups: (1) intervention group participants who attended a six-week Mindfulness course (April–May 2016) and (2) control group participants. Basic socio-demographic data were collected from all participants and all were invited to complete the Warwick-Edinburgh Mental Well-being Scale, the Perceived Stress Scale and the Resilience Scale during weeks 1 and 6. Statistical tests were used to compare mean scores from the scales, and qualitative data were manually analysed using thematic content analysis. Findings indicated significant changes in the scores for well-being, stress and resilience for the intervention group, but not for the control group. Mindfulness may not appeal to all students so it should not be a mandatory component of training, but may be offered as one of the wider approaches to self-care for undergraduate social work degree students.

A Four-Nation comparison of kinship care in the UK: The relationship between formal kinship care and deprivation

The practice of extended family and friends helping to care for children when their parents are unable to is an enduring tradition in many cultures. Kinship care provides the largest proportion of out of home care in Western society but many of these carers experience poverty and deprivation, and do not receive comparable levels of support, financial or professional, to other placement types. This study provides UK evidence for the relationship between kinship care and deprivation and examines how the welfare state frames kinship care in policy and practice.

Coproduction for feasibility and pilot randomised controlled trials: learning outcomes for community partners, service users and the research team

Plain English summaryCo-producing research with members of the public is increasingly recognised as a valuable process. Yet, despite these good intentions, the literature on coproduction has struggled to keep pace with the coproduction ‘movement’. There is a lack of clarity regarding acceptable levels of involvement and attempts at standardising approaches appear generic and lack detail. Moreover, relatively little research has captured the views of all the parties involved (academics, service providers and service users).We conducted interviews with all those involved in developing a new online service for depression in Northern Ireland. Our main questions related to how these three very different groups of people worked together over a two-year period to design, develop and deliver the service (e.g. what were the benefits? What would they do differently?)We found that early involvement was a key factor as this promoted equal ownership. There was also a need to be flexible and recognise other workload pressures. Interestingly, service providers and service users were keen to become more involved in data analysis – this is one of the most under-researched and reported areas within the coproduction literature. Finally, we considered how user involvement worked within complex research designs and how this could be improved. Based on this learning, the paper concludes with a simple 3-step framework that others may wish to follow in order to improve coproduction outcomes within interventions.AbstractBackground Co-production, involving members of the public in research, is increasingly encouraged by research funders. However, reports detailing involvement of the public in the entire research process from design, delivery, analysis and dissemination of findings are lacking. Furthermore, little is known about the lessons learnt from the perspective of the public and researchers; or more specifically lessons learnt when coproducing specific types of research projects, such as feasibility/pilot studies incorporating a randomised controlled trial (RCT) design. This paper aims to provide a more rounded picture of co-production based on the learning outcomes of researchers, their community partners and service users involved in a feasibility/pilot RCT study developing and evaluating an E-health Service for adults with depression. Methods Qualitative research incorporating 11 semi-structured interviews with academic team members (n = 4), community partners (n = 3) and service users with depression (n = 4) Data were analysed using thematic analysis. Results Key factors for successful coproduction include - (1) early involvement at the pre-development stage, including contributing to the scientific grant application; (2) early identification of team strengths and expertise from the outset; (3) regular team meetings and contact (formal or informal) among coproduction partners; (4) a flexible and pragmatic approach to research design (particularly within RCTs); (5) shared decision making and responsibility and (6) recognition of ‘other’ pressures and providing support to each other. Findings also suggested further scope for involving community partners in data analysis and dissemination through co-authored papers. Those seeking to coproduce interventions or utilise RCT designs should consider tensions between data quality and intervention implementation and ethical issues regarding control groups. Conclusion This paper confirms previous research confirming the benefits of coproduction. However, it also highlights a number of barriers, particularly when using complex research design, such as RCTs. Learning points are summarised in an implementation model for coproducing research. This model may provide a useful guide for considering activities associated with meaningful coproduction. We urge others to test this proposed model more widely in different areas of coproduced research.

Legal capacity and the mental health social worker role: An international comparison

ABSTRACT New capacity laws have been introduced to many jurisdictions over the last decade. These laws have substantially changed the way in which mental health social workers and other professionals approach decisions about, and for, clients. Most notably, there is now an expectation that mental health social workers engage more in supported decision-making to prevent the need for substitute decision-making. This article describes the legal and policy drivers that have led to these changes in practice, with a particular emphasis on the significance of the United Nations Convention on the Rights of Persons with Disabilities (the UNCRPD) and the importance of recovery approaches in mental health services. It then uses selected literature to explore the efficacy of the laws and decision-making in this area. The second part of the article identifies the role that mental health social workers can play in supporting legal capacity, drawing from the authors’ experience and knowledge of mental health social work and law in four jurisdictions: Victoria, Australia; Ontario, Canada; England and Wales; and Northern Ireland. It is concluded that mental health and other social workers need to refine skills, knowledge and values to accommodate this paradigm shift in law, policy and practice.