In the United States, intimate partner violence (IPV) is the most common cause of non-fatal injury for women. The Nurse-Family Partnership (NFP) is an evidence-based maternal and early childhood health program where nurse home visitors seek to develop therapeutic relationships and provide health promotion interventions with low-income, young pregnant women and first time mothers and their children, from early in pregnancy until the child’s second birthday. In this program, nurses have a responsibility to identify women exposed to abuse and provide supportive interventions. The purpose of this study is to understand the impact of this work on nurse home visitors’ professional and personal selves. A secondary qualitative content analysis was conducted using a sample comprised of 27 nurses, 18 community partners, and 4 nurse supervisors from an original case study by Jack et al. (2012) for the development of a nurse home visitation IPV intervention. Conventional content analysis and constant comparative techniques were used to code 8 nurse focus group transcripts and 43 transcripts from face-to-face, semi-structured interviews with the community partners and supervisors. Nurses identify that clients are exposed to multiple types of violence. These experiences increase the complexity of delivering the NFP home visitation program. Nurses also experience high levels of uncertainty related to how to respond to disclosures, and how to address IPV. The presence of IPV also significantly impacts many facets of the nurse-client relationship. At times nurses struggle with wanting to “fix” the client’s relationship with her partner; yet understand this is not a healthy response. Setting boundaries and clearly defining one’s role in this work is complex, and many nurses experience high levels of anxiety, worry and fear for their clients. Supervisors and community members confirm nurses’ experiences but also provide strategies for reflective supervision and community level support. Nurse home visitors are in a unique position to provide care for women exposed to IPV and recommendations are provided for nursing education, practice and research in this field. / Thesis / Master of Science (MSc)

No description available.

published_or_final_version / Social Work / Master / Master of Social Work

The term 'hard to reach' first appeared in the Health Visiting Review (Lowe 2007). This review claimed that the health visiting service was able and experienced in reaching the 'hard to reach'. Yet there was a dearth of health visiting literature on what this concept meant and how it was interpreted in practice. A wide literature review was undertaken which examined government child health policies on reducing health inequalities and how the targeting of services to meet the needs of 'vulnerable', 'disadvantaged' or 'hard to reach' families had developed. The literature review identified how the concept of risk in relation to child health promotion had been defined and redefined since the 1970s. The latest shift involved the identification of 'new social risks' and the promotion of early intervention to prevent social exclusion and health inequalities. At the time of the study's inception, health visiting was a service both in decline and under threat. In contrast, the development of new early intervention programmes such as Sure Start (National Evaluation of Sure Start 2005), On Track (Doherty et al. 2003) and intensive home visiting (Barlow et al. 2005) also led to the critical examination of the concept of 'hard to reach'. In response to the lack of information on the concept of 'hard to reach' in health visiting, I set out to examine critically how Health Visitors (HVs) working in a disadvantaged area conceptualised and operationalised the concept of 'hard to reach'. This qualitative ethnographic case study (Yin 2003), by using research methods of focus groups, participant observation of a Well-Baby Clinic and interviews, gathered perceptions and experiences of HVs and service users. Thematic analysis was guided by Gee's (2005) method of critical discourse analysis and revealed how the term was contested by HV practitioners. It was considered a broad term that in practice could be applied widely and negatively as a label for non-engaging service users; yet themes emerged which also demonstrated how HVs related to and constructed the concept in their day-to-day practices of client engagement. The findings were categorised and a typology was developed in relation to the reach of health visiting within a predominantly deficit model of health. The typology consists of four types, all of which relate to the 'reach' of the health visiting service at the interpersonal level. The first type, the 'easy to reach' client, highlights the diversity of clients: not all clients living within a disadvantaged area were 'hard to reach'. This category also identifies how some clients living within this disadvantaged area developed relationships with HVs. Including the type 'easy to reach' within the typology acknowledges the diversity of clients living within an area of disadvantage, and also the facilitators in HV/Client relationships. The second type identified was the 'emotionally hard to reach' client, and identifies characteristics of clients who had a tentative relationship with the health visiting service. Working with 'emotionally hard to reach' clients involved negotiation and the building of trust at each encounter. The third type, 'physically hard to reach', developed following the identification of a range of barriers that reduced access to vulnerable clients. The fourth type, 'hard to reach services', arose from the findings - and this type relates to barriers created by the organisation of the health visiting service in a disadvantaged area. The typology highlights the importance of both clients' and HVs' engagement in the development of working relationships. It recognises the organisational structures and discourses that act as barriers and facilitators to client engagement. It recommends that health visiting should take the opportunity offered in the Health Visitor Implementation Plan (DH 2011) to develop a health visiting service underpinned with a strengths-based model of public health.

Purpose: The purpose of this study is to examine the social determinants of CHIP (Child Health Investment Partnership) of Roanoke Valley children who participated in the preventive oral health program compared to those who did not. Methods: This is a retrospective cohort study of children (n=2,425) enrolled in CHIP of Roanoke Valley from September 2008-September 2014. Bivariate analysis and multivariable logistic regression models were used to compare age, gender, race, locality, parents’ education level, age at enrollment, and length of enrollment for oral health program participants versus those who did not participate. Results: Children who were Hispanic as well as children who enrolled in CHIP at an earlier age were more likely to enroll in the oral health program. Conclusions: By focusing on enrolling children at earlier ages, there is the potential to increase the use of dental care to match the recommended periodicity of dental care for young children.

Inom sjukvården brister det i bemötandet av barn som närstående där de sällan synliggörs, blir delaktiga eller informerade om det som berör den sjukes/skadades hälsotillstånd. Oberoende av sin familj har barn och unga egna rättigheter i samhället vilket barnkonventionen stödjer och arbetar för. 1 januari 2010 omarbetades innehållet i Hälso- och sjukvårdslagen (HSL) och Lagen om yrkesverksamhet på hälso- och sjukvårdens område (LYHS). Där klargörs barns rättigheter till information, råd och stöd samt hälso- och sjukvårdens ansvar att uppmärksamma detta, om barnets förälder lider av sjukdom/skada. Syftet är att beskriva barns upplevelser av att ha en närstående som vårdas på sjukhus samt ge en beskrivning av faktorer som kan påverka barnens upplevelser. Den här uppsatsen baseras på en litteraturöversikt beskriven av Friberg (2006) där granskning och analys av vårdvetenskapliga artiklars innehåll gjorts. Litteraturstudien bygger på kvantitativa och kvalitativa artiklar samt ”literature review”. Resultatet av studien är strukturerat i faktorer och upplevelser som redovisas i fyra huvudteman och tio subteman. Subtemana beskriver orsaker till restriktioner kring barns besök som närstående på sjukhus och betydelsen av att tillåta barn besöka. Barns behov av delaktighet och information skildras samt deras oro och bemästring av krissituationen. Studien visar på vikten av att ett handlingsprogram för barn som närstående utformas och att detta tillvaratar barns rättigheter och konstrueras på ett pedagogiskt sätt där ställning tas till barnets ålder och erfarenheter. Det kan vara fördelaktigt för barnet, familjen och den sjuke/skadade men också för barns framtida välbefinnande om sjukvårdspersonalen bemöter och tar hand om barn som närstående i den rådande stunden. Om barn som närstående till en sjuk/skadad patient uppmärksammas, blir sedda och bekräftade genom besök, tilldelas information, råd eller stöd, skonas de från onödigt lidande samt att de känner sig delaktiga i situationen tillsammans med de övriga i familjen. / Program: Sjuksköterskeutbildning

La dépression postnatale (DPN) est un facteur de risque de trouble des interactions précoces mère-enfant et de troubles de santé mentale de l’enfant. Si les programmes de visites à domicile (VAD) en périnatalité ciblent souvent la prévention de la DPN, les résultats sont peu probants.CAPEDP est la première étude contrôlée randomisée de VAD destinée à des familles multirisques d’une telle ampleur menée en France. Ce travail en décrit les résultats sur la DPN. 440 femmes sont recrutées et randomisées en deux groupes : primipares, âgées de moins de 26 ans, et au moins un facteur de risque parmi : un faible niveau d’éducation, des revenus faibles et/ou être isolées. Le groupe intervention bénéficie de VAD menées par des psychologues du troisième trimestre de grossesse aux deux ans de l’enfant. La symptomatologie de la DPN est évaluée à l’inclusion et 3 mois après la naissance avec l’Edinburgh Postnatal Depression Scale (EPDS). A 3 mois post-partum, les scores moyens à l’EPDS sont respectivement de 9.4 (5.4) pour le groupe contrôle et de 8.6 (5.4) pour le groupe intervention (p = 0.18). Pour certains sous-groupes de femmes ayant bénéficié de l’intervention les scores EPDS sont plus faibles que le groupe contrôle : celles avec peu de symptômes dépressifs en prénatal (EPDS<8), celles qui pensent être avec le père pour élever leur enfant, et celles avec un niveau d’éducation supérieur au BEPC. CAPEDP n’a pas démontré d’efficacité pour prévenir la DPN. Les analyses post hoc montrent que l’intervention peut être efficace pour des femmes sans certains facteurs de risque. Il serait utile de développer des recherches plus intégrées dans le dispositif de droit commun. / Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. CAPEDP is the first French randomized controlled trial for multi-risk families evaluating the impact on PND symptomatology of a home-visiting intervention using psychologists in a sample of women presenting risk factors.440 women were recruited at their seventh month of pregnancy. All were first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. Participants were randomized into either the intervention or the control group. The intervention consisted of intensive multifocal home visits through to the child’s second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS).At three months postpartum, mean EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The intervention group had significantly lower EPDS scores than controls in certain subgroups of women: with few depressive symptoms at inclusion (EPDS<8), who were planning to raise the child with the child’s father, with a higher educational level.CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology may require more tailored interventions.

No description available.

No description available.

Background – People with functional impairments have unmet needs and they are not given the support and service they are entitled to. According to international studies, early measures and treatment may slow down the outbreak of mental illness and relieve its course. Aims - To elucidate and compare both somatic poor health and social needs of people with either physical or mental functional impairments in a rural district, and to explore and compare how different personnel in the primary health care service and psychiatric services are able to detect early signs of psychosis. Moreover, to find out how early signs of psychosis are detected in primary health services, and to explore the patients’ pathways to the GPs. Methods – In studies I and II, people with severe functional impairments were offered a screening health examination followed by an interview. Three vignettes were presented to personnel in the primary health care service and the psychiatric services in study III. The participants were asked to detect any signs and symptoms of psychosis in the vignettes. In studies IV and V, notes in primary health care records were studied during a period of two years and six months, respectively, before a diagnosis of psychosis was made by the general psychiatric services. Results – People with severe functional impairments had poorer health and more problems with their ADL (Activities of Daily Life), economy/work and Quality of Life than people in general. Among the groups studied, people with mental impairments had the poorest living conditions. There were no differences between the participants in study III regarding sex, age and occupation; and the participants detected the signs and symptoms in the vignettes to a high degree (75% of all signs and symptoms). In all, 152 patients (22 with schizophrenia/ schizoaffective disorders, 41 with schizophrenia preceded by other psychotic disorders and 89 with persisting psychiatric disorders) with the diagnosis of psychosis made by the general psychiatric services were included in study IV and V. There were notes in 77% of the primary health records during the two-year study period, and 70% of these notes were about psychiatric signs and symptoms, which means that the GPs detected signs and symptoms of psychosis in 2/3 of the cases. The analysis of the patients’ visiting patterns to GPs showed that many patients did not visit their “own” primary health care centre or their “own” GP. Furthermore, many patients had no contact with the primary health care service at all, and the subgroup with schizophrenia/schizoaffective disorders visited the primary health care service less frequently than the other groups. Main conclusion – People with severe functional impairments must be granted regular contacts with a GP, whose role must be: to identify and motivate the patients; to detect when there are needs for care and social needs; to function as a representative for the patients; to inform the patients about their rights and to guide them to other social or health authorities. The GPs detected early signs and symptoms of an emerging psychosis to a high degree, which would make early intervention possible. The more visits to the GPs, the more symptoms were detected, and out of all signs and symptoms with psychiatric content noted, the GPs would have suspected an emerging psychosis in almost every second patient who visited them. To detect early signs and symptoms of psychosis is difficult, and whenever in doubt, primary health care personnel must be able to consult psychiatric professionals. Otherwise we may miss the opportunity to intervene in an early phase of the illness. Additional training could also mean better understanding and earlier detection of people at risk of an emerging psychosis.