Free school meals or breakfast clubs? Child hunger in England

by Stacey Dingwall

For a lot of us, the removal of the turkey twizzler was the biggest school meals-related political upset of the last decade. However, during the recent election campaign another, more serious, row emerged: over the provision of universal free school meals to English children in Reception through to Year 2.

Manifesto proposals

The proposal to scrap the policy introduced by the coalition government in 2014 was one of the Conservative manifesto proposals that didn’t make it to the Queen’s Speech. Schools minister Nick Gibb confirmed that the policy had been ditched at the start of this month, stating that existing provision would be retained following the government having “carefully listened” to parents.

In their manifesto, the Labour party promised to extend universal provision to all primary school aged children, to be funded by introducing VAT on private school fees.

Is FSM for all viable?

Financially, Labour’s proposal was deemed to be viable, in theory at least. Charging VAT on private school fees was calculated to be worth just over £1.5bn a year, provided all pupils were paying a full fee. The IFS have suggested that extending provision to all primary pupils would cost in the region of £950m annually.

In 2012 the IFS, in partnership with NatCen, carried out an evaluation of a pilot study which offered free school meals to all Year 6 pupils in Newham and Durham. The evaluation found that the pupils made around two months’ additional progress over a two-year period compared to similar children in other areas, although it wasn’t able to definitively identify how this progress was made – i.e. it was unable to conclude that the provision of free school meals was the reason.

Breakfast clubs

Discussing the evaluation findings within the context of the 2017 manifesto proposals, the IFS highlighted findings from other research they’ve carried out into breakfast clubs.  This is something we’ve discussed before on the blog: our 2015 post highlighted a range of evidence that school breakfast clubs have a positive impact on children’s academic performance. The IFS study looked at one of the schemes, Magic Breakfast, and found that improvements in pupil performance were “likely to be the result of the content or context of the school breakfasts”.

The Conservative manifesto pledged to provide free breakfasts in place of universal free lunch provision. This was dismissed as “not comparable” by parents however, and described by some in the education sector as merely a cost-cutting exercise (that had not in fact been costed correctly) rather than a drive to boost attainment.

Child hunger in 2017

The reason why so many were critical of the proposal to remove the universal entitlement to free school meals is that for some children, it’s the only nourishment they’ll receive all day. Just because a child is entitled to a free lunch doesn’t mean they’ll claim it – a range of evidence has highlighted the stigma children can be exposed to if meals aren’t free for all. Extending provision to all has been found to be the best way of helping those who need it most, rather than singling them out.

In 2017, it’s shameful that children in a developed country are still suffering from hunger. As new figures from the Trussell Trust reveal that the already shocking levels of reliance on foodbanks increases even more during school holidays, it’s clear that any policy which risks making the situation for already vulnerable children even worse needs to be abandoned.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other education articles. 

Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

 

Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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Read more about innovative building design in our other blog articles.

Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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Learning from mistakes: reflective learning in social work

No one likes to talk about their own mistakes. They are an inevitable part of the human condition, highlight our flaws, inabilities and limitations and can place a spotlight on what happens when resources and people are stretched too thinly.

In certain professions, including frontline social work, mistakes – however innocent or unintentional – can have potentially life-changing effects for service users. Keeping them to a minimum is of paramount importance. And it’s important that if mistakes have been made that they are not only rectified but also analysed to consider what went wrong, and what can be done to avoid the same thing happening again. For social workers the stakes could not be much higher – people’s lives are in the balance. So how can social workers not only recognise, reduce and rectify mistakes, but also use them as learning opportunities to improve performance and decision making in the future?

Making the most of our mistakes

It is important that practitioners and their managers know which strategies are most effective for them and their team when it comes to extracting valuable insight from mistakes. This only comes from having a strong and secure working relationship, where people feel able to talk openly and reveal insecurities and inadequacies, as well as recognising the positives within their practice.

Working out the correct strategies for each occasion and for each team member will take time. However, some tools and strategies include:

  • learning how to generate effective questions to explore not only how a mistake happened, but why and what steps can be taken to prevent it from happening in the future
  • adopting a strengths-based approach, rather than a deficit-based approach to staff and any mistakes they made
  • reflective frameworks that can be formally incorporated into everyday practice
  • encouraging staff to find a “critical friend” to offer an external perspective and extend personal reflective capacity
  • encouraging staff to take up reflective writing (in everyday life, not just at work) including journals and diary entries
  • training staff on creative models of reflection and on how to give and receive constructive feedback
  • finding ways to feed back to an entire organisation regarding the lessons learned from mistakes and how they can shape practice in the future.

The reflective cycle

One of the traditional models of reflection for social workers is Gibbs’ cycle of reflection (1988).

Among social workers, reflective practice is often promoted. Personal experience and participation should be seen as a positive and an opportunity to develop new skills, learning or approaches. Reflection should be focused on professional errors, asking questions like “why”; “what went wrong”; and “what did I do wrong.”

Reflection can happen at three levels:

  • personal
  • one-to-one with another person (a supervisor, colleague or family member)
  • in groups (at organisational level)

It can be useful to reflect at all levels, where possible, in order to get the most out of the experience and have the biggest impact with regard to what can be learnt from mistakes and how this can be passed to others to avoid them making the same ones.

Taking and giving constructive feedback

Although it may be uncomfortable at the time, social workers and people from other professions should welcome feedback from colleagues and service users as they can be powerful sources to drive professional growth. However, it is important to distinguish constructive feedback from blame. Highlighting helpful advice and using it in a constructive way is not the same as finger pointing and fault picking, and managers must develop the ability to distinguish between the two.

Final thoughts

Mistakes happen, and although we don’t like to talk about them, they can sometimes provide some of the most useful insight for learning and improvement within an organisation. Beyond the organisational level, personal reflection on practice and taking time to consider how you approach certain situations is a vital aspect of the self-aware, continual improvement that social workers must strive towards, even if they don’t always meet the exacting standards all of the time.


If you enjoyed this blog post, you may also find the following article of interest:

Information Service members can also view some of our latest database additions, including the book Reflective practice and learning from mistakes in social work.

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Zero suicide cities: learning from Detroit in the UK

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

The idea of a “zero suicide city” was first adopted in Detroit in the late 2000’s, with others following its lead in subsequent years. With reports finding that around 14 Londoners a week took their own life in 2015 (735 in total), an increase of a third from the 2014 statistics, a report in February 2017 by the London Assembly Health Committee suggested that London too should take this approach.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention based in part on the Detroit model.

Since then, Mersey Care, Cambridge and Peterborough Clinical Commissioning Group and Teesside councils have also become aligned with the programme and are continuing with their approach towards improved suicide prevention. The Centre for Mental Health evaluated the work of some of the sites during 2015.

The evaluation found there were a range of activities that had taken suicide prevention activities out into local communities. They included:

  • training key public service staff such as GPs, police officers, teachers and housing officers
  • training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers
  • creating ‘community champions’ to put local people in control of activities relating to promoting positive mental health and signposting to help services
  • putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways
  • working with local newspapers, radio and social media to raise awareness in the wider community
  • supporting safety planning for people at risk of suicide, involving families and carers throughout the process
  • linking with local crisis services to ensure people get speedy access to evidence-based treatments.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.


If you enjoyed this blog, you may also be interested in our other articles on mental health in the workplace.

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Who am I? The importance of life story books for looked after children

paper family on hand

By Heather Cameron

Every adopted child in the UK should have a life story book – an account of a child’s life in words, pictures and documents containing information on the child’s birth family, care placements and reasons for their adoption – which is given to them and their new family when preparing for a permanent placement.

Local authorities have a statutory duty to create life story books for all adopted children, providing them with a sense of identity and understanding of their early life before adoption. They are a well-established practice in the UK and most local authorities provide guidance on preparing them.

However, research has found that the quality of life story books varies hugely.

Variation in quality

The research, conducted by the Voluntary Adoption Agency, Coram, in collaboration with the University of Bristol, focused on adopters’ perspectives on their children’s life storybooks, which it identified as lacking from the academic literature.

Although adopters welcomed the idea of life story books, they were critical of their execution. And despite accounts of positive experiences, there was a broad consensus that:

  • many books were of poor quality;
  • children had been poorly prepared to explore their histories;
  • adoption professionals and agencies did not seem to prioritise life storybooks; and
  • adopters felt poorly prepared in how to use and update life storybooks with their children.

While 40% of adoptive parents said their books were ‘good’ or ‘excellent’, a third said they were ‘terrible’.

Issues were raised around lack of communication, opportunity to provide input and what was included in the books. One adopter said “We did not have the opportunity to discuss but what I would have said was this is rubbish – all of it is rubbish”. Another said “I can never show my daughter hers because there is stuff in there that I don’t ever what her to see”.

Another theme to emerge was an excessive focus on the birth family, foster family or social worker rather than the child, and the use of inappropriate language.

For those who regarded their books in a positive light, they believed the story was told well, was age appropriate and honest, and didn’t construct a ‘fairy tale’ that would give the child an unrealistic view.

Invaluable

For adopted children, life story books can be key to providing details of their history and background, providing continuity in their life histories and preparing them for a permanent placement.

Often, they are the only thing an adopted child has by way of personal, accurate and detailed information on their past. As one mother commented on the importance of birth photos, “It’s all they have left of their own babyhood”.

Done well, they can be invaluable, as described by one adopter:

‘a good quality life storybook builds a bridge back to that huge part of her that we didn’t see and it is her main link to her past’

It has therefore been argued that life story work should be prioritised and appropriate support provided.

Ingredients for success

Coram’s research highlighted several key things for successful life story work; one being having staff dedicated to life story work.

Bournemouth has been highlighted as an example of good practice for their life story work. Their separate adoption department appointed a dedicated family support practitioner to take on responsibility for the life story books for children adopted in Bournemouth.

In 2012, the council received an ‘outstanding’ rating by Ofsted and was named as joint adoption service of the year.

Also highlighted by the research, was that gaps in the narrative were not helpful, and support for adopters is paramount, as is training for social workers.

To improve the quality of life story work across the board, Coram’s report urges adoption agencies to make considerably better use of life story books and invest in improved training for professionals, while monitoring the quality of books produced and providing better access to support and guidance for adopters to engage in such important work with their children over time.

Bournemouth illustrates the importance of doing life story work well. And as the research concludes, “linking a child’s past and present is crucial ‘bridging’ work in enabling permanence in placements”.


If you enjoyed reading this, you may also like our previous articles on kinship carers and the value of foster care.

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World Social Work Day: promoting community and environmental sustainability

Tomorrow is World Social Work Day (WSWD), and this year the focus is on community sustainability. The theme is inspired by the third pillar of the Global Agenda for Social Work, which was created in 2010 to integrate the aims and aspirations of social workers across the world. It stresses the important role of social workers in prompting sustainable communities and environmentally sensitive development.

This includes:

  • working closely with other partner agencies – including those beyond social work – to create communities of practice, particularly in relation to environmental sustainability;
  • promoting community capacity building, through environmentally friendly and sustainable projects, where possible; and
  • responding to environmental challenges, including helping communities to be resilient to and recover from environmental and natural disasters, as well as in relation to “human disasters” which includes refugee families fleeing persecution or war.

But how does this play out in everyday practice?

Supporting integration

Across the world, social workers are being asked to address ‘human disasters’ as they seek to support and integrate refugee families fleeing persecution and war in conflict zones. Some of the biggest challenges for social workers today relate to refugee and displaced communities. As well as dealing with the effects of trauma, they also help integrate refugees successfully into existing communities and build bridges with others to promote cohesion, reduce tensions and help them make positive contributions to society. Social workers also have a responsibility to encourage all members of the community to help with this support and integration process.

However, in a UK context, supporting people to make positive contributions to their community is not limited to refugee families. It also relates to intergenerational work, valuing the experience of older people, developing the skills of vulnerable adults, or encouraging children to feel connected to a place and community so that they might better take care of it as they grow up.

Supporting sustainability

The role of social workers in supporting the sustainability agenda may not be so obvious. The ability of social workers to adapt and respond to the needs of communities which are experiencing environmental sustainability issues is of growing importance in developing countries. However, social workers in the UK can still contribute to this element of the global social work agenda.

This includes behaving in a way that recognises the need to protect and enhance the natural environment. In practice, this may mean social work departments having policies on going paperless where possible, recycling in offices, and reducing the use of cars, or car sharing (for frontline social workers, however, this is often impractical).

Social work practice can also consider how it supports sustainable social development outcomes within a community, and maintaining personal CPD, education and training levels to reflect this. There should also, as always, be an attempt to share best practice and learn from others.

Final thoughts

This World Social Work Day, let’s take a moment to reflect on the positive contributions that social work professionals are making to their communities as well as to the lives of individuals. It’s also a chance to consider what the future might hold for the profession and how it can continue to promote and support the growth and development of sustainable communities.


If you would like to follow the events going on to mark World Social Work Day or, share any of your own stories you can do so on twitter using the hashtag #WSWD17.

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Helping people with dementia to live well through good urban design

Earlier this year, the Royal Town Planning Institute (RTPI) published their first practice note on how good planning can play a stronger role in the creation of better environments for people living with dementia.

It summarises good practice guidance from Oxford Brookes University, the Alzheimer’s Society and the Scottish Government, among others.

Living with dementia

According to the Alzheimer’s Society, there are currently around 850,000 people living with some form of dementia in the UK.  Although the risk of developing dementia increases with age, it is not just a disease of the elderly.  There are currently around 40,000 people with dementia in the UK under the age of 65.

The vast majority of cases of dementia cannot be cured. However, there is a lot that can be done to enable someone with dementia to live well with the condition. Many people with dementia can continue lead active, healthy lives for years after diagnosis.  Even most elderly people with mild to moderate dementia can continue to live in their own homes.

The importance of good urban design

Evidence has shown that well-planned, enabling environments can have a substantial impact on the quality of life of someone living with dementia and their ability to retain their independence for longer.

For example, being within easy walking distance of shops and other local amenities can help people with dementia to remain physically active and encourages social interaction.

Having access to green space and nature also has particular benefits, including better mood, memory and communication and improved concentration.

Key characteristics of a dementia-friendly environment

Drawing on the principles set out in ‘Neighbourhoods for Life’, the RTPI advises that urban environments should be:

  • Familiar – functions of places and buildings made obvious, any changes are small scale and incremental;
  • Legible – a hierarchy of street types, which are short and fairly narrow. Clear signage;
  • Distinctive – including a variety of landmarks and a variety of practical features, e.g. trees and street furniture;
  • Accessible – access to amenities such as shops, doctor’s, post offices and banks within easy, safe and comfortable walking distances (5-10 minutes). Obvious, easy to use entrances that conform to disabled access regulations;
  • Comfortable – open space is well defined with public toilets, seating, shelter and good lighting. Background and traffic noise minimised through planting and fencing. Minimal street clutter;
  • Safe – wide, flat and non-slip footpaths, avoid creating dark shadows or bright glare.

Dementia-friendly communities

In addition to specific guidance on how to improve the urban environment, the RTPI practice note also highlights the crucial role of planners in the creation of ‘Dementia Friendly Communities’.

This is a recognition process, which publicly acknowledges communities for their work towards becoming dementia friendly.  It aims to involve the entire community, from local authorities and health boards to local shops, in the creation of communities that support the needs of people with dementia.

There are 10 key areas of focus.  Those particularly relevant to planning include:

  • shaping communities around the needs and aspirations of people with dementia;
  • the provision of accessible community activities;
  • supporting people to live in their own home for longer;
  • the provision of consistent and reliable transport options; and
  • ensuring the physical environment is accessible and easy to navigate.

There are currently over 200 communities across the UK working towards recognition as dementia-friendly.  Dementia Friendly East Lothian and the Dementia Friendly Kirriemuir Project are two such examples.

Local government policy

By 2025, it is estimated that the number of people diagnosed with dementia will rise to over one million.  Significant under diagnosis means that the number of people who experience dementia may be even higher.

However, the RTPI report that at present few local authorities have made explicit reference to dementia in their adopted local plans.

Worcestershire County Council and Plymouth City Council are notable exceptions:

  • Plymouth have set out their ambition to become a ‘dementia friendly city’ in its current local plan; and
  • Worcestershire are currently developing a draft Planning for Health Supplementary Planning Document that covers age-friendly environments and dementia.

A beneficial environment for all

While these are important first steps towards the greater recognition of the role of planning in supporting people with dementia, it is imperative that planning explicitly for dementia becomes the rule, rather than the exception.

Not only will this benefit people with dementia and reduce healthcare costs, it may also benefit the wider community, including young families, people with disabilities, and older people.

As the RTPI rightly state, “environments that are easy for people to access, understand, use and enjoy are beneficial to everyone, not just older people with dementia.”


Girls with autism – a hidden issue?

Three young girls hanging upside down in a park and laughing

by Stacey Dingwall

At the end of last month, the National Association of Head Teachers (NAHT) held its Big Shout conference in London. The event gathered together school leaders, health and education experts, parents, carers and women on the autistic spectrum with the intention of raising awareness of the ‘underdiagnosis of thousands’ of girls with autism.

Gender difference in diagnosis

The National Autistic Society points to various studies that estimate the ratio of male/female autism diagnosis as being anywhere from 2:1 to 16:1. Last year, the National Association of Special Educational Needs (nasen) published a guide to supporting girls with autism spectrum conditions which states that the ratio is typically regarded as 4:1. The guide notes that this is an average figure, and that the ratio increases to 10:1 among intellectually able individuals with autism spectrum disorder (ASD), and shrinks to 2:1 for groups with ASD and moderate to severe learning disabilities.

Nasen suggests that this gender difference has only recently been questioned, and points to several possible explanations for the variation:

  • Gender bias in existing screening and referral processes, diagnostic criteria and tools
  • Protective and compensatory factors in females
  • Different gender-specific autism spectrum condition (ASC) profiles

Nasen points to research going back as far as 1944 which found that while the girls who took part in the research displayed signs that were “reminiscent of autism”, they were not as “fully formed” as those seen in the boys.

As noted by Francesca Happé of the MRC Social, Genetic and Developmental Psychiatry Centre at King’s College London, diagnostic systems, as well as research studies and stereotypes of ASD, are still based on the experiences of males to this day. Despite evidence which indicates differences between girls’ and boys’ social-communication skills – an important factor in the diagnosis of ASD – girls are being assessed using a system that is biased towards the opposite gender.

The only specialist state school in the UK

Limpsfield Grange school in Surrey is the only state school for girls with autism in the UK. Headteacher Sarah Wild believes that girls can often go undiagnosed due to their tendency towards ‘masking’. She suggests that autistic girls are often more interested in socialising and building relationships than their male peers, and learn to copy the behaviour of those around them from an early age as a coping strategy.

Nasen makes a similar point with regards to the topics that girls with autism can become obsessive about, which is often a neurological sign of autism. Girls’ special interests can tend to materialise in areas such as boybands, or looking after animals – interests that don’t seem out of the ‘ordinary’ for their age group. Boys, on the other hand, are more likely to focus on technical, niche topics that can make diagnosis more straightforward.

Sarah Wild is not a fan of the word ‘diagnosis’ when it comes to autism, which she thinks “makes it sound like cancer” or another illness. As opposed to US schools which focus on “curing”, Limpsfield Grange employs a ‘hybrid’ model that focuses on moving away from the medical model and towards the social integration model in place in Australia.

Taking action

As the only school of its kind in the UK, Limpsfield Grange recognises its important role in raising awareness of females with autism. The school has published two novels that follow the journey of an autistic girl called M, and made a documentary that was shown on ITV in 2015.

Speaking at the Big Shout, Professor Francesca Happé said that “Unless we change our male stereotypes of autism, and find out much more about female autism, girls will continue to miss out on the recognition and support in childhood that could have helped them to understand themselves and interact with others, to fulfil their potential.”

Her words were echoed by Professor Barry Carpenter, Chair of the Autism and Girls Forum, who said that action from politicians and researchers in this area was “desperately needed”.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other articles on children and young people.