Health care professionals' views of paediatric outpatient non-attendance:implications for general practice

Background. Non-attendance at paediatric hospital outpatient appointments poses potential risks to children's health and welfare. Prevention and management of missed appointments depends on the perceptions of clinicians and decision makers from both primary and secondary care, including general practitioners (GPs) who are integral to non-attendance follow-up. Objectives. To examine the views of clinical, managerial and executive health care staff regarding occurrence and management of non-attendance at general paediatric outpatient clinics. Methods. A qualitative study using individual semi-structured interviews was carried out at three English Primary Care Trusts and a nearby children's hospital. Interviews were conducted with 37 staff, including GPs, hospital doctors, other health care professionals, managers, executives and commissioners. Participants were recruited through purposive and 'snowball' sampling methods. Data were analysed following a thematic framework approach. Results. GPs focused on situational difficulties for families, while hospital-based staff emphasized the influence of parents' beliefs on attendance. Managers, executives and commissioners presented a broad overview of both factors, but with less detailed views. All groups discussed sociodemographic factors, with non-attendance thought to be more likely in 'chaotic families'. Hospital interviewees emphasized child protection issues and the need for thorough follow-up of missed appointments. However, GPs were reluctant to interfere with parental responsibilities. Conclusion. Parental motivation and practical and social barriers should be considered. Responsibilities regarding missed appointments are not clear across health care sectors, but GPs are uniquely placed to address non-attendance issues and are central to child safeguarding. Primary care policies and strategies could be introduced to reduce non-attendance and ensure children receive the care they require. © The Author 2013.

Domestic violence and child abuse: developing sensitive policies

Domestic violence is everywhere and nowhere. No statutory organization or health service has work with either perpetrators or survivors of domestic violence (usually women and children) as the primary focus of their service, yet all agencies will have very significant numbers among their clients/service users. It is therefore crucial that the policy framework is developed both within and between agencies to address the need, and scope, of intervention in this area and particularly the impact on children. Currently, significant steps have been taken by some agencies in the UK to address this previously neglected issue, though the developments are patchy. This paper draws on a UK-wide research study which mapped the extent and range of service provision for families where there is domestic violence and also developed a framework of good practice indicators for ‘Mapped the extent and range of service provision for families where there is domestic violence and also developed a framework of good practice indicators’ provision in this area. This article examines one of the indicators of good practice arising from the research—that of policy development—within social service departments and within the multi-agency arena.

Auctions law and practice

This is the new edition of the leading work on the law and practice of auctions. The book looks at every aspect of auction practice from the economics of auction sales and restrictions on trading to criminal and other liabilities of the auctioneer. There is also a chapter on VAT. There have been important recent developments in the field of consumer protection and the book has been substantially revised to reflect these. In addition to general updating the new edition considers the practice of online auctions for the first time. There is also a section on looted art . The book continues to draw on case law from other common law jurisdictions.

Current practice and opinion in special schools for the maladjusted in England and Wales

This study seeks to describe current practice and opinion in schools for the maladjusted in England and Wales and to exarnlne how far this coincides with earlier descriptions. A review of the literature provides an account of this earlier work, and data accrued from questionnaires completed by 114 schools describe current practice and opinion. The study represents the most extensive empirical enquiry into the work of these schools since 1955 and provides a wide data basis for future research and assessment of progress and change. The data suggest that there is much communality of practice and opinion within the schools, with most schools emphasising their therapeutic rather than their educational purpose. The work is characterised by the wide use and perceived efficacy of warm, caring adult to child relationships, improvement of pupil self-image through success, and individual counselling and discussion, which permeate a structure of routine, discipline and educational concern. Specialised treatments are not used widely and involve only a minority of pupils. Practice tends to be in reference to conduct disordered pupils who are now perceived as the largest single disorder group within the schools, whereas previously neurotic disorders formed the largest single group. The majority of pupils are perceived as underachieving on entry and requiring remedial help: consequently the educational programme has a remedial bias. For staff, qualities of personality are considered to be more valuable than professional skills. The schools differ in the emphasis they allocate to one or more of four identified areas of treatment described as concern for pupils' needs; degree of pupil participation; theoretical orientation: and the use of external controls. There is a diminished reference to psychoanalytical theory and an increased reference to behaviourist theory relative to previous practice. Similarly, the use and perceived importance and effectiveness of pupil participation and unconditional affection has diminished.

Developing the practice of educational psychologists through theory and research

Recent research in literacy acquisition has generated detailed programs for teaching phonological awareness. The current paper will address three issues that follow from this research. Firstly, much of the past research has been conducted under conditions that are divorced from the classroom. As a result, it is not known whether the suggested teaching strategies will lead to an increase in children’s attainments when integrated into a broad reading curriculum implemented by teachers in mainstream classrooms. Secondly, these phonological interventions have been designed either to prevent the occurrence of reading difficulties or to meet the needs of failing readers. Therefore, it is not known whether the same methods would advantage all children. Thirdly, teaching children to read takes a minimum of two to three academic years. We herefore need to develop a reading curriculum that can provide the progression and differentiation to meet a wide range of needs over several academic years. We report two studies that have addressed these issues through monitoring the impact of a reading curriculum, implemented by teachers, which integrated children’s acquisition of phonological skills with broader aspects of teaching reading over three academic years. The attainments of children at all levels of ability in the experimental group were raised relative to controls, and importantly, these gains were maintained after the intervention was withdrawn. These results demonstrate that phonological awareness training can be successfully integrated into real classroom contexts and that the same methods raised the attainments of normally developing children, as well as those at risk of reading failure.

Developing a tool to support communication of parental concerns when a child is in hospital

The involvement of parents in their child’s hospital care has been strongly advocated in paediatric healthcare policy and practice. However, incorporating parental worries about their child’s condition into clinical care can be difficult for both parents and healthcare professionals. Through our “Listening To You” quality improvement project we developed and piloted an innovative approach to listening, incorporating and responding to parental concerns regarding their child’s condition when in hospital. Here we describe the phases of work undertaken to develop our “Listening To You” communications bundle, including a survey, literature review and consultation with parents and staff, before findings from the project evaluation are presented and discussed.

Parenting a child with chronic illness as they transition into adulthood:a systematic review and thematic synthesis of parents’ experiences

Objective - To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services. Methods - Five databases were systematically searched for qualitative articles examining parents’ views and experiences of their child’s healthcare transition. Papers were quality assessed and thematically synthesised. Results - Thirty-two papers from six countries, spanning a 17-year period were included. Long-term conditions were diverse. Findings indicated that parents view their child’s progression toward self-care as an incremental process which they seek to facilitate through up-skilling them in self-management practices. Parental perceptions of their child’s readiness, wellness, competence and long-term condition impacted on the child’ progression to healthcare autonomy. A lack of transitional healthcare and differences between paediatric and adult services served as barriers to effective transition. Parents were required to adjust their role, responsibilities and behaviour to support their child’s growing independence. Conclusion - Parents can be key facilitators of their child’s healthcare transition, supporting them to become experts in their own condition and care. To do so, they require clarification on their role and support from service providers. Practice Implications - Interventions are needed which address the transitional care needs of parents as well as young people.

Interventions for nurses caring for a child who has an unexpected acute life threatening event (ALTE) in hospital

Introduction: Caring for a child who has an unexpected ALTE in hospital can be stressful. An ALTE may include a cardiac arrest, respiratory arrest or call for immediate assistance. An international survey of practice was conducted to identify any existing interventions to inform a PhD program of work aimed at reducing the stress from these events through preparation and support. Purpose: The purpose of the survey was threefold: (1) Describe ‘normal’ practice when it comes to preparing staff or providing psychological support after caring for a child who has had an ALTE. (2) Determine if there are any interventions to prepare clinical staff for potential psychological effects of caring for a child who has an ALTE. (3) Determine if there are any interventions to provide support for clinical staff after caring for a child who has an ALTE. Material - Methods: An 18 item semi structured questionnaire was designed for the study to allow respondent to describe practices within their institution and outline their opinions and professional experiences. Clinicians from selected children’s and adult hospitals in Australia, Canada, New Zealand, United Kingdom and the United States of America were contacted by telephone. Following consent they were given the option to complete the survey via the telephone, by post or online. Results: Of the 61 hospitals approached 44 (72%) clinicians responded. Eighteen (41%) respondents identified interventions in place to prepare nurses for an ALTE ranging from (but not limited to) ad hoc discussions during life support training through to structured simulation training. Thirty-six (82%) respondents identified that they had interventions in place to support nurses after an ALTE ranging from (but not limited to) debriefing through to structured case reviews. Conclusions: Interventions varied across institutions, with no outcome or evaluation data for the interventions published to date.