• Domestic Abuse
• Substance Misuse
• Parental Mental Ill Health
• 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)
• 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
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).
Death
Early
Death
Disease, Disability
Adoption of
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
Birth
Adverse Childhood Experiences
The Influence of Adverse
Childhood Experiences Throughout Life
• Increased risk of lung cancer
• More auto immune disease
• Increased prescription drug use
•
•
•
•
•
•
•
•
•
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
•
•
•
•
•
•
•
•
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
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
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
•
•
•
•
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)
• 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; selfexpectations; personality; type, dosage, admin method
•
•
•
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•
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•
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
• 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
• Effects on Parents
Employment
Income
Relationship strain
Links to substance misuse ad violence
•
•
•
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•
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Separations
Insecure relationships
Neglect
Maltreatment
Carer role
Upset , frightened, ashamed
Bullied
Hear unkind things
Risk of mental illness
Revenge Killing
What a challenge!!
Children’s Voices
• What children say about living
with parental substance misuse
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
• 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.
Evaluation
FED UP & Family SMILES :
Summary of findings so
far
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
people’s emotional & behavioural
problems.
Goodman’s Strengths and
Difficulties Questionnaire
(SDQ)
Child/ Parent
HoNOSCA
Practitioner
Evaluation wheel
Children
To enable children and young
people to process their thoughts
and feelings.
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
To enhance parents’ protective parenting/ to improve the safeguarding of
children & young people: Evaluation wheels with parents
Family SMILES
FED UP
How much I
think my child
is affected by
my behaviour
How much I
think that my
child is
affected by…
5
5
4
4
How much
knowledge I
have about
children's…
How
confident I
feel in asking
for help…
3
How
confident I
feel that I am
doing the…
2
1
0
How
supported I
feel in taking
care of my…
How much
knowledge I
have about
children's
needs at…
How confident
I feel in asking
for help when I
need it
Time 1 (n = 30)
Time 1 (n = 13)
Note: The rating of 1 to 5 where 1 is low and 5 is high
3
2
1
0
How confident
I feel that I am
doing the best
I can for my
child
How supported
I feel in taking
care of my
child
Time 1 (n = 14)
Time 2 (n =6)
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)
Mean at T1 = 19.6, Mean at T2 = 20.8
N = 20 (T1 and T2)
Mean at T1 = 19.05, Mean at T2 = 21.5
25
25
20
20
Score
15
Mean at
T1
Score
15
Mean at T1
Mean at T2
10
10
5
5
0
Mean at T1
Mean at T2
0
Mean at T1
Mean at T2
P value = 0.102 (one tailed t-test)
The change is not statistically significant
P value = 0.009 (one tailed t-test)
The change is statistically significant
To reduce children and young people’s 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
(n=27)
No statistical
significance
between T1 and T2
(n=29)
Parent completed
SDQ
No statistical
significance
between T1 and T2
(n=18)
No statistical
significance
between T1 and T2
(n=9)
HoNOSCA
( completed by
practitioner)
Statistically
significant change
from Time 1 and 2
No statistical
difference
To enable children and young people to process their thoughts and
feelings: Children’s evaluation wheels
Family SMILES
FED UP
I feel
supported
by others
around me
I can talk to
someone if I
am worried
about my
parent's…
5
4
3
2
1
0
I am able to
have a fun
time when I
want to
I can talk to
my parent
about how
their
drug/alcoh…
I can talk to
someone if I am
worried about my
parent's health
5
4
3
I feel supported
by others around
me
I am able to have
a fun time when I
want
Time 1
(n=69)
Time 2
(n=52)
1
0
I can easily
make
friends
I can tell
someone if I
was being
bullied
I can talk to my
parent about how
their mental
health affects me
2
I can easily make
friends
Time 1 (n =
41)
The world is a dangerous place to live. Not
because of the people who are evil, but
because of the people who don’t do anything
about it
(Albert Einstein)
Thank You for Listening
Di Jerwood
djerwood@nspcc.org.uk
Acknowledgements
Professor Julie Taylor
Dr. Prakash Fernandes