Clinical outcomes for women who had continuity of care experiences with midwifery students

BackgroundPre-registration midwifery students in Australia are required to engage in a minimum of ten continuity of care experiences (CoCE). Students recruit and gain consent of each woman to provide CoCE under direct supervision of a registered health professional, usually a midwife. Clinical outcomes for women who had CoCE with a midwifery student placed in a continuity of midwifery care (CMC) or fragmented models are rarely reported.Aims1. analyse clinical outcomes for women experiencing CMC with CoCE by students; 2. analyse clinical outcomes for women in a fragmented care model with CoCE by students; and 3. compare clinical outcomes according to women’s primary model of care.MethodsStudents undertaking a Bachelor of Midwifery program at one Australian university recorded clinical outcomes for women experiencing CoCE during pregnancy [n = 5972] and labour and birth [n = 3933] in an e-portfolio. A retrospective, cohort design compared student recorded maternal data with National Core Maternity Indicators and Queensland Perinatal Data.ResultsMidwifery students providing CoCE reported better or equal clinical outcomes for women compared to population data. Women receiving CoCE had reduced likelihood of tobacco smoking after 20 weeks of pregnancy, episiotomy, and third and fourth degree tears.ConclusionsClinical outcomes for women in fragmented models of care and receiving CoCE by undergraduate, pre-registration midwifery students are equal to or better than State data across 12 variables. CoCE should be offered to all women early in their pregnancy to ensure optimal benefits. Acknowledging midwifery students’ potential to make positive impacts on women’s clinical outcomes may prompt more health services to reconceptualise and foster CoCE.     

LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

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.     

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’.     

The Social Ecology of Race and Ethnicity School Achievement Gaps: Economic,Neighborhood, School,and Family Factors

This study used a nationally representative sample of middle and high school students to examine the degree to which economic, neighborhood, school, and family factors contributed to three points on a proposed school outcome continuum: (1)avoidance of problem behavior, (2)sense of school coherence, and (3)grades. Multilevel models were employed to account for the clustering of students inside schools. Results suggested that though family and neighborhood social factors contribute to variance in school outcomes, family and neighborhood economic factors revealed the largest potential to explain and therefore present leverage points to reduce race and ethnicity achievement gaps.     

Outcomes of permanent family placement for children of minority ethnic origin

The paper explores the outcomes of permanent family placement for children of minority ethnic origin, using a sample of 254 placements drawn, in the main, from a cohort of 1165 British children placed between 1980 and 1985. Statistical techniques are used to explore the relationship between 'success' (defined, for the purposes of this paper, as the placement not known to have broken down) and a range of variables, including the characteristics of the child, the birth parents and the adoptive parents, and the type of placement. In most respects, the findings are consistent with those of similar studies. Age at placement is found to have an important effect, with success least likely for children placed in the middle age range. Lack of problem behaviours in the children at the time of placement is also found to be associated with success. Variables which are found to have no effect on the probability of success include ethnic origin of the child, whether it is an adoptive or permanent foster placement, and whether contact with birth parents continued after placement. There was an interesting gender effect in that boys did better in 'transracial' than in 'matched' placements, but the opposite was the case for girls.     

Gender,Family Structure,and Adolescents’ Primary Confidants

Using data from the National Longitudinal Survey of Youth 1997 (N = 4,190), this study examined adolescents’ reports of primary confidants. Results showed that nearly 30% of adolescents aged 16 – 18 nominated mothers as primary confidants, 25% nominated romantic partners, and 20% nominated friends. Nominating romantic partners or friends was related to increased risk‐taking behaviors, supporting the attachment notion that shifting primary confidants to peers in adolescence may reflect premature autonomy from parents. Tendencies to prefer romantic partners over parents varied by gender and family structure, which were greater for those from single‐father families and girls from mother‐stepfather families, but less for those from single‐mother families and boys from mother‐stepfather families, compared with their counterparts from two‐biological‐parent families.     

Parenting fostered adolescents: skills and strategies

This paper discusses findings from a recently completed study of adolescent foster care, which included a detailed assessment of the parenting approaches and strategies used by the foster carers of adolescents in long‐term placements. Sixty‐eight foster carers were interviewed at two points in time. The first interview was conducted two months after the start of a new adolescent placement and the second after the placement had been continuing for a year, or at the point of disruption if this occurred earlier. The interview schedules were designed specifically for this study and were based upon well‐established techniques developed in other studies of parenting. They enabled the researchers to make summary ratings for each carer on established dimensions of parenting such as control and discipline, responsiveness and the level of engagement with the child. The researchers assessed how these strategies changed and developed in relation to the young person's behaviour and whether these approaches influenced either the likelihood of placement disruption or the quality of the placement for the child. This paper describes the parenting strategies used by the foster carers, highlighting the areas of parenting that significantly affected the placement outcomes and the corresponding implications for policy and practice.     

Parental mental health: disruptions to parenting and outcomes for children

The association between parental mental health problems and negative outcomes for children has been long known. This paper addresses three issues in relation to this. First, the scale of the problem is outlined, in terms of both the prevalence of mental health problems in parents and the likelihood of children exhibiting negative outcomes in these circumstances. Secondly, the specificity, or lack of it, of particular outcomes in the child in relation to different parental mental health problems is explored. Thirdly, the paper focuses on the importance of disruptions to parenting as a mechanism in the transmission of mental health problems to negative impacts on the child. Examples are given of how parenting is disrupted in non‐clinical community populations, and the subsequent impacts on the child. The case is made for the preventative importance of parenting and family support in mediating between parental mental health problems and negative impacts on the child.     

Relationships between leadership and professionals' job attitudes and perceptions: Comparison of two leadership models

The aim of this study was to investigate the power of the Average Leadership Style (ALS) and Vertical Dyad Linkage (VDL) models of leadership in explaining relationships between leader's initiating structure behaviour and consideration behaviour, and subordinates' attitudes and perceptions. The considered dependent variables were five facets of job satisfaction, two role stress variables (role conflict and ambiguity), one role strain indicator (job tension), and four dimensions of workteam climate. The relationships were investigated in two occupational samples comprising 127 family physicians and 155 nurses working in 28 Primary Health Care Teams. Within and between analysis (WABA) and contextual analysis were applied in order to determine the appropriate level of analysis (group as expected from ALS or individual as expected from VDL) for studying the relationships between leader consideration and initiating structure behaviours and the dependent variables. The results obtained showed the prevalence of the VDL model in most of the cases, although two of the relationships studied fitted the ALS model.