Interprofessional Collaboration in Finnish Residential Child Care: Challenges in Incorporating and Sharing Expertise Between the Child Protection and Health Care Systems

Many children taken into care tend to be in need of psychiatric treatment as well as child protection services, and thus the professional expertise of both systems must be coordinated in their care. However, it is widely known across Europe that collaboration between child protection services and mental health services is not working well and the outcomes for looked-after children are poor. In spite of drastic need for knowledge, interprofessional collaboration between residential workers and mental health practitioners is poorly explored in international research. Most importantly, very little is known about shared expertise in multi-agency teams between these systems. Based on the analysis of interprofessional focus group interviews (eight interviews with 17 practitioners) in Finland, it is claimed that both sides have unrealistic expectations and perceptions of the other professional grouping and its facilities to help high-need children. The study also indicates that the collaboration assumes an equality of status and responsibilities between the professionals that does not always exist amongst residential child care practitioners and mental health professionals. The analysis suggests that the concept of residential child care work itself needs more empirical research to strengthen the interprofessional competencies and enhance child-centred integrated care.     

独生子女心理特点与心理健康教育探讨

本对襄樊市１７３２名１０～１５岁的中小学生进行了独生子女和非独生子女心理行为特点的对比研究。结果表明：独生子女的劳动习惯、卫生习惯与自理能力远不如非独生子女（Ｐ＜０．０５～０．００１）；合群性则以独生子女优于非独生子女（Ｐ＜０．００１）。独生子女中“多血质”占３７．８０％，明显多于其它类型气质（Ｐ＜０．００１）；非独生子女中“粘液质”占３４．２０％，明显多于其它类型气质（Ｐ＜０．００１）     

Welfare Reform and Children's Health

This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low‐income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status. Copyright © 2014 John Wiley & Sons, Ltd.     

Infusing Youth Development Principles in Child Welfare Practice: Use of a Delphi Survey to Inform Training

To explore ways to integrate a youth development approach into child welfare work, a Delphi survey of experts was conducted. In particular, the Delphi survey technique was used to generate suggestions regarding: 1) the training needs of child welfare workers dealing with youth transitioning out of care, and 2) potential policy approaches to change in the child welfare system for these youth. A first round survey elicited suggestions of panel respondents and a second round survey requested the rating of these suggestions. Findings illustrate the importance of a holistic approach in working with these youth, as well as the importance of connection and relationship. Training approaches also were perceived as a feasible policy response to helping youth transition from care to independent living.     

When, How and Why Child Caregivers Respond to Children's Behaviors

In a qualitative study, 42 child caregivers participated in one of six focus groups. They were asked to address three questions in open-ended discussion. “What child behaviors are of concern to you?”, “How do you respond to these behaviors?”, and “How do you make the decision about your response?” Responses were analyzed and categorized to examine when, how, and why caregivers discipline young children. Results showed that aggression, not listening, and sexually-related behaviors were most often mentioned by caregivers as behaviors of concern to them. The most frequently mentioned disciplinary strategies were time-out, explanation, and redirection. The question related to how caregivers make decisions about responding to misbehaviors was analyzed in terms of attributions made by caregivers about misbehaviors. The majority of caregivers indicated that their response was dependent of the circumstances. Most frequently mentioned attributions were about the children themselves, for instance, their age, gender, or state. Also mentioned were home and family, society, caregiver emotion, and the child care setting. Results also showed that caregivers with higher levels of early childhood education and more experience, and those working with smaller group sizes and smaller adult-to-chiid ratios provided more thoughtful answers that were more congruent with developmental appropriateness.     

The Welfare of the Child

The interests or welfare of the child are rightly central to anydiscussion of the ethics of reproduction. The problematic nature of thislegitimate concern is seldom, if ever, noticed or if it is, it ismisunderstood. A prominent example of this sort of misunderstandingoccurs in the Department of Health's recent and important `SurrogacyReview' chaired by Margaret Brazier (The Brazier Report) and thesame misunderstanding makes nonsense of at least one provision of theHuman Fertilization and Embryology Act 1990. (The HFE Act).This paper explores and hopefully resolves this misunderstandingand sets out the ways in which the idea of theinterests of the child can legitimately function inbioethics.     

Maternal Mental Health: Pathways of Care for Women Experiencing Mental Health Issues During Pregnancy

Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study (Epstein, 2010 Epstein, I. 2010. Clinical Data-Mining: Integrating Practice and Research, New York, NY: Oxford University Press.  [Google Scholar]) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported (Buist et al., 2002 Buist, A.E., Barnett, B.E., Milgrom, J., Pope, S., Condon, J.T., Ellwood, D. and Hayes, B.A. 2002. To screen or not to screen – That is the question in perinatal depression. Medical Journal of Australia, 177(Suppl S): 101–105.  [Google Scholar]), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy (Vilder, 2006 Vilder, C.H. 2006. Improving treatment outcomes for depressed women: Use of self help inventory in counselling settings. Psychotherapy Australia, 12(2): 74–81.  [Google Scholar]) and suggest the need for change to systems that work to support women's perinatal mental health.     

Unmet Service Needs: A Comparison Between Dementia and Non-Dementia Caregivers

This study compared the unmet service needs between dementia and non-dementia caregivers using data extracted from the Caregiving in the U.S. survey. This study sample included 625 non-dementia caregivers and 208 dementia caregivers. Ordinary least squares (OLS) regression analysis was used in analysis. The study showed that a large percentage of dementia (78.8%) and non-dementia caregivers (69.9%) reported unmet needs in at least one service area. Dementia caregivers who reported higher levels of caregiving strain were likely to report greater unmet service needs (p = .05). To address caregivers' unmet service needs more effectively, a comprehensive assessment of caregivers and their care receivers and interventions addressing the needs of both caregivers and care receivers are needed.     

Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring

Policy Points

• Social indicators of young peoples’ conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being.
• There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators.
• Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.

     

The Effect of Medicaid Policies on the Diagnosis and Treatment of Children's Mental Health Problems in Primary Care

Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low‐income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve‐out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non‐drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified. Copyright © 2013 John Wiley & Sons, Ltd.     

Mental Health in Primary Care: Perceptions of Augmented Care for Individuals With Serious Mental Illness

Individuals with serious mental illness are at increased risk of developing secondary physical illnesses because of lifestyle and psychiatric treatment–related factors. Many individuals with mental illness participate in primary care clinics, such as Placer County Community Clinic (PCCC), which provides primary care and medication-only psychiatric services to low-income county residents. This qualitative study describes an augmented care program provided to this population at PCCC and explores participant experiences with that program. The augmented program consisted of a full-time social worker and part-time registered nurse working as a team to coordinate care between providers, and provide psychosocial education and illness management support. Previous studies have demonstrated that similar programs result in improved clinical outcomes for people with mental illness but have largely not included perspectives of participants in these pilot programs. This article includes participant reports about medical service needs, barriers, and beneficial elements of the augmented program. Medical service needs included the need to provide input in treatment and to be personally valued. Barriers ranged from doubts about provider qualifications to concerns about medication. Elements of the augmented care program that participants found beneficial were those involving care coordination, social support, and weight management support.     

The Power of Supervision in Child Welfare Services

This study examines factors influencing the empowerment of child welfare workers. It correlates relationships among workers' perceptions of supervisors' help-giving behaviors, perceptions of agency support, and their perceived empowerment. The research investigated the associations between length of employment and type of educational degree and worker empowerment. The cross-sectional survey design used a sample of 85 child welfare workers. Multiple regression examined the combined influence of the predictor variables on worker empowerment as well as the degree of influence each predictor variable individually had upon the criterion variable, while others were controlled for. Results, confirmed by path analysis and underscored by qualitative responses, indicated that workers perceived their supervisors' helpgiving behaviors as the only factor that influenced their perceived empowerment. The author discusses implications for practice in human services.     

城市社区妇幼保健服务现状研究

目的掌握当前社区妇幼保健服务基本情况和发展中面临的主要问题,并提出相应的发展建议。方法在武汉市随机抽取4个城区,将所属的41家社区卫生服务中心作为调查对象,采用定量调查和定性访谈方法,了解其妇幼保健部门设置、服务内容、方式及人员情况。结果社区妇幼保健服务现状为经费补偿机制不明确,保健人员年龄结构老化、技术能力薄弱,保健服务项目发展不均衡。计划免疫、产后访视、育儿指导项目开展得最充分,而妇幼心理咨询、营养指导、妇女病普查、婚后卫生指导、更年期保健等项目开展率低。结论政府需进一步明确社区妇幼保健服务经费补偿方式,完善服务项目,提高专业人员技术水平,取得社会的配合,提升妇幼保健服务水平。     

Financial Burden for Families of Children with Special Health Care Needs

Objectives: We describe family finance-related burden experienced by families with children with special health care needs (CSHCN). The paper further seeks to describe correlates of family financial burden. Methods: We examined correlates of family finance-related burden using multivariate methods and the National Survey of CSHCN, a nationally representative cross-sectional survey of CSHCN. We also examined state-level correlations. Results: Fully 40% of families with CSHCN, or 3,746,000 families nation-wide, experience financial burden related to their child’s condition. Experiencing a finance-related problem is negatively associated with Maternal and Child Health Bureau (MCHB) indicators and positively associated with poor-child health status. States that better meet MCHB indicators generally have lower levels of family finance-related problems. Conclusions: Families with CSHCN have high levels of finance-related family problems. Development of appropriate systems of care appears to offer a mechanism for alleviating the financial burdens of these families.