Invisible disability: Building Great Britons

A report was published on Wednesday by the All Party Parliamentary Group (APPG) for Conception to Age 2 – the First 1001 days. It’s called Building Great Britons.
The thrust of the report is similar to Early Intervention: Good Parents, Great Kids, Better Citizens (2008) and Early Intervention: The Next Steps (2011) from MPs Graham Allen and Iain Duncan Smith. Building Great Britons sets out a policy framework aimed at preventing the social problems believed to originate in adverse experiences between conception and a child’s second birthday.

Breaking the cycle

The conceptual model underpinning the report is a familiar one. Neglect, maltreatment and insecure relationships in early childhood are assumed to be a primary cause of mental health problems and antisocial and criminal behaviour. Parents who had such experiences during childhood tend to adopt the same child-rearing strategies as their parents, setting up a damaging (and costly) self-perpetuating intergenerational cycle.

Like the Early Intervention reports, Building Great Britons argues that preventing child neglect, maltreatment and insecure attachment will save money and result in a flourishing society due to the emergence of well-rounded citizens who are “physically and mentally healthy, well educated, empathic, prosocial, hardworking and contributing to the costs of society” (p.3). As Tim Loughton, Co-Chair of the APPG says “the economic value of breaking these cycles will be enormous” (p.4).

“This” it’s claimed, “is not ‘rocket science.’ Technically it is ‘neuro-science’” (p.3).
The basis for that claim seems to reside in repeated references to brain development, although there’s no detail about how brain development is involved. The association between early adverse experiences and long-term unwanted outcomes is well established, but there are some problems with the model.

what causes what?
The first is that just because two things are correlated, it’s not safe to assume that one causes the other. They might both be caused by something else, or be totally unrelated. So parents might neglect, maltreat or form poor attachments with their children because their parents did, or because the family has a genetic predisposition towards severe post-natal depression, or because they are grappling with challenging life circumstances.

multiple causes
The second problem is that even if we could predict with certainty that all neglected, maltreated, chaotically attached children will develop mental health problems or anti-social behaviour in later life, the causal chain doesn’t always hold in the opposite direction because mental health problems and anti-social behaviour have other causes such as poor physical health, adverse life events or peer pressure.

looking back vs looking forward
A third problem is that retrospective surveys linking adverse childhood experience with later health and social problems, such as the ACE study referred to in Building Great Britons (p.14), tend to rely on self-reports – not always the most reliable sources of information, especially about early life. Prospective assessments that track children through their life course such as the Dunedin and Cambridge studies tend to be more reliable. They have also found correlations between adverse childhood experiences and problems in later life but that the emerging patterns are quite complex.

When reading through the research findings, I was struck by how often researchers expressed surprise at the frequency of adverse childhood experiences. The ACE study was prompted by the unexpectedly high incidence of sexual abuse in childhood reported by people dropping out of a weight loss programme. The Dunedin study began as a small-scale follow-up assessment of perinatal risk. Its scope was broadened after researchers found a higher incidence than they expected of accidental injury and impairments to sensory function, development and behaviour in 4/5 year olds. The implication wasn’t that the children had been neglected or maltreated (although some might have been), but that developmental impairments in the general population were more frequent than had been previously thought.

children with disabilities: noticeable by their absence

This brings me to a glaring omission in Building Great Britons. One group of children is especially susceptible to social, emotional and behavioural problems and is at increased risk of poor physical and mental health in later life. They are children with disabilities. But the only mention of disability that I could find in Building Great Britons was of children with Foetal Alcohol Syndrome, caused by a mother’s excessive alcohol intake during pregnancy.

Childhood disabilities can be caused by neglect or maltreatment but they can also be caused by factors such as;

• inherited genetic conditions
• spontaneous genetic variations at or before conception
• mother’s illness during pregnancy
• environmental damage during gestation (e.g. exposure to toxins)
• childhood infections
• accidental injury.

Whether you think disability is caused by a ‘functional impairment’ or by the way society responds to that functional impairment, for administrative and legal purposes a clear-cut distinction is usually made between someone who’s deemed disabled and someone who isn’t. But from a biological perspective the boundary is rather blurred. As the Dunedin study found, a significant proportion of children has some sort of developmental impairment; currently in the USA it’s 15%. In the UK, only 6% of children are classified as disabled, but that figure rises with age. Around 16% of the working-age population has a disability.

Not all disabilities are obvious, and some are difficult to detect. The average age at which autism is diagnosed, for example, is 5.5 years, and diagnosis is often much later than that. Autistic children have unusual attachment patterns and autism is so frequently confused with attachment disorder that Heather Moran, a consultant clinical psychologist, devised the Coventry Grid to help professionals distinguish between them.

There’s little doubt that neglect, maltreatment or poor attachment in childhood can, and does, lead to social, emotional and behavioural problems and to impaired physical and mental health. But what Building Great Britons does is to frame the causes of those problems solely in terms of neglect, maltreatment or poor attachment, and more specifically in terms of the ‘troubled families’ who are deemed to be the source of these societal ills (pp.3-4).

When I was delving into the thinking behind the Early Intervention reports, I asked a few researchers who’d been actively involved how some obviously erroneous claims about brain function had crept in. None had had a say in the final content of the reports, but one told me that it was sometimes necessary to present data in a way that was most likely to persuade government to come up with funding. I take his point; but I couldn’t see how that justified presenting the data in a way that was misleading.

What the data on social, emotional, behavioural, physical and mental health problems tell us is that children by definition are vulnerable, and parenting by definition is challenging. They also tell us that we are all, at all times, at risk from unforseen life events that could trigger social, emotional, behavioural, physical or mental health problems that result in us needing help from the community. That’s why in the developed world we have education, health and social care services.

It’s true that a minority of families cause a disproportionate number of problems, for themselves and others. There are good reasons why early intervention is appropriate for them. But because all children are vulnerable and all parenting is challenging, there are good reasons why early intervention should be available to all families. We shouldn’t have to justify it in terms of ‘good citizenship’ or the financial costs for ‘society’ – which at one time we were told didn’t exist.

Nor should reports produced by Members of Parliament about vulnerable children and challenged parents look right past one of the most vulnerable groups of children and one of the most challenged groups of parents. In the total of 351 pages that make up the two Early Intervention reports and Building Great Britons, childhood disability is mentioned, in passing, only five times – and three of those references are to Foetal Alcohol Syndrome.

When I contacted @first1001days, the Twitter account for http://www.1001criticaldays.co.uk/ to point out the omission, I got a prompt response inviting me to write some supplementary material. Within an hour, another parent and I had responded with a paragraph summarising the main issues, and notified @first1001days. I wasn’t surprised not to get an immediate reply, as the report was being launched that morning. But we’re still waiting…

Disabled people are still invisible, it seems.

Advertisements

protecting disabled children: systems maltreatment and neglect

Ofsted’s assumptions in their report Protecting disabled children: thematic inspection that “risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe” appear to be based on some rather unreliable data. That doesn’t mean Ofsted wasted its time doing an inspection. But what concerned me about the report – in addition to the statistical analysis that triggered it – wasn’t so much what was said, as what wasn’t said about the risks to disabled children and support for them.

If we had robust data I’d be surprised if they didn’t show disabled children to be at an increased risk of maltreatment or neglect. That’s because of the risk factors involved. Many disabilities have a genetic component, meaning that other family members are more likely to have health or disability issues. Add to that the challenge of looking after a disabled child, the impact on siblings, the likelihood of a reduced income with increased expenditure and you have a situation where all those directly involved are likely to be vulnerable. But some protection from those risks can be offered by the community. Appropriate support from relatives, friends, neighbours and the local authority can make a big difference to families’ quality of life and thus reduce the risk of maltreatment or neglect.

Ofsted’s inspection focused on safeguarding and looked after children services in relation to disabled children. Nothing wrong with that focus, per se. But Ofsted also refers to more general support services that could have an impact on the safety and wellbeing of disabled children. In this post I want to examine some of the wider issues relating to child protection and support services for disabled children.

What does child protection mean?

‘Child protection’ is a term commonly used to refer to the protection of children from maltreatment and neglect by people they know well, like family members. There’s no doubt that children are most at risk from people they know well. That’s not because people who know children well are inherently more evil than people who don’t; it’s partly because not everyone who brings up a child is good at doing so, but also because children spend a great deal more time with people they know well, as distinct from with people they don’t. When that situation is reversed, historical evidence from children’s institutions suggests that the main source of risk to children changes accordingly.

‘Child protection’ can also refer to protection from people who work with children (hence Criminal Record Bureau checks), from strangers (hence ‘stranger danger’ warnings), and sometimes from other children (hence anti-bullying policies in schools). But ‘child protection’ is rarely used in the context of what the Australian government calls ‘systems abuse’, defined as:

preventable harm [that] is done to children in the context of policies or programs which are designed to provide care or protection. The child’s welfare, development or security are undermined by the actions of individuals or by the lack of suitable policies, practices or procedures within systems or institutions.

I’d broaden this definition by omitting the words ‘which are designed to provide care or protection’, since children can experience collateral damage from policies of any sort.

An example of what I mean was featured in a recent documentary shown on BBC 4 (unfortunately not currently viewable) entitled ‘Growing children: autism’. The last part of the programme shows footage of two young brothers, Jake and Zaine, both on the autistic spectrum. Their behaviour results in their mother spending much of her time protecting her shins. Zaine explains very clearly and persuasively why he doesn’t want to attend school (the people, the noise) but it’s no use, he has to go to school. (I’m not blaming his mother, incidentally, because her options might have been limited.) If a child had behaved like that at the end of the school day, rather than at the beginning, and said those things about going home, my guess is that social services would have been contacted. But despite much rhetoric about listening to the voice of the child (and s.17. 4(A) of the Children Act 1989 requiring the wishes and feelings of children in need to be ascertained in respect of service provision), the impact of some policies and programmes on children is simply ignored regardless of the distress and harm it causes, as many parents of children with disabilities and those children themselves can testify.

This is what Bronfenbrenner’s ecological systems theory highlighted; that children are most strongly influenced by people they come into direct contact with (for obvious reasons), but that the actions of people they never meet, such as decision-makers in organizations and national and international governments, can have a significant influence too – for good or ill. This brings me to the point about support services.

Support services

The Ofsted inspection involved 12 local authorities – that’s fewer than 10% of the total in England. Of the 12, seven had been judged ‘good’ and five ‘satisfactory’ in previous inspections of safeguarding and looked after children services (p.9). Ofsted wanted to look in detail at the ‘child’s journey through the system’, so it made sense to investigate authorities that were following procedures fairly closely, in order to identify shortcomings resulting from the design of the system rather than because of failures in implementation. Inspectors also met with “18 parents, 10 of whom had disabled children with child in need plans and eight of whom had children subject to child protection plans” (p.9). I couldn’t discover how many families were represented, but at best it was obviously a very small sample, an average of 1.5 per local authority inspected.

Ofsted’s focus is on safeguarding and looked after children services but several references are made to universal services. The introduction (p.7) begins:

When the national Aiming High for Disabled Children programme was being developed in 2007 by the previous government it was estimated that there were 570,000 disabled children in England. This programme put in place a range of support for disabled children and their families.”

Aiming high for disabled children

Let’s take a closer look at the Aiming High programme, as described in Aiming high for disabled children: better support for families, published jointly by HM Treasury and the Department of Education and Skills in May 2007 and signed off by Ed Balls, then Economic Secretary to HM Treasury and Andrew Adonis, then Parliamentary Under-Secretary of State for Schools. The Aiming High programme was the outcome of the Disabled Children Review, one strand of a Review of Children and Young People, in turn part of a Comprehensive Spending Review (CSR), undertaken by the previous Labour government. The CSR set government departmental spending plans and priorities for 2008-2011. (Aiming High p.10)

So what is the ‘range of support for disabled children and their families’ that the Aiming High programme put in place? The Aiming High report identifies three core areas, which I’ve summarized for brevity. You can read them in full on pp. 6-8 of the document.

Empowering disabled children, young people and their families

• a “core offer“ to make it clear what entitlements and services disabled children, young people and their families can expect

• piloting individual budgets

• spreading good practice on engagement such as parents’ forums

Promoting more responsive services and timely support

• a national disabled children indicator

• evaluation and benchmarking good practice on early intervention

• Local Authorities and PCTs will improve their data collection

• continuing the Early Support Programme

• a Transition Support Programme

Boosting provision of vital public services

• provision of short breaks for disabled children

• a childcare accessibility project

• a radical reform of community equipment and wheelchair provision and

• research the skills and behaviours required by the workforce and to identify gaps.

Funding was allocated to some of these areas and funding for short breaks and parent forums, for example, has been maintained by the coalition government. But how much of this actually constitutes ‘support’? And how much support is on offer? Feedback from parent groups and voluntary sector organisations suggests that parents who can access short breaks, specialist childcare and individual budgets value these services, but that provision varies and access is often limited. And although the Aiming High document repeatedly refers to improvements in educational provision, the Education and Skills Select Committee report on Special Educational Needs, published less than a year earlier, had described the SEN system as ‘not fit for purpose’. Little mention is made in the Aiming High document of medical provision except in the context of improving workforce skills and behaviours. More recent reports on the state of healthcare (Kennedy), social care (Munro) and education (Lamb) suggest that there is still considerable scope for improvement in terms of universal services for children with disabilities. This is somewhat at odds with the overall impression I got from the Ofsted report that despite some weaknesses in the system around prevention of maltreatment and neglect by parents and carers (paras. 104-8), most local authorities had good information about disabled children, a high level of commitment to supporting them, and offered a wide range of early support services (para. 15).

Clearly the quality of healthcare, social care and education services has a disproportionate effect on the development of children with disabilities and the functioning of their families. But the home is not the only source of child maltreatment and neglect. It could be argued that disabled children in England have always been subject to systems maltreatment and neglect because they have never had access to consistently high quality support that’s timely, appropriate and effective. Ofsted’s focus was on safeguarding and looked after children services. But a narrow view of what constitutes child protection, overlooking concerns about universal services raised in recent high-profile reports, and basing statistical analyses on assumptions and unreliable data doesn’t help to paint an accurate picture of the real level of risk to disabled children.

A fundamental principle of democracy is that everyone matters. A key indicator of the health of a democratic society is how it treats its most vulnerable members, and disabled children constitute one of the most vulnerable groups in our society. Disability can strike anyone at any time, which is why it’s so important to have timely, appropriate and effective interventions available. Such interventions can optimise the quality of life of disabled people and their families as well as increasing the likelihood that the disabled person and their carers will be able to work and reducing the cost of support and the interventions that are too little too late – outcomes dear to the heart of the current government.

Despite its obvious concerns about the wellbeing of disabled children, I felt the Ofsted report perpetuated their marginalisation by failing to consider the wider failings of systems that are supposed to offer support.

what is it about child protection plans and statistics?

Ofsted warns of abuse risks to disabled children” says the BBC headline about the report entitled Protecting disabled children; thematic inspection published last week. And indeed the report opens by reminding us that research “indicates that disabled children are more at risk of being abused than non-disabled children”. It goes on:

However, they are less likely than other children in need to become the subject of child protection plans. This suggests either that risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe.

The thematic inspection was undertaken to find out more. I’ll come back to the findings later, but in this post I want to take a closer look at the data about risk that appear to have prompted Ofsted’s interest. The research cited in support of Ofsted’s opening claim consists of one paper (Sullivan and Knutson, 2000) describing a large-scale study of children in Omaha, Nebraska during 1994-95. Disabled children were found to be 3.4 times more likely to have experienced maltreatment than non-disabled children.

By contrast, Ofsted points out;

The children in need census as at 31 March 2011 showed that there were 382,400 children in need in England of whom 54,100 (14.2%) were recorded as having a disability. At that time 42,700 (11%) children were subject to a child protection plan of whom 1,600 (3.8%) were recorded as having a disability. Children with a recorded disability were therefore less likely to be the subject of a child protection plan than other children in need.” (p.8)

If I’ve understood this correctly, it’s saying that if disabled children are at a higher risk of maltreatment than non-disabled children, you’d expect to see a higher rate of child protection plans (CPPs) amongst disabled children. But the frequency of CPPs amongst disabled children is lower (3.8% as compared to 11%), prompting concerns about children falling through the net.

There was something that didn’t look quite right about Ofsted’s analysis and I think I’ve figured out what it is. (I should point out that statistical analysis isn’t my forte, so please let me know if I’ve got it wrong.) I think there are three problems with Ofsted’s data;

– the level of risk to disabled children is based on an assumption
– the figures for children in need and disabled children are unreliable
– the level of risk and level of CPPs are derived from qualitatively different populations.

Assumptions about disabled children and the risk of maltreatment

First, let’s look at the figures for the risk of maltreatment. Little relevant research has been undertaken. Sullivan and Knutson’s study did indeed find that disabled children were 3.4 times more likely than non-disabled children to experience maltreatment. But they also cite an earlier finding that the risk was 1.7 times higher (p.1258). It’s clear from previous research that determining the prevalence of maltreatment is dependent on factors such as the quality of available data, quality of support services, definitions of disability and maltreatment, and whether disability has led to maltreatment or maltreatment has led to disability. This means that the prevalence of maltreatment is likely to vary widely between communities. The figure Ofsted took as its baseline for England was one that emerged from data gathered almost 20 years ago and 5,000 miles away in a community with a very different healthcare system. We don’t actually know the risk of maltreatment for disabled children in England.

Who qualifies as a child in need or a disabled child?

Let’s assume for the moment that disabled children are at a higher risk of maltreatment than non-disabled children. Whatever the level of increased risk, we’re still left with the question of the lower proportion of disabled children with a CPP.

Sullivan and Knutson’s sample consisted of 50,278 children enrolled in the Public (OPS) and Archdiocese schools of Omaha, Nebraska during the 1994–95 school year. It included children in other educational programmes and therefore covered an age range between 0-21. So the sample represented almost all children in a specific geographical area. But the sample Ofsted refers to consists, not of all children in a geographical area (in this case England), but of children in need in that location.

Section 17 (10) of the 1989 Children Act defines children in need as follows:

“For the purposes of this Part a child shall be taken to be in need if—
(a) he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority under this Part;
(b) his health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or
(c) he is disabled”

and s. 17 (11) defines ‘disabled’ as;

For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed; and in this Part—
* “development” means physical, intellectual, emotional, social or behavioural development; and
* “health” means physical or mental health.”

The first problem that arises is one of classification. The Children Act appears to class all disabled children as ‘children in need’, whether or not they are considered to be otherwise at risk. But local authorities don’t necessarily do that. DirectGov site says ‘local councils must identify the extent of need in their area and make decisions about levels of service they provide’, and it’s clear from local authority websites that their criteria for ‘children in need’ and criteria for ‘disabled children’ vary somewhat. One local authority officer told me that her LA classifies all disabled children as children in need whereas Cheshire East, for example, carries out an assessment to determine whether a disabled child qualifies as a child in need.

Then there’s the issue of the reliability of local authority records. The Citizen’s Advice Bureau tells us that ‘the local authority must keep a register of children with disabilities in its area but does not have to keep a register of all children in need’. Local authorities might be required to keep a register of children with disabilities, but that doesn’t mean that all children with disabilities will be registered. A recurring complaint from my own local authority is that although they have a register, it’s perpetually out of date and incomplete. In short, if LAs are unclear about how many disabled children and how many children in need are living in their area, the census data cited by Ofsted might not be entirely reliable. I did try to find out what data were collected by the census, but failed. If you can figure it out, let me know.

Qualitatively different populations

A key problem with Ofsted’s data is that if some LAs are treating all disabled children as children in need, but are treating non-disabled children as children in need only if their health or development is at risk, this would result in non-disabled-children-in-need being at a higher risk of maltreatment than non-disabled children-in-the-general-population. Ofsted is comparing data drawn from two qualitatively different populations – the general population vs children in need.

Child protection plans

What difference does that make to Ofsted’s concern about CPPs? It means that you’d expect non-disabled-children-in-need to have a disproportionately high level of CPPs compared to non-disabled-children-overall. That would widen the gap between CPPs for non-disabled children and CPPs for disabled children, making the proportion of CPPs for disabled children look disproportionately low. Some calculations might clarify the point:

Sullivan and Knutson set out their data (for all children) in a 2 x 2 matrix as shown below:

If Ofsted’s data (for children in need) are set out in the same way, they look like this:

In Table 2, the proportion of non-disabled children with CPPs is 4 times the proportion of disabled children with CPPs, exactly the opposite of Sullivan and Knutson’s trend, and that’s what Ofsted is concerned about.

But Sullivan and Knutson’s finding was based on data from all children in a location, not just children in need. If we put Ofsted’s figures into the context of all children in a location (in this case, England), a different picture emerges. (The total figures for all children and for all disabled children are estimates – the figure for disabled children is the Aiming High estimate).

If my calculations are correct, the proportion of non-disabled children with CPPs in the whole population of non-disabled children is only 0.39%, whereas the proportion of disabled children with CPPs in the whole population of disabled children is slightly lower at 0.28%, considerably less than the 4-fold ratio if children in need only are taken into consideration. When the population differences are corrected for (as far as is possible with the data provided), the discrepancy between CPP rates for disabled and non-disabled children almost disappears.

*********

There’s something about child protection plans that seems to have an adverse effect on statistical analysis. UK readers who were home-educating their children during the Badman review in 2009 will probably recall the disagreement between Graham Badman and Graham Stuart (later to become Chair of the Education Select Committee) about the proportion of home-educated children subject to CPPs. The central issue was that the total number of home-educated children in the UK was unknown; estimates had varied between 20,000 and 150,000. You can read the full account here, but I thought it was worth reproducing some of the exchange in full:

Graham Badman: I reflected a great deal on our exchange of views, I promise you. I did go back and look at the figures and I came up with exactly the same conclusion. In fact, if you want me to qualify it, when surveying the number of child protection plans in the authorities that we covered in the last survey, we came up with a figure of 0.4 per cent., which is double that within the normal population. In fact, that figure could be fractionally higher, because we discounted any child protection plan that was there as a consequence of disability. I know you argued that because I did not know about the other half, that therefore negated it and made it even again. My argument in return, as you will recall, was that because we did not know about the other half, that did not mean to say that they were all safe either. It could be exactly the same figure or more.

Q 86Mr. Stuart: May I interrupt you there? The question was not about the letter to the Select Committee in which you suggested that I had said that any child who was not known about was automatically safe. I said no such thing, so you have your facts wrong there—again. What we were establishing was the rate of child protection plans in the home-educating community. We went through it slowly, and you want to rehearse it, so I will rehearse it.

If you have a child protection plan, automatically you are known to the local authority, so children previously not known to the local authority who become subject to a child protection plan are then known to the local authority. It does not by any means guarantee that children who are not known to the local authority and do not have a child protection plan are necessarily safe. But what you do know is that every child with a child protection plan is known to the local authority, and you claimed, completely erroneously—and although you have been corrected, here you are months later still getting it wrong, which is pretty frightening—that the percentage of children who are home educated who have a child protection plan is double the national average, when your own report suggests that the numbers are at least double the 20,000, which is the number registered with the local authority, and the Secretary of State said on Second Reading that the Government estimated the number was 70,000. They do not know for sure, but they think it is 70,000.

If you take the number of home-educated children with a child protection plan and you see that as a percentage of 70,000, it comes out at a great deal less than the average for the population, and that I believe is the definitive statement of what we know. It does not tell us everything we need to know, which is why I would not overstate my reliance on it. Could you please comment on whether you believe that we can truly say, as you have repeatedly said, that there is double the rate of the most serious level of child protection plan among children who are home educated?

Graham Badman: I fear we are in danger of going round in the same circle. I am afraid I fundamentally disagree with you. You think I am wrong; I think you are wrong.

Mr. Stuart: It is maths.

Graham Badman: Well, fine; we might want to debate that later—perhaps you went to a better school than me. The fact remains that I do not agree with your assumptions. On the basis of the data collected from the local authorities and from two surveys that have been validated by DCSF statisticians, I believe that we are quite safe in saying that on the basis of the child protection plan analysis that they carried out, there are twice as many young people on a child protection plan known to local authorities within that population as are within the general population. That is a fact. I am sorry that you do not agree with me, but we could go on for ever disagreeing.

I also have concerns about other aspects of the report, which I’ll discuss in the next post.

Reference

Sullivan, P.M & Knutson, J.F (2000). Maltreatment and disabilities: A population based epidemiological study. Child Abuse & Neglect, 24, 1257–1273,