Where Do We Stand? Testing the Foundation of a Shared Site Intergenerational Program

Abstract

Shared site intergenerational care programs provide ongoing services simultaneously to old and young community members at a single facility, thereby, meeting the care needs of multiple generations. However, they face the challenge of sustainability common to all community-based programs. We employed the results management model to identify program elements that may enhance or inhibit sustainability of intergenerational programming at a shared site facility involving a child development lab school and adult day services program. The 4-step results management approach is a strengths-based model that supports community capacity and achievement of community and program goals. The current paper describes the first step in the results management approach, mapping the terrain, which involves gathering evidence of community needs and strengths. Focus groups were conducted with eleven staff members from both programs after a 4-month intergenerational program. The focus groups targeted the needs and strengths related to intergenerational programming. Respondents identified strengths that enhanced staff members' and clients' capacity for collaboration. These included affective and developmental benefits for both generations and strong partnerships between staff members. Respondents also identified factors that limited collaboration, such as the need for greater authority support and cross-training opportunities. Findings from our study have been used by program administrators to continue using the results management approach to further build intergenerational community and expand the scope of evaluating intergenerational shared site programs. Other intergenerational programs may utilize the results management model to enhance intergenerational programming and increase program sustainability.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

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

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

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program

Summary

Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs (“CHAMP might help me, mine, and other families”), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs.     

Factors contributing to eviction from permanent supportive housing: Lessons from HUD-VASH

IntroductionEviction from housing is associated with several negative outcomes, further exacerbated among high-need populations requiring financial and supportive services to maintain housing stability. This study investigated risk and protective factors—both characteristics and precipitating events of tenant eviction—informing permanent supportive housing (PSH) programs’ efforts to identify tenants at risk and intervene.MethodsUsing administrative data for a cohort of 20,146 Veterans participating in PSH, this study assessed differences in Veterans who exited the program due to eviction and Veterans who exited because they accomplished their goals. A series of logistic regressions identified patterns of health services use that may signal imminent eviction.ResultsVeterans with a drug use disorder and those who received inpatient, emergency, or outpatient care related to mental/behavioral health and substance use conditions proximal to program exit had greater risk for eviction. Receipt of outpatient primary medical care and supportive services was generally protective against eviction. The likelihood of eviction was greatest for Veterans with acute care use within 30 days of exit.DiscussionPSH providers may use these correlates of eviction to identify Veterans in need of an intervention to prevent eviction. Future work should focus on operationalizing these findings and identifying appropriate interventions.     

Living Room Assessment

Abstract

Community living room programs, initially developed as part of the settlement house movement, strive to maintain a safe and welcoming atmosphere for clients with basic needs who can then be linked to concrete services. These rare programs do not generally include formal intake and termination criteria and are thus difficult to assess by quantitative means. In this project, the authors used the Community Oriented Programs Environment Scale (COPES) to perform a social climate assessment of a living room program at an urban homeless shelter. The agency board and staff were concerned that expanding numbers of clientele might deter potential and current members from participation and thus defeat the program's major purpose. This paper reports the social climate perceptions of staff and members and recommends agency program adjustments. This type of evaluation has implications for macro practice in determining whether nontraditional programs can be shown to meet certain human needs that complement those addressed by the broader social service system.     

Serving families with child maltreatment and substance use disorders: A decade of learning

ABSTRACT

An increase in parental substance use disorders (SUD) and the number of infants and toddlers entering foster care has prompted federal and state efforts to change the treatment paradigm toward more integrated and family-centered strategies. The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. The current challenge is to bring effective strategies to scale. This conceptual article highlights the lessons learned from 10 years of implementing and evaluating programs to meet the needs of families affected by parental SUD and child maltreatment. Effective family-centered strategies identified by the RPG program are illustrated with specifics from the Sobriety Treatment and Recovery Team program. These effective strategies could be implemented in any jurisdiction and include (1) collaboration toward integrated services between child welfare and SUD treatment, (2) timely access to SUDS treatment, (3) recovery management and support, (4) tailored family services, and (5) adaptation to local jurisdiction needs. When these strategies are operational, children are more likely to be safe and remain in parent custody, and parents are more likely to achieve sobriety and improve their parental capacity. Future research might examine the unique impact of each of the five strategies independently.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Moving Toward Collaboration

Summary

Traditionally, organizations serving children and families have focused service delivery by available funding stream criteria. Federal funding streams supported fragmented services by tightly channeling monies to specific programs for specific needs. The intensity of providing and improving the delivery of services has overshadowed building connectedness across organizations and systems. Service has been the major goal and intense effort has gone into maximizing opportunities and measuring effects through service frequency. Over the past several years, new funding incentives have provided the opportunity for new collaboratives. This article describes an innovative collaboration between the Idaho Department of Health and Welfare (IDHW) and Eastern Washington University (EWU) and the unique directions and support that a university/agency partnership can provide for both organizations. Key features of this collaboration include shifts in funding and staffing strategies that contributed to more flexible services and increased levels of collaboration between IDHW, EWU and other community and state organizations and institutions. This article describes how funding can be viewed as a tool to increase the level of collaboration between systems, thus potentially leading to a breakdown of the traditional service delivery system. Finally, this article describes how an agency/higher education partnership played a key role in documenting the success of a school based program in meeting the emergency assistance needs of children and families, and how program evaluation, like funding requirements, can provide a supportive role in building collaborative relationships.     

Adapting a Family-Based HIV Prevention Program for HIV-Infected Preadolescents and Their Families

Summary

This article describes a family-based HIV prevention and mental health promotion program specifically designed to meet the needs of perinatally-infected preadolescents and their families. This project represents one of the first attempts to involve perinatally HIV-infected youth in HIV prevention efforts while simultaneously addressing their mental health and health care needs. The program, entitled CHAMP+ (Collaborative HIV Prevention and Adolescent Mental Health Project-Plus), focuses on: (1) the impact of HIV on the family; (2) loss and stigma associated with HIV disease; (3) HIV knowledge and understanding of health and medication protocols; (4) family communication about puberty, sexuality and HIV; (5) social support and decision making related to disclosure; and (6) parental supervision and monitoring related to sexual possibility situations, sexual risk taking behavior and management of youth health and medication. Findings from a preliminary evaluation of CHAMP+ with six families are presented along with a discussion of challenges related to feasibility and implementation within a primary health care setting for perinatally infected youth.     

Agency-Related Barriers Experienced by Families Seeking to Adopt From Foster Care

ABSTRACT

Although about 100,000 children in foster care await adoption, families approved to adopt encounter obstacles in the adoption process. This nationwide longitudinal study identified agency-related barriers faced by prospective adoptive parents. A pur-posively recruited sample of 300 families seeking to adopt from foster care completed an in-depth, semi-structured telephone interview and quarterly follow-up surveys until they either finalized a foster care adoption (n = 98) or discontinued (n = 102) the process, followed by an exit interview by telephone. Findings revealed the top barriers encountered were adoption process logistics (n = 185, 92.5%), agency communication and responsiveness (n = 159, 79.5%), agency emotional support (n = 130, 65%), availability of services (n = 65, 32.5%), and juris-dictional and interjurisdictional issues (n = 52, 26%). Policy and practice implications are provided with recommendations for improving procedures, services, support, and communication to better retain prospective adoptive parents and improve adop-tion outcomes.     

Process evaluation of the ‘Singapore Physical Activity and Nutrition Study’

IntroductionThe Singapore Physical Activity and Nutrition Study (SPANS) aimed to improve the physical activity (PA) and nutrition behaviours of Singaporean women aged 50 years and over. The SPANS program consisted of PA classes, nutrition workshops, telephone dietary counselling, health booklets, a health calendar and program ambassadors. This study aimed to assess and understand the implementation of the program strategies and gain insight into process evaluation components to inform future programs.MethodsThe evaluation was guided by a process evaluation framework and collected data via questionnaires (n = 209), program ambassador documentation and exit interviews with program completers (n = 13) and non-completers (n = 12).ResultsIn total, 295 participants completed the program (response rate = 84 %). Participants reported high levels of satisfaction with the overall program (99.5 %) and program activities (96.7 %), and also rated program ambassadors highly. Participation rates were highest for telephone dietary counselling sessions. The main reason for not attending program activities was having a ‘busy schedule’ (n = 158). Participants cited a need for improved recreational centre facilities and increased flexibility around program delivery.ConclusionsThe process evaluation showed that the program strategies were implemented as planned and were deemed suitable for supporting behaviour change among Singaporean women aged 50 years and over. The program reached and involved the majority of participants throughout the six months. The combination of practical educational resources and supportive program ambassadors were key strategies that facilitated positive PA and dietary behaviours. However, there needs to be some flexibility in the delivery of programs. The findings of this research may inform other programs in the region.     

Meeting the needs of adolescents living with HIV through home based care: Lessons learned from Tanzania

PurposeHome based care is central to HIV care and support throughout Africa. Most programs have not addressed the unique needs of adolescents living with HIV, who display lower retention in HIV care and treatment adherence. This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs.MethodsWe conducted a qualitative study in Dar es Salaam and Tanga Region consisting of in-depth interviews with 14 adolescents living with HIV, 10 primary caregivers, and 12 providers assigned to their households. Interviews examined adolescents' experiences of growing up with HIV, perceptions of current home based care, and challenges in increasing acceptability of services.ResultsWe found the program did not align well with adolescents' expectations. Adolescents felt home based care to be more relevant to their caregivers and did not form independent relationships with providers. They expressed anxiety that participation might lead to inadvertent disclosure of their status and consequent discrimination. Both adolescents and their caregivers felt disappointment that no material or financial support was available despite widespread poverty, although they appreciated receiving psychosocial support and practical referrals. Providers demonstrated motivation to work with adolescents but acknowledged lacking requisite skills such as ways to communicate with young people and key messages to deliver.ConclusionsDespite challenges, we identified feasible adaptations to make home based care more adolescent-centered. These include actively engaging adolescents in program design, improving provider training in communication with adolescents, and proactively addressing unrealistic expectations. Finally, increasing referral links to a wider range of services could improve program effectiveness by integrating it into a broader development approach.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Marketing Postsecondary Health Services

Abstract

This article reviews the major elements of marketing as applied to college and university health service programs. Changes in the health care industry, institutional debate about the advisability of institutionally based health centers, and the erroneous equation of promotion as marketing are reviewed. The necessity for research data to determine campus health program offerings is articulated as the most important aspect of successful marketing programs for health services. Types of segmentation for user groups are detailed, as well as the basic elements of an environmental analysis. The four fundamental aspects of health care marketing are discussed: the need to define the “core of service” for the health center; the issues associated with the access corridor to care; the task of refining communication channels; and the difficulty of measuring the effect of price on service usage rates. For marketing efforts to have a positive effect, colleges and universities must have an institutional commitment to health services. The article concludes by noting that marketing is a major management task.     

Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge

ABSTRACT

Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and their families but also individuals of all ages. We conclude that the development of suitable policies addressing the needs of the very old will benefit from future investigation of cross-cultural similarities and differences in centenarians’ characteristics, available services, as well as life conditions they encounter in communities and institutional contexts.     

Finding and Keeping Child Welfare Workers

Summary

Administrators in public human services are constantly involved in the exhausting challenge of recruiting and training staff in the child welfare arena. This article describes a program that the Commonwealth of Kentucky developed in order to address the recruitment and retention issue. The Public Child Welfare Certification Program is a special multi-university preparation program designed to recruit excellent workers from BSW programs who are prepared to take on complex cases with normal supervision within weeks of employment and to sustain those workers over time. Evaluation of the pilot indicates that the program is a great success in preparing students for child welfare work. Implications are discussed.     

An Aging Workforce in an Increasingly Global World

Summary

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma

IntroductionGlaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma.MethodsThe RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions.DiscussionBy targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17–19%) – a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive.ConclusionsEvaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.