Kate Morris

Investing in children, regulating parents, thinking family: a decade of tensions and contradictions

This article describes the contested and underdeveloped backdrop to ‘“whole family” approaches’, whereby families with care and protection needs are caught in a conflicting set of policy and practice expectations concerning responsibility to care whilst being positioned as families that fail. Questions are raised about how supported families are to navigate their way through these permissive and punitive policies and practices. We suggest that there is an urgent need for more ‘bottom–up’ research informed by the ethic of care to develop the kinds of policies and practices that might make it more possible for them to do so.

The legacy of sperm banking: how fertility monitoring and disposal of sperm are linked with views of cancer treatment

BACKGROUND Sperm banking is recommended for all men before cancer treatment, which carries a risk of long-term gonadal damage. However, relatively few men take up the offer. Among them, few attend for fertility monitoring or agree to sperm disposal where fertility recovers. Sperm banks are therefore burdened by long-term storage of samples that may not be needed for conception, with implications for healthcare resources. The aims here were to determine the views of men regarding personal benefits of sperm banking, and the advantages and disadvantages of fertility monitoring and disposal in the longer term. METHODS Semi-structured interviews were conducted with 19 men who were diagnosed with cancer and had banked sperm at least 5 years previously. Men were asked to recall their experiences from diagnosis to the present time, focusing on the consequences for their fertility. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. RESULTS Results are discussed in relation to decisions surrounding banking sperm, fertility monitoring and attitudes to disposal of banked sperm. Complex attitudes were identified, with mens views reflecting their understanding of their current and future fertility and the possible trajectory of cancer itself. Men are overwhelmed by information on diagnosis and fail to understand the implications of cancer treatment for their future fertility. CONCLUSIONS On diagnosis, men are given large amounts of information about cancer and treatment but fail to understand the longer-term implications of sperm banking. These implications need to be specifically addressed at subsequent appointments in order to optimize fertility monitoring and timely disposal of sperm samples.

Implications of sperm banking for health-related quality of life up to 1 year after cancer diagnosis

Background:Sperm banking is recommended for all men diagnosed with cancer where treatment is associated with risk of long-term gonadatoxicity, to offer the opportunity of fatherhood and improved quality of life. However, uptake of sperm banking is lower than expected and little is known about why men refuse. Our aims were to determine: (i) demographic and medical variables associated with decisions about banking and (ii) differences in quality of life between bankers and non-bankers at diagnosis (Time 1 (T1)) and 1 year later (Time 2 (T2)).Methods:Questionnaires were completed by 91 men (response rate=86.67%) at T1 and 78 (85.71% response rate) at T2.Results:In all, 44 (56.41%) banked sperm. They were younger and less likely to have children than non-bankers. In a subset of men who were not sure if they wanted children in the future (n=36), 24 banked sperm. Among this group, those who banked were younger, more satisfied with clinic appointments and less worried about the health of future children. At T2, there were no differences in quality of life between bankers and non-bankers.Conclusion:For those who are uncertain about future reproductive plans, decisions depend on their health on diagnosis and satisfaction with clinic care. We conclude that extra care should be taken in counselling younger men who may have given little consideration to future parenting. Results support previous findings that the role of the doctor is vital in facilitating decisions, especially for those who are undecided about whether they wanted children in the future or not.

Monitoring fertility (semen analysis) by cancer survivors who banked sperm prior to cancer treatment

STUDY QUESTION What medical and psychological variables predict why men with banked sperm do not return for semen analysis after their cancer treatment has ended? SUMMARY ANSWER Men who decline the offer of semen analysis are less likely to have reported adverse side effects during cancer treatment, and have a more negative experience of banking sperm and a more negative attitude towards disposal of their stored semen than those who attend. WHAT IS KNOWN ALREADY Previous authors have noted that male cancer survivors seem reluctant to have their fertility tested after their treatment has ended. Moreover, the utilization rates of banked sperm are very low (<10%) and the majority of samples are kept for many years without being used. STUDY DESIGN, SIZE AND DURATION A cross-sectional study of 499 cancer survivors who were sent a questionnaire about their views on sperm banking, fertility and post-treatment semen analysis between April 2008 and December 2010. PARTICIPANTS AND SETTING Men (aged 18-55 years) who had banked sperm in Sheffield and Nottingham (UK) prior to gonadotoxic treatment for cancer more than 5 years previously. MAIN RESULTS AND THE ROLE OF CHANCE Completed questionnaires were received from 193 men (38.7% response rate) whose samples had been banked for 9.18 ± 3.70 years (range = 4.94-26.21) and whose current age was 35.08 ± 7.08 years (range = 21.58-54.34; mean ± SD). One-third (35.8%) had never attended for semen analysis. In multivariate analysis, the odds of not attending for semen analysis were significantly greater among men who did not experience adverse treatment side effects [odds ratio (OR) = 5.72, 95% confidence interval (CI) = 2.10-15.56], who reported a more negative experience of banking sperm (OR = 1.82, 95% CI = 1.17-2.82) and a more negative attitude to disposal of their stored semen (OR = 1.56, 95% CI = 1.01-2.42). LIMITATIONS AND REASONS FOR CAUTION Only 38.7% of those eligible agreed to take part. We do not know the characteristics of men who declined to take part, if they agreed to attend semen analysis without completing the questionnaire or whether they had chosen to have semen analysis performed elsewhere (e.g. private sector). Some of the measures used (e.g. experience of banking sperm) relied on mens recall of events many years previously. WIDER IMPLICATIONS OF THE FINDINGS New strategies are required to encourage these men to engage with fertility monitoring programmes if sperm banks are to be used cost-effectively and men are to be given appropriate fertility advice. STUDY FUNDING AND COMPETING INTERESTS This paper was supported by funding from Cancer Research-UK to C.E., A.A.P. and R.R. (C481/A8141). The views expressed are those of the authors. No competing interests declared.

Understanding Child and Family Welfare

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Technology, social services and organizational innovation or how great expectations in London and Cardiff are dashed in Lowestoft and Cymtyrch

The purpose of this paper is to illuminate important aspects of the policy implementation process in UK welfare organizations. We draw on two evaluations in which we were each involved — those of the Integrated Childrens System and the Childrens Fund. Our interpretive frameworks share a concern to foreground the significance of the local, informal, and ground level, but do so in ways that acknowledge the encompassing governmental and policy contexts. We illustrate and assess the significance of multiple policy aspirations, the significance of local implementation contexts, the diverse ways in which practitioners gain and subsequently develop knowledge of how policy works, and how such knowledge moves about in organizations. We indicate the kinds of expertise that social service workers bring to and achieve as actors within policy innovations, and how they may manage and in some cases seek to control knowledge shifts between providers and users of services. We infer the inadequacy of conventional top-down models of implementing policy innovations.

Inequalities in English child protection practice under austerity: a universal challenge?

The role that area deprivation, family poverty, and austerity policies play in the demand for and supply of childrens services has been a contested issue in England in recent years. These relationships have begun to be explored through the concept of inequalities in child welfare, in parallel to the established fields of inequalities in education and health. This article focuses on the relationship between economic inequality and out-of-home care and child protection interventions. The work scales up a pilot study in the West Midlands to an all-England sample, representative of English regions and different levels of deprivation at a local authority (LA) level. The analysis evidences a strong relationship between deprivation and intervention rates and large inequalities between ethnic categories. There is further evidence of the inverse intervention law (Bywaters et al., 2015): For any given level of neighbourhood deprivation, higher rates of child welfare interventions are found in LAs that are less deprived overall. These patterns are taking place in the context of cuts in spending on English childrens services between 2010–2011 and 2014–2015 that have been greatest in more deprived LAs. Implications for policy and practice to reduce such inequalities are suggested.

Let’s stop feeding the risk monster: towards a social model of ‘child protection’

This article explores how the child protection system currently operates in England. It analyses how policy and practice has developed, and articulates the need for an alternative approach. It draws from the social model as applied in the fields of disability and mental health, to begin to sketch out more hopeful and progressive possibilities for children, families and communities. The social model specifically draws attention to the economic, environmental and cultural barriers faced by people with differing levels of (dis)ability, but has not been used to think about ‘child protection’, an area of work in England that is dominated by a focus on risk and risk aversion. This area has paid limited attention to the barriers to ensuring children and young people are cared for safely within families and communities, and the social determinants of much of the harms they experience have not been recognised because of the focus on individualised risk factors.

Working with the whole family: What case files tell us about social work practices

Practice theories to support child protection social work in the United Kingdom, as in the United States and Australia, are being squeezed out by a focus on performance targets and procedural timescales. This study examines an innovative programme designed to reverse this trend initiated by an English local government authority. The programme aimed to embed systemic family practice in situations where children are deemed to be at risk of harm. The findings, derived from an analysis of a case file sample, indicate that social worker interaction with family members is predicated on who is living with the child in conjunction with the risk status of the case file. Conversely, practitioner interactions with family members are divorced from family structure and the lived experiences of kin relationships. This study concludes by examining why, despite training in systemic family practice, it was problematic for social workers to integrate it into their encounters with families.

Why don't some men with banked sperm respond to letters about their stored samples?

Abstract Long-term storage of banked sperm, especially when it is not needed, for reproductive purposes, is costly and poses practical problems for sperm banks. For sperm banks to function efficiently, men must understand the implications of unnecessary storage, and make timely decisions about disposal of their own samples. Men who bank sperm prior to cancer treatment are routinely offered follow-up consultations to test their fertility, update consent and, where necessary, expedite referral for Assisted Conception. Yet sperm banks report that men do not respond to letters, suggesting samples are stored needlessly. We conducted semi-structured interviews with six men with a history of not responding to letters, to document reasons for non-response. Interviews were transcribed and analysed using Interpretive Phenomenological Analysis. Mens reasons for not responding are a complex interplay between past, present and future perspectives. In terms of their past, information is important on diagnosis, because men must understand that fertility can change after treatment. Present and future concerns focus on fears of being told fertility has not recovered and being pressured to dispose of banked sperm. The challenge is to devise invitation letters that address mens concerns while offering them tangible benefits and peace of mind.