Improving service approaches and outcomes for people with complex needs through consultation and involvement

Services have not always catered well for people with complex needs. The term 'complex needs' is used here to signify people who have cognitive impairments and communication difficulties that present major challenges for getting one's views and preferences heard and understood, and/or who may not fit into traditional categories of service provision. Current developments in policy and practice, such as the single shared assessment process, emphasise inclusion through user involvement. There is a danger, however, that people with complex needs will be seen as too difficult to involve, and will therefore remain effectively excluded from the decision-making process and from the opportunity to influence service provision. This article explores the current situation in relation to ensuring genuine involvement for people with complex needs, highlights obstacles to progress and examples of good practice, and identifies future directions for research and practice.     

‘Don't you think you're missing out,living at home?’ Student experiences and residential transitions

Recent policy shifts in higher education impact on the diversity of student experiences, one such trend is an increase in the number of students staying in their parental home for the duration of their studies. This has implications for students’ experiences of university life, particularly non‐academic aspects. Drawing on Bourdieu's theory of practice and habitus, this papers explores how young people go about fitting in to ‘being a student’, and how predispositions to university life influence these practices. Residential status emerges as a key demarcating factor in how successfully students feel they adapt to being at university. Though related to class, this cannot be explained solely by the socio‐economic background of students living at home, but rather reflects both practical problems faced by these students as well as difficulties in incorporating a student habitus while living at home.     

'My mum's thirty years out of date'

It is now widely recognized that the use of the Internet as a source of self-help and support, particularly for health-related matters, is increasing. The recent growth in the number of websites aimed specifically at parents suggests that this group are increasingly accessing the Internet to seek information and advice not only for themselves but also for their children's health and well-being. This paper presents findings from the Cyberparents research project, which aimed to examine how and why parents, in particular new mothers, were accessing parenting sites. Using data collected via an online survey linked to www.babyworld.co.uk, the paper explores the ways in which women are using the Internet to help them adjust to their role during the transition to motherhood. It suggests that the Internet does offer an important source of advice and support for groups such as new mothers, in particular by providing a 'safe', non-judgemental forum in which to share experiences. However, this does not replace face-to-face communication or more traditional support mechanisms such as family, friends, and health carers, rather it serves to supplement these by providing an additional resource. Il est aujourd'hui reconnu qu'il y a une forte croissance de l'utilisation d'internet en tant que source d'auto-aide et support personnel, particulièrement pour des questions liées à la santé. La récente croissance du nombre de sites web qui s'adressent spécialement aux parents suggère que ce group a un accès de plus en plus fréquent au réseau pour l'acquisition d'informations et conseils, pas seulement pour eux-mêmes mais aussi pour le bien-être et la santé de leurs enfants. Ce mémoire présente les résultats du projet de recherche des Cyberparents, dont le but était d'évaluer pourquoi et comment les parents, et plus particulièrement les nouvelles mères, font recours aux sites parentaux. Gra?ce à l'analyse des données ressorties d'une enquête online liée au site www.babyworld.co.uk, le mémoire analyse la façon à travers laquelle les femmes utilisent l'internet pour appréhender leur rôle pendant la période de transition vers la maternité. Il suggère que l'internet représente une source de conseils et support très importante pour des groupes tels que les nouvelles mères, plus particulièrement tout en leur fournissant un réseau 'su?r' et impartial pour partager leurs expériences. Néanmoins, cela ne remplace ni la communication face à face, ni les supports traditionnels tels que la famille, les amis et les apparats médicaux. L'internet sert plutôt de source additionnelle dont le but est de compléter et soutenir les autres.     

Writing Indigenous women's lives in the Bay of Bengal: cultures of empire in the Andaman Islands, 1789-1906

This article explores the lives of two Andamanese women, both of whom the British called “Tospy.” The first part of the article takes an indigenous and gendered perspective on early British colonization of the Andamans in the 1860s, and through the experiences of a woman called Topsy stresses the sexual violence that underpinned colonial settlement as well as the British reliance on women as cultural interlocutors. Second, the article discusses colonial naming practices, and the employment of Andamanese women and men as nursemaids and household servants during the 1890s–1910s. Using an extraordinary murder case in which a woman known as Topsy-ayah was a central witness, it argues that both reveal something of the enduring associations and legacies of slavery, as well as the cultural influence of the Atlantic in the Bay of Bengal. In sum, these women's lives present a kaleidoscope view of colonization, gender, networks of Empire, labor, and domesticity in the Bay of Bengal.     

The career aspirations and action behaviours of Australian adolescents in out-of-home-care

We surveyed 202 adolescents who were in out-of-home care, and compared them with 202 adolescents not in care (matched for age, gender and school achievement) on career-related aspirations (occupational aspirations, educational aspirations, life barriers) and career action behaviours (career exploration, career planning). The out-of-home care adolescents reported lower occupational aspirations, less career planning, more career barriers, lower educational aspirations for themselves, lower parental aspirations, and more school engagement. Further, career exploration was lower for out-of-home care children who had higher aspirations, lower self-efficacy, parents who communicated higher aspirations, and low aspiring friends. Results are discussed in the context of providing career development and supports for out-of-home care adolescents so that their career aspirations and behaviours can mirror more normative levels.     

Australian women's experiences of living with gestational diabetes

PurposeThe purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM.MethodsParticipants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes.ResultsOf 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p = 0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p = 0.061). Those diagnosed with GDM in a previous pregnancy (p = 0.034) and younger women (p = 0.054) were less likely to view the diagnosis as an opportunity to improve their health.ConclusionsThis study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.     

Book reviews

Diffusion Processes and Fertility Transition: Selected Perspectives. 2001. Edited by John B. Caster-Line. National Research Council, Committee on Population. Washington, DC: National Academies Press. Pp. xi + 271. N.p.g. ISBN: 0-309-07610-2. Available online at http://www.nap.edu/books/0309076102/html/Rl.html The Explanatory Power of Models. 2002. Edited by Robert Franck. Boston/Dordrecht/London: Kluwer Academic Publishers. Pp. x + 310. ￡74.00. ISBN: 1-4020-0867-8. Communism, Health and Lifestyle. The Paradox of Mortality Transition in Albania, 1950-1990. 2001. By Arjan Gjon?a. Westport, CT: Greenwood Press. Pp. ix + 227. US$69.95. ISBN: 0-313-31586-8. Historical Studies in Mortality Decline. 2002. By William H. Hubbard, Kari Pitk?nen, Jürgen Schlumbohm, S?lvi Sogner, Gunnar Thorvaldsen, and Frans van Poppel. Oslo: Novus Forlag. Pp. 134. ISBN: 82-7099-360-3. Population and Society in Western European Port-Cities. 2002. Edited by Richard Lawton and Robert Lee. Liverpool: Liverpool University Press. Pp. xx + 385. ￡18.95. ISBN: 0-85323-907-X. The Changing Face of Home: The Transnational Lives of the Second Generation. 2003. Edited by Peggy Levitt and Mary C. Waters. New York: Russell Sage Foundation. Pp. xi + 408. US$39.95. ISBN: 0-87154-517-9. The Demography of Victorian England and Wales. 2000. By Robert Woods. Cambridge: Cambridge University Press. Pp. xxv + 447. ￡50.00. ISBN: 0-521-78254-6. The Life Table: Modelling Survival and Death. 2002. Edited by Guillaume Wunsch, Michel Mouchart, and Josianne Duchêne. Dordrecht: Kluwer Academic Publishers (European Studies of Population, Volume 11). Pp. x + 306. ￡89.00. ISBN: 1-4020-0638-1.