Ian Sinclair

Bullying, sexual harassment and happiness in residential children's homes

Much is now known about bullying and, to some extent, sexual harassment in settings such as schools. In residential childrens homes, however, the two remain disturbing features of institutional life. This is a particular cause for concern as many of the residents in these homes, given their troubled backgrounds, are at greater risk of becoming victims of perpetrators. This article looks at the incidence and effects of these related maladies within the context of a wider study involving 223 children in 48 residential homes in five local authorities. The study found that fellow residents, rather than staff, were the main sources of physical and sexual abuse. Both bullying and harassment (actual and attempted) were strongly associated with the widespread misery reported by many residents. Copyright

‘A Life More Ordinary’: What Children Want from Foster Placements

Based on findings from their recent study, Ian Sinclair, Kate Wilson and Ian Gibbs discuss the criteria which foster care needs to meet if it is to fulfill the requirements of looked after children. Analysis of 150 postal questionnaires from foster children showed five main preoccupations: the care they received from their foster families; the relationship between their feelings for their foster and their birth families; their contact with and prospects of return to their birth families; the predictability of their care careers and their own say in them; and the ‘ordinariness’ or lack of it of their lives. Despite these common preoccupations, the children varied widely in what they wanted (eg whether they wanted to return home).

Multidimensional Treatment Foster Care for Adolescents in English care: Randomised trial and observational cohort evaluation

BACKGROUND Children in care often have poor outcomes. There is a lack of evaluative research into intervention options. AIMS To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England. METHOD A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending. RESULTS The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour. CONCLUSIONS There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.

Analysis of a care planning intervention for reducing depression in older people in residential care

Approximately 40% of older people in residential care have significant symptoms of depression. A training and care-planning approach to reducing depression was implemented for 114 depressed residents living in 14 residential care homes in North Yorkshire, UK. Care staff were offered brief mental health training by community mental health teams for older people. They were then assigned to work individually with residents in implementing the care-planning intervention, which was aimed at alleviating depression and any health, social or emotional factors that might contribute to the residents depression. Clinically significant improvements in depression scores were associated with implementation of the care-planning intervention as evidenced by changes in scores on the Geriatric Mental State Schedule—Depression Scale. There was evidence of an interaction between the power of the intervention and degree of dementia. These improvements were not accounted for by any changes in psychotropic medication. The training was highly valued by care staff and heads of homes, and they considered that the care-planning intervention represented an improvement in quality of care for all residents, irrespective of levels of dementia. Staff also reported improvements in morale and increased confidence in the caring role as a result of their participation. The limitations of this study are discussed. On the basis of a growing body of evidence, it is argued that there is an urgent need for a suitably powered randomised controlled trial and economic evaluation, to test the cost-effectiveness of personalised care planning interventions aimed at reducing depression in older people in residential care.

Mental health in residential homes: a role for care staff

Two linked studies assess the feasibility of involving care staff in reducing the prevalence of depression in homes for older people. Mental health training was provided for care staff, delivered by members of a Community Mental Health Team for the Elderly. The research programme used quantitative and qualitative methods to evaluate the effects of a theoretical training for care staff, a system of mentoring care staff to reinforce the training; and a care-planning intervention for the management of depression which combined psychosocial and medical approaches. The training programme was positively evaluated by the recipients, the trainers and the researcher who observed it. The ability of care staff to detect depression improved significantly over time, and depression was reduced to below case-level in seven of the eight depressed residents who participated in the care-planning intervention. This research suggests that psychosocial interventions that involve collaboration between carers and residents, supported by a Community Mental Health Team, may have an important part to play in supplementing medical management of depression in residential care homes.

Kinship and Stranger Foster Carers: How do they Compare?:

US research suggests that kinship foster carers are a valued resource but less well supported than carers who are strangers. Jennifer Sykes, Ian Sinclair, Ian Gibbs and Kate Wilson draw on data from their own large-scale study of foster carers to see if similar issues arise in England. The study suggests that kinship carers are a heterogeneous group. Some want to be treated as carers entitled to similar levels of financial reward, and in need of training. Others may see support from social services as ‘intrusive’ and regard themselves as qualified by experience to care as they do. On average fostering appeared to have a greater impact on the financial and housing situations of these carers than it did on those of others, and many of them reported conflicts with the birth families. Despite these difficulties they received on average less training, lower levels of financial reward and less back-up than other carers. The authors conclude that, in at least some authorities, more use could be made of kinship foster care but that it is not always an appropriate choice and more thought should be given to its support.

Can the Corporate State Parent

Discussions about provision for children in the care of the state have continually raised the question, can the corporate state parent? Roger Bullock, Mark E Courtney, Roy Parker, Ian Sinclair and June Thoburn consider the question in the light of recent studies of separated children. It is argued that while the state does not need to fulfil all parenting responsibilities when care is shared with families or children are adopted, for three groups of children parenting issues are especially salient. They are: children in kinship care, in long-term foster family care and young people who are seriously troubled and troublesome. Research that would produce relevant information and recommendations to improve the states parenting is suggested.

Measuring the turbulence of English Children's Homes

Abstract A study of 48 English Childrens Homes found wide variations in the way they were perceived by their residents and staff and in the degree to which their residents ran away or got into trouble with the police. Multivariate analysis suggested that the differences in behaviour between homes were not fully explained by intake and provided a measure of the degree to which the residents in a home were behaving in a more delinquent way than might be expected. This measure was associated with the way staff and residents perceived the home and both perceptions and behaviour were included in an overall measure of the homes ‘turbulence’. The article describes the way this measure was developed and some of its properties.

Residential Care for Elderly People: The Correlates of Quality

Given the vulnerability of elderly people living in long-term hospitals and in other forms of institutional provision, it is essential that the quality of their care is as high as possible. This observation, moreover, has widespread relevance irrespective of variations in the structure of health and social care provision in different countries. In pursuit of this objective the newly established ‘arms length’ inspection units in Britain will be responsible for setting and also safeguarding standards in homes. The article, based on research commissioned by the Social Services Inspectorate, uses a global measure of quality derived from the inspection of residential care homes, examines the correlates of this measure in a sample of local authority and independent homes in Britain and discusses the implications of the findings for policy and further research.

Intensive Fostering: An Independent Evaluation of MTFC in an English Setting

Nina Biehal, Sarah Ellison and Ian Sinclair present the results of an independent evaluation of the Multidimensional Treatment Foster Care (MTFC) programme for young offenders in England, where it is known as Intensive Fostering (IF). A quasi-experimental, mixed-methods study was carried out at the three pilot sites, with a total sample of 47 at follow-up. Young people sentenced to IF were compared to a similar group, matched on the eligibility criteria for IF, the majority of whom were sentenced to custody. The groups were well matched in terms of their characteristics and criminal histories. Official data on reconviction were collected at baseline and one year after entry to the IF placement or release from custody (Stage 1), and further data on programme completion and secondary outcomes were collected via interviews with young people and parents, and questionnaires to professionals at baseline and follow-up. Official data on reconviction were also collected one year after exit from the IF placements (Stage 2). At Stage 1 the IF group were less likely to be reconvicted, had committed fewer and less-serious recorded offences, on average, and took longer to commit their first recorded offence. At this point the IF group were more likely to be living with their families and less likely to be in custody than the comparison group. However, by Stage 2 no significant differences in patterns of reconviction remained. IF successfully contained a high-risk group in the community, but the effects of the intervention diminished once they left their foster placements. Environmental effects on entry to and exit from the IF placements may help to explain the results at both stages.