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Based on a Freedom of Information request with data from 75 per cent of all English children's services departments covering over half a million children, this paper shows that 22.5 per cent of children born in the 2009–10 financial year were referred to children's social care before their fifth birthday. Three-quarters of them were at some point assessed, almost two-thirds found to be in need and a quarter formally investigated. These findings show the full extent of children's involvement in children's social care before the age of five. One in every nine children born in 2009–10 was suspected by social workers of being abused and this high level of involvement is only justifiable if it is demonstrably reducing harm and promoting well-being of children—an outcome which is contested. Early Help's introduction was associated with high proportions of children being referred and assessed and rapidly increasing numbers of investigations, thus questioning its ability to prevent entry to the child protection system. The paper calls for a change from the current emphasis on individualised and investigative approaches to child protection in order to provide an effective and humane response to children, the majority of whom live in families affected by high levels of deprivation and poverty.

In England, the dominant policy narrative recognises no association between spending on children’s services and quality and a limited association between quality and deprivation. We combined 374 inspection outcomes between 2011 and 2019 with data on preventative and safeguarding expenditure and Indices of Multiple Deprivation (IMD) scores. A multilevel logistic regression model predicting ‘good’ or ‘outstanding’ judgements suggests each £100 increase in preventative spending per child was associated with a 69 per cent increase (95 per cent CI: 27.5 per cent, 124 per cent) in the odds of a positive inspection. A one-decile increase in deprivation was associated with a 16 per cent (95 per cent CI: −25 per cent, −5.7 per cent) decrease. Safeguarding expenditure was not associated with outcomes. Deprived communities have worse access to good-quality children’s services and government policies that have increased poverty and retrenched preventative services have likely exacerbated this inequality. Further, inattention to socioeconomic context in inspections raises concerns about their use in ‘take over’ policies.

Within child welfare systems, the issue of parental alcohol misuse (PAM) and the responsibility for supporting children affected by PAM impacts on multiple health and social care services. An innovation pilot project (IPP) was set up to reduce the fragmentation between services and to help identify children affected by PAM. The current study presents findings regarding the IPP, examining its implementation, the service delivery, and the perceived impact for family members. Qualitative data were collected from 41 participants. This included interviews with alcohol-misusing parents (n = 13), affected adult family members (n = 5), and children affected by PAM (n = 9). Two focus groups and three one-to-one interviews were conducted with project workers (n = 7) and multi-agency service managers (n = 7). Data were analysed thematically relating to three main themes: (1) innovation in team composition and multi-disciplinary team working, (2) innovative ways of working, and (3) the benefits of a whole-family approach. The findings highlighted the importance of time for the team to ‘bed in’ and come together under one structure, a focus and oversight on whole-family care, and the importance of offering early, targeted, and flexible interventions to prevent crisis points and manage the consequences of PAM. Consideration will need to be given to joint commissioning to strengthen family-focused support.

Purpose The purpose of this paper is to report findings from a service evaluation of a training initiative in participatory practice with children and young people (CYP) for early help (EH) professionals. The training was based on the Lundy model of child participation. Design/methodology/approach A questionnaire-based survey was undertaken of staff completing the training. Within the sample of professionals surveyed, various work contexts were represented. Findings Reported benefits arising from the training included increased understanding of the utility of the tenets of the Lundy model, as well as changes in practice with CYP. Barriers and issues encountered in seeking to work in a participatory way were identified in relation to time for relationship-building, resources and interprofessional and interagency working. Originality/value The evaluation findings provide insight into ways training in participatory practice with CYP is experienced by EH professionals. The role of networks of practitioner champions in influencing participatory practice is also addressed, as well as the interface between participatory and relationship-based practice.

Psychological distress becomes more common during adolescence, yet many young people struggle to access clinic-based mental health care. Digital, self-help single-session interventions (SSIs) could extend current provision and overcome barriers to help seeking. This study aims to pilot Project Care UK, a self-compassion-focused SSI, to examine its feasibility, acceptability, and preliminary efficacy for UK adolescents aged between 13 and 18 years. We used a single-arm, within-subjects pre-post intervention program evaluation. Consenting participants completed a demographic survey and clinical measures at baseline. Self-assessments of hope, hopelessness, negative beliefs about self-compassion, and help seeking were measured immediately before and after the intervention. Acceptability and feasibility were measured after the intervention using the Program Feedback Scale and study completion metrics. Preliminary efficacy was evaluated using linear mixed-effects models. The study protocol was preregistered on the Open Science Framework before publication. Of the 813 individuals who gave consent for the study, 714 (87.8%) initiated the preintervention assessment survey, 610 (75%) initiated the intervention, 341 (41.9%) initiated the Program Feedback Scale, and 329 (40.5%) initiated the postintervention assessment survey. The sample consisted of adolescents (mean age 15.38, SD 1.58 y) who were predominantly assigned female sex at birth, were White, and were nonheterosexual. Intervention completers widely endorsed the intervention as acceptable. Significant, favorable pre- and postintervention changes were observed across all outcome measures, including increased hope (Cohen d=0.72, P<.001), decreased hopelessness (Cohen d=-0.73, P<.001), and reduced negative beliefs about self-compassion (Cohen d=-0.64, P<.001). No significant changes were observed for help-seeking intentions. Although not all participants completed the study, our findings show that recruiting adolescents in the United Kingdom is feasible; completers indicated that the intervention was acceptable, and they showed improvements in the proximal outcomes of hope, hopelessness, and beliefs about self-compassion. More extensive follow-up over time and comparator intervention analyses would allow more robust conclusions to be drawn.

Purpose The purpose of this study was to explore early help provision to children and families not reaching the Children Act (1989) child in need threshold, across all 152 English local authorities in 2017. Design/methodology/approach A freedom of information request was used, in September 2017, to obtain information regarding recorded numbers, attributes and referral reasons for Early Help cases, case categorisation, professional groups involved in this provision and models of practice. Findings Responses revealed there are no common protocols categorising referrals and identified needs of children and young people. Child behavioural issues were the most frequently occurring category followed by parenting issues and child emotional well-being. The numbers of children engaged by Early Help services varied with a range between Barnsley with 7.8% of children under 18 years old and Richmond on Thames with 0.33% and only exceeded children in need in a 7 out of 71 reporting authorities. Models of practice used were most commonly based on the assessment framework, which operates at all social work thresholds including child protection. The enquiry found a diverse workforce involved in Early Help and sets it within a context of local thresholds for dealing with large increases in referral rates to children’s services departments in recent years. Originality/value The study provides a unique insight into the nature and scope of Early Help provision across England. The relationship between existing thresholds of intervention in the child welfare system is underexplored in the social work literature.

Background The rising prevalence of adolescent mild depression in the UK and the paucity of evidence-based interventions in non-specialist sectors where most cases present, creates an urgent need for early psychological interventions. Randomised controlled trials (RCTs) are considered the gold standard for obtaining unbiased estimates of intervention effectiveness. However, the complexity of mental health settings poses great challenges for effectiveness evaluations. This paper reports learning from an embedded process evaluation of the ICALM RCT which tested the feasibility of delivering Interpersonal Counselling for Adolescents (IPC-A) plus Treatment as Usual (TAU) versus TAU only for adolescent (age 12–18) mild depression by non-qualified mental health professionals in non-specialist sectors. Methods A qualitative mixed methods process evaluation, drawing on Bronfenbrenner’s socioecological model to investigate key influences on trial delivery across macro-(e.g. policy), meso-(e.g. service characteristics) and micro-(e.g. on-site trial processes) contextual levels. Data collection methods included 9 site questionnaires, 4 observations of team meetings, policy documents, and 18 interviews with stakeholders including therapists, heads of service and managers. Thematic analysis focused on understanding how contextual features shaped trial implementation. Results The ICALM trial concluded in 2022 having only randomised 14 out of the target 60 young people. At a macro-level, trial delivery was impacted by the COVID-19 pandemic, with services reporting a sharp increase in cases of (social) anxiety over low mood, and backlogs at central referral points which prolonged waiting times for mild cases (e.g. low mood). An interaction between high demand and lack of capacity at a meso-service level led to low prioritisation of trial activities at a micro-level. Unfamiliarity with research processes (e.g. randomisation) and variation in TAU support also accentuated the complexities of conducting an RCT in this setting. Conclusions Conducting a RCT of IPC-A in non-specialist services is not feasible in the current context. Failure to conduct effectiveness trials in this setting has clinical implications, potentially resulting in escalation of mild mental health problems. Research done in this setting should adopt pragmatic and innovative recruitment and engagement approaches (e.g. creating new referral pathways) and consider alternative trial designs, e.g. cluster, stepped-wedge or non-controlled studies using complex systems approaches to embrace contextual complexity. Trial registration ISRCTN registry, ISRCTN82180413. Registered on 31 December 2019.

Background Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet the demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within Local Authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established. This study aims to assess the feasibility of a randomised controlled trial (RCT), evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision. Method Feasibility RCT with process evaluation using ethnographic methodology. Eligible young people ( n = 60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders. Participants Young people aged 12–18 years presenting to non-specialist services with symptoms of depression. Youth workers, young people and stakeholders will participate in the process evaluation. Discussion The need for effective and accessible interventions for young people with mild/sub-threshold depression who, in most cases, do not meet the threshold for mainstream mental health services is long overdue. The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented. Trial registry ISRCTN registry, ISRCTN82180413 , Registered 31 December 2019.

Purpose – The purpose of this paper is to describe a collaboration between independent researchers and an English local authority to develop a framework for understanding and measuring outcomes in children centres. Design/methodology/approach – The project was based on developing a system for collecting quantitative and qualitative data that would reflect the multi-dimensional services delivered by children centres. This was called the Early Intervention Performance Outcomes Framework. It utilised the concept of interim outcomes and in so doing the aim was to create a system that would provide evidence for the difference these services could make to children and their families’ lives. It was also important for the system to enhance and not detract from service capacity in a period of austerity. Findings – The paper reports on the project when it had generated its first year of data. The paper describes the overall success of the project, the on-going challenges it faces and provides some examples of how interim outcomes represented “steps along the way” for children and families. Originality/value – The innovative collaboration described in this paper provides a positive example of how research methods can enhance both service design and delivery. It will be of interest to both those who work and manage children’s services and those engaged in research.

As elevated levels of tumor necrosis factor-alpha (TNF-α) are associated with disease severity in psoriasis and psoriatic arthritis, TNF-α antagonists are being used to treat moderate to severe disease in patients who have contraindications, fail to respond or develop side effects to conventional systemic therapies. It is of utmost importance to be well versed with the possible adverse effects and contraindications of TNF-α antagonists so that they can be used effectively and safely. Many of their adverse effects have been well studied in patients of rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) and may not be completely applicable in psoriasis. This is because patients with RA and IBD are on multiple immunosuppressants while those with psoriasis are mostly receiving single systemic therapy and often have comorbidities that distinguish them from those with RA or IBD. Also, some of the side effects are still controversial and debated. Long-term prospective randomized controlled studies are needed to better understand the associated risk in patients of psoriasis. Baseline screening and periodic monitoring during treatment can reduce and help in early identification and appropriate management of the adverse outcomes. This article reviews the side effects known to be associated with TNF-α antagonists, their pathomechanisms and management guidelines. Some of the common side effects include infusion and injection site reactions, infections particularly reactivation of tuberculosis, autoantibody formation and drug induced lupus erythematosus, liver function abnormalities, hematological, and solid organ malignancies.