What logistic regression does

Logistic regression helps with predicting which of two categories a case is likely to belong to given certain other information (Field, 2000, p 163). The term ‘predict’ is used in the statistical sense that ‘within [a] particular model the variable is strongly, significantly and independently associated with the outcome, and may therefore be viewed as influential in the “pathway” to that outcome’ (Ghate and Hazel, 2002, p 293). It does not mean that the presence of a predictor variable automatically leads to the outcome in question, or that the former causes the latter. Logistic regression is suitable when the outcome or ‘dependent’ variable is categorical, and the predictor or ‘independent’ variables are categorical or continuous.

Why logistic regression is useful

Although several variables may be significantly associated with a target variable, any one may not have independent predictive power once other factors have been controlled for. In other words, the association may be the product of their mutual association with a third factor. For example, since income tends to increase with age, so anything else that generally increases with age, such as dental decay, can be used with some success to predict income. A possible but wrong conclusion would be to say that not brushing one's teeth might be a good career move (more decay equals higher income). Multivariate analysis reduces the chances of making such an error; it is unlikely that dental decay has any predictive power that cannot be explained in terms of age (Bullock et al, 1998). Logistic regression is a multivariate technique that assists with disentangling which are the key factors that predict a target variable that is categorical, and which are statistically associated with the target variable primarily due to a shared underlying factor (Ghate and Hazel, 2002).

How a logistic regression is done

First, correlations are carried out to identify factors that are significantly associated with the outcome variable. Second, those variables are fed into the logistic regression model in SPSS (they can be added all at once or individually). There are various techniques for doing this, but a common one is the ‘forward stepwise’ approach.

The study reported in this book has looked at child well-being in terms of unmet need, violated rights, poverty, poor quality of life (QoL) and social exclusion. Owing to a confluence of several factors, including moral imperatives, legislation and scientific evidence, all five concepts appear currently as policy objectives in children's services in the UK and other western developed countries. In many respects this is welcome; it should be evident by this juncture in the book that there is value in looking at children's lives through different lenses. At the same time, varied terminology and multiple initiatives bring with them the danger of confusion. There is a risk of using different words to refer to the same phenomenon, whether in discussions between researchers, policy-makers and practitioners, or across administrative and disciplinary divides. There is also the potential for policy-makers to speak with a forked tongue; that is, of devising and enacting initiatives that are inherently contradictory. Moreover, unless a concept is properly understood, how can its empirical formulation be measured and addressed? And unless the objective of services is made explicit, how can their effectiveness be assessed?

There is considerable research into each of the concepts individually, showing that although some broad consensus has been reached concerning the contours of each, their definitions remain contested and they continue to be measured in numerous ways. Partly because of this, however, conceptual and empirical research into the links between them, and the implications of this for services, is scant by comparison. In particular, it has not been possible to find an epidemiologystyle survey that examines different perspectives on the well-being of normative samples of children living in the community. More specific gaps in the literature were identified in Chapters Two to Six.

Given this context the contributions of the book can be grouped under three headings corresponding to the study's aims: first, the clarification of how the concepts are defined and measured, and an exploration of how they are related; second, an empirical analysis of the prevalence of the conditions among children representative of a particular community, and an elucidation of the patterns of overlap between them; and third, an attempt to chart theoretically and practically the implications of the ideas and findings for children's services.

The five concepts

Chapters Two to Six have looked in turn at how each of the five concepts of wellbeing is defined and measured. This chapter explores how far each one makes a unique contribution to the understanding of child well-being. It starts by aiming to get to the heart or essence of each concept (see Table 7.1). The exercise might be likened to distinguishing between personality types using techniques such as Myers-Briggs, which are based on the premise that pure types do not exist but the key traits of different personalities may be identified. So it is with the five concepts discussed here, and the task of separating them out offers analytic advantage.

Thus, a child is ‘in need’ if their health or development is actually impaired or likely to become so without some remedial intervention. This reflects an understanding of need as being concerned with ‘agency’ – the capacity to act in society and avoid harm. Needs are thus related to outcomes and in that sense should be defined and measured in terms of aspects of health (physical and psychological) and development (physical, behavioural, emotional, social and intellectual). People have needs in all areas of their lives, all connected with the ability to lead a minimally adequate life, and all objective, universal and timeless. However, the satisfiers that meet needs are relative, varying for example with climate, age and the standards prevailing in society. Subjective taste also has a role to play. Determining whether or not a person has unmet need requires a rounded appraisal of their situation, in other words some knowledge of the context. That said, the antecedents of a person's circumstances have no bearing on whether that person may be considered to be in need. Nor is the type of antecedent relevant: unmet need can reflect personal deficiency or structural injustice.

Rights are defined here as the resources, liberties and opportunities to which children are entitled. Violated rights are therefore identified by contrasting what a child is owed with how they have actually been treated by the person or body with the corresponding duty to assist or forbear.

The dataset

Since practical constraints meant that it was not possible to collect primary data of the nature and volume required, an existing source was sought instead. A range of options were assessed against five considerations. First, the dataset needed to have children as the unit of analysis, with information relating to them directly. Second, it was considered desirable to have information on children of all ages, that is 0-17 years (in line with the England and Wales 1989 Children Act). Third, data were sought that pertain to a cross-section of children living in the community, since this would provide insights into the extent of and relationship between the conditions in society. Fourth, it was evident that examining children living in a discrete neighbourhood would have significant merits (particularly for measuring QoL and social exclusion). Fifth, there should be data on risk and protective factors in all areas of the child's life, and also some evidence of contact with and use of services (the latter is valuable for judging the violation of a child's rights).

In light of these criteria it was decided not to use datasets that:

• • are based on households or that assign children the classification given to the

• reference person;

• • focus on a subset of children in specified school years, or draw the divide

• between children and adults at 15/16 years, or track a cohort of children born

• in a particular week;

• • only include children in contact with service agencies;

• • are restricted to a national picture; or

• • focus exclusively on either child development (thereby omitting information

• on interventions) or process (most such studies are weak on child

• development).

Instead, it was decided to reanalyse data from phase one of Children Supported and Unsupported in the Community – a study funded by the UK Department of Health and conducted by Dartington Social Research Unit (Axford et al, 2003). This was an exploratory study aimed at providing evidence on the nature of need among children in the community, the extent to which they and their families use children's services and how these agencies, together with coping strategies, affect children's development. An added advantage of this source was that the author was joint lead researcher on the study and therefore very familiar with the data from having been closely involved in all stages of the work.

The two-way relationships between the five conditions

Each of the following 10 tables takes a pair of conditions and shows how they are related using data from the N=234 sample. For example, Table D1 shows that 44 of the children who were in need had their rights violated (20% of the sample) compared with the other 43 whose rights were intact (19%). Of those who were not in need, 51 nevertheless had violated rights (23% of the sample).

The 32 five-way combinations of the conditions

Table D11 shows the frequency of each of the 32 five-way combinations of the concepts for the children in the N=234 sample. For example, just three children (1.4%) displayed all of the conditions: in need, violated rights, poverty, poor QoL and social exclusion. This was the joint 16th most common combination.

Two-way relationships between the conditions not covered in Chapter Nine

Chapter Nine included qualitative case studies of children affected by the six most common five-way combinations. Together they covered 27 out of the 40 possible two-way relationships shown in Table D12.

This section provides examples from the N=234 sample of the remaining 13 two-way relationships. Each relationship is given the number of its box from Table D12 (so that ‘Relationship 2’ refers to two-way relationship 2, that is, ‘in need but rights intact’).

In need but rights intact (relationship 2)

A four-year-old girl living with her mother. Need: She was suffering from allergies and a urinary problem. Rights: Her home had been burgled recently, thereby infringing her rights to privacy, but this did not count as a serious breach of her right to protection.

Rights intact but a poor QoL (relationship 23)

A 16-year-old boy living with his father. Rights: This child was subject to inconsistent care and poor boundary-setting (provision). Sometimes he had to undertake caring responsibilities for his disabled father. However, these were not deemed to be serious infringements of his rights. Moreover, social services and the education psychology service were working hard to achieve stability for the child and to provide him with diversionary activities such as holiday schemes. They were trying to take the pressure off him by supporting his father.

Potential contradictions between service styles

It is evident from the previous chapter that while the service responses required to address the five conditions (or type of ill-being) may help to foster a rich service or policy mix, and so arguably increase the chances of improving child well-being, they also exist in tension and potentially contradict one another. Initiatives to address one condition may inadvertently impair efforts to tackle another, thereby creating or perpetuating problems. Moreover, they will almost certainly use resources to generate apparently successful outputs and outcomes, which, measured in terms of another condition, are actually of limited value, even damaging. The first part of this chapter therefore takes services for each condition in turn and discusses possible contradictions as they affect children and families who receive the service.

Services to meet need

Services to meet children's need exist in tension with rights-driven responses in at least four respects. First, the flexibility or discretion that is innate to responses to unmet need tends to generate guidance (rather than rules) that can be interpreted such that someone who technically is not entitled to assistance receives it (and vice versa) – a point made by Donnison (1982) in relation to state benefits. From a rights perspective this might be perceived as an insecure basis for distributing welfare resources to children and families, because it allows proper forbearance and assistance to be withheld at discretion.

Second, because a needs approach is inclined to treat children as passive objects, it generally draws more on the evidence of ‘what works’ than does a rights-orientated response, which views children as social actors and therefore pays greater attention to user opinion. In medicine, for example, children with chronic illnesses may have their right to influence decisions about receipt of drugs or surgery overridden by well-meaning adults on the basis of research studies supporting proven interventions. Although it might be argued that this is in the patients’ best interests, such an approach is vulnerable to criticisms of being authoritarian or paternalistic.

Third, whereas a needs approach is more inclined to provide limited services for children and families, and to expect that this will be sufficient and welcomed, rights protagonists tend to be concerned with countering structural problems and so empowering clients to lead more autonomous lives (Barnes, 1998).

Service styles

One of the main contentions of this book is that the way in which children's well-being is conceptualised will shape the service response to which it gives rise. The aim here, therefore, is not to detail what quantities of which service are required to match particular problems in order to achieve specified outcomes. To do this would require in-depth descriptions of specific interventions. Rather, the purpose of this chapter is to deduce the contrasting styles of service that the five conditions (or types of ill-being) require – in other words, the features that services should have logically if they are to have the potential to be effective in addressing a designated condition.

Of course, no archetypal intervention exists for any of the five conditions. Policy and practice tend to exhibit a mix of approaches (see Chapter One). However, drawing on the distinguishing features of each of the concepts (Chapters Two to Seven) and their empirical manifestations (Chapters Eight and Nine) it is possible for each concept to distil out the kinds of features that would characterise a ‘pure’ service; that is, one that is geared solely towards addressing the condition in question. These are described here in terms of who the service is for, what it does, how it is delivered and why it has those features. Numerous examples from existing provision are given, but where the service response in reality deviates from the pure service this is also noted. Thus, the chapter draws out from actual policy and practice the features that betray the conceptualisation of child well-being with which they are primarily concerned. It is important to stress at the outset that no service style is advocated over others; instead, the analysis is intended as an heuristic device to illustrate how concept drives – or should drive – service style.

Meeting need

Need-orientated interventions should be aimed at children whose health or development is actually impaired or likely to become so without remedial assistance. Potentially this means that a range of children might be targeted, since need can be a product of difficulties in any area of a child's life – living environment, health, identity, relationships and so on (eg DH et al, 2000).

There is a general consensus that some individual interests and liberties are so basic that all states and human beings should respect them. Calling them rights means that they should take precedence over the private interests of those in power and the pursuit of other social goals and aspirations, and that societies should seek to secure them, irrespective of traditions, history or levels of economic development (Waldron, 1984, 1993). This belief is expressed in international law, for example in the 1948 UN Declaration of Human Rights, and many countries have a bill of rights designed to prevent government interference with free speech, religious liberty, equal access to the law and so forth. In the UK, this function is fulfilled by the 1998 Human Rights Act – a higher law with which all other laws, policies, practices and procedures must comply (Klug, 2000). National legislation and associated guidance set out in more concrete terms the goods and freedoms to which citizens are entitled.

The seductive language of rights has also seeped into children's services, as discussed in Chapter One. However, as with need, rights is a controversial and complex concept, a fact often masked by its liberal and somewhat indiscriminate use. There is much rhetoric about rights: the complaint of the scorned, angry shopper; the indignant claim to protection by advocates of torture victims; claims to welfare provision made through various advocacy organisations; and so on. This chapter sketches out some of the key points of agreement and debate concerning rights. It examines different approaches to measuring rights, but first it looks at what rights are and why they are important, how they become violated, what they cover (their substance) and what makes something a right (or how one obtains a right). It is important to note that the chapter does not focus on children's rights per se, although it touches on this (for an extended discussion on this topic see Archard, 2004). Rather, it takes a broader perspective on the concept.

Concept

The nature of rights

A right is a claim to be treated in a certain way. The content of the claim is justified on the basis that every person has inherent worth, irrespective of their virtues, abilities or value to others: this is the ‘Y’ in the formula ‘A has a right to Q against B in virtue of Y’.

Recent years have witnessed a revival in the popularity of measuring need as a precursor to distributing services, particularly in health, housing, social care and children's services (Percy-Smith, 1996; Axford, 2007). There are several reasons for this, starting with new legislation: the England and Wales 1989 Children Act, for example, requires every local authority to identify the needs of children living in their catchment area and to provide services accordingly (subsequently reinforced by the 2004 Children Act). Another factor is the growing expectation that agencies will achieve maximum benefit from minimum expenditure; this increases the pressure to chart the need terrain before allocating resources. There is also the growing realisation among academics, practitioners and policy-makers that children's problems are best understood if viewed from several angles; need as a concept permits this holistic perspective. And public disquiet about social inequalities, notably the way in which people with similar needs are treated differently, has prompted more attention to service consistency.

Notwithstanding this trend, philosophers and social scientists have long argued about the meaning and usefulness of need as a concept. Opinions range from those who think that need provides a rigorous moral basis for the distribution of welfare goods, to those who consider it so ambiguous as to be useless (Plant, 1991). Some would like it to underpin the activities of government, filling the gap left by the collapse of theological and metaphysical convictions. Others argue that this would impose one set of values on a morally pluralistic society.

Concept

Need is a slippery concept that resists definition. It is used diversely in everyday speech without much distinction between the qualitative nature of statements such as ‘I need a burger’ or ‘she needs to get better’. Therapists, social workers, educational psychologists and other professional groups all interpret need differently. What a person is considered to need also varies with age, activity, physical and mental capacity and outlook. Bowlby (1951) looked at infants and stressed the need for intimacy and opportunities for forming close, loving relationships with responsive people. Maslow (1943) examined successful people and suggested that children's needs for nourishment and safety are superseded in adulthood by the need to achieve fulfilment through creativity and relationships.