A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in‐depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.     

Serving Former Foster Youth and Homeless Students in College

ABSTRACT

Many universities have developed campus support programs for former foster youth and homeless college students; however, there are no studies focusing on long-term programs in the college-setting with a mentoring component that focuses on developing relationships with supportive adults. To address the gap, this study examined both mentors' and program staff's experience with providing services to students in a campus support program. The authors collected qualitative data from one success coach (i.e. program staff) and eight mentors through focus group meetings and interviews. Results indicated that the success coach reported the students in the program improved their overall academic performance, while most mentors did not know their mentees' grades. The success coach coordinated most services of the program, assigned financial and academic support, and made service referrals. Mentors helped their mentees to improve academic and independent living skills. However, mentors reported that they received limited support, especially when working with mentees with mental health problems. Recommendations to improve the program include: using a multidisciplinary team for students with mental health problems and adopting systematic approaches to better support mentors' services. Future studies should go beyond program staff and mentors to include students' perspectives regarding their experiences with receiving mentoring services.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

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.     

Making a home, finding a job: investigating early housing and employment outcomes for young people leaving care

This paper presents findings from a new study of outcomes for young people leaving care funded by the Department for Education and Skills. It reports findings for a sample of 106 young people in relation to progress made in housing and employment some 12–15 months after leaving care. The generally poor employment outcomes of care leavers are acknowledged, but ingredients that make for success are also highlighted, including the value of settled care and post‐care careers, sound career planning and, significantly, the value of delaying young people’s transitions from care. Early career paths also interconnect with how young people fare in housing, in developing life skills and with other problems in their lives after leaving care. Housing outcomes were more encouraging and predominantly shaped by events after leaving care, and faring well in housing was the factor most closely associated with positive mental well‐being in young people. Some groups that are at risk of faring badly are identified, including young people with mental‐health problems, young people with persistent offending or substance misuse problems and, in some respects, young disabled people. The implications of these findings for leaving care services are considered.     

Webster‐Stratton Incredible Years Basic Parent Programme (IY) in child care placements: residential staff carers' satisfaction results

The aim of the present study was to investigate residential child care staff satisfaction with their involvement in the Webster‐Stratton Incredible Years Basic Parent Programme (IY). In an exploratory, not randomized study, 27 professionals from two different short‐term Portuguese residential child care centres (IG1, n = 15; IG2; n = 12) completed weekly IY evaluations and an overall satisfaction questionnaire at the end of their participation in the IY intervention. The weekly level of satisfaction was assessed with regard to each of the programme's components (content, DVDs, group leaders, group discussion). At the last session, they filled out a questionnaire aimed to evaluate the levels of satisfaction regarding the programme overall, the teaching format, the group leader(s) and the usefulness of specific educational techniques they learned. Data indicated that residential staff carers were highly satisfied with the weekly sessions and with the overall usefulness of the intervention programme. Results are discussed in terms of implications and future research directions.     

Participation and health – a research review of child participation in planning and decision‐making

Effective child participation in child protection proceedings has proved difficult to achieve in Norway. Although participation is in principle accepted as a human right and something of benefit to children, when children's health is at stake there is a tendency to view participation in decision‐making processes by children as potentially disruptive to their well‐being. The purpose of this study is to review the research evidence for effects, positive or negative, of participation on health outcomes for children in care. A scoping review of major health and social work research databases was undertaken. Searches in five databases yielded 1830 studies of which 21 were finally included in this review. Studies were included if a relationship between health and participation was evident from the data presented, even if this was not the main objective in the study at hand. We conclude that when participation is successful, it may have beneficial side effects. Chief among these are that participation may improve children's safety, increase the success of care arrangements and increase feelings of well‐being for children involved. Evidence for long‐term effects of successful or failed participation attempts on subsequent health outcomes is however largely absent.     

Care leaver needs and accessibility: Findings from the first large‐scale project in Switzerland

Leaving out‐of‐home care is a challenging situation not only for young people leaving care but also for the child welfare system. However, systematic and multiorganizational transitional programmes are often lacking. This study investigated Switzerland's first large‐scale care leaver programme and analysed associations between care leavers' needs and contactability in a sample of 459 care leavers. A first track compared the characteristics of successfully contacted care leavers and of not contactable care leavers (‘dropouts’). The second track analysed the association between need for support and self‐rated or proxy‐rated quality of life in the subsample of 235 successfully contacted care leavers. Odds for indicators of lower educational attainment were substantially increased for dropouts. Additionally, self‐reported need for support was significantly associated with lower self‐ratings of quality of life in seven areas. Care leavers who accepted the programme's offer of coaching rated their quality of life lower than participants who reported no need for support and participants who reported a need for support but turned down coaching. For successfully contacted care leavers, the programme gave access to coaching sessions to the young people the most in need. However, dropouts appeared more vulnerable and might therefore benefit even more from aftercare support.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.     

Facilitators and Barriers to Implementing Transitional Care Managers Within a Public Health Care System

Transitional care is crucial to ensure quality of care and safety for elderly patients. In the context of health care reforms promoting a shift from a hospital-centered approach to a home care approach, transitional care becomes a vital component and social workers can play an important role in easing transitions. Most recent studies have focused on the development or improvement of transitional care intervention models or tools, but few have addressed implementation issues. In this study, the implementation process of an innovative intervention aiming to integrate transitional care managers (TCMs) from Health and Social Services Centres (HSSC) within two Canadian hospitals was evaluated. Data collection comprised focus groups (n = 8), direct observations, meeting minutes, activity grids and logbooks. To facilitate the implementation of TCMs, decisions were made to clearly indicate their involvement in patients’ files and concentrated their efforts on a restricted number of units. Barriers included confusion about target clientele, inequitable information exchange between partners, limited powers regarding coordination of care, and organizational constraints limiting additional measures to improve transitional care. Evaluating implementation processes is crucial to efficiently identify obstacles and apply additional implementation strategies to promote the integration of new practices within the health care system.     

Mental health and wellbeing of care leavers: Making sense of their perspectives

Despite considerable quantifiable data about the circumstances of care leavers in the United Kingdom, there is less qualitative data about how these circumstances are experienced. This article is underpinned by positioning theory, with a particular focus on the unfolding personal narratives of young care leavers in relation to their mental health and wellbeing and the role of a life‐skills programme in supporting them in this respect. The research illustrates that leaving care projects, such as the one in the current study, are more focused on employment and housing issues than on addressing the mental health and wellbeing needs of young people. Our analysis of interviews with young people illustrates the ambiguity of understandings of concepts such as “mental health” and “wellbeing,” and the complexity of responses to questioning around this area. This illustrates one of the major problems in evaluating the outputs and outcomes of such projects in terms of simplistic targets, where mental health and wellbeing are not clearly defined or understood by young people themselves. The current research provides a more complex picture. More research is needed that involves in‐depth and longitudinal assessment of specific mental health needs of care leavers and how they can be addressed successfully.     

Does what happens in group care stay in group care? The relationship between problem behaviour trajectories during care and post‐placement functioning

Residential programmes for youth may improve youth behaviour during placement, but it is not clear whether there is an association between a youth's behaviour pattern during placement and post‐placement outcomes. Life course perspective has been used to understand longitudinal patterns and pathways, and new statistical methods have been developed to identify latent trajectory groups. This study used administrative data from a family‐style group care programme to assess whether a youth's externalizing behaviour trajectory while in placement can significantly predict delinquency and adjustment outcomes at discharge and 6‐month follow‐up. Findings from multinomial logistic regression revealed a statistically significant relationship between a youth's behaviour trajectory class and outcomes. Behaviour pattern during care was a stronger predictor of outcome than cross‐sectional measures such as other demographic factors, placement history or mental‐health need indicators.     

Young people leaving care: health, well-being and outcomes

This paper focuses on the health and well‐being of young people making the transition from care to independent adulthood. It draws on findings from a wider study of outcomes for young people leaving care in England. Notably, the study used, as its key outcome indicators, measures of general and mental well‐being. In doing so, it was able to explore the interrelationship between these areas and young people's overall progress after care. The paper explores the extent to which young people experience difficulties related to physical and mental health, disability and emotional and behavioural problems. It will show that such difficulties can impact upon and be influenced by overall well‐being and post‐care progress in more traditional outcome areas such accommodation and career, and will suggest that the transition from care itself can adversely affect health and well‐being. The paper considers these issues within the context of a changing policy framework which has given increased priority to the health and well‐being of young people in and leaving care, particularly in light of the Children (Leaving Care) Act 2000. It considers the ways that young people are supported to address health and well‐being and the implications for and impact on leaving care services.     

Stability and change – a 7‐ to 8‐year follow‐up study of mental health problems in Norwegian children in long‐term out‐of‐home care

The aim of the study was to explore stability and change in mental health problems in Norwegian children aged 6–12 years old (n = 70) in long‐term out‐of‐home care. The children's mental health problems were assessed shortly after the placement and 7–8 years later by the caregivers and the teachers on the Revised Rutter Scales. Information on pre‐placement and placement factors were collected from the child welfare workers. At a group level the children's mental health problems had improved significantly over time according to the teachers' reports. According to the caregivers' reports, however, the children's problems were high and stable across time. Analyses aimed at detecting individual changes revealed a great variability in development according to both informants, indicating that treating the placed children as a homogenous group could be misleading. Several pre‐placement and placement variables were associated with the change in the children's mental health problems from the time of placement to the follow‐up time according to both informants' reports. However, all the predictors were accounted for by the strong effect of the children's problem scores when entering care.     

Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences

The sexual health problems experienced by homeless youth bring into question their use of available sexual health services. Using a qualitative typological analysis, this study aims to identify sexual health services utilization profiles for homeless youth, and to understand the role of the homeless experience on the utilization of sexual health services. Individual interviews were conducted with 33 homeless youth (17 men, 16 women) between 18 and 25?years of age. Typological analysis identified four profiles: (1) a targeted use of sexual health services to determine one’s serological status following a relational change during the homeless experience; (2) a limited use of sexual health services to manage sexual emergencies that arise during the homeless experience; (3) a regular use of sexual health services to avoid the risks associated with the homeless experience; (4) a frequent use of sexual health services to obtain support when engaging in prostitution during the homeless experience. This study shows that the precarious and unstable conditions within the homeless experience incite youth to utilize sexual health services in different ways. These findings point to the importance of rethinking sexual health services to better adapt them to the different utilization profiles of homeless youth.     

Exploring strategies for re-engaging children and young people in learning while living in out-of-home care in the Northern Territory,Australia

The education of children living in out-of-home care (OOHC) has been a long-standing concern for children and their carers, policy-makers and researchers who have long highlighted the issue of low educational attainment and disengagement among children in care. This study investigates the strategies and practices used within a pilot programme based in the Northern Territory, Australia, that aims to re-engage children living in OOHC with education and training. Drawing on qualitative interviews with programme stakeholders, including educators, carers, child and family welfare workers, as well as an analysis of programme and client documentation, this study explores the programme's strategies to achieve re-engagement. The findings highlight the role of agile child-centred practice responding to the learning needs of participants, a focus on the ‘educational futures’ of students, as well as liaison and advocacy with schools and stakeholders on behalf of children in supporting re-engagement in education settings. Barriers to successful re-engagement include limited consideration of the cultural needs of children across education and OOHC systems, in particular the disruptive impact of OOHC placement changes, as well as programme discontinuity.     

Little cash to large households: Cash transfers and children's care in disadvantaged families in Ghana

Social protection is widely considered to have a positive effect on children, including supporting improvements in nutritional, educational and health outcomes. Much less is known, however, about the impact of interventions on children's care. This article considers the impact of a social cash transfer targeted at poor households – Ghana's Livelihood Empowerment Against Poverty (LEAP) programme – on child well‐being, quality of care and preventing children's separation from their parents as perceived by programme and non‐programme beneficiaries in a context of vulnerability, large households and widespread informal kinship care. Findings suggest that cash transfers can improve both material and non‐material aspects of well‐being and contribute to the quality of care and have the potential to prevent children's separation from their parents. At the same time, not all children appear to benefit equally, with non‐biological children being disadvantaged. The combination of large household sizes with programme design and implementation challenges, including low transfer amounts, a cap on the maximum number of eligible household members and poor sensitization and follow‐up, undermine the positive role that cash transfers can play.     

Quality of experience in residential care programmes: Retrospective perspectives of former youth participants

This exploratory study examined perceptions of care quality within parent‐pay youth treatment programmes such as therapeutic boarding schools, residential treatment centres, wilderness therapy programmes, and intensive outpatient programmes. Reflecting on their personal experiences as youths, 214 adults reported on a total of 75 different treatment settings. Two indices developed for this study measured participants' perceptions of quality of experience and the totalistic programme characteristics of their care settings. Regression analyses and ANOVA tests of means indicated a negative relationship between totalistic programme characteristics and quality of experience index scores. Significant relationships were not found between quality of experience and forcible transport, intake decade, or the amount of time in treatment.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.