Live Work: The Impact of Direct Encounters in Statutory Child and Family Social Wor

The aim of this research project was to examine the impact of direct work on practitioners in the field of statutory child protection. The author’s premise was that this work was anything but straightforward and that surprisingly, given the intense scrutiny on Children’s Services following a child death, there was little research into the day-to-day practice of front line staff. The aim was to explore whether psychoanalytic theory could be useful in understanding and making sense of the social work task. Data was collected through observation and semi-structured interviews in one Local Authority Child in Need team over a period of six months. The findings indicated that practitioners experienced direct work with some individuals and families as profoundly disturbing and that this affected them physiologically as well as psychologically. These effects persisted over time and appeared very difficult for the workers to process or articulate. This could be expressed through embodied or non-verbal communication in the interview. Practitioners appeared to be ‘inhabited’ by particular clients, suggesting phenomena such as projective identification were in operation. The intensity and persistence of the impact on the practitioners appears to be directly related to the quality, nature and intensity of the psychic defences functioning for the particular client. Significantly, the research indicated that when practitioners were dealing with the negative and disturbing projections from the (adult) clients it seemed from the data that the focus on the child would slip so that the child appeared to recede from view. Symptoms experienced by the practitioners were akin to trauma and research and theory on primary and secondary trauma were considered. Other issues raised included shame, which affects the clients, practitioners and the organisation and the meaning and implications of this are explored. Links between neuroscience and projective identification are addressed as well as the role of the organisation, particularly as a container for these toxic and disturbing encounters.

Newham’s Every Child a Sports Person (NECaSP): A Summative Process Evaluation of a School-and-Community Based Intervention in East London, UK

Background: The NECaSP intervention aspires to increase sport and physical activity (PA) participation amongst young people in the UK. The aims of this paper are to report on a summative process evaluation of the NECaSP and make recommendations for future interventions. Methods: Seventeen schools provided data by students aged 11-13 (n=1,226), parents (n=192) and teachers (n= 14) via direct observation and questionnaires. Means, standard deviations and percentages were calculated for socio-demographic data. Qualitative data was analysed via directed content analysis and main themes identified. Results: Findings indicate further administrative, educational and financial support will help facilitate the success of the programme in improving PA outcomes for young people, and of other similar intervention programmes globally. Data highlighted the need to engage parents to increase likelihood of intervention success. Conclusions: One main strength of this study is the mixed-methods nature of the process evaluation. It is recommended that future school based interventions that bridge sports clubs and formal curriculum provision, should consider a more broad approach to the delivery of programmes throughout the academic year, school week and school day. Finally, changes in the school curriculum can be successful once all parties are involved (community, school, families).

An Investigation into the Implementation of CYP-IAPT Routine Outcome Measures in their First Year of Integration into Child Psychotherapy Practice

This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting / monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious.