The study explores the initial decision making of managers within services for children when faced with an allegation of abuse against a member of staff. Much has been written about thresholds for intervention in response to abuse of children within their families. When the alleged abuse or poor childcare practice is by professionals, the initial decision making is equally complex, but the thresholds for inclusion in the formal safeguarding processes have received less attention. The study responds to the gap identified by practitioners in determining the appropriate level of intervention to reported behaviours across a range of children’s services. It makes available summary descriptions of nine allegations reported between March 2008 and February 2009, in two Local Safeguarding Children Board areas. Descriptive accounts from the participants, obtained through semi structured interviews, provide insight into the actions taken and approach to decision making including the role of relationships. The descriptions included systematic information gathering and consultation with others, conducted within a tight time frame, which was not dependent on knowledge of safeguarding children procedures. The findings suggest that awareness of specific safeguarding procedures for the management of allegations did not enhance practice or decision making, and could operate to blur responsibility for decision making. Further data was drawn from semi structured interviews utilising vignettes constructed from the anonymised real cases to explore the levels of incidents reported across agencies. The finding that practice varied more between areas than between agencies suggested that responses were attuned to local interpretation and implementation of the national guidance. The comparison of responses across the study suggests that in some situations the current processes for managing allegations may not serve either the welfare of the child or the best interests of the worker.

Childhood sexual abuse is a major, but hidden public health issue estimated to affect approximately 20% of females and 7% of males. As most women do not disclose to healthcare professionals, midwives may unwittingly care for women who have been sexually abused. The purpose of this study was to address the gap in our understanding of women’s maternity care experiences when they have a history of childhood sexual abuse with the aim of informing healthcare practice. This narrative study from a feminist perspective, explored the maternity care experiences of women who were sexually abused in childhood. In-depth interviews with women, review of their maternity care records and individual and group interviews with maternity care professionals were conducted. The Voice-centred Relational Method (VCRM) was employed to analyse data from the in-depth interviews with women. Thematic analysis synthesised findings, translating the women’s narratives into a more readily accessible form. The main themes identified were: narratives of self, narratives of relationship, narratives of context and the childbirth journey. Medical records provided an additional narrative and data source providing an alternative perspective on the women’s stories. Silence emerged as a key concept in the narratives. This thesis contributes to ‘Voicing the silence’. The particular contribution of the study is its focus on the women’s voices and the use and development of VCRM to listen to them. It highlights where those voices are absent and where they are not heard. Women want their distress to be noticed, even if they do not want to voice their silence. The challenge for those providing maternity care is to listen and respond to their unspoken messages and to hear and receive their spoken ones with sensitivity.