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Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study
Get PDFIntroduction: Almost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation. Methods and analysis: We will construct a retrospective cohort of all women aged 13–24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education). Ethics and dissemination: The Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers
It's personal: Lived experiences of Adult Social Care and Social Work practice in a policy context of personalistion
Get PDFThis study focuses on what can be learnt from lived experiences of adult social care
and social work practice in England in a policy context of personalisation. The concept
of personalisation is increasingly a key driving force in adult social care policy with
significant implications for social work practice. In this study, psychosocial and
participatory methods are purposefully combined, with lived experience and coproduction placed at the centre of a unique qualitative methodology. A reflective
learning group with people with lived experience is a core feature of the research
design. The findings reveal some important learning for social workers. Firstly, a risk is
identified that social workers working within a personalisation framework focused on
independence and strengths might unconsciously collude with psychic defence
mechanisms. Like those defences first identified by Menzies-Lyth (1960) they include
individual and social defences against anxiety associated with unconscious fear and
hatred of dependency. The findings also highlight a phenomenon that the researcher
characterises as depersonalisation – a social care system that appears unreal,
detached and emotionally numb. The need for emotionally engaged social workers
capable of bearing reality is a suggested response to such phenomena in adult social
care. It is proposed that social workers have an essential role to play in perceiving and
responding to such defences and countering the adverse effects of depersonalisation.
Drawing on Fairbairn’s (1952) concept of ‘mature dependence’, the author argues that
the social work role should include facilitating the developmental achievement of
mature dependence for people accessing adult social care. Secondly, the findings
reveal the need for better integration of a form of personalisation rooted in principles of
self-directed support and relationship-based practice approaches in social work.
Finally, a reorientation towards contribution-focused practice and an outline
personalisation relationship-based practice model emerges from the findings. The draft
model proposes that social work practice in adult social care in a policy context of
personalisation should be focused on interdependence, choice and control, and
reciprocity
Exploring the educational experiences of young homeless people
Get PDFThe research explored the educational experiences of young homeless people. It is acknowledged that the outcomes and difficulties experienced within education, are different from those of the homeless population and their housed peers. 7 participants were recruited from Centrepoint, a UK based youth homeless charity, all aged 18-19. Interviews were used to capture the experiences of the young people, and Smith, Flowers & Larkin's IPA stages used to analyse them. Participants’ individual experiences are presented within the research as well as overarching themes found within the participant group. These overarching themes were found to be: 1) needing additional support in school; 2) behavioural or academic failings at school; 3) avoiding failure and building a future; 4) motivation or change in motivation towards education; 5) lack of drive towards education; 6) support from professionals and external organisations; 6) support from teachers; 7) unsupportive educational settings/professionals; 8) challenges meeting basic needs and accessing resources. The findings are discussed within the context of youth homelessness in education, and alongside current research. The research encourages educational professionals to consider how these experiences might impact an individual’s ability to access education, and what school settings can do to support the experience of homeless individuals. Limitations of the research are considered, and opportunities for future research are identified
Steer clear of amorous advances
No full textBoundaries in the doctor-patient relationships can get crossed for a variety of reasons. Dr Gabrielle Pendlebury explores amorous advances from patients and how to handle these delicate situations
Creating a link between CAMHS and children's centres in a deprived area: A case of setting up a Work Discussion Group
Get PDFThis thesis explores the process of setting up a Child Psychotherapy-led outreach
service in Children’s Centres (CC) in a deprived urban setting. Our team decided that
setting up Work Discussion Groups (WDGs) for CC staff would be the best starting
point towards engaging and sensitising frontline workers to early signs of mental
health problems. This research focuses primarily on exploring both CC staff and
Child Psychotherapists’ (CPs’) experience of participating in this initiative. Semistructured interviews were conducted and then analysed using Interpretative
Phenomenological Analysis (IPA), coupled with a psychoanalytic understanding, to
shed light into the lived experience of the participants in this project. The author
draws attention to CC being containers for significant child and parental anxieties.
The CC’s increasing safeguarding role is a concerning finding of this study as it is
particularly stressful for CC staff and has implications for their practice. The study -
in line with existing literature- highlights the importance of time and a consistent
‘therapeutic presence’ in CC. Understanding the culture of the institution and taking
into account the impact of deprivation and financial insecurity are essential aspects
to be considered when designing and implementing an intervention in a deprived
community. Powerful dynamics that give rise to unconscious attacks on the outreach
worker, splitting between good and bad services, paranoid anxieties and lack of trust
are likely to occur. CC staff struggle with managing safeguarding concerns while
they tend to focus more on parents’ difficulties and developmental issues and less on
children’s emotional wellbeing and attachment to their carers. The author suggests
that CC staff could benefit from working closely with CPs and from participating in
WDGs on a regular and voluntary basis, so that they can be better equipped to think
about children’s emotional states
Informing the personalisation of interventions for parents of children with conduct problems: a qualitative study
Get PDFBackground: Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit.
Methods: Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective.
Results: Parents’ accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child’s teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child’s individual issues were never considered.
Conclusions: Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances
Systemic and constructionist therapy change process as performance
No full textThis article presents a systematic, qualitative meta-synthesis review illustrating change process performance by synthesizing 35 papers reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue
From omnipotence to acceptance: the account of an infant observation of the painful and necessary disillusionment of Jacob
No full textThis paper builds on Winnicott’s and Hopkins’ understanding of the potentially detrimental risks of a child receiving ‘too-good mothering’; the paper explores the possible consequences of the prolonged experience of perfectly attuned care of ‘Jacob’, from his sensitive, responsive mother. The author makes use of observational material to consider the important processes of idealisation, splitting and omnipotence involved in Jacob’s relationship to his mother, followed painfully by his difficulty at the next stage, that of integrating reality with ideal. His carefully managed transition to the childminder, so that his mother could work, was felt by all members of the family to be unbearable, and the arrangement fell apart. The author also looks at the roles of Jacob’s father and grandmother who could step in to offer something good enough, providing him with a second chance to work through the developmental task, in Winnicott’s terms, of becoming gradually disillusioned and more able to face reality