The Bristol City Office

Tessa Coombes, PhD student in the School for Policy Studies, former councillor, ex-policy director at Business West, and part-time blogger considers the new plans for the City office and the impact this will have on the way Bristol is governed and the people who govern it.

city-office

Marvin Rees addressing his new office. (Image courtesy of Tesssa Coombes)

There’s a new approach to partnership working being proposed in Bristol.

Living as we do in the most centralised state in the western world, many different approaches have been taken over the years to try and break down barriers, grab additional local power and move away from the silo thinking that dominates our political and administrative systems. However, few of these have managed to make any significant difference to policy and decision making at a sub national and local level.

Recent years have seen more debate about devolution, leadership and collaborative governance. This has manifested itself in discussions around ‘place-based leadership and power’ where different ways of working are being identified to address the challenges faced by localities. There’s also been a change to the way some cities are governed, with the introduction of directly elected mayors providing clear, accountable local leadership with enhanced powers.

Robin Hambleton in his book “Leading the Inclusive City” (2015) sets a conceptual framework that identifies five intersecting realms of leadership: political leadership, public managerial/professional leadership, trade union leadership, business leadership, and community leadership. He suggests that where these realms overlap we create innovation zones where more creative and inventive behaviour takes place, particularly where it can be focused on aspects of unified action.

It is this very concept that is about to be tried in Bristol through the creation of a City Office. It’s an idea that seeks to address some of the challenges faced by the public sector, with ever decreasing budgets and reducing powers. It is about partnership and collaborative governance, bringing organisations, individuals and budgets together to tackle the issues that we have failed to tackle before, where collaboration and joint working are essential, alongside the willingness to be creative and innovative.

Whilst there have been many partnerships developed over the years in Bristol, some that have worked, others that have been less successful, somehow this new partnership feels different. Perhaps the increasingly challenging context for change is one reason why it feels different this time. With a new form of governance in the city, a directly elected mayor who can lead with greater power and greater visibility, maybe there is now the direction and clarity the city has needed to make this work.

There is also the ‘shadow of austerity’ across the whole of the public sector and local government in particular. The council in Bristol once again faces severe cuts that mean its ability to do anything beyond deliver on statutory services is significantly reduced. That in itself is a big restraint, when you are facing big problems in the city that cannot be solved without significant time, effort and resource. Yet, there is a history of partnership working in the city that has successfully delivered change, with business, public and voluntary/community sectors coming together to make things happen.

Bringing these elements together, in a new partnership approach, could provide the impetus needed to make a difference.

The idea is to enable the city to develop solutions to the issue that matter most, issues that to date we have failed to adequately address. It is also about learning, experimenting and innovating, about not being too afraid of failure and being brave enough to take risks in order to find that set of solutions that do work. The city office is unique in its aim of changing the way we do things, by working together and applying collective resources to the challenges we face, by taking a truly ‘total place’ approach to city development.

It will operate at both a strategic and tactical level, bringing organisations together on project activities that deliver in the short and medium term as well as focusing on creating a shared vision for the future. The concept of additionally is critical, all the projects and activity of the city office need to bring with them the ability to provide something extra as a result of working together.

In addition to the project activity, the Mayor introduced the idea of a ‘Single Plan for Bristol‘, a strategic level shared vision for the future of the city, in a similar vein to the OneNYC Plan. A bold idea that has the potential to really make a difference to the key challenges we face as a city. This is where the city office can bring people and organisations together to work collaboratively to set out a long-term simple but ambitious vision with measurable and achievable short and medium term targets. It should be about addressing the root causes of problems and providing sustainable solutions, and not ducking the difficult issues. It is also where we can set out how we address the ‘big’ issues, like how we eradicate inequality and poverty in our city, providing something that everyone should be able to sign up to.

There’s a long way to go on developing the city office and this new approach to ‘place-based leadership’ but so far the signs are positive and the potential is definitely there to influence and create change.

The UK Diet and Diabetes Questionnaire: A new tool for assessing dietary habits.

Dr Clare England, Senior Research Associate and Specialist Diabetes Dietitian, in the Centre for Exercise, Nutrition and Health Sciences and the NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, discusses the challenges of providing individualised dietary advice for people with Type 2 diabetes and introduces a new, validated assessment tool, that may offer a solution.

beer-and-sausage-roll

Diabetes UK estimates that over 3 million people in the UK are living with Type 2 diabetes, and a further 5 million are at high risk. Complications (for example, increased cardiovascular disease, kidney failure, blindness, foot ulcers and amputations) caused by poorly controlled Type 2 diabetes, costs the NHS an estimated at £7.0 billion.

There is an increasing choice of medication available for Type 2 diabetes which can help to reduce blood glucose, cholesterol and blood pressure, but a healthy diet, regular physical activity and good weight management underpin successful control.

There is strong evidence that regular dietary advice, provided by dietitians improves blood glucose control by improving diet. The National Institute for Health and Care Excellence (NICE) recommends that all people with Type 2 diabetes should receive individualised, on-going dietary advice from a health professional with expertise in nutrition, but many people aren’t getting this. Unfortunately, there are not enough specialist diabetes dietitians employed to provide this level of service, and there is considerable variation in provision. For example, the community dietetic service for people living in the north, inner city and east of Bristol is run by a different provider, on a different model, from that provided for people in South and West Bristol.

In the current environment the majority of people with Type 2 diabetes get their routine dietary advice from their GPs, practice nurses or community pharmacists. Some of these health professionals do an excellent job in providing good quality dietary advice but many say that feel they do not have the expertise to assess diets and give individualised advice. I have often heard people with Type 2 diabetes saying that the dietary advice they receive from their general practice is generic, and they struggle to see how to apply the advice they are given to make specific, beneficial changes to their own dietary habits.

avocado-tomato-salad

With this in mind, clinicians and academics at the Centre for Exercise, Nutrition and Health Sciences and School of Clinical Sciences felt there was a need for a brief dietary assessment tool that helps people assess their diets, and enables them to set dietary goals based on this assessment.

Over the last three years we have worked with dietitians, nurses, GPs and people with Type 2 diabetes to develop a brief dietary questionnaire to rapidly assess the dietary habits thought to be of most importance for people with Type 2 diabetes. The resulting questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), asks about consumption of higher energy foods and drinks, fruit, vegetables, oily fish, common higher fibre cereal foods and meal patterns. It takes roughly 10 minutes to complete and can be self-scored. We have just published the validation paper, which showed it to be reliable and compares as well with food diaries as other short dietary questionnaires. The UKDDQ is publically available for download and is equally applicable to people with a diagnosis of Type 2 diabetes, those at risk of Type 2 diabetes and the general population interested in healthy eating. Since the initial development, we have also worked with other researchers from the School of Sport, Exercise and Rehabilitation Science at the University of Birmingham, to check that the questionnaire is relevant to South Asian people (and made a few small changes to wording) and the UKDDQ was adopted by Birmingham South and Central Clinical Commissioning Group as the tool used for dietary assessment in the initial phase of the NHS Diabetes Prevention Programme.

We believe that using the UKDDQ in clinical practice would promote dietary change in people with, or at high risk of, Type 2 diabetes more effectively than the existing generic advice that people are currently hearing. We are planning further work to demonstrate this and would welcome interest from health professionals or people with Type 2 diabetes who would like to be involved in the project.

UKDDQ Project contact details:
Dr Clare England, clare.england@bristol.ac.uk
Centre for Exercise, Nutrition and Health Sciences / Bristol Nutrition BRU

‘Solidari-tea’ with Helen from The Archers

The Archers

Image of Ambridge courtesy of The Archers, bbc.co.uk

Dr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, School for Policy Studies, discusses how the current storyline in The Archers raises the question of what justice means when it comes to abuse?

Social media has once again been a-twitter with discussion about The Archers.

I wrote back in April about the domestic violence and coercive control storyline and how the producers had managed to shine a light on the often hidden aspects of abuse. As the story moves this week into the Courts, the media is once again gripped by the drama, with people posting their pictures of solidari-tea with the central character, Helen. The Mail Online even ran a story with Barristers discussing the fictional case .

As with the issue of coercive control more generally, the programme makers are tackling an important aspect of the experience of abuse, namely what is justice when it comes to abuse? This links directly to our current ESRC funded research which is looking at Justice, Inequalities, and Gender Based Violence. This research includes looking at police case files to examine the trajectory of different cases in relation to inequalities and different types of abuse. In addition, we are currently recruiting victims/survivors to speak to us about their experiences of different types of gendered abuse and justice. This includes adult men and women who may have experienced forced marriage, sexual violence, sexual abuse, ‘honor-based’ crimes, and domestic violence and abuse. This project looks beyond the narrow focus of justice in terms of the police and courts, although this is not excluded, and includes people who, for a range of reasons, haven’t reported to the police or have used alternative forms of justice.

This project, like the current Archers storyline, is intended to illustrate what justice and injustice look like, and how formal and informal responses to abuse can highlight the wider responsibilities of society to address the issue and take a stand.

Whatever the outcome in The Archers, the everyday reality for many victims/survivors is that the very idea of ‘justice’ is more complex than a court outcome. Domestic abuse doesn’t just impact on the victims/survivors, but the perpetrators themselves (research shows they have higher rates of depression and anxiety), friends and family members, as well as wider communities. This is all too real for those who have themselves or know someone who has experienced abuse.

The Archers storyline sheds a light on the wider impacts of abuse as the manipulation of the perpetrator affects a whole raft of relationships within families and communities. Irrespective of whether Helen gets ‘formal’ justice in the coming weeks, the damage to those relationships will continue for many years to come. Some would question therefore whether we can ever get ‘justice’ when so many harms go unanswered.

We look forward to following the fictional court case as well as the on-going struggles which the main characters and the Ambridge community as a whole face as they come to terms with the impact of abuse. We once again commend the writers for staying true to the victim’s story and not turning away.

Anyone interested in taking part in our justice research can register an interest, or contact us to discuss in more detail, at:

Website: http://tinyurl.com/hj5oda5
Email: sps-justiceproject@bristol.ac.uk
Telephone: 07807 799967.

Disability hate crime – Why we need to change the narrative

norah fry logo webDr Sue Porter, Research Fellow at the Norah Fry  Centre for Disability Studies, School for Policy Studies, reflects on the horrific mass attack on Disabled people in Japan on the 26th July and what a Disability Studies lens can bring to our understanding of such hate crimes.

Those attacked in Sagamihara were living in a 150 bed unit for people with learning disabilities, and as such we must assume that the majority of residents were removed from their families and geographical communities. We know that a key factor that encourages hate crime is the “othering” of disabled people, which is reinforced by this sort of segregation. In the UK the Disability rights movement was born out of a desire to resist this sort of institutionalization of disabled people and campaigned to provide the means for disabled people to live within our chosen communities, whether independently or interdependently.

Since the 1980s this has been at the heart of UK government policy, informing personalisation‐related legislation and more recently the Care Act. Even at a time when many question whether austerity‐related cuts in funding to local authorities and changes in welfare benefits are undermining the practicality of independent living for growing numbers of disabled people in the UK, the importance of independent living is acknowledged as key to disabled people being active members of society. However, amongst people with learning disabilities and a label of challenging behaviour or mental health need, there are still over 2.5k living in institutional settings ‐ Assessment and Treatment Units ‐ at a distance from their home communities, for extended periods and without discharge plans. There is little provision in the community for these individuals and a growing number of mini‐institutions (18 or 20 bed) are either in operation or currently being built. So the ‘othering’ and segregation of this particular group of disabled people goes on in spite of the rhetoric, the policy and the promises made after the Winterbourne View abuse scandal.

At the same time cultural references such as the recent Hollywood film ‘Me Before You‘ continue to promote the message that it is better to be dead than disabled. For some it seems hard to imagine that a life lived with impairment or chronic illness is a life worth living. On 11 September 2015, MPs voted overwhelmingly against legalising assisted suicide, but some media coverage would have you believe that the large numbers of the UK population believe it’s a humane choice to legalise assisted suicide for terminally ill or disabled people. Opposition to assisted suicide is not confined to the medical profession and religious groups. Many disabled people, including the very people whom would be most affected by any change in legislation oppose the idea – it’s worth noting that no organization of or for disabled people has campaigned for assisted suicide (including those representing people with Multiple Sclerosis and Motor Neurone disease most often cited as likely to ‘benefit’ from such changes), and that disabled‐led groups like Not Dead Yet UK* continue to raise the issue, most recently protesting at the London premier of ‘Me before
You’.

At the time of writing the state of mind of the perpetrator of the attack in Sagamihara is unclear, what is apparent however is the culpability of the media in perpetrating and endorsing negative narratives of disability, potentially feeding the thinking and actions of some individuals.

The Sagamihara attack was a hate crime undertaken by an individual who denied the value of the lives he took, the 26‐year‐old former employee of the facility was quoted as saying. “It is better that disabled people disappear”. Hate crimes are defined as any crimes that are targeted at a person because of hostility or prejudice towards that person’s: disability, race or ethnicity, religion or belief, sexual orientation or transgender identity (UK Equality and Human Rights Commission). The UK Equality and Human Rights Commission report that there has been significant progress in the reporting and recording of disability hate crime since it was first included in national policy in 2008 . Police records show an increase from 800 in the first year to 2,508 in 2015/16. The number of prosecutions for hate crimes against Disabled people in the UK last year was up by 41.3% compared to 2014/15. In 2015‐16 there were 941 prosecutions for disability hate crimes. (Action Against Hate, The UK Government’s plan for tackling hate crime. July 2016). Disability hate crime represented 5% of police recorded hate crimes in 2014/15, but this is in contrast to the Crime Survey for England and Wales where disability hate crimes represented one‐third of hate crimes. The under‐reporting of disability hate crime demonstrates the importance of more victims
feeling able to come forward, and the prevailing attitudes and cultural references surrounding us in society risk some Disabled people internalising the negative perceptions of the value of their lives.

Regardless of its form and intention, prejudice always has the potential to cause harm because it reduces the value, status or importance attached to people from ‘the other group’. The ‘othering’ of Disabled people, and the belief that disabled lives are not of value raise fundamental questions about social justice in our society. We need to come together to fight for a global society where diversity is valued and where we can all live free from abuse, fear and oppression. And as the understanding of hate crime increases, it becomes even more important that officials across government engage with those working in the research community and with organisations of Disabled people to build the evidence base for policy interventions.

*Not Dead Yet UK is a network of disabled people in the UK who have joined a growing international alliance of disabled people, who oppose the legalised killing of disabled people. All those involved are disabled people including people with physical and sensory impairments, learning difficulties, and mental health conditions.

 

Looked after children and the youth justice system

JS

Dr Jo Staines, Director of BSc Childhood Studies programmes, reports a on recent seminar held by the School for Policy Studies focusing on the over-representation of looking after children in the youth justice system.

Over 30 academics and practitioners from across the country came together last week to discuss how to reduce the over-representation of looked after children in the youth justice system. Inspired by the Prison Reform Trust’s recent Independent Review, In Care, Out of Trouble, this event drew on current research and examples of innovative practice to consider how policy and practice – and changes in attitude – can reduce the number of looked after children who become involved in offending behaviour and who are drawn into the youth justice system.

Statistics indicate that looked after children are five times more likely to be involved in the youth justice system than non-looked after children – although due to the vagaries of recording practices, this is likely to be an underestimate. A review of international research, which I summarised in the first session, helps to explain how looked after children’s early negative experiences, the potentially adverse influences of the care system, and structural criminalisation all combine to increase the likelihood that looked after children will come into contact with the youth justice system. Anne-Marie Day (University of Salford), Julie Shaw (Liverpool John Moores University), Claire Fitzpatrick (University of Lancaster) and Julie Selwyn (University of Bristol) added depth and detail to these theories, drawing from their current research with looked after children.

The key messages from the presentations and ensuing discussions emphasised children and young people’s need for stability – of placement, of social worker, of educational placement, and of support – and the need for trusting, lasting relationships was overwhelmingly apparent. The challenges faced in achieving this were highlighted, particularly by Tanya Grey and Jennie Mattinson of West Mercia police, who have the unenviable task of working with 19 different care providers and no less than 107 local authorities to develop appropriate, non-criminalising responses to looked after children’s challenging behaviour.

Katy Swaine Williams, from the Prison Reform Trust, gave an overview of the findings of their review and the reforms to policy and practice that were recommended. Chris Stevens (Surrey Youth Support Service), Jamie Gill (1625 Independent People) and Darren Coyne (The Care Leavers’ Association) all passionately introduced the work their organisations have undertaken to provide stability and support to looked after children and to reduce their involvement in the criminal justice system. As shown by these examples, and as highlighted within the Prison Reform Trust’s review, many examples of good practice exist – we know that reducing the number of looked after children who become young offenders can be done, as it is being done – but we need to act as a megaphone to transmit our knowledge about successful approaches and interventions, and to invoke the political will needed to make sure that examples of good practice become standard practice nationwide.

In a post-Brexit environment and with a new Justice Secretary now in post, this event provided the enthusiasm, inspiration and evidence needed to help promote this message.

Thanks goes to Policy Bristol, the Centre for Poverty and Social Justice, and the Faculty Families and Parenting Group for their support.

European citizens who are disabled: what about them?

Val Williams, from the Norah Fry Centre for Disability Studies comments on the implications for disabled people of Brexit 

Val Williams

Val Williams

The shock of the BREXIT decision is not just an issue for disabled people who now have to live in a smaller, diminished country. It also has implications for disabled people across Europe, and particularly perhaps those with intellectual (learning) disabilities.

But what about our partnership with disabled people across Europe?  In 1973, when we joined the EU, disabled people in this country did not commonly have a ‘voice’, nor were they taken seriously as a political force. At that time, I had just started working with young people with learning disabilities, within a largely segregated system, which had only just started to recognise their right to an education. Since then, disabled people have themselves taken a lead, and are rightly proud of their achievements within the disabled people’s movement – for instance, over institutional closure, and the ideas of the social model and inclusion. During the 1990s and 2000s I took part in various EU Social Fund projects, where our experiences as UK partners was not just to speak English, but to offer progressive and supportive ideas, while learning alongside other member states. The European Disability Forum has posted the following since the BREXIT decision, which reminds us of some fundamental values:

We strongly believe that a common EU human rights agenda is better achieved together. The tone of the UK campaign, which was characterised by a divisive public debate on migration, reminds us of what is at stake and what we need to fight for, within a strong EU: common values of non-discrimination, human rights and freedom of movement.

Will UK ideas on disability now be discredited?  What of the gains in thinking on independent living?  Institutional closure across parts of Eastern Europe?  Turning specifically to the position of people with intellectual (learning) disabilities, during the latter part of the 1990s, People First groups in the UK set out to link with their European counterparts, and to set up a ‘Europe People First’, genuinely led by people with intellectual disabilities themselves. The movement in Europe has always been within the framework of families’ organisations, but the umbrella organisation ‘Inclusion Europe’ now has a self-advocacy section. This is a European Platform of Self-Advocates, which is composed of member organisations across Europe.  Nothing is perfect, but compared with the 1990s, there has been progress towards an understanding that Europeans with intellectual disabilities have a right to live like others, to self-organise and to get support to have a voice.  And importantly, UK self-advocates have always been strong in demanding these things, and in making a common cause across Europe.

In the UK we are still aware of the many steps that need to be taken towards including people with intellectual disabilities in the wider disabled people’s movement. There is also already a European network, not just through the Disability Forum and an EU umbrella organisation for disabled people’s organisations (DPOs) across Europe.  In the light of the BREXIT decision, they have themselves reached out to disabled people in the UK, as mentioned above in their moving statement on the need to continue the struggle for human rights together across Europe.

Not least, accessible information is key to a meaningful conversation with all disabled people, including those with intellectual disabilities – see the progress made for instance by public and Government organisations in communicating with all. One out of many examples would be Public Health England’s easy English guide to avoiding Flu. UK efforts to work for equality in information, in voice and within public debates and research are now widely recognised across Europe, with a recent publication in Austria on Inclusive Research for instance, written both in English and in German.

As with all disabled people, the position of people with intellectual disabilities has moved on. In the 1990s I was able to visit both Germany and France, on some visits accompanying people with intellectual disabilities. Both countries had strong segregated (albeit meaningful) policies on employment – people lived within a ‘network’ of services, particularly in Germany, and in both countries, they were to some extent treated (and addressed) as children, unlikely to have anything useful to say or to contribute to the debates.  Compare that with the debates in those countries today. On June 26th, the Frankfurter Allgemeine newspaper in Germany led its Society section with a discussion of sexual rights of disabled people with autism. The headline is that people with intellectual disabilities would have aspired merely to be ‘satt und sauber’ (fully fed and clean) until now; the argument is that they can also aspire to enjoy life!   That would not have happened before the progress made by bringing disabled people together, through the European Union. The UK voice is important, and the connection between disabled people across Europe needs to continue, so that disability rights remains a common cause.

Val Williams is Reader in Disability Policy and Practice, Head of the Norah Fry Centre for Disability Studies, and Executive Editor of Disability and Society.

 

Tuning in to the sexual histories and lives of older adults

paul-willisDr Paul Willis, is a Senior lecturer in social work with adults, in the School for Policy Studies. His research interests include sexuality, care and ageing, and trans issues in later life.  This blog was first published on the website for Lyn Romeo, the Chief Social Worker for Adults.

Sex and sexuality are undoubtedly difficult topics to discuss with service users and carers – with older adults, even more so. To open up conversations about sexual intimacy risks causing offence, alienating older adults and compromising rapport built up with service users over time.

In some recent research on care home provision for older lesbian, gay and bisexual adults, we found that often managers and staff were reluctant to have these conversations with residents—these were no-go zones because of concerns about offending others, causing embarrassment (for staff and residents) and infringing people’s privacy.

The notion of individual wellbeing sits at the heart of the Care Act 2014. If we are truly invested in promoting the wellbeing of older adults then sexuality needs to be acknowledged as an integral part of their physical, mental and emotional wellbeing.

We often talk about person-centred approaches in adult social care, but what about sexual personhood? This means recognising the unique elements of an individual’s sexual life-story, including their sexual identity and past and current relationships. Experiences of sexual activity in early adulthood, affirming or negative, can have a lifelong impact on how individuals view themselves and relate to others in later life.

So what makes sex such a tricky subject to discuss with older adults? First, we have to look past the common myth that older people are asexual, in other words older adults are disinterested in sex and it’s no longer important to them. We know that older adults remain sexually active in later life.

The most recent wave of the National Survey of Sexual Attitudes and Lifestyles 3 in Britain included respondents up to 74 years of age for the first time and highlighted how older adults over 59 years continue to engage in sexual activity, albeit with less frequency than younger folk.

The idea of older adults engaging in sex can often evoke individual responses of disgust and repulsion—some researchers in ageing studies refer to this reaction as ‘ageist erotophobia’. These negative beliefs can make us blind to the sexual health needs of older adults, which can prevent older people from accessing sexual health services. Sexually transmitted infections and HIV do not discriminate on the basis of age. According to the National AIDS Trust in 2014, 636 people over 55 years of age were diagnosed with HIV.

Another popular myth is that all older people are straight or have lived heterosexual lives. Many older adults belong to sexual and gender minority groups and identify as lesbian, gay and bisexual (LGB).

Equally, some older adults may be same-sex attracted but do not identify as LGB. For older gay and bisexual men this means they may have had hidden relationships during a time when sex between men was a criminal act and subject to prosecution, prior to decriminalisation in 1967 in England and Wales.

For older lesbian and bisexual women their identities and relationships were not recognised in UK law and policy prior to the wave of equality laws introduced during the last 15 years. During their younger years, some older women and men may have felt compelled to receive psychiatric treatment to ‘cure’ their sexual and gender orientation while others may have experienced social exclusion from faith groups, family and local communities.

These legacies cast a long shadow and we know that older LGB adults are reluctant to access health and social care services as a consequence.

So how do we tune in to the sexual lives and histories of all older service users? This is not a topic easily broached in a first meeting. It’s a gradual and persistent process that relies on trusting relationships built over time, gently and sensitively asking open-ended questions about past and current relationships, and continually signalling to older service users that we are receptive to conversations about sexual health, relationships and identity.

It requires us to ask questions about relationships and intimacy when these issues may not be mentioned or initially appear relevant to people’s care needs. It also requires us to quietly challenge the views of others working with us such as students, colleagues or professionals from other agencies.

And for a lot of us it could mean taking time to reflect on and reconsider the ageist views and assumptions we may hang on to about sex, sexuality and ageing, often unknowingly. This is not an easy endeavour when religious beliefs and personal values about sex and sexuality can run deep.

Fundamentally, social workers have a pivotal role in advocating for the sexual wellbeing of older adults in receipt of care services in their homes, in community settings or in long-term care. Maintaining sexual health and sexual wellbeing is a human right applicable to all—the World Health Organisation reminds us that ‘the sexual rights of all persons must be respected, protected and fulfilled.’ Older people are no exception.

Homophobia and hate

Dr Emma Williamson

Dr Emma Williamson

The Centre for Gender and Violence Research has always engaged within intersecting forms of oppression and inequality. Recently, that has involved ensuring that those who experience domestic violence and abuse within same sex relationships are heard and provided for. The recent events in Orlando remind us however, that the Lesbian, Gay, Bisexual, Trans and Queer (LGBTQ) community remains subject to threats and violence from outside.

The recent attack in Orlando was a homophobic hate crime.

The massacre of 49 people within an LGBTQ venue, the Pulse, in Orlando, Florida, has shocked us all. As such our thoughts and feelings go to those who lost loved ones during the attack and to the 53 who were seriously injured. Our thoughts also go out to wider LGBTQ communities who feel shocked and under threat not just from the crime itself, but from the response of others too it. Immediately the discussion in the media turned to one of gun control, Islamic terrorism, and radicalisation. In our western culture of ‘terror’ it is too easy for any of us, myself included, to think of any crime primarily within these lens.

Such is the strength of the terror discourse that only those events which fit the Islamic terrorist narrative are recognised. Owen Jones in his Sky News appearance was trying, I think, to make that point. This was first and foremost, a homophobic hate crime. The gunman chose to target an LGBTQ safe venue, because it was an LGBTQ venue. Richard Angell in his article talks about the implications of that for the LGBTQ community as a whole. The attack, horrific as it is, is also a reminder that the LGBTQ community still needs such spaces, and that they too can be violated.

Fundamentally that is shocking and frightening for the LGBTQ community. As such we need to show our solidarity with that community, to make more safe spaces where sexual orientation is more than tolerated, out of sight but genuinely accepted in our town, cities, and villages.

Media interviews with ex-work colleagues and family of the Orlando gunman shows people saying that they never heard him express threats to carry out such attacks, but they do report a catalogue of hate, homophobia, sexism, and racism. A wide range of people sought to remove themselves from his presence due to his hate. Yet when investigated by the FBI, their obsession with a certain type of terror clouded their judgement and the risks he posed to the LGBTQ community, and others, were disregarded.

Finally, the most recent media commentary has focused on whether the gunman was himself gay. That narrative is currently unfolding but irrespective of his own sexuality, this gunman deliberately targeted an LGBTQ safe venue to kill and maim LGBTQ people. All of us have a responsibility to seek to change society so that sexual orientation isn’t a cause for hate. Whether that hate is spoken or acted upon.

It is perhaps helpful at this difficult time to consider Andrea Dworkin’s (slightly changed) comment on the Montreal Massacre of 6th December, 1989:

“It is incumbent upon each of us to be the that wanted to kill. We must live with this honour, this courage. We must drive out fear. We must hold on. We must create. We must resist.” https://www.theguardian.com/world/2012/dec/03/montreal-massacre-canadas-feminists-remember

Dr Emma Williamson, on behalf of the Centre for Gender and Violence Research.

If all the evidence points to a Mediterranean diet… Why do UK Dietary Guidelines insist on a low-fat diet?

Dr Angeliki Papadaki, Lecturer in Public Health Nutrition at the Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, argues on the need for UK dietary guidance to loosen the low-fat advice and embrace higher-fat but healthier dietary patterns, like the Mediterranean diet.

olive-oil-photoI come from Crete. I grew up in a house where everything revolved around the kitchen. Most of my childhood memories involve my mother preparing meals from scratch, using olive oil. Meals were accompanied with vegetables and we had a legume soup (like lentils, beans, chickpeas) twice a week. All of them were a pleasure to eat; they just needed olive oil and a slice of bread to scoop up the juices to receive a cook’s highest reward: empty plates.

I’ve lived in the UK for 10 years and I still can’t enjoy vegetables or salad unless I prepare them myself. They are boiled and boring, with uninspiring dressings, and no tomato sauce or sautéing with olive oil and onions to give them some flavour. It’s no wonder that 70% of adults in the UK do not eat enough fruits and vegetables and that on average they consume 14g of legumes a day (half the amount consumed in the traditional diet of Crete).

The argument that olive oil, as one of the most important Mediterranean diet foods, helps the consumption of higher amounts of vegetables and legumes is not new. Yet UK dietary guidance has a long tradition of recommending a low-fat diet. Up to recently, the Eatwell Plate recommended to “eat just a small amount of foods high in fat” and made only one reference to olive oil: “When you’re cooking, use just a small bit of unsaturated oil such as sunflower, rapeseed or olive, rather than butter, lard or ghee”.greek-salad-photo

Granted, the revised Eatwell Guide differentiates unsaturated oils from other high-fat foods, but still emphasises that these foods “should be limited in the diet”, without defining this limit. Again, olive oil comes third in line, after vegetable and rapeseed oil. To contrast this, the Mediterranean diet recommendations suggest that olive oil should be the main source of fat in the diet and used in every main meal. A recent randomised controlled study showed that for each 10 g/day increase in extra-virgin olive oil consumption, cardiovascular disease incidence and mortality decrease by 10% and 7%.

The concern about moving from a low-fat diet recommendation to a higher-fat one (even with the ‘right’ fats) might come from fear of promoting obesity. Yet, despite the advice to limit fats, more than half adults in the UK are overweight or obese. At the same time, diabetes is on the increase and heart disease is one of the most common causes of death. In contrast, and despite its higher fat content, the Mediterranean diet does not cause weight gain, and even if some heart disease risk factors are higher in Mediterranean countries, actual diagnosis of the disease is lower than in the UK. High-fat diets were recently shown to improve risk factors for heart disease among people with diabetes, compared to low-fat diets. The Spanish landmark PREDIMED study also recently showed that following a Mediterranean diet, with high amounts of olive oil (≥4 tablespoons recommended every day), reduces risk of cardiovascular events by 30%, compared to a low-fat diet usually recommended for the prevention of cardiovascular disease.

Traditional Greek dip tzatziki

The EU recently invited its Member States to “promote healthy eating, emphasising health promoting diets, such as the Mediterranean diet”. The US Dietary Guidelines have also recently recommended the Mediterranean diet as an example of a healthy eating pattern. The National Institute for Health and Care Excellence, after reviewing the evidence for its draft public health guideline on maintaining a healthy weight, recommended to “follow the principles of a Mediterranean diet, which is a diet predominantly based on vegetables, fruits, beans and pulses, wholegrains, fish and using olive oil instead of other fats”. After review by the Public Health Advisory Committee however, this recommendation was not included in the final guidance, exposing a resistance of UK experts to the Mediterranean diet recommendations.

Yet we know that the Mediterranean diet is tastier and easier to comply with compared to a low-fat diet. We know that, with appropriate nutrition education, it can be transferable to Western populations. Perhaps we need to show its effect on health through randomised controlled trials in the UK before we see UK dietary guidance embrace its recommendations, similar to what our US counterparts did.

How Social Workers Assess Parental Capacity to Change

 

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Dr Dendy Platt, Senior Lecturer in Social Work, and Head of the Children and Families Research Centre, School for Policy Studies, examines the potential for the C-Change approach.

Social workers’ assessments of parental capacity to change are becoming increasingly important when working with children in need and children who may be at risk of maltreatment.  Expectations from the courts regarding care proceedings in England have increased in the last couple of years, focusing particularly on better analysis in social work assessments, and better exploration of alternative courses of action for the child in question.  Assessing the likelihood of a parent being able to make sufficient changes in their lives to ensure the child’s safety and wellbeing is a part of this analysis.  And capacity to change is now included in the court report template from the Association of Directors of Children’s Services – requiring assessment of whether a parental capability gap can be bridged.

Fulfilling these requirements, however, presents some problems.  One view of court decision-making suggests that the key evidence the courts need to make a decision is:

1) Whether harm has occurred to the child;

2) What caused that harm, and whether it can be attributable to the parent(s);

3) What can be done about the situation – and in particularly, whether the parent(s) can change things sufficiently to ensure that the child is well cared for into the future.

A brief look at the history of child protection work shows that there has been a great deal of research into the first point.  Child maltreatment is well-understood.  Research has helped us develop and improve methods of identifying it, investigating it, utilising medical expertise to arrive at satisfactory diagnoses, and so forth.  Similarly, on the second point, a variety of assessment approaches have been developed over the years to give us ways of exploring the context of the harm, the contributory or causal factors, and to help us understand the parents’ roles.  Examples include the Framework for the Assessment of Children in Need and their Families, and the Signs of Safety approach, but there are many others.  All these developments have been backed up by theory and research.

The third element of the decision, the potential for changes that benefit the child, has received much less attention.  In terms of assessing parents, there are methods that support parents to make changes, and the impact of this can be measured using before and after measures.  Examples include the work of Paul Harnett, but few such approaches are widely used, despite their underpinning research.  In terms of theory related to behaviour change, the only theoretical approach that has had a significant impact in the context of UK social work practice is the Transtheoretical or Stages of Change model.  This model is useful in drawing the practitioner’s attention to the idea that individuals approach change in different ways, and that relapse is a regular part of most attempts to change.  However, the model itself has been widely criticised, particularly in the child welfare field.  The stages themselves have not proved detectable in significant empirical studies, and individuals’ progress from one stage to the next has not been demonstrated at all clearly.

The key point is that theory and research, to date, have not offered very much help to social work practitioners in relation to understanding and assessing capacity to change.

The C-Change approach, developed by Katie Riches and myself at the University of Bristol aims to fill this gap.  Its central principle is that there are two parts to an assessment of capacity to change.  The first involves understanding what helps and hinders change in individual parents.  The second involves creating an opportunity for change and assessing progress.  C-Change brings both of these elements together into one systematic approach.

The first part of the approach draws on behaviour change theories.  It can be seen that capacity to change is affected by a variety of factors, ranging from social and contextual circumstances to individual motivations and intentions.  These factors interact, and practitioners should avoid relying for their assessment on isolated elements – such as whether a parent has ‘owned up’ to actions that have harmed their child.  Some factors may help change, and others may hinder it.  The social work assessment should weigh up barriers and facilitators in the individual situation.

The second aspect of the C-Change approach involves creating an opportunity for change, with appropriate support and help, and assessing the success or otherwise of achieving the necessary changes.  In this, we have drawn on the work of Paul Harnett in particular, including his use of Goal Attainment Scaling.

These two parts have been combined into a single approach, under the name C-Change, and are supported by a practitioner-friendly manual.  The double meaning of “C-“ in the name refers not simply to “capacity” but also indicates our view that a “sea change” is needed in the importance of capacity to change assessment.  Whereas at present this part of the assessment can be a bit of an afterthought, our view is that it should be have a central role in the assessment process in recognition of its real importance in decision-making.

Further information, about the C-Change approach and the ideas put forward here, is available from our website: www.capacitytochange.org.uk. The practice manual can be downloaded free of charge by following the links on the site.

 

See also: Platt D. & Riches K. (2016), Assessing Parental Capacity to Change: The missing jigsaw piece in the assessment of a child’s welfare?  Children and Youth Services Review, vol 61, pp. 141–148.