Training Area Agencies on Aging Case Managers to Improve Physical Function,Mood, and Behavior in Persons With Dementia and Caregivers: Examples from the RDAD-Northwest Study

The Reducing Disability in Alzheimer’s Disease (RDAD) program has been shown to be an effective tool for teaching caregivers strategies to improve mood, behavior, and physical function in persons with dementia. This paper describes how RDAD has been translated and implemented for use by Area Agencies on Aging (AAA) case managers across Washington and Oregon. Modifications to the original RDAD program as part of its community translation included decreasing the number of in-person sessions while preserving all educational content; involving caregivers in exercise activities for themselves as well as acting as exercise coaches for care-receivers; and enrolling persons with cognitive impairment due to mixed etiologies. This paper describes these changes and their rationale, the challenges faced by community agencies recruiting for and delivering evidence-based programs, and illustrates the actual RDAD implementation process through several brief case examples. Case examples also illustrate how RDAD-Northwest can be useful with care-receivers with a range of cognitive impairment severity, family caregiving situations, and levels of mood and behavioral challenges.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

Broadening constructions of family violence: mothers' perspectives of aggression from their children

This qualitative study used feminist insights to explore experiential aspects of the phenomenon of child‐to‐mother violence from the perspectives of six women survivors. Participants took part in conversational style audiotaped interviews lasting between two and four hours. Feminist analysis revealed that fear and violence had become a feature of mothering for these women. Three themes were identified: It was only a matter of time: feeling intimidated and under threat; He just punched me: physical violence from child to mother; and Other men in the house: violence directed to the mothers by friends and associates of their children. Currently the literature overwhelmingly constructs family violence as elder abuse, spousal/partner violence, or child abuse, and generally fails to acknowledge, or address, violence from children to parents. However, findings from this study suggest that the discourse about family violence needs to be broadened to include child‐to‐mother violence. Implications of this study for practice and research are discussed.     

Secondary Traumatic Stress of Service Providers who Practice with Survivors of Family or Sexual Violence: A National Survey of Social Workers

Past research demonstrates that professionals helping survivors of family violence or sexual assault are at risk of experiencing secondary traumatic stress. Although social workers frequently provide services to these families, the risk of exhibiting secondary traumatic stress symptoms has rarely been investigated. Using a national sample (N >= 154), this research project examines the prevalence and severity of secondary traumatic stress among social workers who assist survivors of family violence or sexual assault. Implications for social work practice are also discussed.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Children's experiences and needs in relation to domestic and family violence: Findings from a meta‐synthesis

Domestic and family violence is a significant issue experienced by many children that can have severe detrimental impacts to their health, development, and well‐being. Despite the significance of this issue, it is only recently that children have been included in research that seeks to understand the impacts that domestic and family violence may have on their lives. This paper reports on the findings of a meta‐synthesis, which explored qualitative research about children's experiences of domestic and family violence. Thirty‐two studies, including from the United Kingdom, North America, and Australia were included for review. The meta‐synthesis found that children describe domestic violence as being a complex, isolating, and enduring experience that often results in disruption, losses, and challenges to their significant relationships. Children's common feelings of fear, worry, powerlessness, and sadness were also uncovered, in addition to the strategies they employed to try and facilitate the safety and emotional well‐being of themselves and their family. Children's wants and needs are also highlighted. The findings demonstrate that despite the increasing interest in children's experiences of domestic and family violence, qualitative research remains limited, with many gaps evident. Implications for research, policy, and practice are considered.     

Adolescent‐to‐parent violence and abuse: Parents' management of tension and ambiguity—an interpretative phenomenological analysis

Adolescent violence and abuse towards parents is under researched, especially in the UK where reports of the phenomenon are increasing with little clear guidance as to how practitioners might respond. In this qualitative study, 6 parents were recruited through youth offending teams and were interviewed about their lived experiences of violence and/or abuse from their adolescent child. Using interpretative phenomenological analysis, 3 superordinate themes emerged (a) the tensions and (b) the ambiguities produced by living with the violence and abuse and (c) the ways that parents manage the harms caused by these tensions and ambiguities. Theoretical and clinical implications are discussed, including consideration of how practitioners might support parents who are living with adolescent‐to‐parent violence and abuse to establish healthy and sustainable coping strategies while repairing family relationships.     

Violence in the American Family

The paper reviews current knowledge on violence between family members in the United States, including how and why family violence became a topic of interest after years of being masked by a public and professional perceptual blackout. It presents data from a nationally representative sample of 2,143 American families that measured the extent of child abuse, wife abuse, husband abuse, and violence between siblings. The paper then reports differences in child abuse rates according to factors such as the age and sex of the child, family income, occupation, stress, unemployment, social isolation, and previous exposure or experience with violence. It is suggested that the roots of family violence lie in the organization of the family and in the implicit cultural norms tolerating or approving violence as a means for social control.     

Symbolic Boundaries and Collective Violence. A New Theoretical Argument for an Explanatory Sociology of Collective Violent Action

The sociology of violence still struggles with two critical questions: What motivates people to act violently on behalf of groups and how do they come to identify with the groups for which they act? Methodologically the article addresses these puzzling problems in favor of a relational sociology that argues against both micro‐ and macro‐reductionist accounts, while theoretically it proposes a twofold reorientation: first, it makes a plea for the so called cognitive turn in social theory; second, it proposes following praxeological accounts of social action that focus on the dynamic interpenetration of cognition and socio‐cultural practices. The argument is that symbolic boundaries constitute the “missing link” that allows for overcoming the micro‐macro gap in violence research: Symbolic boundaries can cause people's participation in collective violence by providing the essential relational resources for violent action and by triggering the cognitive/affective mechanisms necessary for social actors to become drawn into mobilization processes that can cause their engaging in coordinated attacks on sites across the boundary. The article offers a new theoretical argument by drawing on knowledge from violence research, social action theory and cognitive science allowing for a non‐reductionist theory of action that explains how and why people engage in collective violence.     

The nature of relationships between orphans and their kinship carers in Botswana

Generations of parents lost to AIDS and other causes have created a vacuum of care for the orphaned children they leave behind. This crisis has resulted in rapid changes in caregiving and family life, with extended family members, having to care for orphaned children. As a result of high numbers of vulnerable orphaned children residing with kinship carers, and the fundamental importance of the relationship between carers and orphaned children, we need to understand more about these relationships. This paper explores the nature of orphaned children–kinship carer relationships in Botswana. Interview guides were used to collect data from 15 caregivers and 15 orphaned children. The results indicate that the nature of relationships between orphaned children and caregivers is influenced by the way the parties communicate, how adolescents behave and the competing responsibilities of caregivers. Lastly, the paper recommends how positive relationships can be developed and nurtured between orphaned children and their caregivers in an African setting.     

Domestic Violence: Comparative Analysis of German and U.K. Research Findings*

Objective. This article examines the notion of the family and within its postmodern definition the research undertaken in the field of domestic violence and its consequences for criminal justice agencies in the United Kingdom and Germany. Has the notion of the family changed in Western culture? How has legislation changed regarding domestic violence in line with criminologists' and social scientists' hypotheses, reflections, and recommendations? How are victims and witnesses protected from perpetrators? Methods. The authors discuss how legislation in both countries has changed to meet the needs of victims and witnesses of domestic violence. The article looks at different forms of law enforcement in domestic violence and how the agencies assess future dangerousness. Results. Research analyses show that domestic violence is now taken seriously in both countries' legislation. But what is the impact on policing domestic violence in both countries? It is argued that U.K. law enforcement agencies are more advanced that the German police in dealing with domestic violence in a practical and pragmatic fashion. Conclusions. The authors explore the shift in cultural beliefs affecting male dominance in the family setting, how public attitudes to domestic violence have changed, and how law enforcement agencies are now dealing with violence within the family in both countries.     

Change and Adaptation in Families with Young Carers

Using grounded theory methodology, members of nine families with 'young carers' were interviewed to explore their experiences of caring. A dynamic theory of change and adaptation emerged in relation to changes in who cares within families, in external support and in the attitudes of young carers towards caring. Adaptations included becoming used to the way life is, knowing how to care, balancing and trading off, rewarding care, and anticipating future adaptations. A model has been developed to offer an explanation of factors which influence young caring in families. These include family expectations about caring; who is available to care; the willingness and capability of young carers to help; and the degree of choice or obligation they experience. Formal and informal support services from outside the family, and environmental adaptations, can reduce the amount of family caregiving required, increase choice and contribute to balancing life for carers.     

What changes in ‘parenting’ approaches occur over the course of adolescent foster care placements?

An overview of the parenting skills and strategies utilized by foster carers looking after adolescents was given in an earlier paper. This paper focuses specifically on the relationship between the behaviour of fostered adolescents and the quality of parenting provided by the carer. In particular, the paper considers the consequences of situations in which fostered young people have a detrimental impact on other children within the foster family, as this was an especially difficult situation for foster carers to manage. Similarly, foster carers appeared to find it difficult to maintain good parenting skills with young people who were at risk due to their own sexual behaviour although, conversely, caring for a young person whose sexual behaviour put others at risk was connected with improved parenting. The quality of parenting provided by the foster carers was also influenced by the level of stress they were experiencing, with increased levels of stress leading to poorer parenting of the fostered adolescent.     

Love and money: payment, motivation and the fostering task

Although the payment of foster carers has attracted greater attention in recent writing and research, coverage of the issues has been limited. In this study, based on interviews with 20 female carers, the place of payment within foster care is explored in greater depth. The focus is on charting how carers perceive their task as ‘parenting’ or ‘job’, whether and how they experience payment as compensation or as an appropriate reward for their skills. Also examined are the ways in which payment may impact upon the practice of foster care, for example in decision making over the taking or ending of placements and the provision of aftercare support for care leavers. The study highlights the distinctive nature of foster care as an institution that straddles the public and private domains, and examines the resulting complexities. It concludes by suggesting that while payment issues provide important threads that run throughout foster care, their influence is ultimately limited by the latter's base within the family.     

Familiar subjects? Domestic violence and child welfare

Historically, domestic violence and child welfare have been seen as largely separate concerns. Over the last decade domestic violence has finally gained a place on social work agendas, partly as a result of linking domestic violence with child protection issues. Whilst welcoming the extent to which domestic violence is being taken seriously, we raise concerns about the dominant feminist perspectives guiding this project. We argue that current feminist theory is based on fixed and essentialist gender and generational categories which are unhelpful in understanding the complexities of family situations and family processes. Instead we argue for the relevance of relational understandings of gender, power and violence developed from feminist post-structuralist and psychoanalytic theorists. In doing so, we challenge accepted feminist understandings of domestic violence, and question the basis upon which dominant feminist approaches claim an unviolable alliance between the interests of women and children.     

Responding to child sexual abuse: an evaluation of social work by children and their carers

This paper presents the views and perceptions of 35 children and their current carers regarding the social work response to child sexual abuse. Interviews with the children and carers, including foster carers and residential carers, were carried out 2–4 years following disclosure, thus the nature of social work support in the longer term, as well as the initial response, is assessed and described. Three evaluations of social work support are presented: the child-ren's evaluations of social workers known since disclosure, and two evaluations from the carers, one focusing on the child's needs, and one focusing on their own as carers. All three evaluations perceived the majority of social workers as having helped. Aspects of social work considered essential included providing emotional support and reassurance, providing information and explanation and arrang-ing and coordinating services, including counselling or therapy.
  Carers of children who were abused by someone outside the family were less likely to receive social work support. The frustra-tion and disappointment expressed by some of these carers reaffirms the importance of assessing needs even when the child is considered protected from further abuse. The findings of this study support the need to refocus responses to abused children and their families.     

Aggressive behaviour in at‐risk children: contribution of subjective well‐being and family cohesion

We examined the contributors to aggressive behaviour in 111 at‐risk Israeli children aged 9–13 years who attended day centres over several years to prevent removal from their homes. This non‐normative transition to a day centre represents a difficult period of change for these children, which often manifests in aggressive behaviours, at least in the short term. To elucidate predictors of aggressive behaviour, we investigated a familial variable (family cohesion) and a personal variable (subjective well‐being [SWB]) that were previously shown to correlate with various aspects of children's aggression. Children's self‐reports underscored the importance of SWB for their aggressive behaviour. SWB's cognitive component – life satisfaction – correlated significantly with all four measures of aggressive behaviour (physical violence, verbal violence, anger and hostility). SWB's emotional component – negative affect – correlated significantly with all but verbal violence. Interestingly, SWB was found to mediate the hostility dimension of aggression (as well as family cohesion). Other significant findings revealed that family cohesion correlated positively with SWB (life satisfaction and positive affect) and correlated negatively with aggression (physical violence, verbal violence, anger and hostility). Various explanations were discussed alongside implications for day care staff's individual and family interventions.     

The reactions of women who have been assaulted and their efforts to gain redress

Women who are subjected to violence are affected by the traumatic event but also by the resultant negative or positive social situations arising from the manner in which society works. The aim of this study was to investigate, against the background of a traumatic incident, the significance of social events that occur after the act of violence itself. The picture of victimization and how it is experienced is complex. Two case studies illustrate the attempts of assaulted women to gain redress, but they also show how this is made more difficult by secondary traumatization. An analytical model gives some of the factors in the process of victimization. Assaulted women react to the assault on the basis of their current and previous life situation at the same time as the extent of the assault and the relation of the victim to the attacker are of importance. The representatives of society, volunteers and family and friends act in accordance with the "status" the victim has been implicitly given, which affects the woman's autonomy and her own ability to act. Secondary traumatization caused by a negative attitude from various actors in society makes the process of redress and a return to normal life more difficult.     

Implementing the Power to Kids programme in home-based (foster) care: Identifying the SAFETY approach

Sexual abuse and dating violence are chronic problems for children and young people in out-of-home care. This study explored the impact of a prevention and response programme Power to Kids, which targets harmful sexual behaviour (HSB), child sexual exploitation (CSE) and dating violence (DV) for children and young people in home-based (foster) care. Twenty-eight case managers, 25 foster carers and 13 children and young people participated in a mixed methods study in Victoria, Australia informed by the research question: How does the Power to Kids programme impact the sexual health and safety of children and young people in home-based (foster) care? The data analysis revealed a SAFETY approach whereby the sexual health and safety knowledge of carers and case managers was enhanced, and carers were given permission to have Brave Conversations with children and young people, who could then apply the new knowledge to their lives. Case managers were upskilled in identifying indicators of sexual abuse and empowered to escalate stalled therapeutic and disruption practice when children and young people were identified as experiencing HSB, CSE or DV.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.