The perspectives of young children in care about their circumstances and implications for social work practice

Recent reviews of research regarding children in care have concluded that there remains little research which specifically focuses on young children. This paper presents the findings of research carried out with a sample of young children in care (aged 4-7 years) regarding their perspectives of their circumstances. The findings reveal that they have deeply held views regarding living with risk; removal from their families; unresolved feelings of guilt and loss; and not being listened to. This paper considers the implications of these findings for social work practice. It concludes by stressing the capacity of young children in care to express their perspectives, and the importance of practitioners seeking these views and incorporating them into assessment and decision-making processes.

Family support, social capital, resilience and adolescent coping

All too often young people are excluded in practice from the general policy and professional consensus that partnership and participation should underpin work with children, young people and their families. If working with troubled and troublesome young people is to be based on family support, it will require not only the clear statement of that policy but also demonstration that it can be applied in practice. Achieving that involves setting out a plausible theory of change that can be rigorously evaluated. This paper suggests a conceptual model that draws on social support theory to harness the ideas of social capital and resilience in a way that can link formal family support interventions to adolescent coping. Research with young people attending three community-based projects for marginalized youth is used to illustrate how validated tools can be used to measure and document the detail of support, resilience, social capital and coping in young people's lives. It is also suggested that there is sufficient fit between the findings emerging from the study and the model to justify the model being more rigorously tested.

Home curation versus teenage photography: Photo displays in the family home

In this paper we report an empirical study of the photographic portrayal of family members at home. Adopting a social psychological approach and focusing oil intergenerational power dynamics, our research explores the use of domestic photo displays in family representation. Parents and their teenagers from eight families in the south of England were interviewed at home about their interpretations of both stored and displayed photos within the home. Discussions centred on particular photographs found by the participants to portray self and family in different ways. The findings show that public displays of digital photos are still curated by mothers of the households, but with more difficulty and less control all with analogue photos. In addition, teenagers both contribute and comply with this curation within the home, whilst at the same time developing additional ways of presenting their families and themselves online that are 'unsupervised' by the curator. We highlight the conflict of interest that is at play within teen and parent practices and consider the challenges that this presents for supporting the representation of family through the design of photo display technology. (C) 2009 Elsevier Ltd. All rights reserved.

Bereavement Assessment Practice in Hospice Settings: Challenges for Palliative Care Social Workers

The management and delivery of bereavement support services in palliative care settings presents practical and ethical challenges. A national survey, conducted in 2007, examined bereavement practice in ten Marie Curie hospices across the United Kingdom. This qualitative study was undertaken using semi-structured telephone interviews with Bereavement Service Leaders located in each hospice. Although findings revealed that bereavement services were in operation and had been reviewed in response to the National Institute for Clinical Excellence Guidance (2004), and all bereaved families were offered support, there was no standardisation of service delivery across sites. Multi-disciplinary team meetings facilitated shared decision-making for bereavement follow-up, and expanded and clarified documentation completed by nursing staff around the time of the patient’s death. However, there was ambiguity regarding professional ‘duty of care’ and agency responses to bereaved individuals who were suicidal. Questions were raised around clinical effectiveness, reliability and professional accountability. The study highlighted ethical issues centred on documentation, user participation and consent, and found staff training was variable across the 10 hospices. The findings have informed the development of a post-bereavement service model which has been subsequently implemented across Marie Curie Cancer Care.

Teaching family carers about home based palliative care: Final results from a group education program

Without the considerable support provided by family carers, many patients receiving palliative care would be unable to remain at home. However, family carers typically lack the required information and skills to prepare them for such a role. Pilot work has demonstrated that group education programs for family carers can be readily developed; they are feasible, accessible, and useful. This project sought to build on our pilot research to further examine the effectiveness of a group education program by evaluating the outcomes with a larger number of participants. The program aimed to prepare primary family carers for the role of supporting a relative with advanced, noncurative cancer at home. The psycho-educational program consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria, Australia. The following dependent variables were measured at three time points: carer competence, preparedness, rewards, and information needs. The three time points were: commencement of the program (Time 1), upon completion (Time 2), and two weeks later (Time 3). A total of 156 participants (including the pilot phase) completed Time 1 questionnaires and 96 completed all three time periods (62%). Between Time 1 and Time 2, the intervention had a statistically significant positive effect on preparedness, competence, rewards, and having informational needs met. Outcomes were maintained at Time 3. There was no difference in the effectiveness of the intervention for participants in regional areas compared to participants in metropolitan areas.

This study demonstrated that a group education program to prepare family carers for the role of supporting a dying relative at home was effective. Implications for further research and practice are outlined.

An Educational Initative in Anaesthetic Nursing Practice

The National Board for Nurses, Midwives and Health Visitors in Northern Ireland (NBNI) has adopted the principles of the UKCC's recommendations for specialist nursing practice and Incorporated these within their continuing education framework. Stage two of this framework decrees the standard required for specialist nursing practice (NBNI, 1995) and, as a result, a specialist anaesthetic nursing course has been instigated. The course extends over 44 weeks and includes 8 weeks of consolidation practice, comprising seven modules at degree and diploma level. The course gives the students an opportunity to deepen their knowledge, skills and attitudes in the field of anaesthetic nursing. Nurses were taught the necessary skills to work in collaboration with other professionals, patients and families in order to coordinate a patient-centred approach to perianaesthetic care. The role of the anaesthetic nurse specialist should be viewed as complementary to that of the anaesthetist. This course facilitates and encourages practitioners to move beyond registered practice on qualifying to a more specialized role where care is delivered in an innovative and creative manner.

Systemic Family Therapy for Families who have Experienced Trauma: A Randomised Controlled Trial

This paper describes a randomised controlled trial (RCT) investigation of the added value of systemic family therapy (SFT) over individually focused cognitive behavioural therapy (CBT) for families in which one or more members has suffered trauma and been referred to a community-based psychotherapy centre. The results illustrate how an apparently robust design can be confounded by high attrition rates, low average number of therapeutic sessions and poor protocol adherence. The paper highlights a number of general and specific lessons regarding the resources and processes involved that can act as a model for those planning to undertake studies of this type and scope. A key message is that the challenges of conducting RCTs in ‘real world’ settings should not be underestimated. The wider implications in relation to the place of RCTs within the creation of the evidence base for complex psycho-social interventions is discussed and the current movement towards a phased mixed-methods approach, including the appropriate use of RCTs, which some might argue is a return to the original vision of evidence-based practice (EBP), is affirmed.

'How long are we able to go on?' Issues faced by older family caregivers of adults with disabilities

Research-informed policy and practice is needed for older caregivers of adult sons/daughters with disabilities. These caregivers are often under tremendous stress because of failing health, financial pressures, bereavement and worry about the future of their sons/daughters. Twenty-nine older parents/caregivers of 27 adults with intellectual and/or developmental disabilities were interviewed to explore their views and experiences regarding long-term care and service arrangements, health and psychological needs and 'future planning'. Findings show a severe lack of support, respite care and future planning which causes high stress levels for caregivers. Policy makers and researchers working in this field need to take into consideration the needs of older caregivers when making future plans for adults with disabilities.

General Practice after the Introduction of the QOF

While the Quality and Outcomes Framework (QOF) is reported to improve performance, its impact on some aspects of organisations need to be explored given the increased reliance on such schemes. Organisational culture can be seen as providing a sense of common values, belief, and norms, which may act as guidelines for behaviour in organisational settings. This research employs a competing value framework depictures different types of culture based on specific focuses and processes. The study is based on interviews with 2 GP practices in the north of England involving 19 participants. Healthcare professionals were aware that there is a dominant value held and shared strongly among members of the organisations-to provide high quality patient-centred services. This study found that while clan culture is still strong in both practices, changes occured in respondents' culture after the implementation of the QOF.

A computerized audit of non-steroidal anti-inflammatory drug prescribing in general practice

The two group practices based in a city health centre decided to prescribe non-steroidal anti-inflammatory drugs in generic form from an agreed date. The practices' computer was used to identify the number of repeat prescriptions being issued for this group of drugs and to monitor the effectiveness of the changeover. Although both practices showed a marked increase in the level of generic prescribing there was considerable interpractice variation. Generic prescribing for one practice increased from 4% to 64% and for the other from 1% to 38% of repeat prescriptions issued for non-steroidal anti-inflammatory drugs over the study period. The reasons for this variation, the advantages of computerized audit and the problems associated with this self-imposed audit are discussed.

Warts in general practice

Eight hundred and ninety seven patients referred by their general practitioner to Health Centre Wart Clinics were interviewed. Seventy one patients (7.9%) were found to have lesions other than cutaneous warts. Females were significantly more likely to have plantar warts on their toes (p less than 0.002) and non-plantar warts on their fingers (p less than 0.03) and less likely to have non-plantar warts on the palms of their hands (p less than 0.03) than males. Patients living in large households (5+ persons) were more likely than patients living in smaller households (2-4 persons) to report an infected co-habitant (p less than 0.001). Patients with periungual warts were significantly more likely to be nailbiters. (p less than 0.001). Patients presenting with warts greater than two years in duration were more likely to have multiple warts than those with warts less than one month in duration (p less than 0.001). Patients who frequently immersed their hands in water were more likely to present with multiple warts on the hands (p less than 0.001). Multiple plantar warts were associated with moist or macerated feet (p less than 0.001). The role of the family doctor in diagnosing and preventing the spread of this infection is discussed.

Correlates of health status for family caregivers in bereavement

The purpose of this retrospective cohort study was to identify aspects of caregiving associated with health status among family caregivers in bereavement. Study participants included 151 family caregivers of terminally ill patients who had died, on average, 294 days prior to the study telephone interview. The interview covered two main areas: patient characteristics and caregiver characteristics. Multivariate linear regressions revealed that as the age of the care recipient (regression coefficient [b] = -0.32; 95% confidence interval [CI] -0.48,-0.15) and caregiver (b = -0.14; 95% CI = -0.25, -0.02) increased, caregivers experienced a decline in their physical health during bereavement. Furthermore, caregivers who reported that caregiving interrupted their usual activities (b = -5.97; 95% CI = -9.79, -2.15) had a decline in physical health during bereavement. A poorer mental health status during bereavement was seen in caregivers who reported poor physical health during caregiving (b = -4.31; 95% CI = -8.17, -0.45); and that they received insufficient family support in caregiving (b = -6.01; 95% CI = -9.75, -2.27). It was also revealed that a home death was associated with higher mental health of the caregiver (b = 3.55; 95% CI = 0.26, 6.84). The practice implications of these findings are discussed in this paper.