Parenting Assessment in a Psychiatric Mother and Baby Unit

Correspondence to Dr Gertrude Seneviratne, Section of Perinatal Psychiatry, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: G.Seneviratne{at}iop.kcl.ac.uk Summary Courts and social services often seek the advice of mental healthprofessionals in deciding whether a mentally ill mother shouldremain the primary carer of her infant. This paper describesthe referral pathways, outcomes at discharge and subsequently,of a sample of mothers referred for parenting assessments toa psychiatric Mother and Baby Unit. A further aim was to examinefactors predicting outcome. A casenote study of sixty-one consecutivereferrals for in-patient parenting assessment over a six-yearperiod is described. Social Services were contacted to establishdevelopments at least nine months after discharge. Fewer thanhalf of the mothers were discharged together with their babiesat the end of the assessment period, and at follow-up, lessthan a third were still caring for their children. Diagnosisof the mother's illness was the main factor determining whethershe continued to care for her child both at discharge and atfollow-up; mothers with depression were more likely to remainprimary carers. Variations in the timing and process of referralsrelated to a lack of antenatal planning were associated withincreased rates of separation of mother and infant before theassessment. The findings illustrate the need for more integratedco-ordination between professionals in mental health and children'sservices to ensure early planning for mothers and infants atrisk.     

More harm than good? Diagnostic codes for child and adult abuse

This study sought to understand the reasons for the lack of use of ICD diagnostic codes for child and adult abuse. New Jersey professionals were recruited to participate in three focus groups on child abuse, adult or primarily woman abuse, and elder abuse. Participants included health care providers, advocates from the community, and representatives of state agencies and the insurance industry. Concerns about coding abuse included further jeopardizing victims/patients, diagnostic uncertainty, and lack of resources. Members of the child abuse group were somewhat more receptive to coding abuse. Reasons to code, such as for documentation and reimbursement were discussed and rebutted. Most participants concluded that use of the abuse codes should be judicious because they have the potential to do more harm than good. More research is needed on the implications of coding for victims/patients along with medical education in the identification of abuse in general and coding abuse in particular.     

'Clinton faces nation': a case study in the construction of focus group data as public opinion

This paper analyses the way in which a particular newspaper report constructs ‘public opinion’ based on data from small‐scale qualitative research. Using as a case study a report of a focus group discussion of Clinton's grand jury testimony, we show how these data are ‘worked up’ as representative, generalisable, and valid. By capitalising on the advantages of focus group data, while attending to and countering their disadvantages, the newspaper report is able to suggest that the views of ten people in San Francisco offer an authoritative indication of public opinion about Clinton across the USA. Finally, we sketch out some of the implications of this case study in relation to the construction of facticity more generally.     

Safety culture

'Developing a positive health and safety culture is important if high standards of health and safety are to be achieved and maintained. There is a limit to the health and safety performance an organization can achieve without addressing the contribution which human factors have to play in eliminating occupational accidents and ill health' (David Eves, Deputy Director UK Health and Safety Executive; HSE 1997).     

Cleveland 20 years on: themes of disruption and repair in the trauma narratives of children,adults and society

This is the second of two linked papers which explores coherent and incoherent narratives emerging from Cleveland. It draws a parallel between the disrupted narratives of child and adult survivors of child sexual abuse and professional and societal narratives of Cleveland. The paper looks at the therapeutic task of individual repair using attachment‐based therapy, illustrated by clinical examples. It identifies five key challenges relevant to repair in the interpersonal, intra‐personal and societal domains. Copyright © 2008 John Wiley & Sons, Ltd.     

Managing Contradiction: Stockholder and Stakeholder Views of the Firm as Paradoxical Opportunity

Stockholder and stakeholder perspectives have been positioned in the literature as being in tension, and thus a potential source of innovation and change. However, researchers have overlooked a systematic examination of this presumption in theory and in practice. This study explores the ways that stockholder and stakeholder assumptions are presented by theorists and compares these with expressions of stockholder and stakeholder perspectives used by firms in practice. We argue that theoretical entrenchment dichotomizing these perspectives has disrupted the ability of researchers to leverage this tension. While scholarship remains trapped in a vicious cycle, we also argue that firms in practice express only the acceptance dimension of a virtuous cycle. Our empirical research demonstrates that firms accept and accommodate the paradoxical tension between managing for stockholders versus balancing the interests of stakeholders. This is evidenced by strategies we identify as book‐ending, cadence, continuous and simultaneous co‐mingling, and hybridization. We find that in practice these tensions are more integrated whereas in theory they are treated as more distinct and, often, in conflict. We suggest ways in which both scholarship and practice can better leverage tension as paradoxical opportunity.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.