Fathers' mental Ill-health and child maltreatment: A systematic review of the literature.

Background: Parental mental ill-health is often described as a risk factor for child maltreatment. Yet the literature commonly foregrounds maternal mental ill-health. To obtain a more complete picture, it is crucial to also understand the associations between fathers' mental health and child maltreatment. Aim: To provide a narrative synthesis of evidence about the relationship between fathers' mental health and child maltreatment. Method: Four electronic databases were searched, identifying 5479 citations. 151 studies were brought to full-text review. 37 were included in the study. Results: Studies revealed mixed evidence for associations between forms of paternal mental ill health and child maltreatment, with stronger evidence for paternal depression and weak or no evidence for PTSD and anxiety. Many confounding factors were identified across the papers. Discussion: The small number and limited range of good quality studies indicate the need to correct the relative invisibility of fathers within research about mental health and child maltreatment. At present, the available evidence is not sufficient to draw firm conclusions about the association between fathers' mental health and child maltreatment or appropriate policy and practice responses.

Inequalities in out-of-home care rates in England: Does local party politics matter?

BACKGROUND: Inequalities in the proportion of children experiencing abuse and neglect or a children's social care intervention have become a research focus in the last decade. One almost unexplored factor of growth in rates of children in out-of-home care is local party politics. OBJECTIVE: We assessed whether growth in rates of out-of-home care in England varied by local authority party political control. METHODS: We collated administrative data on the 152 local authorities in England between 2015 and 2021. We used Bayesian parallel process latent growth models to assess whether growth in rates of children in care in English local authorities has been equal across Labour, Conservative, No Overall Control, and no political majority councils before and after adjusting for trends in child poverty, household income from employment, and expenditure on preventative services. RESULTS: Prior to adjusting for trends in child poverty, average household income, and expenditure, we find little evidence for differences in trends; once adjusted, we find that trends in Labour authorities were lower (-1.125 children looked after per 10,000 per year) than in Conservative authorities. Had growth in family and local authority economic factors remained constant, our findings suggested out-of-home care rates would have, on average, been stable or decreasing in Labour local authorities but would have continued to rise elsewhere. CONCLUSIONS: The contribution of local party politics to growing rates of out-of-home care remains under-theorised and under-researched, but there are potentially substantial differences along party lines that are masked by unequal exposure to changes in poverty.

Child poverty and children entering care in England, 2015-20: a longitudinal ecological study at the local area level.

BACKGROUND: Children in care face adverse health outcomes throughout their life course compared with their peers. In England, over the past decade, the stark rise in the number of cared-for children has coincided with rising child poverty, a key risk factor for children entering care. We aimed to assess the contribution of recent trends in child poverty to trends in care entry. METHODS: In this longitudinal, ecological study of 147 local authorities in England, we linked data from the Department for Work and Pensions and HM Revenue & Customs on the proportion of children younger than 16 years living in families with income less than 60% of the contemporary national median income, before housing costs, with Department for Education data on rates of children younger than 16 years entering care. Using within-between regression models, and controlling for employment trends, we estimated the association of changing child poverty rates with changing care entry rates within different areas. Our primary outcome was the annual rate of children younger than 16 years starting to be looked after by local authorities in England. FINDINGS: Between 2015 and 2020, controlling for employment rates, a 1 percentage point increase in child poverty was associated with an additional five children entering care per 100 000 children (95% CI 2-8). We estimate that, over the study period, 8·1% of the total number of children under the age of 16 entering care (5·0-11·3) were linked to rising child poverty, equivalent to 10 351 (6447-14 567) additional children. INTERPRETATION: We report evidence that rising child poverty rates might be contributing to an increase in children entering care. Children's exposure to poverty creates and compounds adversity, driving poor health and social outcomes in later life. National anti-poverty policies are key to tackling adverse trends in children's care entry in England. FUNDING: National Institute for Health Research (NIHR) School for Public Health Research, NIHR Public Health Policy Research Unit, Swedish Research Council, Wellcome Trust, Medical Research Council, and NIHR Applied Research Collaboration North West Coast.

Income inequality and child welfare interventions in England and Wales.

BACKGROUND: Previous research has identified a relationship between income inequality and child abuse and neglect in the USA. This association has received limited exploration outside the USA. METHODS: Administrative data on child protection (CP) in 172 English and Welsh local authorities between 2013 and 2018 were combined with data on deprivation, ethnic density and education from publicly available data sources. Commercial income data were used for Gini coefficient estimation. We tested whether similar evidence for three key findings from a US study could be found in England and Wales. These included whether there was evidence of a relationship between income inequality and child maltreatment, whether this relationship was non-linear and whether this relationship varied dependent on the level of poverty. RESULTS: There was a significant non-linear relationship between income inequality and state care rates in England and Wales. Predicted state care rates were higher as income inequality increased, up until around average levels where the effect flattens. However, there was no significant relationship for models predicting CP plan/register rates. Income inequality, income deprivation, ethnic density and higher education were able to explain around 75% of the variance in English and Welsh state care rates. CONCLUSIONS: There is some evidence to support the claim of a relationship between income inequality and child maltreatment beyond the USA in England and Wales, and a case for further comparative research, but there are significant limitations in the comparability of data.

The association between child maltreatment and adult poverty - A systematic review of longitudinal research.

Child maltreatment is a global problem affecting millions of children and is associated with an array of cumulative negative outcomes later in life, including unemployment and financial difficulties. Although establishing child maltreatment as a causal mechanism for adult economic outcomes is fraught with difficulty, understanding the relationship between the two is essential to reducing such inequality. This paper presents findings from a systematic review of longitudinal research examining experiences of child maltreatment and economic outcomes in adulthood. A systematic search of seven databases found twelve eligible retrospective and prospective cohort studies. From the available evidence, there was a relatively clear relationship between 'child maltreatment' and poorer economic outcomes such as reduced income, unemployment, lower level of job skill and fewer assets, over and above the influence of family of origin socio-economic status. Despite an extremely limited evidence base, neglect had a consistent relationship with a number of long-term economic outcomes, while physical abuse has a more consistent relationship with income and employment. Studies examining sexual abuse found less of an association with income and employment, although they did find a relationship other outcomes such as sickness absence, assets, welfare receipt and financial insecurity. Nonetheless, all twelve studies showed some association between at least one maltreatment type and at least one economic measure. The task for future research is to clarify the relationship between specific maltreatment types and specific economic outcomes, taking account of how this may be influenced by gender and life course stage.

Good intentions, increased inequities: developing social care services in Emergency Departments in the UK.

Addressing the quality of services provided in Emergency Departments (EDs) has been a central area of development for UK government policy since 1997. Amongst other aspects of this concern has been the recognition that EDs constitute a critical boundary between the community and the hospital and a key point for the identification of social care needs. Consequently, EDs have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. One approach to this has been the establishment of multidisciplinary teams aiming to prevent re-attendance or admission, re-direct patients to other services, or speed patients through EDs with the aim of providing improved quality of care. This study, carried out between September 2007 and April 2008, was the first UK national survey of social care initiatives based in EDs and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. Eighty-three per cent of UK Type I and II EDs responded to the survey. Approximately, one-third of EDs had embedded social care teams, with two-thirds relying on referrals to external social care services. These teams varied in their focus, size and composition, leadership, availability, funding and permanence. As a result, the unintended effect has been to increase inequities in access to social care services through EDs. Three further conclusions are drawn about policy led, locally-based service development. This survey adds to international evidence pointing to the potential benefits of a variety of social care interventions being based in EDs and justifies the establishment of a research programme which can provide answers to key outstanding questions.

Empowerment and advocacy: reflections on action research with Bangladeshi and Pakistani families who have children with severe disabilities.

The concepts of empowerment and advocacy, and how they impinge on power relationships for service providers working with black and Asian communities, are explored through the findings of a 20-month project carried out between 2000 and 2001 with 19 Pakistani and Bangladeshi families who have children with severe disabilities in Birmingham. This action research project evaluated an advocacy project designed to improve the quality of life for Pakistani and Bangladeshi families with at least one child with severe disabilities. The objectives included improving access to resources, services, information and support in ways which were non-stigmatising, and which were sensitive to the particular needs of the children and their carers. The present paper discusses four main themes: (1) advocacy and empowerment in practice; (2) issues of the efficacy of advocacy and of consultation within advocacy; (3) individual empowerment versus the families' needs; and (4) cultural and gender issues which emerged from the analysis of the study. The authors identify features of empowerment which must be addressed in advocacy services which are sensitive to ethnic differences. These issues must be addressed if services are to reap their potential to make a positive impact on the lives of the most vulnerable and powerless members of the community.

Attitudes towards disability amongst Pakistani and Bangladeshi parents of disabled children in the UK: considerations for service providers and the disability movement.

It has sometimes been assumed that religiously based explanations for and attitudes to having a disabled child have led to the low uptake of health and social services by ethnic minority families in the UK. A series of semi-structured interviews were held between 1999 and 2001 with 19 Pakistani and Bangladeshi families with a disabled child as part of an evaluation of an advocacy service. The families' understandings of the causes of their child's impairment, whether they felt shame and experienced stigma, and whether these factors influenced service uptake and their expectations of their child's future are reported. While religious beliefs did inform the ways in which some families conceptualised their experience, the families' attitudes were complex and varied. There was little evidence that religious beliefs and associated attitudes rather than institutional racism had resulted in the low levels of service provision which the families experienced prior to the advocacy service. There was also no evidence that the families' attitudes had been informed by the disability movement. The implications for service providers and the movement are considered.

Supporting carers: is practice still sexist?

Informal carers are central to the community care policies which have emerged during the last two decades. However, research has suggested that caring is a gendered activity, disproportionately expected of women with consequent disadvantage in terms of physical and mental health and material well-being. Moreover, evidence has been presented that, in the past, women carers were less likely to be offered the support of public services than their male counterparts. A research project designed to test whether this pattern still applied in service provision to male and female spousal carers was carried out in an assessment and care management team working with older people. The results suggested that differences in professional responses to female and male carers still persist and that some workers may be unaware of the gap between their intentions and their actions in assessing and planning services. This evidence implies the need for further attention to be paid to these issues in training care managers and the importance of monitoring the outcomes of assessment along gender lines.