Abstract Understanding the experience of women who become mothers during their teenage years is central to ensuring that the support that is offered is appropriate to meet their needs. This paper reports on a small part of a larger ethnographic study that captured the lived experience of young mothers who were between the ages of 16 and 19 years that potentially typifies and illuminates the experiences of young women who become mothers in their teenage years. By collecting data from narrative interviews as well as participant and non‐participant observations over an extended period of time it was possible to identify how the young women experienced a range of difficulties as they made their transition into motherhood. Drawing on the findings, this paper argues that this transition for teenage mothers can be significantly different from the experience of older mothers, and it identifies the importance of appropriate support to mediate the challenges that they face. Understanding the young women's journey to ‘becoming’ is critical when planning services because if their experience of support is negative, it can lead to increased levels of maternal stress and reluctance to engage with support services.
Abstract This paper explores the provision of family support services for young mothers within a Sure Start Children's Centre, drawing on data collected within a larger study. It identifies how the family support team attempted to build supportive relationships with young mothers between the ages of 16 and 19 years. The findings presented here draw on narrative interviews ( n = 10) and focus group interviews ( n = 2) with the family support team that included early years workers, family support workers and their managers. The findings captured how the participants actively resisted the stigma (Goffman 1963) of teenage motherhood in order to support young mothers in gaining the necessary skills and knowledge to care for their child. Drawing on the findings, this paper argues that the building of a supportive relationship enables a young mother to construct positive counter‐narratives about her parenting experience. This suggests that the family \to offer informal early support to young mothers who are at risk of more formal intervention. However, the complexity of this task should not be underestimated because in doing this, the family support team must at all times ensure the well‐being and safety of the child.
Background Differences in the content of care provided by acute in-patient mental health wards and residential crisis services such as crisis houses have not been researched. Aims To compare planned and actual care provided at alternative and standard acute wards and to investigate the relationship between care received and patient satisfaction. Method Perspectives of stakeholders, including local service managers, clinicians and commissioners, were obtained from 23 qualitative interviews. Quantitative investigation of the care provided at four alternative and four standard services was undertaken using three instruments developed for this study. The relationship of care received to patient satisfaction was explored. Results No significant difference was found in intensity of staff– patient contact between alternative and standard services. Alternative services provided more psychological and less physical and pharmacological care than standard wards. Care provision may be more collaborative and informal in alternative services. All measured types of care were positively associated with patient satisfaction. Measured differences in the care provided did not explain the greater acceptability of community alternatives. Conclusions Similarities in care may be more marked than differences at alternative and standard services. Staff–patient contact is an important determinant of patient satisfaction, so increasing it should be a priority for all acute in-patient services.
Background Key questions regarding residential alternatives to standard acute psychiatric care, such as crisis houses and short-stay in-patient units, concern the role that they fulfil within local acute care systems, and whether they manage people with needs and illnesses of comparable severity to those admitted to standard acute wards. Aims To study the extent to which people admitted to residential alternatives and to standard acute services are similar, and the role within local acute care systems of admission to an alternative service. Method Our approach combined quantitative and qualitative methods. Consecutive cohorts of patients in six residential alternatives across England and six standard acute wards in the same areas were identified, and clinical and demographic characteristics, severity of symptoms, impairments and risks compared. Semi-structured interviews with key stakeholders in each local service system were used to explore the role and functioning of each alternative. Results Being already known to services (OR = 2.6, 95% CI 1.3–5.2), posing a lower risk to others (OR = 0.49, 95% CI 0.31–0.78) and having initiated help-seeking in the current crisis (OR = 2.2, 95% CI 1.2–4.3) were associated with being admitted to an alternative rather than a standard service. Stakeholder interviews suggested that alternatives have a role that is similar but not identical to standard hospital services. They can divert some, but not all, patients from acute admission. Conclusions Residential alternatives are integrated into catchment area mental health systems. They serve similar, but not identical, clinical populations to standard acute wards and provide some, but not all, of the functions of these wards.
Background Outcomes following admission to residential alternatives to standard in-patient mental health services are underresearched. Aims To explore short-term outcomes and costs of admission to alternative and standard services. Method Health of the Nation Outcome Scales (HoNOS), Threshold Assessment Grid (TAG), Global Assessment of Functioning (GAF) and admission cost data were collected for six alternative services and six standard services. Results All outcomes improved during admission for both types of service (n = 433). Adjusted improvement was greater for standard services in scores on HoNOS (difference 1.99, 95% CI 1.12–2.86), TAG (difference 1.40, 95% CI 0.39–2.51) and GAF functioning (difference 4.15, 95% CI 1.08–7.22) but not GAF symptoms. Admissions to alternatives were 20.6 days shorter, and hence cheaper (UK£3832 v . £9850). Standard services cost an additional £2939 per unit HoNOS improvement. Conclusions The absence of clear-cut advantage for either type of service highlights the importance of the subjective experience and longer-term costs.
Purpose The purpose of this paper is to understand how patients on a low security personality disorder ward experienced multi-disciplinary team (MDT) meetings, in order to suggest improvements that would benefit the patients and clinical teams. Design/methodology/approach The design was a case study where all patients on a low secure ward that specialised in personality disorders were approached to take part in the research. The study utilised non-participant observations of the MDT meeting ( n =11), followed by individual interviews with the patients ( n =10). Findings The data were subjected to a thematic analysis and this illuminated five themes relating to the patients’ experience of the MDT meetings namely, the importance of leave applications, the formality of the meetings, the opportunity to check on progress, decision-making and the importance of communication. Practical implications The findings suggest that small changes could be made to improve the patients’ experience of the MDT meeting. These included the provision of a less formal setting, ensuring a system where leave can be requested confidentially, greater transparency about the content of progress reports, and clearer communication between the MDT and the patient after the meeting. Originality/value There is limited research that has explored patients’ experiences of MDT meetings within secure forensic settings, and the use of non-participant observations of the MDT meeting followed by semi-structured interviews meant that the researcher and the patient had a shared experience that formed the basis of the later discussion.