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.

Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution

Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of “Porto proposal” criteria. Incidental thyroid cancer, Papillary microcarcinoma, Papillary microtumors, Total thyroidectomy.

A case study of teaching and learning practice in a Chinese adult institution

Résumé: Cette recherche s'est réalisée dans une institution chinoise de formation des adultes. Il existe très peu d'études présentant la pratique de l'enseignement et de l'apprentissage en Chine. Aussi, il semble que cette étude de cas puisse être utile. Elle porte sur le personnel de formation en administration économique dans un centre de formation de Tianjin. Le but premier de cette recherche est de décrire ce qui se fait à cet institut de formation des adultes. Les aspects couverts vont de la sélection du contenu de formation et des modalités d'enseignement jusqu'à la compréhension de l'enseignement et de l'apprentissage. À partir de l'expérience des professeurs de ce centre de Tianjin, cette étude cherche précisément à décrire leurs perceptions et leurs attitudes en regard d'un enseignement centré sur l'apprentissage et développé selon un mode de collaboration. Les fondements théoriques retenus s'inspirent des conceptions andragogiques de Knowles, de celles de Brookfield qui ont trait aux rôles des formateurs et formatrices d'adultes et de Conti qui présente une conception de l'enseignement qui se développe selon un mode de collaboration. Les données sont été retenues à la suite d'interviews et de questionnaires. Ce dernier instrument a été administré à 70 professeurs de formation aux adultes. Les résultats obtenus sont décrits et analysés. Les principaux éléments indiquent que la pratique actuelle de formation des adultes à ce centre de Tianjin ne tient pas compte des principes de l'éducation des adultes présenté selon un mode de collaboration. La formation est centrée sur l'enseignement. Il est à souhaiter que cette recherche contribuera à développer une meilleure compréhension de l'enseignement et de l'apprentissage en Chine tel que perçus par les formateurs et formatrices. Quelques suggestions de recherche complémentaires sont proposées à la fin.||Abstract: The present study grew out of one Chinese adult institute. Relatively few works are available that present a view of what actually happens in Chinese adult teaching and learning practice. Accordingly, it is believed that a case study on Tianjin Institute of Training Economic Management Personnel (TITEMP) which has been working for years in varions forms of adult programs, will be very useful addition to the knowledge of Chinese adult teaching and learning. The primary purpose of the present study is to serve as an introduction to one Chinese adult institute (TITEMP) in terms of characteristics of teaching, including selecting teaching content and teaching pattern, and to expand the understanding of Chinese adult teaching and learning. Based on the experiences of teachers at TITEMP, the study seeks to investigate the issues of teacher's perceptions and attitudes of teaching and learning to obtain implications toward learning-centred and collaborative mode. The theoretical foundations include andragogical conceptions (Knowles), roles of adult teachers (Brookfield), and conceptions of collaborative teaching and learning mode (Conti). The main sources of data are: the interviews and results of the questionnaire. Questionnaire responses from 70 teachers with knowledge of adult teaching and learning are described and interpreted. The general findings of the study are that the existing adult teaching practice at TITEMP does not adequately account for the principles of adult learning in a collaborative mode with adult students. Adult learning is teaching-centred. Some suggestions for further research are offered. It is hoped and believed that this research will contribute to a better understanding of Chinese adult teaching and learning in general, more particularly to the empirical study of the teachers from teaching and learning perspective in a Chinese adult higher learning setting. The research findings will be used as basis for the exploration of Chinese adult teaching.

Les facteurs influençant le maintien à domicile ou l'entrée en institution des personnes de 75 ans et plus aux Îles-De-La-Madeleine

Ce document présente les résultats d'une enquête réalisée auprès de 105 personnes de 75 ans et plus vivant à domicile sur le territoire des îles-de-la-Madeleine. Cette étude permet l'acquisition d'information sur les principales caractéristiques des personnes âgées, de leur ménage, leur habitation, leur environnement physique et social et leur état de santé. De plus, elle favorise une compréhension des principaux événements inquiétants et susceptibles d'orienter ces personnes âgées vers l'hébergement institutionnel. Des services jugés prioritaires sont exprimés par ces aînés. Par conséquent, cette étude démontre qu'il est important de ne pas se fier uniquement à des "experts" pour déterminer les besoins des personnes âgées. Comprendre la dynamique qui met en présence les personnes âgées, le milieu naturel et l'organisation des services présente donc un enjeu très important pour l'avenir et c'est à ce défi que cette étude est consacrée. Dès lors, on peut s'attendre à ce que cette recherche identifie des pistes d'intervention susceptibles de conduire à des améliorations dans les politiques et les modes de distribution des services à domicile.

Valeur accordée à l'autonomie physique dans les activités de la vie quotidienne par les personnes âgées vivant en institution

La gérontologie est un domaine où les connaissances demeurent fragmentaires. Travailler auprès des aînés peut donc susciter des questions dont les réponses restent à éclaircir. L'une d'elles a fourni le point de départ de la recherche décrite dans ce mémoire. Il s'agit du manque de motivation à rester autonome physiquement, présenté chez un grand nombre de personnes âgées résidant en institution. Plus précisément, il sera traité de la valeur accordée à l'autonomie physique, c'est-à-dire d'un facteur intrinsèque de cette motivation. De plus, comme le domaine de l'autonomie physique reste large et imprécis, cette étude s'est limitée volontairement à l'autonomie physique dans les a.v.q. (activités de la vie quotidienne) de base; être autonome dans ses a.v.q., c'est pouvoir se nourrir, se laver, éliminer, s'habiller et se déplacer seul. Le présent travail s'attachera donc au domaine de la valeur accordée à l'autonomie physique dans les a.v.q. par les aînés. En particulier, il cherchera à fournir une réponse à la question suivante: "L'importance accordée à l'autonomie physique dans les activités de la vie quotidienne par les gens âgés diffère-t-elle selon que ces personnes sont institutionnalisées ou non?" Pour ce faire, la problématique rattachée à cette question sera d'abord précisée et les écrits des différents chercheurs et théoriciens sur les thèmes reliés à ce sujet seront résumés. La méthodologie utilisée, incluant les motifs entourant le choix des instruments et les critères définissant la population-cible, sera alors décrite. Puis, les résultats obtenus seront présentés et analysés. La portée de ces résultats, traitant de l'importance de la valeur accordée à l'autonomie physique et de ses déterminants (en particulier en ce qui a trait au lieu de résidence), sera ensuite discutée en rapport avec les limites rencontrées, permettant d'identifier, en conclusion, certaines pistes futures de réflexion.

Le financement du pensionnat Sainte-Marie : une institution indépendante et sous-contrôle, 1930-1960

[…] Dans la seconde moitié du XIXe siècle, on voit l'État québécois abdiquer ses responsabilités en matière d'éducation au profit de l'Église catholique. Durant près d'un siècle, l'État se confinera à un rôle marginal alors que l'Église exercera un monopole quasi-absolu sur le système d'éducation. Du côté des filles, les congrégations religieuses féminines se feront le moteur du développement de l'instruction. Dans ce contexte, la question du financement de l'éducation constitue une variable de première importance. En effet, la faiblesse du développement du système scolaire public a suscité une dynamique particulière dans les rapports entre le réseau d'écoles privées massivement développé par les congrégations enseignantes féminines et le réseau d'écoles publiques. Dans son étude de l'Académie Marie-Rose entre 1876 et 1911, Malouin avance que ce sont les revenus générés par l'école privée qui ont permis à des congrégations religieuses d'assurer, à des coûts dérisoires, l'instruction au secteur public. Est-il possible de reprendre cette hypothèse pour les décennies précédant la réforme scolaire des années 1960? C'est ce à quoi on tentera de répondre par l'examen des mécanismes de financement du pensionnat de Yamaskaville et l'analyse des rapports entre l'école privée et l'école publique.

Trajetórias de inserção e RSI : impactos dos trabalhos da instituição Salvaterra

Dissertação de Mestrado, Ciências Sociais, 30 de Setembro de 2016, Universidade dos Açores.

A critical approach to reading comprehension in english: teaching intervention with group of teenagers at a non-formal education institution [recurso electr?nico]

The following paper is an action research made with a group of 6 teenagers aged 11-13 from the city of Cali. The project was carried out at a non-formal education institution and basically describes the process of a teaching intervention in which the concepts of Critical Pedagogy and Task-Based Learning were the protagonists. The results show first, that students really need to feel motivated in order to accept a critical approach; second, that the role of the teacher in the achievement of the objectives is extremely relevant; it is necessary for them to have a critical perspective before working on this field besides the constant seeking of information in order to innovate in their classes; third, that the TBL (Task Based Learning) and the critical pedagogy are processes that need some time in order to bear fruits; and fourth, that a needs analysis is essential for the quality of the intervention.

Project-Based learning approach to foster strategic competences of adult students at Cafam Santa Lucia School

Tesis (Licenciado en Lenguas Castellana, Inglés y Francés).--Universidad de La Salle. Facultad de Ciencias de La Educación. Licenciatura en Lengua Castellana, Inglés y Francés, 2014

Reactive Attachment Disorder in infants in foster care and associated mental health and cognitive functioning

Background: Reactive attachment disorder (RAD) has been described as one of the least researched and most poorly understood psychiatric disorders (Chaffin et al., 2006). Despite this, given what is known about maltreatment and attachment, it is likely that RAD has profound consequences for child development. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate the presence of RAD due to limited measures for informing a diagnosis. However this study utilised a new observational tool Method: A cross sectional study design with a one-year follow-up explored RAD symptoms in maltreated infants in Scotland (n=55, age range= 16-62 months) and associated mental health and cognitive functioning. The study utilised the Rating of Inhibited Attachment Behavior Scale (Corval, et al., unpublished 2014) that has recently been developed by experts in the field along side The Disturbances of Attachment Interview (Smyke & Zeanah, 1999). Children were recruited as part of the BeST trial, whereby all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. The study sample was representative of the larger pool of data in terms of age, gender, mental health and cognitive functioning. Results: The sample was found to be representative of the population of maltreated children from which it was derived. Prevalence of RAD was found to be 7.3% (n=3, 95% CI [0.43 – 14.17]) at T1, when children are first placed in to foster care. At T2, following one year in improved care conditions, 4.3% (n=2, 95% CI [below 0 – 10.16]) met a borderline RAD diagnosis. Levels of observed RAD symptoms decreased significantly at T2 in comparison to T1 but carer reported symptoms of RAD did not. Children whose RAD symptoms did not improve were found to be significantly older and showed less prosocial behaviour. RAD was associated with some mental health and cognitive difficulties. Lower Verbal IQ and unexpectedly, prosocial behaviour were found to predict RAD symptoms. Conclusions: The preliminary findings have added to the developing understanding of RAD symptoms and associated difficulties however further exploration of RAD in larger samples would be invaluable.

Foster Fathers: their experiences and contributions to fostering

The paper reports some of the findings of an exploratory study which looks at foster fathers’ experiences of fostering and discusses their routes into foster care and their perspectives on their roles and tasks. The study collected quantitative and qualitative data by approaching all foster fathers registered with a single independent fostering agency based in southeast England. They were asked about their personal and professional attributes, and their experiences of and views concerning the role of foster father. The study discusses the foster fathers’ motivation to foster, and argues that what they see as its positives and drawbacks, and how it fits into their own family lives, are all relevant to improving service recruitment, delivery and retention. The study produced some evidence about the distinctive and positive contribution which foster fathers see themselves making to the lives of the children they foster. Further research is needed to refine our knowledge of what this contribution may be. Such knowledge could potentially develop our understanding of the roles of fathers in child development more generally as well as fine-tuning practice in matching what particular placements have to offer to the needs of individual children.

Can foster carers help children resolve their emotional and behavioural difficulties?

Although foster care is generally seen as providing a positive experience for the children and young people for whom it caters, it is rarely conceived of as a place where the children are helped to address their emotional difficulties and modify their often difficult behaviour. Yet research evidence suggests that some foster carers are consistently less likely to have placements which break down, and that foster carers who show particular skills in parenting can make a difference to successful outcomes. The paper draws on a large longitudinal study of foster care to argue that it is possible to learn from what these foster carers do in order to develop these skills in others. A model of successful foster care. developed from the main statistical part of the study is first described. Two cases from the qualitative, case studies component of the research are then analysed to demonstrate a quality of responsive parenting. The model is further developed within the framework of the dynamic of attachment and interest sharing proposed by Heard and Lake, to show how this can be used as a basis for future approaches to working with foster placements.

ANNUAL REPORT OF THE CHILDREN'S FOSTER CARE REVIEW BOARD SYSTEM OF THE STATE OF SOUTH CAROLINA (Covering Period JUly 1, 1980 through June 30, 1981)

The South Carolina Foster Care Review Board at the Office of Executive Policy and Programs annually publishes a report with summary of programs, recommendations, demographic and statistical information, and directory of state board and staff.

ANNUAL REPORT OF THE CHILDREN'S FOSTER CARE REVIEW BOARD SYSTEM OF THE STATE OF SOUTH CAROLINA (Covering Period JUly 1, 1981 through June 30, 1982)

The South Carolina Foster Care Review Board at the Office of Executive Policy and Programs annually publishes a report with summary of programs, recommendations, demographic and statistical information, and directory of state board and staff.