Improving Outcomes for Children who Live in High Risk Families Di Jerwood

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Improving Outcomes for Children who Live in
High Risk FamiliesDi Jerwood
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High Risk Families

• Domestic Abuse
• Substance Misuse
• Parental Mental Ill Health

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Multiple Adversities

• Abuse neglect are often a feature of a range of
  family difficulties and problems
• Often compounded by poverty, house moves
  eviction
• Cumulative harm
• A wicked problem
• Reconceptualisation
• Bunting Toner (2012) Devaney Spratt (2009)

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The ACE Study(Adverse Childhood Experiences)

• Adverse Childhood Experiences their
  relationship to Adult Health and Well-Being
• Child abuse neglect
• Growing up with domestic violence, substance
  abuse, mental illness, crime.
• 18.000 participants
• 10 year study
• Anda, R., Felliti, V., (2010) The Adverse
  Childhood Experiences (ACE) Study
  www.acestudy/org

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Adverse Childhood Experiences determine the
likelihood of the ten most common causes of death
in the United States

• Top 10 Risk Factors
• smoking,
• severe obesity,
• physical inactivity,
• depression,
• suicide attempt,
• alcoholism,
• illicit drug use,
• injected drug use,
• 50 sexual partners,
• history of STD (sexually transmitted disease).

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Early
Early
Death
Death
Death Birth
Disease, Disability
Adoption of
Health-risk Behaviors
Social, Emotional,
Cognitive Impairment
Adverse Childhood Experiences
Adverse Childhood Experiences
The Influence of AdverseChildhood Experiences
Throughout Life
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Some findings so far

• Increased risk of lung cancer
• More auto immune disease
• Increased prescription drug use

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New Themes Emerging

• Importance of ecological frameworks
• Mirroring families and agencies
• Exclusion of fathers
• Fixed thinking
• Start again syndrome
• The rule of optimism
• Silo practice
• Disguised compliance
• Vulnerability of older children and adolescents
• Sidebotham, P., (2012) What do serious case
  review achieve? Arch Dis Child 97 (3) 189-192

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Common themes in SCRs of fatal and child
maltreatment

• Family Characteristics
• Minority previously known to CSC
• The invisible child
• Failure to interpret the information
• Poor recording of information and decisions
• Decision making
• Relations with family
• Thresholds
• Sidebotham, P., (2012) What do serious case
  review achieve? Arch Dis Child 97 (3) 189-192

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Domestic Abuse

• Domestic abuse is a major issue and accounts
  for 25 of all recorded violent crime (police
  statistics)
• On average 2 women a week are killed in England
  and Wales by partners - ex partners ( home
  office)
• 24.8 18 to 24 yr. olds witnessed DV
• at some time during childhood

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Children are affected

• Children who live with domestic abuse are
  significantly affected and this can be manifest
  in a number of ways, including,
• Physical injury
• Disruptive behaviour
• Difficulties at school
• Depression, resentment, anger
• Sleep disturbances
• Sense of loss
• Bed wetting and nightmares
• Guilt, confusion, sadness, self blame
• PTSD

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Drug and Alcohol Related Problems

• 300,000 children in the UK (Scotland 59,600)
• Conflation of substances
• 1100 children pa die as a direct result
• Children four times more likely to develop a
  dependency
• Prevalent in cases of DA and child protection
• Strong links between alcohol and violence
• Little evidence that substance use alone is a
  risk factor
• SG Statistics (2011) Best (2011) Scottish Drug
  Recovery Consortium ACMD 2007 Forrester and
• Harwin (2008)

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Problem Substance Misuse

• Effects on Parents
• Physical Ailments (e.g. infections, injuries)
• Psychological impairments
• Withdrawal symptoms
• Psychoses
• Serious memory lapses
• Most short lived
• Manifestation mental health psychological
  impact of drug self- expectations personality
  type, dosage, admin method

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Children are affected

• Neglect
• Physical abuse, sexual abuse etc
• Exposure to dodgy adults
• Unstable and violent environment
• Feel second to drugs
• Exposure to noxious hazards
• Criminality
• Health issues

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Mental Illness Scale of the Problem

• About on in four adults is affected by mental
  illness
• Most cases will be mild or short lived
• Sometimes severe (e.g. schizophrenia or manic
  depression)
• Many more live with long term personality
  disorder or long term depression
• 40-60 of people with a severe mental illness
  have children
• Around a third of children subject to CPP (CPR NI
  Scotland)
• The Psychiatrist (2003) 27 117-118 ?doi
  10.1192/pb.27.3.117

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Parental Mental Illness

• Effects on Parents
• Employment
• Income
• Relationship strain
• Links to substance misuse ad violence

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Parental Mental Illness Effects on Children

• Separations
• Insecure relationships
• Neglect
• Maltreatment
• Carer role
• Upset , frightened, ashamed
• Bullied
• Hear unkind things
• Risk of mental illness
• Revenge Killing

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What a challenge!!
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Childrens Voices

• What children say about living with parental
  substance misuse

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FEDUP (Family Environment Drug using Parents)

• A family approach to supporting children who
  live with parental substance misuse
• Group work programme with children
• Individual work with parents
• Come together for safety planning

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Family SMILES Simplifying Mental Illness plus
Life Enhancement Skills)

• Based on the Erica Pitman Programme
• Twin track programme working with children and
  their parents to reduce the risk of harm to
  children who live with parental mental ill
  health.

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Evaluation

• FED UP Family SMILES Summary of findings so
  far

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Overview of the evaluation tools
Overall aim To improve the well-being of
children and young people and reduce isolation
Specific aim Tool Perspective
To enhance parents protective parenting/ to improve the safeguarding of children young people. Child Abuse Potential Inventory (CAPI) Evaluation Wheel Parent
To enable children and young people to feel better about themselves. Self Esteem Scale (based on Rosenberg) Child
To reduce children and young peoples emotional behavioural problems. Goodmans Strengths and Difficulties Questionnaire (SDQ) Child/ Parent
To reduce children and young peoples emotional behavioural problems. HoNOSCA Practitioner
To enable children and young people to process their thoughts and feelings. Evaluation wheel Children
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Interim Findings ( October 11 to February 13)
To enhance parents protective parenting/ to
improve the safeguarding of children young
people.

• For both FED UP and Family SMILES there has been
  a decrease in total CAPI score between T1 and T2
  which is statistically significant for both
  programmes. This indicates that for both
  programmes parents are reporting a positive
  change in their parenting behaviours related to
  improving the safeguarding of their children.
• The change in five out of seven subscales on the
  CAPI was statistically significant for FED UP
  suggesting that parents levels of distress,
  unhappiness, problems with the family, loneliness
  and ego strength have all improved. For Family
  SMILES , the distress, unhappiness and ego
  strength subscale are statistically significant

Note For both FED UP and Family SMILES number
of Time 1 and Time 19, Statistical significance
at 95 confidence levels using a one tailed test
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To enhance parents protective parenting/ to
improve the safeguarding of children young
people Evaluation wheels with parents
FED UP
Note The rating of 1 to 5 where 1 is low and 5
is high
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To enable children and young people to feel
better about themselves
Levels of self esteem amongst children as
reported on the adapted Rosenberg scale
increases on both programmes. In Family SMILES,
this change is statistically significant.
FED UP Family SMILES N 28 (T1 and T2)
N 20 (T1 and T2) Mean at T1 19.6, Mean
at T2 20.8 Mean at T1 19.05, Mean at T2
21.5

P value 0.102 (one tailed t-test) P
value 0.009 (one tailed t-test) The change is
not statistically significant The change is
statistically significant
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To reduce children and young peoples emotional
behavioural problems.
At present the evaluation is not showing any
statistically significant change in reducing
emotional and behavioural problems as reported on
the SDQ on either the FED UP or the Family SMILES
programmes. Practioners on FED UP have reported
change that is statistically significant using
the HoNOSCA
FED UP Family SMILES
Self Report SDQ No statistical significance between T1 and T2 (n27) No statistical significance between T1 and T2 (n29)
Parent completed SDQ No statistical significance between T1 and T2 (n18) No statistical significance between T1 and T2 (n9)
HoNOSCA ( completed by practitioner) Statistically significant change from Time 1 and 2 No statistical difference
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To enable children and young people to process
their thoughts and feelings Childrens
evaluation wheels
Family SMILES
FED UP
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The world is a dangerous place to live.
Not because of the people who are evil,
but because of the people who dont do
anything about it (Albert Einstein)
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Thank You for Listening Di Jerwood djerwood_at_nspcc.
org.uk Acknowledgements Professor Julie
Taylor Dr. Prakash Fernandes