‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden

Background Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

Life situations and the care burden for stroke pa­tients and their informal caregivers in a prospective cohort study

Background. The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective. Methods. A total of 377 Swedish stroke patients, aged ‡65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score. Results. Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient’s functional ability, low received municipal social service support, closeness of patient–caregiver relation, and short distance to patient’s home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient’s age, sex, functional ability, and patient–caregiver relationship. CB score increased with amount of informal caregiver support, patient’s age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time. Conclusions. There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

Aligning multiple knowledge perspectives in a health services system : a case study

This chapter reports the results of a feasibility study into electronic collection of service data at “point of delivery” for disability programs. The investigation revealed that while the proposed system would have produced more fine-grained data, it would not have improved any actor’s knowledge of service delivery. The study illustrated the importance of context in the transition from data to knowledge; the diffused and fragmented organisational structure of social service administration was shown to be a major barrier to effective building and sharing of knowledge. There was some value in the collection of detailed service data but this would have damaged the web of relationships which underpinned the system of service delivery and on which the smooth functioning of that system depended. The study recommended an approach to managing the informal and tacit knowledge distributed among many stakeholders, which was not especially technologically advanced but which supported, in a highly situated manner, the various stakeholders in this multi-organisational context.

Pharmaceutical benefits in Australia and Sweden: welfare policy and the cost of prescription drugs

Pharmaceutical benefits provide a stable framework within which consumers, prescribers, suppliers, pharmacists and other actors undertake transactions. The state in effect delivers a good that enhances individual autonomy. A major reason for the legitimacy enjoyed by pharmaceutical benefits in both Australia and Sweden is that these programs have strong attributes of universalism (rather than targeting). Sweden's predominantly public health system allows greater scope for pharmaceutical policy innovation. Australia's Pharmaceutical Benefits Scheme (PBS), while historically resilient and effective, is now wedged precariously between traditional considerations of equity and public health on the one hand, and constant pressure for increased marketisation on the other.

Privatising human rights: what happens to the state`s human rights duties when services are privatised?

Human rights law has traditionally focused on the obligations of states in fulfilment of human rights - how a state-focused approach fits in a world where social services are frequently privatised or contracted out - examples of social service provision, health, education and prisons, and inquiries into the obligations of the state and the private operators in relation to these services - private providers of social services have certain human rights obligations within their respective spheres of activity - the state retains an obligation to guarantee the protection and realisation of human rights of everyone under its jurisdiction, regardless of the character of the service provider.

The limitations of using statutory child protection data for research into child maltreatment

Child protection legislation has undergone a number of changes since its inception, changes that have redefined the population of children in need of protection. However, child protection data on notifications and substantiations remain the most common source of data for statistics on the rate of maltreatment and the breakdown of specific maltreatment types. In the present study, three factors are identified that have compromised the accuracy of child protection data reporting the incidence of child abuse and neglect: (i) the legislative changes that mandate child protection services to protect children from harm rather than from identifiable adult actions; (ii) the shift from the Harm Standard to the Endangerment Standard; and (iii) the assignment of responsibility solely to parents.

`Building bridges`: a case study of a collaborative research process

'Building bridges' is a metaphor we have used to describe a collaborative research process involving social work academic and senior practitioners from government and non-government child protection and family service organizations in Victoria, Australia. The purpose of the research was to develop a 'practice-generated approach to policy implementation' in child protection practice. The research sought to explore the appropriateness of social constructionist approaches for child protection practice that might enhance the existing risk paradigm. This article aims to critically evaluate the process of 'building bridges' and its outcomes, by focusing on how potential and actual differences between organizational contexts, namely universities and various serviceproviding organizations, may influence relationships between theory and practice. We critically reflect on our research process comparing it with idealized forms of collaborative research discussed in the literature.

Issues in developing e-health systems: an Australian case study

Over the last few years, perceptions of the importance of eHealth have increased rapidly, together with the use of IS&T in the delivery of health and social services. Although “e” approaches to health and social services have much potential, they are not panaceas, and the use of new technologies in improving the efficiency and effectiveness of such systems cannot be considered in isolation from their wider context. eHealth systems remain complex socio-organisational systems and, as we will argue and illustrate through this case study, require that a balanced approach to feasibility and desirability analysis be taken.

The case study in this paper describes a feasibility study into the potential effectiveness of a smartdevice-based electronic data collection and payment system which was proposed for the provision of disability services. A key finding of the study was that the most significant impediment to such a system was the highly diffused, fragmented, interlocking organisational structure of the social service administration itself. Rather than raise issues specific to the implementation or diffusion of new technologies in designing e-health services, it raised issues associated with decision making and control in such an environment, and with the design of the underlying organisational system: for service provision, the level of detail required in the service data, and the locus of decision-making power among the stakeholders.

In our account we illustrate the existence of multiple, incommensurate but valid perceptions of the human service provision problem, and discuss the implications for developers or managers of information systems in the arena of e-health or governance. We examine this environment from sociological and information systems perspectives, and confirm the usefulness of socio-organisational approaches in understanding such contexts.

Multiple barriers to obtaining child support : experiences of women leaving violent partners

This article reports on a study which explores how policies and practices shape the experiences of single parents when seeking and using child support from violent ex-partners. The findings of this and similar research studies on violence, child support and poverty indicate that the receipt of child support is a multi-step process plagued with multiple barriers.

Conflict resolution and policy making mediation in the Mekong River Basin

The Mekong River serves China, Myanmar, Thailand, Laos, Cambodia and Vietnam covering an area of approximately 795, 000 square kilometres and the Mekong River basin is a delicate eco-system rich in natural resources and bio-diversity. Competing demands for increasingly scarce supplies of water, the reciprocal impacts of land and water uses and inadequate governance arrangements have given rise to conflicts that has to be resolved by policy making to facilitate a process, whereby the main principles adopted in the Mekong River Agreement can be implemented.