Attachment to mother and father at transition to middle childhood

The present study investigated concordance between representations of attachment to mother and attachment to father, and convergence between two narrative-based methods addressing these representations in middle childhood: the Manchester Child Attachment Story Task (MCAST) and the Secure Base Script Test (SBST). One hundred and twenty 6-year-old children were assessed by separate administrations of the MCAST for mother and father, respectively, and results showed concordance of representations of attachment to mother and attachment to father at age 6.5 years. 75 children were additionally tested about 12 months later, with the SBST, which assesses scripted knowledge of secure base (and safe haven), not differentiating between mother and father attachment rela- tionships. Concerning attachment to father, dichotomous classifications (MCAST) and a continuous dimension cap- turing scripted secure base knowledge (MCAST) converged with secure base scriptedness (SBST), yet we could not show the same pattern of convergence concerning attach- ment to mother. Results suggest some convergence between the two narrative methods of assessment of secure base script but also highlight complications when using the MCAST for measuring attachment to father in middle childhood

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Secure Base Representations in Middle Childhood Across Two Western Cultures: Associations With Parental Attachment Representations and Maternal Reports of Behavior Problems

Recent work examining the content and organization of attachment representations suggests that 1 way in which we represent the attachment relationship is in the form of a cognitive script. This work has largely focused on early childhood or adolescence/adulthood, leaving a large gap in our understanding of script-like attachment representations in the middle childhood period. We present 2 studies and provide 3 critical pieces of evidence regarding the presence of a script-like representation of the attachment relationship in middle childhood. We present evidence that a middle childhood attachment script assessment tapped a stable underlying script using samples drawn from 2 western cultures, the United States (Study 1) and Belgium (Study 2). We also found evidence suggestive of the intergenerational transmission of secure base script knowledge (Study 1) and relations between secure base script knowledge and symptoms of psychopathology in middle childhood (Study 2). The results from this investigation represent an important downward extension of the secure base script construct.status: publishe