What can children in the care system tell us about their well-being?

Professor Julie Selwyn is a Professor and Director of the Hadley Centre for Adoption and Foster Care Studies at the School for Policy Studies. Here, she shares the findings from the new report she co-authored, Our Lives, Our Care: Looked after children’s views on their well-being.

There were 70, 440 children in care in England as of 31 March 2016, according to the Department for Education. The majority of children enter care because of parental abuse and neglect and often enter with physical, emotional and behavioural difficulties as a result of traumatic experiences. Every year ‘outcome’ data are collected and published by the Department for Education on children’s educational achievements, offending, mental health, and number of teenage pregnancies.

Children’s experiences not heard across system

Generally, children in care do not achieve the same level of academic success as their peers and are much more likely to have problems with crime, drugs and have poor mental health. Consequently, the care system is often viewed as failing but there is no systematic collection of information on how children feel about their lives in care. Nor do we know whether children in care emphasise the same aspects of their lives as being important to their well-being, as those identified by children in the general population.

This excerpt was taken from the original post in the WhatWorksWellbeing blog. Read the post in full.

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Crisis in care homes: how can we improve standards in the context of austerity?

Liz Lloyd, Professor of Social Gerontology in the Centre for Health and Social Care discusses the factors behind deteriorating standards in care homes.

There is a crisis in British care homes, arising not merely from bad behaviour by staff members but from the economic and political context of the social care market.

There are currently close to half a million individual places (‘beds’) used by around 4% of the population aged 65+ and 17% of people aged 85+. Statistics vary somewhat, according to what is being measured, but we can be certain that although the number of older people in the population have risen, a smaller proportion of them live in a care home, that they are older on average when they first enter the home and have more complex, long-term illness that require more skilled assistance.

Older people are also increasingly likely to pay at least a part of their care home fees. According to Laing and Buisson’s 2012-2013 Care of Elderly People UK Market Survey, some 43.4% of older residents in the independent sector paid the full costs and a further 14% received partial council support and topped up their fees. The majority therefore still rely wholly or partially on public resources but this proportion is falling.

Running parallel to these changes is the rise in private ownership of care homes and payment of fees. Over three decades, the proportion of places in local authority run care homes in the UK has dropped while the proportion in the private, for-profit, sector has risen so it now has a 75% share of all places. The voluntary, not-for-profit, sector share has been more stable but is falling slightly. The current crisis involves increasing levels of provider failure and exit from the care home market. Several big providers are deeply in debt, raising fears of a major collapse like that of Southern Cross in 2008. Owners point to rising costs as a consequence of the introduction of the national living wage and falling profits because fees paid by local councils have not risen in line with increased costs. The consequences for providers is an unsustainable business model.

The consequences for older people who need residential care are evident in delayed discharges and hospital waiting lists, a point illustrated perfectly in the case of Mrs Iris Sibley, who remained in the Bristol Royal Infirmary for six months while her family sought a care home place. For residents and their families the insecurity associated with provider failure means added anxiety and stress. Add to this the associated problem of worsening standards, which the Care Quality Commission fears will grow in the absence of major reform. Mrs Sibley’s son described how one place she was offered was so bad that he ‘wouldn’t put a sick dog in there’.

Not all older residents experience the same thing, of course. According to Norman Lamb MP, former Health Minister, the market has come to benefit older people with enough money to pay for their own care while disadvantaging those who rely on state support. Care homes where all or most residents pay their own fees are more secure than those that rely mostly on the local authority payments and are more able to absorb the additional cost of the national living wage. We might question why anyone would argue against a decent level of pay for the people who care for us when we are sick and disabled, but the dominant theme in social care for older people is that it should be as cheap as possible – hence, high numbers of migrant workers in the care home sector.
In fact, debates about care homes focus overwhelmingly on keeping costs down and agreeing who should pay. Should it be individuals (during their lifetime or after their deaths), their families or the public in general? Health and social care are frequently portrayed as unaffordable in the context of the ageing of the baby boomer generation.

I declare an interest here, being a baby boomer, but take issue with such a simplistic argument. Demographic trends have an impact on demand for care, for sure, but there is evidently a wider set of factors at play. Indeed it is arguable that demographic trends provide a useful rationale for cuts to public spending that would be made anyway. Policy-makers have placed themselves in a bind as cuts to public spending have impacted on private sector profits, proposals to recoup the cost of care from older people’s estates after death are met with outrage in the press, as are stories like that of Mrs Sibley.

Evidence on what makes a care home a good place to live and work is abundant. Higher standards of care are usually reflected in higher levels of staffing, more skilled workers and a culture of person-centred care that attends to the whole range of an individual’s needs, not merely to their basic physical requirements. A culture of ‘person-centred care’ promotes a sense of belonging and security and enables residents to maximise their capacities, enjoy new experiences and take risks. Care homes are likely to remain a part of the care system, despite their reputation, so we need to focus on standards. A sizeable number of us who will live in a care home at some stage of our lives, or have a close relative who does. But more importantly, care homes are inextricably linked with other parts of the care system so it is in our interests to think about standards in care homes as a policy issue that affects us all.

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International Day for the Elimination of Violence against Women

Dr Emma Williamson, Senior Research Fellow in the Centre for Gender and Violence Research, comments on why recognising the subject of violence against women has never been more relevant than it is now.

25 November marks International Day for the Elimination of Violence against Women, followed by 16 days of Activism against Gender-Based Violence.

On this day, communities reflect on the damage caused by violence against women and its impact on women, children, men, and societies around the globe.

As well as acknowledging the harm that violence against women causes, 25 November is also a day to celebrate the achievements of a movement which seeks to eradicate the gendered violence which many face every day. To recognise the men and women who work to support victims and perpetrators, to challenge abusive behaviours within societies across the world, and to stand up to the causes of violence by naming misogyny and oppression in its many forms.

At the Centre for Gender and Violence Research based at the University of Bristol, we know only too well about the experience and impact of gendered abuse. Researchers are currently engaged in projects speaking to victims and perpetrators of a wide range of abuses; collecting official data from the police and other statutory bodies; working with refugee communities to address violence against women during displacement; and working with a range of non- governmental organisation (NGO) partners to ensure that research makes a difference in the world.

So, along with our partners in the UK, Europe, and internationally, we mark 25 November as a day to recognise the achievements of a social movement which still has many uphill struggles to face.

In addition to the consistently high rates of domestic and sexual violence and other forms of gender-based violence which are experienced every year, this year in particular is a poignant year. Women’s rights have been attacked in a number of countries around the world: Poland and its attempts to restrict access to safe abortions; US presidential candidates’ “locker-room banter” about grabbing women whether they want it or not; the re-trial of a footballer on the basis of the introduction of evidence about the victim’s sexual history; and the crowning of Bono as one of Glamour magazines “women of the year”.

Okay, so the last one isn’t quite an obvious offence to women and equality – he does a lot of work about poverty and its impacts on women- but in a world where over half the population is female, it would be nice if an honour for women were given to one!

These examples show the struggles which we face to challenge the oppression which underpins gendered violence and abuse. They also show us the power of solidarity in the many acts of resistance they evoke. Polish women striking and taking to the streets against the attack on their already limited rights. Michelle Obama’s eloquent speech about the everyday reality of sexism and misogyny. Government reaction to the use of sexual history in sexual assault cases. We have yet to see how sisters uncut respond to Bono but you can be assured it will be creative and fitting!

Of course we also face an additional challenge in the UK with the recent Brexit vote to leave the European Union. The Centre for Gender and Violence Research in Bristol has a long tradition of working with European partners and we regularly meet to identify the emerging challenges which threaten the elimination of violence against women.

Whilst the terms of Brexit remain unclear, we continue to appreciate the importance and power of a global network of campaigners, researchers, and activists challenging the status quo and fighting for women’s human rights.

In Spring 2017, the Centre will be launching a new Journal of Gender-Based Violence. This is the first European- based international journal focusing specifically on this type of violence and abuse. We believe that now, more than ever, we need a space where evidence, policy, and ways of tackling gender-based violence across national borders, can be shared. It will provide a critical space in which we can continue to learn from one another and recognise the connectivity between the different challenges we face.

To articulate how far we still have to go, take a moment to look at the predicament of women worldwide below. (Infographic reproduced with kind permission from United Nations Women).

infographic-violence-against-women-en-11x17-no-bleeds

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Gender, Violence and Justice: What does justice look like?

Dr Emma Williamson shares her reflections on the recent Thinking Futures event at the University of Bristol, which debated what justice means for victims of gender based violence.

What does justice look like? This was the question asked at last week’s Thinking Futures event run by the Centre for Gender and Violence Research at the University of Bristol. The event was part of the wider Thinking Futures programme which celebrates research from the University’s Faculty of Social Science and Law, and supports the national ESRCs Festival of Social Sciences.thinking-futures-cgvr-event

We chose the topic of Gender, Violence and Justice as it coincides with current research looking at Justice, Inequalities, and Gender Based Violence being conducted in partnership with Women’s Aid, England, and Welsh Women’s Aid.

The event, held at the Church Above The Shops, was introduced by Thangam Debbonaire, MP for Bristol West. Thangam brought to the evening her experience of working with the perpetrators of abuse, whether individuals or collective within processes and systems. She reminded us of the need to challenge and change those behaviours and the ideas from which they come. Thangam also recognised the long and on-going history in Bristol of women fighting gender based violence, from the early Women’s Aid movement, to Rape Crisis, to Integrate – all of whom were represented on the evening.

Geetanjali Gangoli, from the Centre for Gender and Violence Research was first to speak, highlighting findings from a recent study conducted for Her Majesty’s Inspectorate of the Constabulary (HMIC) on so called ‘honour violence’. Geetanjali highlighted the barriers faced by Black and Minority Ethnic Women when trying to challenge abuse which might be categorised as honour based. She recognised that for some of the women in the research other relatives, including male relatives, were sometimes the ones to encourage victims/survivors to seek justice through the police and official systems. Geetanjali also discussed the difficulty of challenging abuse which might be condoned by families and communities, and the importance therefore of thinking about what justice means in wider and community based context.

Layla Ismail was next on the podium, both in her capacity as director of Refugee Women Bristol, and in her role for FORWARD, the national charity concerned, for many years, with the issue of Female Genital Mutilation (FGM) or ‘cutting’. Again, the importance of community justice was raised. – To stop this particular abuse, adult survivors of FGM should be given the space to talk about their experience and the impacts it had had, in the hope that it would be a catalyst for social change. Young women in Bristol, supported by FORWARD, have been at the forefront of work on this issue nationally, and it was a pleasure to hear about their success in changing attitudes. In terms of our initial question, what does justice look like, justice here looks like no more FGM/cutting.

As well as inspiring the audience, Layla also challenged the multiple and sometimes contradictory oppressions which women might face. In this case the abhorrence society directs to FGM whilst condoning within popular media similar plastic surgery procedures. These contradictions do not go unnoticed within those populations where FGM has been an issue.

Following Layla was Rowen Miller from SARSAS – Somerset and Avon, Rape and Sexual Assault Service. Rowen was talking about sexual violence and justice, and what it feels like, from a survivor’s perspective to walk into a court of law, to take steps to seek formal types of justice. For most it feels like walking into the lion’s den. Rowen highlighted the importance of empowering survivors following assault to make they own decisions about how they wish to proceed, and the systems they have put in place to assist with this, including acting as a go-between for survivors who might want to report anonymously and the police. As with all of the speakers, Rowen offered us hope about the growth which is possible for survivors following experiences of gender based violence, and the importance of supporting, standing alongside and behind, survivors to their sources of justice, whatever that is.

The final panel speaker of the evening was Marianne Hester. Marianne focused more on domestic violence as one part of the wider gender based violence continuum. She highlighted the failures of formal justice to offer ‘justice’ in the sense of convictions for crimes, and discussed the alternatives we might then wish to explore. If formal justice on a population level, on the whole, doesn’t work for victims/survivors then what are the alternative available to us?

Following the panel presentations, the chair opened up the discussion to the audience. Initially reluctant, understandably, the audience come forward with a wide range of ideas about what justice might look like: rough justice, social justice – social change, restorative justice – in its true and safe form, empowerment, and resistance. As well as people’s experience of working in the field of gender based violence, people also talked about their experiences of abuse and the formal justice system.

We would like to thank all of the audience members for creating a safe space and atmosphere where survivors felt able to speak, and to those speakers for sharing their experiences with us. Injustice was not being able to face the perpetrator, in court, and tell him what he did. Injustice is over five years fighting a perpetrator who twists the system to drag you, as a victim/survivor, through the courts repeatedly. Injustice is being told by a therapist that if you choose to report an incident to the police then you cannot continue to receive their help.

So, taking the injustices which unfortunately inform our ideas of what justice might look like, for this group justice was about a wider recognition of gender, and other, inequalities. It is recognising misogyny as a form of gendered hate crime, and of finding new ways to challenge it. It is challenging schools to implement relationship and respect education – despite the government not making it mandatory. It is fighting for the support services needed to allow victims/survivors to seek the help they need, and to stand alongside them in their struggles to stop it happening in the future to others. Above all justice was what victims/survivors think it should be.

In a week when the US elected a president who admitted sexually groping women without asking (many would call that sexual assault) – justice is living in a society that says that is not okay and stands together to change it.

For further information about the Centre for Gender and Violence Research: http://www.bristol.ac.uk/sps/research/centres/genderviolence/

Anyone interested in talking to the research team about experiences of abuse, as part of the Justice Project, please contact us via the project page or email: sps-justiceproject@bristol.ac.uk

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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.

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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.

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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.

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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.

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Abuse in Ambridge

The ArchersDr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, School for Policy Studies, discusses how the recent storyline in The Archers highlights the often silent issue of coercive control and its effect on victims/survivors.

I have to admit that I don’t normally listen to The Archers.  And people don’t normally talk to me about the story lines.  That all changed when the long running series began a story over 18 months ago which looked at the issue of domestic violence and coercive control.  One of the most difficult things that victims/survivors of abuse tell us, and have consistently told us since the first women’s refuges in the 1970’s, is that it is the non-physical abuse they experience which is the most difficult to deal with [Williamson, 2000].  The bruises and other injuries victims suffer from physical abuse are visible.  They are evidence to other people but also to oneself.  There it is in black and blue.  What is more difficult to prove and believe, is that someone who purports to love and care for you would bully, undermine, and manipulate you.  The women I spoke too after the fact would either say, ‘how could someone treat me like that?’ or more often than not, ‘how could I let someone treat me like that?’ – still blaming themselves.

As the Archers storyline shows, this type of abuse is characteristic of a pattern of ‘low level’ abusive behaviours rather than the explosive incident people tend to think about when they consider ‘a domestic’.  It involves small everyday things which result in people staying away, isolating victims from their family, friends, and networks of support.  Recent research from Bristol has documented the massive impact of such abuse on friends and family [Gregory et al, 2016], as well as the evidence we know about the impact on victims [Mullender et al, 2005], their children [Mullender et al, 2002], and perpetrators themselves [Hester et al, 2015]. Doctors, the police, courts, social services, all tend to think of interventions in terms of those single incidents which means that the on-going manipulation of victims goes unnoticed.

Some call this type of abuse coercive control [Evan Stark, 2008], others intimate terrorism [Johnson, 1995], but for many victims it is this type of abuse which has the greatest impact on their liberty and personhood.

Work conducted at the University of Bristol has shown the long term health and emotional impacts of this type of abuse on victims [Abrahams, 2010; Williamson, 2010].  Indeed researchers at Bristol have been at the forefront of developing adequate measures which enable us to include this type of insidious and often invisible abuse within our survey’s and analysis of DV within various population groups [Hester et al, 2011].

In 2016, following work with Evan Stark, oft time visiting professor at the Centre for Gender and Violence Research, the British Government introduced a new criminal law on domestic violence which explicitly identified coercive control as a pattern of abusive behaviours.  It is this concept which forms the basis of the current Archers storyline and which the script writers have slowly and meticulously explored.

Working with national charities, including Women’s Aid[i], the script writers have demonstrated the impact of this type of on-going abuse and by taking their time, shown how such a manipulative partner operates.  18 months in it is harder for the listener to simply blame the victim and ask why she doesn’t leave.  Hopefully the audience can begin to understand how the gradual nature of the abuse undermines someone’s sense of self, their personhood, and ultimately their liberty and/or human rights.

I don’t know what the outcome of the current storyline will be.  I hope that there is enough evidence so that Rob gets his commuppence, yet we know from sad reality that for many in this situation escaping the abuse is easier said than done.  Even when victims physically leave an abusive relationship they are not ‘free’.  Many women are blamed when they retaliate, or killed during the process of leaving[ii] , when the abusers control is being challenged the most.  For those with children their contact with the abuser might be on-going through child contact proceedings[iii] [Hester, 2011].

What we do hope however, is that whatever happens with the current story, that the audience leaves with a greater understanding of the ways in which domestic violence operates and how it impacts on those involved.  We hope listeners will understand how hard perpetrators make it to leave.

If anyone has been affected by the storyline, and wants to talk to someone in confidence, then the National Domestic Violence helpline are an excellent resource.

24 hours, 7 days a week.  0808 2000 247.

References

Abrahams, H. (2010) Rebuilding lives after domestic violence: long term outcomes. London: Jessica Kingsley

Gregory, A., Williamson, E., & Feder, G. (2016) The impact on informal supporters of domestic violence survivors: A systematic literature review.  Journal, Violence and Victims.  3 Mar 2016.

Hester, M, Ferrari, G, Jones, S, Williamson, E, Peters, T, Bacchus, L & Feder, G (2015) Occurrence and impact of negative behaviour, including domestic violence and abuse, in men attending UK primary care health clinics: a cross-sectional survey. BMJ Open, vol 5: pp. 1-10.

Hester, M. (2011). The three planet model – towards an understanding of contradictions in approaches to women and children’s safety in contexts of domestic violenceBritish Journal of Social Work41, 837 – 853.

Hester, M., Fahmy, E., & Donovan, C. (2011). Feminist Epistemology and the Politics of Method: Surveying Same Sex Domestic Violence. In C. Hughes, & R. Cohen (Eds.), Feminism Counts: Quantitative Methods and Researching Gender. London: Routledge.

Johnson, M.P. (1995) Patriarchal terrorism and common couple violence: Two forms of violence against women. Journal of Marriage and the Family 57 (2):283-294.

Mullender, A., & Hague, G. M. (2005). Giving a Voice to Women Survivors of Domestic Violence through Recognition as a Service User GroupBritish Journal of Social Work35 (8), 1321 – 1341.

Mullender, A., Hague, G. M., Imam, I., Kelly, L., Malos, E. M., & Regan, L. (2002). Children’s Perspectives on Domestic Violence. SAGE Publications Ltd.

Stark, Evan (2008) Coercive Control.  Oxford Uni Press; Oxford.

Williamson, E. (2010) Living in the world of the domestic violence perpetrator: Negotiating the unreality of coercive control, Violence Against Women, 16, pp.1412-1423.

Williamson.E. (2000) Domestic Violence and Health: The response of the medical profession, Bristol: Policy Press.

 

[i] http://www.mumsnet.com/Talk/guest_posts/2607008-Guest-post-Domestic-abuse-I-am-a-real-life-Helen-Warning-upsetting-content

[ii] https://kareningalasmith.com/counting-dead-women/2015-2/

[iii] https://www.womensaid.org.uk/launch-of-nineteen-child-homicides-report-child-first-campaign/

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Daryl Dugdale, Programme Director of MSc Social Work in the School for Policy Studies reflects on teaching and learning in the field

International Social Work Day- Promoting the dignity and worth of people; A social work educator’s PerspectiveDr Daryl Dugdale

In celebrating International Social Work Day it is important that social work students experience dignity and self worth in the delivery of social work education. I should declare at the outset a vested interest in this issue as Programme Director of an MSc Social Work course at a Russell Group University. My responsibility, alongside that of my colleagues, is to ensure we deliver a rigorous learning experience so we can optimise the chances of developing top quality social workers. This of course is no easy thing. As Jonathan Dickens has acknowledged, the complex and contradictory roles and responsibilities associated with social work means “that change is always a work in progress and never a task achieved” (p22, 2011). How do we respond to the individual challenges and complex needs of our service users in what is a constantly changing environment? There are challenges for all practitioners in responding to increased volumes of work, whilst experiencing reduced capacity, during a period of near constant agency reconfiguration, and at a time of austerity. Additionally these challenges exist when there is significant political and academic discussion surrounding the future of social work as a profession and debate around the best methods of delivering social work education.

I have a responsibility to ensure the students’ learning environment models best practice and introduces skills to support behaviour expected in their engagement with their prospective service user groups. The learning experience of the student group must promote dignity and provide examples of self-worth; failure to do so risks these qualities not transferring to their practice.

Attempts to fulfil this aim are supported by ensuring the structure and content of the programme has at its core the ‘three Rs’, the student experience must be Robust and Reflexive with opportunities to develop Resilience – these are foundational to the programme.

Robustness is ensured through immersion in the latest research and opportunities to share innovative practice. We consider our programme to be research live and practice near. The students are taught by academic staff who are all involved in undertaking research. The areas of research address the broad spectrum of social work including mental health, learning disability, children and families and gerontology. Students are able to access up to date research messages and debate cutting edge methodologies both of which help inform the development of their practice. This supports Croisdale-Appleby`s suggestion that social workers be acknowledged as social scientists. This research robustness is further enhanced by close collaboration with partner agencies. Practitioners are actively involved in the design and delivery of all elements of the programme. In addition the programme has a very active Service User Carer Forum group who ensure lived experiences and the importance of power are shared with the student group. This promotes healthy discussion and debate around the professional role, the relevance of social work values, and intersections of oppressions. It also asks fundamental questions on what constitutes ethical practice. The collaboration between academics, practitioners and service users ensures students are able to draw on a broad range of knowledge and experiences to help inform their professional judgements. It is important professional decision making doesn`t rely on instinct but has a robust evidence base at its core.

Reflexivity is the second R and fundamental to social work learning and everyday practice. The students are told on the first day of the course that on completion in two years there is an expectation that there will be a change in how they understand the world and how they understand the construction of knowledge. I acknowledge the process of learning is deskilling and by definition a painful experience. The use of reflection is a vital tool in the social workers toolkit. Pedagogy informs the variety of teaching styles on the programme and opportunities to engage in group work informed by an enquiry and action learning approach helps facilitate the reflective process. It also ensures the students take responsibility for their own learning. The act of reflection is further influenced and supported on placement by quality supervision, peer support, and additional training opportunities. I expect space for reflection to be a fundamental right for all practitioners and this opportunity should begin at the qualifying stage.

Resilience, the third R, is crucial to practitioners being able to sustain themselves in what is an increasingly challenging practice environment. It helps amongst other things to protect against experiences of vicarious trauma. The emotional component of the social workers role demands all students develop emotional elasticity. It also requires the student is able to develop strategies to help self-manage. This might include developing strategies for chairing difficult inter-professional meetings, communicating with reluctant children or adolescents, developing rapport with adults experiencing mental unwellness, or identifying best ways of de-briefing after a challenging home visit.

The three Rs exist as a golden thread fundamental to the design and delivery of the social work programme.

During this period of rapid and significant change there is I believe a real risk to the golden thread. Whilst engaged in celebrating social work in its international context, recent developments in England suggest dangers are afoot. I have anxieties that the Rs may be lost or at the very least diluted, which may impact on students’ experiences of dignity and worth.

I`m not so arrogant to assume there is only one way to deliver social work education, nor would I suggest the structure we have designed is necessarily the best example. However recent changes to how social work education is being delivered does concern me. Fundamental to this concern is the rapid rise of fast track programmes, and there are number of reasons why:

• First of all the proposed numbers involved. One third of the 4,590 social work graduates (2013-14-figures from HESA) undertook post graduate social work programmes. The proposed advance of fast track programmes both Step Up and Frontline aim to train 950 students by 2019. This figure constitutes two thirds of the current post graduate figure. This proposal will have a significant impact on those research intensive HEIs who currently run social work programmes.

• These changes appear to be ideologically driven with a lack of robust evidence to support the assumption that this method of delivering social work education adds value to that which currently exists.

• The focus on children and families work and the move towards specialism puts at risk the benefits of the generic programme. It is a generally held view of social work academics that the generic programme offers the best opportunity for social work students to appreciate the wider social context of family and human development as a whole life course.

• The fast track programmes with their significantly larger bursaries offers a financially perverse attraction to applicants. This creates a two tier application process with those traditional programmes having their bursary allocation squeezed. There is no guarantee that the fast track programmes will attract the best possible candidates with their mix of social care and life experience, all key to supporting the development of well rounded practitioners. In addition there are questions around diversity. In targeting high performing undergraduates there is the potential risk that the fast track programmes attract students of a certain age, class and ethnicity. This will impact on the makeup of the social work profession moving forward, which will further impact on the experiences of the vastly diverse service user groups.

• Squeezing the learning into a fourteen month period places significant pressures on the student. The complexity of the social worker role demands time is taken to help form effective links between social work theory and practice. There are dangers this pace of learning will result in knowledge deficit. This runs the risk of practice becoming overly bureaucratised, target driven, and risk averse. This manifestation mirrors weaknesses in current practice regimes. The result may be paternalistic practice that pathologises service users and fails to acknowledge the impact of the wider social and political context. The danger is such an approach risks creating an ethically naive profession, where principals of social justice are deemed a luxury rather than a fundamental human right.

It is important on this day that we acknowledge all those involved in learning the craft of social work as well as those delivering social work education. Social work “promotes social change, problem solving in human relationships and ensures the empowerment and liberation of people to enhance wellbeing” (IFSW 2011). This task is both complex and messy. The act of delivering social work education has many challenges, Wenger (1998) suggests that “learning is the engine of practice and practice is the history of that learning”. The suggestion is people’s learning and the environment in which it is experienced influences what they become. I suggest the principles and structures of the fast track movement offer potential dangers to social work education and the qualifying experience. There is a risk that a learning context is being created that negates the long history of research messages relating to social work education. There is a need for this debate to be amplified and the discussion should be informed by robust research to ensure the student social worker experience is maximised. There is a need to ensure the three Rs remain a fundamental part of any social work programme and aren`t replaced by the three D`s, risk of dilution, the risk to diversity and the risk from dogma.
Dickens, J. (2011) Social Work in England at a Watershed—As Always: From the Seebohm Report to the Social Work Task Force British Journal of Social Work Vol. 41 p22

IFSW. Ethics in social work, statement of principles. Available at www.ifsw.org/f38000032.html
Wenger, E. (1998) ‘Communities of Practice. Learning as a social system’, Systems Thinker, http://www.co-i-l.com/coil/knowledge-garden/cop/lss.shtml

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