Comparing long-term placements for young children in care: Does type of placement really matter?

This paper presents findings from the third phase of a longitudinal study, entitled Care Pathways and Outcomes, which has been tracking the placements and measuring outcomes for a population of children (n = 374) who were under the age of five and in care in Northern Ireland on the 31st March 2000. It explores how a sub-sample of these children at age nine to 14 years old were getting on in the placements provided for them, in comparative terms across five placement types: adoption; foster care; kinship foster care (with relatives); on Residence Order; and living with birth parents. This specifically focused on the development of attachment and self-concept from the perspective of the children, and behavioural and emotional function, and parenting stress, from the perspective of parents and carers. Findings showed no significant placement effect from the perspective of children, and a statistically weak, but descriptively compelling, effect from the perspective of parents. The findings challenge the notion of adoption as the gold standard in long-term placements, specifically from the perspective of children in terms of their parent/carer attachments and self-concept, and highlight what appears to be the central importance of placement longevity for delivering positive longer-term outcomes for these children, irrespective of placement type.

Mobile Phones and Contact Arrangements for Children Living in Care

This article reports the findings from the first UK study to examine the use of mobile phones by looked after children. Contact with family and friends is important, but it has sometimes to be carefully managed to avoid unintended consequences such as placement instability. The study examined the ways in which mobile phone technology impacts on contact, drawing on the experiences of children and young people in foster-care and residential care, and of policy makers, social workers, foster parents and residential care staff. No guidance was available that addressed the issue of mobile phone contact arrangements for looked after children and young people. Three years on from the start of the study, this remains the case in the area where the study was conducted, resulting in variation in the way mobile phone use for contact is managed; the issue appears only to be specifically addressed when identified as a problem. The position of mobile phone facilitated contact as a recognised form of contact requires review. The evidence suggests it should routinely form part of children’s care plans, and that residential staff and foster parents need to be adequately prepared and supported for the dynamics of mobile phone facilitated contact.

Doing Relationships and Sexuality Education with Young People in State Care

Background: Existing literature indicates that young people in state carehave particular sexual health needs that include addressing their social andemotional well-being, yet little has been published as to how thesecomponents of sex education are actually delivered by service-providers.Objective: To analyse the processes involved in delivering relationship andsexuality education to young people in state care from the perspectives ofa sample of service-providers with a role in sexual health care delivery.Design: Qualitative methodological strategy.Setting: Service-delivery sites at urban and rural locations in Ireland.Method: Twenty-two service-providers were interviewed in depth, and datawere analysed using a qualitative analytical strategy resembling modifiedanalytical induction.Findings: Participants proffered their perceptions and examples of theirpractices of sex education in relation to the following themes: (1)acknowledging the multi-dimensional nature of sexual health in the case ofyoung people in care; (2) personal and emotional development educationto address poor self-esteem, emotional disconnectedness and an inabilityto recognise and express emotions; (3) social skills’ education as part of arepertoire of competencies needed to negotiate relationships and safer sex;(4) the application of positive social skills embedded in everyday socialsituations; and (5) factual sexuality education.Conclusion: Insights into service providers’ perceptions of the multidimensionalnature of the sexual health needs of young people in statecare, and the ways in which these service-providers justified their practicemake visible the complex character of sex education and the degree of skillrequired to deliver it to those in state care.

GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.