John Devaney

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.

Accessing Social Work Case Files for Research Purposes: Some Issues and Problems

The use of social work case files as an important research resource is being threatened by the increasing regulation of both the research process and access to personal identifiable information. While these developments can be seen as a reaction to specific incidents of inappropriate research and the misuse of personal information, it is argued that the pendulum has swung too far the other way, and in seeking to protect the rights of vulnerable individuals, the lives of these same individuals may go unstudied with the consequence that they receive less appropriate services. Drawing upon the current research of the authors, this article explores the difficulties encountered in gaining access to social work case files for research purposes without the explicit consent of service users and highlights the uncertainty surrounding this issue. Suggestions are made for improvements in the situation.

Reflecting on outcomes for looked-after children: an ecological perspective

Despite huge investment over the past 10 years, improving outcomes for looked-after children remains elusive. A challenge for practitioners, researchers and policy-makers alike has been the absence of a shared conceptual framework for considering and responding to the needs of looked-after children. A second challenge relates to the measurement of outcomes. In this article the authors reflect on the multiple factors that contribute to outcomes for looked-after children and, drawing upon the work of Cronen and Pearce, propose an organising framework. In as much as it facilitates reflection on the complex interplay between looked-after children and their environments, the ecological perspective outlined in this article holds some promise as an aid to targeting interventions more effectively and efficiently.

Mandated prevention in child welfare: Considerations from a framework shaping ethical inquiry

• Summary: This article outlines a framework for approaching ethical dilemmas arising from the development, evaluation and implementation of child welfare policies. As such, it is relevant to policy-makers, social researchers and social workers. The central tenets of the framework are developed by drawing on ideas from moral philosophy and critical social theory. These ideas are presented as axioms, theorems and corollaries, a format which has been employed in the social sciences to offer a rational justification for a set of claims. • Findings: This process of reasoning leads to four principle axioms that are seen to shape the ethical scrutiny of social policy: 1) problematizing knowledge; 2) utilizing structured forms of inquiry to enhance understanding; 3) engendering enabling communication with those affected by the ethical concern; and 4) enhancing self-awareness. • Applications: The four axioms are then applied, by way of example, to the current and contentious, ‘third way’ policy of mandated prevention in child welfare, where the aim is to obviate deleterious outcomes in later life. It is argued that the framework can be applied beyond this specific concern to other pressing, ethical challenges in child welfare.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

BackgroundAlthough disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services.MethodsEleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement.ResultsFindings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse.ConclusionsBased upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base.

Male Perpetrators of Domestic Violence: How Should We Hold Them to Account?

Domestic violence is now widely acknowledged as being a significant social, health and legal issue. At both a national and transnational level governments have sought to develop strategies built upon prevention, support for victims and holding perpetrators to account through criminal justice sanctions. However, the current paradigm that informs the policy response to most perpetrators of domestic violence has failed to deliver the outcomes required, in terms of a reduction in levels of recidivism or the improved safety of women and children. It is argued that holding men to account through external controls has failed and that interventions should support men to take responsibility for their own behaviour.

Disabled women’s experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study

BackgroundWomen and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.MethodsThe aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers impacting their access to care. Data were generated during 2013 using one-to-one interviews.ResultsFive women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.ConclusionsPositive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

Priorities and strategies for improving disabled women’s access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps

BackgroundDomestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies.MethodsThis multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen’s model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women’s access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach.ResultsThe three most highly ranked barriers to women’s access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women’s fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure.ConclusionsThe study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings.

Promoting Contact for Children in State Care: Learning from Northern Ireland on the Development of a Framework for Assessing Contact

ABSTRACT While the principle of contact between children in care and their families is enshrined in law, the precise form and frequency is at the discretion of social workers and the courts. Professionals must seek to balance the twin principles of children’s need for protection from the psychological, emotional and physical harm that may arise from having contact with parents and other family members, with the need of family members and children to have their relationships and identity promoted. Courts require clear, structured and unambiguous information about the needs of children and their parents in order to make decisions which will have potentially life-changing implications for families. In this article we explore one approach to supporting the decision making of legal and social work professionals in relation to the frequency and form of contact by reflecting upon the development by the first author of an approach to assessing the quality and benefits of contact for children in State care in Northern Ireland. We discuss the key principles that should inform decisions and good practice through reflecting on the learning gained from developing and implementing such a structured approach. We conclude that practice has been informed by promoting legal rights without sufficient consideration of the relational aspects of making contact work for each of the involved parties.

Allowing imprisoned fathers to parent: maximising the potential benefits of prison based parenting programmes

ABSTRACT During imprisonment, fathers are separated from their families and contact is limited. When delivering a prison based parenting programme, providing an opportunity to rehearse newly acquired parenting skills can be key for mastering the performance of these skills and using these skills to improve father-child relationships. This paper takes an in-depth look at how one parenting programme in Northern Ireland sought to overcome this challenge by providing additional opportunities to parent via increased telephone contact and special family friendly visits. Using a combination of in-depth interviews and observations, how fathers and their families responded to this increased contact is explored, as well as the extent to which this increased contact facilitated the acquisition of the parenting skills being taught on the programme. It is argued that while prison based parenting programmes can improve parenting skills and father-child relationships, their potential long-term effectiveness may be limited by wider prison policies, procedures and practices surrounding prison visitation, telephone access and the progression of fathers following the completion of such programmes. Recommendations and suggestions for future practice are offered.