Transition Programming for Sustainable Livelihoods Beyond Institutional Care in Zimbabwe: Service Providers’ Perspectives

This article explores the perspectives and programme needs of transition service providers (institutions and the government) in preparing and supporting adolescent girls leaving institutional care in Harare, Zimbabwe. Key informant interviews and focus group discussions were conducted with institutional staff from Institution A (government‐owned) and Institution B (privately owned) and social services officers from the Department of Child Welfare and Probation Services. Service providers define successful transition programming as the provision of comprehensive services and support to facilitate the achievement of sustainable livelihoods beyond care and recommend the development of well‐resourced transition models for adolescent girls leaving institutional care.     

Predicting adoption dissolutions for children involved in the child welfare system

While the majority of foster care adoptions are stable and secure, some dissolve, resulting in the return of children to the system. The purpose of this study was to identify factors associated with children’s reentry into the foster care system after adoptions are formally finalized. Using case records from the Los Angeles Department of Children and Family Services’ (DCFS) Bureau of Information Systems (BIS), we compared 123 dissolved adoptions to 74 successful ones. We found that children’s gender, history of physical abuse, exposure to drug use, and the number of foster care placements prior to adoption are associated with greater odds of dissolution. Furthermore, the odds of dissolution were higher for relative adoptive parents and for adoptive parents with prior substantiated Child Welfare cases. Implications for practice include ongoing targeted training and supportive services for families and improved screening procedures that address the unique needs of adoptive parents.     

Social support and interdependency in transition to adulthood from child welfare services

This qualitative study explores the need for social support in transition to adulthood for youths in the child welfare service, focusing on what support they need and from whom they can get such support. We have conducted individual and focus group interviews with in all 43 adolescents that are, or have been, in contact with the child welfare service in adolescence/young adulthood. The interviews are transcribed and analyzed by doing initial longitudinal analysis, and thematic analysis inspired by the main structure in Systematic Text Condensation (STC).Through the analyses we have highlighted four different categories of social support that the youths need; practical support, emotional support, affirmational guidance support and participation support. Our findings indicates that such support is necessary, but not always available for youths transitioning out from the Child Welfare System, as many of them lack an informal network of adults that can support them in their transition to adulthood. Several of them consequently need continued support from employees in the Child Welfare Service, which for many of these youths seems to represent a crucial source of social support. One of the challenges seems to be that the youths urge of independency together with the expectations of independency from the Child Welfare Services, makes youths end the contact with the Child Welfare Service too early. The simultaneously need for social support and urge for independency makes it relevant to discuss this in light of the concept of interdependency; which emphasizes the importance of connections and social relations as not only normal but also necessary. This underlines the need for more flexibility and a gradual independency; in contrast to the “sudden adulthood” that many youths transitioning out of child welfare seem to experience.     

Preparation,support, and satisfaction of adoptive families in agency and independent adoptions

Information gathered from over 1000 adoptions in the fourth year of a prospective study of adoptions finds satisfaction levels to be quite high, with those families adopting through private agencies to feel best prepared and satisfied. Differences by adoption auspice are detailed and discussed.The senior authors are Co-Principal Investigators of the California Long-range Adoption Study. This research was supported by the Child Welfare Research Center, Family Welfare Research Group, University of California at Berkeley, through a grant from the Children's Bureau, Administration for Children and Families, Department of Health and Human Services. The authors wish to thank the families for their participation. Please address correspondence to Mary Berry at the Center for Child Welfare, UTA School of Social Work, P.O. Box 19129, Arlington, Texas 76019.     

Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program

Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.     

Social services: the Navajo way

The development of child welfare services in Indian Country followed enactment of the 1975 Indian Education and Self-Determination Act and the 1978 Indian Child Welfare Act. These acts allow tribal contracting with the Bureau of Indian Affairs (BIA) to provide social services. Because the BIA model has not fit well with Navajo needs, the Navajo Nation Division of Social Services is creating a more holistic case management paradigm for child and family services, which is more congruent with its culture and its rural, sparsely populated land.     

Markets,Institutions and Technology: Missing Links in Livelihoods Analysis

The benefits of livelihoods thinking and approaches are widely recognised. This article focuses on an important gap in much of the conceptualization and application of ‘livelihood approaches’— a lack of emphasis on markets and their roles in livelihood development and poverty reduction. The omission is important, as it can lead to failure to identify and act on a wider range of market, institutional and technological opportunities and constraints. An alternative conceptualisation is proposed, with markets as one particular set of institutional mechanisms for co‐ordination and exchange in an economy. It is argued that more explicit attention to interactions between institutions, technology and assets in livelihood analysis may be valuable in conceptualising and managing programmes for livelihood development and poverty reduction.     

The Development of a Computerized Information System for Integrated Home Care in The Netherlands

ABSTRACT

In September 1992, The Netherlands Institute of Care and Welfare (NEW) started development of GIRST_S a computerized information system for the new integrated home care services in The Netherlands. These services integrated home nursing and family care services, with many institutions merging to facilitate the process. Integration of services required reorganization of all of the information processes and new technology provided the opportunity for improvement in their quality. These factors of reorganisation and of new technology opportunities stimulated NIZW to develop GIRST, which is designed as a tool to facilitate provision of care. It is not focused on managerial issues but on the information needs and concerns of those who actually provide care. The process of providing home care can be divided into four stages which correspond with the four modules of GIRST: care coordination-care allocation-care in practice-care evaluation.     

Fathers' encounters with the Child Welfare Service

In this article, we examined fathers who were or had been in contact with the Child Welfare Services in Norway. All of the fathers included in this study had children with women who were unable to take care of them, either because of substance abuse or mental health problems. Hence, the fathers had the primary responsibility for the children. We looked at how these fathers experienced being met and assessed as caregivers by the Child Welfare Service, as well as how they experienced their own competency as caregivers. To explore these themes, seven fathers who were in contact with or had recently been in contact with the Child Welfare Service were interviewed. The discourses on fatherhood, inspired by Scourfield (2003), were used as a framework for the analysis, and interpretive phenomenological analysis (IPA) was used to analyse the interviews. We found the fathers' experiences to be considered within the discourses on “fathers as a threat”, “fathers as irrelevant” and “fathers as better than mothers”. In addition, we shed light on topics such as the cultural lag, being single-handedly responsible for the children, and the fathers' views on what is important in their contact with the children.Our goal was to increase awareness about fathers who are in contact with the Child Welfare Service so that they are met in a way that helps to support them in their role as fathers for the benefit of their children.     

Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. DESIGN AND METHODS: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS. RESULTS: New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA). IMPLICATIONS: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

Profiles of Systems Involvement in a Sample of High-Risk Urban Adolescents with Unmet Treatment Needs

This study examined profiles of involvement in four systems (education, child welfare, legal, and treatment) in a sample of 253 high-risk urban adolescents with unmet behavioral health needs. Self-report data were collected on multiple dimensions of involvement within each system, demographics, and DSM-IV diagnoses. Latent class analysis revealed four profiles: Education System: Academic and Disciplinary, Education System: Academic Only, Legal/Juvenile Justice Involved, and Multiple Systems/Child Welfare. Profiles differed based on gender and psychiatric diagnoses. Boys were overrepresented in Education System: Academic and Disciplinary and Legal/Juvenile Justice Involved, and girls were overrepresented in Multiple Systems/Child Welfare. The two education system focused classes were characterized by depressive disorders and ADHD. Youth in Legal/Juvenile Justice Involved and Multiple Systems/Child Welfare were characterized by conduct disorder and substance abuse. Implications for assessment and treatment planning for high-risk youth and for the organization of community-based behavioral health services are discussed.     

Better together? Cooperation between youth welfare office and child and adolescent psychiatry: A methodological approach

Previous international literature describes a lack of systematic research about cross-institutional cooperation in social and health services although the need is indicated. More and more children and adolescents have complex psychosocial needs. Thus, they require help from different institutions and professions to receive optimal care. However, there is a great need of improvement of the cooperation between institutions in social (e.g. Youth Welfare Office) and health services (e.g. Child and Adolescent Psychiatry (CAP), even in Germany. Therefore, an official Agreement of Cooperation (AoC) between these institutions was implemented as a first attempt to enhance and structure cross-institutional work in Dresden, Germany. This methodological paper describes the corresponding evaluation project that includes cross-sectional and longitudinal assessments. It thereby focuses on the employees' and families' satisfaction as well as the psychosocial development and mental health of children at the intersection of the aforementioned institutions before and after the implementation of the AoC. In addition, it gives a review of literature about cross-institutional work.     

Combining child welfare and substance abuse services: a blended model of intervention

Montgomery County, Maryland's Child Welfare Services (CWS) and Adult Addiction Services (AAS) developed an initiative to address the requirements of the Adoption and Safe Families Act (ASFA) while meeting the needs of families and the community of providers. A blended model of intervention was determined to be the best strategy to achieve the dual mandates of CWS and alcohol and other drugs (AOD) providers. Drawing from criminal justice, systems theory, social work, and addiction treatment, the approach made use of graduated sanctions or levels of intensity in providing services, engaging client participation, and engendering motivation. This article proposes strategies at client and organizational levels to understand the process of adaptation to ASFA and to guide planning for blending services.     

A Community's Perceptions of Pediatric Social Outcomes in a Downsized Urban Hospital System

This article describes parental perceptions of pediatric services at Los Angeles County King/Drew Hospital and Medical Center after the hospital and its community clinics were restructured in the 1990s. Qualitative and quantitative measures are used to capture parental perceptions of service utilization, service convenience, and quality of care. The results are compared to hospital institutional operational data from patient flow analysis reports, appointment delay reports, and improving organizational performance committee reports. A comparison of parental perceptions of pediatric care is also made with findings from other post-devolution studies on access and quality of care at the Los Angeles County Department of Health Services. The implications of the findings for hospital quality assurance processes and health services outcomes research are discussed.     

Estimating the Expense of a Mandatory Home- and Community-Based Personal Assistance Services Benefit Under Medicaid

Abstract

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability.

Design and methods: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS.

Results: New expenditures for PAS are estimated to be $1.4–$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).

Implications: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

Legislated residential treatment of emotionally disturbed chronic runaways—a contentious approach

Those children involved with the Department of Community Services in New South Wales have a history of childhood abuse, neglect, domestic violence and seriously dysfunctional family dynamics. This has resulted in the children developing inappropriate strategies to cope with their adverse environment by physically acting out, in such ways as destroying properties, stealing, lying, fire-setting and chronic running away, and/or internalizing conflicts by self-mutilating behaviours. The critical ages are the pre-puberty and adolescent children, who engage in a pattern of running away and are at high risk of further exploitation by others. In New South Wales, the Children (Care & Protection) Act 1987 is the primary legislation which sets out the role of the state in the care and protection of children and young persons. However, this Act makes no provision for the physical containment of severely emotionally disturbed children to enable their access to the services they need. This paper attempts to identify the special needs of these children, who do not fit any diagnostic category, and proposes legislative changes to physically contain them in a therapeutic residential centre in order for them to access special protection and care services which would create the opportunity for long-lasting positive life experiences. © 1998 John Wiley & Sons, Ltd.     

Expanded medical home model works for children in foster care

The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates.These children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.     

'The longest road to equality': The Politics of Institutional Desegregation Under Truman

Abstract This paper addresses two questions. First, how did selected public institutions (principally the Armed Services and US Civil Service Commission) sustain segregationist values and assumptions? Second, how did President Truman tackle institutional segregation given the political support for this system in Congress and the Democratic party before the 1950s? I draw upon the ‘new institutional’ framework to analyse the role of public sector organisations in maintaining institutional segregation. I reject the new institutional thesis that such institutions are relatively autonomous because this claim neglects their political support and political origins, and the extent to which the values and assumptions they embody are protected politically. I argue that the national political coalition underpinning segregation explains why Truman relied upon executive action to effect institutional desegregation. Archival material from the investigative committees Truman established is marshalled to support these arguments.     

Crossover youth post arrest: Placement status and recidivism

The association between child maltreatment and juvenile delinquency is well established. Maltreated youth experience significantly higher delinquency rates than their peers. Studies report that placement instability in substitute care and placement in congregate settings (e.g., group homes) contribute to higher rates of offending. To date, no studies have focused on the judicial response and the likelihood of continued offending. The current study investigates the association between post-arrest placement decisions and recidivism. We analyze administrative records from the Los Angeles County Department of Probation and the Department of Children and Family Services. The sample includes all first-time violent offenders with an open child welfare case. Forty-nine percent of youth experienced a subsequent arrest. Using Cox regression, we find that moving crossover youth from a family-like setting to a congregate care setting was associated with significantly higher rates of recidivism. We discuss the policy and practice implications of these findings.