Summary of the impact

Clinical, observational and biographical research developed at UEL has produced and supported the novel application of a practice-near methodology adapted to evaluate social work practice and social problems. The benefits of this are described here in the context of two illustrative examples exemplifying the adaptation of the UEL methodology to address self-harm/suicide prevention and the safeguarding of children's rights in London's African communities. Those benefits accrue to practitioners, policy makers, community organisations and individual health and social care service users, and include: the delivery of training leading to positive changes in professional practice; and contributions to discussion, debate and policy and guideline formulation. The research has also been used to enhance public awareness of important social and cultural issues.

Underpinning research

The impacts described here arise from the application of a distinctive model of `practice-near' research produced at UEL. The development of that model was given crucial impetus by the ESRC seminar series `Practitioner research and practice-near methods' (2006-9), led by Stephen Briggs (Professor of Social Work at UEL since 2006) in collaboration with Professor Lynn Froggett (UCLAN). This series facilitated an exploration by 50 academics and practitioners in the UK and Europe of the application of biographical and observational methods in a range of practice settings. The outputs of that seminar series (for example [1]) defined the criteria for practice-near research and its applications; they were disseminated particularly through special issues of the Journal of Social Work Practice published in 2009 and 2010, edited by Briggs and Froggett and including articles by UEL researchers Cooper and Hingley-Jones. These emerging conceptualisations have also been communicated through contributions to conference symposia including JSWEC 2010, 2011 and 2013 and European Social Work Research Conferences 2011 and 2013.

The approach draws on two key research methods: an in-depth biographical narrative interviewing method (BNIM), and the Tavistock method of infant observation. The BNIM was developed at UEL as part of the EU-funded Social Strategies in Risk Societies project (1996-99), jointly coordinated by Prue Chamberlayne (Senior/Principal Lecturer at UEL until 1999) and Michael Rustin (Professor of Sociology at UEL since 1970) [2]. A central principle of the BNIM is the capacity to connect the `micro' of an individual life experience - particularly in emotional and relational contexts - to the `macro' of social trends and experiences. UEL has a longstanding collaborative relationship with the Tavistock Clinic, which is renowned for its application of psychoanalytic approaches to multidisciplinary professional practice. The method of infant observation is a specialism of this approach; initially devised for training psychotherapists, its potential application within research was demonstrated by Rustin [3]. Through his doctoral research (1990-1995) and subsequent book (Growth and Risk in Infancy, London 1997), Briggs translated this observational approach into a practice-relevant research method through its application to `at risk' infants. The observational methodology is distinguished by the use of reflective seminar groups to analyse connections between observations, conceptualisations and the emotional experiences of the observer. This reflective process was incorporated into BNIM as a `panel' method of analysis to facilitate rigorous reflexive data analysis.

His subsequent application of both infant observation and aspects of the BNIM approach to a series of services assessments allowed Briggs to develop a coherent, innovative approach to the evaluation of social work practice. This began with evaluations of Maytree (2006, 2012), a respite centre for suicidal people [4, 5], in which he drew on his existing research specialism in self-harm and suicide [6, 7]. Practice-near aspects in the Maytree studies included: a central role for observation; in-depth biographical follow-up interviews for Maytree residents; the application of the panel method for data analysis; and a focus on participant and researcher emotionality and relationships in the research process. The Trust for London subsequently commissioned Briggs for a 2008-11 evaluation of a community-based initiative to effect changes in attitudes among, and reduce the abusive use of religious practices in, London's African Communities. The practice-near approach was applied here to generate rigorous research findings, using aspects of the infant observation model to study sensitive interactions between community members and organisations working to effect change. The evaluation demonstrated the relationship between religious practices and potential child abuse, and showed how social factors, including poverty and marginalisation, in these communities, increase the risks of abuse [8].

References to the research

Briggs was the grant holder for the 2006-2009 ESRC Seminar series `Practitioner research and practice near methods' (RES-451-25-4319): £14732

Details of the impact

Briggs' significant contribution to the development of the practice-near research method and his expertise in infant observation contributed to his development and application of the distinctive approach outlined above to the evaluation of services and organisations. Funded evaluative studies employing this approach to address complex practice and policy issues have been commissioned by governmental organisations including Skills for Care and the Department for Education; health commissioners such as Surrey PCT; and charitable organisations including the Trust for London, Goldsmith's Charity, and Kids Company. The application of Briggs' approach in evaluations for such organisations has had significant impacts on the quality and delivery of the services they provide, with subsequent benefits not only to the organisations themselves but to the many people who use them. The benefits to these organisations have resulted particularly from the capacity of Briggs' novel evaluative methodology to produce rigorous, systematic research findings responsive to sensitive and/or unusual organisational settings and complex social problems. Thus, for example, the Kids Company CEO explains: "We are very pleased with the results of the research and we are using the report to show our stakeholders how our work helps young people, and also to support our government funding: Professor Briggs has an exceptional ability to capture significant and complex issues and communicate them in an accessible way" [a]. Two key examples illustrate the benefits of the application of Briggs' approach in the context of its commissioned use by organisations dealing with (i) suicide prevention and adolescent self-harm; and (ii) child abuse linked to Witchcraft and Spirit Possession in London's African Communities.

(i.) Suicide prevention and adolescent self-harm

Improving service delivery through practitioner training: Briggs has transferred the specialist insights and expertise developed through his work on relationship-led approaches to suicide and self-harm through CPD and other training influencing professional practice both within and beyond the UK. Important examples since 2008 include the provision of training to: 200 social workers in Tower Hamlets (6 June 2013); over 100 social care staff at a Hounslow Safeguarding Board Conference (11 November 2011); 35 cognitive and behavioural therapists at an evidence-based skills class (BABCP 17 July 2013); 60 Bromley Samaritans (10 November 2012); Sussex Central YMCA Counselling (February 2010, 80 attendees); Kent CAMHS (November 2012, 55 attendees); KCA (Drug, Alcohol and Mental Health Services, April 2013, 25 attendees). Feedback from two nScience UK seminars on adolescent self-harm (23.06.2011; 25.04.2013; 105 attendees) indicates that sessions were "very well received" and of practical relevance to attendees [b].

The reach of these impacts has been extended internationally through Briggs' delivery of training to 160 psychotherapists, health and social care workers in Australia (Sydney and Canberra, August 2012 and Feb 2013) [c]. A 10-week CPD programme, `Relating to self-harm', devised by Briggs using his UEL research, has been delivered annually since 2008 through the Tavistock Centre and attended by between 15 and 20 participants per year (96 in total since 2008). Course feedback, including a DVD, recording participants' reflections on their experiences, demonstrates the beneficial and, for some transformational, impacts of the course on working practices: reported changes include an increase in relational focus, and confidence in assessing risks and working in emotionally intense situations. One participant described how the course had "opened up her mind" and helped her overcome her fear of self-harm by being able to build relationships and focus on how the work affected her emotionally [d]. The reach of the impacts on practitioner services - and subsequently the benefits to patients - has also been significantly enhanced by BMJ Learning's inclusion in its online course for GPs working with self-harming patients of a video commissioned from Briggs in 2012. This video addresses key factors in assessing risks of self- harm, and emphasises the need to assess motivations in each case through relating to the patient. It is one of two videos on the site and the only one produced by an academic. Feedback from 131 course participants showed that the video was well received: comments included "excellent", "very informative", and "really thought provoking and useful" [e].

Informing changes in policy and guidelines: Briggs' work was valued highly by Maytree, who have since made extensive use of his evaluation report: "There is no doubt", its Director states, "that the report...assists us in securing funding, promotes our service to medical and non-medical practitioners, in building new partnerships with statutory and voluntary sector services, and reassures potential service users that our model is effective" [f]. Maytree have used the evaluations to support successful funding applications amounting to £284,950 in the past 2 years alone, a considerable sum for this small organisation; the research has also supported the development since 2012 of a partnership with the British Transport Police [f]. In 2008, Briggs' invited presentation of the findings of his work with Maytree persuaded the then-lead for NHS mental Health, Louis Appleby, to accept the case for NHS support for Maytree.

The research (particularly [6]) has also attracted interest from policy-makers and practitioners in Norway, and in 2012 Briggs advised suicide prevention specialists in Australia on the replication of the Maytree model. On the basis of his expertise in this field, Briggs was also an invited member of the National Clinical Institute for Excellence (NICE) Clinical Guideline Development Group for `Self- harm, longer term management (2009-11). He was subsequently invited to contribute to panels advising on commissioning (2012) and evidence update (2013). His involvement influenced the incorporation into the Guidelines of a paradigm-changing focus on the centrality of relationship-led approaches to working with self-harm, which is now being implemented across the NHS [g].

(ii.) Safeguarding Children's Rights

Supporting the development of organisations tackling child abuse linked to witchcraft and spirit possession in London's African communities. Briggs' commissioned work for the Trust for London [8] included the provision of a supportive, consulting relational approach for use by practitioners in newly-founded, small African community organisations. Based on the practice-near approach, this facilitated the structural, strategic and operational development of organisations including the Victoria Climbie Foundation (VCF), Africans Unite Against Child Abuse (AFRUCA), and Congolese Family Centre. VCF found the evaluation findings "helpful in developing the VCF organisation, both in terms of communicating our work around child abuse linked to witchcraft and spirit possession to safeguarding and other statutory professionals, and in raising child protection awareness in the communities with whom we work" [h].

Informing changes in policy and guidelines. The findings of the Trust for London evaluation were shared widely with relevant professionals and government bodies through contributions to policy discussion and debate, helping to reduce the `wall of silence' around the important social problems addressed in the research. The evaluation outcomes were also announced at a conference for 100 practitioners, chaired by Baroness Howarth on 13 May 2011. They were shared with a further 170 practitioners via two conferences hosted by AFRUCA and the Tavistock in October and November 2011: participants evaluated these as positively informing their understanding of the complex issues involved.

A 2012 National Action Plan produced by the Department for Education Working Group to tackle child abuse linked to faith or belief cited the Trust for London evaluation report as providing "critical learning which should be taken into account in future projects or activity by statutory and non- statutory partners" [i, p. 5]. It also repeated key findings of that evaluation, including recognising: "the importance of engaging with faith leaders and of training to help build understanding" and that "broader engagement with communities is more effective than narrower engagement on the issue of witchcraft and spirit possession" [i, p. 6]. A literature review of evidence on child abuse linked to faith or belief was commissioned from The Childhood Wellbeing Research Centre in 2012 by the Department for Education, in conjunction with the National Action Plan. That review, which was commissioned to help inform future policy in the area, likewise repeatedly used key evaluation findings to suggest future directions of travel in generating evidence in this area [j]. In April 2012 Briggs was invited with another member of the UEL/Tavistock research team, Elaine Ryan, to contribute specialist insights to a House of Commons summit sponsored by Chuka Umunna MP and AFRUCA on the abuse of children of African heritage linked to belief in witchcraft or possession. Briggs and Ryan drew, again, on the evaluation findings to highlight the complex relationships between beliefs and child protection, and to recommend training professionals to use the child protection framework for assessment of cases of suspected faith abuse. This resulted in the allocation from 2012 of funding to support AFRUCA's training of 100 `children's champions'.

Increasing public awareness: The findings of the evaluation report were communicated to much wider public and practitioner audiences through their coverage in popular media and practitioner outlets including The Times (14/05/2011: average daily circulation of 475,250 in January 2011) and Community Care (16/052011: 300,000 online users). The evaluation was widely cited again, both in the traditional media and online, in coverage of the verdict in the Kristy Bamu case in January 2012, and Briggs discussed issues raised by that case on Radio Five Live's Victoria Derbyshire Programme (02/03/2012: average audience of 6.3 million March 2012).

Sources to corroborate the impact

[a] Factual statement from the CEO of Kids Company about the benefits of evaluation to the organisation. Available on request

[b] Factual statement from the Director, nScience UK about the benefits of the training to practitioners. Available on request.

[c] Factual statement from the Director of the New South Wales Child and Adolescent Psychoanalytic Psychotherapy about the benefits to practitioners is available on request

[d] Course evaluations including DVD of the CPD "Relating to self-harm and suicide in adolescents and young adults" course are available on request

[e] Copies of course evaluations of the DVD on the BMJ online course are available on request. The module can be viewed at: http://bit.ly/1am288F

[f] Factual statement from the Director of Maytree about benefits to them. Available on request.

[g] For NICE clinical guidance reflecting the influence of Briggs' research: Self-harm (longer term management) (CG133) http://www.nice.org.uk/CG133 especially recommendations 4.6.1.1 (p.106); 5.5.1.3 (p. 123); 6.7.1.8 (p.196); and 7.2.11.1 page 254

[h] Factual statement provided by the Director of VCF about the benefits of the research to the organisation. Available on request.

[i] For citation of the evaluation report for the Trust for London in policy documents commissioned by the Department for Education see National Action Plan to tackle child abuse linked to faith or belief: http://bit.ly/15ZZFyd see pp. 5-6 and 34

[j] For citation of the evaluation in the Childhood Wellbeing Research Centre review of evidence on child abuse linked to faith or belief: http://bit.ly/1aabUJt pp.9, 22, 23, 24, 25, 26, 28