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

1. Improving Outcomes for Children who Live in High Risk FamiliesDi Jerwood

2. High Risk Families • Domestic Abuse • Substance Misuse • Parental Mental Ill Health

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

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

6. Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States Top 10 Risk Factors: • smoking, • severe obesity, • physical inactivity, • depression, • suicide attempt, • alcoholism, • illicit drug use, • injected drug use, • 50+ sexual partners, • history of STD (sexually transmitted disease).

7. Early Early Death Death Death Birth Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences Adverse Childhood Experiences The Influence of AdverseChildhood Experiences Throughout Life

8. Some findings so far… • Increased risk of lung cancer • More auto immune disease • Increased prescription drug use

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

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

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

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

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

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

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

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

19. Parental Mental Illness • Effects on Parents Employment Income Relationship strain Links to substance misuse ad violence

20. Parental Mental Illness: Effects on Children • Separations • Insecure relationships • Neglect • Maltreatment • Carer role • Upset , frightened, ashamed • Bullied • Hear unkind things • Risk of mental illness • Revenge Killing

21. What a challenge!!

22. Children’s Voices • What children say about living with parental substance misuse

23. FEDUP (Family Environment Drug using Parents) • A family approach to supporting children who live with parental substance misuse • Group work programme with children • Individual work with parents • Come together for safety planning

24. Family SMILES Simplifying Mental Illness plus Life Enhancement Skills) • Based on the Erica Pitman Programme • Twin track programme working with children and their parents to reduce the risk of harm to children who live with parental mental ill health.

25. Evaluation FED UP & Family SMILES : Summary of findings so far

26. Overview of the evaluation tools Overall aim: To improve the well-being of children and young people and reduce isolation

27. Interim Findings ( October ‘11 to February ‘13) To enhance parents’ protective parenting/ to improve the safeguarding of children & young people. • For both FED UP and Family SMILES there has been a decrease in total CAPI score between T1 and T2 which is statistically significant for both programmes. This indicates that for both programmes parents are reporting a positive change in their parenting behaviours related to improving the safeguarding of their children. • The change in five out of seven subscales on the CAPI was statistically significant for FED UP suggesting that parents’ levels of distress, unhappiness, problems with the family, loneliness and ego strength have all improved. For Family SMILES , the distress, unhappiness and ego strength subscale are statistically significant Note: For both FED UP and Family SMILES number of Time 1 and Time =19, Statistical significance at 95% confidence levels using a one tailed test

28. To enhance parents’ protective parenting/ to improve the safeguarding of children & young people: Evaluation wheels with parents FED UP Note: The rating of 1 to 5 where 1 is low and 5 is high

29. To enable children and young people to feel better about themselves Levels of self esteem amongst children as reported on the adapted Rosenberg scale increases on both programmes. In Family SMILES, this change is statistically significant. FED UP Family SMILES N = 28 (T1 and T2) N = 20 (T1 and T2) Mean at T1 = 19.6, Mean at T2 = 20.8 Mean at T1 = 19.05, Mean at T2 = 21.5 P value = 0.102 (one tailed t-test) P value = 0.009 (one tailed t-test) The change is not statistically significant The change is statistically significant

30. To reduce children and young people’s emotional & behavioural problems. At present the evaluation is not showing any statistically significant change in reducing emotional and behavioural problems as reported on the SDQ on either the FED UP or the Family SMILES programmes. Practioners on FED UP have reported change that is statistically significant using the HoNOSCA

31. To enable children and young people to process their thoughts and feelings: Children’s evaluation wheels Family SMILES FED UP

32. The world is a dangerous place to live. Not because of the people who are evil, but because of the people who don’t do anything about it (Albert Einstein)

33. Thank You for Listening Di Jerwood djerwood@nspcc.org.uk Acknowledgements Professor Julie Taylor Dr. Prakash Fernandes