‘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.     

Employer‐Supported Child Care: Who Participates?

Child‐care vouchers are becoming more common and can provide child‐care assistance to a wide spectrum of the population. There is little empirical research, however, on which workers participate in their employer's child‐care programs. In this exploratory study, employees with children at 1 large university completed questionnaires to gather information on their child‐care arrangements and their experience with the employer's child‐care voucher program (N = 949). Results indicate that the employees who were most in need of child‐care assistance in terms of family structure, job type, and child‐care expenses were more likely to receive vouchers. Federal policy limiting the structure of employer‐sponsored voucher programs appeared to present barriers to participation for certain groups of employees.     

Attitudes Toward Housework and Child Care and the Gendered Division of Labor

Research on the division of household labor has typically examined the role of time availability, relative resources, and gender ideology. We explore the gendered meaning of domestic work by examining the role of men's and women's attitudes toward household labor. Using data from the Dutch Time Competition Survey (N = 732), we find that women have more favorable attitudes toward cleaning, cooking, and child care than do men: Women enjoy it more, set higher standards for it, and feel more responsible for it. Furthermore, women's favorable and men's unfavorable attitudes are associated with women's greater contribution to household labor. Effects are stronger for housework than child care, own attitudes matter more than partner's, and men's attitudes are more influential than women's.     

正式照料抑或非正式照料:照料模式对高龄老人临终照料成本的影响

本文基于2014～2018年中国老年人健康影响因素跟踪调查数据(CLHLS),尝试探究了机构照料、社会照料和家庭照料3种照料模式对我国高龄老人临终照料费用和天数的影响.结果发现,家庭照料和社会照料均与较高的临终照料费用与临终照料天数显著相关,但机构照料仅与较高的临终照料天数显著相关.此外,临终老人的照料依赖程度对于不同...     

论我国城镇化进程中传统村落的消失与保护

随着城镇化进程不断推进,农村劳动力逐渐向城市和城镇转移。在此过程中,传统村庄人口数量锐减,老龄人口与未成年人口占据了村庄人口的主要部分。即使这样,在农村剩余人口中,绝大多数未成年人有着强烈的进城意愿。因此,传统村落将面临人口数量逐渐减少,结构老龄化问题。长此以往,一些地区出现了传统村落的消失。传统村落承载着独特的民族文化与优秀文明,如果任其消亡,可能导致众多非物质文化的丢失与遗弃,在不断推进城镇化建设过程中,对传统村落承载的历史传统文化应有选择地进行继承和发展。     

Professional responses to post bureaucratic hospital reforms and their impact on care provision

BackgroundPost bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers.QuestionTo explore experiences of post bureaucratic hospital reforms and their impact on care provision.MethodData builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy.FindingsTwo overarching themes were identified: ‘Time, tasks and institutional duties’ which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures.ConclusionThe institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others.     

Determinants of prenatal health care utilisation by low-risk women: A prospective cohort study

BackgroundPrenatal health care is pivotal in providing adequate prevention and care to pregnant women.AimWe examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.MethodsWe used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.FindingsWe collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.ConclusionInadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services.     

Sexual risk behaviors among youth in the child welfare system

This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to provide estimates of sexual risk behaviors for 877 youth, age 11–14 at baseline, in the child welfare system. It examines the association between baseline psychosocial risk and protective factors on engagement in sexual risk behaviors after 36 months. It further compares rates of sexual risk behaviors between youth placed in out-of-home care and those who remained with their biological family. Key findings include a high rate of pregnancy, a high percentage of youth who initiated sexual activity at or before age 13 as well as a limited role of protective factors in moderating sexual risk behaviors. A history of placement into out-of-home care is not significantly associated with greater engagement in sexual risk behaviors. Implications for intervention development and child welfare policy for this population are discussed.