The Common Assessment Framework: the impact of the lead professional on families and professionals as part of a continuum of care in England

This paper utilizes data gathered as part of an exploratory study to assess the costs and impact of the Common Assessment Framework (CAF), to examine the impact that the lead professional role had on families and workers. The study found that both families and workers believed the lead professional to be central to the CAF process, providing a range of support, coordinating multi‐agency responses to need and acting as a single point of contact between families and workers. The paper highlights the need for consideration to be given to inter‐agency working, data sharing, training for workers and the capacity implications for those taking on the role. The extent to which the lead professional might be more integrated into the continuum of support for vulnerable children and families is also examined. The paper highlights the need to consider the lead professional's role in not only preventing the need for more intensive services, such as those provided by statutory social work, but also maintaining outcomes achieved once a child protection plan is closed, or a child is reunified with his or her birth family after a period of being in care. The implications of the findings for policy and practice are discussed.     

Micro‐provision of Social Care Support for Marginalized Communities – Filling the Gap or Building Bridges to the Mainstream?

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro‐providers – very small community‐based organizations, which can work directly with individuals. These micro‐providers are assumed to be able to cater for the ‘seldom heard’ groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer‐reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small‐scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self‐organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community‐based micro‐providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.     

Characteristics of the Social Support Networks of Maltreated Youth: Exploring the Effects of Maltreatment Experience and Foster Placement

Little is known about the social support networks of maltreated youth or how youth in foster care may compare with those who remain with their parent(s). Social network characteristics and perceived social support were examined between (1) maltreated and comparison youth, (2) maltreated youth who remained with their biological parent, those with a foster parent, or a those with a kin caregiver, and (3) youth in stable placements and those who have changed placements. Data came from a sample of 454 adolescents (241 boys, 9–13 years old at enrollment) who took part in a longitudinal study of child maltreatment. Participants completed three assessments approximately 1 year apart. Results showed that on average, maltreated adolescents named significantly fewer people in their network than comparison adolescents. At Time 2, comparison adolescents reported more same‐aged friends. In the maltreatment group, youth with a foster parent reported significantly more older friends than maltreated youth with a kin caregiver. Fewer maltreated youth named a biological parent on the social support questionnaire at all three time points. More youth in kinship care described their caregiver as supportive than those in foster care. These findings indicate that despite heterogeneous placement histories, social support networks among maltreated youth were very similar.     

History of perinatal loss and maternal–fetal attachment behaviors

BackgroundMaternal–fetal attachment (MFA) is an important requirement for optimal maternal–infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/neonatal death) affects maternal attachment in pregnancy.Research question“Does a history of perinatal loss affect maternal–fetal attachment behaviors?”MethodsOne hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly's Maternal–Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann–Whitney tests.FindingsFinding showed that total score of MFA for women with a history of PL (68.95 ± 9.20%) is not significantly different from this score for women without such a history (71.22 ± 11.75%; p < 0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors “differentiation of self from fetus” compared to women without of a history of PL (78.25 vs. 83.21%; p < 0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups.ConclusionIn this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal–fetal attachment behaviors related to “differentiation of self from fetus” in a subsequent pregnancy.     

Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BackgroundThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.MethodData from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).ResultsCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.ConclusionsFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.     

Gay Abuse Screening Protocol (GASP):Screening for Abuse in Gay Male Relationships

ABSTRACT

Thirty-two male patients in gay relationships and eight family physicians were recruited from a family practice in order to determine comfort with an eight-question Gay Abuse Screening Protocol (GASP). The GASP was administered during a typical clinical encounter. After the encounter, physicians and patients each completed a 5-point Likert Scale questionnaire to assess their comfort levels with each of the 8 GASP questions (Likert Scale: 1?=?not at all comfortable to 5?=?very comfortable). The mean comfort score was high (Likert?>4) for both patients (4.16 ± 0.18) and physicians (4.71 ± 0.18). However, mean comfort scores were significantly lower for abused patients (3.26 ± 0.75) than nonabused patients (4.57 ± 0.26). Patients were comfortable (Likert?>3) with 76.2% of GASP items while physicians were comfortable with all GASP items.     

Primary Care Providers’ Attitudes,Practices, and Knowledge in Treating LGBTQ Communities

ABSTRACT

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers’ cultural competency regarding LGBTQ health using a survey that assessed providers’ attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers’ comfortability and competency in the needs, management, and referrals within LGBTQ health care.     

LGBTQ College Students’ Experiences With University Health Services: An Exploratory Study

ABSTRACT

Access to inclusive, equitable health care is central to the wellbeing of all college students yet little is known about LGBTQ students’ experiences with university health services. In this article, individual interviews with a convenience sample of 14 LGBTQ students at a large public university were analyzed to explore their perceptions of and experiences with the university’s health center and its services. Our findings demonstrate that the university is not adequately meeting their health care needs. Participants’ narratives offer insights into how to improve campus-based health services for LGBTQ students.