Maternity waiting homes as a costâ effective intervention in rural Liberia

ObjectiveTo analyze the costâ effectiveness of maternity waiting homes (MWHs) in rural Liberia by examining the cost per life saved and economic effect of MWHs on maternal mortality.MethodsA costâ effectiveness analysis was used to evaluate costs and economic effect of MWHs on maternal mortality in rural Liberia to guide future resource allocation. A secondary data analysis was performed based on a prior quasiâ experimental cohort study of 10 rural primary healthcare facilities, five with a MWH and five without a MWH, that took place from October 30, 2010 to February 28, 2015.ResultsCalculations signified a low cost per year of life saved at MWHs in a rural district in Liberia. Total populationâ adjusted number of women’s lives saved over 3 years was 6.25.ConclusionWhile initial costs were considerable, over a period of 10 or more years MWHs could be a costâ effective and affordable strategy to reduce maternal mortality rates in Liberia. Discussion of the scaling up of MWH interventions for improving maternal outcomes in Liberia and other lowâ and middleâ income countries is justified. Findings can be used to advocate for policy changes to increase the apportionment of resources for building more MWHs in low resource settings.Maternity waiting homes are an affordable and highly costâ effective strategy to decrease maternal mortality in Liberia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149550/1/ijgo12830.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149550/2/ijgo12830_am.pd

Domestic abuse and safeguarding children : critical issues for multiagency work

This paper reports upon the learning that emerged from a development project which aimed to facilitate improvements in multiagency work in domestic abuse and safeguarding children. The two-year project (2011–13), funded by the Department for Education and led by WomenCentre, a specialist voluntary sector organisation based in West Yorkshire, was undertaken in nine local authorities in the north of England. Activities undertaken during the project included case mapping, service user and professional engagement exercises, observation of local multiagency meetings and provision of training. An evaluative research study examined the work of the project and the learning that emerged. Drawing upon data from telephone interviews with project participants, analysis of case mapping and project reports, this paper discusses some critical issues which emerged from this project. The paper draws attention to the different understandings and priorities which shape interprofessional practice in relation to safeguarding children and domestic abuse, and the complexities of the wider interagency environment including coordination, resources and expertise. Recommendations for improving multiagency work to achieve better outcomes for women and children experiencing domestic abuse are discussed

Cumulative incidence of entry into out-of-home care:Changes over time in Denmark and England

Policies and thresholds vary for placing children into out-of-home care (OHC) at different ages. Evidence is lacking that quantifies the risk of entering OHC by age, and how this varies over time and between countries. We determined the age-specific cumulative incidence of ever entering OHC during childhood in Denmark and in eight local authorities in England. We used administrative data for any form of OHC (except respite care) provided by children's social services in Denmark and England from 1992 to 2008. Using life tables and national population estimates, we calculated the cumulative incidence of entry into OHC by year of age for cohorts born in 1992–1994 through to 2006–2008. The cumulative incidence of entry into OHC decreased over time in Denmark and increased in England at all ages. Cumulative incidence of OHC in the first year of life was similar in Denmark and England for infants born in 1992–1994 (Denmark 2.83/1,000, England 2.89/1,000), but infants born in 2007–2008 were nearly three times as likely to enter OHC before their first birthday in England (4.50/1,000) than in Denmark (1.61/1,000). Entry into OHC during adolescence was more common in Denmark than in England so that by 16 years old the cumulative incidence of ever entering OHC during childhood was twice as high in Denmark (33.83/1,000) as in England (15.62/1,000). Diverging trends over time in the use of OHC in Denmark and England are likely to reflect changing policies in the two countries

A systems approach to policy evaluation

There is growing interest in evaluating policy implementation in ways that grapple with the complexity of the process. This article offers an example of using systems methodology to explore how the child protection policy in child contact centres has functioned in practice. Rather than just asking the traditional evaluation question “is it working?” this study sought to understand how the policy was working and how it was interpreted as it interacted with other systems, producing conflicts, local variation and emergent effects. It illustrates how the systems concepts of ‘emergence’, ‘local rationality’, ‘socio-technical systems’ and ‘feedback for learning’ can contribute new knowledge and understanding to a complex policy evaluation problem

The first legal mortgagor: a consumer without adequate protection?

This article contends that the UK government’s attempt to create a well-functioning consumer credit market will be undermined if it fails to reform the private law framework relating to the first legal mortgage. Such agreements are governed by two distinct regulatory regimes that are founded upon very different conceptions of the mortgagor. The first, the regulation of financial services overseen by the Financial Conduct Authority, derives from public law and is founded upon a conception of the mortgagor as “consumer”. The other is land law, private law regulation implemented by the judiciary and underpinned by a conception of the mortgagor as “landowner”. Evidence suggests that the operation of these two regimes prevents mortgagors from receiving fair and consistent treatment. The current reform of financial services regulation therefore will change only one part of this governance regime and will leave mortgagors heavily reliant upon a regulator that still has to prove itself. What this article argues is that reform of the rules of private law must also be undertaken with the aim of initiating a paradigm shift in the conception of the mortgagor from “landowner” to “consumer”. Cultural shifts of this kind take time but the hope is that this conceptual transformation will occur in time to deter the predicted rise in mortgage possessions

The formalized framework for decision-making in child protection care orders : a cross-country analysis

Care orders within the child protection system are some of the most invasive interventions a state can make. This article examines the discretionary space governments set out for child protection workers when they prepare care orders. We analyse the formalized framework for these decisions in England, Finland, Norway and the United States. We focus on knowledge, timelines, how children and parents are involved and accountability. We find that Norway and Finland have highly de-regulated systems with wide discretionary space, whereas England and the United States are highly regulated systems with narrow discretionary space. The United States differentiates itself with relatively little parent and/or child involvement in decision-making. England and Finland do not have defined deadlines for terminating the process, and Norway has few directives on what information to collect. Such differences will influence the quality of decisions as well as the principles of the rule of law

Changing practice: the possibilities and limits for reshaping social work practice

Since 2010 the United Kingdom has witnessed a number of initiatives that shift away from reliance on performance management to improve social work with children and families, towards a renewed interest in practice models. This study reports on the evaluation of a local government programme in England to introduce and embed systemic family practice through the roll out of intensive training to social workers and frontline managers. It was anticipated through the programme that child protection social workers would undertake more direct work with families and build more positive relationships, resulting in a fall in the number of child protection plans and children experiencing repeat periods of care. The evaluation adopted a mixed method approach encompassing an online survey of social workers, interviews with team managers and family members, a case audit and statistical analysis of local level metrics. It found limited employment of systemic family practice or improvement due to the programme. Adopting the 7 S framework, this study examines the barriers to and facilitators of successful change and identifies generic considerations for change programmes in child protection social work

Emotion in responses to the child with ‘additional needs’

The work that is done with children and young people by the practitioners of health, education or social care forms part of their experience of growing up, and can have a profound impact on their future outcomes. Children may find themselves ‘impotent at the hands of powerful others’, particularly where their behaviour causes concern. This paper reports on a key theme from the author's doctoral research, demonstrating the ways that the emotion-laden interactions between practitioners in multi-agency children's services, children and parents, affected the diagnosis, treatment, communication and outcomes for children's well-being, as defined within Every Child Matters. Exploring the emotion within interactions permits a different perspective on ‘need’, and finally, the paper argues for a more careful and emotionally reflective practice from those who work with children