Does the way maternity care is provided affect maternal and neonatal outcomes for young women? A review of the research literature

BackgroundYoung pregnant women who continue a pregnancy are primarily from a socioeconomically deprived background. The risk factors associated with low socio-economic status may independently affect perinatal and neonatal morbidity to a greater extent than the young age of the woman. Young pregnant women are frequently sceptical about health care providers who they can perceive to be judgemental. This may lead to late booking for pregnancy care, attending few appointments, or not attending the health service for any antenatal care.QuestionDoes the way maternity care is provided affect maternal and neonatal outcomes for young women?MethodA systematic search of the major health databases.ResultsNine research articles met the eligibility criteria: one randomised controlled trial, three prospective cohort studies, two comparative studies with concurrent controls, two comparative studies with historical controls, and one case series.DiscussionProviding young women with a non-standard model of maternity care has some beneficial and no known detrimental effects on childbirth outcomes. While there is a dearth of evidence on the effectiveness of a Midwifery Group Practice model of care for young women, there is strong evidence to suggest that a Group Antenatal Care model increases antenatal visit attendance and breastfeeding initiation, and decreases the risk of preterm birth. There is research to indicate that a Young Women's Clinic model may also increase antenatal visit attendance and decrease the incidence of preterm birth.ConclusionMore well-designed and resourced midwifery models of care for young women should be implemented and rigorously researched.     

Older Women's Perceptions of Elder Maltreatment and Ethical Dilemmas in Adult Protective Services: A Cross-Cultural,Exploratory Study

In this study, older African American, Latina, and Caucasian women from varying socioeconomic backgrounds participated in eight focus groups that examined their perceptions of elder maltreatment and three ethical dilemmas within adult protective service work: mandatory reporting, involuntary protective services, and criminalization of elder maltreatment. Participants espoused a broad and inclusive view of elder maltreatment. In responding to illustrative case scenarios, participants strongly favored protection over freedom by supporting mandatory reporting and involuntary protective services. Criminalization of elder maltreatment also was supported. This article presents results of each scenario and broad themes across the study, with attention paid to areas of consistency and difference across ethnicity and socioeconomic categories.     

Three Types of Memory for Childhood Sexual Abuse: Relationships to Characteristics of Abuse and Psychological Symptoms∗

ABSTRACT

Data from a clinical sample (N?=?88) reporting childhood sexual abuse was compared by types of memory, abuse characteristics, and psychological symptoms. Three types of memory were identified from a questionnaire (“Always” n?=?27 [31%], “Recovered” n?=?41 [46%], and “Both” n?=?20 [23%]). When compared with narrative reports from a subset (n?=?30) of the sample, the lines between “Always,” “Recovered,” and “Both” types of memory were ambiguous. Consistency across reports, however, was 83%. Memories classified as either “Recovered” or “Both” were associated with earlier age-at-onset and more severe psychological symptoms compared to those who “Always” remembered CSA. No significant differences were found between the “Both” and “Recovered” groups.     

Problem Gambling in Non-English Speaking Background Communities in Queensland,Australia: A Qualitative Exploration

This paper provides an overview of qualitative research into problem gambling among non-English speaking background (NESB) communities in Queensland, Australia. The focus for this pilot study was the Chinese, Greek and Vietnamese communities. Using qualitative methodologies, this community-based research explored the motivations for gambling, and the impacts of problem gambling upon individuals and communities. Findings indicate that problem gambling is evident in each of the communities of study, but the issue is characterised by a pervasive sense of denial. Gambling is an issue of enormous shame and stigma, not only for the problem gambler but their entire family. As a result, most problem gamblers do not seek professional help but try to resolve the problem themselves or within the family unit. Research findings indicate that service access could be increased through a range of strategies including the provision of culturally appropriate community education and gambling help services, partnerships between NESB communities, gambling help services and community workers, and the development and implementation of preventative strategies.     

The surprisingly weak evidence base for supervision: Findings from a systematic review of research in child welfare practice (2000–2012)

Objective

The objective of this study is to ascertain what is known about the effectiveness and cost-effectiveness of supervision in child welfare in relation to outcomes for consumers/service users, staff and organizations.

Method

This is a systematic review of the English language literature (2000–2012). Scoping study is followed by database searches of indexes and abstracts including Campbell Collaboration, CINAHL, the Cochrane Library, Medline, PsycInfo and Social Work Abstracts, journal hosts (EBSCO and IngentaConnect) plus specialist journals. Inclusion criteria: studies that reported on the associations between the provision of supervision and outcomes for service users/consumers, workers and organizations as well as intervention studies. Potentially relevant studies were independently screened by two reviewers (Stage 1) and if meeting the eligibility criteria proceed to full text review and data extraction (Stage 2). Studies were subject to critical appraisal by three reviewers using the Weight of Evidence approach (Stage 3). An analysis of included study characteristics is followed by a narrative synthesis of findings structured to answer the research objective.

Results

690 unique studies were identified at Stage 1, 35 proceeded to Stage 2 and, following quality appraisal, 21 were included in the review. Almost all of the studies were cross-sectional, providing evidence of associations between the provision of supervision and a variety of outcomes for workers, including job satisfaction, self-efficacy and stress and for organizations, including workload management, case analysis and retention. There was only one, poorly reported, intervention study and no studies of outcomes for consumers. No economic evaluations were found.

Conclusions

The evidence base for the effectiveness of supervision in child welfare is surprisingly weak. An agenda for research based on a framework for the development and evaluation of complex interventions is proposed.