Safeguarding Current Awareness Bulletin - February 2021 - Royal United Hospitals Bath
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Safeguarding
Current Awareness Bulletin
February 2021
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Contact us: Academy Library 824897/98
Email: ruh-tr.library@nhs.netTitle: Examining nurses' role in Adult Protective Services related to safeguarding
older people.
Citation: Journal of advanced nursing; Feb 2021
Author(s): Liu, Pi-Ju; Hernandez Chilatra, Jessica Andrea; Phelan, Amanda
Aim: To examine the role of Adult Protective Services' (APS's) nurses in helping abused,
neglected and exploited older people, this study investigated how nurses' contribution differs
from social workers. Though the majority of APS' workforce is staffed by social workers,
some programmes also employ nurses.
Design: Secondary data analysis using convergent parallel mixed-method design was
conducted.
Methods: Using survey data from the National Adult Protective Services Association, 99
nurses' responses between October 2014 and August 2015 were analysed to examine their
agency characteristics, training and qualities, job responsibilities and interprofessional
collaboration.
Results: The majority of nurses work with social workers or other professionals using a
multidisciplinary team (MDT) approach. Among those carrying a caseload, 69% (49 out of
71) of nurses work in conjunction with social workers. Out of all nurses, 64% (63 out of 99)
indicated participation in at least one MDT. While the responsibilities nurses provided were
similar to social workers, nurses were also able to provide healthcare related services, in
their professional competencies, without referral.
Conclusion: Nurses in APS are in a privileged position to investigate mistreatment and
provide/coordinate direct care for victims.
Impact: Not much was known about nurses who directly investigate elder mistreatment and
provide services to victims. This study was the first to highlight the nursing workforce in APS,
and described the nurses' unique contribution to the field. Nurses functioned as both social
workers and healthcare professionals in APS. Since victims of elder mistreatment often
suffer from negative physical, psychological and social consequences, having nurses in APS
benefits victims to receive and the programmes in providing better care and services.
Title: Remote Examination and Screening for Domestic Abuse. Comment on "Online
Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges".
Citation: Journal of medical Internet research; Feb 2021; vol. 23 (no. 2); p. e23295
Author(s): Grimes, Hannah Lee; Uppal, Ramnik
Title: The association between exposure to domestic abuse in women and the
development of syndromes indicating central nervous system sensitisation: a
retrospective cohort study using UK primary care records.
Citation: European journal of pain (London, England); Feb 2021
Author(s): Chandan, Joht Singh; Keerthy, Deepiksana; Gokhale, Krishna M; Bradbury-
Jones, Caroline; Raza, Karim; Bandyopadhyay, Siddhartha; Taylor, Julie; Nirantharakumar,
Krishnarajah
2Background: Domestic abuse is a global public health issue. The association between the
development of central sensitivity syndromes (CSS) and previous exposure to domestic
abuse has been poorly understood particularly within European populations.
Methods: A retrospective cohort study using the 'The Health Improvement Network,' (UK
primary care medical records) between 1st January 1995- 31st December 2018. 22,604
adult women exposed to domestic abuse were age matched to 44,671 unexposed women.
Average age at cohort entry was 36 years and median follow up was 2.5 years. The
outcomes of interest were the development of a variety of syndromes which demonstrate
central nervous system sensitisation. Fibromyalgia, chronic fatigue syndrome and
temporomandibular joint disorder outcomes have been reported previously. Outcomes were
adjusted for the presence of mental ill health.
Results: During the study period, women exposed to domestic abuse experienced an
increased risk of developing chronic lower back pain (adjusted incidence rate ratio (aIRR)
2.28; 95% CI 1.85-2.80), chronic headaches (aIRR 3.15; 95% CI 1.07-9.23), irritable bowel
syndrome (aIRR 1.41; 95% CI 1.25-1.60) and restless legs syndrome (aIRR 1.89; 95% CI
1.44-2.48). However, no positive association was seen with the development of interstitial
cystitis (aIRR 0.52; 95% CI 0.14-1.93), vulvodynia (aIRR 0.42; 95% CI 0.14-1.25) and
myofascial pain syndrome (aIRR 1.01; 95% CI 0.28-3.61).
Conclusion: This study demonstrates the need to consider a past history of domestic abuse
in patients presenting with CSS; and also consider preventative approaches in mitigating the
risk of developing CSS following exposure to domestic abuse.
Title: Adverse Childhood Experiences and Spanking Have Similar Associations with
Early Behavior Problems.
Citation: The Journal of pediatrics; Feb 2021
Author(s): Ma, Julie; Lee, Shawna J; Grogan-Kaylor, Andrew
Objectives: To examine whether adverse childhood experiences (ACEs) and physical
punishment (ie, spanking) are unique risk factors for behavior problems in early childhood,
and whether ACEs moderate the associations of spanking with child behavior problems.
Study Design: We conducted prospective, longitudinal analyses on 2,380 families in the
Fragile Families and Child Wellbeing Study (FFCWS). Mothers reported outcomes of
externalizing and internalizing behavior problems at age 5; and the main predictors, ACEs
and spanking, at age 3. ACEs included nine items: physical abuse, emotional abuse,
physical neglect, emotional neglect, mother's exposure to intimate partner violence (IPV),
parental mental health problem, parental substance use, parental incarceration, and parental
death. Multilevel models examined the associations between ACEs, spanking, and behavior
problems, and the moderating effect of ACEs in the associations of spanking with behavior
problems. Analyses were adjusted for pre-existing behavior problems, demographics, and
neighborhood conditions.
Results: ACEs (β = .028, p < .001) and spanking (β = .041, P < .001) at 3 years were
unique risk factors for increased externalizing problems at 5 years, after controlling for
covariates. The magnitude of the associations of ACEs and spanking with externalizing
behavior were statistically indistinguishable.
Conclusions: ACEs and spanking have similar associations in predicting child externalizing
behavior. Results support calls to consider physical punishment as a form of ACE. Our
Findings also underscore the importance of assessing exposure to ACEs and physical
punishment among young children and providing appropriate intervention to children at-risk.
3Title: Leveraging the adverse childhood experiences (ACEs) framework to strengthen
safeguarding in youth sport.
Citation: The Lancet. Child & adolescent health; Feb 2021; vol. 5 (no. 2); p. 94-96
Author(s): Tuakli-Wosornu, Yetsa A; MacLeod, Jelena G
Title: Risk Factors and Indicators for Commercial Sexual Exploitation/Domestic Minor
Sex Trafficking of Adolescent Girls in the United States in the Context of School
Nursing: An Integrative Review of the Literature.
Citation: The Journal of school nursing : the official publication of the National Association
of School Nurses; Feb 2021; vol. 37 (no. 1); p. 6-16
Author(s): Jaeckl, Simone; Laughon, Kathryn
Abstract: As trusted health care providers in the school setting, school nurses are
positioned uniquely to identify children at risk for or victims of commercial sexual exploitation
of children (CSEC). Nevertheless, many victims go unrecognized and unaided due to
inadequate provider education on victim identification. This review provides a
comprehensive overview of the major risk factors for CSEC of girls aged 12-18, the largest
group of CSEC victims in the United States. A search of four databases (Web of Science,
CINAHL, PsychINFO, and PubMed) yielded 21 articles with domestic focus, published in
English between January 2014 and May 2020. While childhood maltreatment trauma was
found most relevant, a variety of other risk factors were identified. Future nursing research is
called to address the numerous research gaps identified in this review that are crucial for the
development of policies and procedures supporting school nurses in recognizing victims
quickly and intervening appropriately.
Title: Conceptualising the social networks of vulnerable children and young people: a
systematic review and narrative synthesis.
Citation: Social psychiatry and psychiatric epidemiology; Feb 2021; vol. 56 (no. 2); p. 169-
182
Author(s): Nevard, Imogen; Green, Chloe; Bell, Vicky; Gellatly, Judith; Brooks, Helen; Bee,
Penny
Purpose: The relationship between social networks and health and wellbeing is increasingly
demonstrated in vulnerable adult populations. This relationship for vulnerable children and
young people has not hitherto been systematically reviewed. This narrative synthesis aims to
consolidate research to provide a foundational basis for future health-related social network
research and interventions for children and young people.
Methods: This mixed methods systematic review synthesises research investigating whole,
egocentric social networks of 32 vulnerable child groups with a mean age below 18. There
were no setting, language or date restrictions. The quality was assessed using the Mixed
Methods Appraisal Tool. Of 6360 search results, 49 were included for narrative synthesis.
Results: The majority of pertinent research originates from the USA; the most frequently
investigated vulnerabilities were minority ethnic status, homelessness and the presence of
special educational needs. Research aims and methodologies varied significantly between
studies. Key findings included (i) vulnerable (excluding minority ethnic) children and young
4people have impoverished networks (ii) access to networks is a protective factor against
negative outcomes (iii) social ties, primarily immediate family, provide access to personal
resources and (iv) network ties are to a degree substitutable.
Conclusions: Networks are associated with wellbeing and vulnerable children and young
people commonly have impoverished networks, excluding cases where vulnerability
classification relates to minority ethnic status. Network embeddedness is associated with
positive outcomes, particularly for homeless children. Family are typically primary providers
of support, but ties are substitutable when networks are restricted. Egocentric social network
research is currently limited for vulnerable child populations. Further research could inform
interventions that harness networks to improve health, wellbeing and functional outcomes for
these child groups.
Title: The Sexual Politics of Anti-Trafficking Discourse.
Citation: Feminist legal studies; Feb 2021 ; p. 1-23
Author(s): Kotiswaran, Prabha
Abstract: 20 years since the negotiation of the Palermo Protocol on Trafficking in 2000, the
anti-trafficking field has gone from an early, almost exclusive preoccupation with sex work to
addressing extreme exploitation in a range of labour sectors. While this might suggest a
reduced focus on the nature of the work performed and a greater focus on the conditions
under which it is performed, in reality, anti-trafficking discourse remains in the grip of
polarised positions on sex work even as the carceral effects of anti-trafficking law become
evident and the Swedish model of criminalising the purchase of sexual services spreads. In
this article, I demonstrate how despite the recent discursive shifts to 'modern slavery' and
'forced labour', the anti-trafficking transnational legal order itself reinforces, rather than
diffuses cultures of sex work exceptionalism. The growing international sex workers'
movement has offered resistance, yet a closer look at the movement and the widespread
support that it has garnered for decriminalisation from international organisations, while
valuable, helps reveal the greatest cost yet of anti-trafficking discourse, namely, the inability
of the sex workers' movement to produce a sophisticated theory of regulation to reduce
levels of exploitation within sex work, one which is commensurate with the informality and
heterogeneity of sex markets the world over. Finally, to the extent that neoabolitionist
projects derive legitimacy from interventions abroad, especially in the global South, I
chronicle the edifice on which it rests in one such context, namely India, to demonstrate how
countries in the global South are not merely conduits for the global North's preoccupation
with moral gentrification through neo-abolitionism, but rather, that the circuits of global
governmentality while influential, are highly contingent, thus producing opportunities for
creative forms of mobilisation by sex workers.
Title: How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a
Different Approach to Child Welfare.
Citation: Child maltreatment; Feb 2021; vol. 26 (no. 1); p. 9-16
Author(s): Herrenkohl, Todd I; Scott, Debbie; Higgins, Daryl J; Klika, J Bart; Lonne, Bob
Abstract: The onset of the COVID-19 pandemic brings new worries about the welfare of
children, particularly those of families living in poverty and impacted other risk factors. These
children will struggle more during the pandemic because of financial pressures and stress
placed on parents, as well as their limited access to services and systems of support. In this
5commentary, we explain how current circumstances reinforce the need for systemic change
within statutory child welfare systems and the benefits that would accrue by implementing a
continuum of services that combine universal supports with early intervention strategies. We
also focus on promising approaches consistent with goals for public health prevention and
draw out ideas related workforce development and cross-sector collaboration.
Title: How nurses can support victims of slavery and human trafficking.
Citation: Nursing Management - UK; Feb 2021 ; p. 11-11
Author(s): Pearce, Lynne
Abstract: Essential facts: Modern slavery is an umbrella term for all forms of slavery, human
trafficking and exploitation, says the Office for National Statistics.
Title: How to spot the signs of domestic abuse and support colleagues who may be
affected: Nurses in all sectors will come into contact with people experiencing
domestic violence and coercive control, but can also be at risk of abuse themselves.
Citation: Nursing Management - UK; Feb 2021 ; p. 14-17
Author(s): Trueland, Jennifer
Abstract: In the early stages of the COVID-19 pandemic, reports of domestic violence and
abuse soared.
Title: Abuse and coercive control: Could you spot the signs?: Nurses in all sectors
will come into contact with people experiencing domestic abuse –but it may be
colleagues as well as patients that need your support.
Citation: Nursing Standard; Feb 2021 ; p. 14-17
Author(s): Trueland, Jennifer
Abstract: In the early stages of the COVID-19 pandemic, reports of domestic violence and
abuse soared. According to the charity Women's Aid, the pandemic created the 'perfect
storm', with lockdown leaving some people trapped with their abuser and feeling like 'sitting
ducks'.
Title: Testosterone Associations With Parents' Child Abuse Risk and At-Risk
Parenting: A Multimethod Longitudinal Examination.
Citation: Child Maltreatment; Feb 2021; vol. 26 (no. 1); p. 50-62
Author(s): Rodriguez ; Granger, Douglas A.; Leerkes, Esther M.
Abstract: The current investigation considered salivary testosterone as a potential
biomarker of physical child abuse risk. Parents enrolled in a prospective, longitudinal,
multimethod study beginning prenatally provided saliva when their toddlers were 18 months
6old. Mothers and fathers self-reported on their empathy, frustration tolerance, and child
abuse risk, as well as completing analog tasks of frustration intolerance and child abuse risk
and participating in structured parent-child interactions. In contrast to mothers, fathers'
higher testosterone levels were associated with increased child abuse risk, less observed
positive parenting, more observed negative parenting, and an analog task of frustration
intolerance; such findings were reflected across time. Further, fathers' socioeconomic status
moderated the association between testosterone levels and abuse risk. No evidence of
partner effects was observed in dyadic analyses. The current findings suggest that higher
testosterone levels reflect an increased likelihood that paternal physically abusive behavior
may be expressed.
Title: Fighting or fuelling forced labour? The Modern Slavery Act 2015, irregular
migrants and the vulnerabilising role of the UK's hostile environment.
Citation: Critical Social Policy; Feb 2021; vol. 41 (no. 1); p. 68-90
Author(s): Hodkinson ; Lewis, Hannah; Waite, Louise; Dwyer, Peter
Abstract: Abolishing 'modern slavery' has now achieved international policy consensus. The
most recent UK initiative – the 2015 Modern Slavery Act (MSA) – includes amongst other
aspects tougher prison sentencing for perpetrators and the creation of an independent anti-
slavery commissioner to oversee its implementation. However, drawing on research into
forced labour among people seeking asylum in England, this article argues that when
considered alongside the UK government's deliberate creation of a 'hostile environment'
towards migrants, not least in the Immigration Acts of 2014 and 2016, state action to outlaw
modern slavery is flawed, counter-productive and disingenuous. We show how the MSA
focuses only on the immediate act of coercion between 'victim' and 'criminal', ignoring how
the hostile state vulnerabilises migrants in ways that compel their entry into and continued
entrapment within severe labour exploitation.
Title: Early childhood psychosocial family risks and cumulative dopaminergic
sensitizing score: Links to behavior problems in U.S. 9-year-olds.
Citation: Journal of Affective Disorders; Feb 2021; vol. 280 ; p. 432-441
Author(s): Mullola ; Brooks-Gunn, Jeanne; Elovainio, Marko; Hakulinen, Christian;
Schneper, Lisa M.; Notterman, Daniel A.
Background: We examined, (a) whether in early childhood exposure to risky family
environment in different domains (socioeconomic, mental, parenting practices, health
behavior, and child-related risks) and accumulatively across various domains (cumulative
risk) is associated with child's problem behavior at age 9, and (b) whether the association is
more pronounced in children carrying cumulative dopaminergic sensitizing genotype or living
in low-income families.
Methods: Participants were 2,860 9-year old children (48% females; 48% Black) and their
mothers from the 'Fragile Families and Child Wellbeing Study', a probability birth cohort from
large U.S. cities. Mothers responded to questions on child's problem behavior (CBCL).
Children responded to questions about their vandalism and substance use.
Results: Cumulative family risk was associated with higher internalizing and externalizing
behavior and higher vandalism and substance use. All domain-specific risk clusters were
associated with higher internalizing behavior and, with the exception of child-related risk,
7with higher externalizing behavior. Mental health risks, risky parenting practices, and risky
health behavior were associated with higher vandalism. Risky parenting practices were
associated with higher substance use. The associations were robust to adjustment for
cumulative dopaminergic sensitizing genotype. No G x E interactions with dopaminergic
genotype and family SES were observed.
Limitations: Sample size was relatively small for genetic analysis and polygenic risk scores
were not available.
Conclusions: Exposure to cumulative psychosocial family risks from early childhood is
associated with early indicators of problem behavior in adolescence.
Title: The role of the paramedic in identifying modern slavery.
Citation: Journal of Paramedic Practice; Feb 2021; vol. 13 (no. 2); p. 1-11
Author(s): Wilson ; Hill, Lawrence
Background: Modern slavery is the recruitment or harbouring of people through the use of
force and coercion for exploitation. Paramedics have significant potential and unique
opportunities regarding the detection, prevention and combating of modern slavery.
Aim: To analyse the literature relating to modern slavery and synthesise it for paramedic
practice.
Method: Following a structured literature review, a comparative analysis was undertaken of
articles concerning the relationships between modern slavery and healthcare.
Findings: Five major themes were identified: barriers to healthcare access; causes of
missing the indicators of trafficking; clinician knowledge; the need for training and education;
and trauma-informed practices.
Conclusions: Paramedics are in an optimal position to identify and intervene in cases of
modern slavery. The introduction of survivor-centred education is recommended to better
understand the barriers to healthcare access.
Title: The importance of upholding the duty of candour during patient care.
Citation: British Journal of Nursing 2021;30(1):74–75.
Author(s): Glasper A.
Abstract: In light of recent media coverage, Emeritus Professor Alan Glasper discusses
polices and guidance pertinent to the duty of candour. In September 2020 the Care Quality
Commission (CQC) successfully prosecuted University Hospitals Plymouth NHS Trust for
breaching duty of candour policies. At Plymouth Magistrates' Court the Trust was ordered to
pay a total of £12 565 in the case of an elderly patient who died following an incident during
an endoscopy in 2017 (Morris, 2020).
Sources Used: The following databases are used in the creation of this bulletin: CINAHL, Medline, BNI.
Disclaimer: The results of your literature search are based on the request that you made, and consist of a list of
references, some with abstracts. Royal United Hospital Bath Healthcare Library will endeavour to use the best,
most appropriate and most recent sources available to it, but accepts no liability for the information retrieved,
which is subject to the content and accuracy of databases, and the limitations of the search process. The library
assumes no liability for the interpretation or application of these results, which are not intended to provide advice
or recommendations on patient care.
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