Exploring associations between violent discipline and aggressive behavior in children ages 4-5 in The Republic of Nicaragua: A secondary data analysis of the 2011 Demographic and Health Survey

Thesis (Master's)--University of Washington, 2016-06

Suporte, Stress e Solidão: um estudo sobre o apoio offline e online percecionado pelas mães portuguesas

Uma “rede social” diz respeito a uma estrutura constituída por pessoas ou organizações que partilham interesses, motivações e valores comuns. Um ponto partilhado pelos diversos tipos de rede social é a troca de informações, conhecimentos, interesses e esforços na tentativa de atingir objectivos comuns, muitas vezes potencializando forças e recursos em situações de crise. Recentemente tem-se ouvido falar bastante deste conceito aplicado à internet. A maternidade constitui, por si só, um momento de crise na vida de cada família e de cada mulher, requerendo adaptações e mudanças. O estudo realizado teve o intuito de avaliar o suporte online e offline (denominando-se essas ligações de redes sociais), no caso específico de assuntos ligados à maternidade. Pretendeu-se verificar também se existia uma correlação entre estes tipos de suporte e os níveis de stress e solidão sentidos pelas mães. Por último, aferiu-se ainda a influência que a idade dos filhos teria nesta adesão a grupos de suporte à maternidade, no Facebook. Este estudo teve uma amostra constituída por 170 mulheres (mães), estando as suas idades compreendidas entre os 25 e os 62 anos. Os resultados revelaram que apesar de não haver diferenças estatisticamente significativas entre o apoio online e offline, as mulheres que pertencem a grupos do Facebook tendem a sentir mais suporte por parte das plataformas de suporte disponíveis. Constatou-se ainda que não existem diferenças significativas entre os níveis de solidão e stress, entre mães que pertencem a grupos e mães que não pertencem. Foi interessante verificar que as mulheres com filhos mais novos (faixa etária dos 0-4 anos) têm uma presença mais significativa em grupos de apoio à maternidade, no Facebook. Pensamos que isso se deve às dúvidas e ao stresse gerado por um primeiro filho ou pela introdução de mais um filho no núcleo familiar, nos primeiros anos em que tal ocorre, procurando por isso mais activamente grupos que ajudem como rede de suporte, para partilhas, apoio emocional e esclarecimento de dúvidas. / A “social network” refers to a structure formed by individuals or organisations that share interests, motivations and common values. A feature shared by several types of social network is the exchange of information, knowledge, interests and efforts, in an attempt to achieve common goals, often potentiating strengths and resources in crisis situations. Recently, we have heard of this concept applied to the internet. Motherhood is, by itself, a moment of crisis in the life of every family and every woman, requiring adaptations and changes. This study aimed to assess online and offline supports (being these connections themselves denominated social networks), in the specific case of motherhood-related issues. It was also intended to confirm whether there was a correlation between these types of support and stress and loneliness levels sensed by mothers. Finally, it was evaluated as well the influence that the children’s age would have on this adherence to motherhood support groups on Facebook. This study had a sample of 170 women (mothers), with ages between 25 and 62 years. The results showed that, although there are no statistically significant differences between the online and offline support, women who belong to Facebook groups tend to feel more support from the available support platforms. It was shown as well that there are no significant differences between loneliness and stress levels among mothers who belong to groups and mothers who do not belong to those groups. It was interesting to find that women with young children (aged 0-4 years old) have a more significant presence in motherhood support groups on Facebook. We think that this is due to the doubts and the stress generated by a first child or the introduction of another child in the household, therefore making sense that they seek, in the early years of the child’s life, groups that help as a support network, for shares, emotional support and answering questions.

Lärares ledarskap som möjliggörande och begränsande i mötet med ’alla’ barn : En deltagarorienterad studie

The aim of this thesis is to, based on teachers’ experiences, describe and analyse meanings of teachers’ leadership in general, and in relation to children in need of special support in particular. The study was carried out within the tradition of participatory-oriented research, a research circle. The dialogues in the circle were based on the participants’ questions, experiences, interests, and knowledge. The circle included a researcher and nine teachers from the following types of schools: preschool, preschool class, compulsory school, and compulsory school for pupils with learning disabilities. The study is based on an understanding of leadership as a relational practice. Leadership is practised in the interaction between teacher and child. Both parties exert influence over the practice of leadership. A central assumption in the study is that knowledge can develop through and in interactions between people, that knowledge and power are connected, and that knowledge and actions are intertwined. Another central assumption is that learning is a complex phenomenon. In the analysis of the research circle’s dialogues, the following meanings of teachers’ leadership emerge: to facilitate learning and discipline, and to promote different interests. The practice of leadership involves teachers handling complex situations in their interactions with ‘all’ children, i.e. children in need of special support and children without such needs. Leadership is practised between teachers and children, and the teachers have to consider the group of children as a collective in relation to the individual children. At the same time, the teachers have to consider their intentions versus what happens during the interactions. In addition, the teachers have to pay heed to the fact that their own actions and the children’s actions influence one another. Finally, the teachers have to consider the individual child’s ‘best interest’ in relation to the requirements of the policy documents. Furthermore, the results indicate that the practice of leadership is perceived as both unpredictable and, to some extent, predictable at the same time, which adds to the complexity of leadership. The teachers cannot know for sure what the children understand or if the children’s actions facilitate learning. However, the teachers can make certain assumptions about how to practice leadership in order to facilitate learning and discipline in children with different needs. The meanings of leadership were expressed in different ways in the circle’s dialogues; both as enabling and limiting in interactions with children in need of special support. One of the study’s conclusions is that leadership seems to be particularly complex in interactions with children in need of special support. The research circle’s dialogues served to promote a democratic knowledge process. The dialogues were characterised by respect for the participants’ different opinions; however, this does not mean that they were free from power structures.

La perception de la collaboration école-famille des parents d'élèves victimisés par leurs pairs au primaire

Ce mémoire vise à connaître la perception des parents de la collaboration école-famille principalement lorsque leur enfant est victime de violence à l’école primaire. Un total de 4 394 parents a complété le QSVE/parents (Beaumont Paquet et Leclerc, 2013). Les résultats révèlent que l’ensemble des parents a une perception positive de cette collaboration, mais elle est perçue plus positivement chez ceux ayant des enfants d’âge préscolaire comparativement à ceux de la fin du primaire. Les parents qui croient leur enfant victime de violence montrent cependant une perception plus négative de cette collaboration. Au primaire, c’est près de 20 % des parents qui ont dit avoir rapporté à l’école la victimisation de leur enfant au cours de l’année scolaire. Une relation significative a été observée entre le nombre de fois que les parents ont avisé l’école et leur niveau de satisfaction de l’accueil et de l’aide reçus par les intervenants scolaires. Même si la perception de la collaboration école-famille devient moins positive en fonction du nombre de fois que le parent a signalé cette victimisation, les résultats suggèrent que près de 40 % des parents qui ont signalé quatre fois et plus la victimisation de leur enfant au cours de l’année se sont dits satisfaits de l’aide reçue par l’école. Des pistes de réflexion sont finalement suggérées soulignant l’importance de pousser plus loin la réflexion sur les conditions facilitant la collaboration école-famille dans ce type de situation difficile.

Caring for Children Dying from Cancer at Home: a Qualitative Study of the Experience of Primary Care Practitioners

Background. The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective interprofessional collaboration with the team that forms to provide the care often working together for the first and only time. Objective. To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home. Methods. The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes. Results. GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child’s transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child’s family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases. Conclusions. Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help. Keywords. Cancer, family medicine, palliative care, paediatric.

Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Managing Transition from Curative to Palliative: GP and Bereaved Parent Experiences

Background Children with cancer in the UK are treated in regional childhood cancer centres (RCCC). Families and health care professionals can develop close working relationships over the often-long duration of treatment. Cancer still accounts for largest numbers of childhood disease related deaths and as home is commonly the choice of location for palliative and end of life care, the child and family can face transitions both from curative to palliative care and from hospital to home. This paper reports on findings relating to these transitions from the perspectives of parents and family doctors highlighting implications for both hospital and community based health care practitioners. Aims To explore the experiences of bereaved parents and family doctors following the death of a child with cancer in the family home. Methods Ethical approval was sought and obtained. In this qualitative study one-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents. The parents were those whose child had received treatment for cancer at a RCCC in the UK and who died at home, the GPs were those involved in the palliative care. Chronological comparative data analysis using grounded theory was completed. Results Cessation of contact with the RCCC when the child receives palliative care at home can be traumatic for parents. Hospital and community based health care professionals need to carefully consider how they establish, maintain and end working relationships with the child and family. Conclusions Findings from this study provide a new perspective to the effective management of transition in paediatric oncology palliative care; managing working relationships. Findings highlight the need for hospital and community based staff to identify and employ strategies that ensure working relationships with families are effectively managed prior to, during and following the child’s transition from curative to palliative care.

Processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus.

Challenges Facing Long Term Foster Carers: Exploration of the Nature of Psychoanalytic Parent/Carer Support

This research study investigates the role and impact of psychoanalytically-informed short-term parent work with long-term foster carers of looked-after children, in support of the foster placement. The study reflects on the data gathered from four child assessments and five foster families seen by a psychoanalytic child psychotherapist for four sessions each. It draws on psychoanalytic ideas from a range of theoretical traditions, exploring such concepts as trauma, defences, compulsion to repeat, psychological-mindedness, ‘container/contained’ (Bion) and ‘holding environment’ (Winnicott). One distinctive contribution of this research is what it adds to our already existing understanding of the defences (or responses) aroused in the carer when faced with the intense and distressing affect associated with the child’s early trauma; and the impact of this legacy of trauma on the child, on the carer and on the wider Social Services system. Applying Grounded Theory and psychoanalytically-informed clinical case study methodology to the research material, the study breaks down the data analysis into seven stages of coding, from the initial reading of the data to the eventual development of two key hypotheses. One of the predominant themes that emerged from the analysis was the carer’s capacity to remain focused on the child’s emotional needs and how this in turn was linked to the direction of the therapist’s focus. The successive analyses of the data culminated in the hypothesis that the more the therapist focused on the carer and the carer’s emotional states in the course of the parent work, the more the carer was enabled to focus on the child’s emotional needs. As the system of categories emerged according to the themes exemplified in the sessions, a particular focus of analysis became the concept of psychologicalmindedness, considered under several sub-categories: displaying insightful comments; awareness of the child’s bodily states; awareness of the child’s affect; the carer’s ability to recognize the child’s defences; and the carer’s ability to make links between the child’s current difficulties and the child’s past experiences. Through this analysis it became apparent that degree of psychological-mindedness was closely linked to the individual carer’s capacity to metabolize the child’s distressed and distressing communication. This in turn led to a deeper exploration of the situations that were particularly challenging for the carers: i.e., instances when the child was compelled to repeat past traumatic emotional states and as a result was communicating intense distress. This exploration eventually generated the second hypothesis: that in reaction to the child’s distress, the response of each carer could be plotted somewhere along a spectrum, from either distancing themselves from the child’s emotional state to seeking excessive closeness with the child (merging). The next stage of the analysis developed four new categories of carer responses to the distressed child: identification and distancing from the child; identification and merging with the child; the category that describes the carer’s psychologicalmindedness as being ‘impaired’; and ‘good enough’ caring. This then led to an exploration of the carer’s own defences at these most challenging times. This research demonstrates clearly that even within the short space of four sessions of weekly psychoanalytic parent work, it is possible to achieve significant improvement in a carer’s capacity to bear the child’s compulsion to repeat early traumas, and to help the carers become more emotionally available to provide the child with effective psychological parenting at such difficult and challenging times. Key words: looked-after children; long-term foster carers; psychoanalytic short-term parent work; trauma; compulsion to repeat; psychological-mindedness; empathy; defences; psychoanalytically-informed clinical case study research methodology; Grounded Theory research methodology.

Mothers’ perception of recovery and satisfaction with patent medicine dealers’ treatment of childhood febrile conditions in rural communities

Background Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine ‘mothers’ perception of recovery’ and ‘mothers’ satisfaction’ after PMD treatment of childhood febrile conditions, as likely drivers of mothers’ health-seeking behaviour, which must be targeted to reverse the trend. Methods Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15–45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21–47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05. Results Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs’ treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers’ satisfaction with PMDs’ treatment is significantly (p < 0.05) associated with mothers’ perception of recovery of their child (χ2 = 192.94, df = 4; p < 0.0001; Cramer’s V = 0.7079). However, predicting mothers’ satisfaction with PMDs’ treatment from a knowledge of mothers’ perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers’ perception of recovery based on knowledge of mothers’ satisfaction with PMDs’ treatment (lambda[A from B] = 0.4727). Conclusions Mothers’ satisfaction could be the key ‘driver’ of mothers’ health-seeking behaviour and is less likely to be influenced by mothers’ perception of recovery of their child. Therefore, mothers’ negative perception of their child’s recovery may not induce proportionate decline in mothers’ health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers’ satisfaction with the positive attributes of PMDs’ personality/practice and sets an important agenda for PHC reforms.

A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury

Primary objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. Design: The study was qualitative, using a thematic analysis approach. Methods and procedure: Six children between 9 and 18 years of age, six parents (three with ABI), and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. Conclusions: The results reveal an interaction between the child’s experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child, and the children’s need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

Values and Beliefs Held About Parenting and Education by School Staff and Parents of Pupils with Special Educational Needs in the Context of Home- School Collaboration

Effective collaboration between school staff and parents of children identified as having special educational needs is considered to be an essential component of the child’s successful education. Differences in beliefs and perspectives adopted by the school staff and parents play an important role in the process of collaboration. However, little is known about the precise relationship between the beliefs and the process of collaboration. The purpose of this study was to explore the values and beliefs held by the school staff and parents in the areas of parenting and education. The study also explored the link between these beliefs and the process of collaboration within four parent-teacher dyads from mainstream primary schools. Focus groups and semi-structured interviews based on repertory grid technique were used. The findings highlighted an overall similarity in the participants’ views on collaboration and in their important beliefs about parenting and education. At the same time, differences in perspectives adopted by parents and teachers were also identified. The author discusses how these differences in perspectives are manifested in the process of collaboration from the point of Cultural Capital Theory. The factors such as power differentials, trust between parents and teachers, and limited resources and constraints of educational system are highlighted. Implication for practice for teachers and educational psychologists are discussed.

My Ideal School: A Personal Construct Psychology Approach to Understanding the School Constructs of Children Described as Anxious

This research explores the school constructs of children described as anxious. Little research exists that looks at understanding children’s school-related anxiety through the lens of Personal Construct Psychology (PCP). This qualitative research design includes semi-structured interviews that followed a PCP theoretical framework. The interviews were carried out with five children aged between 7 and 11, who attended state schools in Malta, and who were experiencing school-related anxiety. Participants were asked to comment and produce drawings about the kind of school they would like to attend (their ideal school), and the kind of school they would not like to attend. The children’s constructs were organised according to whether they related to adults in school, their peers, the school and classroom environment, and the participants themselves in each of these two imaginary schools. Participants were also asked to think of how the school they currently attend can become more like their ideal school. Findings indicate the importance of relationships between teachers and pupils, relationships amongst pupils themselves, a positive learning environment within the classroom and the belongingness to a common value system and school ethos to which anxious children can relate. This research aims to shed light on the responsibility of professionals working with children with school-related anxiety to look beyond within-child factors and understand possible stressors in the child’s environment as potentially contributing to heightening their anxiety.

Child Safety Signal Learning in the Context of Parental Worry, Overprotection, PTSD, and Depression

Thesis (Ph.D.)--University of Washington, 2016-08

Den nyanserade bilden av barnet : -En studie av samtalsmallar inför utvecklingssamtal på förskolan

Målet med studien är att förstå hur och vad som beskrivs och bedöms genom de samtalsmallar som används inför utvecklingssamtal på förskolan. Det är en kvalitativ studie baserad på innehållsanalys av insamlade dokument. Innehållsanalysen utfördes genom kodscheman som tas upp av Bergström och Boréus (2008). I analysarbetet har vi inspirerats av diskursanalysen. Studien är baserad på åtta samtalsmallar inför utvecklingssamtal från olika förskolor i en kommun i Mellansverige. Studien visar att samtalsmallarna innehöll flera olika sätt att beskriva och bedöma barn. Genom vårt analysarbete fann vi framför allt fem tydliga teman som utgör vårt resultat; Det lärande barnet, där barnet genom samtalsmallarna beskrivs och bedöms inom olika områden och ses som lärande eller under utveckling. Barnet som person, baserat på punkterna i samtalsmallarna som utgörs av bedömning och beskrivning av barnets personliga attribut. Det bristande barnet, med grund i samtalsmallarnas fokus på barnets tillkortakommanden och brister. Barnet i verksamhetens kontext, utifrån punkter i samtalsmallarna där verksamheten beskrivs och bedöms och Det positivt framställda barnet, grundat i till exempel uppmaningar i samtalsmallarna om att hålla samtalen i positiv anda. Tillika visar studien att flera olika barnsyner ligger till grund för hur barn ska beskrivas och bedömas i samtalsmallarna, samt att det råder motsägelser och bristande direktiv i förskolans styrdokument för utvecklingssamtalens syfte och innehåll.