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.     

Foster Carer Strain and its Impact on Parenting and Placement Outcomes for Adolescents

Drawing on recently completed research funded by the Departmentof Health, this article examines the extent of strain on thefoster carers of adolescents, its influence on parenting practicesand the overall impact on placement outcomes. The research find­ingsshow that foster-carers’ parenting capacity was markedlyreduced in a number of specific areas when they had experienceda high number of stressful life events in the six months priorto the young person’s arrival or were under considerablestrain during the placement. Conduct problems, hyperactivityand violent behaviour by the young people increased carer strain,as did contact difficulties with the children’s families.Problems in contacting social workers were linked to elevatedstrain, whilst strain was lessened when carers received helpfrom friends or from local professionals. Signifi­cantlyhigher disruption rates were experienced by strained carersand these placements were also less beneficial to the youngpeople.     

GIRLS MAKING CHOICES ABOUT CAREERS: THE IMPORTANCE OF PERSONAL EXPERIENCE

Because of the gender-differentiated nature of the Australian workforce, it is important to gain a clear understanding of how girls and women make choices about careers. The data in this paper originate from a study involving girls discussing their subject choices as they move into Year 11 at school. The study revealed a strong link between subject choices and career aspirations. Furthermore, personal experiences of a career through home or school activities were usually necessary for a girl to aspire towards that career. This raises questions about the efficacy of trying to influence career decisions through brief exposure to role models. It also suggests the need to supplement the experiences of those girls with limited experiences related to careers.     

Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture

This article uses a literature review to examine the ways inwhich professional culture might shape inter-organizationalexchange of personal information in a health and social carecontext. The aim is to explore a simplified model of possibleinformation-sharing behaviours (‘ideal’, ‘over-open’,‘over-cautious’ and ‘chaotic’) and tosuggest that patterns of information sharing may be influencedby a number of factors. It is proposed that these factors includenot only inter-professional differences in the approach takento information sharing but also the ways in which the professionsinterrelate.     

Partnership Working in Public Policy Provision: A Framework for Evaluation

Partnership working has emerged as a key feature of New Labour's approach to social policy. However, although the theoretical benefits of partnership have been well rehearsed, agencies charged with fostering partnerships lack "evidence" about how best to proceed in bringing about organizational change. This paper describes the development and implementation of a practical approach to capturing the strategies that can be used to establish, strengthen and sustain local partnerships. To this end, it presents a conceptual framework for the evaluation of partnership working and demonstrates the application of the framework to an investigation of partnership working in Cornwall and Isles of Scilly, and Plymouth Health action zones.     

Using the 'Looking After Children' dimensions to collect aggregate data on well-being

The Department of Health has funded the development of a set of schedules for collating information on and monitoring the progress of children looked after by local authorities. An additional aspiration underlying official encouragement of the use of these ‘Looking After Children’ (LAC) materials was that they would provide aggregate data to feed into national and local policy and planning. Progress on this aim has been slow, in part because instruments designed to aid practice in individual cases have not adapted easily to the hoped for dual role, and in part because completion rates have been patchy and often poor. This paper describes an action research project designed to use the children's reviewing system to collect aggregate data on the LAC dimensions of well‐being. It comments on the viability of this method of aggregate data collection as well as locating the information on a cohort of 96 children in the context of other studies, and debates about whether the state can be a ‘good parent’.     

Measuring the Dynamics of Interactional Synchrony

Past research has revealed that natural social interactions contain interactional synchrony. The present study describes new methods for measuring interactional synchrony in natural interactions and evaluates whether the behavioral synchronization involved in social interactions is similar to dynamical synchronization found generically in nature. Two methodologies, a rater-coding method and a computational video image method, were used to provide time series representations of the movements of the co-actors as they enacted a series of jokes (i.e., knock?Cknock jokes). Cross-spectral and relative phase analyses of these time series revealed that speakers?? and listeners?? movements contained rhythms that were not only correlated in time but also exhibited phase synchronization. These results suggest that computational advances in video and time series analysis have greatly enhanced our ability to measure interactional synchrony in natural interactions. Moreover, the dynamical synchronization in these natural interactions is commensurate with that found in more stereotyped tasks, suggesting that similar organizational processes constrain bodily activity in natural social interactions and, hence, have implications for the understanding of joint action generally.     

An Evaluation of Caller Satisfaction with Solution-Focused Telephone Counselling

Abstract

‘Practice Forum’ is intended to provide a forum for social work practitioners to share their practice with others; to describe what they are doing and assess its effectiveness.

We extend an invitation to all social work practitioners to submit articles for ‘Practice Forum’ and we look forward to receiving your contribution.

The telephone is a potentially valuable intervention tool in family counselling. The Child, Adolescent & Family Health Service has been experimenting with a response which combines the traditional advantages of telephone counselling with aspects of Steve deShazer's solution-focused approach (deShazer 1985). In 1990 a study was conducted to evaluate caller satisfaction with this approach. Results indicate a high level of satisfaction with the counselling. At a time of increasing funding cuts and lengthening waiting lists, it is important that as many options as possible remain available to our clients. An expansion in effective telephone counselling services may well be one way of achieving this.