Short breaks for families caring for a disabled child with complex health needs

Data from two research studies concerned with disabled children who have complex health needs were analysed in relation to families' experiences of accessing short breaks (respite) services. Many families experience serious problems finding suitable services which can cater for both their child's complex health needs and their own need for significant levels of support. This paper highlights which services families were using and the difficulties of obtaining a coherent and consistent package of support. Regulatory concerns relating to the piece-meal provision of services and use of children's hospices are raised along with recommendations for improving policy and practice.     

The relationship between foster care families and birth families in a child welfare context: The determining factors

Children placed in foster care families usually continue to see their birth parents in supervised and home visits. These children deal with the fact that they belonged to two families in a context where the relationship between the two families is sometimes complex and tense. Based on 45 semi‐structured interviews conducted with foster care families and kinship foster care families, the present study examines the relationship between foster care parents and birth parents in a placement context, and focuses on the factors affecting the nature and quality of this relationship. The results showed that the quality of the relationship dynamics varies according to the following: how well and how often the parent–child visits took place, the birth parents' characteristics, and the foster carers' attitudes. The results also showed that placements in kinship foster care families were more likely to result in conflict and tension between the two parties than placements in regular foster care families.     

Adapting the Friends of the Children programme for child welfare system‐involved families

Research has shown the importance of long‐term, caring adults for children in foster care. This paper reviews the Friends of the Children (FOTC) long‐term mentoring programme and how it was adapted to serve children and families with child welfare system involvement. This study's two research questions are (1) How do Friends (FOTC's paid professional mentors) currently work with, and in turn, have an impact on, child welfare‐involved families? and (2) How can Friends better support child welfare system‐involved caregivers and families to promote family stability, permanence, and child well‐being? Data were collected from 21 caregivers (foster and biological), 24 FOTC Friends, five child welfare workers, and five teachers. Qualitative analyses of focus group, interview, and open‐ended survey data revealed a wide variety of ways Friends currently support children and families. In addition, several recommendations were made for strengthening programming. These findings provide valuable insights into providing long‐term mentoring to child welfare system‐involved children and families.     

Why parents matter: exploring the impact of a hegemonic concern with the timetable for the child

In a climate of austerity, timescales and targets, this paper probes whether parents matter sufficiently within the current child protection system in England. Evidence suggests that achieving partnership working in the context of child protection has become increasingly illusive, particularly when parents are notified that the local authority is considering compulsory intervention to remove their children under the Children Act 1989. Recent changes to legislation, policy and practice ushered in with the aim of achieving earlier decisions within the time frame for the child are laudable, but there are consequences for both children and their parents. The aspirations of the Public Law Outline (2008) are well rehearsed, but the changes being introduced with the recent reform of the family justice system, alongside particular constructions of parenting, may be failing to recognize the potential of many parents, if offered appropriate support, to care safely for their children.     

A family-centred practice supervision project conducted for a child welfare agency

ABSTRACT

This paper reports on a supervision project that aimed to enhance a child welfare agency staff’s professional competence in family-centred practice through a strength-based approach. A qualitative study was designed to explore the effectiveness and the change agents of the supervision. Purposive sampling was used. Two agency supervisors and two social workers participated the study voluntarily. The findings indicated that after the period of supervision, the staff had changed in three respects: their conceptualisation of the meaning of family work in the care context; their understanding of the importance of relationship-based interventions with families; and their development of alternative ways of practice. The agents of change from the supervision were the consultants’ modelling effect and the co-worker experience of the consultants and the social workers. This supervision approach can discern the synergistic effect of supervision on an agency’s routine supervision and balance the cultural beliefs in qing, yuan and ‘face’ embedded in the supervisory process.     

Interventions for families with multiple problems: Similar contents but divergent formats

For families with multiple problems (FMP), knowledge is lacking on the practice elements of interventions (the distinct techniques practitioners use to promote positive outcomes) and their program elements (intervention design and delivery systems). The aim of this study is to identify both common and specific practice and program elements so as to determine contents and overlap between interventions. For FMP, we selected interventions that had at least moderate (>0.5) effect sizes in the Dutch context (N = 8). A deductive content analysis was used to assess the manuals of these interventions with the taxonomy of interventions for FMP. We defined as common those elements found in at least five of the eight interventions and as specific those found in fewer than five. Of the practice elements, 79% were common across the interventions, and 21% were intervention specific. Interventions with the highest percentages of intervention‐specific elements derived from the taxonomy were 10 for the Future (15%), Family Central (14%), Intensive Family Therapy (14%), and Multisystemic therapy (11%). Core program elements: duration, intensity, intervision, supervision, and consultation, varied greatly between interventions. Among interventions for FMP, we found practice elements to have considerable overlap. Among program elements, we found greater variety.     

Building home on a fault line: Aging out of child welfare with a serious mental health diagnosis

Youth aging out of foster care are at high risk for homelessness. This research explains how and why homelessness occurs among youth with serious mental health struggles after aging out of residential and transitional living programmes. Using a longitudinal constructivist grounded theory design, we analyse 20 in‐depth interviews exploring youth's transition experiences and perceptions of transition success within 4 months of emancipation and at 6 and 12 months postemancipation. Monthly 15‐min check‐ins prevented attrition. A three‐phase transition process was observed driven by participant desires and actions to cultivate psychological home through establishing physical home alone away from social networks. Pre‐emancipation, the promise of home was privacy and opportunity for self‐redefinition. Shortly after emancipation, home became a physical and social space to be, a valuable resource to share and a demonstration of personal transition success. However, later in the year postemancipation, maintaining physical home proves nearly impossible given the risk context. Findings speak to how and why youth aging out appear overly self‐reliant upon emancipation. Cultivating a psychological sense of home has practice implications for child welfare providers who aim to prepare youth to live independently postemancipation.     

Learning Experiences of Older Volunteers in a Community-based Social Program for People with Dementia

Abstract

This qualitative study aimed to explore older adults’ perspectives on volunteering in an activity-based social program for community-dwelling people with dementia called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include (a) self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.     

Pacific Islands Families Study: Factors associated with living in extended families one year on from the birth of a child*

Abstract

Using data from the “Pacific Islands Families: the first two years of life (PIF) study”, this paper explores the factors associated with the living arrangements of mothers with a one‐year‐old Pacific child. Three living arrangements are considered: (1) those children who live with immediate family members only; (2) children who live with extended family members including at least one of their grandparents; and (3) children who live with extended family members but do not live with any of their grandparents. Findings of interest include: mothers who were born in New Zealand are much more likely to live in an extended family with the child's grandparent(s) compared to those who came to New Zealand as an adult; and mothers with high New Zealand identity and low Pacific identity being more likely to live with extended family members other than the child's grandparent(s) relative to those with low New Zealand and high Pacific identity.     

The experience of sole mothers balancing paid work with care for a child with a disability

There are increasing numbers of families in Australia headed by sole parents, but little is known about the experiences of those who also care for a child with a disability. Additional caring responsibilities have previously been shown to impact on the work participation of parents. This study involved qualitative analyses of interview data conducted with sole mothers with school‐aged children with disability (N = 11). Thematic analysis revealed four themes that enabled and supported participation in the workforce: social support; managing appointments; characteristics of the workplace; and the role of the school. Results suggest the importance of practical help from family and friends in facilitating participation in paid employment. Additionally, the importance of flexible appointment scheduling on the part of service providers was highlighted, as well as the importance of workplace flexibility and supportive workplace cultures. Such factors were important in supporting sole mothers to balance work with care, with important implications for personal and family wellbeing.     

Parents' perceptions of a group‐based parenting programme in families with child protection and other family support services in a real‐life setting

The aim of this study was to assess parents' satisfaction and perceived usefulness of the Incredible Years® (IY®) parenting programme in the Child Protection Services (CPS) context, where children's behaviour problems are common. Evidence‐based programmes are rarely offered in CPS, and little is known about how they are perceived by parents. We compared parents (N = 62) with (N = 43) and without (N = 19) CPS contact regarding their satisfaction with the IY® parenting programme, with information gathered from weekly and final evaluation forms. The attendance rate of parents to the weekly sessions (max 19) was also calculated. Comparisons between CPS and non‐CPS clients were analysed using multilevel models. Satisfaction scores ranged between 5.8 and 6.2 (max 7) for all studied domains. Mean attendance rate to the group sessions was 11.5 (SD 5.9), and 74% of participants attended at least nine out of 19 sessions. No group differences emerged in satisfaction or attendance between CPS and non‐CPS parents. Parents in CPS committed well to the programme and found it as useful as parents without CPS contact. IY® appears to be acceptable to parents involved in CPS, and their engagement to the programme can be considered as reasonably good.     

Preparedness of representatives for people with dementia in a self-directed program

ABSTRACT

Representatives enact their role as decision-making partners across the intersection of participant direction (PD) and dementia care. Self-rated preparedness for key dimensions of the role endorsed by a panel of experts in PD and dementia was assessed by telephone survey of 30 representatives of persons with dementia in a PD program. The sample (daughters 60%; Black 50%; rural 70%) was diverse in length of time in the role and additional responsibilities. They represented participants with moderate to advanced dementia and ≥ two additional chronic illnesses. Overall preparedness scores were in the pretty well to very well prepared range, with variation across dimensions and between individuals. Preparedness varied according to what has to be done day-to-day in dynamic or unpredictable situations, gauging decisional capacity, anticipating changing needs, ensuring safety, supporting a dementia-capable care team and negotiation. Stress was related to having a safety net of capable back-up supports and dementia care literacy. Areas of strength, individual variation and particular challenges along the trajectory of representing can guide development of support counselor interventions to provide representatives with tailored training and resources as they enable the benefits of PD for persons with dementia.     

The Case for a New 'Case' Management in Services for People with Learning Disabilities

Micro-organization is currently fragmented in services for peoplewith learning disabilities. Care management, person-centredplanning (PCP) and direct payments have developed through separatepolicy strands, with tasks and agency responsibilities blurred.A wide diversity of care management arrangements currently operate,with the relationship between care management, PCP and directpayments imprecisely defined. PCP and direct payments have alsobeen variably implemented. This paper argues for a new ‘person-centredcase management’, with these different devices betterintegrated and decision-making and action more person-centred.Drawing on practice experience from the original British casemanagement experiments, the new ‘case’ managementwould be centred on the needs and wants of individuals, be conductedindependently from assessment, operate outside the public sectorand be able to access personal budgets. It would consequentlyhave the capacity to further de-institutionalize services andsupport and transfer more control to people with learning disabilities.     

Creating a better kinship environment for children in Ghana: Lessons from young people with informal kinship care experience

Traditionally, the involvement of the extended family in nurturing children is seen as an essential cultural practice in most communities in Ghana. Though not formally regulated, often in the absence of birth parents, kin and kith continue to be involved in the care of children to promote family relations and culture. Yet there is little empirical evidence on how to improve the well‐being and safety of children in informal kinship care in Ghana. Thus, this study reports findings from in‐depth interviews with 15 young people, 18 to 23 years, from Banda—an ethnic group where informal kinship care is an accepted cultural practice. Data from the interviews were subjected to the constructivist grounded theory analysis. Adequate income for provision of basic needs, education and training, and supervision emerged as useful measures to promote the safety and well‐being of children in kinship care. It was recommended that informal kinship caregivers must be registered with the Department of Social Welfare to enable them access support and training. Further, social workers should create awareness among kinship caregivers in Ghana about their availability to provide counselling services for caregivers facing challenges.     

Research Review: The role of grandparents in intergenerational support for families with disabled children: a review of the literature

The family in late modernity faces demographic change. However, it is still apparent that intergenerational relationships and exchanges of resources are valued. There is a growing literature on the important role that grandparents play in their children’s families. In contrast, there is limited research exploring the support grandparents provide to families with disabled children. This is an important gap in our knowledge, as families with disabled children frequently face additional caring responsibilities and emotional demands. From the studies that do exist, it is clear that grandparents’ support to families with disabled children is generally valued. However, the literature remains partial: past studies are small‐scale, focused upon parents’ perceptions of support (especially mother’s), and frequently based upon North American data. Recognizing these limitations and the fact that grandparents themselves have support needs which require consideration, this paper identifies key areas where important issues remain unanswered and further research is required. It argues that research is needed to begin untangling the different support needs of parents, grandparents and other family members, and the different effects of grandparent support that different family members’ experience. Exploration of grandparents’ own support needs also indicates the need for wider policy and service consideration.     

Patients with Minor Mental Disorders Leading to Sickness Absence: A Feasibility Study for Social Workers' Participation in a Treatment Programme

Minor mental disorders are common among patients who visit theirgeneral practitioner. In the Netherlands, they are associatedwith high costs due to absenteeism, disability benefits andmedical consumption (consumption of drugs as well as expenditureof medical staff’s time). In the Netherlands, a protocolwas developed for the treatment of minor mental disorders, basedon the principles of brief cognitive behaviour therapy. Thecost-effectiveness of this protocol was tested in a group ofpatients whose minor mental disorders had lead to sickness absence.The protocol was completed by Dutch social workers, one of whosecore tasks normally is to provide psychosocial care. The mainaims of the protocol are for the patient to regain functionalityand to prevent long-term disability. The protocol emphasizespatients’ own responsibility and active role in the recoveryprocess, includes homework assignments and stresses the importanceof early work resumption. This article focuses on a discussionof the feasibility of this treatment for minor mental disorders.The evidence for or against the protocol’s cost-effectivenesswill be discussed in future papers. The results show that patients,social workers and general practitioners were motivated to participateand that the protocol was well received by all three groups.If the treatment also proves to be cost-effective, it wouldappear to be a promising intervention for a frequently encounteredproblem in primary care.     

Multiple Family Group Therapy for Families with Children Placed in Out-Of-Home Care in a Chinese Context

Since the 1980s, the family-centered approach has been widely adopted in the west (e.g., the United States) as an approach to serving children living in an out-of-home care context. In comparison, in Hong Kong, out-of-home care services tend to be child-centered and child-protection oriented. This article (1) examines the child welfare service, specifically out-of-home care services, in Hong Kong and (2) makes the case for integrating family-centered out-of-home care services for children. Three vignettes are presented that demonstrate the use of Multiple Family Group Therapy (MFGT) to promote family-centered practice. The article concludes with a discussion of challenges and recommendations related to a shift to family-centered practice.