Operationalising caseload midwifery in the Australian public maternity system: Findings from a national cross-sectional survey of maternity managers

Background

Despite high-level evidence of the benefits of caseload midwifery for women and babies, little is known about specific practice arrangements, organisational barriers and facilitators, nor about workforce requirements of caseload. This paper explores how caseload models across Australia operate.

Guidelines for Use of the Approximate Beta‐Poisson Dose–Response Model

For dose–response analysis in quantitative microbial risk assessment (QMRA), the exact beta‐Poisson model is a two‐parameter mechanistic dose–response model with parameters and , which involves the Kummer confluent hypergeometric function. Evaluation of a hypergeometric function is a computational challenge. Denoting as the probability of infection at a given mean dose d, the widely used dose–response model is an approximate formula for the exact beta‐Poisson model. Notwithstanding the required conditions and , issues related to the validity and approximation accuracy of this approximate formula have remained largely ignored in practice, partly because these conditions are too general to provide clear guidance. Consequently, this study proposes a probability measure Pr(0 < r < 1 | , ) as a validity measure (r is a random variable that follows a gamma distribution; and are the maximum likelihood estimates of α and β in the approximate model); and the constraint conditions for as a rule of thumb to ensure an accurate approximation (e.g., Pr(0 < r < 1 | , ) >0.99) . This validity measure and rule of thumb were validated by application to all the completed beta‐Poisson models (related to 85 data sets) from the QMRA community portal (QMRA Wiki). The results showed that the higher the probability Pr(0 < r < 1 | , ), the better the approximation. The results further showed that, among the total 85 models examined, 68 models were identified as valid approximate model applications, which all had a near perfect match to the corresponding exact beta‐Poisson model dose–response curve.     

Will Direct Payments Make Adult Residential Care more Personalized? Views and Experiences of Social Care Staff in the Direct Payments in Residential Care Trailblazers

Direct payments, i.e. cash payments made directly to the individual in lieu of social care services, have become an established option in council‐funded domiciliary care as a means to better personalize care and support. As part of its agenda to modernize social care, the Government tested their use in long‐term residential care in 18 trailblazing councils in England. This article presents findings from the independent evaluation of this initiative, using interviews with project leads seconded to the programme in all participating councils, and with council and care home staff involved in implementing direct payments in residential care in five sites. Interviews were conducted between September 2014 and November 2015. They explored professionals' views and experiences of personalization in residential care and their thoughts on the potential contribution of direct payments to promoting personalization. Whilst there was agreement that good care takes personal preferences into account and that many care homes could provide a more personalized service, doubts were voiced about whether direct payments were an appropriate mechanism to achieve this aim. This was seen as particularly pertinent in relation to residents with very high care needs and limited capacity to exercise choice and control. Interviewees also identified a number of risks and challenges to implementation, including financial risks to care homes. The findings from these interviews suggest that the contribution of direct payments to personalizing residential care may be more modest than expected.     

Sex differences in psychological distress,behavioural and emotional problems,and substance use in young people in out‐of‐home care

The aim of the study was to examine sex differences in self‐reported psychological distress, behavioural and emotional problems, and substance use in young people living in out‐of‐home care (OoHC). One hundred seventy‐six young people aged 12–17 years (females 53.4%) in OoHC in metropolitan Melbourne, Australia, were interviewed. Participants completed self‐report measures: Kessler Psychological Distress Scale, Strengths and Difficulties Questionnaire, and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test—Youth Version. Girls had more OoHC placement instability over the past year compared with boys (p = .019). Compared with boys, the girls had significantly higher levels of distress (p < .001) (p = .007), were more likely to have self‐reported emotional symptoms (p < .001) and peer relationship problems (p = .043) and were more likely to use sedatives (p = .004). Girls had more psychological distress, behavioural disturbance, and sedative abuse; placement instability might contribute to these problems. Greater integration across OoHC, mental health, and substance use sectors is required. Girls in OoHC may benefit from interventions targeting problems with peer relationship and substance use and supporting prosocial behaviour; such targets may reduce distress and emotional symptoms and possibly prevent longer term problems.     

Parenting challenges of African immigrants in Alberta,Canada

African immigrant children and youth have some of the poorest social and mental health outcomes in Canada. Although parenting challenges have been widely documented as a key driver of these outcomes, limited systematic research has investigated this phenomenon. In this paper, we report the results of a study examining parenting challenges among a sample of African immigrant parents in Alberta, Canada. We relied on the theoretical lens of transnationalism to collect and analyse data from a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), and a range of stakeholders (n = 30). Our thematic data analysis revealed several intricately intertwined parenting challenges, organized around six overarching themes, namely, cultural incompatibility, family tension, state interference, limited social supports, poor access to services, and low socioeconomic status. We present these themes and the policy and service implications of our findings.     

Wellbeing and Society: Towards Quantification of the Co-benefits of Wellbeing

Social Indicators Research - The objectives of this paper are twofold. First, it reviews the empirical evidence showing the existence of linkage between wellbeing and possible co-benefits,...     

Family support services delivered using a restorative approach: A framework for relationship and strengths‐based whole‐family practice

Family support services, an integral part of many welfare systems across the developed world, have witnessed a growing demand for the use of relationship and strengths‐based whole‐family approaches in the belief that this increases service engagement and effect. Despite this, knowledge that delivering services using such approaches can be challenging and calls for the identification and exploration of methods likely to promote and sustain their use. Restorative approach is an ethos and method centred on building and sustaining positive relationships, which is increasingly being adopted in family and children's services in the United Kingdom. Despite this, the scarcity of research conducted in this area as yet, means little is known of its use and effect in this context. This article draws on empirical data collected in a wider study exploring the efficacy of different family service delivery models to describe the use of restorative approach in family service provision and determine whether its adoption promotes sustained use of strengths and relationship‐based whole‐family approaches when working with families. Furthermore, it explores whether the process incorporates wider evidence‐based methods of change.     

Consistency and Accuracy in Decision Aids: Experiments with Four Multiattribute Systems*

There have been a number of multiattribute decision aids developed to aid selection problems. Multiattribute value theory and the analytic hierarchy process are two commonly used techniques. Different systems can result in radically different conclusions if they inaccurately and inconsistently reflect the preference structure of decision makers, or if they are based on inappropriate theoretical models. This study examines the impact of the underlying theoretical model, the method in which preference information is elicited, and the structure of alternatives as influences on the results from using various decision aids. It was found that two systems based on the multiattribute value theory model were just as diverse in their conclusions as were results between AHP and the multiattribute value theory models. Therefore, accuracy of information reflecting decision maker preference is an important consideration. Feedback capable of assuring the decision maker that information provided is consistent is a necessary feature required of decision aids applied to selection problems. The study also found that the way in which information is elicited influenced the result more than did the underlying model. Exact numerical data for complex concepts such as attribute importance and alternative performance on attributes is not necessary, and elicitation procedures that are more natural for the user are likely to be more accurate.