Lisa Davies

Distribution of accidents, injuries, and illnesses by family type

Objective. To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children. Design and Subjects. The study is based on a longitudinal, prospective study of a large (n = ∼10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood. Main Outcome Measures. Frequency of accidents, illnesses, and medical interventions. Results. At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and childrens physical health. Conclusions. The consequences of family transitions on childrens health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider childrens physical health and health-related behaviors.

Family lives and friendships: The perspectives of children in step-, single-parent, and nonstep families

Childrens reports on their experiences in different family settings (stepfamilies, single-parent families, and intact families), their contact with friends, and the quality of their friendships were studied with data from 238 children drawn from a community sample. A particular focus was on childrens confiding and communication: childrens recall of communication about family transitions and their current communication about stepfamily issues with family and friends. Friends were found to be key confidants. The relations between childrens family lives (confiding, parent-child relationships, family activities, involvement in parental conflict, and communication about stepfamily issues) and their friendships were investigated and found to be linked to biological relatedness and family setting.

Young children’s perceptions of their relationships with family members: Links with family setting, friendships, and adjustment

A total of 258 children aged 4-7 years, from 192 families of diverse structure (stepfather, single parent, stepmother/complex stepfamilies, and nonstep families), participated in this study of young children’s perceptions of their family relationships. Children completed a Four Field Map, in which they placed their family members and friends in a series of concentric circles representing the closeness of the relationship. Biological relatedness and family type affected the placement of fathers, but not mothers or siblings; children in stepfather families were more likely to place their stepfathers as “not close”. Links were found between the quality of child-mother and child-sibling relationships and the closeness of children’s friendships. Children’s externalising problems were related to their perceptions of their relationships with fathers and their prosocial behaviour to their closeness with both fathers and mothers.

The security, clinical and social needs of patients in high security psychiatric hospitals in England

Previous studies have indicated that between one and two thirds of patients in the high security psychiatric hospitals (HSPHs) could be transferred to lower security. The aim of this study was to measure the individual and placement needs of all patients in the three HSPHs in England. In total 1255 patients were assessed using staggered census dates. Five hundred (40%) patients were rated as suitable for transfer to lower security. Long-term medium and low security facilities constituted over half of the recommended alternative placements. Unmet needs for the total population were most frequently reported with daytime activities, substance misuse, sexual offending, safety to others, and psychotic symptoms. Most clinical and social needs were met. High secure Responsible Medical Officers (RMOs) reported that 500 patients could be transferred immediately to lesser levels of hospital security if such facilities existed. However 60% of patients were rated as continuing to require high secure care therefore special hospitals, or their equivalent, continue to be needed for the foreseeable future in England.

The individual needs of patients in high secure psychiatric hospitals in England

A comprehensive assessment of the needs of all high security psychiatric hospital (HSPH) patients in England has not previously been conducted. All inpatients in the three HSPHs in England (Ashworth, Broadmoor and Rampton, n = 1256) were assessed. Factors associated with placement need were modelled using logistic regression, then cluster analysis was used to identify patient subgroups on the basis of their individual needs. Forty percent of the patients could be transferred out of high security, according to the RMOs. While it was possible to identify factors associated with the continued need for high security the false negative rate was high. Patients had very diverse needs that did not fit neatly into clustered sub-groups. Due to the heterogeneity of the individual patients currently in the HSPHs, future service planning will need to focus on individualized treatment packages that are based on individual assessments of need. Such assessments should be considered in the wider framework of risk and accountability.