• Co-production of two whole-school sexual health interventions for English secondary schools: positive choices and project respect

      Ponsford, Ruth; Meiksin, Rebecca; Bragg, Sara; Crichton, Joanna; Emmerson, Lucy; Tancred, Tara; Tilouche, Nerissa; Morgan, Gemma; Gee, Pete; Young, Honor; et al. (BioMed Central Ltd, 2021-02-17)
      Background: Whole-school interventions represent promising approaches to promoting adolescent sexual health, but they have not been rigorously trialled in the UK and it is unclear if such interventions are feasible for delivery in English secondary schools. The importance of involving intended beneficiaries, implementers and other key stakeholders in the co-production of such complex interventions prior to costly implementation and evaluation studies is widely recognised. However, practical accounts of such processes remain scarce. We report on co-production with specialist providers, students, school staff, and other practice and policy professionals of two new whole-school sexual heath interventions for implementation in English secondary schools. Methods: Formative qualitative inquiry involving 75 students aged 13–15 and 23 school staff. A group of young people trained to advise on public health research were consulted on three occasions. Twenty-three practitioners and policy-makers shared their views at a stakeholder event. Detailed written summaries of workshops and events were prepared and key themes identified to inform the design of each intervention. Results: Data confirmed acceptability of addressing unintended teenage pregnancy, sexual health and dating and relationships violence via multi-component whole-school interventions and of curriculum delivery by teachers (providing appropriate teacher selection). The need to enable flexibility for the timetabling of lessons and mode of parent communication; ensure content reflected the reality of young people’s lives; and develop prescriptive teaching materials and robust school engagement strategies to reflect shrinking capacity for schools to implement public-health interventions were also highlighted and informed intervention refinements. Our research further points to some of the challenges and tensions involved in co-production where stakeholder capacity may be limited or their input may conflict with the logic of interventions or what is practicable within the constraints of a trial. Conclusions: Multi-component, whole-school approaches to addressing sexual health that involve teacher delivered curriculum may be feasible for implementation in English secondary schools. They must be adaptable to individual school settings; involve careful teacher selection; limit additional burden on staff; and accurately reflect the realities of young people’s lives. Co-production can reduce research waste and may be particularly useful for developing complex interventions, like whole-school sexual health interventions, that must be adaptable to varying institutional contexts and address needs that change rapidly. When co-producing, potential limitations in relation to the representativeness of participants, the ‘depth’ of engagement necessary as well as the burden on participants and how they will be recompensed must be carefully considered. Having well-defined, transparent procedures for incorporating stakeholder input from the outset are also essential. Formal feasibility testing of both co-produced interventions in English secondary schools via cluster RCT is warranted. Trial registration: Project Respect: ISRCTN12524938. Positive Choices: ISRCTN65324176
    • Diffusion theory and multi-disciplinary working in children’s services

      Bostock, Lisa; Lynch, Amy; Newlands, Fiona; Forrester, Donald; University of Bedfordshire; Cardiff University (Emerald Publishing, 2018-04-16)
      Purpose The purpose of this paper is to explore how innovation in children’s services is adopted and developed by staff within new multi-disciplinary children’s safeguarding teams. It draws on diffusion of innovations (DOI) theory to help us better understand the mechanisms by which the successful implementation of multi-disciplinary working can be best achieved. Design/methodology/approach It is based on interviews with 61 frontline safeguarding staff, including social workers, substance misuse workers, mental health workers and domestic abuse workers. Thematic analysis identified the enablers and barriers to implementation. Findings DOI defines five innovation attributes as essential for rapid diffusion: relative advantage over current practice; compatibility with existing values and practices; complexity or simplicity of implementation; trialability or piloting of new ideas; and observability or seeing results swiftly. Staff identified multi-disciplinary team working and group supervision as advantageous, in line with social work values and improved their service to children and families. Motivational interviewing and new ways of case recordings were less readily accepted because of the complexity of practicing confidently and concerns about the risks of moving away from exhaustive case recording which workers felt provided professional accountability. Practical implications DOI is a useful reflective tool for senior managers to plan and review change programmes, and to identify any emerging barriers to successful implementation. Originality/value The paper provides insights into what children’s services staff value about multi-disciplinary working and why some aspects of innovation are adopted more readily than others, depending on the perception of diffusion attributes.  
    • Evaluating the quality of social work supervision in UK children's services: comparing self-report and independent observations

      Wilkins, David; Khan, Munira; Stabler, Lorna; Newlands, Fiona; Mcdonnell, John; Cardiff University; University of Bedfordshire; London Borough of Islington (Springer, 2018-12-31)
      Understanding how different forms of supervision support good social work practice and improve outcomes for people who use services is nearly impossible without reliable and valid evaluative measures. Yet the question of how best to evaluate the quality of supervision in different contexts is a complicated and as-yet-unsolved challenge. In this study, we observed 12 social work supervisors in a simulated supervision session offering support and guidance to an actor playing the part of an inexperienced social worker facing a casework-related crisis. A team of researchers analyzed these sessions using a customized skills-based coding framework. In addition, 19 social workers completed a questionnaire about their supervision experiences as provided by the same 12 supervisors. According to the coding framework, the supervisors demonstrated relatively modest skill levels, and we found low correlations among different skills. In contrast, according to the questionnaire data, supervisors had relatively high skill levels, and we found high correlations among different skills. The findings imply that although self-report remains the simplest way to evaluate supervision quality, other approaches are possible and may provide a different perspective. However, developing a reliable independent measure of supervision quality remains a noteworthy challenge.
    • How do we assess the quality of group supervision? : developing a coding framework

      Bostock, Lisa; Patrizo, Louis; Godfrey, Tessa; Munro, Emily; Forrester, Donald; University of Bedfordshire; Frontline; Cardiff University (Elsevier, 2019-03-14)
      The importance of supervision for social work practice is one of the most widely accepted tenets of the profession. Yet, surprisingly little is known about what happens in supervision, making it difficult to unravel what it is about supervision that makes a difference to social work practice. This paper describes the development of a framework for assessing the quality of group supervision. It focuses on one sub-category of group supervision – systemic group supervision – and draws a wider evaluation of systemic social work practice in the UK. It is based on 29 observations of “live” of supervision to illustrate differences in quality of supervisory practice. The process of developing the coding framework was cyclical, and ultimately resulted in a three-point ordinal grouping for assessing systemic supervisory practice. Analysis of observational data assessed group systemic supervision as follows: 8 as non-systemic (28%); 12 (41%) as demonstrating some incorporation of systemic ideas into interactions, described as “green shoots” (or showing encouraging signs of development but not yet reached its full potential); and 9 (31%) supervision sessions demonstrating a full incorporation of systemic concepts and practice. What marked “systemic” sessions from “green shoots” supervision was the move from hypothesis generation about family relations and risk to children to purposeful, actionable conversations with families: the move from reflection to action. This paper supports a small but growing body of evidence about the fundamental characteristics of successful or effective supervision within children and families social work.
    • The need to improve fertility awareness

      Harper, Joyce; Boivin, Jacky; O'Neill, Helen C.; Brian, Kate; Dhingra, Jennifer; Dugdale, Grace; Edwards, Genevieve; Emmerson, Lucy; Grace, Bola; Hadley, Alison; et al. (Elsevier, 2017-04-08)
      Women and men globally are delaying the birth of their first child. In the UK, the average age of first conception in women is 29 years. Women experience age-related fertility decline so it is important that men and women are well-informed about this, and other aspects of fertility. A group of UK stakeholders have established the Fertility Education Initiative to develop tools and information for children, adults, teachers, parents and healthcare professionals dedicated to improving knowledge of fertility and reproductive health.
    • Ofsted and children’s services: what performance indicators and other factors are associated with better inspection results?

      Wilkins, David; Antonopoulou, Vivi; University of Bedfordshire; Cardiff University (Oxford University Press, 2018-11-26)
      ‘Failing’ an Office for Standards in Education, Children’s Services and Skills (Ofsted) inspection has severe consequences for a local authority. Senior managers may lose their jobs and the workforce as a whole can be destabilised. In extreme cases, central government can decide the authority is no longer capable of running children’s services. On the other hand, receiving positive Ofsted judgements often brings with it a national reputation for excellence. This study reports the findings of an analysis of key performance indicators, expenditure and deprivation in relation to Ofsted inspections for eighty-seven local authorities in England undertaken between 2014 and 2016. Our aim was to examine the association between these factors and Ofsted judgements. Our findings suggest that, for most of the factors we considered, there is no clear pattern of better or worse performance between local authorities with different Ofsted ratings. However, ‘good’ and ‘outstanding’ authorities tend to outperform other authorities in relation to some procedural variables. By itself, the level of local-authority deprivation was most clearly associated with the Ofsted rating and expenditure was associated with the authority’s deprivation level, but not their Ofsted judgement. Comparisons are made with the Department of Education’s concept of ‘value-added’ education in relation to schools.
    • A randomized controlled trial of training in Motivational Interviewing for child protection.

      Forrester, Donald; Westlake, David; Killian, Mike; Antonopoulou, Vivi; McCann, Michelle; Thomas, Roma; Waits, Charlotte; Whittaker, Charlotte E.; Hutchison, Dougal; Thurnham, Angela; et al. (Elsevier, 2018-02-12)
      There has been interest in developing more evidence-based approaches to child and family social work in the UK in recent years. This study examines the impact of a skills development package of training and supervision in Motivational Interviewing (MI) on the skills of social workers and the engagement of parents through a randomized controlled trial. All workers in one local authority were randomly assigned to receive the package (n = 28) or control (n = 33). Families were then randomized to trained (n = 67) or untrained (n = 98) workers. Family meetings with the worker shortly after allocation were evaluated for MI skill. Research interviews gathered data including the WAI. Follow-up interviews 20 weeks later repeated the WAI, and other outcome measures including Goal Attainment Scaling (GAS) and rating of family life. Between group analysis found statistically significant difference in MI skills, though these were not substantial (2.49 in control, 2.91 MI trained, p = .049). There was no statistically significant difference between groups in any other outcome measures. The package of training and supervision did not create sufficient increase in MI skills to influence engagement or outcomes. Implications for understanding the relationship between skills, engagement and organizational change are discussed.
    • A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT

      Ponsford, Ruth; Bragg, Sara; Allen, Elizabeth; Tilouche, Nerissa; Meiksin, Rebecca; Emmerson, Lucy; Van Dyck, Laura; Opondo, Charles; Morris, Steve; Sturgess, Joanna; et al. (NIHR Journals Library, 2021-01-31)
      The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenthood is associated with adverse medical and social outcomes for mothers and children, and increases health inequalities. This study evaluates Positive Choices (a new intervention for secondary schools in England) and study methods to assess the value of a Phase III trial. To optimise and feasibility-test Positive Choices and then conduct a pilot trial in the south of England assessing whether or not progression to Phase III would be justified in terms of prespecified criteria. Intervention optimisation and feasibility testing; pilot randomised controlled trial. The south of England: optimisation and feasibility-testing in one secondary school; pilot cluster trial in six other secondary schools (four intervention, two control) varying by local deprivation and educational attainment. School students in year 8 at baseline, and school staff. Schools were randomised (1 : 2) to control or intervention. The intervention comprised staff training, needs survey, school health promotion council, year 9 curriculum, student-led social marketing, parent information and review of school/local sexual health services. The prespecified criteria for progression to Phase III concerned intervention fidelity of delivery and acceptability; successful randomisation and school retention; survey response rates; and feasible linkage to routine administrative data on pregnancies. The primary health outcome of births was assessed using routine data on births and abortions, and various self-reported secondary sexual health outcomes. The data sources were routine data on births and abortions, baseline and follow-up student surveys, interviews, audio-recordings, observations and logbooks. The intervention was optimised and feasible in the first secondary school, meeting the fidelity targets other than those for curriculum delivery and criteria for progress to the pilot trial. In the pilot trial, randomisation and school retention were successful. Student response rates in the intervention group and control group were 868 (89.4%) and 298 (84.2%), respectively, at baseline, and 863 (89.0%) and 296 (82.0%), respectively, at follow-up. The target of achieving ≥ 70% fidelity of implementation of essential elements in three schools was achieved. Coverage of relationships and sex education topics was much higher in intervention schools than in control schools. The intervention was acceptable to 80% of students. Interviews with staff indicated strong acceptability. Data linkage was feasible, but there were no exact matches for births or abortions in our cohort. Measures performed well. Poor test–retest reliability on some sexual behaviour measures reflected that this was a cohort of developing adolescents. Qualitative research confirmed the appropriateness of the intervention and theory of change, but suggested some refinements. The optimisation school underwent repeated changes in leadership, which undermined its participation. Moderator analyses were not conducted as these would be very underpowered. Our findings suggest that this intervention has met prespecified criteria for progression to a Phase III trial. Declining prevalence of teenage pregnancy suggests that the primary outcome in a full trial could be replaced by a more comprehensive measure of sexual health. Any future Phase III trial should have a longer lead-in from randomisation to intervention commencement. Current Controlled Trials ISRCTN12524938. ; Vol. 9, No. 1. See the NIHR Journals Library website for further project information.