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This article focuses on access to domestic violence services within Belize. Using data from community asset mapping, interviews with key informants, and focus groups with community members, the multiple streams framework was used to identify potential areas for intervention to improve access and ameliorate the effects of family violence in Belize. Identified challenges to accessing limited domestic violence resources were mainly confidentiality concerns and mistrust. Existing laws and regulations, organizational structures, and policies and plans also influenced access. Women's groups, nongovernmental organizations, and the health department can play a crucial role in improving access to domestic violence services.

To understand the positives and negatives of online dating according to the lived experience of older women, telephone interviews were conducted with 45 women ages 50+ who date online. Interviews were audio recorded, transcribed verbatim, and thematically team coded. The opportunity to expand one's social network for both friendships and romantic partners, the ability to control dating risks and pace of relationship formation, and knowing more about one's partner were significant reported benefits of online dating. Dating online also includes unique risks, such as pervasive lying, attempted financial exploitation in the form of scammers, and unwanted electronic sexual aggression.

Our objective was to explore if women who experience emergency peripartum hysterectomy (EPH), a type of severe maternal morbidity, are more likely to screen positive for post-traumatic stress disorder (PTSD) compared to women who did not experience EPH. Using a retrospective cohort design, women were sampled through online communities. Participants completed online screens for PTSD. Additionally, women provided sociodemographic, obstetric, psychiatric, and psychosocial information. We conducted bivariate and logistic regression analyses, then Monte Carlo simulation and propensity score matching to calculate the risk of screening positive for PTSD after EPH. 74 exposed women (experienced EPH) and 335 non-exposed women (did not experience EPH) completed the survey. EPH survivors were nearly two times more likely to screen positive for PTSD (aOR: 1.90; 95 % CI: 1.57, 2.30), and nearly 2.5 times more likely to screen positive for PTSD at 6 months postpartum compared to women who were not EPH survivors (aOR: 2.46; 95 % CI: 1.92, 3.16). The association of EPH and PTSD was statistically significant, indicating a need for further research, and the potential need for support services for these women following childbirth.

Background: Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants’ perceived barriers to managing early breastfeeding problems. Methods: This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. Results: A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother’s self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Conclusion: Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

In contrast to younger populations, little attention has been paid to the increase in seniors using Internet-based venues to find relationships and the potential risk for adverse outcomes this poses. This study examined data collected via an online survey from 45 ethnically diverse women aged 50+ "seeking relationships" on MySpace. The majority of women reported a relationship with someone they met online (85%). They also reported experiencing adverse events including financial exploitation (40%), threats (55%), and physical harm (38%) by someone they met online at levels greater than traditional relationship seeking in the general population. Directions for future research are explored.

Background: Little is known of the experience and perceptions of care for survivors of emergency peripartum hysterectomy (EPH), an obstetric event that is increasing in incidence. We sought to explore women's experiences of EPH to make recommendations for care. Methods: This qualitative study utilized purposive sampling through an online support group of women who experienced EPH. Eligible participants were at least 18 years old, had their hysterectomy at least 6 months but no more than 3 years before the interview, had a surviving infant associated with the delivery, and did not report suicidal ideation. In- depth, semi-structured telephone interviews were conducted and analyzed using Constant Comparative Analysis. Kappa statistics assessed interrater reliability for two independent coders. Results: Fifteen women participated with a mean age of 32.5 years. Most had a cesarean section, with uterine atony as the most common indication for EPH. Kappa statistics indicated near-perfect interrater agreement between two coders, ranging from .82 to .89. Seven major themes were identified: fear; pain; death and dying; numbness or delay in emotional reaction; bonding with baby; communication; and the need for information. Psychological upset occurred postpartum and was often delayed. A major finding is the need for additional follow-up visits to address the emotional after-effects and to fill in gaps in women's understanding and memory of what had occurred. Conclusion: Understanding women's experiences with EPH can help practitioners address not only women's initial complications but provide needed long-term support. (BIRTH 40:4 December 2013)

Background Parents involved with child welfare services are often mandated to attend a variety of therapeutic services based on the stressors they face. Despite the need to understand how to best offer services to parents, there is limited research that examines parents' experiences with and barriers to accessing these services. Purpose This study utilized a family-centered care framework to examine the experiences of parents related to the development of case plans and the provision of mandated therapeutic services as a result of being involved with the child welfare system. Methods Semi-structured, in-depth, in-person qualitative interviews were conducted with 21 participants of a child welfare-related intensive therapeutic parenting program, including mothers, fathers and father-figures, and grandparents who acted as caregivers. The constant comparative method was used for coding and analysis. Results Results indicated that while the therapeutic services themselves often meet the needs of family members, parents are not empowered to influence the service plan; they face several important barriers to receiving services; and that case plans are not designed to take into account systemic family issues in addition to addressing the stressors of individual parents. Conclusions Increased attention to comprehensive family assessments and engaging parents in the design of their case plan may provide mechanisms for increasing family-centered services in child welfare.

While conducting a prospective study of 100 sexually abused children, we found a much higher rate of out-of-home placement than has been previously described for child maltreatment. This study was designed to determine which factors were most influential in predicting the placement experiences of this cohort. The children, ages 6–17 years, were recently substantiated victims of intrafamilial sexual abuse whose parents or guardians permitted study involvement. We examined child and family demographics, abuse characteristics, and family response as possible determinants of immediate and later placement. At the initial assessment, within a few weeks of the disclosure. 50% of the children had already been removed. A follow-up assessment of 83 children two years later revealed that 73% had been removed from the abusing home. In a multivariate regression model, only maternal support of the child emerged as a significant predictor of immediate placement and placement over time. The offender's status as a resident in the child's home was an important predictor of immediate placement but was not significant as a predictor of all placements at any time. As maternal support is an important predictor of the need for placement, workers are encouraged to seek ways of enhancing maternal support as a means of reducing placement.

Examining the psychologic risks of court and related interventions on child sexual abuse victims.A prospective cohort study with follow-up at 5 months.Eleven county social service departments in central North Carolina.100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study.Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05).Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.

A child sexual abuse research project was designed which was dependent on referrals from local departments of social services. Significant differences in needs and goals existed between the referral sources and the research team. Modifications of project designs were necessary in the areas of subject recruitment, allocation of project resources, design and measurement, and analysis and reporting. These modifications resulted in a beneficial blend of service and research and produced a useful service in the setting of competent research.

In Florida, the need for clinically oriented social workers with expertise in planning and evaluating maternal and child health programs has led to the establishment of a joint master of social work and master of public health degree program. This program has a clinical social work concentration combined with a public health concentration in maternal and child health content, administration, and research design. The philosophy and development of the program, the course content and degree requirements, the field placement content, issues regarding student acceptance and advisement, faculty appointments, and program directions and goals are discussed. Descriptions of both the social work and public health programs that operate the joint-degree curriculum and the differing perspectives are outlined as well as skills that students obtained through their participation in the program.

Fifth and sixth grade children randomly assigned to experimental and control groups saw videotaped television programs in which the drinking of alcoholic beverages by the principal characters appeared in the experimental condition but not the control condition. Parents' drinking and home television watching were similar for both groups. Immediately after viewing the television programs, the children completed alcohol attitude and subjective expected utility (SEU) questionnaires. There were no significant differences in attitudes or SEU scores with one exception. Among boys only, those who saw the film with drinking were significantly more likely to respond that the good things about alcohol are more important than the bad things. Further research into the potential effects on children of drinking on television serials is indicated.

Bureau Common Reporting Requirements (BCRR) data tapes for Fiscal Year 1980 were analyzed to determine whether the type of sponsoring agency influenced the productivity or indicators of care of Maternity and Infant Care and Children and Youth Projects. Sponsors were classified as either health department or non-health department, health department or major medical center, or public or private in three separate sets of analyses. Some of these analyses indicated that special projects that were either health department or public agency sponsored were more likely to have more non-medical patient encounters and more health education and social work staff for a given level of expenditures. Although publicly sponsored projects employed fewer physician equivalents than did the non-public projects, those physicians were more productive. Despite these differences in encounters, staffing, and utilization of physicians, there were no differences in available measures of the process of care between categories of projects in any of the analyses.