Helen Austerberry

Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial

Study objective: To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on maternal and child health outcomes. Design: Randomised controlled trial with economic and process evaluations and follow up at 12 and 18 months. The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor (SHV), or a year of support from community groups providing drop in sessions, home visiting and/or telephone support (CGS). Each was compared with a control group that received standard health visitor services. Setting: Two disadvantaged boroughs of London, United Kingdom. Participants: 731 women from culturally diverse backgrounds with infants. Main results: At 12 and 18 months, there was little impact for either intervention on the main outcomes: child injury (SHV: relative risk 0.99; 95% confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use (with fewer taking their children to the GP) and had less anxious experiences of motherhood than control women. User satisfaction with the SHV intervention was high. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. Conclusions: There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population. The SHV intervention was associated with improvement in some of the secondary outcomes.

Health outcomes of youth development programme in England: prospective matched comparison study

Objective To evaluate the effectiveness of youth development in reducing teenage pregnancy, substance use, and other outcomes. Design Prospective matched comparison study. Setting 54 youth service sites in England. Participants Young people (n=2724) aged 13-15 years at baseline deemed by professionals as at risk of teenage pregnancy, substance misuse, or school exclusion or to be vulnerable. Intervention Intensive, multicomponent youth development programme including sex and drugs education (Young People’s Development Programme) versus standard youth provision. Main outcome measures Various, including pregnancy, weekly cannabis use, and monthly drunkenness at 18 months. Results Young women in the intervention group more commonly reported pregnancy than did those in the comparison group (16% v 6%; adjusted odds ratio 3.55, 95% confidence interval 1.32 to 9.50). Young women in the intervention group also more commonly reported early heterosexual experience (58% v 33%; adjusted odds ratio 2.53, 1.09 to 5.92) and expectation of teenage parenthood (34% v 24%; 1.61, 1.07 to 2.43). Conclusions No evidence was found that the intervention was effective in delaying heterosexual experience or reducing pregnancies, drunkenness, or cannabis use. Some results suggested an adverse effect. Although methodological limitations may at least partly explain these findings, any further implementation of such interventions in the UK should be only within randomised trials.

Foster carers and family contact: foster carers’ views of social work support

Foster carers have an important role to play in maximising the quality of any contact between children and their parents and monitoring its effects on the child. This article explores how a sample of foster carers view family contact and the professional support they receive concerning their role in this activity. It draws on a large-scale survey (N = 1405) of English foster carers conducted in 2011 as part of the Social Work Practices evaluation. Data provided by those carers who had had difficulties relating to contact (N = 405) were further analysed thematically. Foster carers with disabilities and those experiencing difficulties in contact arrangements were less satisfied with support from the child’s social worker than other foster carers. Foster carers valued social workers who considered the interests of all parties affected by contact plans and decisions. The practice implications of the findings are discussed.

Independent Children’s Social Work Practice Pilots: Evaluating Practitioners’ Job Control and Burnout

Objectives: To investigate whether a new model that delegates some out-of-home care services from the public to the private and not-for-profit sectors in England enhances practitioners’ job control and stress levels. Methods: A 3-year longitudinal matched-control evaluation examined changes in Karasek demand-control model and Maslach burnout levels of 2,050 staff working in five social work practice (SWP) pilots, their host local authorities and comparable sites. Results: Mixed-effect models indicated no significant difference in main outcomes among SWP staff when compared to staff in host and comparison local authorities. There were notable differences in relation to job insecurity and social support. Conclusion: The minimal effects observed may relate to the diverse nature of SWPs with no specific work model predominating.

The Palgrave handbook of gender and healthcare, by Ellen Kuhlmann and Ellen Annandale

Gender and Healthcare is an edited handbook that brings together international perspectives on gender and health policy, practice and research from nearly 50 academics and other professionals working in the field of gender and health. Kuhlmann and Annandale draw together accounts and debate, including critical feminist analysis, on how to make healthcare systems more sensitive to sometimes differing needs of women and men. The editors’ introduction flags up how gender is linked to other social inequalities and that individual agency, institutional conditions and wider social structures interplay in a nuanced way to constrain or enable choices for health. They reflect on how pursuing a strategy of gender mainstreaming provides opportunities to reduce social inequalities in health, and improve the provision and delivery of healthcare – but that this does not necessarily challenge hegemonic masculinities. They locate the main substance of this book within current controversies in gender theory, such as the sex–gender distinction, and criticisms of a simplistic notion of the gender binary. The handbook is organised into five sections that explore different aspects of current debates on changing health policy and healthcare governance. Part 1 looks at globalised healthcare and policy through the lens of gender, differentiating gender equality and equity and exploring the relevance of both in the field of health. Part 2 looks at the social dimensions of health and gender, including how biology intersects with female and male stereotypes and the impact of these on patterns of care: for instance, how seeing coronary heart disease as a disease of men leads to poorer quality care and prevention strategies for women. Part 3 focuses on equity and access to healthcare, and the relevance of gender to institutional barriers as well as perceptions of health and help-seeking. One contribution debunks the generalisation that women always seek help more readily than men (e.g. not true in the case of colorectal cancer). Part 4 looks at the gendered nature of the organisation and delivery of healthcare; for example, that gender as a key issue relevant to improving health has often been seen as secondary to other issues such as class and ethnicity. Part 5 looks at how health professionals’ role as mediators between institutions and service users may be used to encourage or discourage gender sensitive care: bringing more women into medicine does not necessarily translate into less gendered patterns of care. The editors conclude by suggesting that barriers to advancement are twofold: an insufficiently nuanced understanding of the concepts of sex and gender, and their