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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Growing the conversation: how to make Bristol a Child Friendly city

Close up of little boy in canvas shoes drawing with chalks on the sidewalk

Debbie Watson reports as The Bristol ‘Child Friendly City’ Network ran the first Child Friendly Symposium as part of the 2015 Thinking Futures festival.

Inspired by global UNICEF guidelines, the Child Friendly City’s Network aim is to bring together a wide range of partners to campaign strategically and deliver grass roots projects that support child friendly environments. The Child Friendly Symposium brought together around 20 children and young people, as well as 80 adults who worked for and with this demographic, from all over Bristol.

Mayor George Ferguson opened the event and emphasised the need for cities to actively consider children and young people, whether in urban planning decisions, allocation of community resources or in the respect afforded to our youngest citizens. He said: “A child-friendly city is a healthy, happy, liveable and playable city”.

The symposium then saw short presentations delivered by Bristol academics: Dr Angie Page on children’s activity levels and public health outcomes; Dr Helen Manchester on a project which explored young people’s cultural engagement in Bristol; and Dr Debbie Watson on a project which co-developed research capability and awareness with Room13 Hareclive children and artists.

But the main event saw child-led participatory activity to engage adults in the room. Together they made creative banners, highlighting what needs to change in Bristol for it to be truly child friendly. These banners were then showcased, sharing many powerful and provocative messages.

Giving young people from Room 13 Hareclive, Hartcliffe and Felix Road Adventure Playground, Easton, a contributing role in the symposium was an important statement of intent. Harnessing this potential is what Child Friendly Cities (CFC) are all about, holding true to the principle that ‘if a city is successful for children it will be successful for all people’.

“The Thinking Futures Bristol Child Friendly City Symposium was a great opportunity for us to bring together representatives from different backgrounds in the city to share an equal platform: children and young people, academics, organisations working with children and young people, arts and cultural organisations, Bristol’s mayor and Bristol City Council officers.”

We heard compelling arguments from different perspectives – research, local government and children themselves – about why it’s so important for Bristol to be more child friendly. Children and adults identified key calls for change in the city such as ‘free bus travel for children’, ‘safer streets’ and ‘believe and trust in us’, which we all endorsed. It was good to see children and young people, many of them from more disconnected parts of Bristol, sharing thoughts and ideas with academics and practitioners, and vice versa.

This event in partnership with the University of Bristol really helped to raise the profile of Bristol CFC and to consolidate and move on our agenda within the city. We’re excited by the possibility of further collaborative work with academics.” – the Child Friendly City network.

The event is part of a wider strategy to grow the conversation in Bristol, beyond immediate partners and interested parties. Already, impact can be seen across the city through press releases, media coverage, and new partnerships. Bristol and other cities have already been in touch, with potential collaborations stretching as far as Sweden. In late February these interested parties came together at a seminar hosted by Cardiff University’s Children’s social care research and development centre (CASCADE), opened by Dr Sally Holland, the children’s commissioner for Wales.
Ongoing local campaigning includes: a proposal for research impact funding to tackle one key issue with children in the city; organising a young people’s Mayoral hustings in May; and an international conference hosted in Bristol, for the city to truly lead on child friendly policy and practice.

For more information:

Towards a child-friendly city

The Child Friendly City network consists of University of Bristol academics and grassroots organisations Architecture Centre, Playing Out, and Room13 Hareclive.

Debbie Watson is Reader in Childhood Studies in the Centre for Family Policy and Child Welfare.

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Letting the Future In

Tricia Jessiman, Research Associate in the School for Policy Studies, reports on a study of therapeutic support for children affected by sexual abuse.

It has at times felt difficult to keep up with overlapping high profile Child Sexual Abuse (CSA) scandals dominating the UK headlines in recent years. Jimmy Saville, Operation Yewtree, Rotherham, the ‘Westminster Paedophile Ring’ – the headlines have kept coming in. There has been rather less media coverage on the impact of sexual abuse on those children who experience it. The academic literature tells us that CSA is associated with a range of psychological and behavioural symptoms in both childhood and adulthood including post-traumatic stress (PTSD), depression, alcohol and drug misuse, suicide, and self-harming behaviour. Children who have been sexually abused need help – but it may not be readily available. The NSPCC’s current campaign, It’s Time, seeks to highlight the scarcity of therapeutic support in the UK for children who have experienced abuse.

Even were it more widely available, it is unclear ‘what works’. Research on the effectiveness of therapeutic support for CSA is limited. Colleagues in the School for Policy Studies have published two Cochrane systematic reviews of the effectiveness of therapeutic interventions. Geraldine McDonald led a review of cognitive-behavioural interventions (CBT), and concluded that “…CBT may have a positive impact on the sequelae of child sexual abuse, although most results were not statistically significant.” Most of the 10 studies in the review were American, and the most recent was published in 2004. William Turner’s review of psychoanalytic/psychodynamic psychotherapy for CSA failed to find a single study that met the inclusion criteria.

Hence we are delighted to see the publication today of our evaluation of ‘Letting the Future In’ (LTFI), a therapeutic service for children affected by sexual abuse. Led by Professor John Carpenter, the study was conducted with colleagues at Durham University and is the first impact evaluation of a therapeutic service for CSA published in over a decade. It’s also a rare example of the use of a randomised control trial in social work research with children and families in the UK (and we certainly learned just how much time, effort and goodwill is required to conduct one).

LTFI was developed by the NSPCC and at the time of the study delivered across 20 service centres in England, Wales and Northern Ireland. It is available to children aged between four and 17 without a diagnosed learning difficulty who have been affected by sexual abuse. Children are offered up to four therapeutic assessment sessions followed by up to 20 intervention sessions (extended up to 30 if necessary) with a children’s services practitioner (CSP). CSPs delivering the intervention vary in their background, training and experience but most commonly are qualified social workers with additional training in therapeutic work with children. At the same time, the child’s safe carer (typically the non-abusing parent, but sometimes a grandparent or foster carer) is offered up to eight sessions to help them process the impact of discovering that their child was sexually abused, and to support the child in their recovery.

We conducted a randomised control trial (RCT) with waiting-list control of LTFI, as well as a process evaluation of its implementation by NSPCC teams, and qualitative case studies with 15 children and young people who received the intervention. A total of 242 children took part in the RCT, making it the largest trial of a CSA intervention ever conducted. Three quarters of them were girls and most had experienced contact sexual abuse – inappropriate touching or penetration. Unlike the high profile headlines would have us believe, the children in our study were not abused by strangers or celebrities. They were almost twice as likely to have been abused by someone in their family as by someone outside it and in four out of ten cases where the perpetrator was known, they were also a child under 18 years of age.

The study confirms that children who have experienced CSA need support. When they were referred to LTFI, over half of the children and young people over eight years old in our study reported ‘clinical’ level scores on a standardized measure of psychological and behavioural symptoms, rising to 70% when one or more ‘significant difficulties’ were included. Parents/carers reported ‘clinical’ or ‘significant difficulty’ level scores for nine out of ten younger children under eight. Many of the children in our sample had also experienced three or more other types of victimization, such as physical and verbal abuse at home and bullying by other children, in addition to sexual abuse.

Did receiving LTFI help? We won’t give too much away, because the findings of the study are published today and we want you to read them. In short, the impact evaluation revealed that LTFI had a significant effect on older children and young people (broadly speaking, those aged eight years and older) after six months. The report provides a detailed account of the service delivered, the evaluation design and results, as well as details of how much it costs to deliver LTFI. It also has a strong service-user element; our qualitative research with children and their families who had received the intervention revealed that they valued it hugely, in particular the bond or ‘alliance’ that developed between NSPCC practitioners and the children. One of the young people we spoke who had this to say about LTFI:
“If you’re in a really bad place like I was, they will definitely bring you out of it and you’ll see there’s so much more to life. It’s probably one of the best decisions I made to do LTFI. Before I met them I was really quiet, withdrawn, wouldn’t really talk to anybody. Now since finishing with them, I’m such a more positive, outgoing person and I have a lot of confidence. They did their job.”

This blog post is based on Carpenter, J., Jessiman, T., Patsios, D., Hackett, S. & Phillips, J. (2016) Letting the Future In: a therapeutic intervention for children affected by sexual abuse and their carers: An evaluation of impact and implementation. NSPCC
https://www.nspcc.org.uk/services-and-resources/research-and-resources/2016/letting-the-future-in-evaluation

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An engaging pilot study: How the PLAN-A study has been built on participant input.

Plan A logoDr Mark Edwards, from the Centre for Exercise, Nutrition and Health Sciences, discusses the value of participant inclusion in project implementation.

Physical activity is a big problem in the UK. We’re not doing enough of it. Lots of evidence suggests that when people are more active they are also healthier, have a greater sense of wellbeing, and help reduce their risk of future disease. So, why isn’t everybody active? This is a difficult question. We could ask why some people still smoke or why we don’t all eat a healthy diet. The potential answers to these questions are complex and multifaceted.

We do know a few things about physical activity however; firstly, females are less active than males at all ages. Secondly, adolescence is a key time when females become less active and the divide between males’ and females’ activity widens; around the beginning of secondary school. Thirdly, when adolescents stop being active, it becomes even more difficult to (re-)engage them. Fourth, being physically active is not a simple as it seems: the choice and ability to be active is wrapped in myriad social and psychological factors.

The PLAN-A team, led by Dr Simon Sebire at the University of Bristol’s Centre for Exercise, Nutrition & Health Sciences, hope to advance our understanding of how we can increase the physical activity of girls during early adolescence. We are testing the feasibility of increasing the activity levels of Year 8 girls (aged 12-13) through a ‘peer-led’ concept that has proved successful in reducing adolescent smoking rates (www.decipher-impact.com/). The basic concept of PLAN-A is: 1) ask all Year 8 girls in a school to nominate who they think are the most influential girls in their year, 2) recruit the top 15% of the girls nominated to attend a training course to be a peer-supporter, 3) train peer-supporters to recognise the importance of being active, how they can overcome barriers commonly faced by teenage girls and incorporate more activity into their friends’ lives, and how to communicate effectively, and 4) send the girls  back to their peer groups to informally encourage their peers to be more active.

A central belief that underpins PLAN-A is that the people taking part – the girls whose behaviour we are trying to change and, to a lesser extent, the trainers who will train the girls – are best placed to know what will work for them. Despite having a diverse range of experience in our team, we are not Year 8 girls, and as such can only go so far to develop an educational experience that meets their expectations. If the PLAN-A intervention is to help increase the physical activity levels of Year 8 girls, it needs to reflect what they find important, speak their language, engage and enthuse and inspire them to encourage their friends to be active. As such, we have continuously engaged our “end users” in the design of the PLAN-A study, as can be seen in the following narrative.

Our stakeholder engagement started when the grant application was being written. A group of adolescent girls from the DECIPHer ALPHA (Advise Leading to Public Health Advancement) group took part in a focus group and gave valuable feedback on the design of a peer-led activity intervention. The intervention we designed expressly adhered to the girls’ suggestions that the training should focus on health, vitality and enjoyment. The girls also wanted the training to equip them with practical skills. We took what the girls said and edited the training and recruitment materials in light of this.

Before we conducted the ‘feasibility’ study we wanted to explore the materials and training we had developed in light of the DECIPHer ALPHA group’s suggestions with more year 8 girls. We hoped that this would provide a further opportunity to tailor the intervention to their preferences. A school in Wiltshire kindly allowed us to pilot the whole of the PLAN-A intervention with their Year 8 girls. As such, we tested the recruitment, peer nomination, pupil briefings and training with these girls. The process was interesting, a little reassuring, and hugely constructive. Children can be good critics!

In total we conducted six focus groups with the Year 8 girls. The first two focus groups sought feedback on our proposed peer-supporter recruitment and training materials, including the study logo. We mainly wanted to know if what we were proposing appealed to Year 8 girls. Although we weren’t too far off, we redesigned elements of the intervention and then invited the girls to two more focus groups to check whether we had done what they asked. Following a few more revisions based on their input, we felt we were ready to rehearse the intervention.

We ran a pilot recruitment drive, which entailed a presentation to all Year 8 girls and an information pack for themselves and their parents. This went well and 95.7 % of girls in the year wanted to take part. We then conducted the peer nomination with the year group. This provided the chance to test the nomination process out. Again, this went smoothly and a few days later we invited the girls who had been nominated as peer supporters to a briefing session. As they suggested in the earlier focus groups, the girls were reminded of the kudos of being identified as one of the most influential people in their year group. Of the 14 girls who were nominated, 12 attended the training.

In the meantime we trained our PLAN-A trainers – the two people who would be training the peer supporters. The trainers received a training course (run by study staff) and then delivered the peer supporter training. We had an experienced observer sit in and watch the training to help identify any issues that may not be apparent to the trainers (and to also check that everything flowed as planned). Immediately after the training, we interviewed each trainer and conducted two focus groups with the girls who took part. We wanted a ‘warts and all’ account of their experience with PLAN-A, and that’s what we got!

In general the girls loved the training (and their trainers). The biggest issue was that there was too much writing and not enough moving. The trainers largely agreed with the girls and raised similar issues. We took this feedback and used it to change as many activities as possible to reflect what the girls wanted. We revised the activities and now have a “final” intervention package that targets the intended learning outcomes using much more activity, less writing and sitting, and more role play. We will be delivering the intervention over the next few months and will, once again, seek detailed feedback on how this was received by the people taking part.

 

This project is funded by the National Institute for Health Research [Public Health Research Programme] (project number 13/90/16). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health.

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From the narrative of failure to the narrative of potential?


DB_photo
David Berridge, Professor of Child and Family Welfare at the School for Policy Studies, considers the process of making an impact on policy and practice by discussing his research on looked after children. 

It is interesting, and advisable, at the completion of a research project to reflect on how it went.  There can be a tendency to delay this process, encouraged by feelings of relief as well as no doubt the need to catch-up with other responsibilities that are now overdue.

These thoughts were with me at the end of 2015 on the conclusion of our joint-research with the Rees Centre, University of Oxford, funded by the Nuffield Foundation, on the Educational Progress of Looked After Children in England.  We were certainly pleased to complete what for us was a major piece of work. There were many challenges in the work (to borrow a well-used euphemism), including: obtaining and analysing large government databases; negotiating access to six contrasting local authorities; contacting groups of older teenagers in care, their social workers, carers and teachers; obtaining and analysis large amounts of qualitative data; and writing-up the results.

Social researchers are familiar with these processes, with varying degrees of success. But we also give particular attention to the dissemination of research and trying to ensure that it impacts on the worlds of policy and practice.  These stages need proper planning throughout the research process, not just at the end.

We were certainly pleased with our research results, which we feel contain important, new messages.  Comparing large groups of children in care who took their GCSEs in 2013 with ‘children in need’ (receiving social work support at home) and the wider pupil population, we found that, once controlling for a wide variety of factors, those in care (particularly foster care) made greater educational progress than did children in need.  This is despite, one would assume, having less acute problems.  Generally, therefore, the care system appears to operate as an educational protective factor.

This is a new message as commentators in the past have generally focused on the often disappointing attainments of young people in care (exam/test results etc), rather than their educational progress after becoming looked after – an important distinction. Indeed, there was an overwhelming view from the young people interviewed that leaving home and entering care had benefited them educationally. Furthermore, it was mainly late adolescent entrants to care who experienced particular educational problems.  Clearly, we should not overlook that high attainment is important and our research is intended to contribute to this by a detailed examination of the nature of the problem and its causes.

Other important findings include that children’s emotional and behavioural problems often underlie educational difficulties.  Taking into account pupil variation and school effectiveness, there was little difference between Councils in the educational progress of children in care.  Responses of school and care systems were important, including the level of stability provided.  Nonetheless, this questions aspects of a ‘league table’ approach and of the OFSTED inspection framework.  Other results are available on the website, including the individual technical reports.

We were grateful that the Minister for Children and Families, Ed Timpson MP, spoke at our launch event at the Nuffield Foundation.  He concluded his speech by repeating the statement made by Robbie Gilligan earlier in the day, that we need to move ‘…from the narrative of failure to the narrative of potential’.  This is an important observation and it is interesting to reflect on what it means and its implications. The statement is ambiguous. On the one hand it could be referring to the fact that we should not label individual children in care as unintelligent or incapable, as their school performance has been hampered by their social and emotional development and poor parenting.  On the other, the ‘narrative of potential’ comment could denote the need to recognise that the care and school systems makes positive progress with these disadvantaged pupils, especially when there it a reasonable period of time for there to be an effect. The statement could have both micro and macro meanings; although for me ‘narrative’ usually has broad application.

In his autumn 2015 Conservative Party conference speech the Prime Minister referred to the poor outcomes for children in care: ‘These children are in our care; we, the state, are their parents – and what are we setting them up for…the dole, the streets, an early grave?  I tell you: this shames our country and we will put it right’.

A fortnight after the launch of our research the Prime Minister announced further proposals to take over failing local authority children’s services: reported to be as transformative a policy as the Academisation programme in the last Parliament.  It is unclear if children’s services’ failures relate specifically to child protection and child tragedies, to poor outcomes for children in care, or to both.  The Prime Minister’s conference speech located it in a section on entrenched family poverty.

Reform of children’s services, therefore, is signalled as a flagship policy for this Conservative administration.  We hope that our research findings, and other sources of evidence, are allowed to contribute to this debate: to help pinpoint the exact nature of child welfare problems, their complexity and the effectiveness of responses. It will be interesting to see if a narrative of potential or a narrative of failure will be maintained 2016.

 

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Are we really witnessing a great ‘devolution deception’?

Ben-HarrisonjpgAs part of the ESRC’s Festival of Social Science, a debate took place in Bristol on 9/11/15 on the impacts of directly elected mayors on cities, including contributions from Baroness Barbara Janke, former Leader of Bristol City Council and Member of the House of Lords, Thom Oliver, Political Scientist, UWE, David Sweeting, Senior Lecturer, University of Bristol, and Ben Harrison, Centre for Cities.  A lively debate included reference to George Osborne’s plans for cities and city regions, and particularly whether we are witnessing a ‘devolution deception’.

Here, Ben Harrison argues the case against such an interpretation. 

To dismiss the Government’s devolution agenda simply as a “deception” is to opt out of a debate at the very time that real change is finally possible.

I was recently in Bristol earlier this week speaking about the merits of directly elected mayors, when I heard a familiar refrain during the audience Q and A. Far from being a significant redistribution of power from the central state to local areas, the Government’s entire devolution agenda, the attendee said, was nothing more than a “devolution deception”.

This is far from the only time I’ve heard this kind of critique put forward, not least from the national Labour party and its new leader, and earlier this week from the leader of the Liberal Democrats. But does it really stack up – is the Government really deceiving people when it comes to its intentions on devolution?

Let’s examine the biggest concerns that tend to underpin claims that devolution is but a fig leaf for other, hidden policy agendas.

  1. The Cities Bill does not specifically commit the Government to provide any additional powers to local government

A key part of the parliamentary opposition to the Government’s agenda has been that despite the rhetoric, the Devolution Bill does not identify a list of specific policies that will be devolved to a specific set of places, and therefore it won’t allow for the devolution of anything at all.

In fact, the opposite is the case. The Bill is a deliberately generic and enabling piece of legislation that essentially allows for the devolution of almost anything – housing, health, welfare, policing and more – to a local level, and allows for different settlements to be reached in different places depending on local appetite and capacity. The only limit on devolution under the model will be the willingness and ability of local and national politicians to reach agreement on what will be included. And of course the experience in London, where the powers of the GLA has grown significantly since the turn of the century, suggests this picture can and will change over time.

  1. The Government is driving this process from the top down

Yet despite the potential expansiveness of what is on offer, many still struggle to equate the current policy process with devolution because they see the Government setting the agenda and criteria for what will or won’t be devolved within the framework set by the Bill. If it’s a ‘top down process’, how could it possibly be devolution?

The major factor that has led to the current round of city-region deals, featuring more substantial devolution than previous attempts to decentralise, has been the active involvement of the Chancellor of the Exchequer. George Osborne has had to deploy his own substantial political capital to set clear criteria that must be met to achieve devolution, and most critically, in order to prise control away from Whitehall departments (including the Treasury) who instinctively look to control and constrain any moves to push power down from the centre.

That’s why it is not contradictory for the process of decentralisation to be set out and driven from the centre – in fact, in a country where central Government holds almost all the power, it is necessary if we are to see tangible progress made. In 21st Century Britain, the dominance of Whitehall departments, coupled with the lack of power held by UK cities, means that only the authority of the highest offices in the land can drive the devolution of real power to cities and city-regions across the country.

  1. The process has taken place entirely behind closed doors with no public scrutiny

A separate concern relates to the lack of transparency that has characterised the deals currently being negotiated between the Government and city-regions. Unlike in previous rounds of city and growth deals, proposals have not always been made public, and with goalposts shifting, councils have struggled to communicate to their communities and colleagues in the private sector what devolution will mean for their place.

These concerns are understandable and should be addressed as a priority in the months to come – indeed already places are engaging in more detailed consultations on new arrangements for their places. But it is also important to recognise that these deals are being negotiated by politicians at a national level with a manifesto commitment to do so, and locally elected politicians with a mandate to represent the interests of their constituents. Equally, while other approaches may have been possible, the reasons why the process has to date been undertaken in this way are also understandable.

The Government has deliberately eschewed setting out a ‘one-size-fits-all’ approach to devolution, and has encouraged places to come forward with their own proposals in time for them to be implemented during the coming Parliament. Agreeing these proposals requires political compromise and a willingness to take on, share, and give up different powers and responsibilities. The political reality is that these are often difficult and uncertain conversations that benefit from a degree of privacy, to allow for more honest and frank conversations to take place. It would be much harder, if not impossible, to conduct these negotiations in public.

  1. This isn’t about the devolution of power, but the devolution of budget cuts

Finally, and perhaps most significantly in terms of an accusation that the Government has a “hidden agenda” when it comes to devolution, is the issue of cuts to local government budgets. Many believe that the Chancellor is in essence giving a little with one hand, but taking dramatically more with the other, while leaving councils with the responsibility to deal with the consequences for public services.

There can be no doubt that local government has undergone significant resource reductions since 2010, and as we heard from the Chancellor this week, there will be more pain for the sector to come in this Parliament. Observers are right to suggest such moves signal a concerted effort to change the size and scope of the state, and that doing so raises profound questions regarding the future of public service provision. But to suggest this is some kind of hidden agenda is, I think, misjudged.

Firstly, the Chancellor advertises his ‘austerity credentials’ proudly – they are a key part of his own personal brand and no one can have been surprised that the forthcoming Spending Review will feature more cuts. Secondly, whether one agrees with the ambition or not (and many do not), I think the Chancellor sees devolution as a necessary and complementary factor required to deliver a smaller state. The thinking here is, yes budgets will be dramatically smaller in the future, but the ability of (and imperative on) local leaders to drive efficiencies and new models of public service provision will be enhanced. Of course this is a political and financial judgement, and the merits of it can and will be contested, but on the Chancellor’s terms at least, devolution is not a distraction from austerity, but actually goes hand in hand with it.

It is to be expected that many are suspicious of the impact devolution will have across the country, and that many remain sceptical regarding the Government’s commitment to truly give power away. We have, after all, been here many times before, and failed to see control wrestled away from the central state. Equally, given the scale of public spending cuts planned, concerns regarding the future provision of public services are also understandable.

Yet to dismiss the Government’s devolution agenda simply as a “deception” is to opt out of a debate at the very time that real change is finally possible. It’s true that the prizes on offer today may seem modest, particularly when compared to the kinds of powers wielded by cities in Europe or America. But after decades of centralisation, the real questions those with doubts about the current agenda should be asking is how can we make sure that the incremental reform that is on the table today is delivered; how do we ensure that places do have greater ability to shape the way in which the forthcoming cuts affect them; and how do we ensure that, bolstered by newly established city-region leadership across the country, the devolution deals of 2015 mark the beginning of the story, not the end.

This was first posted on the Centre for Cities blog.

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Why how we measure poverty matters

Tessa Coombes: @policytessa

Tessa Coombes, PhD student in the School for Policy Studies, former councillor, ex-policy director at Business West, and part-time blogger considers the latest debates in poverty measurement as illustrated in an event organised by the Centre for Poverty and Social Justice

There’s an interesting debate that’s been going on for some time now about measuring poverty and getting the issue onto the agenda so people sit up and take notice in the right way. It’s an area of academia that I haven’t really engaged in before, but one where I have a personal interest in seeking to see the debate move in the right kind of direction. A direction that takes us away from the concept of demonising the poor and those living in poverty and instead acknowledges the levels of inequality and seeks to do something about it in a way that benefits those most in need. The recent Policy & Politics conference in Bristol had inequality and poverty as one of its main themes and at the time I wrote a couple of blogs on the plenary sessions – the human cost of inequality (Kate Pickett) and why social inequality persists (Danny Dorling). Both these presentations provided plenty of evidence to illustrate just how significant a problem we have in the UK and how it is getting worse.

Last week I went to a seminar on this very issue run by the Centre for the Study of Poverty and Social Justice at the University of Bristol, where the subject of debate was about how to gain traction and create change from academic research and evidence. The focus of the discussion was about using living standards rather than poverty indicators and the difference this can make when trying to attract the attention of politicians and policy makers. It was an interesting and thought provoking debate which gave some pointers on how we can translate measures and indicators into policy and action, as well as why it’s helpful to look at living standards for everyone rather than just looking at those in poverty.

The first speaker, Bryan Perry from the Ministry of Social Development in New Zealand, talked about how by using evidence in the ‘right’ way, that was responsive to the needs of politicians, using the Material Wellbeing Index, they had managed to gain traction and make an impact on policy. The key was talking about trends rather than absolute numbers, providing simple statistics that tell the ‘right’ story and making the most of the opportunities as they arise. The focus of their work on living standards has served to highlight the differences, to show how life at the bottom is radically different, and to emphasise the point, in simple terms, about what people don’t have rather than about what they need. This has resulted in a centre-right government actually implementing increases in benefit payments as part of their policy, rather than seeking to reduce them at every opportunity.

The discussion then turned to the UK with a presentation from Demi Patsios, on the development of a UK Living Standards Index (UKLSI), where the point was made that in order to understand the poor we need to understand the rich, therefore just looking at those in poverty is only a small part of the story we need to capture. The ability to understand poverty in the general context of society provides that broader picture and story, which serves to highlight the extent and levels of inequality, rather than just the hardships at one end of the spectrum and enables us to develop policies that are directed at the full spectrum of society. The UKLSI aims to measure what matters most to people under three main themes: what we have, what we do and where we live. Whilst it is much more complicated that this and brings together both objective and subjective data into 10 domains and 275 different measures, the overall concept and themes are simple to understand and highlight some important differences and issues. The Index helps us to understand ‘what we have’ by looking at essential v desirables and luxuries v wants. It looks at ‘what we do’ through political, social and community engagement and ‘where we live’ by satisfaction with our accommodation and neighbourhood. It brings together the types of measures that appear in things like the Living Wage calculations and local authority Quality of Life indicators, and it does it in a comprehensive and compelling fashion.

But what does all this add to the debate and will our politicians take any notice? How do we make this type of discussion gain traction in the UK, in the face of current media and government interest in individualising the problem and stigmatising the poor, whilst ensuring the poverty discourse is firmly focused away from the rich and powerful?

The current government’s approach, as outlined by Dave Gordon in his presentation, is to repeal the only legislation we had with real targets to reduce poverty (the Child Poverty Act) and to replace this with measures on educational attainment and workless households. It’ll certainly be interesting to see how this approach can work with the recent commitment under the new United Nations Sustainable Development Goals to “end poverty in all its forms everywhere” and to “reduce inequality within and among countries”.

From my own experience, as an ex-politician and someone who has worked with politicians and policy makers over many years, the key for me is making the messages simple. Yes, providing the evidence to support the simple statements, but only after you’ve sold them the message to begin with. Overcomplicating things with lots of measures and targets just serves to mask the message and hide the key points. Something that combines simple messages with supporting evidence; that illustrates disparities in living standards; and provides for micro level analysis would seem to be the right kind of approach.

This blog was first posted on Tessa’s own blog

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