Janice McGhee

Social work with children and families

Social work with children and families raises public and professional concern. Inquiries into the fatal non-accidental injury and sexual abuse of children highlight the need for sound child-care decisionmaking and effective interagency and interdisciplinary collaboration, and for the child’s best interests to have paramountcy at all times. From the mid-1970s in the UK, public accountability demanded and influenced the shape of social work services with children and their families, giving rise to an emphasis on investigation and surveillance mediated through detailed procedural guidance in local authorities and some voluntary agencies. Since 1990, major changes in child and family law have been enacted throughout the UK, leading to a greater emphasis on parental responsibility and ascertaining children’s views.

Maltreatment or violence-related injury in children and adolescents admitted to the NHS: comparison of trends in England and Scotland between 2005 and 2011

Objective Legislation to safeguard children from maltreatment by carers or violence by others was advanced in England and Scotland around 2004–2005 and resulted in different policies and services. We examined whether subsequent trends in injury admissions to hospital related to maltreatment or violence varied between the two countries. Setting and participants We analysed rates of all unplanned injury admission to National Health Service (NHS) hospitals in England and Scotland between 2005 and 2011 for children and adolescents aged less than 19 years. Outcomes We compared incidence trends for maltreatment or violence-related (MVR) injury and adjusted rate differences between 2005 and 2011 using Poisson or negative binomial regression models to adjust for seasonal effects and secular trends in non-MVR injury. Infants, children 1–10 years and adolescents 11–18 years were analysed separately. Results In 2005, MVR rates were similar in England and Scotland for infants and 1–10-year-olds, but almost twice as high in Scotland for 11–18-year-olds. MVR rates for infants increased by similar amounts in both countries, in line with rising non-MVR rates in England but contrary to declines in Scotland. Among 1–10-year-olds, MVR rates increased in England and declined in Scotland, in line with increasing non-MVR rates in England and declining rates in Scotland. Among 11–18-year-olds, MVR rates declined more steeply in Scotland than in England along with declines in non-MVR trends. Conclusions Diverging trends in England and Scotland may reflect true changes in the occurrence of MVR injury or differences in the way services recognise and respond to these children, record such injuries or a combination of these factors. Further linkage of data from surveys and services for child maltreatment and violence could help distinguish the impact of policies.

Care and protection in Scottish child welfare: evidence of double jeopardy?

Since the inception of the Scottish childrens hearings system, an increasing concentration of child care and protection referrals has emerged. Data on 225 children referred on care and protection grounds are examined. Children faced a double jeopardy of personal adversity against a background of social and economic disadvantage. A smaller group of children were also victims of an offence by an adult. A significant proportion of children had multiple referrals suggesting a recycling of some children. Social adversity in the backgrounds of children has been found in other child welfare studies. The significance accorded to this by social work agencies and the links between neglect and poverty may be overlooked. The importance of policy that provides comprehensive public assistance and services, as found in other European countries, is an inescapable conclusion.

Children's hearings in Scotland: compulsion and disadvantage

This paper outlines some key findings from a study of 1,155 children referred in 1995 to the childrens hearings system in Scotland. The majority of children formally processed in the system were found to come from less well off families, often facing multiple adversities. Children subject to compulsory measures of supervision were especially likely to have backgrounds characterized by factors associated with social disadvantage. The national picture suggests an overall increase in the number of children subject to compulsory measures of supervision over the last ten years. Independent evidence highlights a potential use of compulsion as a means to access scarce resources. When taken together, these three separate findings raise fundamental questions about the role of compulsory measures in the operation of the system. It is argued that using compulsion for resource acquisition would offend against the principle of minimum intervention, ultimately transgressing childrens rights. Compulsion as a gatekeeping mechanism may allow, in effect, for the targeting of scare resources to those children perceived to be most in need; but this may be at the cost of increasing state intervention in the lives of some families and decreasing access to resources for others.

Time-trends in rates of hospital admission of adolescents for violent, self-inflicted or drug/alcohol-related injury in England and Scotland, 2005-11: population-based analysis

Background Incidence of emergency admissions for violent injury in 10- to 18-year olds decreased in England and Scotland between 2005 and 2011, but more steeply in Scotland. To generate hypotheses about causes of these differences, we determined whether trends were consistent across admissions for three common types of adversity-related injury (violent, self-inflicted and drug/alcohol-related). Methods Emergency admissions to NHS hospitals were captured using Hospital Episode Statistics and Scottish Morbidity Records. Adversity-related injury was defined using ICD-10 codes. Analyses were stratified by sex/age groups (10-12, 13-15 and 16-18 years) and adjusted for background trends in admissions for injury. Results During 2005-11, rates declined in all sex/age groups in Scotland (reductions adjusted for background trends ranged from -22.0 to -103.7/100 000) and in girls and boys aged <16 years in England (adjusted reductions -12.0 to -49.9/100 000). However, these rates increased in England for both sexes aged 16-18 years (adjusted increases, girls 71.8/100 000; boys 28.0/100 000). However, throughout 2005-11 overall rates remained relatively similar in England and Scotland for both sexes aged <16 years, and remained higher in Scotland for both sexes aged 16-18 years. Conclusions A greater decline in the rates of emergency admissions for adversity-related injury for adolescents in Scotland compared with England could signal more effective policies in Scotland for reducing violence, self-harm, or drug/alcohol misuse, particularly for 16 to 18-year olds.

Comparative juvenile justice policy: The alliance between Scotland and the State of Massachusetts revisited

Abstract This paper examines policy and practice developments in juvenile justice in Europe and the USA. Many jurisdictions have become increasingly concerned with the control of youth crime reflecting a shift in emphasis from welfare to justice approaches. Adult models of justice have come to the fore in the treatment of juveniles in a range of jurisdictions, separating them from children in need of care and protection. Scotland and the State of Massachusetts share a common history of research interests and approaches to dealing with juvenile offenders. The way these jurisdictions have adapted to the demand for public protection in the past decade is explored. It is argued that Scotland has retained a clear welfare focus whilst developments in Massachusetts are more varied. Massachusetts can be seen to offer the appearance of greater public protection by increasing the emphasis on punishment within a system that still deals with the majority of juveniles separately.

The Scottish children's hearings tribunals system: a better forum for parents with learning disabilities?

Parents with learning disabilities are over-represented in child care proceedings and are more likely to lose their children to state care. Evidence from Anglophone countries suggests that the adversarial forum of the court disadvantages these parents and limits their direct participation in the process. This exploratory study examines whether the Scottish childrens hearings tribunal system could promote greater responsiveness to parental needs and support fuller direct participation in decisions about the welfare of their child. Views were not unanimous but on balance, potential for the parental voice to be heard was found and the support of lay advocates was key. The findings point to deficits in legal representation, underscoring the importance of structured time and skill in communicating with people with learning difficulties as a pre-requisite for the effectiveness of legal representation provisions for parents.

Justice and welfare : has the Children (Scotland) Act 1995 shifted the balance ?

Abstract The Children (Scotland) Act 1995 introduces important changes that may in the long term undermine the principles of early intervention, partnership and child welfare embodied in the Children‘s Hearings System. The Act can also be seen to represent a shift towards a more justice-oriented approach to child-care decision-making. Paradoxically whilst child-care policy is moving towards a renewed interest in prevention, family support and partnership, already central concerns in the Children’s Hearings System, the Children (Scotland) Act 1995 may in practice operate to endanger these strengths.

Time trends in hospital admissions for violent, self-inflicted, and drug-related or alcohol-related injury for adolescents in England and Scotland, 2005–11: observational population-based study

Abstract Background In England, a third of emergency admissions of adolescents for injury are adversity related (violent, self-inflicted, drug-related, or alcohol-related). A comparison of time trends of the incidence of admissions for violent injury between England and Scotland revealed steeper declines in 2005–11 in Scotland. We aimed to determine whether incidence of admissions for any adversity-related injury varied substantially between the two countries. Methods We conducted time-series analyses of emergency admissions between 2005 and 2011 for adversity-related injury (defined by the 10th revision of the International Classification of Diseases) to National Health Service hospitals in England (Hospital Episode Statistics) and in Scotland (Scottish Morbidity Records) in 10–18 year olds. Analyses were stratified in groups by sex and age (10–12 years, 13–15, 16–18) and were adjusted for background trends in admissions for any injury. Findings In 2005, rates of admissions per 100 000 for adversity-related injury ranged from 48·9 for girls aged 10–12 years in Scotland (95% CI 0–98·9) to 978·2 for boys aged 16–18 years in Scotland (764·0–1184·3). Rates for 10–12-year-old girls and boys, respectively, were similar between the two countries, but were higher in Scotland for 13–15 year olds and 16–18 year olds. From 2005 to 2011, rates decreased in both countries for all groups by −1·5% per year (95% CI −3·2 to 0·21) to −10·0% per year (–15·2 to −4·4), except for 16–18-year-old girls and boys in England, where rates increased by 0·25% per year (0·09–0·41) to 2·5% per year (1·2–3·7). Decreases in all groups were greater in Scotland than in England after adjustment for trends in admissions for any injury. By 2011, although incidences of admissions for adversity-related injury in adolescents aged 13–15 and 16–18 years remained higher in Scotland, differences between England and Scotland were smaller than in 2005. Interpretation Our finding that rates of admissions for adversity-related injury decreased more steeply in Scotland than in England raises questions about the factors driving these discrepancies. Several initiatives within each country might have been influential. For example, the English government attempted to tackle incidence of violence and gangs by targeting high crime areas with higher levels of policing. The Scottish government set up contracts with local gangs to exchange a so-called clean slate for psychosocial support. Further research into potentially successful practices in Scotland could be used to develop future initiatives to reduce harm in adolescents in both countries and further afield. More research is needed, especially into why the incidence of admissions for adversity-related injury increased for older adolescents in England. Funding AH was supported by the Policy Research Unit in the Health of Children, Young People and Families, which is funded by the Department of Health Policy Research Programme (grant reference number 109/0001). AH is also supported by the University College London Impact studentship. The study sponsors played no part in the design, data analysis, and interpretation of this study; the writing of the abstract; or the decision to submit the abstract for publication.