Alternative Care Research Articles

The Perspectives of Family Foster Care in the Czech Republic, Hungary, Poland and Slovakia

Reforms of the child protection systems, provision of family- and community-based alternative care has been developed to a certain level in all countries in Central and Eastern Europe and has increased the role of care provided by foster families replacing institutions to ensure that the best interests principle is taken into consideration when children are separated from their families. The research describes the foster care system in the so-called Visegrád countries: the Czech Republic, Hungary, Poland and Slovakia, and the results based on at least 50 interviews in each country conducted by local experts on subjective well-being of foster parents, their perceptions about their roles and place in their respective countries and their needs. The article includes the legal framework, recruitment, preparation and support to foster families, their subjective well-being and needs in the four countries, including the history of their child protection systems to better understand the current situation. The outcomes show differences in approach to foster care, the perception on the roles, responsibilities and needs based on the different traditions, earlier and current policies and practices. Understanding the attitude changes related to the rights of children, those in vulnerable situations, and to their families of origin would be essential to further develop and improve the child welfare and protection systems, and listening to children on their perceptions and the realisation of their rights.

Trends in Emergency Department Capacity and Utilization (2005 -2022): An Update from California, Pre- and Post-COVID-19

This study investigates long-term trends in hospital emergency department (ED) capacity and utilization in California, focusing on the impact of the COVID-19 pandemic. Utilizing data from the California Department of Health Care Access and Information (HCAI) and the U.S. Census Bureau, we analyzed trends over an 18-year period (2005-2022), segmented into pre-pandemic (2005-2019), pandemic (2020-2021), and post-pandemic (2022) phases. Adjusting for population growth, our findings indicate a 7.3% decrease in total admissions and a 14.0% reduction in total inpatient days. Conversely, ED visits increased by 16.1%. Despite an 8.5% decrease in the number of hospitals with EDs, ED treatment stations expanded by 36.3%. The average number of ED visits per treatment station decreased by 10.2%, suggesting improved capacity utilization. Additionally, the number of hospitals with designated trauma centers increased by 11.5%. The COVID-19 pandemic significantly disrupted these trends, initially causing sharp declines in ED visits and total admissions in 2020. However, by 2022, ED visits and inpatient days rebounded close to pre-pandemic levels. The pandemic also accelerated the adoption of telehealth, which partially offset the burden on EDs. Despite this, the average inpatient length of stay increased, indicating more complex or severe cases requiring longer hospitalization. Overall, our study highlights the critical role of EDs in hospital operations, with a growing reliance on EDs for hospital admissions, which rose from 43% in 2005 to 68% in 2022 for non-maternity patients. These findings underscore the need for strategic planning to enhance ED capacity and efficiency, ensuring resilience against future public health emergencies. The economic implications of rising healthcare costs and the essential nature of ED services in contract negotiations with commercial health plans are also discussed, emphasizing the strengthened bargaining position of hospitals due to the indispensable nature of emergency services. Further research is needed to explore alternative care models and payment schemes to improve efficiency and reduce healthcare costs.

“Unable to Feed My Hungry Child”: Experiences of Mothers Caring for Children With Prader-Willi Syndrome

Mothers’ experiences of caring for children with Prader-Willi Syndrome (PWS) is largely unknown. With no treatment for PWS, parents undertake (extra)ordinary care practices to keep children safe from overeating and self harm. Knowledge of these care practices could lead to effective interventions. Narrative inquiry was used to study everyday experience with Canadian mothers. Participants cared for a child 3 to 17 years old who had hyperphagia. Participants were interviewed 8 to 12 times each over the course of a year. Narrative accounts were co-composed through a collaborative process of analysis. Engaging with participants’ everyday experiences amplified complex care needs for families and gaps in health and social care systems. Narrative threads focused on engaging in (extra)ordinary care practices, rigid care work to keep children healthy and safe, tension from others while enacting these care practices, and difficulty conforming to social expectations with childrearing and care work. Recommendations for practice and policy include (a) shifting from untenable care practices, (b) reconceptualizing care work, and (c) alternative care models.

Financing Policy Considerations From Texas to Optimize Care for Children With Medical Complexity.

Texas has a tremendous opportunity and momentum to build a more effective system of care for children with medical complexity (CMC) and their families. This is evidenced by growing collaboration among many committed partners since implementation of the Medicaid STAR Kids managed care program in 2016 and Texas' participation in a US Health Resources and Services Administration-funded, 10-state Collaborative Improvement and Innovation Network to Advance Care for CMC from 2017 to 2022. Texas has several comprehensive health homes for CMC that position the state to serve as a national model of integrated, family-centered care for CMC and ensure high-quality care to an exceedingly vulnerable population. Further, Texas' elected leaders demonstrated their interest in system innovation in 2019 and 2021 by enacting state legislation to explore alternative care models and conduct a health home pilot for CMC. Much more must be done to sustain the work underway and bring the promise of care transformation to reality. To this point, we recommend that care planning and coordination be delegated to provider-led, integrated health homes for CMC with alternative payment structures that appropriately reimburse and align incentives with optimal care delivery. To realize the policy aspirations of an effective system of care for CMC, regulatory oversight, payment models, and outcome measures need to be improved to align with the vision articulated in Texas legislation and agency guidance. Although each state's Medicaid program is different, we believe each state can take away policy lessons from those learned by Texas.

Social work perspective of the achievements of the Fit Person (s) Program in Temeke, Dar es Salaam – Tanzania

Like other countries in the developing world, Tanzania has faced more children needing protection and care. However, the available old and traditional alternative care systems have inadequately reduced the demand for protection and care for needy children. This study was undertaken to assess the achievements of the fit person program. Twenty (20) social workers employed at Temeke District Council were selected to participate and inform the study. Four focus group discussions of five members each and five key informants' interviews were used to generate information while observing the African-centred approach. This study was guided by Ubuntu theory, as it considers Africans' values, aspirations, beliefs and experiences in the efforts to protect and care for the children. The findings revealed that the Fit Person Program has achieved its obligations to protect and care for children to a large extent; as a result, it was scaled up to all Dar es Salaam region districts. The study recommends comprehensive research to explore the challenges faced by fit persons, social workers and children under the fit person's program.ent factors affecting access to Pre-Trial Diversion services by juvenile offenders from high density suburbs in Zimbabwe. How to cite this article using ASWNet style Buhori, J, A. (2023). Social work perspective of the achievements of the Fit Person (s) Program in Temeke, Dar es Salaam – Tanzania. People centred – The Journal of Development Administration (JDA), 8(4), 94-102. https://dx.doi.org/10.4314/jda.v8i4.1 Visit journal website: https://jda.africasocialwork.net

IN TELEHEALTH, PHYSIOTHERAPISTS CAN TRIAGE ORTHOPEDIC WAITING LISTS: PILOT STUDY

Objectives: The purpose of this study is to understand the reasons for long waiting lists in orthopedic screening clinics in terms of duration and quantity, as well as to examine physical therapy visibility as an alternative form of management to improve the patient journey according to individual current needs through Telehealth. Background:In public hospitals, there is typically a significant waiting period for outpatient orthopedic appointments with specialists. Subsequently, patients often face another waiting period if surgery is deemed necessary. Unfortunately, individuals with greater medical urgency are seldom given priority, which can lead to heightened morbidity for those who have to wait. Furthermore, alternative care options are generally unavailable during this waiting period. Methods:The current study implemented a telephone triage method executedby two physiotherapists to evaluate new patients on the waiting list of an orthopedic screening clinic. The research took place at Qatif Central Hospital in the Eastern province of Saudi Arabia, spanning from October to December 2021. Telephone triage involves remotely assessing patients over the phone to determine the nature of their condition and determine if physical therapy could serve as a viable alternative treatment option. To ensure consistency in evaluations, the physiotherapists utilized a standardized instrument consisting of a predetermined set of questions and prompts. Results: It was found that 66% of participants experienced a three-month waiting period for their appointments. Additionally, the study revealed a significant number of referrals originating from primary health centers (81%),withknee osteoarthritis being the most commonly diagnosed condition (45%). Another notable finding is that 72% of cases were considered suitable for physical therapy as an alternative treatment option. Conclusion: Integrating physiotherapists into telephone triage for orthopedic outpatient appointments presents a valuable chance to address and prioritize lengthy waiting lists for orthopedic services. This approach offers cost-effectiveness and substantial benefits for institutions facing challenges in managing their orthopedic waiting lists.

Evaluating the Challenges Facing Single Parenting in Kigamboni District of Tanzania

The study focuses on challenges facing single parenting in Tanzania and the Kigamboni district in particular. While most scholars asserted single parenting is ineffective in sub-Saharan Africa, little evidence is available on the challenges of single parenting, particularly in Tanzania. Becker’s economic theory and Bowlby's attachment theories were applied in the study. The former focuses on an economic angle as the atomy of family formation and the latter shows that our attachment representation is from the sensitivity of care received from our primary caregivers. The study used a case study design in which Kigamboni district of Tanzania was the area of investigation. Qualitative data, that is, words and phrases were analysed. Ten single-parents' families were selected purposefully by using the snowball technique. Unstructured interviews were used as a method to collect the intended data from the participants. Findings have shown that the challenges of single parenting centred on the aspects of psychological, financial constraints, and academic performance. In Tanzania there is a steady rise in single parenting, which has an impact on the welfare of the children, parents, and community at large. It is recommended that alternative care and guidance and counseling programmes should be established especially for needy children and single parents.

Juridical Examination of Foster Care in Malaysia: Navigating Legal Dimensions

oster care plays a crucial role for children in Malaysia who lack a family environment, making it challenging for them to stay with their biological families. This study examines foster care as an alternative care option for children in Malaysia, delving into its concept, legal aspect as well as international and Islamic perspectives. The aim is to identify ways to enhance foster care within Malaysia's child protection system, focusing on abandoned and parentless children. The Child Act 2001 and the practice of the Department of Social Welfare oversees foster care, aiming to provide family-based care and reunite children with their families whenever possible. Using a qualitative approach, the study uncovers shortcomings in the current legal framework. Despite limited provisions for foster care in Malaysia, the emphasis is on bolstering legislation by improving resources and support for foster parents, implementing standardized training, strengthening monitoring, and fostering collaboration among agencies. These efforts are crucial for ensuring positive outcomes and the well-being of fostered children in Malaysia.

What is in a space? Exploring experiences providing or receiving patient care in unique spaces for patients waiting to transition to their next point of care in Ontario, Canada

Introduction: Delayed discharge is a key challenge for health systems globally. Pandemic-related capacity pressures on hospitals have increasingly led to patients being moved to unique spaces (overflow units, hotels) while they wait to transition to their next point of care. However, it is unclear how patient care is managed and coordinated in these spaces or how patients and caregivers experience care in these environments.
 Rationale/Objective: Our study aimed to understand how to optimize care experiences and outcomes for patients with a delayed discharge, their families and care providers. The purpose of our study was to learn about people’s experiences in unique spaces, including what works well and what needs to improve. 
 Methods: Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with patients/caregivers (n=9) and care providers (n=20; e.g., nurses, rehabilitation therapists, physicians, discharge planners) who had experience with receiving or providing care in a unique space. We interviewed participants from three different unique spaces associated with a hospital across rural and urban health regions in Ontario, Canada: a hotel previously used for patient and caregiver accommodations while receiving care away from home (beside hospital), a structured, heated tent (hospital parking lot) and a clinical building (1 hour away from hospital). Interviews were transcribed and a codebook was developed and applied to all transcripts. Thematic analysis was used to analyze the transcripts, specifically focusing on key challenges and opportunities.
 Results: Patient, caregiver and care provider experiences in these unique spaces included positive aspects, such as care teams focused on facilitating integrated care transitions, the opportunity to develop a collaborative team culture from the ground up and having increased interdisciplinary patient assessments. Areas of improvement were also described across interviews, such as the need for adequate space and infrastructure for optimal patient care and safety, more integration of information sharing about patient care and journeys between and across providers, patients and caregivers, more resources and support from the associated hospital and clear patient eligibility criteria for care provider referrals.
 Lessons learned: Unique spaces have the potential to be alternate care settings when hospitals are managing capacity pressures now and in the future; however, hospitals considering moving patients with delayed discharge to these spaces should consider both the opportunities and benefits of providing care within these environments compared to traditional hospital units. It is also important for hospitals to understand the challenges associated with providing care in these settings and develop plans to mitigate these challenges. 
 Next steps: These findings provide learnings to inform a co-design initiative with patients, caregivers and care providers to identify best practices and resources for providing or receiving care in unique spaces that responds to patient needs as the health system continues to look to alternate care settings to ease pressures. This work will have implications on how integrated health care services are implemented in unique spaces so that patients experience a continuum of care both while they wait and as they transition to new points of care.

Provision of Timely Alternative Multidisciplinary Protocols for Patients Refusing Blood or Blood Products

Blood components and products are life-saving therapeutics but with inherent, life-threatening risks. There are patients who do not accept blood products for different reasons, including fear of blood borne viruses, transfusion reactions and religious beliefs. It is important to determine the standard of care and outcomes for such patients, within any clinical setting. The aim of this audit was to evaluate adherence to the agreed standard of care for patients who do not accept blood transfusion. Methods All patients who refused transfusions between 2019 and 2021 were included. Scanned forms and Electronic Patient Records were used to gather data. Expected care standards were: (1) a multidisciplinary team (MDM) led alternative care plan, agreed at least 3 weeks prior to the intervention/ procedure, to prepare for blood loss, and (2) that the MDM should involve: either a surgeon or physician, anaesthetist (if the treatment is surgical or antenatal), haematologist or transfusion practitioner and the patient. Results There were 195 patients referred to MDMs, of which 105 were surgical (54%), 52 were interventional (27%) and 38 were antenatal (19%). Of these, 188 (96%) were sent before a procedure (or birth) with the remaining 7 (4%) referred for ongoing treatment of medical patients, i.e. with severe anaemia. In 72 patients (38%) the MDM did take place ≥3 weeks before the procedure (similar to the results from the first cycle of the audit, in 2017-18 = 40%). Almost 85% (165) of MDM included all relevant stakeholders. Discussion The delay in timely referral for MDM led alternative care plan was likely due to a lack of awareness of transfusion policies, and potentially could lead to cancellation of the procedure or unavailability of alternative protocols in an emergent scenario during surgery or intervention. Conclusion Improvement was required for safer procedures and outcomes, by investment in training, regular refreshers/ updates for staff and electronic protocols/ prompts.

SYSTEMATIC REVIEW OF REHABILITATION IN SKILLED NURSING FACILITIES FOR PERSONS LIVING WITH DEMENTIA

Abstract We conducted a systematic review of published literature though April 2023 to identify the experiences and outcomes of persons living with dementia (PLWD) undergoing post-acute care rehabilitation in skilled nursing facilities (SNF). A systematic search for studies published in English was carried out in eight databases including PubMed, Scopus, Google Scholar, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science. Two reviewers independently screened articles and conducted a quality appraisal of selected studies. Forty-one articles met inclusion criteria. There was heterogeneity of study designs with most articles (n=33) being observational and cross-sectional, while randomized clinical trials (n=3) and qualitative studies (n=5) were less represented. Certain themes emerged from the results regarding patient outcomes and experiences. Measured outcomes demonstrated increased health service utilization, varied functional outcomes, and suboptimal patient care. Patient experiences included significant challenges with health care transitions, gaps in healthcare worker and caregiver knowledge & education, emphasis on alternate models of care, and importance of goal alignment. Overall, this systematic review provides a comprehensive understanding of the outcomes and experiences of post-acute care rehabilitation in SNFs for PLWD. The findings highlight the need for alternative care pathways, improved healthcare transitions, tailored rehabilitation approaches, enhanced dementia training for healthcare professionals, and person-centered goal setting. By addressing these critical aspects, future interventions can be developed to improve the delivery of post-acute care for PLWD and enhance their health outcomes.

The quality of family relationships in dementia: Mixed methods to unravel mixed feelings.

Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.

Giving birth on the way to the clinic: undocumented migrant women’s perceptions and experiences of maternal healthcare accessibility along the Thailand–Myanmar border

BackgroundMillions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can’t access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants’ experiences and perceptions of maternal healthcare accessibility.MethodsWe held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand–Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed.ResultsWomen learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain.ConclusionsUndocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports.Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo—Norwegian Centre for Research Data (58542).

Using a systems perspective to examine child protection systems and practice: A scoping review on child abandonment and institutionalisation in the Maghreb

The Maghreb (Algeria, Libya, Mauritania, Morocco (including Western Sahara), Tunisia) has high rates of child maltreatment and child abandonment, leading to high rates of child institutionalisation. This review aims to provide an estimate of the prevalence of children in institutions in the countries of the Maghreb and to compare and contrast the child protection systems in the region. Using a scoping review approach, we identified 44 relevant studies from databases including Academic Search Premiere, Africa-Wide Information, Policy file Index, Google, and Google Scholar. Estimated children in institutions were as follows: Algeria 550,000, Libya 80–145,000, Mauritania 45,850, Morocco 471,006, and Tunisia 140,000. Common elements included limited child protection resources, lack of transparent databases, limited separation between religion and state, Shariah's influence on social and cultural norms, and a kafala system, an Islamically prescribed from of permanent guardianship for abandoned children. Mauritania and Tunisia had dedicated child protection codes, and all countries except Libya reported to the CRC. The literature indicates that components of the child protection systems in the countries of the Maghreb are fragmented with competing purposes, prioritising existing communitarian cultural mores over child protection. High rates of child abandonment and institutionalisation in the region result from inadequate child safeguarding structures and the stigmatisation of unmarried mothers and their children. Kafala, is a common element of Maghrebian child protection systems, with little alternative care provision, such as foster care. The scoping review highlights the opportunity to develop and adapt existing child safeguarding and alternative care structures and practice between countries of the Maghreb. Intra-regional research is urgently needed to facilitate changes and reduce rates of child abandonment and institutionalisation.

Does Group Size of Provision Matter for Children Who Experience Residential Group Care in Scotland?

It is widely recognised that trauma-informed care is fundamental to meeting the needs of children who experience residential care. Service design is central to this, and the aim of this article is to illustrate the experiences of 13 young people who have lived within group care settings, to highlight how a service’s capacity can impact on children’s needs being met. Using findings from a PhD thesis engaging 18–29-year-olds in Scotland, the research used a mixed methodological approach of questionnaires and semi-structured interviews to elicit young people’s retrospective care experiences. The findings show that the number of children within a setting can adversely affect the feeling of being emotionally and practically supported, resulting in some children feeling that their needs were not fully met. This will offer insight to practitioners, managers and decision makers who are engaged in the delivery and development of children’s services. Background: The United Nations Convention on the Rights of the Child (UNCRC) articles 3, 9 and 20 and Scotland’s Independent Care Review state what children should expect from authorities and services responsible for providing alternative care. The ambition for Scotland’s children is that they “grow up loved, safe, and respected so that (they) realise their full potential”. For those who spend a period of their childhood growing up in residential care, they should experience a relational, trauma-informed and caring approach from staff.

Methods for the development of clinical practice guidelines for traditional Chinese medicine

The clinical practice guidelines (CPGs) are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Currently, CPGs have been developed in the field of traditional Chinese medicine (TCM) for years; however, the method of the CPG formulation process is not standardized, which has caused problems in the quality of CPGs for TCM. To promote the development and improve the status of CPGs for TCM, we used the different processes for the development of CPGs in the world for references, combined with the characteristics of TCM research, and formulated the standardized process of CPGs for TCM to provide a reference for the developers of CPGs for TCM.

Challenges when monitoring and providing care to loved ones,Perspectives of Dementia caregivers in Canada

AbstractBackgroundFamily caregivers see firsthand the progression of their care recipient’s dementia and know every aspect of their lives and needs. They make important decisions on interventions and care. Currently, there are no measures that account for caregivers’ perspectives when evaluating the impact of dementia or interventions. The aim of this study was to explore the perspectives of caregivers’ of people living with dementia across Canada to generate domains for a new caregiver‐reported measure.MethodParticipants were recruited across Canada. Listening sessions were conducted virtually over three months, using open‐ended questions to encourage participants to share their perspectives. A semi‐structured interview guide was developed to facilitate the sessions. The interviewer asked questions to encourage caregivers to share their experiences on providing care, dementia monitoring, treatment impact and seeking alternative care. The data were coded and analyzed using NVivo. A thematic analysis approach was applied by two reviewers to analyze the data.ResultSeven listening sessions were conducted with 34 caregivers who were providing care to their loved ones with dementia. Seventy‐four percent of the participants were women and 59% had 6 or more years of caregiving experience. Each listening session included three to six caregivers and was approximately one hour long. Example of codes included gait limitations, distance walked, difficulties with memory, and changes in behaviour. Overall, data were organized into three broad themes (i) psychosocial impact of dementia, (ii) physical and emotional changes for dementia monitoring and treatment, (iii) symptomalogy changes for dementia monitoring and treatment.ConclusionThis study explored the perspective of caregivers across Canada, the activities and symptoms that are important to assess when evaluating dementia progression. It also questioned caregivers on how best to evaluate treatment effects. These findings may help identify strategies to better support caregivers and improve the quality of life of individuals living with dementia. Furthermore, the findings of this study can be a resource to help healthcare professionals, communities, and policymakers to provide better support for caregivers and the lives of individuals with dementia.

Consent practices in midwifery: A survey of UK midwives

ObjectiveTo explore midwives’ knowledge and understanding of the law and practice of consent in the post-Montgomery world. DesignCross-sectional online survey. Descriptive statistical analysis of midwives’ survey responses. SettingsSocial media: Instagram, Facebook and Twitter. Survey distribution was via the UCL Opinio survey platform. ParticipantsA total of 402 midwives, surveyed over a four month period between 2nd March and 2nd July 2021. MeasurementsKnowledge of legal consent, ‘sureness’ of meeting current legal requirements and competence to gain consent. Findings91% of participants acknowledged correctly that consent must be voluntary. 91% reported that women must be informed of all the risks associated with their care, although 26% reported that women should be informed of some of the risks associated with their care. Most participants were ‘sure’ that their discussions of consent meet current legal requirements (91%). 21% rated their competence to gain consent as ‘excellent’, 71% rated themselves as ‘very good’, whilst 1% rated their competence as ‘poor’. Deficiencies in fundamental knowledge of consent were noted in some participants rating themselves highest in ‘sureness’ of meeting legal requirements and competence to consent. Key conclusionsFundamental gaps in midwives’ knowledge of legal consent were identified. Participants demonstrated uncertainty regarding the extent of risk disclosure and discussion of alternative care options. Participants generally rated themselves highly in their consenting practices, despite lacking in basic knowledge of legal consent, revealing a discrepancy between midwives’ self-perceptions and their actual knowledge. Implications for practiceThe overconfidence displayed by some participants is concerning for clinical midwifery practice. Professional education and guidance for midwives on legal consent in keeping with Montgomery is urgently required to ensure that midwives are legally compliant in their consenting practices.

Unheard voices: The living reality of unaccompanied refugee children in Jordan

BackgroundUnaccompanied refugee children are highly susceptible to challenging living conditions, as they lack the presence of biological caregivers. This study addresses a critical gap in the existing literature, providing valuable insights into a vulnerable population that has been relatively understudied. Moreover, understanding the specific circumstances and difficulties faced by unaccompanied refugee children in Jordan can inform the development of more effective support systems and policies. ObjectiveThis study aimed to investigate the lived experiences of unaccompanied refugee children in Jordan and shed light on their unique challenges and needs. Participants and settingSixteen unaccompanied refugee children residing in Jordan were purposefully selected as participants for the study. They were selected based on accessibility and permission from the responsible entity. The limited number of participants (16) reflects the challenges associated with accessing this group and the need to prioritize their privacy and confidentiality. MethodsTo achieve this goal, a qualitative research approach was employed. Semi-structured interviews were used as the data collection method in the study, allowing participants to share their experiences and perspectives in their own words. The collected data were analyzed using the inductive thematic analysis method. Steps were taken to prioritize the well-being and rights of the participants, including obtaining informed consent, ensuring confidentiality, and providing psychosocial support when needed. ResultsThe study revealed three primary forms of alternative care provided to unaccompanied refugee children in Jordan: foster families, supervised groups, and institutional care. These findings shed light on the challenges faced by children in each of these care settings. The research unveiled that these children often experience various forms of abuse and violations. ConclusionsUnaccompanied refugee children face numerous challenges and difficulties in destination countries. In light of the study's findings, several crucial recommendations emerge. First, there is an urgent need to strengthen the foster care system in Jordan while ensuring rigorous oversight to safeguard their rights. Moreover, policymakers should prioritize the provision of cost-free, high-quality healthcare and unhindered access to free education for these children.

A Case Study on Community Treatment Center for Response to COVID-19 in Korea: Focusing on Surge Capacity 4S Component Analysis and Social Well-Being Perspective

ABSTRACT In March, 2020, during the COVID-19 pandemic in Korea, the first Community Treatment Center (CTC), which is a motel-type Alternate Care Site (ACS) for mild and asymptomatic patients, was opened. This is a case study of the first Community treatment center prepared to respond to COVID-19. One of the researchers worked as a medical doctor in one of the CTCs operated by the Korean government. The CTC’s eight medical staff members were interviewed in-depth one-on-one. Then the data obtained from observation, collection, and interview were triangulated. In this study, it was identified based on the 4S factor that evaluates the surge capacity to meet the medical needs of CTC. And how the CTC was operated from a medical and social welfare perspective and what problems appeared to patients during the operation were analyzed. Three dormitories of a national training center were used as the CTC. Each patient used a room equipped with a toilet, a shower, and a washbasin. Medical staff and government officials with various backgrounds were dispatched. Telemedicine was also used to prevent the spread of infection. The CTC made a significant contribution to both medical and social welfare fields. It provided patients psychological stability in a comfortable environment. But some patients had psychological problems and difficulties involving work and family care. Various efforts in conjunction with participation from social workers are required to reduce these problems.