Managing sexually abused and/or abusing children in substitute care

This paper reports on research on the characteristics, management and therapeutic treatment of sexually abused and/or abusing children in substitute care. Of the 40 sexually abused and/or abusing young people aged 10 or over in the interview sample, two‐thirds showed sexual behaviours in the placement studied but one‐third did not. The range of sexual behaviours shown by the young people is described. Analysis of the findings shows that four key components of effective management are supervision, adequate sex education, modification of inappropriate sexual behaviour and therapeutic attention to the needs that underlie such behaviour. Supervision includes planning for safe care before placement, preparing other children in the setting, teaching young people how to keep themselves safe when out on their own, and careful monitoring of contact with birth family members. The need for a proactive approach to sex education is stressed. Effective management approaches to masturbation, sexualized behaviour and sexually abusing behaviour are discussed but the processes of denial and minimization of sexual abuse and the development of high thresholds for action when looked after children are abused or at risk are shown to present obstacles to effective care. Finally, the importance of addressing children's deeper needs is emphasized, including the importance of regular review of their need for counselling. At the end of the article two case examples from the study are given.     

THE ELUSIVE QUEST FOR ‘THOSE MOST IN NEED’

It seems plausible to argue that scarce resources such as social security payments should be targeted to those most in need, and that income should play a large role in defining need. Even though some aspects of targeting, such as whether to have tapered means tests or not, are obviously political in nature, it may appear that at least the identification of ‘those most in need’ in terms of income is largely a technical exercise. The argument of this article is that even the measurement of income is only partly a technical exercise.¹ It is also a highly problematic and political one that will always lead to understandable resentment on the part of the ‘nearly poor’, that is, those who are excluded by policy decisions regarding components of the scale by which income is assessed. We illustrate this with an example of a hypothetical family payment where those who are classified as ‘poor’ and ‘nearly poor’ on one income-scale are classified otherwise on a plausible alternative scale. It does not follow that targeting of payments on the basis of income should be abandoned. But it does suggest that all targeting should be recognised for the blunt political instrument that it is, and that its status as a precise technical tool for achieving greater efficiency be regarded with less confidence than is currently fashionable.     

Christ-Centered Therapy: Empowering the Self

Abstract

In Australia, systematic and widespread provision of family-support services is just 30 years old. The present paper traces some of the developments, recurrent tensions, and themes in family-support services, principally in Victoria, over those decades, drawing attention to challenges for social workers’ continuing participation in the development of family services.     

Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.     

The commonalities and differences in health professionals’ views on home birth in Tasmania,Australia: A qualitative study

ObjectivesHome birth has attracted great controversy in the current context. There is a need for the public and health professionals to understand why maternity care providers have such different views on home birth, why they debate, what divides them into two opposite sides and if they have anything in common.MethodA qualitative study involving twenty maternity health providers in Tasmania was conducted. It used semi-structured interview which included closed and open-ended questions to provide opportunities for exploring emerging insights from the voices of the participants.FindingsHealth practitioners who support home birth do so for three reasons. Firstly, women have the right to choose the place of birth. Secondly, home birth may be more cost effective compared to hospital birth. Thirdly, if home birth is not supported, some women might choose to have a free birth. Those who opposed home birth argue that complications could occur at childbirth and the transfer time is critical for women's and babies’ safety. These differences in opinions can be due to the differences in the training and philosophy of the maternity care providers. Despite the differing views on home births, health professionals share a common goal to protect the women and the newborns from unexpected situations during childbirth.ConclusionThis article provides some significant insights derived from the study of home birth from the maternity health professionals’ perspectives and could contribute to the enhancement of mutual understanding and collaboration of health professionals in their services to expectant mothers.     

Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study

BackgroundAround-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice.Research questionWhich communication modalities are used, and most frequently, by MGP midwives and clients?MethodsA prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife–client contact were collected 24 h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected.FindingsDetails about 1442 midwife–client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred.ConclusionThe majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.     

Change agents or defending the status quo? How senior leaders frame workplace gender equality

Senior leaders are usually understood to be ideally positioned to drive the organizational changes needed to promote workplace gender equality. Yet seniority also influences leaders' values and attitudes, and how they interpret evidence of inequalities, determine organizational priorities, and design and implement remedies. This article examines leaders' perceptions of workplace gender equality using system justification theory to explain survey data from Australia's public sector (n = 2292). Multivariate analysis indicates that male and female leaders more positively rate the gender equality climate in their agencies, compared with lower-level staff, and that male leaders show most propensity to defend the status quo. Findings call into question the effectiveness of change strategies that rely on leadership and buy-in of those whose privilege is embedded in existing arrangements, and problematize dominant organizational approaches casting senior leaders as effective change agents for gender equality. The article helps to explain gendered power dynamics, which produce and sustain organizational inequalities and make workplace equality so hard to achieve, and points to ways to strengthen practical approaches to promote equality in organizations.     

A psychological contract perspective to the link between non-profit organizations' management practices and volunteer sustainability

This study applies the concept of the psychological contract to the relationship between management practices and volunteers. Formalization of the voluntary sector is impacting on volunteers' experiences and may breach the psychological contract from the volunteers' perspective. This mixed method study interviewed 67 volunteers and volunteer coordinators/administrators, and collected mail survey information from 152 volunteer organizations. The transactional management practices of keeping formal records and not paying volunteers out of pocket expenses are negatively associated with volunteer recruitment and retention. Alternatively, publicly recognizing volunteers through a volunteer newsletter supports volunteers' relational expectations and is positively linked to adequate volunteer numbers. Our findings have important implications for the human resource development practices of non-profit organizations in dealing with theirvolunteers: they suggest that the relational expectations of volunteers are animportant aspect of the psychological contract, which could be used by organizations as a framework for developing management practices that fit the volunteer ethos of trust and networks.