General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study.

BACKGROUND: Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare. METHODS: From a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity. RESULTS: Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions. CONCLUSIONS: General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.

How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List.

Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.

Changes in attachment representations for young people in long-term therapeutic foster care.

This article reports on a 1-year follow-up study exploring changes in attachment security of children placed in long-term therapeutic foster care over three data collection time points. A group of eight children (age 14 to 17) were assessed over a period of 1 year using a modified version of the Separation Anxiety Test (SAT). Interviews were also conducted to explore the young people's and the carers' experiences of the placements and their personal perspectives of changes. The findings indicated some positive changes in the young people's attachment security over time, for example, a reduction in extreme reactions and a trust that adults could understand their feelings (PAE - parental accurate empathy). However, despite this PAE, the young people did not expect adults to enact this by offering them support, and this lack of expectation persisted over the 1-year period. Specific differences in relation to placement success were suggested in that young people for whom their placements broke down indicated more initial fearful and aggressive representations of adults. Overall, young people emphasised positive aspects of their placements as including being treated as adults, listened to and made to feel safe.