Staff and youth views on autonomy and emancipation from residential care: A participatory research study

The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n = 10) and 4 focus groups with youth (n = 21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy – a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).     

Relatedness,autonomy, and competence in the caring relationship: The perspective of nursing home residents

Based on self-determination theory and person-environment congruence models, this study investigated the importance and experiences of relatedness, autonomy, and competence in the caring relationship from the perspective of residents of somatic nursing homes. Furthermore, discrepancies between the attached importance and the fulfillment of these three needs, as well as the role of resident age, health and cognition were explored.Structured questionnaires and semi-structured interview questions were used with 75 recently admitted somatic nursing home residents. The results show that relatedness was considered as more important than autonomy and competence, on average, but there also was large variation between residents in the importance attached to these three needs (n = 75). A subgroup that was asked about relatedness, autonomy, and competence in the caring relationship (n = 35) experienced rather high fulfillment of these needs, although the semi-structured interview questions revealed more nuances. In addition, discrepancies existed between the importance and the fulfillment of the needs for a considerable group of residents in this subgroup. Subjective health and cognitive functioning were correlated with the evaluation of relatedness, autonomy, and competence in the caring relationship.It is concluded that, in nursing homes, the focus should be on the match between individual preferences and actual support of relatedness, autonomy, and competence.This involves asking residents for personal preferences and facilitating caregivers in taking these into account during daily caregiving.     

The subjective well-being of adolescents in residential care compared to that of the general population

The aim of this research is to study the subjective well-being of adolescents in residential care and compare it with that of the general population of the same age in Catalonia. Two samples were used: one from the general population in the first year of secondary education (n = 491; 50% boys; mean age = 12.1 years) and another from the residential care population aged 12–13 years (n = 226; 56% boys; mean age 12.5). The questionnaire of the International Survey of Children's Well-Being (ISCWeB) was used. It includes two psychometric scales: the Personal Well-Being Index—School Children (PWI-SC7) and the Overall Life Satisfaction (OLS); the former being adapted for the in-care population. To test the validity of the factorial structure of data for the two groups, a Confirmatory Factor Analysis (CFA) of the PWI-SC7 and different multi-group structural equation models (SEMs) were conducted. The CFA of the PWI-SC7 showed a good fit with the pooled sample and good comparability of correlations and regressions between the two groups. The SEM with constrained loadings allowed us to compare the contribution of the different items on the PWI-SC7 latent variable which was higher in all cases for adolescents in care. Likewise it showed a high correlation between OLS and PWI-SC7 in both populations, being it more intense among adolescents in care. Scores on the OLS and on the PWI-SC7 are significantly lower among adolescents in care. However, according SEM results mean scores of the PWI-SC7 are not strictly comparable between groups. Results challenge public policy concerning children by increasing efforts to promote equal opportunities for the in-care community and improve satisfaction with particular life domains, such as school and residential homes.     

Program records as a source for program implementation assessment and youth outcomes predictors during residential care

This study used point card information from a residential program to generate treatment fidelity metrics and determine if the metrics predicted youth outcomes after six months in care. Youth outcomes included staff (n = 52) and youth (n = 143) ratings, youth conduct records kept by the residential program's teaching-family homes and school records. Treatment fidelity metrics included the program components: (a) percentage of positive interactions, (b) number of privileges earned, and (c) a skills taught to interactions ratio. The percentage of positive interactions averaged 90% per youth; 76% of the point cards indicated that privileges were earned; and a variety of life skills were typically taught to the youth (skills ratio = .61). The data from the treatment fidelity metrics supported that the program was implemented consistent with program expectations. The range of implementation quality for each measured component was then used to predict youth outcomes. Increased percent of positive interactions predicted significantly decreased externalizing behaviors as reported by staff (β = − 0.31, p < .001) and youth (β = − 0.30, p < .001), and significantly fewer incidents of non-compliance (Exp(b) = 0.93, p < .001) and school problems (Exp(b) = 0.91, p < .001) as indicated on the program records. The skills ratio indicated similar trends across outcomes, although non-significant at the p < .01 level. Permanent products may be helpful to develop program treatment fidelity metrics, which may be useful for monitoring implementation and may be associated with improved youth outcomes.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

To be or not to be a rights holder: Direct and indirect effects of perceived rights on psychological adjustment through group identification in care

This study explores how young people in residential care perceive their rights and the relationship with their adjustment, through the role of group identification. Data from a non-random sample of young people (N = 356; aged 11–18 years) in Portuguese residential settings was analysed and a set of mediation effects was found. Findings revealed a set of mediation effects on the relationship between Participation and Protection and Positive Self and between Respectful system practices and behaviours and Emotional Distress, Anger Control and Antisocial Behaviour. Higher scores of these rights perceptions were associated with lower psychological problems, through the indirect effect of group identification (i.e., the sense of belonging to the group in residential care). These findings are discussed based on social and developmental insights together with empirical evidence on residential care. These results provided important practical implications in residential care, namely, assuring the young people's participation, the promotion of professional practices based on the respect for young people and their families, non-discriminatory behaviours and equal opportunities.     

Unmet legal and social advocacy needs of children with sickle cell disease: Implications for health care payer costs

Previous studies of advocacy needs faced by children and families have not differentiated needs that require attorney involvement (“legal advocacy needs”) from needs best addressed by social workers or lay advocates (“social advocacy needs”). Studies have also not examined the relationship between either type of need and health care costs. We developed a novel, replicable process to differentiate between legal advocacy needs and social advocacy needs. We then collected cross-sectional data from a sample of 52 children with sickle cell disease who were at least 1 year of age, a population with high advocacy needs and high health care costs. Mean annual health care costs to payers for children whose families had a least one legal advocacy need were $16,314, compared to $5552 for children in families with no legal advocacy needs (P = 0.007). After adjusting for covariates, the presence of a legal advocacy need was associated with $12,040 more in health care costs to payers (P = 0.02). Whether interventions to prevent and resolve legal advocacy needs can reduce health care costs by addressing the social determinants of health warrants future study.     

Aggressive behaviors among Korean children in out-of-home care: The role of placement characteristics

Using data from the Korean Panel Study on Children in Out-of-Home Care, this study examined the impact of placement characteristics on aggressive behaviors among children in out-of-home care by placement type. The sample was divided into three groups based on placement type: institutional care (n = 118), group homes (n = 95), and foster care (n = 212). Results from hierarchical multiple regression analyses indicated that the length of stay in out-of-home care significantly influenced aggressive behaviors amongst children in institutional care, such that increased duration of out-of-home care decreased the level of aggressive behaviors. Perceptions of stigma/discrimination also significantly influenced aggressive behaviors displayed by children in institutional and foster care. Children with a higher perception of stigma/discrimination were more likely to exhibit severe aggressive behaviors than were their counterparts. On the other hand, placement characteristics had no significant influence on aggressive behaviors of children in group homes. The study findings suggest that children's mental health problems and disabilities should be considered during the placement procedure and interventions focusing on decreasing stigmatization should be developed and provided for children in out-of-home care.     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.     

A parent's place: Parents', mentors' and program staff members' expectations for and experiences of parental involvement in community-based youth mentoring relationships

Youth mentoring has been conceptualized largely as a dyadic relationship between a mentor and mentee, with less attention paid to the role of parents. This study contributes to an emerging body of research on parent involvement by examining expectations for parents' roles in the mentoring process held by program staff, mentors, and parents themselves. In-depth interviews with mentoring program staff (n = 12), mentors (n = 30), and a parent or guardian of the youth being mentored (n = 30) were analyzed to identify these participants' views on the role of parents. Findings indicate that mentors and program staff were more aligned in their views and tended to be more focused on the ways that parents could potentially interfere with or otherwise disrupt the mentor–youth relationship. Parents' views were more varied and rooted in differences in both their individual values and beliefs about the role of a mentor in their child's life, their parenting styles and ways they expected adults outside of the family who were interacting with their child to engage with them. Implications for future research on parent involvement and for mentoring program practices are discussed.     

Resident councils between lifeworld and system: Is there room for communicative action?

In long-term care facilities, the participation of older people relates to individual care provision (individual level) and to policy decisions that affect all residents in a care organization (collective level). In the Netherlands, resident councils are set up in order to improve resident participation on a collective level. However, our research shows that managers and resident councils are faced with mutual frustration and ineffective interaction. This article investigates the extent to which Habermasian communicative action (herrschaftsfreie Kommunikation) between resident councils and managers in residential elderly care is actually possible by examining the interaction between resident councils and managers in two case studies. We conclude that resident councils find themselves between lifeworld and system. There is communicative action between resident councils and managers, but it is easily dominated by strategic action. Therefore, space for communicative action needs to be deliberately created in order to support resident council participation and influence.     

The ties that bind? Social networks of nursing staff and staff's behaviour towards residents with dementia

This study investigated social networks of nursing staff and staff's behaviour towards residents with dementia. We focused on two types of networks: communication networks among staff, and networks between nursing staff and relatives/acquaintances of residents. Data was collected in 37 long-term care units in nursing- and residential homes in the Netherlands.     

Surprise in Social Work Education

Training is commonly seen as the most viable way of ensuring good quality care in residential homes for elderly people. The literature on training has focused on a shift in emphasis from traditional 'professional' social work training for staff at a senior level to training which is to be provided for junior level staff. To this end, Scottish/National Vocational Qualifications have been introduced which, through workplace assessment of competence, have been proclaimed to be the means by which to raise the status and career prospects of a social care workforce. This article argues that task-based competence is increasingly being seen as relevant for a 'para-professional' social care workforce such as that found in the residential care sector. In the light of this, research was undertaken to establish whether residents preferred 'trained' staff, holding formal qualifications and/or NVQs, to 'untrained' staff with no recognised qualifications. The research concluded that residents want kind, understanding and experienced staff, and when length of time in post was taken into account, the effect of training was negligible. The study concluded that homes need to select staff for their good personal qualities and encourage them to stay. Staff need training that integrates skill with understanding and above all, assessment should reflect this perspective. Moreover, residents need to be involved in the assessment process.     

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family.MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care.ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR = 1.05, CI = 1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR = 1.84, CI = 1.04–3.24). Child's psychosocial care use was more likely among older children (OR = 1.94, CI = 1.20–3.15); greater social support by family and friend (OR = 1.03, CI = 1.00–1.06); more psychosocial problems (OR = 1.75, CI = 1.04–2.97); and when there were more parenting concerns (OR = 1.19, CI = 1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR = 1.27, CI = 1.17–1.38, and OR = 1.39, CI = 1.25–1.55).ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.     

Quality improvement learning collaborative to examine foster care guidelines

Learning collaboratives (LC) are an important method of implementing quality improvement by serving as laboratories to translate research into practice and sharing knowledge. We created a Foster Care Learning Collaborative (FCLC) of 11 foster care health sites to share best practices on providing health services for children in foster care. Using a collaborative approach involving monthly conference calls, we invited each health site to present specific health care delivery issues for the purpose of developing collaborative quality improvement projects regarding the delivery of healthcare to children placed into foster care. For health sites providing primary care (n = 8 of 11 sites), we examined adherence to two American Academy of Pediatrics (AAP) guidelines for children entering foster care: a) the initial health screen, and b) the comprehensive medical evaluations. At least four distinct types of health care models that provide either direct primary care or administrative oversight for children in foster care were identified: 1) medical home sites (n = 3); 2) foster care evaluation/intake sites (n = 2); 3) specialized primary care sites (n = 1); and, 4) state administrative programs (n = 2). Data from the six direct primary care sites (n = 586 children) and two state administrative models (n = 3855 children) was collected. The time-frame for the initial health screen was adjusted to 7 days after entry and adherence (31%) was comparable among primary care sites. Adherence to AAP guidelines regarding completion of a comprehensive medical evaluation within 30 days of intake varied among medical homes (30%–86%), intake models (23%–33%), specialized primary care site (43%), and state models (43%–73%). No site was fully compliant with the AAP guideline for universal comprehensive medical evaluation within 30 days, and there is variation within and among care models. A foster care learning collaborative identified significant variability in adherence to a commonly accepted guideline for timely access to healthcare for children placed into foster care. The LC c model offers the opportunity to evaluate best practices, identify barriers to care, and provide objective feedback for improvement.     

“At times I kinda felt I was in an institution”: Supportive housing for transition age youth and young adults

Housing stability is essential for young adult development. Older youth and young adults transitioning from public systems of care, such as foster care, the public mental health system and residential settings, commonly experience high levels of transience and housing instability. In recent years, supportive housing policies and programs have emerged to address this situation, yet we know little about whether (or not) new programs are meeting the needs of youth in transition, and, if so, how they are addressing the unique developmental, social, and emotional needs of this population. This study is one of the first to speak directly with young adults living in a supportive housing program designed specifically for youth transitioning out of children's systems of care. Study participants spoke about both their overall transition experience and their views on the housing program where they reside. The study conducted four focus groups (N = 26) with transitioning youth and young adults, ages 18 to 25 (Mean age = 22), in order to explore the following three broad research questions: 1) what is it like to make the transition to adulthood from public children's systems of care?; 2) how does the supportive housing model they reside in shape their transition experiences?; and, 3) how do they experience the services and staff who are part of the program? Data analysis included grounded theory coding techniques and constant comparison with four coders. Results suggest that participants feel like they continue to be treated as children, and they receive mixed messages regarding their need to be increasingly autonomous, yet follow the rules. Finally, they reported specific aspects of what they found to be helpful in both staff relationships and overall program components. These themes constitute the results of the study. Findings underscore the importance of both listening directly to service users, and developing young adult supportive housing programming expressly designed to meet the unique needs of marginalized young adults transitioning to increased independence and self-sufficiency.     

Emergency department use for injuries by adolescents in foster care

Youth in foster care are overrepresented with respect to their utilization of emergency department (ED) services. This study examines the ED utilization patterns of adolescents in foster care and evaluates the characteristics of injury related versus non-injury related visits. We found that adolescents in foster care have high rates of ED use (1.84 visits per year (95% CI 1.59, 2.12)), with 31.2% of ED visits being injury-related. Male gender was found to be the only independent predictor of having an injury related vs. non-injury related ED visit (odds ratio 2.22 (95% CI 1.27–3.87)). Regarding the mechanisms of injury, adolescent youth in group homes were significantly more likely to present with injuries inflicted by themselves or by others in their residence (p < 0.05 for both) but less likely to present with accidental injuries or injuries sustained during recreation (p < 0.05 for both). Resources and interventions targeted at both youth and group home staff related to behavioral health assessment, post-traumatic coping skills and conflict management may have beneficial effects.     

The characteristics of delinquent behavior and predictive factors in Japanese children's homes

The purpose of this study was to examine the risk factors of delinquent behavior in children's homes in Japan and the co-occurrence of externalizing problem behavior and internalizing problem behavior. Eight hundred and nine children (436 boys, 373 girls were recruited from such homes. Childcare workers from these homes completed sets of questionnaires. Our results found significant relationships between delinquent behavior and gender [odds ratio (OR) = 1.66; 95% confidence interval (CI), 1.16–2.38], age (OR = 1.25; 95% CI, 1.16–1.35), parent–child conflict (OR = 2.79; 95% CI, 1.45–5.36), neglect (OR = 1.43; 95% CI, 1.03–2.11), and aggressive behavior (OR = 1.10; 95% CI, 1.08–1.12). Results also showed externalizing problem behaviors and internalizing problem behaviors were associated with age (OR = 1.23; 95% CI, 1.08–1.41), thought problems (OR = 1.37; 95% CI, 1.17–1.59), attention problems (OR = 1.12; 95% CI, 1.02–1.23), and physical abuse (OR = 3.09; 95% CI, 1.64–5.83). Our study clarifies the predictive factors for delinquency and related internalizing behavior symptoms and externalizing behavior problems. These results indicate that children in children's homes have various problems and require multilevel intervention. Our findings may be used to improve current policies governing children's homes.     

Using a community-based participatory research approach to evaluate resident predictors of involuntary exit from permanent supportive housing

ObjectiveThe aim of this study was to determine an association between resident characteristics at time of entry to permanent supportive housing and exit status.MethodsA community-based participatory research (CBPR) approach was the guiding framework for the design, implementation and evaluation of this project. This retrospective observational study used an administrative data source from a local permanent supportive housing provider to compare resident characteristics among those who left housing voluntarily or involuntarily.ResultsThe population based sample (n = 407) was comprised of 51% males and 47% African-Americans with a mean age of 40 years (SD = 11.8). Involuntary exits (IEs) occurred in 40% of the sample (n = 166). IE was less likely with receipt of mainstream benefits, compared to employment income (O.R. = .546, p = .032). IE was more likely for residents self-identifying as African-American (O.R. = 1.56, p = .037) and when children resided in the household (O.R. = 2.03, p = .013).ConclusionsDespite limitations of community-derived data, findings suggest that supportive housing providers consider income source and family status when designing interventions to decrease IEs. A CBPR approach is a promising framework to guide evaluation efforts for supportive housing programs.     

Development & maintenance of social support among aged out foster youth who received independent living services: Results from the Multi-Site Evaluation of Foster Youth Programs

This study uses secondary data from the Multi-Site Evaluation of Foster Youth Programs, a randomized controlled trial of four independent living programs for youth in foster care. The subject of this investigation is the Life Skills Training Program (LST) of Los Angeles County, CA. We had three interrelated aims: (1) Evaluate the effectiveness of the LST program as compared to services as usual on the change in social support over time; (2) Examine the differences over time in social support by race and ethnicity among LST participants; and (3) Investigate the explanatory value of prosocial activities, educational involvement, current living arrangement, employment, victimization experiences, placement instability, and behavioral health symptomology on changes in social support over time among LST participants. We employed multilevel longitudinal modeling to estimate growth in social support over three time points (baseline, first follow-up, and second follow-up) among 482 youth (n = 234 LST; n = 248 control). We found a significant reduction in social support across the three time points. But, there was no difference in the social support trajectory between the LST and control groups. In addition, no racial/ethnic difference in the social support trajectory was detected. Results underscore the need to critically examine how independent living programming is intended to increase social support and whether modifying these practices can improve promotion and maintenance of social support for youth who age out of foster care.