Parent–infant co‐sleeping: fathers' roles and perspectives

Dyadic co‐sleeping (mother–baby) is a common strategy for night‐time infant care in the majority of world cultures. Triadic co‐sleeping (mother–father–baby) is less common, although still widely practised cross‐culturally. This paper examines triadic co‐sleeping in an opportunistic sample of parents from the North Tees region of England, and explores fathers' expectations and experiences of sleeping with their babies. Using a prospective study design, 36 sets of parents, pre‐ and post‐natally, were interviewed about infant care strategies, particularly at night. Although they did not anticipate sleeping with their infants at the pre‐natal interview, the majority of fathers (81%) had done so by the time of the second interview. First‐time fathers were afraid that they would squash or suffocate the baby in their sleep, and some were concerned that the infant's presence would adversely affect their own sleep. Fathers used a variety of strategies to help overcome their initial fears of co‐sleeping. Among those for whom triadic co‐sleeping became a regular night‐time infant care strategy, the pleasures of prolonged intimate contact with their infant were clearly apparent. It is suggested that the experience of sleeping with their infant ameliorates some of the distancing effects felt by fathers outside the breast‐feeding relationship, and helps encourage paternal involvement in night‐time infant care‐giving. Copyright © 2000 John Wiley & Sons, Ltd.     

Do Health Care Workplaces Affect Treatment Environments?

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, but the potential effect of health care workplaces on the treatment environment has been little studied. Building on a model proposed by Schaefer and Moos (1993), we propose that the workplace factors of supervisory work environment (e.g. support from supervisors, managerial control) and programme philosophical orientation (e.g. disease model of addiction, psychosocial learning model of addiction) predict four treatment environment elements: patient autonomy, staff control, staff sensitivity, and patient alienation. Multiple regression analysis of data drawn from a survey (response rate = 86%) of 327 staff members at 15 Veterans Affairs (VA) inpatient substance abuse treatment programmes revealed that greater managerial control over staff predicted greater patient alienation, lower staff sensitivity towards patients, and greater staff control over patients. Stronger disease model programme orientations predicted less patient alienation and greater staff sensitivity, whereas stronger psychosocial model programme orientations predicted less staff control. These results suggest that health care workplaces may influence treatment environments. Implications for further research and practice are discussed. © 1997 John Wiley & Sons, Ltd.     

Infant care from infants' viewpoint: the views of some professionals

Debate about infant care tends to focus on still unresolved questions about whether or not day care is harmful, while research studies often confine care options to an unrealistic axis of choice between group care and mother care. Research that delineates constituents of day care quality in relation to measurable outcomes for different groups of children is urgently needed and should be based on a broader view of infant care options. A postal opinion survey sought the confidential views of members of an international organization of infant mental health professionals as to the kinds of care they considered likely to be best for infants from birth to 36 months, assuming that all types of care were of equally high quality and availability. Surprisingly lengthy periods of care by mothers were consistently endorsed; fathers were almost entirely disregarded as principal or joint caregivers; all forms of family care were endorsed over all forms of purchased care, but all forms of individual care were preferred to full-day group care for all age groups and to half-day group care up to the age of 2. The patterns of care judged by these respondents as likely to be best for infants are very different from those which most infants experience now, and from those which policy- and opinion-makers, practitioners and parents aspire, publicly at least, to provide for infants in the future. ©1997 John Wiley & Sons, Ltd.     

Social validity assessment of behavior data recording among human services care providers

Care providers within human services organizations have many job responsibilities and performance expectations. In the present study, we conducted social validity assessment with 78 care providers concerning their attitudes and opinions about behavior data recording with adults who had intellectual disability and lived in community group homes. Specifically, the care providers responded to a written questionnaire that inquired about the practicality, training/supervision, and value of behavior data recording in the context of service delivery. Results indicated generally high approval of behavior data recording practices, purposes, and approaches to training. We discuss implications of these findings for implementing data recording by care providers and the contribution of social validity assessment to training and performance management within human services organizations.     

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

Abstract

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

The effects of the Newborn Behavioral Observations (NBO) system in early intervention: A multisite randomized controlled trial

The purpose of this pilot study was to evaluate the effect of an infant mental health intervention, the Newborn Behavioral Observations system (NBO), versus usual care (UC) on infant neurodevelopment and maternal depressive symptoms in early intervention (EI). This multisite randomized trial enrolled newborns into the NBO (n = 16) or UC group (n = 22) and followed them for 6 months. Outcome measures included the Battelle Developmental Inventory (BDI-2), Bayley Scales of Infants Development (BSID-III), and Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D and BSID-III were collected at 3- and 6-months post EI entry and the BDI-2 was collected at EI entry and 6-months post-EI entry. We estimated group differences [95% CI], adjusting for program characteristics. At 6 months, the NBO group had greater gains in Communication (b = 1.0 [0.2, 1.8]), Self-Care (b = 2.0 [0.1, 3.9]), Perception and Concepts (b = 2.0 [0.4, 3.6]), and Attention and Memory (b = 3.0 [0.4, 6.0]) than the UC group. The NBO group also had greater decline in maternal postnatal depressive symptoms (b = −2.0 [−3.7, −0.3]) than the UC group. Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months than infants receiving UC. Caregivers receiving NBO care had greater improvements in maternal depressive symptoms than caregivers receiving UC.     

Adaptation and implementation of the German social–emotional learning programme Papilio in Finland: A pilot study

This study investigated the cross-national adaptation and implementation of Papilio, a German social–emotional learning programme, in Finnish early childhood education and care (ECEC) centres. Papilio is a developmentally focused, scientifically based intervention programme focused on preventing behavioural problems and fostering social–emotional competence in children aged 3–7. The aim of this study was to investigate and evaluate the cross-national adaptation and cross-cultural adaptation and implementation of Papilio in the Finnish ECEC context. Results from qualitative interviews with one Finnish Papilio trainer, 11 early childhood education (ECE) teachers, two ECE special education teachers and two nursery nurses are supplemented with teachers' and nursery nurses' (N = 75) questionnaire data. Qualitative thematic analysis revealed that cultural adaptations were necessary on four levels: accommodation of materials, adaptation of the contents of the materials, structure and delivery. The materials and training contents were culturally adapted, whereas the delivery of the intervention was adapted according to Finnish ECEC practices. The structural adaptation included discarding timeout, due to opposition by some educators. The educators were committed to implementing the programme as instructed and resolving the practical difficulties they encountered. Their motivation to implement Papilio increased as they observed improvements in the children's social–emotional competence during intervention.     

Living with a Rare Chronic Illness: A Phenomenological,Systemic Examination of Hemophilia Complicated by an Inhibitor

Abstract

Up to 20% of individuals with hemophilia experience the added complication of an inhibitor. An inhibitor results in severe bleeds, joint damage, impaired mobility, and even death. We conducted a focus group with eight individuals affected by inhibitors (three patients and five caregivers). Data were analyzed using the immersion/crystallization method. The following themes emerged: (a) fear and anxiety within the family, (b) social isolation of the patient, (c) unique impacts on caregivers and siblings, and (d) desired changes in treatment. Similar experiences may be common across comparable disorders that are incapacitating, acute, and relapsing in nature.