Regulation of unregistered birth workers in Australia: Homebirth and public safety

Background

Australian midwives are regulated under the National Registration and Accreditation Scheme. Unregistered birth workers may provide midwifery services at homebirths without any regulatory oversight. To address this issue, several states have passed legislation enabling prohibition orders to be made (negative licensing) against unregistered health practitioners who fail to comply with a statutory code of conduct developed for those not covered by the National Scheme.

The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean

Background

Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean.

‘Who do I turn to if something really bad happens?’ Key working and relationship-based practice in residential child care

ABSTRACT

This article explores the psychodynamics of relationship-based practice from the perspective of young people in residential care. This research involved qualitative semi-structured interviews with 10 care leavers, aged 18–24 years, who had been in residential care in Ireland. Drawing selectively from that research, this article reports their views and experiences of key-working and how relationship-based practice acted as a reparative method within their experiences of care and aftercare. Similar to previous research, this study underscores the necessity to ensure that children in care are cared for and supported by a trusted adult. In addition, based on this study, the role of a key worker appears capable of providing this ideal type of supportive relationship. It also highlights the importance of the care system working to provide consistency and support for the young people and confirms the importance of relationships with trusted adults, such as key workers.     

Reclaiming complexity: beneath the surface in residential child care

ABSTRACT

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff.     

Initial reflections and learning from the development and delivery of staff consultations in an innovative residential childcare pathway

ABSTRACT

This paper explores the development of staff consultation in the context of an innovative residential childcare pathway within a local authority in the United Kingdom. A preceding attempt to develop group consultations in residential homes has been expanded upon and enhanced as part of implementing a broader therapeutic residential service model. A wide-ranging training programme and consultations have been developed for residential childcare workers to introduce and embed therapeutic ideas. Systemic therapy and attachment theory ideas have been used explicitly through exploring with staff how these approaches can inform practice, and implicitly by providing a framework of consultation to inform and expand individual and team thinking. Promoting reflective practice through group consultations has highlighted complex challenges, stimulating opportunities as well as a need to consider multiple levels of context. Recommendations from this learning are discussed to help inform practice in new and existing residential services.     

Primary Care Providers’ Perspectives on Screening Older Adult Patients for Food Insecurity

Food insecurity has been associated with poor health and health outcomes among older adults, yet food assistance resources are available and underutilized. Routine screening and referral for food insecurity in primary care is one avenue to connect food-insecure older adults with available resources. This qualitative study aims to better understand the beliefs of primary care providers (PCPs) about food security screening and referrals in a primary care setting and perceived barriers to implementation. PCPs (n = 16) who have older adult patients but do not routinely screen for food insecurity were interviewed by phone. PCPs recognize the importance of food security for older patients and discuss nutrition and food access with patients under certain circumstances. Concerns emerged with regard to implementing a systematic screening and referral process: limited time to meet with patients, a lack of resources for addressing food insecurity, and prioritizing food insecurity at both the health system and the patient levels. Despite perceived challenges, PCPs are receptive to the idea of systematically screening and referring patients to external resources for food assistance and support. Barriers could be addressed by health systems prioritizing food insecurity as a health concern and public and private payers providing reimbursement for screening.     

Fingerprint-based background checks for personal care workers: Stakeholder views of policy criteria

Decision makers face difficult choices when tasked with identifying and implementing appropriate mechanisms for protecting the elderly and other vulnerable adults from abuse. A pilot project involving fingerprint-based criminal history background checks for personal care workers in Michigan has supplied an opportunity to examine one such mechanism. In conjunction with the pilot project, we have conducted a stakeholder analysis with the aim of informing decision makers about stakeholder perceptions of standard policy criteria like effectiveness, efficiency, and equity. We employed focus groups and a Web-based survey to collect data from stakeholders. While stakeholders generally see fingerprint-based background checks for personal care workers as potentially effective and as a net benefit, they also point to a variety of contingencies. They also recognize difficulties and constraints for government involvement. This preliminary analysis provides solid foundational information for decision makers and for more extensive benefit–cost analysis.     

Transition Programming for Sustainable Livelihoods Beyond Institutional Care in Zimbabwe: Service Providers’ Perspectives

This article explores the perspectives and programme needs of transition service providers (institutions and the government) in preparing and supporting adolescent girls leaving institutional care in Harare, Zimbabwe. Key informant interviews and focus group discussions were conducted with institutional staff from Institution A (government‐owned) and Institution B (privately owned) and social services officers from the Department of Child Welfare and Probation Services. Service providers define successful transition programming as the provision of comprehensive services and support to facilitate the achievement of sustainable livelihoods beyond care and recommend the development of well‐resourced transition models for adolescent girls leaving institutional care.     

Personalisation as vision and toolkit. A case study

With the objective to eradicate disability related discrimination and promote choice, control, independence and inclusion for all individuals, the personalisation agenda paved the way for a transformation of social care and disability services in the UK. This paper explores personalisation both as a vision of care and support services and as a toolkit promoted by government policies in order to allow for such vision to translate into practice – the use of direct payments and personal budgets being an example. A qualitative case study analysis has been conducted in the context of care services for disabled young people and by means of in-depth interviews with professionals, parents and the young people themselves. Such analysis reconstructs the implementation of personalisation showing how the toolkit offered by government policies has been used and interpreted differently by the different actors in the field and how this has brought to a wide range of opportunities but also risks. What seems to emerge from the study is that the vision of personalisation risks being hampered by its toolkit and that alternatives might be needed in order to safeguard the potential of personalisation as a vision.