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Muirden CE, Appleton JV. Health and social care practitioners' experiences of exercising professional curiosity in child protection practice: An integrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3885-e3903. [PMID: 36281954 DOI: 10.1111/hsc.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full-text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty-four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro-level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research.
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Affiliation(s)
| | - Jane V Appleton
- Formerly Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK ('retired')
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David Morgan L, Spargo D. School nurses' perceptions of undergraduate children's nursing safeguarding education. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjsn.2017.12.5.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Llewellyn David Morgan
- SCPHN (School Nursing), lecturer in children's nursing, Children and Young People's Nursing Team, College of Human and Health Sciences, Swansea University, Swansea
| | - Dwynwen Spargo
- Senior lecturer, Faculty of Life Sciences and Education, University of South Wales
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Malone M, Whittaker KA, Cowley S, Ezhova I, Maben J. Health visitor education for today's Britain: Messages from a narrative review of the health visitor literature. NURSE EDUCATION TODAY 2016; 44:175-186. [PMID: 27429349 DOI: 10.1016/j.nedt.2016.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 03/28/2016] [Accepted: 04/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This paper draws on a narrative review of the literature, commissioned to support the Health Visitor Implementation Plan, and aimed at identifying messages about the knowledge, skills, and abilities needed by health visitors to work within the current system of health care provision. DESIGN The scoping study and narrative review used three complementary approaches: a broad search, a structured search, and a seminal paper search to identify empirical papers from the health visitor literature for review. The key inclusion criteria were messages of relevance for practice. DATA SOURCES 378 papers were reviewed. These included empirical papers from the United Kingdom (UK) from 2004 to February 2012, older research identified in the seminal paper search and international literature from 2000 to January 2016. REVIEW METHODS The review papers were read by members of the multidisciplinary research team which included health visitor academics, social scientists, and a clinical psychologist managed the international literature. Thematic content analysis was used to identify main messages. These were tabulated and shared between researchers in order to compare emergent findings and to confirm dominant themes. RESULTS The analysis identified an 'orientation to practice' based on salutogenesis (health creation), human valuing (person-centred care), and viewing the person in situation (human ecology) as the aspirational core of health visitors' work. This was realised through home visiting, needs assessment, and relationship formation at different levels of service provision. A wide range of knowledge, skills, and abilities were required, including knowledge of health as a process and skills in engagement, building trust, and making professional judgments. These are currently difficult to impart within a 45week health visitor programme and are facilitated through ad hoc post-registration education and training. The international literature reported both similarities and differences between the working practices of health visitors in the UK and public health nurses worldwide. Challenges related to the education of each were identified. CONCLUSIONS The breadth and scope of knowledge, skills, and abilities required by health visitors make a review of current educational provision desirable. Three potential models for health visitor education are described.
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Affiliation(s)
- Mary Malone
- Dept of Child and Adolescent Nursing and the Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, UK.
| | | | - Sarah Cowley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | | | - Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Abstract
Purpose: The purpose of this study was to evaluate the psychometric properties of a revised intuition instrument developed for nursing students. Method: Principal component factor analysis was used to establish construct validity, and the Cronbach’s alpha was used to examine reliability. Findings: Statistical analysis resulted in a 26-item intuition instrument with 6 factors accounting for 62% of the variance. The factors were labeled as Feelings That Reassure (27.7%), Spiritual Connections (10.9%), Feelings That Alert (8.4%), Feelings That Forewarn (5.8%), Physical Sensations That Alert (4.7%), and Reading Physical Cues (4.2%). Eigenvalues ranged from 1.100 to 7.225, and factor loadings ranged from .572 to .848. The overall Cronbach’s alpha was .89 with a range of .73 to .85 for each factor. Conclusions: The 26-item intuition instrument showed evidence of construct validity and reliability. Implications: The intuition instrument can serve as a stimulus to foster students’ intuitive abilities.
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Ho GWK, Gross DA. Pediatric nurses' differentiations between acceptable and unacceptable parent discipline behaviors: a Q-study. J Pediatr Health Care 2015; 29:255-64. [PMID: 25620720 DOI: 10.1016/j.pedhc.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/04/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nurses are mandated to report suspected cases of child maltreatment. However, it is unclear how nurses decide what constitutes child abuse or evidence for reporting. It is crucial to examine how nurses define various forms of child maltreatment, including child abuse and its differentiation from physical discipline, to enhance our services to families with young children. OBJECTIVE The present study examined pediatric nurses' views on acceptable versus unacceptable discipline behaviors to better understand parent behaviors that nurses are likely to deem reportable to child protective services. METHODS Using Q methodology, a convenience sample of 48 pediatric nurses from one urban medical center sorted 71 statements related to the behavior or outcome of punishing a child via the Internet application FlashQ. The statements were sorted on a predefined continuum ranging from "Most Unacceptable" to "Most Acceptable." By-person factor analysis was used to uncover groups of nurses with similar sorts and to generate a unique sort that represented the viewpoint of nurses in that group. RESULTS Two distinct viewpoints were uncovered. Although there was consensus on what constitutes most acceptable and most unacceptable parent behaviors, nurses varied on their endorsement of using physical force as a form of discipline, suggesting a potential for discrepant tendencies to identify and report child abuse.
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Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: a narrative review of the literature. Int J Nurs Stud 2014; 52:465-80. [PMID: 25304286 DOI: 10.1016/j.ijnurstu.2014.07.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/15/2014] [Accepted: 07/19/2014] [Indexed: 12/29/2022]
Abstract
INTRODUCTION There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. OBJECTIVES Through a narrative review of empirical literature, to identify: (1) What are the key components of health visiting practice? (2) How are they reflected in implementing the universal service/provision envisaged in the English Health Visitor Implementation Plan (HVIP)? DESIGN The paper draws upon a scoping study and narrative review. REVIEW METHODS We used three complementary approaches to search the widely dispersed literature: (1) broad, general search, (2) structured search, using topic-specific search terms, (3) seminal paper search. Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). RESULTS The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. CONCLUSIONS Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future.
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Wilson P, Barbour RS, Graham C, Currie M, Puckering C, Minnis H. Health visitors’ assessments of parent–child relationships: A focus group study. Int J Nurs Stud 2008; 45:1137-47. [PMID: 17761183 DOI: 10.1016/j.ijnurstu.2007.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 07/09/2007] [Accepted: 07/11/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health visitors (HVs), also known as public health nurses, in the UK provide a universal community-based service to preschool children and their parents. Since they have ongoing supportive contact with almost all mothers and young children they have opportunities to identify problems in the parent-infant relationship: for example during developmental screening, home visits and immunisation clinics. Research into the role of screening for problems in the parent-child relationship in early childhood is sparse and little is known about how such problems are currently identified in the community. OBJECTIVE To explore the approaches taken by health visitors (HVs) to identifying problems in the parent-child relationship. DESIGN Focus group study. SETTING Glasgow, Scotland. PARTICIPANTS 24 health visitors sampled purposively. RESULTS Multiple sources of information were used by health visitors in assessing parent-child relationships. These include use of known risk factors, knowledge of local norms, direct observations of behaviour, reflection on the relationship between the parent and health visitor, as well as more intuitive reactions. In many cases understanding difficulties in parent-child relationships involved piecing together a jigsaw over a considerable time span. Continuity of relationships appeared to be crucial in this task. Home visits were described as the most informative setting in which to develop an understanding of the parent-child relationship. PARTICIPANTS reported a lack of formal training in the assessment of parent-child relationships and were keen to obtain more training. CONCLUSIONS Health visitors use complex strategies to integrate information about parent-child relationships. These strategies are acquired in a variety of ways, but receive little emphasis during basic professional training.
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Affiliation(s)
- Philip Wilson
- Section of General Practice and Primary Care, University of Glasgow, Glasgow, G12 9LX, UK.
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Appleton JV, Cowley S. Health visiting assessment processes under scrutiny: a case study of knowledge use during family health needs assessments. Int J Nurs Stud 2007; 45:682-96. [PMID: 17418848 DOI: 10.1016/j.ijnurstu.2006.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 11/24/2006] [Accepted: 12/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Accurate assessment of family health need is a core health visiting skill, requiring considerable knowledge and expertise. To date, there has been only limited empirical examination of the types of knowledge and ways of knowing which are likely to influence health visiting practice during family health needs assessments. OBJECTIVES This paper will present a detailed analysis of health visiting assessment processes and will explicate some of the many elements associated with the processes of identifying and assessing family health needs. DESIGN An in-depth case study was undertaken to explore health visiting practice across three study sites. The focus of interest was to attempt to understand the factors that may influence a health visitor in making a professional judgement to offer a family extra support. SETTINGS The study was conducted in three community Trust case sites in England, UK. METHODS AND PARTICIPANTS The study was informed by a constructivist methodology. Data collection took place during 56 observed home visits to families receiving increased health visiting support and intervention. Following the home visits separate in-depth interviews were undertaken with the health visitors and the clients. RESULTS/CONCLUSIONS This paper will explicate some of the many elements associated with the processes of identifying and assessing family health needs. It endeavours to unravel some of the complexity and intricacies of these processes and provide insights into health visitors' practical 'know-how'.
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Affiliation(s)
- Jane V Appleton
- School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston, Oxford OX3 0FL, UK.
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Abstract
AIMS AND OBJECTIVES The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. BACKGROUND Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. DESIGN Literature review. METHODS Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. RESULTS The characteristics of the three models of decision making were identified and the related research discussed. CONCLUSIONS Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. RELEVANCE TO CLINICAL PRACTICE It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.
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Affiliation(s)
- Maggi Banning
- The School of Health Sciences and Social Care, Brunel University, UK.
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Smith AJ, Thurkettle MA, dela Cruz FA. Use of intuition by nursing students: instrument development and testing. J Adv Nurs 2004; 47:614-22. [PMID: 15324430 DOI: 10.1111/j.1365-2648.2004.03149.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intuition has been described as an important type of nursing knowledge and has gained acceptance as a valid way of knowing in clinical nursing. Use of intuition has become one way of explaining professional expertise. Measures of the use of intuition have been developed primarily for experienced nurses, but few measures of intuition use among nursing students exist. AIM The aim of this paper is to describe the development and psychometric testing of an instrument to measure use of intuition by nursing students. METHODS Instrument development consisted of concept clarification, item development, and psychometric testing. Intuition was defined as a non-linear process of knowing perceived through physical awareness, emotional awareness, and/or through physical or spiritual connections. Initial measurement items were derived inductively from the literature and informal interviews with senior nursing students. Seven content experts established a content validity index of 0.86 for the initial 33-item measure. It was pretested with a sample of 20 senior nursing students prior to its nationwide validation with a random sample of 1000 senior bachelor of science and associate degree nursing students. RESULTS Postal mail data collection resulted in 349 responses (35% response rate). Principal component analysis with orthogonal varimax rotation resulted in seven factors accounting for 66.2% of the variance: physical sensations (28.4%); premonitions (9.7%); spiritual connections (7.7%); reading of cues (6.1%); sensing energy (5.7%); apprehension (4.3%); and reassuring feelings (4%). Eigenvalues ranged from 1 to 7.1 and factor loadings ranged from 0.534 to 0.858. The validation resulted in a revised 25-item measure that demonstrated an overall Cronbach's alpha of 0.89 and a range of 0.69-0.84 for each factor. The study is limited by the use of a self-report measure and the attrition in the randomized sample. CONCLUSIONS The intuition measure for use with students showed evidence of construct validity and reliability. With further testing, the measure could serve as a stimulus to foster students' intuitive abilities.
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Affiliation(s)
- Anita J Smith
- Point Loma Nazarene University, San Diego, California 92106-2810, USA.
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Abstract
BACKGROUND Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children. AIMS The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse. METHODS A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis. FINDINGS There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities. CONCLUSION In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.
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Affiliation(s)
- Beth R Crisp
- Department of Social Work, University of Glasgow, Glasgow, UK.
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Paavilainen E, Tarkka MT. Definition and identification of child abuse by Finnish public health nurses. Public Health Nurs 2003; 20:49-55. [PMID: 12492825 DOI: 10.1046/j.1525-1446.2003.20107.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.
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Gray B. Working with families in Tower Hamlets: an evaluation of the Family Welfare Association's Family Support Services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2002; 10:112-122. [PMID: 12121270 DOI: 10.1046/j.1365-2524.2002.00347.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes an evaluation carried out by South Bank University of the work of the Family Welfare Association's (FWA's) Family Support Services (FSSs) in Tower Hamlets, London. Tower Hamlets is a multi-racial area in east London that, according to the 1991 census, has high levels of poverty, overcrowding and unemployment. Increasing poverty and social exclusion, which further entrench inequalities in health, are reported by sources such as government, health and social services and research as requiring innovative local responses to meet pressing welfare needs. The evaluation reported here examined three projects: Family Support, Building Bridges and Quality Protects - these are referred to collectively as FSSs. The evaluation shows that FSSs are innovative services that demonstrate effective ways of working with vulnerable families affected by experiences of racism, bullying, mental health difficulties, domestic violence or child abuse. In common with other successful initiatives in the UK and abroad, FSSs are aimed to be non-stigmatising, non-intrusive and responsive to the ethnicity, views and specific needs of families. This paper focuses on the participatory work of FSSs with families to illustrate effective methods of quality support, detail outcomes, and draw lessons for policy and practice.
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