Early intervention and holistic,relationship‐based practice with fathers: evidence from the work of the Family Nurse Partnership

This paper seeks to add to the literature on working with fathers by focusing on early intervention. It draws on research into fathers involved in a home visitation service delivered by the Family Nurse Partnership in England and evaluates the men's experiences of the intervention. The vulnerability of fathers was striking and many were helped to develop their practical skills and confidence in caring for their babies. The intervention was effective because of the quality time that was invested in developing relationships with fathers (as well as mothers), the focus on their strengths as well as areas for improvement and the skilled, therapeutically oriented, holistic approach through which the service was delivered. The ‘early’ nature of the help was crucial to its success because of how it so effectively tapped into the men's redefinition of themselves as caring fathers during pregnancy and following the birth. We argue that there is important learning here for social care and health services in general about how to engage men and promote fathers' capacities to care for their children.     

Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness

ABSTRACT

Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.     

Little cash to large households: Cash transfers and children's care in disadvantaged families in Ghana

Social protection is widely considered to have a positive effect on children, including supporting improvements in nutritional, educational and health outcomes. Much less is known, however, about the impact of interventions on children's care. This article considers the impact of a social cash transfer targeted at poor households – Ghana's Livelihood Empowerment Against Poverty (LEAP) programme – on child well‐being, quality of care and preventing children's separation from their parents as perceived by programme and non‐programme beneficiaries in a context of vulnerability, large households and widespread informal kinship care. Findings suggest that cash transfers can improve both material and non‐material aspects of well‐being and contribute to the quality of care and have the potential to prevent children's separation from their parents. At the same time, not all children appear to benefit equally, with non‐biological children being disadvantaged. The combination of large household sizes with programme design and implementation challenges, including low transfer amounts, a cap on the maximum number of eligible household members and poor sensitization and follow‐up, undermine the positive role that cash transfers can play.     

对“吴起教育模式”的思考——从陕西吴起县建立公共财政全覆盖的教育体系说起

陕西省吴起县建立起了公共财政全覆盖的教育体系。该县加大了对基础教育所有环节的投入,包括学校基础建设、设施设备、教师报酬、学生资助。吴起教育模式代表了基础教育未来发展的方向,但有其脆弱性,需要各级政府和全社会的呵护。     

The ‘good mother’ struggles: Obstacles to the attainment of motherhood ideals among adult women formerly placed in residential care

We analysed narratives of motherhood produced by 13 women who were involved with the welfare system or the justice system during adolescence. The original contribution of our study was its focus on mothers who were turning age 30, so they were not in that period of generalized instability that characterizes the transition from care and into adulthood. This qualitative study was part of a larger study on French‐Canadian adolescents with a history of residential care. Semi‐directed interviews were conducted with 13 women, more than 15 years after their admission to residential care. Our data highlights that motherhood can contribute to the vulnerability of women who were involved with the welfare or the justice system as adolescents. Our results suggest that in order to shed a perceived deviant label and to compensate for the adverse events they experienced, they pursue internalized ideals of “good motherhood” that translate into restrictions and strain. Furthermore, they tend to refrain from allowing people into their lives and asking for help for fear of being judged. Yet, as their children are getting older and exhibiting problem behaviors of their own, the questioning of their parental practices and skills only becomes more intense.     

Young children returning home from care: the birth parents' perspective

While a wide range of literature exists on the experiences of children in foster care or adoption, much less is known about children who return home from care to their birth parents. This paper focuses on the perspectives of a small sample of birth parents of young children who returned home from care. It draws on findings from the Northern Ireland Care Pathways and Outcomes Study that has been following a population ( n  = 374) of children who were under 5 years and in care in Northern Ireland on the 31st of March 2000. As part of this study, interviews were conducted with the foster parents of 55 children, the adoptive parents of 51 children and the birth parents of nine children who had returned home from care. The paper explores the birth parents' views on how they coped while their child was in care, how they were coping after the child had returned home and how their child was faring at home. Results revealed that these parents, and their children, were experiencing multiple difficulties and struggled to cope after the children had returned home.     

Suicidal behaviour in transition‐aged youth with out‐of‐home care experience: Reviewing risk,assessment, and intervention

The rates of suicidal behaviours in youth with out‐of‐home care experience, particularly those who are on the verge of emancipation, appear to be alarmingly high. The purpose of the current study is to highlight the rates of suicidal ideation and behaviour in these youth, illuminating the empirical risk factors that may increase their vulnerability. We offer a review of screening measures and suicide interventions that may hold promise for administrators, practitioners, and researchers who wish to provide comprehensive assessment for transition‐aged youth with out‐of‐home care experiences and effectively treat those who may be at the highest risk.     

Examining the Experiences of Fathers of Children with a Life-Limiting Illness

Families who have a child diagnosed with a life-limiting illness (LLI) face substantial challenges resulting from the complexity and devastating impact of the condition and potential closeness of death. The experiences of fathers of a child with LLI have been understudied; therefore, this study explored the stresses, experiences, and strategies of these fathers, including their perceptions about support needs. Based on grounded theory, in-depth semi-structured interviews were conducted with 18 fathers of children with LLI. Six fathers had experienced the death of their child. The overarching themes were stresses, means of coping, and perceived needs for support. Generally, fathers in this study struggled relative to discursive and internalized notions of fathers as providers and protectors for their children, combined with an inability to ease their child’s vulnerability to LLI. Participants were engaged in the care of their child with LLI, but several felt marginalized by health care providers in care planning and staff/family communication. Some fathers recognized and valued their support network while others had few supports. Some described personal growth and desired to help other fathers. Practice implications and recommendations include renewed application of family-centered care, overcoming presumptions about fathers’ roles, and recognizing the impact of LLI beyond physical health.     

Battling parenting: The consequences of secure care interventions on parents

Secure care in Sweden is the most intrusive child welfare intervention, and children and their family members have restricted contact. For each child in secure care, there are at least twice as many affected family members and parents who must manage the consequences of this institutionalization. Clearly, it is just as important to understand how secure care affects parents as it is to understand how secure care affects children. To address this issue, we conducted in-depth interviews with 11 parents to eight children who had been placed in secure care during their childhood, focusing on the institutional and societal structures that affected these parents and their parenting. With a narrative approach, stories alluding to a metaphor of war are identified. These stories reveal how all parents (but especially single mothers) are affected by their diverse socio-economic positions and the rigid frames of family life presumed by child welfare interventions. In these narratives, parenting emerges as a social practice rather than a skill. Above all, the stories demonstrate a great deal of vulnerability and sensitivity of parenting. The findings raise critical questions about the meaning and overarching consequences of institutional interventions in a family life.     

Enhancing the capacity of kin caregivers and their families to meet the needs of children left behind

Based on qualitative research of the experiences of 23 kin caregivers and five school personnel, this article explores the role of informal kinship care in addressing the needs of school-age children left behind in rural China. The findings of this study suggest that kin caregivers' child-rearing capacity is limited in the rural context, and they are often overwhelmed by children's diverse and complex needs, particularly their emotional ones. In view of the huge population and their vulnerability, it is imperative for the state to take up its responsibilities and develop specific social work services and other support for children left behind and their families.     

A qualitative inquiry into women’s experiences of severe maternal morbidity

Severe acute maternal morbidity (SMM) is a near-death experience during pregnancy, childbirth or termination of a pregnancy. Nine women recruited from hospital intensive care or high dependency units following the birth of their baby participated in two qualitative interviews about their SMM experience. The interpretative phenomenological analysis led to the identification of three superordinate themes related to participants: moving from a state of normal pregnancy to being severely unwell, being in critical care and returning to normal. Participants’ transition to a SMM event occurred quickly and was frightening, with participants expressing concerns about their husbands/partners’ trauma. Participants’ time in hospital was particularly hard for those separated from their baby, with this eased by staff kindness and family support. After discharge participants continued to seek explanations for their SMM. Implications include more formal support for mothering when women are in maternal critical care, and support for husbands/partners following a SMM event.     

Kinship Foster Care and Its Impact on Grandmother Caregivers

Summary

Kinship foster care programs are designed to address the needs of relatives, usually grandparents, who have taken in children who have been removed from their homes voluntarily, or following a substantiated report of neglect and/or abuse. The author reviews the history of kinship foster care nationally and examines related research. Reported are findings on a survey of kinship foster care programs nationwide and from qualitative interviews with nine grandmothers from New York City who were kinship foster care providers. Particular attention was paid in these surveys to the impact of kinship foster care on families caring for children with disabilities.     

Promoting psychosocial well-being in unaccompanied asylum seeking young people in the United Kingdom

Unaccompanied minors looking for asylum in industrialized nations come with a host of psychosocial needs associated with separation and settlement. They are also resourceful, and willing to make the best of themselves in their new environments. This paper reviews literature concerning vulnerability and resilience that has emerged from refugee related studies, and those from social work with children looked after by local authorities. In combining these two areas of enquiry, the paper tests the messages they contain in reference to the work of a young asylum seekers project run in the United Kingdom. It confirms the view that unaccompanied minors are children first and foremost, exhibiting understandable vulnerabilities associated with separation and trauma, as well as being carriers of capacities that can help them to recover and settle after arrival. In this paper, it is proposed that promoting psychosocial well‐being for unaccompanied minors involves entering the young people's inner and outer worlds with therapeutic care, to aid the processes of self‐recovery. It also involves finding ways to regenerate a lost sense of belonging and of being in charge of their lives. Examples from the project's work with the young people are used to illustrate the complexity of helping them find a sense of home within their new territories.     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

Childcare with gloves on: protecting children and young people in residential care

Summary Abuse of young people in out-of-home care has caused internationalpublic and professional concern over the last fifteen years.Although research has been undertaken to identify factors thatare likely to contribute to a safer environment for young people,little consideration has been given to the impact of abuse scandalson workers' perceptions of what constitutes abusive behaviour.This paper presents the findings of a study undertaken in threeresidential children's units in one local authority which soughtto explore this area and considers two key findings which raiseissues for the social work profession. These are, first, thatthe perception of abusive behaviour was in the main determinedin terms of the workforce's own vulnerability to allegations.Secondly, staff found it difficult to conceive of a colleagueas a potential perpetrator of abuse. The paper concludes byevaluating recent government policy documents in the light ofthe study findings.     

The role of family care-givers for an older person resident in a care home

Summary A sample of 61 relatives of residents admitted during the precedingthree years to 35 independent sector nursing or residentialcare homes in four local authority areas was interviewed. Thissample included spouses, daughters and sons. Five discrete rolesfor family care-givers in the care homes were described: checkingthe quality of care, companionship, handling the cared-for personwith personal care. Although family care-givers described themselvesas very satisfied with the care homes as a whole, as many ashalf were worried about some aspect of care. A third of theoffspring felt that their relationship with the cared-for personhad improved following the admission to a care home. None ofthe spouses felt this to be the case and most felt that theirrelationship had deteriorated. Spouses tended to visit veryfrequently. Unlike offspring, spouses rarely took the cared-forperson out of the care home. Because of the lack of privacy,visits could be a difficult experience. Those wanting to continuegiving their partner practical support were discouraged by stafffrom doing so. The research has implications for social workers,care home proprietors and registration and inspection unitsin encouraging care homes to adopt more 'relative friendly'policies.     

Giving Voice to Black Children: An Analysis of Social Agency

In the last decade, a new sociology of childhood has made importantcontributions to our understanding of children as social agentsshaping their daily lives in various contexts and situations.Although social difference and diverse childhood experienceshold a central place in these new paradigms, several researchershave noted the neglect of black¹ children in mainstream researchagendas, with little attention paid to their lived experiencesin social institutions. This conceptual paper begins with abrief discussion exploring the intersections between black children,marginalization and childhood studies. The following sectionreviews ongoing concerns implicated in the high presence ofblack children in public care. By applying theories about childhoodto children in public care generally and specifically to blackchildren, this paper advocates participatory approaches to incorporatenew initiatives in working with black children in public care.     

Cash versus Child Care Services in Finland

In 1985 the Finnish Parliament passed a law which stipulated that all children under age three were to be guaranteed a day care place as from the beginning of the 1990s. The law was made possible by a political compromise in which the agrarian Centre Party won the backing it needed to push through a system of state subsidies for the home care of children. As an alternative to a day care place, parents were now given the option of taking a child home care allowance and using that allowance either for purposes of looking after their child themselves or for paying for a private place. Measured in terms of the number of users, the child home care allowance was a hugely successful innovation. Most parents of small children have used the allowance for at least some period of time. This was due above all to the size of the allowance compared with other social benefits. However, following cutbacks in allowance expenditure of more than 20 per cent from 1995, the use of home care allowances declined at almost the same rate as the allowances were reduced. This brought significant short-term savings to the Government and to local authorities, but in the longer term other costs have been rising. There has even been a sharp, unexpected decline in the birth rate. The case of Finland goes to show that, even in a country where wage-earning motherhood has become firmly established, income transfers through family policy can have a very significant influence on the numbers opting temporarily for homemaking.     

POPULATION AGEING AND THE PUBLIC PURSE: AUSTRALIA IN COMPARATIVE PERSPECTIVE

A comparative analysis of three decades of OECD public spending change is used to test propositions concerning the likely consequences of population ageing for public expenditure development in coming years. The World Bank and the OECD Secretariat suggest that population ageing has a direct impact on public expenditure through increased spending on pensions, health care and services for the elderly; and an indirect impact through increasing levels of public indebtedness. The analysis here suggests that only the pensions effect is supported by available comparative evidence and that, even here, the relationship is weaker than often implied in the population ageing literature. The vulnerability of different nations to problems arising from population ageing varies widely, with Australia among the least vulnerable.