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Early regulatory disturbances (ERD), such as excessive crying, feeding, or sleeping difficulties and attachment problems, have a population prevalence in very young children (ie, at age 1.5 years) that is very similar to that for behavioral problems in older children1 and for which the stability is similarly high (ie, 50%). They also predict longer-term difficulties including delays in motor, language and cognitive development, and parent-child relational problems.2 Some types of regulatory disturbance (eg, insecure and disorganized attachment) are strongly associated with later psychopathology including behavioral problems3 and personality disorder.4.

Background Attempts to improve child protection outcomes by implementing social work practice models embedded in a particular theory and practice approach, have increased internationally over the past decade. Objective To assess the evidence of the effectiveness of child protection practice models in improving outcomes for children and families. Participants and setting Children < 18 years and their families involved in child protection services. Methods A systematic review was conducted to synthesize evidence regarding the effectiveness of child protection practice models. Systematic searches across 10 electronic databases and grey literature were conducted to identify quasi-experimental studies minimally. Included studies were critically appraised and the findings summarized narratively. Results Five papers, representing six studies, focusing on three practice models (Solution-Based Casework; Signs of Safety; and Reclaiming Social Work) met the inclusion criteria. All studies applied a quasi-experimental design. Overall, the quality of the evidence was rated as being poor, with studies suffering from a risk of selection bias, small sample sizes and short-term follow up. Conclusions Despite the popularity of practice models, the evidence base for their effectiveness is still limited. The results suggest that high-quality studies are urgently needed to evaluate the impact of practice models in improving the outcomes of child-protection-involved families. The findings also illustrate the difficulties of conducting high-quality outcome evaluations in children’s social care, and these challenges and future directions for research, are discussed. peerReviewed

Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.

Summary Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes—the Nurse–Family Partnership (best evidence) and Early Start—have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother–child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.

The burden of disease in wealthy industrialised countries is changing and this is reflected by the fact that emotional and behavioural problems are now the major causes of disability in children. Parenting has been shown to have a significant role not only in the aetiology of emotional and behavioural problems, but in more general terms as regards children's health. The Royal College of Paediatrics and Child Health has responded to this transition by establishing a multidisciplinary working group to examine the issues. Their report calls for greater attention to be given to the support of parents through the development of universal and targeted services for parents from the antenatal period throughout the first three years of the child's life. This paper examines the specific role of paediatricians in supporting parenting, not only through clinical work with parents and children, but also through the development of policy and practice to promote helpful parenting.

Background SPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report findings from the preparatory phase of SPRING-ELS. Methods To develop an explanatory model of early life stress in the community, 45 mothers of children under 2 years old took part in eight focus group discussions. To determine potential barriers to sampling, in-depth interviews were done with five mothers and two barbers (to understand cultural beliefs about young children's hair). In addition, five focus group discussions were done with mothers, grandmothers, and barbers. Salivary and hair cortisol (to assess diurnal rhythm and chronic stress) were measured in 13 children aged 11–13 months. The SPRING trial is registered with ClinicalTrials.gov, number NCT02059863. Findings Causes of stress included violence, poverty, poor hygiene, neglect and poor care, maternal stress, and carer alcoholism. Consequences included a range of physical and mental adversity. Improved caregiving was seen as the most important prevention method. However, in contrast to previous research, stress was seen to affect older children, who have a better understanding of their environment, than younger infants. Taking saliva samples was straightforward. Mothers preferred to be helped by assessors to take these samples rather than doing it themselves. However, hair sampling was challenging. There are many cultural beliefs surrounding young children's hair and a child's first haircut is a ceremonial occasion: rates of refusal were high (four of 13 families refused). Sample size was adjusted accordingly. Interpretation Measuring early life stress in the community is feasible and acceptable. Careful introduction in the community has achieved a 14% refusal rate to take hair samples despite major cultural barriers. These stress measures have been integrated into SPRING outcome assessments, which are being performed with a total of 1200 children. Each assessment is done over 2 days when a child reaches 1 year of age. 60 children are being assessed at home each week using salivary and hair cortisol measurments and questionnaires of environmental stressors developed using findings from our explanatory model. To our knowledge, SPRING is the first large child health intervention trial to include measures of early life stress and the first time that hair cortisol will be assessed in South Asian children. Funding Wellcome Trust research training fellowship to SB (grant number 107818/Z/15/Z).