Saul_s_presentation by pjwns


									Collaborative Research Projects in the East Midlands

3rd ISEEP Policy Seminar

Building Better Children’s Services through Collaborative Research
University of Birmingham, 9th May 2005 Professor Saul Becker, Institute of Applied Social Studies
© Saul Becker 2005

Why collaborate?
Many reasons, including:
• To draw on the skills, knowledge and resources of other key stakeholders (helps to make research multidisciplinary, relevant, timely etc) • To bring us out of our ‘tribe’ and ‘comfort zone’ and subject our understanding, knowledge and assumptions to wider scrutiny, dialogue and debate (helps to make research critical and informed) • To provide academic and research-based answers (and questions) to difficult issues of policy and practice (helps to ensure research is high quality, ethical, robust, reliable etc)

• To provide a research evidence-base to inform policy and practice that can lead to better outcomes for children, families and providers (helps to develop evidence-informed policy and practice)

Example 1
Collaborative research on children who provide unpaid family care (‘young carers’)

The growing awareness of young carers through collaborative research
• The YCRG and others have conducted much of the research in the last twelve years which has highlighted the experiences & needs of young carers. This research has been done collaboratively with many stakeholders. Pressure groups, the media and others have also helped make children’s ‘hidden’ and ‘private’ world visible and public. Law, policy & practice in the UK and internationally have changed as a result.

Collaborative research on young carers
Research into Practice
• • • • • • • • • • • Academic-led Started small-scale (qualitative) and local Collaborations with local health, social services and education authorities (policy makers and practitioners as a ‘steering group’) – ‘joint ownership’ critical Collaborations with voluntary sector stakeholders, including children’s and carers’ charities Collaborations with funders (eg Gulbenkian, JRF, etc) Collaborations with media to highlight issues – also helped secure ongoing funding Local studies had national (and international) relevance Larger surveys became possible as more young carers became visible and as dedicated support projects became established Government bodies became engaged, including DoH, DfES and Office for National Statistics (Census 2001) Policy, law and practice changed in a symbiotic relationship with research evidence Collaborative research provided the foundation on which to build better children’s services (in social care, health and education)

What we know today from research:
Numbers of children who provide care • Census 2001: 175,000 children in UK (150,000 in E&W) who provide some unpaid care • Becker 2004: 1.5% of all children, and 6% of all children living in families with illness/disability, provide unpaid care
(excludes children caring for parents who misuse alcohol or drugs)

Number and age of young carers aged 0-17 in England and Wales, by hours caring per week (2001 Census) 1-19 hours 20-49 hours 50+ hours Total


5-7 8-9 10-11 12-14 15 16-17 All

0 4,161 6,361 13,727 39,983 18,265 43,179 125,676

0 512 610 1,180 3,429 1,865 5,717 13,313

0 792 863 1,360 2,982 1,272 3,684 10,953

0 (0%) 5,465 (4%) 7,834 (5%) 16,267 (11%) 46,394 (31%) 21,402 (14%) 52,580 (35%) 149,942 (100%)

Number and age of young carers aged 0-17 in Birmingham, by hours caring per week (2001 Census) 1-19 hours 20-49 hours 50+ hours Total


5-7 8-9 10-11 12-14 15 16-17 All

0 86 157 377 1,038 548 1231 3,437

0 10 21 18 116 136 206 507

0 23 18 27 95 43 126 332

0 119 196 422 1,249 727 1,563 4,276

(3%) (5%) (10%) (29%) (17%) (36%) (100%)

2004 Report: Characteristics and caring relationships
6,178 young carers in contact with 87 projects

• • • • •

56% girls; 44% boys
Average age 12 84% white; 3% African Caribbean 56% living in lone parent families 52% of people receiving care are mothers (then siblings 31%; fathers 14%; grandparents 3%) 50% of children caring for relatives with physical impairments; 29% for relatives with mental illness; 17% for relatives with learning difficulties; 3% for relatives with sensory impairments 12% caring for more than one person 21% of families receive no additional support or services except for the young carers project

• •

Caring tasks
Caring tasks Domestic 1995



General & nursing Emotional Intimate
Child care Other




11% 10%

7% 29%

11% 7%

Time spent caring (years)
Years caring
2 years or less 3-5 years 6-10 years Over 10 years

36% 44% 18% 3%

Note: Data on 4,028 cases

• limited opportunities, horizons, aspirations • limited opportunities for social and leisure activities • a lack of understanding from peers, restricted friendships • ‘stigma by association’ • feelings of exclusion or being ‘outsiders’ • fear of what professionals might do • ‘silence’ and ‘secrets’

• emotional difficulties
• educational problems • health problems

• difficulties in transition to adulthood
• employment difficulties

Educational difficulties
Age group 5-10 11-15 1995
20% 42%

17% 35%

13% 27%

All 5-15




Why do some young people become carers?
Some pushes and pulls:
• • The nature of the illness/condition, its intensity, stage, duration, change An interplay of family-related factors, including ‘co-residency’; attachment/love; reciprocity; family structure; availability of others to care; ages of other children; gender etc Some children are socialised into caring roles; power; availability; expectations; cultural/religious expectations



Many become carers because families lack good quality and affordable support services to prevent caring taking place or to reduce young people’s caring responsibilities
Many families lack adequate income to purchase alternative caring arrangements. Poverty & social exclusion are common Disabled/ill parents rarely get any support in their parenting role A labour of love, but also a matter of necessity… balance will vary among families Quantitative research and national surveys have confirmed and developed the picture provided by the earlier qualitative and local studies

• • •

Example 2
Collaborative research on therapeutic interventions for pupils with SEBD in secondary schools: What works?

Concerns in Nottingham
• How are pupils with SEBD matched with services/therapeutic interventions? • Is this process research evidence-based? • What works? • Why does it work? • What’s happening in Nottingham secondary schools? • Can the existing research literature teach us anything?

Collaborative research on pupils with SEBD and therapeutic interventions:
Practice into Research
• • • Practitioner-led Small-scale (mixed methods approach) and local Collaborations with local schools, LSU managers, education policy makers, therapeutic service providers, pilot therapeutic service providers, academics, pupils, parents, teachers etc ‘Trained up’ a practitioner (Team Leader CAMHS) to conduct research using tools designed by researchers with professionals. Analysis shared Local study with national relevance – do you know what therapeutic services and interventions are being provided in your local area? Do they work? DfES interested and promoting the findings Collaborative research can provide the foundation on which to build better children’s services (in terms of therapeutic interventions, education, social care, health)

• • • •

Mapping of therapeutic interventions used in 17 Nottingham City secondary schools showed:
Youth Provisions Behaviour Support Service Community Education Psychology Service Learning Support Unit own therapeutic provision Social Services Learning Mentors Child and Adolescent Mental Health Services Local Education Authority Provisions Youth Offending Team Voluntary Agencies Training Support Agencies Medical Counsellors School Projects Sporting Organisations/Outdoor Art National Organisations Government Initiatives Substance Misuse Services Connexions 16 15 15 15 14 14 14 11 10 10 6 6 5 5 4 4 3 2 2 1

172 therapeutic service provisions

Most frequently referred behaviours to therapeutic service providers
(% of all service provisions)

Aggression Low self esteem General emotional problems Relationship difficulties Parenting issues Offending/potential offending behaviour Learning needs Poor attendance Welfare/child protection Attention disorder/hyperactivity Complex behavioural problems/autism Self harm Health/sexual health/pregnancy Substance misuse Sexualised behaviour Disaffection/non-cooperation Bullying Statementing Other

23.0 15.2 11.9 8.2 4.9 4.5 4.5 4.1 4.1 2.5 2.5 2.0 2.0 1.6 1.6 1.6 1.2 0.4 4.1

Types of therapeutic approaches provided by service providers
(% of all service provisions, rounded. Each service provider can provide a range of approaches)

Counselling Group work Consultation Social skills training Activity based Anger management Family therapy Psychological/psychiatric assessment Parent training Family resource workers Brief solution focused Learning support Art/music/drama Assessment/observation Medical/medication Play therapy Other

30 25 20 17 15 11 11 8 7 6 5 5 4 4 2 2 13

How do LSU managers choose a particular therapeutic service provider?
Practice, custom and supply are the key determinants, not ‘research evidence’ • The service is seen as having specialist expertise with this ‘type’ of child/need • It is established practice to make use of this service • It is the defined procedure to use the service for specific behaviours or concerns • All other options have been exhausted

The research literature (a)
Policy makers and practitioners unaware of the research evidence 1,500 texts reviewed; 150 relevant Review published as an A-Z of therapeutic interventions

Very few therapeutic approaches for secondary school age pupils have been shown through rigorous (& replicated) research studies to be well-established treatments (proven to have absolute and relative effectiveness):
some parent training programmes

A handful of therapeutic approaches have been shown to be probably efficacious treatments (producing the intended result - that they are better than doing nothing):
parent training; anger-control training; anger-coping training; parent-child interactive therapy; problem-solving skills training; rational-emotive therapy; multisystemic therapy; functional family therapy. Some of these await replication to become ‘well established treatments’

The research literature (b)
Most therapeutic approaches should be regarded as experimental treatments, because they have not yet been proven to be at least probably efficacious (eg long-standing or traditional treatments not fully evaluated, or newly developed treatments):
activity therapy; art therapy; bibliotherapy; circle of friends; counselling; dance therapy; drama therapy; homeopathy; music therapy; pharmacotherapy; play therapy; psychotherapy; quiet room; relaxation therapy

A few therapeutic approaches are promising treatments, in that there is a growing body of research evidence, even if it is not yet substantial or the most robust, that shows these approaches can have significant beneficial outcomes:
learning mentors, nurture groups, technology/computer mediated education

Interviews with pupils, parents’ and teachers and preliminary assessment of 9 pilot projects
Therapeutic interventions can help pupils: • • • • • • • develop trusting relationships improve behaviour in school and at home progress with schoolwork develop friendships develop positive attitudes and self esteem improve home-school working relationship Improve parent-child relationships

Shared characteristics of therapeutic approaches that seem to lead to beneficial outcomes
Evidence from in-depth interviews: • time and space • relationships and trust with staff who care and who are supportive • safe environment • activities that motivate and engage pupils (and some parents) Evidence from pilot projects: • LSUs occupy a dedicated (safe) space • the work is intensive • everyone accentuates the positive • parents are involved

Is it the shared characteristics of therapeutic approaches that lead to beneficial outcomes, or is there something distinctive about each therapeutic approach? The literature review suggests a mixture…

Some messages from this research
1. We need robust research evidence on absolute and relative effectiveness & clinical significance for each therapeutic approach 2. Just because there is little or no robust research evidence on effectiveness, it doesn’t mean you shouldn’t use an approach. Use those where there is some reasonable evidence that they will: (a) be better than nothing at all, and (b) are better than something else 3. Practitioner knowledge and experience is important, especially in the absence of robust research evidence 4. Keep informed of new developments in theory and practice, and the supporting research evidence 5. Rigorous and ongoing monitoring and evaluation of therapeutic interventions is critical – all of us can add to the body of research Evidence The final report can be downloaded free of charge from:

Challenges (and opportunities!)
• ‘What works’ assumes that it is the policy or intervention that works Most, if not all, therapeutic approaches have some beneficial outcomes (because of shared and specific characteristics) • A challenge is to determine which therapeutic approaches work for which pupil(s), and why? We need to consider and investigate whether different pupils react differently to specific approaches – in other words, perhaps it’s not the approach that’s always critical but the characteristics and reactions of the pupil that makes the approach ‘work’ for them combined with the characteristics, skills and approach of the person delivering the intervention

Research – policy – practice ‘cycle’

Factors that help bring about evidence-informed policy and practice
• The generation of good quality data (eg on effectiveness), produced by a trusted and authoritative source, using appropriate research designs and methods, which are timely and address relevant issues Service users have contributed to the research agenda Results are reported with a low degree of uncertainty and implications for action are clear A workforce critically able to appraise ‘best’ evidence (and contribute to the process of systematic reviews of research findings?) The dissemination of data and/or research synthesis in a readily accessible form to research users, including policy makers, professionals, managers, and to service users A work and policy environment that facilitates, rather than impedes, the development of practices that reflect ‘best evidence’ (learning organisations) A commitment to the ideology of evidence-informed p&p - professionals understand and believe in the benefits of using research evidence

• • • •



Saul Becker
Professor of Social Care and Health & Director of Research Institute of Applied Social Studies University of Birmingham Edgbaston Birmingham B15 2TT 0121 415 8030 (direct line) 07970 861944 (mobile)

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