Journal articles on the topic 'Caregivers Australia Attitudes'

Background and objectivesAlthough patient and caregiver involvement in research is widely advocated to improve the relevance and uptake of study findings, barriers and uncertainties in achieving this goal remain. This study aimed to describe patient and caregiver experiences and perspectives of their previous involvement in research, to inform strategies to strengthen patient involvement in research.Design, setting, participants, & measurementsSemistructured interviews were conducted with 23 adult patients with CKD and caregivers who had previously been involved in research, from Australia, the United States, the United Kingdom, and Denmark. Transcripts were analyzed thematically.ResultsWe identified six themes: grappling with CKD diagnosis (overwhelmed by the burden of illness, silenced by stigma and shame, absence of advocacy, and awareness), bearing the responsibility for involvement (autonomy in their own care, forced to be proactive to access opportunities, infrastructural support to connect researchers and patients), battling big agendas (struggling in a system of disincentive, changing research culture, becoming equals), seeing the person behind the patient (harnessing broader knowledge, expertise, skills and interests, understanding patient needs, motivations for involvement), sensitivity to complexities of payment (accounting for individual circumstances, denoting value, enabling diverse involvement), and championing the patient voice (links to important stakeholders, drivers of innovation, responsibility to end users).ConclusionsThe burden of CKD, limited opportunities, and power asymmetry between patients/caregivers and researchers were challenges to meaningful involvement in research. Building trust, awareness of opportunities, and recognizing the broad expertise and value of patients/caregivers, including and beyond their illness experience, may better support patient and caregiver involvement in research in CKD.

Background/AimsSalt intake among Australian adults exceeds recommendations, increasing the risk of cardiovascular disease. Knowledge, attitudes and behaviours (KABs) are modifiable factors that may influence salt consumption. It is not known whether salt-related KABs among parents and caregivers of children under 18 years of age differ from other adults who do not care for children under 18 years of age. Therefore, we aimed to determine whether salt-related KABs differed between parents and caregivers and other adults. This information can be used to inform messages included in salt reduction consumer awareness campaigns.MethodsAdults, aged 18–65 years, were recruited from four shopping centres, Facebook and a consumer research panel in the state of Victoria, Australia. Participants indicated if they were a parent or a caregiver of a child/children <18 years (‘parents/caregivers’) or not (‘other adults’). Regression models, adjusted for covariates, assessed differences in KABs between the two groups. Construct scores for KABs were developed, with high scores for knowledge indicative of high salt-related knowledge, for attitude indicative of lower importance of using salt to enhance the taste of food, and for behaviours indicative of higher frequency of engaging in behaviours to reduce salt in the diet.ResultsA total of 840 parents/caregivers and 1558 other adults completed the survey. Just over half of the parents/caregivers and other adults were female, with a mean (SD) age of 41.1 (10.3) years and 44.3 (15.3) years, respectively. Mean construct scores for salt-related KABs were similar between the two groups. Parents/caregivers were less likely to be aware of the relationship between salt and sodium (OR=0.73, p=0.002) and more likely to report difficulty in interpreting sodium information displayed on food labels (OR=1.36, p=0.004). Parents/caregivers were more likely to be concerned about a range of food-related issues, including the amount of saturated fat, sugar and salt in food. Parents/caregivers were more likely to report that they were trying to reduce their salt intake (OR=1.27, p=0.012) and more likely to report adding salt at the table (OR=1.28, p=0.008).ConclusionsThere were some differences in salt-related KABs between parents/caregivers and other adults. These findings provide insight into particular messages that could be focused on in consumer awareness campaigns that seek to improve parents’/caregivers’ KABs related to salt intake. Specifically, messages targeted at parents/caregivers should include practical guidance to reduce table salt and resources to assist in interpreting sodium information on food labels and the relationship of sodium to salt.

Background: Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals’ attitudes to palliative care with few studies exploring the views of patients and their carers. Aim: To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings. Design: Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. Setting/participants: Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia. Results: Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a ‘lesser’ treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one’s care given all other options have expired. Conclusion: While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the ‘institutional death’ and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.

IntroductionIt is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being.Methods and analysisPragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6–12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient’s health-related quality-of-life and quality of chronic disease care; (ii) caregiver’s health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff’s self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention.Ethics and disseminationApproved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks.Trial registration numberACTRN12617000280303.

Background and objectivesPresymptomatic testing is available for early diagnosis of hereditary autosomal dominant polycystic kidney disease (ADPKD). However, the complex ethical and psychosocial implications can make decision-making challenging and require an understanding of patients’ values, goals and priorities. This study aims to describe patient and caregiver beliefs and expectations regarding presymptomatic testing for ADPKD.Design, setting and participants154 participants (120 patients and 34 caregivers) aged 18 years and over from eight centres in Australia, France and Korea participated in 17 focus groups. Transcripts were analysed thematically.ResultsWe identified five themes: avoiding financial disadvantage (insecurity in the inability to obtain life insurance, limited work opportunities, financial burden); futility in uncertainty (erratic and diverse manifestations of disease limiting utility, taking preventive actions in vain, daunted by perplexity of results, unaware of risk of inheriting ADPKD); lacking autonomy and support in decisions (overwhelmed by ambiguous information, medicalising family planning, family pressures); seizing control of well-being (gaining confidence in early detection, allowing preparation for the future, reassurance in family resilience); and anticipating impact on quality of life (reassured by lack of symptoms, judging value of life with ADPKD).ConclusionsFor patients with ADPKD, presymptomatic testing provides an opportunity to take ownership of their health through family planning and preventive measures. However, these decisions can be wrought with tensions and uncertainty about prognostic implications, and the psychosocial and financial burden of testing. Healthcare professionals should focus on genetic counselling, mental health and providing education to patients’ families to support informed decision-making. Policymakers should consider the cost burden and risk of discrimination when informing government policies. Finally, patients are recommended to focus on self-care from an early age.

Purpose Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur (PTSD+SUD). The onset of these disorders often occurs during adolescence. There is limited understanding of the perspectives of service providers working with this population. The purpose of this paper is to identify the practices, attitudes, experiences and training needs of Australian service providers treating adolescents with PTSD+SUD. Design/methodology/approach Service providers in Australia were invited to complete an anonymous online survey regarding their experiences working with adolescents who have PTSD+SUD. Ninety participants completed the 48-item survey that comprised multiple choice and open-ended questions. Findings Service providers estimated that up to 60 per cent of their adolescent clients with PTSD also have SUD. They identified case management, engaging with caregivers and difficult client emotions as specific challenges associated with working with this population. Despite this, providers rated treating PTSD+SUD as highly gratifying for reasons such as teaching new coping skills, developing expertise and assisting clients to achieve their goals. There were mixed perspectives on how to best treat adolescents with PTSD+SUD, and all participants identified a need for evidence-based resources specific to this population. Originality/value This is the first survey of Australian service providers working with adolescents who experience PTSD+SUD. The findings improve our understanding of the challenges and rewards associated with working with this population, and provide valuable information that can enhance clinical training and guide the development of new treatment approaches for this common and debilitating comorbidity.

Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. Methods This study is part of the “Integrating a neonatal healthcare package for Malawi” project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). Findings A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. Conclusion Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.

The values of filial piety have strongly influenced the care of older people in traditional Chinese societies. Changes in family structure and relationships have occurred and in recent decades, transnational migration has become a factor in how filial piety is perceived and practiced in contemporary translocal Chinese families. Through the use of in-depth interviews, this pilot study explores transnational family patterns, elder care practices, attitudes towards filial piety, and opinions of the medical systems in Taiwan and Australia among 14 Taiwanese families who have lived in Australia for over 20 years. The study finds that despite immigration, filial piety remains an important value for these families. Most participants have/had provided care to their aged parents at the site of immigration and back home, and some of these parents were immigrants who had returned to Taiwan in their old age. Participants generally felt that older people are better looked after in Taiwan than in Australia, as Taiwan has a better healthcare system, and hired caregivers are more readily available. Elders’ expectations of filial piety from their children varied among participants, but all were prepared for a weakening of filiality and ongoing changes in intergenerational relations while living in a Western country. 傳統中國社會的老人照顧，受到孝道價值觀的影響很深。因為家庭結構及成員關係的改變，特別是近三十年來移民國外人口的增加，對當代華人家庭對孝道的認知與實踐產生了新的影響。本研究透過深入訪談居住澳洲二十年以上的台灣移民，探索跨國家庭類型、照顧年長父母的方式、對孝道的看法，以及台灣及澳洲兩地醫療體系的差異。研究發現雖然移民海外，盡孝道仍是重要的家庭價值。大部分的受訪者都曾為長者提供資源或參與照顧，無論是在澳洲或在台灣。年長父母也曾經在成年子女居住澳洲期間前往探視、短期逗留或移民。他們大部分都已回流台灣，原因是在台灣的年長者會得到較好的照顧，台灣的健保制度較適合年長者的需要，而且可以僱用外傭幫忙。已定居澳洲的台灣移民，對孝道的看法雖有差異，但對自己的成年子女是否能在環境不同的西方國家盡孝道，均有所保留。 (This article is in English.)

The Australian population consumes more salt than recommended and this increases the risk of raised blood pressure and cardiovascular disease. In 2015, a state-wide initiative was launched in the Australian state of Victoria to reduce population salt intake. This study examines whether salt-related knowledge, attitudes and behaviors (KABs) of Victorian adults changed following the first 22 months of a consumer awareness campaign targeting parents. Repeated cross-sectional surveys of adults (18–65 years) recruited from research panels. Analyses were weighted to reflect the Victorian population. In both surveys mean age of participants (1584 in 2015 and 2141 in 2018) was 41 years, and 51% were female. This includes 554 parents/caregivers in 2015 and 799 in 2018. Most indicators of KAB remained unchanged. Among parents/caregivers the percentage who agreed limiting salt in their child’s diet was important increased by 8% (p = 0.001), and there was a 10% reduction in the percentage who reported placing a saltshaker on the table and a 9% reduction in those who reported their child added salt at the table (both p < 0.001). Some small adverse effects on other indicators were also observed. During the first 22 months of a salt reduction consumer awareness campaign, there were limited changes in KAB overall, however the target audience reported positive changes regarding their children, which aligned with the campaign messages.

Background: Healthcare systems worldwide will be increasingly challenged to meet the complex needs of aging populations. In particular, the operation of residential aged care facilities will require improved surveillance and monitoring to ensure that quality assurance systems are in place that support holistic and humane care of all aged care residents.Objectives: To undertake a selected literature search including a focus on Australian based case studies with the intention of a) developing a philosophical orientation towards improving awareness and understandings among policy makers and residential aged care workers to transform residential aged care into an environment that protects human rights b) drawing attention to how the adoption of an attitude that sees aged care recipients as having left while still living has the potential to create a minimalist approach to care and c) highlighting the need for emotionally intelligent leadership as a core component for establishing, facilitating and coordinating the delivery of quality assurance systems in residential aged care.Methodology: This is not a quantitative study but one essentially focused on offering a professional perspective on residential aged care resulting from a reading of selected literature and the combined existential experiences and understandings of both authors. The preceding approach provided the groundwork for presenting a case for honouring human rights in tune with the adoption of a substantive philosophy for the overall operation of residential age care facilities.Conclusion: While entry into residential aged care can be seen to represent the final chapter in an older person’s life, there remains the ever-present mandate for formal caregivers to not stray from the moral obligations associated with ‘ethical caregiving’.

During physical distancing, children do not meet their peers to play or talk together. Peer relationships have a crucial influence on all child development, especially for social skills or behaviour during early childhood. This study aims to determine changes in children's social behaviour during physical distancing during the Covid-19 pandemic. This research method is a descriptive quantitative study designed with the percentage value was used as a score for measuring the results of parental observations of children concerning the child's social behaviour instrument. Quota sampling (150 parents) was used to reach participants from various cities in Indonesia to see cultural differences. Data on children's social behaviour was obtained using the Preschool and Kindergarten Behaviour Scale (PKBS) tests. The data were then analysed using descriptive statistics. The results show that there are changes in children's social behaviour during physical distancing. 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Introduction: Hospital-at-Home (HaH) programmes are well-established in Australia, Europe, and the United States. However, there is limited experience in Asia, where the hospital is traditionally seen as a safe and trusted space for healing. This cross-sectional study aimed to explore attitudes and perceptions among patients and caregivers in Singapore toward this care model.Methods: A quantitative study design was adopted to collect data among patients and their caregivers from medical wards within two acute hospitals in Singapore. Using a series of closed-ended and open-ended questions, the investigator-administered survey aimed to explore barriers and facilitators determining patients' and caregivers' responses. The study questionnaire was pretested and validated. Data were summarised using descriptive statistics, and logistic regression was performed to determine key factors influencing patients' decisions to enrol in such programmes.Results: Survey responses were collected from 120 participants (101 patients, 19 caregivers; response rate: 76%), of which 87 respondents (72.5%) expressed willingness to try HaH if offered. Many respondents valued non-quantifiable programme benefits, including perceived gains in quality of life. Among them, reasons cited for acceptance included preference for the comfort of their home environment, presence of family members, and confidence toward remote monitoring modalities. Among respondents who were unwilling to accept HaH, a common reason indicated was stronger confidence toward hospital care.Discussion: Most patients surveyed were open to having acute care delivered in their home environment, and concerns expressed may largely be addressed by operational considerations. The findings provide useful insights toward the planning of HaH programmes in Singapore.

Abstract Background Exploring parental motives for providing smartphones and tablets to young children is important to better understand ways to optimise healthy use of mobile screens in early childhood. To date, no study has qualitatively examined the factors underpinning parental motives of providing mobile screens to young children, using a theoretically driven approach. Methods We conducted 45 in-depth, semi structured online interviews with primary caregivers of toddlers and pre-schoolers from diverse family backgrounds who participated in a large online survey in Australia. Themes were generated from the transcribed interviews using template thematic analysis. The coding was completed deductively using the Theory of Planned Behaviour (TPB) and data-driven induction. Results Participants consistently reported a spectrum of attitudes, subjective norms and perceived behavioural control aspects which drove their decision to provide or not provide a mobile screen device to their child. Five main descriptive themes were generated, guided by the TPB: (1) Convenience, connection, and non-traditional learning experience; (2) Negative behavioural consequences and potential activity displacement through mobile screens; (3) Influences of society and resources; (4) Managing and achieving a balance; (5) External challenges. Conclusions Overall, the findings demonstrated that parents experienced cognitive dissonance between their attitudes and behaviour, primarily from perceived behavioural control and subjective norms negating the influence of attitudes on their motives to provide a device. These insights offer important avenues for public health messaging and resources to better involve and support parents in decision-making relating to mobile screens in everyday lives of young children.

Abstract Objective: To understand how healthy menu labelling information is used by parents/caregivers and where it fits within predictors of healthy meal choices when eating out. Design: Parents were recruited to complete a 15-min observational, online survey regarding their experiences and hypothetical choices when eating out with their child/ren. Setting: Australia. Participants: Eligible participants had one or more child/ren aged between 2 and 12 years and attended cafes, restaurants, hotels and clubs (CRHC) for lunch or dinner at least four times a year. Of initial respondents (n 1802), 92·5 % provided complete and valid data. Participants were 84·7 % female, ranging from 18 to 68 years old. Results: 98·3 % believed that healthier alternatives should be available for children in CRHC. For general food choices, health was a strong motivator (45·7 %); however, parents reported eating at CRHC mainly for pleasure or a treat (61·2 %) and being driven by children’s taste preferences (85·9 %) when selecting menu items. 59·0 % of orders included a combination of healthy and traditional items. 42·0 % of the sample were influenced by the healthy choice (HC) labelling. Multiple regression revealed that, in addition to some demographic variables, the percent of HC ordered was positively associated with self-reported parent vegetable consumption, making food choices for the children for health reasons, familiarity with HC items and making order choices due to dietary needs and good nutrition. Conclusions: Despite a preference for availability of healthier children’s menu choices in CRHC, menu labelling highlighting healthy options may have limited impact relative to child preferences.

Purpose The purpose of this study is to explore the psychosocial aspects of palliative care provision for incarcerated persons drawing on a human rights perspective. Design/methodology/approach Seven databases were searched to identify empirical studies published from 2010 to 2020. Articles included were qualitative, quantitative, mixed methods, written in English and with westernised health/prison settings, with a key focus on the psychosocial aspects of palliative care provision and human rights. The quality of the articles was appraised using the Mixed Methods Assessment Tool (2018). Findings The results from 26 articles revealed multiple models of care, with the US prison hospice program depicted as optimal, because of the use of trained incarcerated caregivers, working as aides to the interprofessional team. The bereavement needs of caregivers were highlighted. The barriers to adequate psychosocial care were negative public discourse, prison processes and resources, provider attitudes and the incarcerated person’s level of knowledge and trust. Identified facilitators were related to incarcerated persons’ caregiving programs, a sense of purpose and visitation leniency. Human rights principles were identified in studies that featured compassionate release and advance care planning. Research limitations/implications There is inconsistency in the literature regarding what constitutes psychosocial care, which meant that the authors needed to draw on multiple literature sources to formulate a definition. Additionally, the review only included studies written in English, meaning some high-quality studies could have been missed. The articles that conducted interviews with incarcerated individuals were undertaken in male prisons only and not female prisons. Practical implications Understanding the importance of psychosocial care for incarcerated persons with a life-limiting illness requires a shift in negative public discourse and the need for a stronger human rights focus. Some countries, such as the USA and UK, are achieving effective outcomes; however, countries such as Australia are yet to contribute to this knowledge base. Originality/value If palliative care is a human right, then its philosophy should be considered in its entirety, with the inclusion of psychosocial care.

Abstract Background Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s. Methods This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. Conclusion We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered.

Introduction Children are beginning to use digital technologies at younger and younger ages. The emerging trend of very young children (babies, toddlers and pre-schoolers) using Internet connected devices, especially touch screen tablets and smartphones, has elicited polarising opinions from early childhood experts. At present there is little actual research about the risks or benefits of tablet and smartphone use by very young children. Current usage recommendations, based on research into passive television watching which claims that screen time is detrimental, is in conflict with advice from education experts and app developers who commend interactive screen time as engaging and educational. Guidelines from the health professions typically advise strict time limits on very young children’s screen-time. Based for the most part on policy developed by the American Academy of Paediatrics, it is usually recommended that children under two have no screen time at all (Brown), and children over this age have no more than two hours a day (Strasburger, et al.). On the other hand, early childhood education guidelines promote the development of digital literacy skills (Department of Education). Further, education-based research indicates that access to computers and the Internet in the preschool years is associated with overall educational achievement (Bittman et al.; Cavanaugh et al; Judge et al; Neumann). The US based National Association for Education of Young Children’s position statement on technology for zero to eight year-olds declares that “when used intentionally and appropriately, technology and interactive media are effective tools to support learning and development” (NAEYC). This article discusses the notion of Digitods—a name for those children born since the introduction of the iPhone in 2007 who have ready access to touchscreen technologies since birth. It reports on the limited availability of evidence-based research about these children’s ICT use concluding that current research and recommendations are not grounded in the everyday life of very young children and their families. The article then reports on the beginnings of a research project funded by the Australian Research Council entitled Toddlers and Tablets: exploring the risks and benefits 0-5s face online. This research project recognises that at this stage it is parents who “are the real experts in their toddlers’ use of screen technologies. Accordingly, the project’s methodological approach draws on parents, pre-schoolers and their families as communities of practice in the construction of social meaning around toddlers’ use of touch screen technology. Digitods In 2000 Bill Gates introduced the notion of Generation I to describe the first cohort of children raised with the Internet as a reality in their lives. They are those born after the 1990s and will, in most cases; have no memory of life without the Net. [...] Generation I will be able to conceive of the Internet’s possibilities far more profoundly than we can today. This new generation will become agents of change as the limits of the Internet expand to include educational, scientific, and business applications that we cannot even imagine. (Gates)Digitods, on the other hand, is a term that has been used in education literature (Leathers et al.) to describe those children born after the introduction of the iPhone in 2007. These children often begin their lives with ready access to the Internet via easily usable touch screen devices, which could have been designed with toddlers’ touch and swipe movements in mind. Not only are they the youngest group of children to actively engage with the Internet they are the first group to grow up with a range of mobile Internet devices (Leathers et al.). The difference between Digitods and Gates’s Generation I is that Digitods are the first pre-verbal, non-ambulant infants to have ready access to digital technologies. Somewhere around the age of 10 months to fourteen months a baby learns to point with his or her forefinger. At this stage the child is ready to swipe and tap a touch screen (Leathers et al.). This is in contrast to laptops and PCs given that very young children often need assistance to use a mouse or keyboard. The mobility of touch screen devices allows very young children to play at the kitchen table, in the bedroom or on a car trip. These mobile devices have, of course, a myriad of mobile apps to go with them. These apps create an immediacy of access for infants and pre-schoolers who do not need to open a web browser to find their favourite sites. In the lives of these children it seems that it has always been possible to touch and swipe their way into games, books and creative and communicative experiences (Holloway et al. 149). The interactivity of most pre-school apps, as opposed to more passive screen activities such as watching television shows or videos (both offline or online), requires toddlers and pre-schoolers to pay careful attention, think about things and act purposefully (Leathers et al.). It is this interactivity which is the main point of difference, one which holds the potential to engage and educate our youngest children. It should be noted within this discussion about Digitods that, while the trope Digital Natives tends to homogenise an entire generation, the authors do not assume that all children born today are Digitods by default. Many children do not have the same privileged opportunities as others, or the (parental) cultural capital, to enable access, ease of use and digital skill development. In addition to this it is not implied that Digitods will be more tech savvy than their older siblings. The term is used more to describe and distinguish those children who have digital access almost since birth—in order to differentiate or tease out everyday family practices around these children’s ICT use and the possible risks and benefits this access affords babies, toddlers and pre-schoolers. While the term Digital Native has also been criticised as being a white middle class phenomenon this is not necessarily the case with Digitods. In the Southeast Asia and the Pacific region developed countries like Japan, Korea, New Zealand and Singapore have extremely high rates of touchscreen use by very young children (Child Sciences; Jie; Goh; Unantenne). Other countries such as the Philippines and Indonesia have moved to a high smart phone usage by very young children while at the same time have only nascent ICT access and instruction within their education systems (Unantenne). The Digitod Parent Parents of Digitods are usually experienced Internet users themselves, and many are comfortable with their children using these child-friendly touch screen devices (Findahl). Digital technologies are integral to their everyday lives, often making daily life easier and improving communication with family and friends, even during the high pressure parenting years of raising toddlers and pre-schoolers. Even though many parents and caregivers are enabling very young children’s use of touch screen technologies, they are also concerned about the changes they are making. This is because very young children’s use of touch screen devices “has become another area where they fear possible criticism and in which their parental practices risk negative evaluation by others” (Holloway et al). The tensions between expert advice regarding young children’s screen-time and parents’ and caregivers’ own judgments are also being played out online. Parenting blogs, online magazines and discussion groups are all joining in the debate: On the one hand, parents want their children to swim expertly in the digital stream that they will have to navigate all their lives; on the other hand, they fear that too much digital media, too early, will sink them. Parents end up treating tablets like precision surgical instruments, gadgets that might perform miracles for their child’s IQ and help him win some nifty robotics competition—but only if they are used just so. (Rosin)Thus, with over 80 000 children’s apps marketed as educational in the Apple App Store alone, parents can find it difficult to choose apps that are worth purchasing (Yelland). Nonetheless, recent research regarding Australian children shows that three to five year olds who access touch screen devices will typically have five or more specific apps to choose from (5.23 on average) (Neumann). With little credible evidence or considered debate, parents have been left to make their own choices about the pros and cons of their young children’s access to touch screens. Nonetheless, one immediate benefit that comes to mind is toddlers and pre-schoolers video chatting with dispersed family member—due to increased globalisation, guest worker arrangements, FIFO (fly-in fly-out) workforces and family separation or divorce. Such clear benefits around sociability and youngsters’ connection with significant others make previous screen-related guidelines out of date and no longer contextually relevant. Little Research Attention Family ownership of tablet devices as well as touch screen phones has risen dramatically in the last five years. With very young children being loaned these technologies by mum or dad, and a tendency in Australia to rely on market-orientated research regarding ownership and usage, there is very little knowledge about touch screen usage rates for very young Australian children. UK and US usage figures indicate that over the last few years there has been a five-fold increase in tablet uptake by zero to eight year olds (Ofcom; Rideout). Although large scale, comparative Australian data is not available, previous research regarding older children indicates that Australia is similar to high use countries like some Scandinavian nations and the UK (Green et al.). In addition to this, two small research projects in Australia, with under 160 participant families each, indicate that two thirds of these children (0-5) use touchscreen devices (Neumann; Coenenna et. al.). Beyond usage figures, there is also very limited evidence-based research about very young children’s app use. Interactive technologies available via touch screen technologies have been available domestically for a very short time. Consequently, “valid scientific research has not been completed and replicated due to [the lack of] available time” (Leathers el al. 129) and longitudinal studies which rely on an intervention group (in this case exposure to children’s apps) and a control group (no exposure) are even fewer and more time-consuming. Interestingly, researchers have revisited the issue of passive screen viewing. A recent 2015 review of previous 2007 research, which linked babies watching videos with poor language development, has found that there was statistical and methodological issues with the 2007 study and that there are no strong inferences to be drawn between media exposure and language development (Ferguson and Donellan). Thus, there seems to be no conclusive evidence-based research on which to inform parents and educators about the possible downside or benefits of touch screen use. Nonetheless, early childhood experts have been quick to weigh in on the possible effects of screen usage, some providing restrictive guidelines and recommendations, with others advocating the use of interactive apps for very young children for their educational value. This knowledge-gap disguises what is actually happening in the lives of real Australian families. Due to the lack of local data, as well as worldwide research, it is essential that Australian researchers obtain a comprehensive understanding about actual behaviour around touch screen use in the lives of children aged between zero and five and their families. Beginning Research While research into very young children’s touch screen use is beginning to take place, few results have been published. When researching two to three year olds’ learning from interactive versus non-interactive videos Kirkorian, Choi and Pempek found that “toddlers may learn more from interactive media than from non-interactive video” (Kirkorian et al). This means that the use of interactive apps on touch screen devices may hold a greater potential for learning than passive video or television viewing for children in this age range. Another study considered the degree to which the young children could navigate to and use apps on touch screen devices by observing and analysing YouTube videos of infants and young children using touch screens (Hourcade et al.). It was found that between the ages of 12 months and 17 months the children filmed seemed to begin to “make meaningful use of the tablets [and] more than 90 per cent of children aged two [had] reached this level of ability” (1923). The kind of research mentioned above, usually the preserve of psychologists, paediatricians and some educators, does not, however, ground very young children’s use in their domestic context—in the spaces and with those people with whom most touch screen usage takes place. With funding from the Australian Research Council Australian, Irish and UK researchers are about to adopt a media studies (domestication) approach to comprehensively investigate digital media use in the everyday lives of very young children. This Australian-based research project positions very young children’s touch screen use within the family and will help provide an understanding of the everyday knowledge and strategies that this cohort of technology users (very young children and their parents) have already developed—in the knowledge vacuum left by the swift appropriation and incorporation of these new media technologies into the lives of families with very young children. Whilst using a conventional social constructionist perspective, the project will also adopt a co-creation of knowledge approach. The co-creation of knowledge approach (Fong) has links with the communities of practice literature (Wegner) and recognises that parents, care-givers and the children themselves are the current experts in this field in terms of the everyday uses of these technologies by very young children. Families’ everyday discourse and practices regarding their children’s touch screen use do not necessarily work through obvious power hierarchies (via expert opinions), but rather through a process of meaning making where they shape their own understandings and attitudes through experience and shared talk within their own everyday family communities of practice. This Toddlers and Tablets research is innovative in many ways. It seeks to capture the enthusiasm of young children’s digital interactions and to pioneer new ways of ‘beginnings’ researching with very young children, as well as with their parents. The researchers will work with parents and children in their broad domestic contexts (including in and out-of-home activities, and grandparental and wider-family involvement) to co-create knowledge about young children’s digital technologies and the social contexts in which these technologies are used. Aspects of these interactions, such as interviews and observations of everyday digital interactions will be recorded (audio and video respectively). In addition to this, data collected from media commentary, policy debates, research publications and learned articles from other disciplinary traditions will be interrogated to see if there are correlations, contrasts, trends or synergies between parents’ construction of meaning, public commentary and current research. Critical discourse tools and methods (Chouliaraki and Fairclough) will be used to analyse verbatim transcripts, video, and all written materials. Conclusion Very young children are uniquely dependent upon others for the basic necessities of life and for the tools they need, and will need to develop, to claim their place in the world. Given the ubiquitous role played by digital media in the lives of their parents and other caregivers it would be a distortion of everyday life for children to be excluded from the technologies that are routinely used to connect with other people and with information. In the same way that adults use digital media to renew and strengthen social and emotional bonds across distance, so young children delight in ‘Facetime’ and other technologies that connect them audio-visually with friends and family members who are not physically co-present. Similarly, a very short time spent in the company of toddlers using touch screens is sufficient to demonstrate the sheer delight that these young infants have in developing their sense of agency and autonomy (https://www.youtube.com/watch?v=aXV-yaFmQNk). Media, communications and cultural studies are beginning to claim a space for evidence based policy drawn from everyday activities in real life contexts. Research into the beginnings of digital life, with families who are beginning to find a way to introduce these technologies to the youngest generation, integrating them within social and emotional repertoires, may prove to be the start of new understandings into the communication skills of the preverbal and preliterate young people whose technology preferences will drive future development – with their parents likely trying to keep pace. Acknowledgment This research is supported under Australia Research Council’s Discovery Projects funding scheme (project number DP150104734). References Bittman, Michael, et al. "Digital Natives? New and Old Media and Children's Outcomes." Australian Journal of Education 55.2 (2011): 161-75. Brown, Ari. "Media Use by Children Younger than 2 Years." Pediatrics 128.5 (2011): 1040-45. Burr, Vivien. Social Constructionism. 2nd ed. London: Routledge, 2003. Cavanaugh, Cathy, et al. 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Rosin, Hanna. "The Touch-Screen Generation." The Atlantic, 20 Apr. 2013. Strasburger, Victor C., et al. "Children, Adolescents, and the Media." Pediatrics 132.5 (2013): 958-61. Unantenne, Nalika. Mobile Device Usage among Young Kids: A Southeast Asia Study. Singapore: The Asian Parent and Samsung Kids Time, 2014. Wenger, Etienne. Communities of Practice: Learning, Meaning, and Identity. New York: Cambridge University Press, 1998. Wenger, Etienne. "Communities of Practice and Social Learning Systems." Organization 7.2 (2000): 225-46. Yelland, Nicola. "Which Apps Are Educational and Why? It’s in the Eye of the Beholder." The Conversation 13 July 2015. 16 Aug. 2015 ‹http://theconversation.com/which-apps-are-educational-and-why-its-in-the-eye-of-the-beholder-37968›.

ObjectivesPalliative care (PC) service involvement for hepatocellular carcinoma (HCC) patients is suboptimal and little is known about the underlying reasons for this. We aimed to study clinicians’ experience and attitudes towards PC in HCC.MethodsA nationwide survey was conducted of consultants/trainees recruited from the Gastroenterological Society of Australia membership directory. Clinician demographics, experience and attitudes towards PC use for HCC patients were collected.ResultsThere were 160 participants. Most attended weekly multidisciplinary team meetings (MDTM, 60%) and had no formal PC training (71%). MDTM with PC attendance was reported by 12%. Rates of PC referral increased incrementally from BCLC 0/A to D patients but were not universal even in advanced (46%) or terminal (87%) stages. Most acknowledged PC patient discussions occurred too late (61%). Those with prior PC training were more likely to refer BCLC 0/A and B patients for early PC. Referral rates for outpatient PC were higher in respondents who attended MDTM with PC present across all BCLC stages. PC service was rated good/very good by 70%/81% for outpatients/inpatients. Barriers to PC referral included clinician-perceived negative patient associations with PC (83%), clinician-perceived patient/caregiver lack of acceptance (81%/77%) and insufficient time (70%).ConclusionsPC referral for HCC patients is not universal and occurs late even in late-stage disease. Prior PC training and/or PC presence at MDTM positively influences referral practices. Barriers to PC referral are not related to quality of PC services but rather to clinician-perceived patients’ negative reactions to or lack of acceptance of PC.

Photo by Hédi Benyounes on Unsplash ABSTRACT The current incarceration facilities for the growing number of women are depriving expecting mothers of adequate care crucial for the child’s mental and physical development. Programs need to be established to counteract this. INTRODUCTION Currently, Diana Sanchez was eight months pregnant when she was arrested for identity theft and put in a prison cell in Denver. At five a.m., two weeks after being incarcerated, she announced to a deputy outside her cell that she was going into labor. Footage from a camera in her cell shows her pacing anxiously or writhing in her bed for the five hours preceding the arrival of her son. She banged on the door and begged for help. All she received was an absorbent pad. She gave birth alone in her prison cell on July 31, 2015, around 10:45 am. At 11:00 am, a prison nurse walked in to cut the umbilical cord and take Sanchez’s newborn baby without offering postnatal care. Sanchez was later sent to a hospital, and her baby was separated from her until she was put on probation. In 2018, on behalf of her three-year-old son, Sanchez sued Denver Health and Denver Sheriff Department and won a $480,000 settlement.[1] Though many more men are incarcerated than women, the rate of growth of female incarceration has exceeded that of male incarceration for decades. One study estimated that 231,000 women are currently incarcerated in the US,[2] 80 percent of whom are mothers, and 150,000 pregnant.[3] Another recent study of 1,396 incarcerated pregnant women found that 92 percent had live births, 6.5 percent had stillbirths or miscarriages, and 4 percent terminated the pregnancy. The authors found that there is no system of reporting pregnancy outcomes in US prisons. There is a noteworthy ethical lapse in mental, emotional, and medical care that threatens the well-being of pregnant women in prison. According to Carolyn Sufrin, “Pregnant incarcerated people are one of the most marginalized and forgotten groups in our country… and women who don't get counted don't count.” [4] Poor documentation, visibility, and transparency contribute to the systemic abuse of incarcerated women. Studies document women giving birth alone in cells and shackles in solitary confinement. Their complaints regarding contractions, bleeding, and other pains of labor are often ignored.[5] l. Prenatal Care in American Prisons Diana Sanchez was not offered any prenatal care after she was incarcerated. And neither she nor her son received appropriate postnatal care.[6] Sanchez was on medication for opioid withdrawal while pregnant, which could have been detrimental to her baby’s health.[7] There is an unacceptable absence of pre- and postnatal care in most US prisons. A lack of regulation makes the availability of perinatal care unpredictable and unreliable. Several studies confirmed that there is not a standard for prenatal care for women incarcerated during pregnancy. [8] Knowledge of the appropriate mental and physical care pregnant women require, addiction support, and support for maternal-infant bonding all exists outside the prison system and ought to be used as a benchmark. At the very least, pregnant women, birthing women, and new mothers should not be placed in solitary confinement or shackled.[9] In the prenatal arena, depriving an individual of adequate healthcare is not appropriate and could be cruel and unusual. Only 18 percent of funding in prisons goes to health care for the prisoners. That is roughly $5.7 thousand per prisoner, according to an NIH study done in 2015.[10] There should be an adequate amount of funding for the health needs of incarcerated pregnant women. By depriving pregnant women of healthcare, the prisons are depriving the fetus of adequate care. ll. Respect for Autonomy During Incarceration Women maintain healthcare autonomy even when incarcerated. The purpose of a prison sentence is retribution for crimes and rehabilitation to prevent reoffending.[11] The separation of a mother and newborn causes significant developmental and psychological harm to the child and the parent. Parent-child separation does not serve the purpose of retribution or rehabilitation and is authorized only due to prisons’ limited space and resources that make it difficult to accommodate children, as well as a state interest in children’s best interests or the custody rights of the other parent. When it is possible to keep a family together, prisons should make every effort to do so for the health of the mother-child relationship. Incarcerated people may become a burden to family or society due to prison medical neglect. For example, diabetes and hypertension, which can occur during pregnancy, can worsen without treatment. The inability to access the care they would otherwise want and need endangers women and poses a burden to the healthcare system after incarceration, Depersonalizing individuals convicted of crimes must be placed in the context of historical eugenics practices. State-sanctioned sterilization and efforts to prevent women from reproducing were widespread during the early 20th century.[12] Cases of coerced and nonconsensual sterilization of incarcerated women and men evidence the history of eugenics.[13]Abortions are offered to some incarcerated women.[14] However, many incarcerated women are denied the right to see healthcare providers to thoroughly discuss abortion or other options.[15] Although the abortions are consensual, the quality of consent is questionable. lll. Prison Nursery Programs, “I need something to live for…” Indiana Women’s Prison (IWP), a max security female prison, has a program called Wee Ones that enables women convicted of nonviolent crimes to spend 30 months bonding with their newborn child. It is one of eight programs in the country that allows pregnant mothers to spend the last few months of their sentence with their children. It is a voluntary program that allows pregnant offenders a private room in a housing unit. It offers parent education, resources that are accessible after release, and career education. The program application process and the rules to which women must adhere to remain in the program are stringent. The programs generally have a zero-tolerance policy. Even simply sleeping in the same bed as the child or arguing with other mothers can result in termination from the program. Kara, a pregnant woman incarcerated for drug possession, had a history of abuse in her family and tended to act out in anger against her peers in the program. She was learning how to have healthy reactions to anger when handling her child, but her temper ultimately led to her removal from the program. Her son was placed in foster care, and Kara returned to the regular cells. In an interview before her transfer, she told the camera that Charlie gave her a purpose. With tears in her eyes, she said, “Charlie was my way of life here [...] I need something to live for [,] and I screwed up.”[16] Pregnancy in prison can be a way to improve quality of life for some women. Studies demonstrate that nursery programs improve mental health of the incarcerated women.[17] The secure attachment of the infant to its primary caregiver promotes healthy development in the child and a bonded relationship with the mother.[18] The close bond between mother and child in prisons has been shown to decrease recidivism and to reduce the burden on the foster care system.[19] Women who do not qualify for these programs, or are incarcerated in prisons without them, are separated from their newborn babies and their other children. The disconnect can lead to the child rejecting the incarcerated mother once she is released.[20] Programs like Wee Ones honor women’s autonomy while they are incarcerated. During interviews, the women expressed that although raising a child in that environment is difficult, it was better than not being with their children. While rocking a baby in her lap, one inmate expressed her frustrations with Wee Ones but then paused to express gratitude and said, “After all, it’s prison. And prison ain’t supposed to be nice.”[21] The ethical issue of autonomy reflects a more difficult dilemma in the prison landscape. lV. Counter Arguments: Do the Nursery Programs Work for the Children and the Women Typically, newborns are taken from their incarcerated mothers within two to three days of birth and sent to live with a relative or placed in foster care. Many women are never reunited with their babies. There is much debate over whether the programs are beneficial to the children. One ethical issue is whether children, as innocents, are being punished either by being in the prison system or by being separated from their mothers. Skeptics, like James Dwyer, have argued against keeping innocent babies in the custody of incarcerated mothers asserting that there is little evidence demonstrating that the programs rehabilitate the women.[22] Dwyer commented on the “reckless” hopefulness the programs provide: "It might, in fact, be the babies distract them from rehabilitation they should be doing instead. […] They're so focused on childcare and have this euphoria — they think they'll be just fine when they get out of prison and they're not. We just don't know."[23] One study showed that 58 percent of incarcerated women are arrested again after release, 38 percent are reconvicted, and 30 percent return to prison within three years.[24] Dwyer uses this data to argue that the programs are not worthwhile. However, the data is not limited to the special population that had the prison nursery experience. The data applies to all incarcerated women limiting its applicability. More importantly, there is compelling evidence to support prison nursery programs.[25] The programs do decrease recidivism[26] and prison misconduct,[27] and they allow women to create stronger bonds with their children.[28] Bev Little argues that allowing mothers to bond with their babies only delays the inevitable separation and will cause trauma and have other ill effects on the baby. [29] But others feel that stronger maternal-fetal attachment is best for both parties. There is evidence that the bond, once formed, is long-lasting. Later in life, there is less drug addiction among children who stayed in the nursery rather than being separated from their mothers.[30] Another counterargument is that the policies in prison nurseries are not as useful for motherhood outside of the facility; thus, an issue with recidivism occurs because the women are less prepared for motherhood upon release from prison. Prison nursery programs establish methods and procedures for successful motherhood that are unique to operation within correctional environments. Yet, fortunately, parenting classes offered by prisons and jails emphasize sacrifice, self-restraint, and dedicated attention to the baby. These classes aptly apply to motherhood outside of prison.[31] One incarcerated mother experiencing addiction, Kima, was described as ambivalent toward her pregnancy. “It’s something about knowing but not knowing that makes me not accountable or makes me think I’m not accountable,” Kima shared.[32] After the nurse confirmed her pregnancy, she acknowledged fear and knew she would be held accountable to the baby. The occurrence of pregnancy ambivalence is common.[33] A study of a population of prisoners from Rhode Island found that 41 percent of the women expressed ambivalent attitudes about pregnancy. 70 of the women from a population in San Francisco expressed ambivalent or negative attitudes towards pregnancy.[34] But the ambivalence of some women toward pregnancy is not a reason to prevent women who feel differently from reaping the full benefits of programs that support them during pregnancy. Another counterargument is that prison is becoming a comfort that women might seek if they are homeless or housing insecure. For example, Evelyn was released from a San Francisco jail after being arrested for using cocaine. She was 26 weeks pregnant and had a four-year-old son in the custody of her aunt. Following her release, she was homeless and using drugs in the streets. She felt that her only hope of keeping her baby safe was to go back to jail. Like Kima, she had been in and out of jail from a young age. She grew accustomed to and dependent on the care provided there. While incarceration can provide a home and a nursery, there is no ethical reason to argue for making prison less comfortable by separating babies and children from incarcerated women. Instead, these facts suggest we are not doing enough for women outside prisons either. CONCLUSION Many experts stress the dearth of research and information on these women and their babies. There is no empirical data to show how big the problem is, but there is evidence that programs providing nursery care for the children of incarcerated women have many benefits. Because the research is not largescale enough, many pregnant women in the prison system are ignored. Many women give birth in unacceptable conditions, and their children are taken from them the moment the umbilical cord is cut. While the US incarcerates too many women, a movement to expand prison nurseries could help new mothers bond with their children. Strong educational programs could aid in lowering the rates of recidivism by providing therapeutic resources for mothers.[35] There is a growing problem of mass incarceration in the US as many women are placed in correctional facilities. Most of these women are convicted of possession or use of illegal substances.[36] Many women come from disadvantaged backgrounds, poverty, and have experienced addiction. Depriving an expectant mother of adequate care is cruel and irresponsible both to the mother and her innocent child. The criminal justice system is harming children both mentally and physically. Reform of the system is needed to provide the basic care those children need. Programs like IWP’s Wee Ones are necessary for physical, psychological, and social development. A program that offers a place for mothers to raise their babies in the community of other mothers would incentivize and facilitate healthy parental habits. Further programs for mothers who are released from prison would give them valuable resources to keep them from returning and encourage healthy relationships between the mother and the baby. - [1] Li, D. K. Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance. Denver: NBC News, 2019. [2] Kajstura, Aleks. “Women's Mass Incarceration: The Whole Pie 2019.” Prison Policy Initiative, 29 Oct. 2019, https://www.prisonpolicy.org/reports/pie2019women.html. (“Including those in prisons, jails, and other correctional facilities.”) [3] Swavola, E, K Riley and R Subramanian. "Overlooked: Women and Jails in an Era of Reform." Vera Institute of Justice August 2016. [4] Sufrin, C. Pregnant Behind Bars: What We Do and Don't Know About Pregnancy and Incarceration Allison Chang. 21 March 2019. Transcript. [5] Sufrin, C., 2019. (Suffrin expressed that she had seen such practices firsthand working as an OB/GYN for incarcerated women.) [6] Padilla, M. “Woman Gave Birth in Denver Jail Cell Alone, Lawsuit Says,” New York Times, Sep. 1, 2019. [7] Li, D. “Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance,” NBC U.S. News, Apr. 29. 2019. [8] Knittel, A. and C. Sufrin. "Maternal Health Equity and Justice for Pregnant Women Who Experience Incarceration." JAMA Network Open 3.8 (2020). A study in Ontario, Canada, coincided with a study done in Australia. [9] Sufrin, C., et al. "Pregnancy Outcomes in US Prisons, 2016–2017." p. 803-804. [10] Sridhar, S., R. Cornish and S. Fazel. "The Costs of Healthcare in Prison and Custody: Systematic Review of Current Estimates and Proposed Guidelines for Future Reporting." Frontiers in Psychiatry 9.716 (2018). [11] Kifer, M., Hemmens, C., Stohr, M. K. “The Goals of Corrections: Perspectives from the Line” Criminal Justice Review. 1 May 2003 [12] Perry, D. M. "Our Long, Troubling History of Sterilizing the Incarcerated." The Marshall Project: Sterilization of Women in Prison 26 July 2017. [13] Rachel Roth & Sara L. Ainsworth, If They Hand You a Paper, You Sign It: A Call to End the Sterilization of Women in Prison, 26 Hastings WOMEN's L.J. 7 (2015); See Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942) (procreation considered a fundamental right; fact pattern of male sterilization in prison based on type of crime.) [14] Sufrin, C., M. D. Creinin, J. C. Chang. “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers.” Perspectives on Sexual and Reproductive Health. p. 6-11. 23 March 2009. [15] Kasdan, D. “Abortion Access for Incarcerated Women: Are Correctional Health Practices in Conflict with Constitutional Standards?” Guttmacher Institute. 26 March 2009. [16] Born Behind Bars. Season 1, Episode 5, “They Can Take Your Baby Away,” produced by Luke Ellis, Francis Gasparini, & Jen Wise, aired on 15 Nov. 2017 A&E Networks [17] Bick, J., & Dozier, M. (2008). Helping Foster Parents Change: The Role of Parental State of Mind. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 452–470). New York: Guilford Press. [18]Sroufe, L. A., B. Egeland, E. A. Carlson, W. A. Collins. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press. [19] Goshin, L. S., & Byrne, M. W. “Converging Streams of Opportunity for Prison Nursery Programs in the United States.” Journal of Offender Rehabilitation. 15 Apr 2009. [20] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. Another IWP pregnant woman is Taylor. At the time of the show, she was pregnant and expecting twins. In interviews throughout the episode, she expressed how her pregnancies in prison had put her in a better mood and felt beneficial to her. She had tried to sign up for the nursery program for her previous pregnancy, but her sentence was too long to get it. Her child was sent to live with a caregiver, and when Taylor was on probation, Taylor’s daughter didn’t want to be around Taylor. Taylor was so distraught that she messed up and went back, this time, pregnant with twins. After she was reincarcerated, she was able to be accepted into Wee Ones. She expressed to the camera man that the program might help her feel more like a mother so that when she gets out, she will have someone to care for. Taylor, Kara, and many other women depend on their children or their pregnancy for a purpose while behind bars. They relied on their babies to be a boon for them. [21] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. [22] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [23] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [24] Owen, B. & Crow, J. “Recidivism among Female Prisoners: Secondary Analysis of the 1994 BJS Recidivism Data Set” Department of Criminology California State University (2006) p. 28 [25] Prison Nursery Programs: Literature Review and Fact Sheet for CT. Diamond Research Consulting, 2012, www.cga.ct.gov/2013/JUDdata/tmy/2013HB-06642-R000401-Sarah Diamond - Director, Diamond Research Consulting-TMY.PDF. [26] New York Department of Correction Services (NYDOCS). (1993). Profile of Participants: The Bedford and Taconic Nursery Program in 1992. Albany, NY. Department of Correction Services.Rowland, M., & Watts, A. (2007). Washington State’s effort to the generational impact on crime. Corrections Today. Retrieved September 12, 2007, from http://www. aca.org/publications/pdf/Rowland_Watts_Aug07.pdf. [27] Carlson, J. R. (2001). Prison nursery 2000: A five-year review of the prison nursery at the Nebraska Correctional Center for Women. Journal of Offender Rehabilitation, 33, 75–97. [28] Carlson, J.R. [29] Little, B. "What Happens When a Woman Gives Birth Behind Bars?" A+E Networks, 29 October 2019. <https://www.aetv.com/real-crime/what-happens-when-a-woman-gives-birth-in-jail-or-prison>. [30] Margolies, J. K., & Kraft-Stolar, T. When “Free” Means Losing Your Mother: The Collision of Child Welfare and the Incarceration of Women in New York State 1, 9 (Correctional Association of N.Y. Women in Prison Project 2006) [31] Sufrin, C. Jailcare: Finding the Safety Net for Women Behind Bars. Berkeley: University of California Press, 2017. [32] Sufrin, C. Jailcare: p. 155. [33] Peart, M. S. & Knittel, A. K. “Contraception need and available services among incarcerated women in the United States: a systematic review.” Contraception and Reproductive Medicine. 17 March 2020 [34] LaRochelle, F., C. Castro, J. Goldenson, J. P. Tulsky, D.L. Cohan, P. D. Blumenthal, et al. “Contraceptive use and barriers to access among newly arrested women.” J Correct Health Care. (2012) p. 111–119. [35] Goshin, L., & Byrne, M. (2009). “Converging streams of opportunity for prison nursery programs in the United States.” Journal of Offender Rehabilitation. 2009. p.271–295. [36] Elizabeth Swavola, Kristine Riley, Ram Subramanian. Overlooked: Women and Jails in an Era of Reform. New York: Vera Institute of Justice, 2016.