Re: changes in rates of violent deaths 1974-2008

February 13, 2012

Yes, I've been watching that series too. Unfortunately, it's all too

real life and it's hard to watch. The parents include some deeply

damaged people with substantial mental health problems and some with

learning disabilities. They're simply unable to comprehend what

they've taken on in parenting young children. As if the parents

weren't sad enough cases, the effects of their failures on their

children are very severe.

I suspect it'll redress some of the balance where SWs have come in

for criticism for (a) taking children away from caring families and

( failing to take children away from dangerous families. Up to

now, they can't win. Maybe this'll help in PR terms, but it raises

trickier questions too. The filming seems terribly intrusive, but I

think it's truthful.

It also raises the issue for me about how on earth any society could

support such unhappy and failing parents to raise children. I note

the degree of impetuous violence and risky behaviour involved and

this makes the position of children very unpredictable. These would

rate as high risk, high vulnerability families on any measure. If

these are families where children are only coming into the care

system now, post Connolly, could they ever have been considered

as safeish environments?

Hope I'm making myself clear. It's something I'm trying to think

through.

From: Cowley <sarahcowley183@...>

Date sent: Mon, 13 Feb 2012 20:05:19 +0000

Subject: changes in rates of violent deaths 1974-2008

Send reply to:

A useful analysis: I think this paper has just been published after

being 'online' for almost a year, so others may have already seen it,

but it flags up some good news about the falling rates of violent

deaths to infants and children in the middle years, although those in

adolescence are rising.

http://adc.bmj.com/content/97/3/193.abstract?etoc

This is a review of ONS data and related Home Office homicide

figures. It adds to the evidence published a couple of years ago,

which was based on a review of WHO data, confirming the improvements.

I have just been watching the deeply depressing 'protecting our

children' series about Bristol social workers on television, and it

is encouraging to think there is some good news around in this field!

best wishes

February 13, 2012

I watched the first two Bristol programmes and was struck by the total absence of HV in them. Sent from my iPhoneOn 13 Feb 2012, at 20:31, " hwood@... " <hwood@...> wrote: Yes, I've been watching that series too. Unfortunately, it's all too real life and it's hard to watch. The parents include some deeply damaged people with substantial mental health problems and some with learning disabilities. They're simply unable to comprehend what they've taken on in parenting young children. As if the parents weren't sad enough cases, the effects of their failures on their children are very severe. I suspect it'll redress some of the balance where SWs have come in for criticism for (a) taking children away from caring families and ( failing to take children away from dangerous families. Up to now, they can't win. Maybe this'll help in PR terms, but it raises trickier questions too. The filming seems terribly intrusive, but I think it's truthful.It also raises the issue for me about how on earth any society could support such unhappy and failing parents to raise children. I note the degree of impetuous violence and risky behaviour involved and this makes the position of children very unpredictable. These would rate as high risk, high vulnerability families on any measure. If these are families where children are only coming into the care system now, post Connolly, could they ever have been considered as safeish environments?Hope I'm making myself clear. It's something I'm trying to think through. From: Cowley <sarahcowley183@...>Date sent: Mon, 13 Feb 2012 20:05:19 +0000Subject: changes in rates of violent deaths 1974-2008Send reply to: A useful analysis: I think this paper has just been published after being 'online' for almost a year, so others may have already seen it, but it flags up some good news about the falling rates of violent deaths to infants and children in the middle years, although those in adolescence are rising. http://adc.bmj.com/content/97/3/193.abstract?etocThis is a review of ONS data and related Home Office homicide figures. It adds to the evidence published a couple of years ago, which was based on a review of WHO data, confirming the improvements. I have just been watching the deeply depressing 'protecting our children' series about Bristol social workers on television, and it is encouraging to think there is some good news around in this field! best wishes University of Greenwich, a charity and company limited by guarantee,registered in England (reg. no. 986729). Registered office:Old Royal Naval College, Park Row, Greenwich, London SE10 9LS.

February 14, 2012

Quite. I've commented on this elsewhere. When one looks at the

babies & younger children and the neglect cases, where else would

their referrals have come from? GPs? Midwives? Community Mental

Health/Substance Misuse Teams? School teachers?

The evidence from all the reviews of serious maltreatment cases going

back to the early 1990s shows that health visitors were usually the

only service in regular contact with these troubled families. These

would've been direct contacts too - home visits and detailed

observation.

I've just completed some work on similar cases and suddenly realised

that the reduction in HV numbers might possibly be having an effect

here too. I haven't gone back to the data formally yet, but rather a

lot of the cases seemed to be picked up only when the infant was

brought to A & E or an ambulance was called. It's hard to tell without

more work, but the thought of missed cases occuring is a bit of a

worry.

The focus of these programmes also meant that the wider health issues

for damaged and troubled adults who fail to cope just got overlooked

and one might've been left with impression that once the kids had

left, that was it - job done!

Even given the missing elements, it's amazing that they were able to

film what they did.

" " < >

From: Meerabeau <E.Meerabeau@...>

Date sent: Mon, 13 Feb 2012 23:00:13 +0000

Subject: Re: changes in rates of violent deaths 1974-

2008

Send reply to:

I watched the first two Bristol programmes and was struck by the

total absence of HV in them.

Sent from my iPhone

On 13 Feb 2012, at 20:31, " hwood@... "

<hwood@...> wrote:

Yes, I've been watching that series too. Unfortunately, it's all too

real life and it's hard to watch. The parents include some deeply

damaged people with substantial mental health problems and some with

learning disabilities. They're simply unable to comprehend what

they've taken on in parenting young children. As if the parents

weren't sad enough cases, the effects of their failures on their

children are very severe.

I suspect it'll redress some of the balance where SWs have come in

for criticism for (a) taking children away from caring families and

( failing to take children away from dangerous families. Up to

now, they can't win. Maybe this'll help in PR terms, but it raises

trickier questions too. The filming seems terribly intrusive, but I

think it's truthful.

It also raises the issue for me about how on earth any society could

support such unhappy and failing parents to raise children. I note

the degree of impetuous violence and risky behaviour involved and

this makes the position of children very unpredictable. These would

rate as high risk, high vulnerability families on any measure. If

these are families where children are only coming into the care

system now, post Connolly, could they ever have been considered

as safeish environments?

Hope I'm making myself clear. It's something I'm trying to think

through.

From: Cowley <sarahcowley183@...>

Date sent: Mon, 13 Feb 2012 20:05:19 +0000

Subject: changes in rates of violent deaths 1974-2008

Send reply to:

A useful analysis: I think this paper has just been published after

being 'online' for almost a year, so others may have already seen it,

but it flags up some good news about the falling rates of violent

deaths to infants and children in the middle years, although those in

adolescence are rising.

http://adc.bmj.com/content/97/3/193.abstract?etoc

This is a review of ONS data and related Home Office homicide

figures. It adds to the evidence published a couple of years ago,

which was based on a review of WHO data, confirming the improvements.

I have just been watching the deeply depressing 'protecting our

children' series about Bristol social workers on television, and it

is encouraging to think there is some good news around in this field!

best wishes

University of Greenwich, a charity and company limited by guarantee,

registered in England (reg. no. 986729). Registered office:

Old Royal Naval College, Park Row, Greenwich, London SE10 9LS.

February 14, 2012

Perhaps there is an issue of ‘threshold’ in this? I am not suggesting the most serious cases were overlooked by health visitors but that the level of referrals to social services and level of uptake by them shifts about both in time and geographically. I worked as an HV once in an area where child protection referrals were higher than in a more deprived neighbouring area. It was concluded that in the area of more unemployment, lower literacy and education achievement, there was a different level of tolerance of parenting standards. There are many references in the literature to ‘missed cases’ for various reasons. For example, abusive head injuries may not be recognised as such on clinical presentation although much work has been done to improve this. The variance in recognising and reporting child abuse amongst paediatricians is well documented e.g ‘ Forty years later: inconsistencies in reporting of child abuse’ D Sege and Emalee G Flaherty Arch. Dis. Child. 2008;93;822-824 doi:10.1136/adc.2006.100545. Standardisation of reporting or recognising cases of child abuse is never to be assumed as training, experience, education, local policy, fear of reprisal if mistaken, are amongst factors that influence intervention. Without thorough up to date training all those on the front line are disadvantaged in this fast evolving field of knowledge about child abuse.From: [mailto: ] On Behalf Of hwood@...Sent: 14 February 2012 11:08 Subject: Re: changes in rates of violent deaths 1974-2008 Quite. I've commented on this elsewhere. When one looks at the babies & younger children and the neglect cases, where else would their referrals have come from? GPs? Midwives? Community Mental Health/Substance Misuse Teams? School teachers? The evidence from all the reviews of serious maltreatment cases going back to the early 1990s shows that health visitors were usually the only service in regular contact with these troubled families. These would've been direct contacts too - home visits and detailed observation.I've just completed some work on similar cases and suddenly realised that the reduction in HV numbers might possibly be having an effect here too. I haven't gone back to the data formally yet, but rather a lot of the cases seemed to be picked up only when the infant was brought to A & E or an ambulance was called. It's hard to tell without more work, but the thought of missed cases occuring is a bit of a worry. The focus of these programmes also meant that the wider health issues for damaged and troubled adults who fail to cope just got overlooked and one might've been left with impression that once the kids had left, that was it - job done! Even given the missing elements, it's amazing that they were able to film what they did. " " < >From: Meerabeau <E.Meerabeau@...>Date sent: Mon, 13 Feb 2012 23:00:13 +0000Subject: Re: changes in rates of violent deaths 1974-2008Send reply to: I watched the first two Bristol programmes and was struck by the total absence of HV in them.Sent from my iPhone On 13 Feb 2012, at 20:31, " hwood@... " <hwood@...> wrote: Yes, I've been watching that series too. Unfortunately, it's all tooreal life and it's hard to watch. The parents include some deeplydamaged people with substantial mental health problems and some withlearning disabilities. They're simply unable to comprehend whatthey've taken on in parenting young children. As if the parentsweren't sad enough cases, the effects of their failures on theirchildren are very severe.I suspect it'll redress some of the balance where SWs have come infor criticism for (a) taking children away from caring families and( failing to take children away from dangerous families. Up tonow, they can't win. Maybe this'll help in PR terms, but it raisestrickier questions too. The filming seems terribly intrusive, but Ithink it's truthful.It also raises the issue for me about how on earth any society couldsupport such unhappy and failing parents to raise children. I notethe degree of impetuous violence and risky behaviour involved andthis makes the position of children very unpredictable. These wouldrate as high risk, high vulnerability families on any measure. Ifthese are families where children are only coming into the caresystem now, post Connolly, could they ever have been consideredas safeish environments?Hope I'm making myself clear. It's something I'm trying to thinkthrough. From: Cowley <sarahcowley183@...>Date sent: Mon, 13 Feb 2012 20:05:19 +0000Subject: changes in rates of violent deaths 1974-2008Send reply to: A useful analysis: I think this paper has just been published afterbeing 'online' for almost a year, so others may have already seen it,but it flags up some good news about the falling rates of violentdeaths to infants and children in the middle years, although those inadolescence are rising.http://adc.bmj.com/content/97/3/193.abstract?etocThis is a review of ONS data and related Home Office homicidefigures. It adds to the evidence published a couple of years ago,which was based on a review of WHO data, confirming the improvements.I have just been watching the deeply depressing 'protecting ourchildren' series about Bristol social workers on television, and itis encouraging to think there is some good news around in this field!best wishesUniversity of Greenwich, a charity and company limited by guarantee,registered in England (reg. no. 986729). Registered office:Old Royal Naval College, Park Row, Greenwich, London SE10 9LS.

February 15, 2012

I appreciate your expertise in this area, ! Threshold notions

mark a curious difference in agency & professional perspectives,

don't they?

I worked in Gloucestershire, where there was a sense that it was a

royal county, a prosperous and respectable place where child abuse

wasn't an issue. It made it very difficult to refer cases for child

protection and I suspect some of my HV colleagues became pessimistic

about the chances of getting support with what the SSD considered

'borderline' cases, unless it was early in the financial year. It

wasn't really because the LA had high thresholds, but rather because

they thought such problems only arose in large cities with more

obvious problems of deprivation. Then the West case blew up...

Thresholds seem to apply to eligibility for services, rather than the

evidence for neglect or abuse. If you maintain that focus, it

wouldn't seem unreasonable to refuse a service or even a full

assessment if the fixed budget was tight and you believed you'd have

to meet the needs of worse cases sometime - a different perspective.

It's morally easier to ignore needs if you haven't had to look too

closely at them, so it's better not to assess. The fear would be

about possible litigation, as arose with unmet needs for community

care. As far as I know, no failure to meet needs for child

protection has ever been allowed to go to a judicial ruling - they

always settle out of court and quietly rather than risk a precedent.

The difficulty for us is that we're involved anyway, as a primary

care service that still tries to be universal. There's no

disengagement. Instead of comparing the case to worse cases, you see

it in relation to the normal child and family and that's a different

focus. It's especially true of neglect & emotional abuse, where the

situation appears less acutely dangerous. Recent neurodevelopmental

evidence challenges that perspective, but the impact was pretty clear

from the psychopathology evidence anyway.

The Baby P case was close enough to a tranche of other similar cases

to shatter illusions of relative safety, especially since the

response to perceived service failures were so punitive. Result was

a sudden change of thresholds & a deep itch between the corporate

shoulderblades. Not sure about the future.

What's your perspective?

< >

From: " Coles " <lisa@...>

Date sent: Tue, 14 Feb 2012 14:37:59 -0000

Subject: RE: changes in rates of violent deaths 1974-

2008

Send reply to:

Perhaps there is an issue of `threshold´ in this? I am not suggesting

the most serious cases were overlooked by health visitors but that

the level of referrals to social services and level of uptake by them

shifts about both in time and geographically. I worked as an HV once

in an area where child protection referrals were higher than in a

more deprived neighbouring area. It was concluded that in the area of

more unemployment, lower literacy and education achievement, there

was a different level of tolerance of parenting standards. There are

many references in the literature to `missed cases´ for various

reasons. For example, abusive head injuries may not be recognised as

such on clinical presentation although much work has been done to

improve this. The variance in recognising and reporting child abuse

am

February 15, 2012

So much wisdom. Thank you and , for your thoughtsOn 15 Feb 2012, at 11:07, hwood@... wrote: I appreciate your expertise in this area, ! Threshold notions mark a curious difference in agency & professional perspectives, don't they? I worked in Gloucestershire, where there was a sense that it was a royal county, a prosperous and respectable place where child abuse wasn't an issue. It made it very difficult to refer cases for child protection and I suspect some of my HV colleagues became pessimistic about the chances of getting support with what the SSD considered 'borderline' cases, unless it was early in the financial year. It wasn't really because the LA had high thresholds, but rather because they thought such problems only arose in large cities with more obvious problems of deprivation. Then the West case blew up... Thresholds seem to apply to eligibility for services, rather than the evidence for neglect or abuse. If you maintain that focus, it wouldn't seem unreasonable to refuse a service or even a full assessment if the fixed budget was tight and you believed you'd have to meet the needs of worse cases sometime - a different perspective. It's morally easier to ignore needs if you haven't had to look too closely at them, so it's better not to assess. The fear would be about possible litigation, as arose with unmet needs for community care. As far as I know, no failure to meet needs for child protection has ever been allowed to go to a judicial ruling - they always settle out of court and quietly rather than risk a precedent. The difficulty for us is that we're involved anyway, as a primary care service that still tries to be universal. There's no disengagement. Instead of comparing the case to worse cases, you see it in relation to the normal child and family and that's a different focus. It's especially true of neglect & emotional abuse, where the situation appears less acutely dangerous. Recent neurodevelopmental evidence challenges that perspective, but the impact was pretty clear from the psychopathology evidence anyway. The Baby P case was close enough to a tranche of other similar cases to shatter illusions of relative safety, especially since the response to perceived service failures were so punitive. Result was a sudden change of thresholds & a deep itch between the corporate shoulderblades. Not sure about the future. What's your perspective? To: < > From: " Coles" <lisa@...> Date sent: Tue, 14 Feb 2012 14:37:59 -0000 Subject: RE: changes in rates of violent deaths 1974- 2008 Send reply to: Perhaps there is an issue of `threshold´ in this? I am not suggesting the most serious cases were overlooked by health visitors but that the level of referrals to social services and level of uptake by them shifts about both in time and geographically. I worked as an HV once in an area where child protection referrals were higher than in a more deprived neighbouring area. It was concluded that in the area of more unemployment, lower literacy and education achievement, there was a different level of tolerance of parenting standards. There are many references in the literature to `missed cases´ for various reasons. For example, abusive head injuries may not be recognised as such on clinical presentation although much work has been done to improve this. The variance in recognising and reporting child abuse am Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

February 15, 2012

The book currently out Call the Midwife is a good read about the changes in public health since the 1950s . I know there is a television series at the moment but the book seems to capture the details of what life was like very well .This supports the current themes discussed on senate regarding the changes in home visiting etc .

February 15, 2012

Dear ,

Both today's Guardian (page 10) and the bmj.com homepage (News) have summaries of Marmot's recent talk on child health inequalities: the 2010 Marmot Review team made very clear recommendations about Universal services to address the gradient of social

inequalities in health, through the lifecourse....

Woody.

From: [ ] on behalf of Cowley [sarahcowley183@...]

Sent: Wednesday, February 15, 2012 11:14 AM

Subject: Re: changes in rates of violent deaths 1974-2008

So much wisdom. Thank you and , for your thoughts

On 15 Feb 2012, at 11:07,

hwood@... wrote: