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Abstract For many local authority children and family services in the UK faced with the task of responding to children and families facing difficulties and with declining budgets, there is an increasing imperative on how services can respond more effectively to the diverse needs of families on the edge of care. At the same time policy and paradigm shifts have affected the way in which social workers engage with families. This paper is rooted in research commissioned by one local authority that used an innovative visual 'river of experience' co- production approach to understand better the experiences of children and families on their journeys to the edge of care and to inform how statutory services might respond 'better', and possibly earlier, to prevent children being taken into care. The research highlights the gap between assumptions and practices of child and family services and the realities and needs of children and families. The paper discusses these disjunctions and draws out questions to challenge statutory services. In particular, the paper asks why, in spite of serial involvement of professionals, do children still end up in the care system. The paper contributes to current discourses about rethinking child protection, arguing for a different approach to responding to families facing difficulties involving human centred, holistic family support and a more reflexive and relational approach to professional practice. Highlights • The continuing gap between services and the needs of children and families • Children's voices frequently go unheard in statutory professional interventions. • Insufficient attention to emotional/psychological legacy of early neglect • Reiterates the need for re-imagining child protection as family-centred practice • Need for Children and Family services to be flexible and adaptive learning systems [ABSTRACT FROM AUTHOR]

The emergence of independent advocacy services for children and young people has had an impact on promoting the rights of children and young people. Historically, advocacy has been considered an important social work skill underpinned by principles of human rights and social justice. However, the development of independent advocacy and changes in the delivery of health and social care services have had an impact on how far social workers now feel able to directly advocate for service users. This paper interrogates the tensions faced by social workers in managing their advocacy role through a discussion of advocacy in relation to children and young people. By examining the concepts of 'best interests' and the welfare of the child the paper considers dilemmas for social workers committed to advocating for children and young people. It argues that if principles of social justice are to be upheld practitioners need to actively consider ways to reclaim a culture of advocacy. [ABSTRACT FROM AUTHOR]

The development of child and youth advocacy has been informed by varying theoretical perspectives and in the last decade has been increasingly incorporated into policy and legislation for young people in receipt of welfare services. Through examining the varying perspectives of young people, advocates and commissioners of advocacy services it can be seen that although there is some consensus about how advocacy should be provided, the construction of advocacy by adults may have a significant impact on how it is experienced by young people. This paper draws on material from five advocacy projects to examine how advocacy is constructed by those involved in the provision and receipt of services. It argues that there is a danger that the construction of advocacy in an adult proceduralised way is likely to compromise its potential to challenge the structures that deny young people opportunities to participate in decision making about their lives. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article examines the development of child and youth advocacy through an analysis of the meaning of professionalization and argues that a culture of advocacy is needed to facilitate the development of professional advocacy expertise. Findings: The fragmented development of child and youth advocacy in England and Wales has accelerated within the modernizing agenda of New Labour. While child and youth advocacy competes with other imperatives in the provision of health and social care services, advocates seek to develop professional status in order to ensure effectively the involvement of children and young people in decision making. The nature of advocacy practice creates resistance to traditional models of professionalization but a committed practitioner model, recognizing advocacy expertise, enables advocacy to develop in a way that does not compromise its role. Applications: Debates about the professionalization of child and youth advocacy are ongoing, particularly with the publication of advocacy standards in England and Wales. This article contributes to the discussion and suggests a model for developing the theory and practice of child and youth advocacy. [ABSTRACT FROM AUTHOR]

Two letters to the editors are presented in response to the article "Effect of enhanced information, values clarification, and removal of financial barriers on use of prenatal genetic testing: a randomized clinical trial" by M. Kuppermann and others, along with reply from the authors to the same.

Objective: Studies summarizing the outcome of first-trimester septated cystic hygroma are generally based on small studies or from multiple centers with limited ascertainment. We reviewed the natural history of a large cohort of such cases from a single tertiary referral center, with the aim being to establish contemporary outcome data, particularly in the setting of normal karyotype. Methods: A retrospective cohort study from 2007 to 2017 was conducted at a single tertiary referral prenatal diagnosis center. Data were analyzed from a prospectively collated fetal anomaly database. Search terms were "increased nuchal translucency (NT)," "cystic hygroma," and "septated cystic hygroma." All cases were confirmed to have NT >3 mm with septations. Cases of simple increased NT without septations were excluded. Results: During the study period, over 110,000 pregnancies were delivered at our center, resulting in 410 cases of septated cystic hygroma diagnosed prior to 14 weeks' gestation. Pregnancy outcome was obtained in 99% (405/410) of cases, with detailed pathology outcome available in 92% (378/410). A total of 87% (351/405) underwent invasive prenatal testing, and postnatal chromosome status was established in further 27 cases. A total of 61% (230/378) had abnormal chromosomal status. Of the 39% (148/378) with normal chromosomal status, only 13% (19/148) had a significant structural fetal abnormality, which included 7 cardiac and 12 noncardiac abnormalities. Overall, the perinatal loss was 62% (253/405). The total survival rate in the setting of euploid cystic hygroma without structural abnormality was 84% (108/129). Conclusions: Counseling regarding outcomes in the setting of first-trimester septated cystic hygroma initially focuses on the strong likelihood of an abnormal karyotype, which occurs in 61% of cases. However, once fetal chromosomal abnormality is excluded, our results demonstrate only a 13% incidence of major structural fetal abnormality, which appears significantly less than previously reported. Normal fetuses have a 77% survival rate. These data represent the largest single-center study of first-trimester cystic hygroma with complete outcome data and therefore will be useful for contemporary patient counseling. Such counseling can be more positive than previously expected, once chromosomal abnormality is first excluded. [ABSTRACT FROM AUTHOR]

This article is based on the experiences of social work staff and students involved in the Self-Assessment in Professional and Higher Education Project (SAPHE), funded by the Higher Education Funding Council for England through the Fund for the Development to Teaching and Learning. The rationale for self-assessment is explored, together with its links to reflective learning and the core competence in the requirements for the Diploma in Social Work 'Develop professional Competence'. Work in progress on the project is described and analysed across three sites (the DipSW programmes at the Universities of Briston, Bath and the West fo England). The focus here is on the use of self-assessment in university work; self-assessment in relation to practice learning is considered in parallel article. The centrality of self-assessment to social work education is confirmed, and some preliminary themes emerging from the project are identified. [ABSTRACT FROM AUTHOR]

Objective With the recognition of the role of fetoscopic laser ablation for twin to twin transfusion syndrome (TTTS), there is a requirement for auditable standards for this technically challenging and specialized treatment. The purpose of this study is to report on the perinatal and medium-term neurodevelopmental outcomes following an 8-year national single center experience in the management of TTTS using the selective fetoscopic laser ablation technique. Study design An audit of all cases of TTTS treated with selective laser ablation by a single national fetal medicine team was performed. Overall perinatal survival and medium-term neurodevelopmental outcomes were reported and correlated with gestational age at diagnosis, placental location, volume of amnio-reduction, Quintero staging and percentage inter-twin growth discordance. Procedure-related complications were recorded. Results The overall fetal survival for the first 105 consecutive cases of TTTS was 61% (128/210 fetuses). Dual survival occurred in 47% (49/105) of cases, and with a single survival rate of 28% (30/105), perinatal survival of least one infant was achieved in 75% (79/105) of cases. No correlation was found between any clinical or sonographic marker and perinatal outcome, although dual survival was noted to be significantly decreased with increasing Quintero stage ( p = 0.041). Currently, 86% of survivors have been reported to have a normal medium-term neurological outcome. Conclusion Fetoscopic laser ablation is the established optimal treatment for severe twin to twin transfusion syndrome (TTTS). We report comparable short and medium-term outcomes following the selective fetoscopic technique comparing results from our national program with internationally published single-center outcomes, supporting the efficacy and safety of this treatment at our center. [ABSTRACT FROM AUTHOR]